Acting Surgeon General Boris Lushniak marked the 50th year of the federal government’s war on tobacco two years ago, noting, “We are at a historic moment in our fight to end the epidemic of tobacco use.” (here) “The good news,” he continued, “is that we know which strategies work best… [to make] the next generation tobacco-free.” The declaration left no room for consideration of tobacco harm reduction. The government’s grand plan does include telephone quitlines and web-based interventions for current tobacco users – two programs that in 2012 cost taxpayers about $100 million (here).
According to new study from the Centers for Disease Control, “…only 1% to 2% of adult tobacco users in the U.S. access quitlines each year.” (abstract here). That's about one half to one million individuals.
Do quitlines work? The CDC offered results for calendar year 2011 telephone and web-based quitlines in Alabama, Arizona, Florida and Vermont. Dr. Antonio Neri and CDC colleagues assessed rates of cessation (defined as not smoking by self-report for the past 30 days) seven months after each subject’s enrollment.
The reported rates – 32% for quitline users and 27% for web-based users – were actually inflated by manipulating the numbers.
Of the 16,332 participants in the programs, just over half (n=8,277) were lost to follow-up. The CDC researchers sought the missing subjects via email, postal mail, express mail, computer-assisted phone calls and $40 inducements. These plus another 3,969 participants were dropped from the critical denominator.
The fact that Neri et. al. based their calculations on only 25% of the original enrollees skewed the results. Using the original enrollment numbers, success rates are only 8.1% for quitline users and 6.7% for web users. Considering that in any given year about 5% of smokers quit on their own, about 800 of this study’s 16,000 smokers would have quit with no assistance. The quitlines and web therefore generated about 400 quitters, a paltry number.
My estimates are consistent with real-world numbers. The quitlines provided free nicotine medicines (which have been shown to work for 7% of smokers who try them) and counseling, which likely included current coping tips from the National Cancer Institute, such as, “take a time out; call or text a friend; take a walk, play a game, read a good book; make a list of fun events, do one a day; get out of the house when you can.” It is doubtful that many of the 12,000 drop-outs actually used these tips to quit.
This CDC study was supported by the American Recovery and Reinvestment Act of 2009. That legislation was aimed at creating jobs, assisting those most impacted by the recession, investing in infrastructure and stabilizing state and local government budgets (here), with $1 billion earmarked for “prevention and wellness.” Using tax dollars to defend wasteful programs with contrived analytics is bad public policy.