Cessation

in Tobacco Prevention and Control
Acknowledgements

This guide was produced for the Centers for Disease Control and Prevention by the Center for Public 

Health Systems Science at the Brown School at Washington University in St. Louis. 

Primary contributors:

Stephanie Andersen, Laura Brossart, Amy Endrizal, Isaiah Zoschke, Rachel Hackett, Rebecca Ballard, Douglas Luke

Input was provided by:

Rob Adsit, Stephen Babb, Brian King, Michon Mabry, Catherine Saucedo, Anna Schecter, Karla S. Sneegas, Brenna 

VanFrank, Renee Wright

Input for the case studies was provided by:

Christin M. Kirchenbauer, Oklahoma State Department of Health

Eric Finley, Oklahoma Hospital Association

Dana McCants Derisier, Rhode Island Tobacco Control Program

Other contributions:

Photograph on page 14 courtesy of the California Department of Public Health

Photographs on page 20 courtesy of Oklahoma Tobacco Settlement Endowment Trust

Photograph on page 26 courtesy of the University of Wisconsin Center for Tobacco Research and Intervention 

(UW-CTRI)

Photographs on page 28 courtesy of Tobacco Free Florida

Photograph on page 31 courtesy of the New York City Department of Health and Mental Hygiene

Photograph on page 36 courtesy of ClearWay Minnesota

Photograph on page 42 courtesy of the New York State Department of Health

Photograph on page 49 courtesy of the Rhode Island Department of Health
Table of Contents

Guide to the Reader ...........................................................................1

Making the Case for Cessation .................................................................2

Brief History .................................................................................. 3

How To ....................................................................................... 4

Understanding Cessation Interventions ............................................... 4

Getting Started ....................................................................... 8

Promoting Health Systems Change .................................................. 11

Improving Cessation Coverage ....................................................... 20

Supporting State Quitlines ........................................................... 27

Reducing Tobacco-Related Disparities ............................................... 33

Evaluating Cessation Interventions .................................................. 38

Sustaining Cessation Interventions ................................................... 42

Providing Support ........................................................................... 45

Case Studies ................................................................................. 46

Case for Investment ......................................................................... 50

Resources ................................................................................... 52

References .................................................................................. 62
Cessation l 1

GUIDE TO THE READER

Purpose

The Center for Public Health Systems Science at 

Washington University in St. Louis is developing a 

set of user guides funded by the Centers for Disease 

Control and Prevention (CDC), contract 200-2015-

87568, for the Best Practices for Comprehensive 

Tobacco Control Programs—2014 (Best Practices 

2014), an evidence-based tool to help states develop 

and sustain comprehensive tobacco control programs.

The purpose of the user guides is to help tobacco 

control staff and partners implement evidence-based 

best practices by translating research into practical 

guidance. The guides focus on strategies (e.g., programs 

and interventions) that have shown strong or promising 

evidence of effectiveness. Recommendations in this 

guide are suggestions for programs helping people quit 

tobacco. Programs can follow these recommendations 

according to their needs, goals, and capacity. In the 

user guides, tobacco refers to the use of manufactured, 

commercial tobacco products. 

Content

This user guide focuses on how comprehensive tobacco 

control programs can promote cessation through 

population-wide efforts. According to Best Practices 

2014, “encouraging and helping tobacco users to quit 

is the quickest approach to reducing tobacco-related 

disease, death, and healthcare costs.”1 Populationbased interventions can dramatically increase access to 

proven cessation treatment and help more people quit 

for good. This guide offers program staff and partners 

information on how to promote health systems change, 

improve insurance coverage for cessation treatment, 

and support state quitlines.

Links to More Information

Each instance of italicized, bolded blue text in the 

guide indicates a link to an additional resource or a 

page within the guide with more information. Website 

addresses for all of the blue resources noted throughout 

the guide are also included in the Resources section.

Organization

8 Making the Case: A brief overview of why 

cessation interventions are an essential part of 

tobacco control efforts

Brief History: How cessation interventions have 

changed from treating individual smokers to 

promoting quitting at the population level

How to: Strategies to plan and carry out cessation 

interventions

Providing Support: How tobacco control 

programs can support cessation efforts

Case Studies: Real-world examples of successful 

cessation interventions

Case for Investment: Information to raise 

awareness about the importance of cessation 

interventions

Resources: Publications, toolkits, and websites to 

help in planning efforts

Best Practices for Comprehensive 

Tobacco Control Programs–20141

Best Practices 2014 is an evidence-based 

guide to help states plan, establish, and 

evaluate comprehensive tobacco prevention 

and control programs. The report offers 

recommendations and evidence for five 

essential components of effective programs:

• State and community interventions 

• Mass-reach health communication 

interventions

• Cessation interventions

• Surveillance and evaluation 

• Infrastructure, administration, and 

management
Cessation l 2

MAKING THE CASE

Making the Case for Cessation

Every year, more than 480,000 Americans die from smoking.2 Another 16 million Americans live with a serious 

disease caused by smoking.2

 Helping people quit using tobacco is the quickest way to reduce the disease, death, 

and immense cost caused by tobacco use.1 Cessation interventions are an essential part of a comprehensive tobacco 

control program because they: 

8 Improve health and save lives

Quitting tobacco is not easy, but it is possible. 

Quitting improves smokers’ health almost 

immediately. Within 20 minutes, blood pressure 

and heart rate decrease.3

 Within a year, the risk 

of heart attack drops sharply.4

 In 2–5 years, the 

chance for stroke can fall to about the same as 

a nonsmoker’s.5

 Although quitting has health 

benefits at any age, people who quit smoking before 

age 40 avoid most of the risk of dying early from a 

smoking-related disease.6

Maximize the impact of other effective tobacco 

control strategies

Comprehensive smoke-free laws, tobacco product 

price increases, and hard-hitting media campaigns 

motivate people to try to quit using tobacco and 

make it easier for them do so.1,7-9 Combining 

these efforts with cessation interventions can 

connect people who use tobacco to evidencebased treatment and help them quit successfully, 

maximizing the impact on cessation.1 Supporting 

people who want to quit can also pave the way for 

smooth implementation of tobacco control policies 

and interventions.10

Reduce tobacco-related disparities

Some adults who smoke are less likely to quit 

successfully, including people with less education, 

those living below the poverty level, and those 

without health insurance.11 These disparities 

may result from factors such as limited financial 

resources, lack of health insurance, lack of 

information about cessation treatments, or living in 

environments less supportive of quitting tobacco.1,11 

Cessation interventions help overcome these 

barriers by increasing access to evidence-based 

treatment so people can quit using tobacco for good.

8 Address other community health priorities

Smoking cessation can help address other 

community health priorities, such as mental health 

and substance use recovery outcomes, cancer 

survival rates, and pregnancy and child health 

outcomes.12-16 It also helps people better control 

diabetes and lowers the risk for heart disease as 

much as or more than other common treatments 

like aspirin.5,17

Create a return on investment

Helping people quit tobacco is a smart investment. 

Tobacco use is expensive—people who smoke 

cost nearly $6,000 more per year to employ than 

people who do not smoke.18 Excess costs include 

healthcare costs and lost productivity due to 

absenteeism, smoking breaks, and lower on-thejob productivity (presenteeism).18 In comparison, 

evidence-based cessation interventions cost only 

a few hundred to a few thousand dollars for each 

person who quits.19 The savings can add up quickly; 

lower healthcare costs can save employers money 

in less than two years.20

Support state and national healthcare goals

Changes in healthcare delivery and payment 

models are increasingly being implemented to 

improve quality of care and population health 

outcomes, while reducing healthcare costs. 

Cessation interventions support these goals by 

increasing access to and use of evidence-based 

treatments, quit attempts, and successful cessation, 

which in turn increases patient satisfaction and 

reduces tobacco-related disease, death, and 

healthcare costs.21-23 Because quitting smoking 

prevents and improves the prognosis for many 

chronic diseases, it has the potential to dramatically 

improve health and reduce costs.19
BRIEF HISTORY

A Changing Landscape 

By the 1980s, the public health and scientific community 

had begun to recognize that smoking was an addiction 

driven by nicotine, not a habit, and had begun to develop 

effective cessation treatments.24 In 1984, the U.S. Food & 

Drug Administration (FDA) approved the first cessation 

medication, nicotine gum, followed by the nicotine patch 

(1991–92), the nicotine nasal spray (1996), the nicotine 

inhaler (1997), buproprion (1997), lozenge (2002), and 

varenicline (2006).25,26 In 1990, the Surgeon General 

released the report, The Health Benefits of Smoking 

Cessation (see Figure 1 below).27

Telephone cessation services also began to grow rapidly. 

In 1992, California launched the first publicly funded 

state tobacco quitline.12 Evidence of effectiveness and 

leadership from early adopters led to the creation of 

more state quitlines.28 In 2004, at the direction of the 

Department of Health and Human Services, the National 

Cancer Institute created a toll-free, national quitline 

portal, 1-800-QUIT-NOW, and CDC began directly 

funding state quitlines.29 By 2006, all 50 states, the 

District of Columbia, and Puerto Rico offered quitlines.30

As effective cessation treatments became more widely 

available, there was also growing recognition of the 

need for healthcare providers to treat tobacco use.31

The U.S. Public Health Service released its first clinical 

practice guideline on tobacco in 1996, with updates in 

2000 and 2008. The 2008 update concluded that tobacco 

dependence is a chronic disease that often requires 

repeated intervention, counseling and FDA-approved 

medications are effective cessation treatments, and the 

combination of counseling and medication is more 

effective than using either alone.19

The 2008 update was also one of the first guidelines 

to recommend that insurers provide comprehensive 

cessation coverage and that health systems identify and 

treat every patient who uses tobacco.19 Other reports 

also encouraged systems changes, including Ending 

the Tobacco Problem: A Blueprint for the Nation, Best 

Practices 2014, and Healthy People 2020.

1,32,33

Today, the healthcare system is undergoing a 

transformation to enhance quality of care, improve 

population health, and reduce costs. Federal legislation 

such as the 2009 HITECH Act and the 2010 Affordable 

Care Act have helped improve cessation coverage and 

encouraged providers to treat tobacco use.34,35 Health 

systems are also emphasizing coordinated approaches to 

manage chronic diseases and collaborating with public 

health programs. One example is CDC’s 6|18 Initiative, 

which forms partnerships between public health and 

healthcare stakeholders to address six common and 

costly health conditions, including tobacco use.36

The internet, email, chat, text messaging, and apps are 

also increasing the potential of cessation services to 

reach more people who use tobacco.37 Since 2012, CDC 

has annually aired Tips From Former Smokers®, the first 

federally funded national tobacco education campaign. 

CDC also provides supplemental funding to quitlines to 

meet increased demand due to the campaign, including 

Guam. As of 2018, Tips® helped over half a million people 

quit successfully, adding to the evidence that populationwide interventions help people quit tobacco.38

In January 2020, the Surgeon General released a new 

report, Smoking Cessation. The report covers the latest 

scientific evidence on the health benefits of smoking 

cessation, effective cessation treatments, and broad 

population-based strategies to help more people 

successfully quit smoking.

Figure 1. History of Cessation Interventions

Cessation l 3
HOW TO

Understanding 

Cessation Interventions

Although many effective tobacco cessation treatments 

exist, quitting tobacco is not easy. Most people who 

smoke make many quit attempts before succeeding.39

Most people try to quit on their own, and overall 

cessation rates remain low.11 In 2015, nearly 70% of 

adults who smoke wanted to quit, more than 50% 

tried to quit, but less than 10% succeeded (Figure 

2).11 People who use tobacco may be unaware that 

cessation treatment is available, may be unable to afford 

treatment, or may face other barriers, such as limited 

insurance coverage for certain treatments.40 In 2015, 

only 31% of adults who smoke used evidence-based 

cessation treatment when trying to quit.11

Figure 2. Smoking Cessation Among 

U.S. Adults, 2015

Source: Babb S, Malarcher A, Schauer G, Asman K, Jamal A11

Population-based cessation interventions seek to help 

people quit successfully by ensuring that barrier-free, 

evidence-based tobacco use treatments and services 

are accessible to anyone who wants or needs them. 

These strategic efforts have the potential to dramatically 

improve health. They change policies and systems in 

ways that normalize quitting and institutionalize tobacco 

use screening and treatment in medical care. Populationlevel cessation interventions include three approaches:1

• Promoting health systems change to integrate 

tobacco use treatment into routine clinical care

• Improving insurance coverage for evidencebased cessation treatment and increasing use of 

covered treatments

• Supporting state tobacco quitlines

Improving Cessation Access

Cessation interventions increase access to 

evidence-based treatment by ensuring that: 

• Treatment is offered to every person 

who smokes via a method they can 

access and are comfortable using 

• Treatment does not have limits or 

other barriers

• People are aware of treatments 

available to them

Promoting Health Systems Change

Because 8 in 10 people who smoke see a doctor each 

year, healthcare providers play an important role in 

promoting cessation.1 Yet in 2015, less than three in 

five smokers received advice to quit from a health 

professional.11 Providers often have only a limited 

amount of time with patients to cover many topics.41

They may also lack training and confidence in delivering 

cessation interventions, and are not adequately 

reimbursed treating tobacco use.19,41 Providers may also 

think that patients will resist quitting or do not want to 

quit.41,42 It is important, though, that providers talk to 

their patients about cessation. People who smoke value 

doctors’ advice about quitting, and even brief counseling 

(under three minutes) is effective.19

Health systems change strategies aim to screen every 

patient for tobacco use and offer every tobacco user 

help to quit at every visit. Health systems change is 

focused on making changes throughout the health 

system. Changes may include revising organizational 

policies, administrative and clinical processes, 

information technologies, staff training, performance 

feedback, and quality improvement initiatives to 

support tobacco use treatment.43 The goal is to make 

screening and treatment automatic, rather than 

depending on providers to remember to act.

