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.
1 comment:
We really cannot say anything based on data like theirs. People who try particular quit methods are self-selected in countless ways, and so their propensity to quit is almost certainly quite different from the average smoker. The most obvious guess is that someone who tries one of these "services" is well on the way to quitting and so the service provides, at most, a focusing moment to just get it done. Given that someone has to be pretty darn clueless to learn anything at all from these interventions, the best explanation for any elevated quit rate is propensity, not efficacy.
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