New Study Shows that Quitline Cessation Counseling is of No Value for Young Adult Smokers

An article published in the May issue of Nicotine & Tobacco Research reports the results of a clinical trial of a quitline-based smoking cessation counseling intervention among young adult smokers ages 18-24. The article reports no significant effect of the intervention on attempted quitting or successful quitting.

(See: Sims TH, McAfee T, Fraser DL, Baker TB, Fiore MC, Smith SS. Quitline cessation counseling for young adult smokers: a randomized clinical trial. Nicotine & Tobacco Research 2013; 15(5): 932-941.)

The study's methods are described as follows: "This was a 2-group randomized clinical trial. The quitline-based counseling intervention (CI) included up to 4 proactive telephone counseling sessions; participants in the self-help (SH) group received only mailed cessation materials. Participants included 410 young adults who had smoked at least 1 cigarette in the past 30 days and who called the Wisconsin Tobacco Quit Line (WTQL) for help with quitting. Primary study outcomes included whether or not a quit date was set, whether or not a serious quit attempt was undertaken, and self-reported 7-day point-prevalence abstinence at 1-, 3-, and 6-month postenrollment."

The results were as follows: "Relative to self-help, quitline counseling motivated young adults to set a quit date but abstinence rates were not improved."

The Rest of the Story

Although quitlines are the mainstay of current tobacco control approaches to smoking cessation, this study shows no evidence that this approach has any value for the young adult smoking population. Yong adults who participated in the quitline counseling program were no more likely to try to quit and were no more likely to actually quit.

It is interesting that rather than concluding that more effective methods of motivating young adult smokers to quit are necessary, the study concludes that: "Research is needed on how to motivate young adult smokers to seek cessation treatment including quitline services."

If quitline services don't work for this population, then why do we need better ways of getting young adult smokers to use quitline services?

The answer appears to be simple:

We don't. However, one of the study authors has a conflict of interest by virtue of having owned stock in Free & Clear, the quitline vendor used by the vendor in this study. This study author was also employed by Free & Clear in the past. And the University of Wisconsin paid Free & Clear through a grant subcontract during the study, which supported this co-author.

Thus, this conflict of interest has the appearance of creating a bias in the paper's recommendations. Rather than stick with the study findings, the paper ignores those findings and recommends that we continue to focus on quitlines as a smoking cessation intervention for young adults. This flies in the face of the evidence presented within the paper itself, which shows no benefit, even with a rather intensive counseling intervention.

It is also interesting that two of the co-authors (Dr. Fiore and Dr. Baker) report no conflicts of interest.

However, in a 2008 article, Dr. Fiore acknowledged: "In the past 5 years, Dr Fiore reports that he has lectured and consulted for Pfizer and has served as an investigator on research studies at the University of Wisconsin (UW) that were supported by GlaxoSmithKline, Nabi, Pfizer, and sanofi-aventis. In 1998, the UW appointed him to a named chair, made possible by an unrestricted gift to the UW from GlaxoWellcome."

Also in 2008, Dr. Baker reported that: "reported that he has served as a co-investigator on research studies at the University of Wisconsin that were sponsored by four pharmaceutical companies."

Why weren't these financial conflicts of interest with Big Pharma disclosed in the current article? Certainly they represent a conflict because Big Pharma stands to lose substantially if quitlines drop out of favor as a focus for the nation's smoking cessation strategy. And although it appears that neither of these co-authors has maintained pharmaceutical company funding or consulting over the past 5 years, I see no reason why these prior conflicts are not relevant to readers of the study.

If a former tobacco industry consultant published an article, would anti-smoking advocates be comfortable with that individual not disclosing his prior financial relationship with Big Tobacco? I doubt it.

The rest of the story is that: (1) this article provides evidence that quitline-based cessation counseling is of no value for young adult smokers; (2) that there is an apparent bias in the article's recommendation that appears to be related to a financial conflict of interest of one of the study authors; and (3) that two of the study authors are failing to report a prior conflict of interest that is very relevant to the current study.