Many healthcare providers can treat tobacco use.44

For example, providers may work in primary care, 

emergency medicine, obstetrics and gynecology, 

dentistry, or behavioral health. Health systems changes 

Cessation l 4
can be implemented in any setting, including outpatient 

and inpatient care, public and private practices, and 

settings with one or many providers. It is best if all 

staff who interact with patients, including front desk 

staff, nurses, doctors, and pharmacists, are involved in 

developing and implementing the changes.44

Evidence of the benefits of health systems change is 

compelling. Although interactions with providers may 

last only a few minutes, brief tobacco use treatment 

helps people who smoke quit for good and can even 

increase the likelihood that people not yet ready to quit 

will try in the future.19 Combining strategies increases

their overall effectiveness.19 For example, when training 

is coupled with reminder systems, providers are more 

likely to screen patients for tobacco use, help set a 

quit date, and arrange follow-up.19 When consistently 

implemented, these changes can reduce cigarette 

smoking prevalence.34 Treating tobacco use can also 

improve patient satisfaction and help meet federal 

health priorities, such as improving quality of care and 

reducing healthcare costs.21-23,45

Health Systems Change 

Components

Health systems change is not “one size fits 

all.”43 Successful health systems changes 

are tailored to the characteristics of each 

health system. They can include many 

different activities, depending on the system’s 

financial resources, workflow, staffing, 

patient population, use of electronic health 

records (EHRs), and quality improvement 

efforts.43 Typically, health systems change 

involves activities in the following areas: 

• Educating healthcare leadership, 

providers, and staff on the 

importance of treating tobacco use

• Integrating tobacco screening and 

treatment into the existing workflow

• Referring patients to quitting 

resources

• Creating reminders for staff to treat 

tobacco use (e.g., EHR alerts or 

medical chart stickers)

• Documenting cessation treatment 

and sharing results with providers 

and staff as part of quality 

improvement initiatives

• Reimbursing providers for tobacco 

use treatment 

Improving Cessation Coverage

Comprehensive insurance coverage for cessation 

treatment increases the number of people who try to 

quit smoking, use evidence-based treatment, and quit 

successfully.1,19,46 Figure 3 describes the elements of 

comprehensive cessation coverage. Learn more about 

what is covered under different plans on the American 

Lung Association web page, Tobacco Cessation 

Treatment: What is Covered?

Figure 3. Elements of 

Comprehensive Cessation Coverage

*Five forms of nicotine replacement therapy (patch, gum, lozenge, nasal spray, 

and inhaler), bupropion, and varenicline

Source: CDC1

Improving coverage also has the potential to give states 

and insurers a strong return on their investment. In 

Cessation l 5

HOW TO
2006, Massachusetts began offering an evidence-based 

tobacco cessation benefit for Medicaid enrollees. The 

state also promoted the benefit heavily to enrollees 

and healthcare providers. Over 21⁄2 years, smoking 

prevalence among Medicaid enrollees decreased from 

38% to 28%.47 Hospitalizations for heart attacks and 

other acute heart disease diagnoses fell by almost 

half.48 For every $1 spent on the benefit from 2007 to 

2009, Massachusetts saved over $3 in medical costs for 

cardiovascular conditions alone.49

Strategies to improve coverage seek to ensure that all 

people who use tobacco have access to comprehensive 

coverage with minimal barriers. Staff can work with 

employers, health insurers, and state agencies to make 

tobacco use treatment as easy to access as possible. 

One way to expand access is to remove barriers such 

as copays, prior authorization, limits on the duration 

and number of treatments, and step therapy (requiring 

people who smoke to try certain treatments before they 

can try others).40 Programs can also help raise awareness 

of cessation coverage and evaluate benefit use.

Supporting State Quitlines

State tobacco quitlines offer free, confidential, evidencebased telephone counseling to help people quit tobacco. 

Trained quitline coaches provide callers with individual 

counseling that includes practical advice on how to quit, 

information on cessation medications and how to use 

them, and help developing a quit plan.1 Coaches may also 

refer callers to quitting resources, send self-help materials, 

and, in some cases, provide cessation medications.1 The 

first state quitlines offered only telephone counseling and 

mailed self-help information, but many quitlines have 

expanded services. Quitlines now offer internet, chat, text 

messaging, and mobile app options, as well as healthcare 

provider training and support.50

Quitlines receive 1.3 million calls per year and operate 

in all 50 states, the District of Columbia, Puerto Rico, 

and Guam.51 The national quitline portal, 1-800-QUITNOW, operated by the National Cancer Institute, 

automatically routes callers to their state quitline 

based on their area code. Services are also available 

in languages other than English. 1-855-DEJELO-YA 

links callers to Spanish-language services from their 

state quitlines, and the Asian Smokers’ Quitline offers 

services in Chinese, Korean, and Vietnamese.

State quitlines are highly effective and widely 

accessible.1,19 Using quitlines increases the chance 

of quitting successfully, and combining quitline 

counseling with medication is more effective than 

using either alone.19 Because anyone with a phone 

can call a quitline, quitlines can reach more people at 

lower cost than face-to-face interventions. Quitlines 

may be the only free cessation resource available to 

tobacco users who are uninsured or live far from a 

healthcare provider.40 They are also convenient because 

they operate during evenings and weekends, reducing 

transportation and child care barriers.50

Despite these advantages, state quitlines only reach 

about 1% of people who smoke each year.1 Best Practices 

2014 recommends that state quitlines reach at least 8% 

of people who use tobacco.1 Quitlines struggle to reach 

more people, in part, because of chronic underfunding 

for operations and promotion.40 Budget constraints can 

force quitlines to shorten hours of operation, scale back 

communications campaigns, or limit proactive calls 

made by the quitline and provision of medication.52

Strategies to support state quitlines focus on securing 

consistent quitline funding and increasing reach among 

the uninsured, underinsured (callers whose health 

insurance does not provide adequate cessation coverage), 

and other underserved populations. With enhanced 

resources and promotion, quitlines have the potential to 

significantly increase their reach and impact.

Cessation l 6

HOW TO
Taking a Comprehensive Approach

The three cessation interventions described earlier 

are effective on their own and have an even larger 

impact when implemented together. For example, 

comprehensive, barrier-free cessation coverage 

supports health systems change by making the 

provider’s job easier. State quitlines can also serve as 

a “treatment extender,” reinforcing and enhancing 

treatment by healthcare providers. 

CDC’s Three Buckets of Prevention framework shown 

in Figure 4 can help programs map out a comprehensive 

approach. Bucket 1 includes traditional prevention 

strategies delivered to patients in clinical settings, such 

as screening for tobacco use at a doctor’s office. Bucket 

2 includes innovative strategies delivered outside the 

clinical setting, such as incorporating tobacco screening 

into community health programs. Bucket 2 interventions 

may be implemented by community health workers, 

nurses, or other healthcare providers. 

Bucket 3 includes population-based strategies delivered 

in the community or workplace, such as implementing 

and enforcing smokefree laws. These interventions may 

be led by community members or decision makers. 

Strategies in Bucket 3 support cessation in several ways:1

• Conducting health communications campaigns 

motivates people who smoke to quit and makes 

them aware of available treatment. 

• Implementing comprehensive smokefree laws 

creates a supportive environment for quitting 

and motivates smokers to quit.

• Increasing the price of tobacco products 

encourages people to quit and could generate 

revenue for cessation services.

To make the largest gains, it is important to coordinate 

strategies across all three buckets.53

Figure 4. Tobacco Cessation in CDC’s Three Buckets of Prevention

Source: Auerbach53

Cessation l 7

HOW TO
Getting Started

A strong tobacco cessation effort begins with a clear 

understanding of the quality of cessation services and 

how healthcare systems work in the state. Program staff 

can use this information to identify areas where the 

state is doing well and where improvement is needed, 

select strategies that could make a big impact on 

cessation, and choose partners.

Understanding Health Care Delivery

Understanding how the healthcare system works is 

an important first step, especially if tobacco control 

staff have not worked with health systems or insurers 

before. These partners may have very different needs, 

goals, and concerns from those of the program.53 They 

may use different terminology and work in different 

environments.54 Program staff can review information 

on the following topics:

• Parts of the healthcare system and how they 

influence health care delivery (e.g., hospitals and 

private practices)44

• Challenges faced by the healthcare system to 

improve care and reduce cost55

• Quality improvement and its role in health care44

• Types of health plans44

• The role of federal and state requirements in 

promoting cessation56

• Common terms used by health 

systems and insurers to talk 

about cessation54

• Key healthcare decision 

makers44

New tobacco control staff can also 

review information on effective 

cessation treatments from the Clinical 

Practice Guideline on Treating 

Tobacco Use and Dependence and the 

U.S. Preventive Services Task Force

recommendations for Tobacco Smoking 

Cessation in Adults. For a complete list 

of resources, see page 52.

Gathering Information 

Programs can start gathering information by 

identifying the state’s largest health plans, employers, 

and health systems. These organizations are rich 

sources of information about cessation services in the 

state. They can provide information on what treatment 

options are covered and how treatment is provided. 

The Healthcare Effectiveness Data and Information Set 

(HEDIS) is also used by more than 90 percent of health 

plans to track performance.57 

Information about state employee coverage is also 

useful, because the state is often one of the largest 

employers and helps set the standard for private 

coverage.1 It is also important to gather information 

about cessation coverage under other plans, including 

Medicaid managed care plans and plans offered 

through the state health insurance marketplace. See 

page 9 for a list of questions to ask staff of health 

systems and health plans about cessation services.

Health systems may already collect information about 

tobacco use and cessation treatment in EHRs and 

hospital admissions databases. Hospitals also conduct 

community health needs assessments every three 

years to identify the community’s health priorities and 

create a plan to meet these needs. Learn more about 

how these assessments can help inform cessation 

strategies in the American Lung Association’s toolkit, 

Hospital Community Benefits and Tobacco Cessation. 

Other helpful data sources on tobacco use trends 

Cessation l 8

HOW TO
include the National Survey on Drug Use and Health 

(NSDUH) and the Behavioral Risk Factor Surveillance 

System (BRFSS).

Understanding Cessation Services in the State

A complete assessment of a state’s cessation services includes questions about tobacco use treatment, 

cessation coverage, the state quitline, and cessation support for priority populations. Input from many 

different people may be needed to answer questions, including health plan staff, state Medicaid program 

staff, employee benefits managers, health systems leadership, and quality improvement staff. Local health 

and social service organizations are also valuable resources for learning about community assets and needs.

Tobacco Use Treatment

• Do health systems routinely screen patients for tobacco use and advise them to quit?58

• How do healthcare staff feel about tobacco use? How many of them use tobacco?45

• How often are healthcare staff trained in treating tobacco use? Which staff are trained?58

• How supportive is health system leadership of treating tobacco use?55

• Is cessation included in health system goals and quality improvement strategies?55

• Do health systems record patient tobacco use and cessation treatment in EHRs?58

Cessation Coverage

• How many people are covered by each of the state’s large health plans?59 How many people in each 

plan use tobacco? 

• What cessation counseling options are covered?60

• Which FDA-approved cessation medications are covered by each health plan, and for how long?61

• Is the cessation benefit offered by the health plan standard or an additional benefit with a cost?61

• Are there barriers to accessing treatment, such as copays, prior authorization, or coverage limits?58

• How do health plans promote cessation coverage to members and providers?60

State Quitline Capacity

• Who uses the state quitline?10

• What types and quantities of services does the quitline provide?10

• Do health systems refer patients to the quitline? How many patients do they refer each year? 

• Do health systems use EHRs to refer patients to the quitline?58

• How many members from each plan are referred to and use the quitline each year?60

Priority Populations

• What is the rate of cessation coverage and treatment use among populations with higher tobacco use?

• Are tailored resources in place to meet the needs of these populations?62

• What type of health insurance plan is offered to the Medicaid population (e.g., fee-for-service vs. 

managed care, or both)?63

• What cessation treatments are covered under Medicaid? Are there any barriers to accessing 

covered treatments?62

State agencies such as Medicaid or departments 

of mental health can also be important resources 

for information about tobacco use and treatment 

Cessation l 9

HOW TO
in the state. Learn more about building successful 

partnerships with Medicaid agencies on page 22. 

Existing data sources may not give enough information, 

especially about private health plans. Programs may 

need to conduct their own surveys. See the North 

American Quitline Consortium’s Public-Private 

Partnership Initiative for sample coverage surveys and 

the American Academy of Family Physicians resource, 

Treating Tobacco Dependence Practice Manual, for a 

sample health system survey.

