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52 CHAPTER 2 ■ Reducing Tobacco Use in the United States

Cost-Effectiveness
Based on caller databases, telephone surveys, and budget records, the following
costs were calculated; these can be used, in combination with expenditures, to
determine a return on investment of resources:

• Estimated cost of the Quit Line service per Washington State smoker:
$150.
• Estimated cost of the Quit Line per caller who made a serious attempt to
quit: $140.
• Estimated cost of the Quit Line per caller who was tobacco free at six
months: $830.

A DDITION A L E VA L U ATION NOTES

Program managers for the Washington Quit Line offer a few additional insights
for those considering adopting a similar service.
The Quit Line is most effective when used in combination with additional
strategies, including tax increases, restrictions on smoking in public places such
as restaurants and bars, and in combination with community-based activities
such as recommendations from healthcare providers to call the Quit Line. They
encourage others to advocate for cessation benefits to be included in health plans
offered by employers to their employees, as well as by Medicaid and community
health plans. Additionally, and though not formally tested, administrators have a
“strong hunch” that offering a Quit Line and then having a highly visible cam-
paign promoting it may help to “normalize” and increase quitting even among
people who never call the line. After all, there are more than 25% fewer fellow
smokers around in just seven years.

C O N C L U D I N G N O TE: W E H AV E TH E KN O W-H O W, B U T W I L L
W E D O IT?

Although much has been accomplished, the mission remains unfinished, with it
unlikely that the United States will meet the Healthy People 2010 goal of 12% to-
bacco use for adults and 16% for high school youth (IOM, 2007, p. 124).
Concerns with waning momentum of tobacco control efforts and about de-
clining attention to what remains the nation’s largest public health problem, led the
American Legacy Foundation (2004) to ask the Institute of Medicine (IOM) to