The largest randomized trial of its kind has shown that offering more intensive tobacco quitline services, including longer phone counseling sessions and free nicotine replacement therapy (NRT), is a highly effective - and cost-effective - way to help smokers quit.

Published in a special supplement on quitlines in the December 2007 Tobacco Control and partially funded by NCI's Tobacco Research Initiative for State and Community Interventions, the trial was led by researchers from the Kaiser Permanente Center for Health Research in Portland, Oregon.

The trial included 4,600 smokers who called the Oregon tobacco quitline. Callers were randomly assigned to receive one of six types of services: three different types of phone counseling approaches (brief, moderate, or intensive), each with or without free NRT. The most effective approach was the intensive counseling plus free NRT, which helped more than 21 percent of the smokers quit. In comparison, less than 12 percent of smokers quit in the brief counseling with no free NRT arm. The research team defined quitting as no use of any form of tobacco for at least 30 days at the 12-month follow-up.

Callers' satisfaction with the quitline services were far higher in the intensive counseling/NRT arm compared with the brief counseling/no NRT arm (92.5 percent vs. 53.9 percent), although the cost per participant was nearly four times higher, $268 vs. $67, respectively.

"However, our results suggest that higher quit rates, greater client satisfaction, and the potential to attract more smokers to quitlines more than offset the modest additional costs, " said the study' lead author, Dr. Jack Hollis. "Heavily addicted smokers, who have the highest health care costs over time, may benefit even more from intensive counseling and medication."