Collecting information creates an opportunity to form 

relationships with organizations who may become key 

partners later on. It is important to respect potential 

partners’ concerns about sharing information.64 Letting 

partners know how data will be used and protected may 

make them more willing to share information that is 

not publicly available.64 Once data have been collected, 

a small group of partners can help staff organize the 

information so that it can be used for planning.64

Identifying Strategic Opportunities

Information collected from health systems and 

insurers is vital to identify areas where the state 

is doing well and where improvement is needed, 

focusing on efforts that:65

• Can have a significant impact on cessation

• Can be easily added to the existing system

• Have demonstrated effectiveness

• Are cost-effective

It may also help to make changes in phases, starting with 

a small pilot project or lower-cost strategies to build 

momentum for changes that require more resources.44

This can be especially useful when health systems or 

plans are reluctant to make changes. For example, 

tobacco use screening is widely accepted and generally 

straightforward to implement.66 Starting with tobacco use 

screening can help build support for other changes.66

Including multiple approaches (e.g., expanding state 

quitline reach and promoting health systems change) 

ensures that all partners have something of interest to 

work on and can help coordinate efforts if cessation 

initiatives are already underway. It also avoids internal 

struggles over how to prioritize efforts.67 When partners 

come together, new opportunities to promote cessation 

may appear. Programs with enough flexibility to 

take advantage of these opportunities can strengthen 

partnerships and achieve cessation goals.

It is also important to balance the reach and intensity of 

interventions when planning strategies. Both increasing 

the number of quit attempts (through higher reach 

interventions) and successful cessation (through more 

intensive strategies) are important to increase the 

overall quit rate.

Choosing Partners

Partners, such as health systems, large employers, 

and state agencies, are critical to successful cessation 

interventions. Partnerships work best when all partners 

understand their roles and the expectations of the 

partnership (e.g., the expected commitment of staff 

time and resources). The following characteristics are 

important when choosing partners:44

• The size and complexity of the partner 

organization

• The population served by the organization 

• The organization’s cessation policies and 

practices

• Obstacles to implementing cessation 

interventions (e.g., resource or time constraints)

• The organization’s current culture toward 

tobacco use 

• Whether the organization has an existing 

relationship with the tobacco control program 

Organizations that have shown a strong commitment 

to cessation can lead efforts and serve as models for 

other organizations. Once programs have selected 

key partners, they are ready to begin planning and 

implementing cessation efforts. The following sections 

describe steps to promote health systems change, 

improve cessation coverage, and support state quitlines.

Cessation l 10

HOW TO
Promoting Health 

Systems Change

Health systems change strategies help clinical settings, 

such as hospitals, health clinics, or private practices, 

integrate tobacco use treatment into routine care. 

Although providers often consider helping patients quit 

an important part of their job, many lack the time and 

skills to make cessation a priority.42 Tobacco control 

staff provide the knowledge and attention necessary to 

help organizations make system changes. This section 

describes how programs can support health systems 

change, including:

• Forming a health systems change team 

• Involving partners in systems change efforts

• Creating an action plan for short-term and longterm goals

• Helping healthcare staff embrace change

• Training staff to provide tobacco use treatment

• Supporting health systems during changes

Forming a Health Systems Change Team

Successful health systems change takes the coordinated 

efforts of many individuals. A team builds support for 

cessation and ensures changes happen as smoothly 

as possible. The health systems change team assesses 

current tobacco use treatment processes, decides what 

changes to make, and builds support among providers 

and other staff who will be making the changes. The 

makeup of the team may vary depending on the size 

and structure of the health system. The ideal team is 

large enough to represent all of the key perspectives 

of the health system but small enough to work as 

a group.45 A health systems change team typically 

includes the following roles (described in Table 1):

• Health system leadership

• Initiative coordinator

• Provider or staff champions

• Information technology (IT) staff

• Quality improvement staff

Support from health system leadership elevates the 

importance of cessation within the health system. It is 

especially important in the early stages of the initiative 

to secure resources, dedicate staff time for planning 

and training, and communicate the importance of 

changes to staff.68 Highlighting the effectiveness of 

tobacco use treatment and potential cost savings 

can engage leaders. Program staff can also share 

what other health systems are doing in cessation and 

explain how the changes support other system goals 

such as quality improvement. Learn how to make 

the case to health system leadership in the American 

Lung Association’s How to Make the Case for Tobacco

and ClearWay Minnesota’s Return on Investment for 

Tobacco Cessation.

The initiative coordinator

leads day-to-day project 

activities, such as reaching 

out to clinical offices and 

convening team meetings. A 

public health expert, such as a 

tobacco control staff member, 

often holds this position. To 

help the coordinator succeed 

in their role, it is important to 

include health system change 

tasks in their regular job 

description.44

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HOW TO
Table 1. Roles and Characteristics of Health System Change Team Members

Possible Team Members Health Systems Change Role Key Qualities

Health System Leadership

• Chief Executive Officer 

• Other members of the leadership 

team (e.g., Chief Operating Officer, 

Chief Information Officer, and 

Chief Medical Officer)

• Medical directors (e.g., internal 

medicine, primary care, pediatrics, 

and emergency medicine)

• Nurse managers

• Secure resources and staff time for 

health systems change

• Find and engage champions

• Ensure changes complement health 

system goals

• Communicate the importance of 

changes to staff

• Help scale up changes system-wide

• Set performance targets and give 

feedback

• Authority to make system-level 

changes

• Credibility among health system 

staff

• Commitment to improving tobacco 

use treatment

Initiative Coordinator

• State tobacco control program staff

• Cessation staff within the health 

system

• Convene health systems change 

team meetings

• Regularly communicate with team 

members

• Conduct outreach to potential sites 

(e.g., clinics and departments) 

• Provide technical assistance and 

training to staff 

• Help set performance targets 

• Oversee data collection and 

evaluation

• Cessation knowledge

• Experience managing complex 

projects

• Familiarity with the health system’s 

culture and practices

• Ability to work effectively with 

many partners, including healthcare 

providers

Champions 

• Doctors, nurse practitioners, and 

physician assistants 

• Nurses

• Health educators

• Clinical office managers

• Medical assistants

• Pharmacists

• Assess and revise office protocols 

and clinical workflow

• Train staff on changes 

• Encourage staff in other offices and 

departments to adopt changes

• Deliver tobacco use treatment

• Monitor performance and report 

back to health systems change team

• Passion for helping staff and patients 

quit

• Authority to make changes to office 

protocols, test implementation, and 

fix problems

• Direct access to providers and office 

staff

IT Staff

• IT manager

• Data analysts

• Draft and implement EHR changes 

• Communicate with software 

developers on behalf of the larger 

team

• Create periodic reports for health 

systems change team and providers

• Knowledge of the health system’s 

current capabilities

• Technical knowledge and skills

Quality Improvement Staff 

• Quality improvement manager

• Data analysts

• Operations staff

• Set performance targets

• Manage data collection processes 

for evaluation

• Give performance feedback to staff 

and health systems change team

• Knowledge of the health system’s 

current quality improvement process 

and existing data

• Experience planning and evaluating 

efforts to improve related chronic 

disease outcomes (e.g., diabetes and 

asthma)

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HOW TO
Champions lead the changes “on the ground” in 

clinical settings. Many people can serve as champions, 

from providers to office managers. The champion’s 

job title is less important than their commitment to 

cessation and ability to influence and sustain change 

within the practice.69 Some champions may volunteer 

or be identified early; others may not emerge until 

changes are underway.44 Multiple champions can share 

health systems change responsibilities. The health 

systems change team can support champions by 

ensuring they have the time, power, and resources to 

make sustainable changes.70

IT and quality improvement staff are both important 

members of the health systems change team. IT staff 

are key if the health system is planning changes to 

the EHR. Quality improvement staff may be able to 

streamline efforts by sharing how cessation data are 

collected for other quality initiatives. The team may also 

include health system staff from other roles, including 

marketing, legal, accounting, or pharmacy.

Involving Partners

Partnerships are critical to extend and support the 

work of the health systems change team. Many 

different organizations may be able to help make 

health systems changes:

• Health-related professional associations, such as the 

American Medical Association, the American 

Nursing Association, and state medical 

associations, can provide cessation information 

and training to their members64

• Hospital associations can build support for health 

systems change and recruit health systems to 

participate 

• Primary care associations can share resources and 

training with providers serving uninsured or 

underinsured populations64

• Quality improvement organizations can provide 

technical assistance, IT consulting, and data for 

planning and evaluation64

• Employers and health plans can improve coverage 

and reimbursement for cessation treatment and 

promote cessation services to their members44

• Local media can inform the public about 

available cessation services and share patient 

success stories44

• State tobacco quitlines can share data, set up a 

referral system, and provide materials for patients

• Other health systems can share their successes, 

challenges, and lessons learned making health 

systems changes

For a map of Primary Care Associations, visit the Health 

Resources Services Administration website. A list of 

Quality Improvement Organizations is available on the 

Center for Medicare & Medicaid Services website.

The strongest partners are those with a clear interest in 

cessation and systems change, strong credibility with 

health systems and providers, and resources to support 

the initiative.64 When approaching potential partners, 

it is important to explain the purpose of the initiative, 

the role of the tobacco control program, and what they 

would gain from participating. Patient and provider 

testimonials and endorsements from state healthcare 

leaders can encourage other partners to join.64

Bringing partners and health systems together regularly 

gives everyone working on health systems change a 

chance to coordinate activities and learn from each 

other’s experiences. It also helps streamline the work 

of the tobacco control program by allowing partners 

to seek answers from each other before turning to 

tobacco control staff for help. Large initiatives may also 

consider forming smaller groups of partners focused on 

particular tasks, topics, or populations, such as a tribal 

work group. Learn more about forming partnerships 

in the CDC Division for Heart Disease and Stroke 

Prevention resource, A Guide to Facilitating Health 

Systems Change.

Creating an Action Plan

The health systems change team can begin its work by 

drafting an action plan with clear short- and long-term 

goals, objectives, and activities.64 The plan typically 

includes team member roles, deadlines, and steps to 

evaluate the initiative. 

A critical first step is to understand what is already 

happening within the health system. For instance, 

how often are patients advised to quit? Some of this 

information may have been collected during planning 

(see the Gathering Information section on page 8). 

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HOW TO
Engaging Pharmacists as Partners in Cessation

Pharmacists play an increasingly important role 

in promoting community health, making them 

a natural partner for cessation. Pharmacists 

are consistently rated among the most 

trusted healthcare providers.71,72 They are also 

accessible—most Americans live within five miles 

of a pharmacy and visit a pharmacist up to 10 

times more often than primary care providers.73,74

They often have convenient hours and do not 

require appointments, making them especially 

important for vulnerable populations who may 

face barriers visiting other providers.75 In some 

states, pharmacists can provide counseling and 

cessation medications according to statewide 

protocols.76 In other states, pharmacists provide 

cessation counseling and over-the-counter 

cessation medications, working with patients’ 

other providers when prescription medications 

are necessary.77

Yet pharmacists can face challenges to providing 

cessation counseling. Reimbursement concerns 

and lack of time or training can all be barriers.75

Tobacco control programs can involve 

pharmacists in promoting cessation through the 

following actions:

• Learn what pharmacists can and cannot do in the state—in some states, pharmacists may need to 

form collaborative practice agreements with providers to deliver cessation services.

• Educate decision makers about the importance of allowing pharmacists to deliver cessation 

counseling and medication and reimbursing them for treatment.

• Train pharmacists how to ask about tobacco use at prescription intake and give brief advice using 

a simple, fast framework such as Ask-Advise-Refer (depicted on page 15). 

• Offer continuing education credits to pharmacists for tobacco use treatment training.

• Work with pharmacists in inpatient settings, such as hospitals or substance use treatment centers, 

to treat tobacco use, and include cessation counseling and medication instructions on discharge.

• Encourage pharmacists to support ending tobacco product sales in pharmacies.

Learn more about involving pharmacists in cessation in the Tobacco Control Network resource, Access 

to Tobacco Cessation Medication through Pharmacists and get access to free online cessation training 

for healthcare providers at Rx for Change. Free resources and materials are also available on CDC’s Tips 

From Former Smokers® website.

Flyer promoting pharmacists as resource for people who want to quit 

smoking Source: California Tobacco Control Program

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HOW TO
A workflow assessment describes in more detail 

how tobacco use treatment is delivered. Workflow 

assessments can be completed at the provider, clinic, 

unit, or department level. Staff input is also essential at 

this stage. They may have concerns about integrating 

tobacco use treatment into their practices.45 See an 

example of a workflow assessment and staff survey 

in the University of Colorado online training, 

Foundations and Strategies of Tobacco Control.

The results of this information gathering phase can 

help the health systems change team decide what they 

want to achieve and set short- and long-term goals. 

An important role of tobacco control staff is to help 

the team choose evidence-based strategies. Staff can 

educate the larger team on clinical practice guidelines 

and encourage them to adopt a tobacco use treatment 

model like those shown below. 

Understanding Tobacco Use Treatment Models

The 5 As brief intervention model is a simple framework to ask about tobacco use and offer help to quit.78

Yet implementation of all five As is inconsistent, with fewer providers assisting with quit attempts and 

arranging follow-up.79 Other models have streamlined the 5As to three steps. Ask-Advise-Refer guides 

providers to assess tobacco use, advise patients to quit, and refer them to cessation resources such as 

quitlines.78 Ask-Advise-Connect focuses on connecting patients directly to cessation resources through a 

link in the EHR.80

Adapted from: CDC78 and Vidrine et al80

One approach is to create a “menu” of evidence-based 

strategies that gives health systems some flexibility to 

choose the option that will work best for their system 

and available resources, while ensuring high-quality 

care for each patient.68 Table 2 on page 17 outlines 

a sample menu of strategies and planning questions 

to guide the health systems change team. For a list of 

more strategies and tools to integrate tobacco treatment 

into clinical care, see the Million Hearts® resource, the 

Tobacco Cessation Change Package.

