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Introduction: Understanding the characteristics of smokers who enroll in a trial of quitline support and those who decline could guide recruitment approaches and service delivery to better engage smokers and increase successful quitting. However, it is unknown whether factors such as smokers' perceived effectiveness of using quitting aids or self-exempting beliefs are associated with quitline uptake. We compared the sociodemographic characteristics, smoking behaviours, perceived effectiveness of using quitting aids, and self-exempting beliefs of participants and nonparticipants who were actively telephoned and offered quitline support as part of a randomized controlled trial., Methods: Overall, 48,014 telephone numbers were randomly selected from the electronic telephone directory and contacted. A total of 3,008 eligible smokers were identified and invited to participate in a trial of quitline support. Consenting trial participants (n = 1,562) and nonparticipants (n = 500) completed a baseline interview., Results: Multivariate analysis showed that the following factors were associated with trial participation: consumption of 21 or more cigarettes per day (odds ratio [OR] = 1.45 [1.07-1.99]), readiness to quit within 30 days (OR = 4.45 [3.20-6.19]) or 6 months (OR = 3.22 [2.46-4.23]), perceiving that calling the quitline was definitely (OR = 2.34 [1.62-3.39]) or partly effective (OR = 2.15 [1.63-2.83]), believing that using self-help materials was partly effective (OR = 1.50 [1.16-1.94]), thinking that nicotine replacement therapy was partly effective (OR = 1.38 [1.04-1.84]), perceiving that using willpower alone was partly (OR = 1.99 [1.48-2.67]) or not effective (OR = 2.60 [1.95-3.46]), and not holding a self-exempting belief (OR = 1.45 [1.11-1.89])., Conclusions: Increasing smokers' utilization of quitlines is likely to require changing their perceptions of the effectiveness of quitting strategies compared with using willpower alone and addressing self-exempting beliefs.

Introduction: Only 1%-7% of smokers use quitlines annually. Active telephone recruitment ("cold calling") can enroll about 50% of community smokers to quitline services. However, whether cold-called smokers' characteristics differ from traditional quitline clients is unknown. To assess whether active telephone recruitment reaches new groups of smokers, New South Wales (NSW) Quitline callers were compared with cold-called smokers who received telephone counseling as part of a randomized controlled trial., Methods: Data were extracted from the NSW Quitline database from September 13, 2005, to April 10, 2007, to coincide with the trial's recruitment period. Records (n = 18,584) of first-time quitline callers, who smoked daily, resided in NSW, Australia, and received telephone counseling were included. Cold-called participants who received telephone counseling (n = 695) were recruited by telephone from the electronic NSW telephone directory. Eligibility requirements were daily tobacco use, aged 18 or older, NSW resident, and English speaking. Smokers were eligible regardless of their quitting intention., Results: Male smokers, older age groups, those living in nonmetropolitan areas, smokers who took longer to smoke their first cigarette after waking, consumed fewer cigarettes per day, and were less motivated to quit had greater odds of being referred to the quitline through cold calling., Conclusions: Active telephone recruitment enrolls new groups of smokers to quitlines. The reach of quitlines could be improved if quitlines incorporated cold calling into their recruitment strategies.

Background: Systematic reviews demonstrated that proactive telephone counseling increases smoking cessation rates. However, these reviews did not differentiate studies by recruitment channel, did not adequately assess methodological quality, and combined different measures of abstinence., Methods: Twenty-four randomized controlled trials published before December 31, 2008, included seven of active recruitment, 16 of passive recruitment, and one of mixed recruitment. We rated methodological quality on selection bias, study design, confounders, blinding, data collection methods, withdrawals, and dropouts, according to the Quality Assessment Tool for Quantitative Studies. We conducted random effects meta-analysis to pool the results according to abstinence type and follow-up time for studies overall and segregated by recruitment channel, and methodological quality. The level of statistical heterogeneity was quantified by I(2). All statistical tests were two-sided., Results: Methodological quality ratings indicated two strong, 10 moderate, and 12 weak studies. Overall, compared with self-help materials or no intervention control groups, proactive telephone counseling had a statistically significantly greater effect on point prevalence abstinence (nonsmoking at follow-up or abstinent for at least 24 hours, 7 days before follow-up) at 6-9 months (relative risk [RR] = 1.26, 95% confidence interval [CI] = 1.11 to 1.43, P < .001, I(2) = 21.4%) but not at 12-15 months after recruitment. This pattern also emerged when studies were segregated by recruitment channel (active, passive) or methodological quality (strong/moderate, weak). Overall, the positive effect on prolonged/continuous abstinence (abstinent for 3 months or longer before follow-up) was also statistically significantly greater at 6-9 months (RR = 1.58, CI = 1.26 to 1.98, P < .001, I(2) = 49.1%) and 12-18 months after recruitment (RR = 1.40, CI = 1.23 to 1.60, P < .001, I(2) = 18.5%)., Conclusions: With the exception of point prevalence abstinence in the long term, these data support previous results showing that proactive telephone counseling has a positive impact on smoking cessation. Proactive telephone counseling increased prolonged/continuous abstinence long term for both actively and passively recruited smokers.

