Long-term implications of Quitline reach on smoking prevalence in Arkansas

Introduction: Quitline, a smoking cessation intervention combining hotline counseling and pharmacological assistance, could encounter budget cuts in many states. To explore the implications of Quitline downsizing vs. enhancement, we use UCLA Health Forecasting Tool, a microsimulation model simulating individual life histories, to project future smoking prevalence under different levels of Quitline reach among active smokers in Arkansas.

Method: Trends of tobacco smoking are calibrated to fit the Arkansas' observed smoking prevalence. Quitline users are 7.5 times as likely to non-users to quit tobacco smoking, according to reports from Arkansas' Quitline program. We plot four scenarios for Quitline reach starting from 2011 (“reach” here means percent of the active smokers who use the Quitline service): Scenario 1: Quitline reach decreases to 2% from the current level of 4% and then remain at 2%; Scenario 2: Quitline reach stays at 4%; Scenario 3: Quitline reach increases to 6% as recommended by CDC; Scenario 4: Quitline reach increases to 8%(the best achieved Quitline reach among American states) in 2020 by an annual increase of .4 percentage point.

Results: In 2025 the smoking prevalence in Arkansas will be 19.2%, 18.4%, 17.6%, 16.5% in Scenario 1, 2, 3, and 4, respectively. In 2035 the smoking prevalence under the four scenarios will be 18.9%, 17.8%, 16.9%, and 15.3%, widening the gap between the 1st and the 4th scenarios.

Conclusion: This study shows that different Quitline reach levels, even though they differ from each other only by 2 percentage points, has sizable long-term impact on smoking prevalence.