Completing health systems changes in phases can 

make the process more manageable, especially when 

time and resources are limited. Testing changes with 

a small number of providers or one department can 

help find and resolve potential problems quickly. This 

approach can also create buy-in among early adopters 

whose support can build momentum for more complex 

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HOW TO
changes.44 A planning framework like the Model for 

Improvement helps staff test changes and learn from 

the results in small, rapid cycles. The model uses PlanDo-Study-Act cycles to quickly test small changes:81

• Plan: Develop a plan to test the change

• Do: Test the change on a small scale

• Study: Observe the test and learn from the results

• Act: Make changes based on what was learned

Small changes that are likely to be met with little 

resistance may be appealing to the planning team, but it 

is important that programs also pursue more significant 

changes. Ideally, these “small wins” are steps toward 

adopting more complex changes. 

For more guidance on supporting the health systems 

change team during planning, see the Partnership for 

Prevention’s action guide on Healthcare Provider 

Reminder Systems, Provider Education, and Patient 

Education and ClearWay Minnesota’s Tobacco Health 

Systems Change Starter Toolkit for Clinics.

Helping Staff Embrace Change

Successful health systems change depends on all staff 

making tobacco use treatment a priority. Building 

support among all clinical team 

members helps ensure new protocols 

are actually used in practice.45 Staff 

can also provide valuable information 

about how changes are working and 

what needs improvement. Healthcare 

staff are more likely to support changes 

if they:70

• Understand the reason and 

goals for the changes 

• Feel included in the process

• Like and respect the person(s) 

making changes

• Like the way changes are 

communicated

• Have a sense of challenge and 

achievement

The tobacco control program can educate staff on the 

importance of cessation for their patients. Using data 

can help show the need for the change. Explaining how 

treating tobacco use can help meet other goals, such 

as reimbursement through the Centers for Medicare & 

Medicaid Services’ Quality Payment Program, can also 

help build support among providers. 

Staff want to know how health systems changes will 

affect their day-to-day activities. Champions can 

help explain the changes, describing how roles and 

responsibilities will be defined and how patient care 

will be improved.70 Staff may also be able to identify 

potential challenges early on and brainstorm solutions. 

Involving staff in the decision-making process can 

motivate them to take part and decrease resistance.

Reaching busy providers can be challenging, especially 

when patient visits and office hours limit opportunities 

to meet in person. Using multiple communications 

methods and repeating messages helps spread the word. 

Phone calls and webinars supplement presentations at 

staff meetings, one-on-one visits, and online training 

modules. Email may not be the best way to reach 

providers; other forms of electronic communication 

like e-newsletters and posts on the health system’s 

website or intranet may be more successful.82

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HOW TO
Table 2. Menu of Health Systems Change Strategies

Strategy Planning Questions

Identification and documentation: Ask 

every patient about tobacco use at every 

visit 

• Who will ask patients about tobacco use?

• What questions will be asked (e.g., form of tobacco, frequency of use)? 

• What method will be used (e.g., written intake form, verbal assessment) and 

how will responses be recorded?

Brief tobacco use treatment: Select 

a tobacco use treatment model and 

incorporate it into the clinical workflow 

• What evidence-based model will be used (e.g., 5As, Ask-Advise-Refer)?

• Who will carry out each step?

• When will each step occur?

• What information will be needed for each step?

• How will treatment be documented?

Provider reminder system: Create a 

system to remind providers to talk to 

patients about quitting

• How will reminders be delivered (e.g., chart stickers, EHR alerts)?

• Will the reminder system include information to help providers make 

decisions (e.g., clinical guidelines, talking points)?

Provider education: Train healthcare staff 

on treating tobacco use and provide 

supporting educational materials

• What will be the objectives of healthcare provider training?

• How will training be delivered (e.g., in-person, online, a mix of formats)?

• How often will the training be delivered?

• How will training and materials be tailored for providers who treat priority 

populations?

Referrals: Create a referral system for 

tobacco users interested in counseling

• Where will patients who use tobacco be referred (e.g., state quitline, community 

cessation programs, tobacco treatment specialists in the health system)?

• How will referrals be made (e.g., fax, EHR)?

• How will providers be updated on patient progress?

Follow-up care: Develop a process to 

follow up with patients who receive 

tobacco use treatment

• Who will follow up with these patients, when, and how?

• What information will be covered (e.g., services used, ongoing needs)?

• How will follow-up be documented and tracked?

Reporting and feedback: Create a system 

to regularly share tobacco use and 

treatment data with healthcare staff

• How will progress be tracked (e.g., patient chart audits, EHRs)

• How will data be shared with leadership and staff, and how often?

Chronic disease integration: Integrate 

cessation into protocols for managing 

chronic diseases 

• How can cessation be included in group visits or other chronic disease 

management programs?

• How can cessation information be included in health education efforts for 

patients with chronic conditions?

Quality improvement, accreditation, and 

standards: Integrate cessation treatment 

into existing quality improvement, 

accreditation, and performance efforts

• What cessation measures are currently tracked (e.g., screening, treatment 

delivery, quit rates)?

• What existing performance and accreditation standards relate to cessation 

(e.g., Joint Commission hospital performance measures)?

Reimbursement: Develop coding and 

billing practices to reimburse providers 

for cessation services

• How will providers bill for tobacco use treatment?

• What training will be provided on billing and coding for cessation treatment? 

• Who will be trained (e.g., providers, medical billing staff)?

Population management: Create a 

tobacco use registry to follow up with 

patients who have reported current use

• Where will registry information be housed (e.g., spreadsheet, EHR)?

• Who will develop and maintain the registry?

• Who will follow up with patients?

 Adapted from: Jansen, Capesius, Lachter, Greenseid, & Keller68

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HOW TO
Training Healthcare Staff

Providers with cessation training are more likely to 

advise patients to quit and refer them to the state tobacco 

quitline, especially when training is combined with a 

reminder system.19 Yet surveys reveal that most providers 

have not been trained to talk to patients about tobacco 

use and are not aware of clinical practice guidelines.42

Cessation training is typically delivered through inperson lectures, role play, and discussion led by trained 

specialists (often tobacco control staff).44 Training 

increasingly includes hands-on technical assistance, such 

as help developing office protocols. However, in-person 

training is more costly and a greater time commitment 

for program staff than other formats, such as online 

training. Online training is a convenient, low-cost 

alternative to in-person training but usually cannot be 

tailored to the health system’s specific context or local 

resources.43 Online training also does not generally 

include technical assistance. Including a mix of formats 

can help keep costs down while customizing some 

information. For example, providers might watch an 

online tutorial on the 5As and use face-to-face training 

to practice what they have learned. Learn more about 

online training at Rx for Change and the University of 

Wisconsin’s Tobacco Treatment Training.

A “train-the-trainer” model may also help reduce training 

costs. In this approach, providers are trained on the 

curriculum and then teach other providers. Peer training 

may be easier to integrate with existing training and be 

better received than training by outside staff.68 Since 

quitting tobacco helps prevent other chronic diseases 

such as heart disease and cancer, training costs could also 

be shared across other chronic disease programs.19,84

Cessation Training Checklist

Effective cessation training has the following 

characteristics:

• Includes staff from different roles 

(e.g., doctors, medical assistants, 

pharmacists, nurses, health educators, 

office staff, and volunteers)45

• Takes place at convenient times, such 

as before office hours, at lunchtime, 

or during regular meetings (e.g., staff 

meetings or grand rounds)83

• Covers all forms of tobacco use, 

including e-cigarettes

• Stays up to date on the latest evidence 

and adapts as provider needs change45

• Occurs periodically to refresh skills45

• Offers continuing education credit to 

encourage participation45

Supporting Health Systems during 

Changes

Tobacco control programs become health systems’ 

biggest supporters as they begin to make changes, 

making sure that project activities keep moving 

forward. Programs can help make health systems 

changes by meeting regularly with healthcare staff and 

discussing performance data with staff and leadership.

Scheduling regular meetings or calls with staff builds 

in time to evaluate progress, plan activities, and deal 

with barriers that may occur during implementation, 

such as staff resistance or turnover. Tobacco control 

staff can also use meeting time to brainstorm solutions 

and give more training when needed. Periodic outreach 

(e.g., newsletters with updates on the latest research, 

resources, and training opportunities) can also keep 

providers engaged in cessation activities, even as 

different priorities may compete for their attention.

Staff are more likely to support changes if they feel a 

sense of progress and achievement. Health systems can 

prepare reports using EHR data to show progress toward 

project benchmarks and identify areas for improvement. 

Sometimes called “performance feedback,” reports can 

be shared with individual providers, clinics, departments, 

or across the whole system. Posting results on clinic 

performance boards or including data from multiple 

sites can spark friendly competition and motivate staff 

to make changes.85 More frequent performance feedback 

is useful at the start of the initiative so staff can make 

adjustments.44 Periodic reports are helpful later on as 

staff maintain changes.44 Learn more about sustaining 

health systems changes on page 42.

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HOW TO
A CLOSER LOOK: Electronic Health Records (EHRs)

EHRs are digital versions of paper patient 

charts.86 They contain medical histories 

and can also include other features, such as 

templates to save time and evidence-based 

tools to help providers make decisions about 

patient care.86 As of 2015, most providers used 

some form of EHRs, although many only 

have a basic system that may not include extra 

features.87 EHR use is also lower among rural 

and specialty hospitals.88

As health systems adopt and improve 

EHRs, tobacco control programs have an 

opportunity to encourage changes that make 

it easier to deliver cessation treatment. EHRs can include fields to document tobacco use status, alerts 

that remind providers to counsel patients, and guidance on how to talk about tobacco use with patients. 

They can also be used to give healthcare staff performance feedback and document health systems change 

outcomes. When EHRs include cessation information, rates of screening and referrals increase.89,90

It is important that EHRs are easy to use and include current, evidence-based information on treating 

tobacco use.43 EHRs will vary depending on the needs of the health system but are most useful when they 

mirror the provider’s workflow and include fields for every step of tobacco use treatment (e.g., documenting 

tobacco use status, advising to quit, offering counseling and medication, and creating a follow-up plan).43

Check boxes, drop-down lists, and pre-populated fields (e.g., provider notes and medication order sets) can 

simplify data entry.91 Cessation information can also be programmed to appear at all wellness visits and 

when patients have related health conditions, such as a cough, diabetes, or depression.92

EHR changes require input from many partners across the health system. Tobacco control staff can help 

coordinate efforts to include cessation in EHRs by:

• Asking the health systems change team to assess current system capabilities, including existing 

cessation-related EHR features, available financial resources, high-speed internet access, IT staff 

capacity, and data entry skills of healthcare staff93

• Meeting with health system leadership to get their support for EHR changes93

• Ensuring IT staff is involved early in planning to answer technical questions94

• Forming partnerships with the state quitline to add electronic referrals to the EHR95

• Consulting medical billing staff to ensure the EHR includes the right billing codes96

• Asking healthcare staff to test EHR changes to ensure that they match the patient visit workflow 

and include clear recommendations45

• Training all staff on how to use new EHR functions for treating tobacco use45

Visit HealthIT.gov’s Health IT Playbook and the American Academy of Family Physicians resource, 

Integrating Tobacco Cessation Into Electronic Health Records, for examples and more on EHRs.

Cessation l 19

HOW TO
Improving Cessation 

Coverage

Comprehensive coverage makes tobacco cessation 

treatment more accessible and affordable and supports 

healthcare providers’ efforts to treat tobacco use.1

Tobacco control programs can help improve cessation 

coverage by: 

• Working with employers and health insurers

• Improving Medicaid cessation coverage

• Working with state and local health benefit 

agencies to improve cessation coverage for state 

and local government employees

• Raising awareness of coverage through health 

communications campaigns

Working with Employers and Health 

Insurers

As of 2018, more than two-thirds of U.S. adults had 

private health insurance, and more than half got 

insurance through their employer.97 State programs can 

help improve private coverage by educating employers 

and health insurers about the benefits of cessation 

coverage and tobacco-free workplaces.

Web banner from Oklahoma’s “Tobacco Stops with Me” campaign Source: Oklahoma Tobacco Settlement Endowment Trust

Educating Employers and Insurers on Benefits 

of Cessation Coverage 

People who smoke have higher health and life 

insurance costs, more missed days of work, and lower 

productivity than people who do not smoke.18,98,99

Yet employers and health insurers may hesitate to 

offer comprehensive cessation coverage because of 

misunderstandings about its costs and benefits. In 

fact, cessation coverage is actually saves employers 

and insurers money by lowering healthcare costs.19,100

Figure 5 describes key messages about cessation 

coverage that staff can communicate to employers and 

health plans.

Online return-on-investment (ROI) calculators can 

also help estimate potential cost savings. Tools such as 

the America’s Health Insurance Plans ROI Calculator

compares the cost of usual care to the cost of providing 

cessation coverage. It also takes into account healthcare 

cost savings and productivity increases when people 

who smoke quit. Examples from other employers and 

insurers can also show the positive financial impact of 

investing in cessation coverage. 

