Phone counseling to help smokers kick the habit won’t do much if it doesn’t include callbacks or other follow-up strategies, new research shows.

While studies have shown that “proactive” telephone counseling, in which counselors make calls to smokers based on a prearranged schedule, is effective in helping people to quit, evidence for “reactive” counseling, in which smokers themselves initiate all calls to the quit line, isn’t as strong, Dr. Akshay Sood of the University of New Mexico School of Medicine in Albuquerque and his colleagues note in their report.

To investigate the “real world” effectiveness of the reactive approach, Sood and his team randomly assigned 990 men and women who called a telephone helpline between 2003 and 2006 to receive self-help information on quitting by mail or the mailed information plus telephone counseling.

Each person in the phone counseling group had at least one counseling session, but the schedule for calls was at the smokers’ discretion. The researchers followed up with study participants one, three, six and 12 months later.

Sood and his colleagues found no difference in smoking abstinence between the groups that received mailings only and the groups that used reactive phone counseling at any of the follow-up points.

They did find, however, that black callers had lower abstinence rates than whites three and 12 months into the study, while black smokers were also less likely than whites to have tried aids such as nicotine gum or patches.

The US is relying heavily on phone counseling in its efforts to help smokers quit, Sood noted in an interview; now all 50 states have smoking cessation phone lines. The services provided vary by state.

What the findings show, the researcher said, is that in order to be effective, phone counseling must include some proactive component.

“We’re not telling them to pack up and go, that’s certainly not the message of this paper,” Sood said. “Overall they play a very important role. They attract a clientele that otherwise is underserved.”

He added, “Reactive recruitment is still a good idea but then there should be some built-in accountability with call-back counseling.” Also, Sood added, efforts should be made to ensure that helplines are useful for black individuals as well as whites.

Most quitlines supported by states offer proactive counseling, Dr. Lori Pbert, of the University of Massachusetts Medical School in Worcester, notes in an editorial accompanying the study. Also, she adds, research shows that the more frequently smokers receive callbacks, the more effective this type of counseling is.

Nevertheless, she added, just 1 percent of smokers in the US make use of quitlines. The new findings, Pbert concludes, demonstrate “the need to evaluate strategies to enhance and maximize the utilization of existing, effective smoking cessation telephone counseling offered through quitlines, including the use of proactive, call-back counseling and linking quitlines to health-care systems and providers.”

SOURCE: CHEST, November 2009.