Brief reportTelephone Recruitment into a Randomized Controlled Trial of Quitline Support
Introduction
Quitlines provide effective smoking-cessation support.1, 2, 3, 4 Passive recruitment channels requiring smoker-initiated contact with quitlines5 are commonly utilized (e.g., mass media6, 7, 8, 9). However, quitlines have also adopted active recruitment channels that involve recruiter-initiated contact with smokers5 (e.g., fax referrals10, 11, 12, 13). Only 1%–7% of adult smokers call quitlines each year.7, 9, 14, 15, 16, 17 A much higher proportion must be reached in order for quitlines to have a substantial impact on smoking prevalence. A target of 16% of smokers receiving quitline services annually has been proposed.18
Active telephone recruitment could potentially increase quitline utilization given that it recruits the largest proportion of smokers,5 is acceptable,19 and re-enrolls more former quitline users.20 For example, 41% of cold-called smokers received quitline services.21 The few trials that actively telephoned smokers to offer proactive telephone counseling (i.e., counselor-initiated support)22, 23, 24 found that 38%22 and 67%24 of smokers were receptive. However, smokers who were interested in quitting,22 had young children,24 or who were health maintenance enrolees23 were targeted. No trial engaged smokers from the entire general population or calculated the cost per smoker recruited.22, 23, 24
Compared with the general smoking population, quitline callers are more likely to be women,14, 16, 25, 26 younger,14, 25, 26 unemployed,14, 26 never married,26 more highly educated,25, 26 more addicted,14, 16, 25, 26 to have previously quit,26 and to be ready to quit within 30 days.25 Active telephone recruitment may increase the reach of quitlines by enrolling currently under-represented smokers.27, 28 Past trials offering proactive telephone counseling to smokers actively recruited by telephone have not assessed their sample's representativeness compared to the general smoking population.22, 23, 24
This study aims to (1) assess the proportion of adult daily smokers from the entire general population enrolled into a proactive telephone counseling trial via active telephone recruitment, (2) calculate the cost per smoker recruited, and (3) determine the representativeness of participants compared to New South Wales (NSW) smokers.
Section snippets
Sample
Recruitment occurred between September 2005 and April 2007. Eligibility criteria were (1) daily tobacco user; (2) aged ≥18 years; (3) NSW, Australia, resident; and (4) English speaker. Nondaily smokers were excluded given fewer in this group wish to quit and receive cessation assistance.29
Procedures
Telephone numbers were randomly selected from the NSW Electronic White Pages telephone directory. An information letter was mailed to households, followed by a telephone call within 2 weeks. At least six
Results
Of 48,014 households selected, 4304 were unreachable. Of 43,710 reached, 40,702 were ineligible. From 3008 eligible households, 939 (31.2%) smokers refused; 502 (16.7%) household members refused; and five (0.2%) interviews were not completed. If smoking status was not identified before the call ended, the household was assumed to contain an eligible smoker. Consequently, the recruitment rate may be underestimated (Figure 1).
Discussion
Approximately half (52%) of eligible smokers were recruited actively by telephone to cessation support. This rate is higher than that in a U.S. trial (38%)22 but lower than that in a Hong Kong trial (67%).24 The Hong Kong trial subjects were parents of young children who had already participated in research24 and thus may have been more motivated to participate than smokers in the general population. The trial recruitment rate (52%) was substantially higher than the 1%–7% of adult smokers using
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Cited by (27)
The Equity Impact of Proactive Outreach to Smokers: Analysis of a Randomized Trial
2018, American Journal of Preventive MedicineCitation Excerpt :Traditional smoking-cessation interventions rely on motivated smokers to seek out services. Smokers who independently call quitlines for support41 or volunteer for intervention programs42 are more likely to come from a higher educational background than the general smoking population. By proactively calling smokers, the proactive outreach intervention addressed the fear of being judged, fear of failure, and lack of knowledge43 that may prevent low-SES smokers from seeking assistance.
Just how high-risk are ongoing smokers? Exploring clusters of health risk behaviours among current and ex-smokers
2016, Preventive MedicineCitation Excerpt :The sample frame places some limitations on the data in that study participants had participated in a prior cessation trial and therefore would not be representative of all smokers. However, as the participants in the trial were recruited using an active rather than passive recruitment strategy, they were likely to be more representative of smokers than samples recruited to many other cessation trials (Tzelepis et al., 2009). The study response rate (51.3% of prior trial participants), while reasonable given the time elapsed since trial completion, may limit the generalizability of the results to smokers.
Improving the continuity of smoking cessation care delivered by quitline services
2015, Patient Education and CounselingCitation Excerpt :Another limitation of this study is that it measured intended use rather than behaviour. However our previous work found that when smokers were proactively offered quitline support, uptake (52%) [37] exceeded prior reports of intended use (46%) [38]. Furthermore, reported use of NRT (78–89%) when provided via international quitline services [27,30] although similar, exceeded the intended use of subsidised NRT reported by smokers (75%) in the current study.
Acceptability of proactive telephone recruitment to a telephone support service to encourage healthy eating, physical activity and weight loss
2012, Australian and New Zealand Journal of Public HealthTelephone survey methods: implications of the increasing mobile‐only population for public health research
2011, Australian and New Zealand Journal of Public HealthBarriers and facilitators to the uptake of online and telephone services targeting health risk behaviours among vocational education students: A qualitative study
2021, International Journal of Environmental Research and Public Health