Hosting summits, or meetings that bring together key 

leaders, is another way to raise awareness about the 

importance of improving cessation coverage. Summits 

teach representatives from large employers, business 

coalitions, and insurance companies what is included 

in comprehensive cessation coverage and the benefits 

of providing coverage.101 Participants can explore 

partnerships, learn from others’ experiences, and share 

resources.101 Surveying health plans and employers 

Cessation l 20

HOW TO
about their cessation coverage before the summit 

allows them to discuss the results when they meet. See 

the North American Quitline Consortium’s Resource 

Center for sample surveys.

Figure 5. Key Messages for Employers and Insurers

Encouraging Tobacco-Free Workplaces

Workplace policies and practices that support 

cessation make quitting tobacco easier for employees 

and encourage them to use cessation coverage.103

Employers can take the following steps to create 

tobacco-free workplaces:104

• Implement and enforce written policies for a 

tobacco-free workplace

• Promote available cessation coverage to 

employees to increase awareness and use

• Form a cost-sharing partnership with the state 

tobacco quitline to provide employee cessation 

services (learn more on page 27)

Cessation l 21

HOW TO
• Recognize and reward employees who 

successfully quit tobacco

• Ask employees who have quit tobacco to share 

their stories in employee newsletters or on 

company websites

• Regularly evaluate cessation policies and practices 

to ensure they still meet employees’ needs

Improving Medicaid Cessation Coverage

Medicaid provides health insurance coverage to 

millions of low-income Americans.105 One in four 

Medicaid enrollees smokes, more than twice the rate of 

adults with private health insurance (see Figure 6).106

Although they express similar interest in quitting as 

people with private insurance who smoke, Medicaid 

enrollees who smoke are less likely to quit successfully.11

Improving tobacco cessation coverage among Medicaid 

enrollees can help reduce these disparities.4

Figure 6. Smoking among Medicaid 

Enrollees, 2016 

Source: Jamal106

According to Best Practices 2014, “providing 

comprehensive state Medicaid cessation coverage is one 

of the most important steps a state can take to increase 

cessation and reduce tobacco use.”1 Figure 7 lists 

what is included in comprehensive cessation benefits. 

Helping people enrolled in Medicaid quit smoking can 

also save states money. One study found that reducing 

adult smoking prevalence by just 1% saved states an 

average of $26 million in Medicaid costs the following 

year ($2.5 billion total across all states).107

Since 2014, traditional state Medicaid programs 

have been required to cover all seven FDA-approved 

cessation medications for all adult enrollees. 

Programs do not have to cover cessation counseling 

and may allow cost-sharing or prior authorization 

requirements.108 Since 2010, programs have had 

to cover all FDA-approved cessation medications 

plus counseling for pregnant women, without costsharing.108 States that choose to expand Medicaid 

eligibility under the Affordable Care Act must cover 

tobacco use as preventive service with an A rating 

from the U.S. Preventive Services Task Force.109 Learn 

more about Medicaid coverage requirements on 

the American Lung Association web page, Tobacco 

Cessation Treatment: What is Covered?

Figure 7. Cessation Benefit Checklist

Source: American Lung Association110

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HOW TO
As of March 2019, most state Medicaid programs did 

not offer comprehensive cessation coverage.111 Only 

two states (Kentucky and Missouri) did so without 

added cost or other barriers (see Figure 8).111 Tobacco 

control programs can help improve and increase use of 

Medicaid cessation coverage by forming partnerships 

with state Medicaid agencies and educating healthcare 

providers about available cessation benefits. 

Figure 8. Medicaid Cessation Coverage in 50 States and Washington, DC

 * Five forms of nicotine replacement therapy (patch, gum, lozenge, nasal spray, and inhaler), bupropion, and varenicline

 † Barriers include copayments, prior authorization requirements, counseling requirements for medications, limits on the duration of treatment and number of 

quit attempts, and stepped-care requirements. These barriers may vary among a state’s different Medicaid managed care plans.

Source: Centers for Disease Control and Prevention111

Medicaid is administered by the states according to 

broad federal requirements.105 Traditionally, states have 

operated Medicaid under a fee-for-service system, in 

which healthcare providers are paid at set rates for each 

service they provide.112 To manage costs and use of 

services, many state Medicaid agencies contract with 

managed care organizations (MCOs) that are paid per 

member per month rather than by service. Building 

relationships with both state Medicaid agencies and 

MCOs is crucial to improve Medicaid tobacco cessation 

Cessation l 23

HOW TO
coverage. These partners can help state programs by 

sharing tobacco use and cessation data, improving 

benefits, and promoting coverage to Medicaid recipients. 

Programs can begin discussions with Medicaid 

organizations by talking about the health and economic 

benefits of improving cessation coverage. Information 

about Medicaid enrollees’ tobacco use, tobacco-related 

healthcare costs, and use of evidence-based treatment 

are important talking points. To learn more, read the 

CDC fact sheet, STATE System Medicaid Coverage of 

Tobacco Cessation Treatments. State Medicaid staff 

may also be unaware that there is an opportunity for 

federal funding to cover some of the cost to provide 

cessation counseling to Medicaid recipients through the 

state quitline (learn more on page 44).113

In states where Medicaid and the tobacco control 

program do not have an existing partnership, tobacco 

control staff can take the following steps to form a 

strong working relationship: 

• Understand where Medicaid’s priorities align 

with and differ from those of the tobacco 

control program (e.g., Medicaid is focused on a 

single population rather than the population as 

a whole)114

• Conduct cross-training to learn about state 

Medicaid processes, vocabulary, and cessation 

requirements and teach state Medicaid staff 

about tobacco control114

• Build support among tobacco 

control program leadership for 

state Medicaid partnerships, 

since communication between 

the programs may happen at the 

director level114

• Take and distribute notes on 

any decisions made during 

planning to help keep things 

moving if a champion on either 

side unexpectedly leaves114

• Once agencies are ready to begin 

a partnership, develop a written 

memorandum of understanding 

to clarify the purpose, scope, and 

responsibilities of each partner63

Learn more about forming successful partnerships 

between tobacco control and state Medicaid programs 

in the CDC case study on Massachusetts’ efforts to 

increase use of cessation treatment and successful 

cessation among Medicaid enrollees. CDC’s 6|18 

Initiative, described on page 25, also focuses on 

bringing together partners such as state tobacco control 

and Medicaid programs to improve health and control 

healthcare costs.36

Improving Coverage for State 

Employees

Because state governments are among the largest 

employers in the state, improving coverage for state 

employees could expand access to tobacco cessation 

treatment. State plans often serve as an example for 

other health plans.1

As of 2018, only nine states—Illinois, Iowa, 

Massachusetts, Michigan, Minnesota, Mississippi, 

North Dakota, Rhode Island, and South Carolina—

provided comprehensive cessation coverage for all state 

employees.115 Tobacco control programs can help state 

agencies improve coverage by surveying insurers about 

coverage and sharing the results.101 They can also help 

state benefits directors find coverage gaps, educate 

insurers about the health and economic benefits of 

coverage, and answer questions.101

Cessation l 24

HOW TO
A CLOSER LOOK: CDC’s 6|18 Initiative

Launched in 2015, CDC’s 6|18 Initiative was designed to focus on 6 common and costly health conditions, 

including tobacco use, and 18 evidence-based interventions that can improve health and control costs.35

Tobacco control goals of 6|18 include improved coverage, barrier-free treatment, and increased use of 

covered treatments.36 By strengthening collaboration between public health and health care, 6|18 seeks to 

put these interventions into practice more quickly to reach the greatest number of people. 

The first phase of the initiative brought together federal partners, public health departments, and 

Medicaid agencies in nine states: Colorado, Georgia, Louisiana, Massachusetts, Michigan, Minnesota, 

New York, Rhode Island, and South Carolina. The initiative now includes healthcare partners, such as 

providers, private insurance purchasers (employers responsible for employee health coverage), and payers 

(public and private health insurers).116 Bringing many partners together to improve access to evidencebased interventions requires open communication and dialogue.116 6|18 partners are working together to:

• Leverage partners’ skills to accelerate use of best practices116

• Share knowledge among the public health community, insurers, and healthcare providers54

• Help the public health community learn the culture and vocabulary of healthcare insurers and 

providers54

• Find common interests and overcome barriers to building effective partnerships54

State health department and Medicaid staff report that 6|18 has increased communication, resource 

sharing, understanding, and accountability among partners.116 It has also raised awareness of program 

activities among other stakeholders.116 Next, 6|18 partners plan to evaluate the initiative and expand to 

include employers and other states and insurers.116 To learn more about applying 6|18 strategies to reduce 

tobacco use, visit the Center for Health Care Strategies’ Resource Center.

Cessation l 25

HOW TO
Similar to how the state offers health insurance to its 

employees, city and county governments also provide 

health benefits to their employees.101 Tobacco control 

staff can also educate local governments about the 

importance of comprehensive cessation coverage.

Raising Awareness of Coverage

Comprehensive, barrier-free cessation coverage is only 

effective if tobacco users and healthcare providers are 

aware of coverage and use it.1

 Health communications 

strategies encourage people who smoke to quit, use 

evidence-based treatments, and turn to providers as a 

resource. It is important that messages describe which 

treatments are covered, point out any coverage limits, 

and explain how to access treatment.117

Promotion is especially important when insurers 

improve coverage. Providing information in multiple 

ways makes it easy for members to find coverage 

information and understand how to use it. For example, 

programs can encourage state Medicaid agencies and 

health plans to send emails and mailings, post flyers 

in provider waiting rooms, and include information in 

member handbooks, newsletters, and websites.117

Communications can also include messages for providers 

urging them to treat tobacco use and explaining how to 

get reimbursed. For example, New York’s Don’t Be Silent 

About Smoking campaign emphasized the important role 

that providers play in helping patients quit. Campaign 

materials appeared in print, online, and outdoors.118

Later phases of the campaign sought to increase cessation 

among low-income New York residents by encouraging 

providers to educate patients about Medicaid cessation 

coverage.118 Learn more about New York’s efforts at the 

Talk To Your Patients website.

Communications campaigns can also help people 

enrolled in Medicaid quit smoking. For example, when 

Wisconsin improved Medicaid cessation coverage, 

it launched the Medicaid Covers It campaign to raise 

awareness and increase use of covered benefits. Cessation 

medication claims increased from 1.5% of Medicaid 

smokers at the beginning of the campaign to 4.4% 

at the end.119 Quitline registrations also dramatically 

increased.119 Medicaid agencies facing tight budgets 

may hesitate to promote coverage.120 Highlighting the 

potential healthcare cost savings when people enrolled 

in Medicaid quit smoking may help encourage Medicaid 

agencies and MCOs to publicize coverage.

Healthcare providers who treat Medicaid patients are 

also important partners to increase use of cessation 

benefits among Medicaid enrollees. Providers are trusted 

by Medicaid patients to deliver cessation messages and 

can refer patients to quitting resources.121 It is important 

for these providers to know what Medicaid covers and 

understand how to code and bill Medicaid for services. 

Staff can make sure providers receive training and 

information on these topics. For example, the Vermont 

tobacco control program informed medical and dental 

providers about Medicaid cessation coverage and new 

reimbursement codes through mailings, webinars, 

newsletters, and a website.122

Wisconsin’s “Medicaid Covers It” campaign informed people who smoke about 

new cessation coverage available through Medicaid Source: University of 

Wisconsin Center for Tobacco Research and Intervention

Cessation l 26

HOW TO
Supporting State 

Quitlines

State tobacco quitlines provide evidence-based, costeffective cessation services to hundreds of thousands 

of people each year over the phone, web, and other 

communications channels.123 Despite these advantages, 

quitlines are underfunded and only reach 1 out of 100 

people who smoke on average in any given year.1

 To 

support state quitlines, programs can:

• Form cost-sharing partnerships

• Use new communications technologies

• Promote the quitline through health 

communications campaigns 

Forming Cost-Sharing Partnerships

Partnerships with health insurers and large employers 

can help offset quitline costs and reach more people. 

These public-private partnerships can use several 

different cost-sharing models:56

• Triage and transfer: the state quitline receives all 

incoming calls, and the partner pays for callers 

to be transferred to cessation services provided 

by the partner

• Independent contract: the partner contracts 

directly with the quitline vendor, expanding 

the reach of the quitline with little to no 

involvement by the state program

• Reimbursement: the state quitline provides all 

services and the partner reimburses the quitline 

for some or all of the cost

• Cooperative fax referral: the state quitline and health 

insurance plans share costs for a single fax referral 

system, which may provide all services through 

the state quitline or transfer insured callers to 

services operated by the health plans

Which model will work best depends on the capacity 

of both the state quitline and the potential partner. 

The triage and transfer model can work well when the 

partner offers its own high-quality, evidence-based 

cessation services.56 In other cases, a reimbursement 

model where the quitline provides all services may 

work best. This approach ensures high-quality services 

for every caller, but the state quitline must be able to 

serve a large number of callers.56

Programs can start the work of forming partnerships 

by finding out who uses the quitline and where gaps 

in cessation coverage exist.101 This can help identify 

insurers and employers that may make good partners. 

