Reach and Assist Underserved Smokers through Quitlines

This study addresses the need for more effective smoking cessation assistance for ethnic minority and low socioeconomic populations. These populations continue to suffer disproportionate rates of tobacco-related disease. The Reach and Assist study mobilizes the resources of the recently formed North American Quitline Consortium to conduct interrelated, collaborative study projects encompassing five venues: the University of California, San Diego (San Diego, California); the University of Waterloo (Waterloo, Ontario, Canada); the University of Rochester (Rochester, New York); the American Cancer Society (Austin, Texas); and the Free and Clear organization (Seattle, Washington).

The Reach and Assist study has two main thrusts. First, it sets up a comprehensive data pool among all 54 state and provincial quitlines across the United States and Canada. Next, it investigates a variety of innovative ways to work with the targeted populations. A brief description of the nine projects captured by category is provided below.

Category 1: Building an infrastructure to pool data from all state/provincial quitlines and making the data easily accessible to all quitline researchers, practitioners, and policy makers

Quitlines, with their combination of broad reach and efficient, centralized operation, have the potential to become a highly efficient system of conducting research and translating it into practice. This project facilitates the realization of quitlines' potential by establishing a pool of non-individualized data reflecting the Minimum Data Set questions agreed upon by the North American Quitline Consortium.

Category 2: Analyzing pooled data to examine how well quitlines currently reach and serve African Americans, Latinos, Asian Americans, American Indians/Aboriginal populations, and low SES groups

This project narrows the knowledge gap regarding the targeted populations' smoking and cessation behaviors and the effectiveness of services for these populations.

Category 3: Pilot testing screening questions on depression that all state and provincial quitlines can use to capture co-morbidity across ethnic and socioeconomic groups

This project adds an important but minimally investigated element to the data pool, providing guidance for future research and practice.

Category 4: Documenting past and present promotional strategies for quitlines across North America, and conducting further qualitative studies of potentially effective strategies for reaching underserved populations

This project helps to clarify needs, challenges, and successes in quitline promotion among targeted minority groups.

Category 5: Studying innovative promotional strategies for increasing underserved populations' quitline use

Several Reach and Assist projects fall under this category. One project studies a telemarketing strategy in which trained staff members contact households proactively by telephone and determine whether any household members smoke. Callers ask smokers about their willingness to use a quitline for cessation help, and, if they are willing, invite them to speak immediately with a quitline counselor or to make an appointment for a counselor to call them in the near future.

Another project in this category studies a proactive mailing strategy. This project involves reaching ethnic minority groups through a series of postcard mailings. One set of postcards targets smokers, while another targets nonsmokers who live with smokers. Thus, the project explores the feasibility of reaching smokers through their nonsmoking family members or significant others, an approach that may be particularly useful for ethnic minority groups with strong collectivist tendencies.

A third project in this category studies an incentive strategy. This project tests the effectiveness (including cost-effectiveness) of incentive offers, examining ethnic minority group rates of response to an offer of free, directly mailed electronic devices to assist with exercise. These devices are low in cost but high in perceived value. Responses to this offer are compared to responses to offers of free nicotine patches.

Category 6: Examining ways to re-engage former quitline clients who have relapsed to smoking

This project compares the effectiveness of a proactive postcard campaign to that of a proactive postcard-plus-telephone campaign for ethnic minority clients in various geographic areas. Results will also be compared to results in the previously described studies of proactive telemarketing and direct-mail campaigns for promoting the quitline to new clients.

In summary, the Reach and Assist study represents the first efforts of North American Quitline Consortium members to work together on critical questions and issues. It targets underserved populations, whose need is greatest, laying essential groundwork for researchers and practitioners in the field and speeding the translation of research results into practice.