Introduction: Passive recruitment strategies relying on smoker-initiated contact probably contribute to particular groups of smokers using quitlines. Compared with the smoking population, smokers who call quitlines are more likely to be female, younger, higher educated, more addicted, quit previously, and motivated to quit. Quitlines could adopt new recruitment approaches such as active telephone recruitment involving recruiter-initiated contact, since this may enroll a broader representation of smokers. This study explored acceptability of active telephone recruitment to quitline support, smokers' use, and acceptability of assistance and predictors of acceptability., Methods: Smokers (N = 1,562) randomly selected from the New South Wales telephone directory were actively recruited by telephone into a randomized controlled trial that offered proactive telephone counseling (n = 769) or self-help materials (control: n = 793). Overall, 1,369 completed the 4-month postrecruitment interview, which examined acceptability., Results: More than 90% of 4-month interview respondents found active telephone recruitment to cessation assistance acceptable. Of smokers allocated to proactive telephone counseling (n = 769), 90% accepted at least one and 65% three or more counseling calls. Of control participants who completed the 4-month interview, 84% read at least some self-help materials. Proactive telephone counseling recipients were significantly more likely than self-help material users to find the advice useful. Few characteristics predicted acceptability of proactive telephone counseling or self-help materials, suggesting that many types of smokers actively recruited by telephone are receptive to support., Discussion: Active telephone recruitment could potentially enroll a broader representation of smokers to quitline services. Given these smokers are receptive to cessation assistance, quitlines should consider active telephone recruitment.

Introduction: Levels of hospital smoking cessation care are less than optimal. This study aimed to synthesize the evidence regarding the effectiveness of interventions in increasing smoking cessation care provision in hospitals., Methods: A review identified relevant studies published between 1994 and 2006. A description of studies, including methodological quality, was undertaken. Intervention effectiveness in increasing smoking cessation care practices was examined for controlled studies using meta-analysis. Care practices examined were assessment of smoking status; advice to quit; counseling or assistance to quit; advising, offering, or providing nicotine replacement therapy (NRT); and follow-up or referral., Results: Of the 25 identified studies, 18 were U.S. based and in inpatient settings. Of the 10 controlled trials, 4 addressed cardiac patients, 5 measured one smoking cessation care practice, and 9 implemented multistrategic interventions (e.g., combining educational meetings with reminders and written resources). The methodology described in these studies was generally of poor quality. Meta-analysis of controlled trials demonstrated a significant intervention effect for provision of assistance and counseling to quit (pooled risk difference = 16.6, CI = 4.9-28.3) but not for assessment of smoking status, advice to quit, or the provision or discussion of NRT. Statistical heterogeneity was indicated for all smoking cessation care practices. An insufficient number of studies precluded the use of meta-analysis for follow-up or referral for further assistance., Discussion: Interventions can be effective in increasing the routine provision of hospital smoking cessation care. Future research should use more rigorous study design, examine a broader range of smoking cessation care practices, and focus on hospital-wide intervention implementation.

Hospitals are key settings for the provision of smoking cessation care. Limited data are available that describe the prevalence and type of such care delivered routinely in this setting. We reviewed studies conducted in hospitals and published between 1994 and 2005 that reported levels of smoking care delivery. This review describes the proportion of patients receiving, and the proportion of health professionals providing, various smoking cessation care practices. We used both descriptive and meta-analytic methods. According to the meta-analysis, smoking status was assessed in 60% of patients, 42% were advised or counseled to quit, 14% were provided with or advised to use nicotine replacement therapy (NRT), and 12% received referrals or follow-up. Significantly fewer patients received follow-up or referrals than were assessed for smoking status or received advice or counseling to quit. Some 81% of health professionals reported they assessed smoking status, 70% advised or counseled patients to quit, 13% provided NRT or advised its use, and 39% provided referrals or follow-up. Significantly fewer health professionals advised or prescribed NRT than assessed smoking status or advised or counseled patients to quit. Statistical heterogeneity was indicated for all smoking care practices. Levels of smoking cessation care are less than optimal in hospitals, and the levels of some important care practices are particularly low. Future research should identify effective methods for increasing smoking care provision in this setting. In addition, standardized measures of smoking care should be developed. Hospital organizations should enhance and continue to monitor their delivery of smoking care.

There has been no systematic examination of issues surrounding pension funds and their tobacco shareholdings. This paper describes two studies designed to document the tobacco investment policies and practices of pension funds, and to assess community and fund member attitudes to pension fund shareholdings in the tobacco industry. Chief executives (n = 282) of Australian pension funds were mailed questionnaires. Of 241 eligible funds, 107 (44.4%) returned questionnaires, representing about 61% of total Australian primary superannuation accounts. Twelve percent indicated that they did not currently hold tobacco investments, 30% held tobacco shares and 58% did not know or failed to answer. Overall, 6% of respondents said that they held no tobacco investments and would not consider future investments; 2% had formal policies precluding tobacco investments. Funds with 10,000 or more members were more likely (p = 0.0006) to report tobacco investments. External fund manager advice was the most important factor influencing the funds' position. In the second study, a one-third random sub-sample of consenting subjects from 12,000 households randomly selected from the New South Wales Electronic White Pages completed phone interviews. From 7141 eligible households, 3503 (49.1%) subjects consented. One-third (n = 1158) were asked the pension fund questions. Over three-quarters (77.4%) of all respondents disagreed that pension fund investments in tobacco were ethical. Approximately two-thirds (63.6%) of fund members (n = 852) agreed that their funds should not make tobacco investments. There were three statistically significant predictors of opposition to such investments: being female, more highly educated and non-smoking status. Nearly all pension funds treat tobacco investments like any other investment. In contrast, most of the public including fund members are strongly opposed to such investments. Suggestions for public health advocacy strategies to reduce the negative health promotion effects of pension funds in this area are outlined.