It also lays the groundwork for strong relationships 

as programs work with potential partners to collect 

information about how their members and employees 

use quitlines.101 Focusing on large health plans and 

employers helps partnerships have the greatest impact 

by expanding quitline reach to many people at once.101

Making the Case for Cost-Sharing

Supporting the state quitline helps employers and health plans provide highly effective cessation 

treatment. To make a strong case to potential partners for sharing costs, tobacco control staff can 

emphasize the following points:

• Quitlines increase the likelihood of quitting successfully.19

• Quitlines are widely accessible and offer convenient hours.19,50

• Supporting quitlines is a smart investment: people who quit smoking have greater productivity, 

reduced absenteeism, and lower healthcare costs.19

• Partnering with the quitline can help plans meet federal requirements.124

• Partner support is important to maintain consistent, high-quality quitline service for all callers.1

Cessation l 27

HOW TO
Health insurance purchasing groups or unions can 

also be potential cost-sharing partners. Learn more 

about gathering coverage information from partners 

on page 8. 

Once programs have identified potential partners, they 

are ready to reach out to partners about the possibility 

of cost sharing. Effective strategies to bring partners to 

the table include:

• Educating partners about the health and 

financial benefits of cost-sharing101

• Building support among state health department 

leadership, who can communicate with leaders 

at partner organizations101

• Participating in partnership initiatives, such as 

CDC’s 6|18 Initiative101

• Leading by example to form cost-sharing 

partnerships with the state Medicaid agency and 

the state employee benefits program56

Financial constraints may sometimes require quitline 

services to be limited to certain groups of callers, such as 

Medicaid enrollees or those without insurance. However, 

limiting services can also limit the reach of services and 

potential for future partnerships. States have found that 

potential partners appreciate the program working with 

partners first, rather than requiring cost-sharing or 

strategically limiting services.56

Screenshot from Tobacco Free Florida’s Quit Your Way website designed to help visitors quit tobacco 

Source: tobaccofreeflorida.com/quityourway

Once insurers and employers are ready to develop a 

partnership, a written costsharing agreement can help 

clearly define roles and how 

costs will be shared.63 An 

ideal agreement is formed 

through consensus, requires 

partners to promote the 

quitline to their members, 

includes data sharing, and 

maintains quality services. 

Learn more about 

developing partnerships 

from the North American 

Quitline Consortium’s 

Public-Private 

Partnerships Initiative. 

Using New Quitline Technologies

The way that people communicate has changed 

drastically over the past decade.125 As of 2019, almost 

every U.S. adult has a cell phone and 8 out of 10 own 

smartphones.125 A growing number of quitlines offer 

cessation services through digital channels in addition 

to telephone-based services.50 Text-messaging programs 

send messages to a user’s phone with quitting advice 

and encouragement, and some can tailor messages 

based on responses from users.126 Smartphone apps 

offer interactive features, such as progress trackers 

and customized reminders, to support people who 

want to quit using tobacco.127 Cessation services 

can also be delivered through websites and other 

online tools. These web-based services may simply 

share information or include interactive features like 

personalized quit plans and online chat tools.128

These new technologies are promising because 

they could expand the reach of telephone quitlines, 

especially among young people who might not seek 

more traditional methods of treatment.129 They can also 

be used at times that telephone services and clinics are 

not operating.130 Despite these potential advantages, 

evidence of effectiveness for new quitline technologies 

varies greatly and is not yet equal to that of telephone 

quitlines.50 New technologies work best when used to 

supplement, rather than replace, telephone quitlines. As 

programs add these technologies, they can contribute 

to the evidence base by carefully evaluating their use. It 

Cessation l 28

HOW TO
is important that programs use new technologies with 

the following characteristics:50

• Follow clinical practice guidelines

• Connect users to other cessation services, such 

as telephone quitlines

• Feature interactive elements like group chat or 

real-time messaging with a counselor

• Deliver frequent, customized quitting messages 

based on the user’s tobacco use history, current 

health information, and reasons for quitting

Learn more about the pros and cons of new cessation 

technologies in Table 3 below.

Table 3. Pros and Cons of New Cessation Technologies

Platform Pros Cons Example

Text Messaging • Can be used by anyone 

with a basic cell phone

• Can reach large audiences 

at low cost131

• Strong evidence of 

effectiveness132

• Can support telephone 

quitlines with reminder 

texts50

• Communication limited to 

text and simple graphics127

• High participant dropout 

rates133

• Some may offer only 

automated messages 

with no interactive chat 

feature50

• Messages may only be 

delivered for a set period 

of time

• Requires users to have a 

data or texting plan

https://smokefree.gov/

SmokefreeTXT

Smartphone Apps • Can deliver customized 

support based on users’ 

mood, smoking history, or 

triggers127

• Can include interactive 

progress trackers and 

challenges127

• Can include games and 

videos to distract from 

cravings133

• Can deliver messages at 

certain locations or times of 

day when extra support is 

needed134

• Require a smartphone data 

plan

• Most do not follow 

U.S. clinical practice 

guidelines135

• Evidence of effectiveness is 

still emerging127

• Require user to open app 

regularly133

• Users may be able to turn 

off notifications

https://smokefree.gov/toolstips/apps

Web-based Services • Can reach large audiences 

at low cost50

• Can include interactive 

tools such as online chat, 

blogs, or build-your-own 

quit plan50

• Can be accessed from 

anywhere with a computer, 

such as public libraries or 

internet cafes50

• Require internet access

• May be challenging 

to keep participants 

engaged136

• Website maintenance can 

be time consuming137

http://tobaccofreeflorida.

com/quityourway

Cessation l 29

HOW TO
Promoting State Quitlines

Quitlines are more likely to be effective if people 

are aware of available services and how to reach 

them.138 Three strategies are effective to promote state 

quitlines:123

• Implement health communications campaigns 

featuring quitline contact information

• Promote the availability of free cessation 

medication for quitline callers

• Generate referrals from healthcare providers and 

community organizations

Implementing Health Communications 

Campaigns

Health communications campaigns increase cessation 

by motivating people who smoke to try to quit.123

Campaigns can also motivate people to contact the 

quitline and educate providers on the importance of 

helping patients quit.123 The most effective messages 

combine hard-hitting information about the negative 

health consequences of smoking with how to contact the 

quitline.139 For example, the Tips From Former Smokers® 

campaign features adults who have quit smoking and 

are living with the serious health effects of tobacco use. 

Campaign messages also included the quitline portal 

telephone number, 1-800-QUIT-NOW, and the National 

Cancer Institute website http://www.smokefree.gov. The 

campaign led to over nine million quit attempts and over 

a half million successful quits in only three years.38 From 

just March to June 2012, the campaign increased quitline 

calls by 132% and visits to the website by 428%.140

Billboard ad from the 2018 Tips From Former Smokers campaign® featuring Christine, who was diagnosed with oral cancer at age 44 after smoking for 28 years

Source: Tips From Former Smokers® Download Center

Programs may also choose to develop campaigns on 

other issues, such as raising awareness about a new 

comprehensive smokefree law. It is important that all 

campaigns are tagged with quitline contact information 

so people who decide to try to quit smoking know where 

they can get help.

Paid ads on TV, radio, billboards, transit, newspapers, 

magazines, and the internet are one of the best ways 

to raise awareness of the quitline.141 Paid media allows 

programs to reach large audiences, but some channels 

are expensive.142 Incorporating other strategies, such as 

news coverage or social media, can help keep costs down. 

News coverage is free, but it can be harder to control 

the timing and content than with paid ads. Social media 

allows programs to communicate directly with people 

about quitting tobacco. Posting on social media can also 

be free but takes time and staff resources to manage. 

Learn how to select the best mix of communications 

strategies in CDC’s Best Practices User Guide: Health 

Communications in Tobacco Prevention and Control.

Ideally, the goal of quitline promotion is to generate a 

steady flow, rather than a large spike, of calls. Programs 

can air ads in “pulses” strategically throughout the year 

to allow time to catch up on outgoing calls.139 Providing 

quitlines at least 90 days’ notice before a campaign 

begins also gives them time to adjust staffing levels and 

plan for an increase in calls.143 In general, programs 

should give quitlines as much advance notice and 

information as possible about upcoming campaigns.

Throughout the year, other local and national partners 

may run their own communications campaigns that 

reach tobacco users in the state. It is important that 

Cessation l 30

HOW TO
programs are aware of these campaigns so that they 

can be prepared for increased call volume. They may 

also adjust their own media placements. For example, 

programs can choose to air ads when no other 

campaigns are running or create social media posts to 

extend the reach of a national TV campaign.

Promoting Free Cessation Medication

Providing free cessation medication is another strategy 

to increase quitline calls. Quitlines sometimes offer 

a 2-week starter supply kit of nicotine replacement 

therapy (NRT) medications, such as the nicotine patch 

or gum. The amount and type of NRT distributed may 

vary based on the state’s resources and restrictions. 

To promote free NRT, tobacco control programs have 

included the details in campaign ads and mailings. 

Free medication can also generate news coverage of the 

quitline.144 These promotions are even more successful 

when paired with other major campaigns or events. 

For example, during CDC’s Tips From Former Smokers® 

campaign in 2012, the Florida Quitline provided free 

cessation medication to callers. The promotion led to 

the greatest spike in quitline enrollment and web-based 

cessation services during the campaign.145

Using free NRT with quitline counseling may also 

increase the number of calls and successful quits, 

especially for those who may not be able to afford 

medication or lack coverage.1,123 Quitlines may be 

hesitant to provide starter kits because of concerns about 

their cost, but evidence shows that the small added 

cost is more than offset by their effectiveness in helping 

people quit.146 In fact, using cessation medication can 

double the chance of quitting for good.19

Generating Referrals

Compared to media campaigns and NRT promotions, 

referrals from healthcare providers and other community 

organizations can be a lower-cost and more sustainable 

way to increase state quitline calls.142 In bi-directional 

referral systems, quitlines can also send information back 

to providers, letting providers know whether the quitline 

reached the patient, if the patient enrolled in quitline 

services, and whether the patient succeeded in quitting. 

Most states already use fax referral systems and many 

are developing electronic referrals (e-referrals).1

E-referrals allow healthcare providers to send referrals 

electronically through electronic health records (EHRs) 

and potentially receive feedback from the quitline. 

E-referrals can save time for healthcare and quitline 

staff and increase the number of quitline referrals.90

Developing e-referrals takes a joint effort. The quitline 

service provider develops the capacity to accept 

e-referrals, and health systems develop the capacity to 

send e-referrals to the quitline. Putting the necessary 

relationships in place with health systems can require 

a lot of time and staff resources. The tobacco control 

program can support both partners by identifying 

health systems, helping create quitline referral forms, 

and training healthcare staff on quitlines and the referral 

process.95 To learn more about developing e-referral 

systems, see the North American Quitline Consortium’s 

resource, Quality Improvement Initiative Issue Paper: 

Quitline Referral Systems.

Print ad from New York City Department of Mental Health & Hygiene’s 

“Suffering Every Minute” campaign urging people who smoke to contact the 

quitline and promoting a nicotine patch and gum giveaway Source: CDC Media 

Campaign Resource Center

Cessation l 31

HOW TO
A CLOSER LOOK: Counseling About E-cigarettes

E-cigarettes are electronic devices that heat a liquid usually 

containing nicotine, flavoring, and additives into an aerosol 

inhaled by users.147 Quitline callers may ask about these 

products, either as cessation aides or because they want to 

quit using e-cigarettes. 

E-cigarette aerosol generally contains fewer toxic chemicals 

than the deadly mix of 7,000 chemicals in cigarette smoke.148

E-cigarettes have the potential to benefit adults who smoke 

and are not pregnant, if used as a complete substitute for 

cigarettes and other smoked tobacco products.149 But many 

adult e-cigarette users continue to smoke cigarettes (dual 

use), which does not provide a meaningful health benefit.150

Smoking even a few cigarettes a day has significant health risks.151 E-cigarettes have not yet been approved 

as safe and effective for cessation.152 E-cigarette aerosol is also not harmless.153 It can contain heavy metals, 

small particles that can be inhaled deep into the lungs, and cancer-causing chemicals.153 E-cigarettes are not 

safe for youth, young adults, pregnant women, or adults who do not currently use tobacco products.149

Patients and quitline callers may ask providers and quitline coaches about using e-cigarettes as part of 

an attempt to quit smoking cigarettes, or they may ask about quitting e-cigarettes. Providers and quitline 

counselors can follow these steps to talk about e-cigarettes:

• Ask about e-cigarette use

It is important to ask all patients and quitline callers, particularly youth and parents, about 

e-cigarette use and exposure. Because e-cigarettes go by many names, it is important to ask using 

popular terms for these products (e.g., JUUL, vape pens, and e-hookah).154

• Counsel about the known and unknown risks of e-cigarette use

E-cigarettes typically contain nicotine, a highly addictive chemical.153 Nicotine is harmful to the 

developing brain.152 E-cigarette aerosol may also contain other harmful chemicals.153 The longterm health effects of heating and inhaling these chemicals is still not well understood.153

• Emphasize the importance of quitting completely

Reducing daily smoking by substituting some cigarettes with e-cigarettes is not an effective way to 

reduce the health risks of smoking. Using e-cigarettes can prolong nicotine addiction and make 

quitting more difficult.153 The only way to meaningfully reduce risk is to quit smoking completely. 

• Reinforce proven cessation treatment

FDA-approved cessation medications can double or triple the chances of successfully quitting.19

These medications are even more effective if combined with counseling.19 While there is limited 

evidence about treatment for e-cigarette use, a similar approach using counseling and FDAapproved medication could be considered when assisting individuals quit e-cigarette use.

