The Impact of Smoke-Free Policy on Quitline Utilization and Smoking Outcomes

Cigarette smoking produces substantial and staggering health and health-related economic costs to society. The Commonwealth of Kentucky (location of the applicant institution) ranks first in the nation in adult smoking prevalence (28.2%) and subsequently has one of the highest smoking attributable cancer incidence and death rates in the U.S. One of the Healthy People 2010 objectives is to reduce tobacco use among adults to 12% or less. Evidence demonstrates that telephone QuitLines are effective in helping tobacco users quit. The CDC, as part of its Comprehensive Tobacco Control Initiative, has suggested, in addition to enacting smoke-free policies, every state implement a publicly-accessible telephone QuitLine for tobacco users who want to quit. Since July 2005 Kentucky has implemented a free, statewide evidence-based telephone QuitLine. To date, no documented research has examined the efficacy of the telephone QuitLine in Kentucky nor examined the impact of enacting smoke-free policies on telephone QuitLine utilization, reductions in smoking, and smoking cessation rates. The proposed study is a quasi-experimental time-series design involving secondary data analyses on a large data set collected as part of the publicly-funded state-wide telephone QuitLine in Kentucky. The primary objective of the proposed investigation is to test the effects of the enactment of municipal smoke-free legislation/regulation on telephone QuitLine utilization rates, average daily cigarette consumption, and cessation rates among cigarette smokers in Kentucky who initiated state telephone QuitLine contact between July 2005 and June 2009. The analysis utilized will not only allow for comparisons between communities with and without these laws, but also comparisons from pre- to post-law, in communities that enacted laws during the study period. Implementation of comprehensive tobacco control programs, including enacting policy change and providing cessation resources, can reduce the prevalence of smoking and its associated cancer mortality and mortality. What is less clear is whether the enactment of smoke-free legislation influences state telephone QuitLine utilization and smoking behavior (including reductions in smoking and smoking cessation). Furthermore, it is unclear whether the strength and extent of smoke-free policy law/regulation impacts smoking cessation efforts within particular communities. The proposed data set provides a unique opportunity to examine telephone QuitLine usage and cessation rates in communities that have enacted various strengths of smoke-free legislation/regulation and those that have not. Results of the proposed project will provide novel information about the impact of smoke free laws/regulations on telephone QuitLine utilization and smoking related outcomes. This information will assist in understanding how to guide the successful application, promotion, and dissemination of this evidence-based treatment, with the goal of refining treatment and informing policy to ultimately reduce smoking-attributable cancer morbidity and mortality.