Learn more about e-cigarettes in the CDC resources, About Electronic Cigarettes and E-cigarettes Shaped 

like USB Flash Drives. More information is also available at the Surgeon General’s website, The Facts on 

E-cigarette Use among Youth and Young Adults.

Cessation l 32

HOW TO
Reducing TobaccoRelated Disparities 

Most people who smoke are interested in quitting.12 Yet 

some groups face more challenges accessing cessation 

treatment than others and struggle to quit. These 

priority populations are based on socially determined 

circumstances and characteristics such as age, disability, 

education, income, occupation, geographic location, 

race, ethnicity, sex, sexual orientation, gender identity, 

behavioral health status, and military status.1,155

For example, people with low income and education 

levels and those without health insurance are just as likely 

as other people who smoke to be interested in quitting 

but are less likely to succeed.11,12 Use of evidence-based 

cessation treatment is also lower among certain groups, 

including racial and ethnic minorities; lesbian, gay, or 

bisexual smokers; and people without health insurance.11

People from certain racial, ethnic, and socioeconomic 

status groups are also more likely to live in communities 

with more tobacco advertising.156 These environmental 

cues to smoke can make cessation more difficult.157

Tobacco control staff can reduce cessation disparities by:

• Considering the needs of priority populations 

during planning for cessation interventions 

• Supporting health systems serving priority 

populations 

• Improving coverage and use of 

cessation treatment among priority 

groups

• Expanding state tobacco quitline 

reach to these groups

Preparing to Reach Priority 

Populations

An important first step to reduce cessation 

disparities is to assess whether current 

strategies are effective for the population and 

fit with their culture. For example, people 

who avoid counseling may not want to call 

quitlines. Other strategies may be needed to 

reach them. 

Members of priority populations and the 

organizations who serve them are vital to planning 

efforts. They can provide information about how 

priority groups use cessation services and what 

barriers they face to getting help. Including them in 

planning also ensures that cessation interventions take 

into account the needs and culture of the population. 

Programs can ensure that these groups are active 

participants in discussions and decision making. 

To learn more about reducing tobacco-related disparities, 

see the CDC resource, Best Practices User Guide: 

Health Equity in Tobacco Prevention and Control and 

Networking2Save, a consortium of national networks 

focused on eight priority populations.

Supporting Health Systems Serving 

Priority Populations 

Despite an overall increase in advising patients to quit 

using tobacco, healthcare providers are still less likely to 

advise some groups to quit, such as young adults, certain 

racial and ethnic minorities, and the uninsured.11,158

Providers serving these populations may lack the time or 

training to give cessation advice.159 Patients from these 

groups may also face competing health priorities.159

Tobacco control programs can support providers who 

work with priority populations by:

• Educating providers on the importance of 

cessation for the populations they serve

• Helping healthcare staff create procedures to ask 

about and treat tobacco use at every patient visit

Cessation l 33

HOW TO
• Providing cessation information tailored 

to patients’ cultures, literacy levels, native 

languages, and ages

• Incorporating cessation into behavioral health 

treatment (learn more on page 37)

• Training healthcare staff on delivering culturally 

competent cessation treatment 

Smaller health systems may have fewer resources to 

support systems change, especially for integrating 

cessation treatment into EHRs. Programs can support 

smaller organizations by connecting them to resources 

and partners that can help develop health information 

technology. It can also help to connect organizations to 

each other so they can learn from others’ experiences. 

For example, Oklahoma developed a tribal work group 

to connect health systems change partners working with 

tribal communities. Learn more on page 46.

It is also important to take advantage of every chance 

to encourage priority populations to quit, including 

opportunities outside of healthcare settings. For example, 

Tobacco Free Florida worked with the Florida Workforce 

Development Association to ask about tobacco use 

and refer people at employment centers to the state 

quitline.160 People were facing challenges finding work 

because of their tobacco use, so the program was able to 

capitalize on their motivation to quit.160

Improving Coverage for Priority 

Populations

As of 2015, more than half of people who smoke 

reported making a quit attempt in the last year.161 But 

only one-fifth of uninsured smokers and one-third 

of smokers with private insurance or Medicaid used 

proven cessation treatments when trying to quit.161

Uninsured smokers were also less likely to receive 

advice to quit from a healthcare provider.161 Since 

using evidence-based treatment doubles the likelihood 

of quitting successfully, providing comprehensive 

cessation coverage is an important way to increase 

cessation.19 Tobacco control programs can work to 

improve coverage for priority populations by:

• Encouraging state Medicaid programs to remove 

cost barriers, which are especially challenging 

for low-income populations

• Creating health communications that educate 

people about coverage and motivate them to use 

covered treatments 

• Ensuring that messages fit the audience’s culture 

and language preferences

• Placing messages where the population will 

see them, such as billboards near community 

health centers

• Supporting use of community health workers 

and health navigators to enroll people in 

coverage and educate them about their benefits 

• Monitoring how priority populations use 

cessation coverage

Promoting Cessation Among 

Priority Populations

Partners can be helpful in promoting 

cessation to reduce disparities. Potential 

partners include: 

• Behavioral health providers

• Community and tribal health clinics 

• Community health workers 

• Dentists

• Faith-based organizations 

• Free clinics

• Federally qualified health centers

• Homeless shelters

• Lesbian, gay, bisexual, transgender, 

and queer/questioning (LGBTQ+) 

organizations

• Local public housing authorities 

• Primary care providers 

• Pharmacists

• Workforce development organizations

Cessation l 34

HOW TO
A CLOSER LOOK: Promoting Cessation in Multi-unit Housing

Each year, about 28 million people living in multi-unit housing are exposed to secondhand smoke that 

came from outside their unit.162 Because there is no safe level of secondhand smoke exposure and it can 

spread between apartments to harm nonsmoking residents, many multi-unit properties are becoming 

tobacco-free.163 Since August 2018, the U.S. Department of Housing and Urban Development has 

required most public housing authorities to be smokefree, except for mixed-finance developments and 

tribal housing.164,165 These changes mean that residents of multi-unit public housing are especially in need 

of help to quit smoking. 

State tobacco control programs can support multi-unit housing residents by:166

• Sharing culturally relevant quitting information through signs, newsletters, and resident forums

• Offering resources that are convenient for residents, such as on-site cessation education 

• Connecting property managers with nearby healthcare providers, including community health 

centers that serve low-income housing residents

• Helping property managers update leases

• Recommending a staged enforcement process that includes offering cessation assistance (e.g., 

warning for first violation plus quitting information) 

Learn more about creating tobacco-free multi-unit housing in the American Lung Association’s online 

course, Smokefree Policies in Multi-Unit Housing: Steps for Success.

Cessation l 35

HOW TO
Improving Medicaid cessation coverage is one of the 

most important steps a state can take to reduce 

cessation disparities.1

 Despite similar interest in 

quitting, Medicaid recipients are less likely to quit 

successfully than those with private health insurance.11

Tobacco control staff can educate Medicaid agencies on 

the benefits of evidence-based cessation coverage. 

Learn more about strategies to improve Medicaid 

cessation coverage on page 22. 

Print ad from “Keep Tobacco Sacred” campaign about differences between traditional and commercial 

tobacco Source: ClearWay Minnesota

Expanding Quitline Reach to Priority 

Populations

Quitline counseling is effective among priority 

populations.19 Quitlines are especially effective at 

reaching Medicaid, African American, and some 

American Indian and Alaska Native populations.167,168

State quitline use is lower among Hispanic, Asian/

Pacific Islander, and LGBT populations.168,169

Anyone with a phone can reach a quitline. Smartphone 

apps, text messaging, and web-based services have 

made quitlines even easier to reach. However, it is 

also important to consider the unique needs of each 

population the program intends to reach. For example, 

quitlines may not be as accessible 

for American Indians living on 

tribal lands, which have the lowest 

number of telephone subscribers 

in the U.S.170

Tobacco control programs can use 

the following strategies to expand 

state tobacco quitline reach to 

diverse groups: 

• Offer a free 2-week 

starter supply of cessation 

medication to uninsured and 

underinsured callers1

• Work with faith leaders, 

elders, or other trusted 

messengers to emphasize 

the importance of quitting 

and dispel myths about 

what happens when 

a smoker contacts a 

quitline171

• Use universally effective hard-hitting messages 

about the health consequences of tobacco use to 

motivate people to contact the quitline1

• Place quitline ads where the population is most 

likely to see and hear messages (e.g., newspapers 

printed in their native language)1

• Strategically promote the Spanish-language 

quitline portal (1-855-DEJELO-YA) and the 

Asian Smokers’ Quitline1

• Form partnerships with national networks 

and healthcare providers serving priority 

populations to promote the quitline171

• Monitor how priority populations use quitlines

Many quitlines use special protocols for callers from 

certain groups, such as pregnant women, people with 

behavioral health conditions, and American Indian/

Alaska Natives.171 These protocols are important to 

prepare quitline staff to help diverse callers. Cultural 

competence training can also help staff recognize 

their cultural values and biases, learn about others’ 

cultures, and prevent stereotyping.171,172 Learn more 

about communicating with diverse groupsin the Think 

Cultural Health resource, Guide to Providing Effective 

Communication and Language Assistance Services.

Cessation l 36

HOW TO
A CLOSER LOOK: Promoting Cessation in Behavioral Health Treatment

People with behavioral health conditions, 

such mental health or substance use 

disorders, make up 25% of the U.S. 

population but smoke 40% of all 

cigarettes.173 Yet many treatment centers 

do not screen patients for tobacco use. In 

2016, 49% of mental health and 64% of 

substance use treatment centers reported 

asking patients about tobacco use.174

Some providers have viewed smoking as 

a secondary concern to behavioral health 

conditions, allowing tobacco use to be 

tolerated among patients and staff.175

People with mental illness who smoke are 

as interested in quitting as other people 

who smoke, despite myths that they are 

unmotivated or unable to quit.175 Quitting 

tobacco does not interfere with behavioral 

health treatment. In fact, quitting smoking 

could reduce symptoms of depression and improve substance use recovery outcomes.176,177 Tobacco 

control programs can work with behvaioral health providers such as social workers, psychologists, and 

psychiatrists to:178

• Dispel myths about tobacco cessation among people with behavioral health disorders

• Educate providers and staff on the importance of treating patients’ tobacco use during behavioral 

health treatment 

• Develop protocols and reminder systems to help providers and staff ask patients about tobacco use

• Create partnerships with the state quitline, Nicotine Anonymous, or other groups that can serve as 

resources to patients for tobacco cessation 

• Implement tobacco-free campus policies in behavioral health treatment centers that apply to both 

patients and staff 

• Offer counseling and medication to staff who want to quit tobacco

• Reimburse providers for cessation treatment

Tobacco control programs can support these efforts with communications campaigns encouraging 

people with behavioral health disorders to quit smoking. Messages can also focus on empowering their 

family members and providers to help.171 Learn more about promoting cessation in behavioral health 

treatment in the National Association of State Mental Health Program Directors resource, Tobacco-Free 

Living in Psychiatric Settings and the Substance Abuse and Mental Health Services Administration 

toolkit, Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings. Free 

resources and materials are also available on CDC’s Tips From Former Smokers® website.

Web banner ad from 2016 “Tips From Former Smokers®” national tobacco education 

campaign Source: CDC Media Campaign Resource Center

Cessation l 37

HOW TO
Evaluating Cessation 

Interventions 

Evaluating cessation interventions is vital to show their 

impact on reducing tobacco use. Evaluation can also 

help programs:44

• Build on successful elements and change things 

that are not working

• Justify time and resources spent on cessation 

interventions

• Secure resources

• Show partners the impact of their participation

• Plan for the future

• Share lessons learned with other organizations 

that are considering cessation interventions

The information collected for evaluation will depend 

on the program’s cessation activities. For example, 

programs pursuing health systems change can collect 

patient visit data to determine how tobacco use is being 

treated. Programs can also gather data from employers 

and insurers on awareness and use of cessation coverage. 

Information about state quitline callers can help improve 

the reach and quality 

of quitline services. 

Programs can also 

track changes in quit 

attempts, cessation 

rates, and visits or 

hospitalizations 

for tobacco-related 

diseases over time. 

These longer-term 

measures are critical 

to assess the impact of 

efforts on increasing 

cessation and reducing 

tobacco use. Table 4

on page 40 includes 

examples of measures 

and data sources for 

all three cessation 

interventions. 

More information is also needed about interest in 

quitting, cessation rates, and use of evidence-based 

treatment among those who face the greatest barriers 

to quitting. For example, questions about LGBT status 

are often not included in cessation surveys.179 Data 

may also be aggregated, masking differences across 

subgroups. For example, data may reported about Asian 

people who use tobacco instead of reporting differences 

among Korean, Vietnamese, and Chinese tobacco 

users.179 Collecting cessation data on these groups can 

help determine if they are being reached by current 

efforts, understand which interventions work best to 

help them quit, and decide where to focus efforts. 

Learn more about priority populations from the 

Networking2Save national networks, which focus on 

preventing commercial tobacco use and cancer in eight 

priority populations. For more on including priority 

groups in evaluation, see the Best Practices User Guide: 

Health Equity in Tobacco Prevention and Control.

Evaluating Health Systems Change

Data are critical to plan health systems changes and 

track progress. Health systems can use data from paper 

and electronic patient charts and patient visit surveys to 

measure how healthcare staff are treating tobacco use. 

Cessation l 38

HOW TO
Tracking the same data over time can show whether 

health systems changes are increasing delivery of 

tobacco use treatment and patient cessation. It can also 

help identify treatment gaps. 

Hospital systems often already collect evaluation data for 

internal quality improvement programs. For example, 

the Joint Commission hospital measures include 

information on cessation interventions.180 Tobacco use 

screening and intervention is also listed as a Centers for 

Medicare and Medicaid Services quality measure in the 

Quality Payment Program.180 Using existing data makes 

data collection easier for health systems and lowers 

evaluation costs.182 Showing how changes can help meet 

other performance goals can also raise the profile of 

health systems change initiatives.

Cessation data can also help build staff awareness 

and increase buy-in for health systems changes. 

Performance feedback can be shared with providers 

through monthly or quarterly reports or during annual 

staff performance evaluations to help them set goals 

and assess their own performance. 

Learn more about evaluating health systems change 

in the Partnership for Prevention’s action guide on 

Healthcare Provider Reminder Systems, Provider 

Education, and Patient Education.

Learn More about Evaluation 

from CDC • Read about using data to improve 

programs in CDC’s Best Practices 

User Guide: Program Infrastructure 

in Tobacco Prevention and Control

• Learn how to measure cessation 

outcomes in CDC’s Promoting 

Quitting Among Adults and Young 

People: Outcome Indicators for 

Comprehensive Tobacco Control 

Programs—2015

• Visit CDC’s Surveillance and 

Evaluation web page to learn about 

planning tobacco control evaluations 

and sharing results

Evaluating Cessation Coverage

Evaluation can help identify coverage gaps and shows 

the impact of improving coverage on cessation, health 

outcomes, and healthcare costs. Evaluating campaigns 

to raise awareness of coverage is also important. 

Programs can use these results to design better ways to 

reach tobacco users and healthcare providers. 

Evaluating coverage is easier when states form 

partnerships with health insurers and employers. 

With help from tobacco control programs, these 

organizations may be able to provide critical 

information about how many people use tobacco, how 

many use covered cessation treatments, how many quit, 

and the resulting cost savings. Programs can work with 

health plans and employers to gather tobacco use and 

cessation data from personnel records, claims data, or 

electronic health record (EHR) data. They can also

conduct surveys about cessation coverage (learn more 

on page 9).

Programs can also work with state Medicaid agencies 

and managed care organizations (MCOs) to track 

smoking prevalence and use of cessation treatment 

among Medicaid recipients. Many of these agencies 

have cessation data, but they may not have the 

resources to analyze it.183 Programs can work with 

partners to track Medicaid enrollees’:

• Awareness of coverage184

• Knowledge of how to access coverage184

• Use of cessation coverage and services such as 

quitlines184

• Cessation rates184

• Rates of smoking-related diseases, healthcare 

usage (e.g., heart attack hospital admissions), 

and healthcare costs44

It is also important to track coverage offered through 

other insurance plans, such as short-term, limitedduration health plans. These plans are designed to 

Cessation l 39

HOW TO
fill temporary gaps in coverage that may occur when 

transitioning from one type of coverage to another, 

such as when changing jobs.185 They do not have to 

meet Affordable Care Act cessation requirements, and 

many do not cover cessation treatment. Monitoring 

what these and other plans cover can help give 

programs a fuller picture of the cessation benefits 

available to insured populations.

Table 4. Sample Measures for Evaluating Cessation Strategies 

Strategy Sample Measures Examples of Data Sources

Promoting Health 

Systems Change

• Percentage of patients asked about tobacco use

• Percentage of tobacco users who have been advised 

to quit

• Percentage of tobacco users who have been assisted in 

quitting by a healthcare professional

• Percentage of patients who were followed up with 

after visit

• Adoption of health system campus tobacco-free 

policies

• Patient quit attempts and cessation rates

• Visits and hospitalizations for tobacco-related diseases

• Healthcare Effectiveness Data 

and Information Set (HEDIS)

• Joint Commission standards

• Physician Quality Reporting 

System

• Health Resources and Services 

Administration Core Clinical 

Measures 

• Patient records (paper or 

electronic)

• Patient visit surveys

• Health system billing data

Improving Coverage • Percentage of insured population with coverage for all 

recommended evidence-based cessation treatments

• Percentage of insured population without health 

insurance-related barriers to accessing cessation 

services

• Awareness of cessation coverage among health plan 

members and providers

• Number of health plan members using cessation 

coverage

• Employee health indicators (e.g., productivity, 

absenteeism, tobacco use, tobacco-related illness) 

• Quit attempts and cessation rates among health plan 

members

• Insurance claims

• Health plan surveys

• Medicaid and MCO enrollee 

data and claims information

• Employee surveys

• Personnel records

Supporting State 

Quitlines

• Quitline call volume

• Types and quantities of services provided

• Percentage of tobacco users who have used 

mobile cessation services (e.g., text messaging or 

smartphone apps)

• Percentage of quitline users from priority populations

• How tobacco users heard about the quitline

• Satisfaction with quitline services

• Quit rate at 7-month follow-up

• Quitline intake surveys

• Follow-up surveys of quitline 

users

• National Quitline Data 

Warehouse

Evaluating State Quitlines

All state tobacco quitlines conduct some evaluation, 

which usually includes collecting information from 

quitline users during intake and conducting follow-up 

surveys with some users after they receive treatment.10

Careful staff records at intake can gather most of the 

necessary information for quitline evaluation. When 

first speaking with a caller, quitlines may collect 

Cessation l 40

HOW TO
information about the caller’s demographics, tobacco 

use, past quit attempts, and referral source. They may 

also document the quitline services provided to the 

caller. At follow-up, quitlines often ask a sample of 

callers about their success in quitting and satisfaction 

with the quitline.

Evaluating quitlines helps programs:

• Improve quitline operations10

• Track effectiveness of health communications 

campaigns and nicotine replacement therapy 

(NRT) promotions and make changes if 

necessary138

• Find potential cost-sharing partners95

• Assess effectiveness of health systems change 

referrals process95

• Show the value of quitlines to funders and 

potential partners10

• Determine whether services are reaching 

priority populations10

All state quitlines use 

the standard intake and 

follow-up measures in the 

North American Quitline 

Consortium’s Minimal 

Data Set to evaluate 

quitlines.186 State quitline 

data are also reported to 

the National Quitline Data 

Warehouse. These tools 

make it easier to compare 

performance across states 

and improve services for 

priority populations.186

Learn more at the 

Minimal Data Set web 

page and CDC’s National 

Quitline Data Warehouse

web page.

Although evaluation data are standardized across 

most quitlines, new technologies such as web services 

and smartphone apps are not consistently evaluated. 

It is important that programs measure how well these 

technologies follow cessation best practices, which 

features are most effective, and how they compare with 

telephone quitlines in terms of quit rates. Program 

staff may also need to rethink how they traditionally 

measure quitline reach to include these technologies.

Another important consideration for quitlines is the 

effect of cost-sharing partnerships on evaluation. When 

health plans and employers contract directly with 

quitline service providers, it may be harder for state 

programs to get data about quitline callers and calculate 

reach. Data use agreements can help preserve state 

access to data by requiring partners to share data about 

quitline reach with the tobacco control program.101

Some states have made agreements directly with the 

partner; others have set up foundations to manage 

these agreements.101

Cessation l 41

HOW TO
Sustaining Cessation 

Interventions

Quitting tobacco is not easy, but it is possible. Tobacco 

use and dependence is a chronic, relapsing condition 

that often requires repeated intervention.19 Most 

people who smoke make multiple quit attempts 

before succeeding, and the average person may try 

30 or more times before quitting successfully.39 Longterm support is important to help people quit using 

tobacco.19 Sustaining efforts also ensures that cessation 

interventions reach as many people as possible, 

including new tobacco users. Each day, more than 3,200 

young people try their first cigarette and another 2,100 

become daily smokers.12 By continuing to promote and 

improve cessation interventions, programs can help 

more people quit using tobacco for good.

Sustaining Health Systems Change

Health systems change is easier to sustain when all 

staff view cessation as a vital part of health care. 

State programs can keep healthcare staff involved 

by organizing regular meetings to identify potential 

problems, review progress reports, and discuss ways to 

improve delivery of tobacco use treatment.44 Programs 

can also help health systems make cessation part of 

their culture by:

• Identifying a dedicated backup champion in 

each provider office in case of staff turnover187

• Training new health system employees and 

volunteers and offering refresher sessions for 

existing staff44

• Updating training resources and materials 

to stay current with tobacco use trends, 

new tobacco products, and new cessation 

developments45

• Recommending health systems build alerts into 

EHRs that remind staff to screen all patients for 

tobacco use and offer cessation interventions to 

tobacco users at every visit43

• Working with health systems to add cessation 

treatment to staff job descriptions and include it 

in employee performance reviews44

• Sharing new cessation research, emerging 

trends, and resources regularly through email or 

newsletters138

• Encouraging health systems to implement 

tobacco-free campus policies44

Web banner fromTalk to Your Patients website Source: New York State Department of Health

Cessation l 42

HOW TO
Taking the time to recognize success is also important 

to show healthcare staff that their hard work is 

appreciated. Programs can encourage health systems 

to highlight successes in website posts, internal 

employee newsletters, patient communications, 

and the news media.44 Personal stories from staff 

champions and patients who have quit can be 

especially compelling. Hearing these success stories 

can sustain staff commitment and encourage others 

to help their patients quit.44 Involving health systems 

staff in presenting results to other staff members or 

stakeholders also strengthens their commitment to 

maintaining the changes.

The Clinical Sustainability Assessment Tool (CSAT) 

can also help sustain health systems changes. Health 

care providers, staff, and evaluators can use this free, 

online tool to rate the sustainability capacity of a 

practice or intervention (e.g., a new surgical procedure 

or protocol for treating tobacco use). Learn more at 

sustaintool.org/csat.

Other chronic diseases such as asthma, cancer, diabetes, 

and heart disease can be caused and worsened by 

smoking.13 Integrating tobacco use treatment into 

healthcare visits for these diseases can also help sustain 

momentum. For example, providers can screen for 

tobacco use and offer cessation treatment during 

cancer screenings and asthma 

and diabetes visits. Chronic 

disease programs often include 

health education, which can share 

information about the dangers 

of tobacco use and how to quit.45

Tobacco use data can also be 

included in clinical dashboards 

used for other chronic diseases.68

Competing priorities, busy 

schedules, and communications 

issues can make integration more 

challenging.66 In Oklahoma, the 

state’s health systems change 

initiative began a chronic disease 

integration workgroup aimed at 

increasing communication among 

different chronic disease partners. 

Learn more about Oklahoma’s 

health systems change efforts on 

page 46.

Maintaining Strong Cessation Coverage

Lasting relationships with insurers, employers, 

Medicaid agencies, state government, and healthcare 

providers are critical to keep tobacco cessation coverage 

strong. Dedicating staff to work with these partners 

helps ensure that messages are consistent.101 Regular 

meetings with partners sets aside time to update them 

on progress and discuss opportunities and challenges.

Economic, political, or other changes can also impact 

cessation coverage. It is important that programs respond 

to these outside influences so that cessation coverage 

stays as comprehensive and accessible as possible. 

The characteristics of the population who uses coverage 

may also change. This is especially true for Medicaid, 

where people often move in and out of the program due 

to changes in eligibility status.188 Over time, the tobacco 

use patterns, use of cessation services, demographic 

characteristics, and media preferences of Medicaid 

recipients may change. Staying aware of these changes 

can help programs work more effectively with Medicaid 

agencies and refocus health communications to better 

reach their audience.

Cessation l 43

HOW TO
Sustaining State Quitlines

Since most people try to quit using tobacco multiple 

times before succeeding, consistent tobacco quitline 

service is critical.39 Outside influences can create surges 

in calls that may challenge quitlines to offer the same 

level of service to each caller. For example, national 

media campaigns or new referral systems can increase 

calls.189 Without planning and budgeting to handle the 

increased volume, call lines can get overloaded, callers 

may have to wait longer to be connected, or the quitline 

may be forced to cut back services or temporarily 

suspend operations.190 Unexpected funding changes 

may also cause service interruptions. To develop a longterm quitline funding strategy, programs can take the 

following steps:

• Start planning for potential change during 

normal operations, instead of waiting until 

unexpected changes occur.190

• Estimate how much funding is needed to 

support ideal quitline service levels and consider 

ways to increase staff levels or adjust services 

during other times.190

• Explore cost-sharing partnerships with health 

insurers and employers or other funding sources 

such as universities or business health coalitions.1

• Dedicate funds collected from tobacco taxes to 

the state quitline.191

• Arrange for flexible funding that can be split 

between providing and 

promoting quitline services 

as demand changes.189

• Work with Medicaid 

agencies to secure federal 

matching funds for quitline 

services provided to 

Medicaid recipients.1

In 2011, the Centers for Medicare 

and Medicaid Services announced 

that the federal government 

would cover 50% of the cost for 

quitline counseling to Medicaid 

recipients.113 To get this funding, 

tobacco control programs have 

to work with the state Medicaid 

agency to set up a process to bill 

Medicaid for quitline services.114 Although securing 

Medicaid matching funds can be a time-consuming 

process, it can also help strengthen vital relationships 

with Medicaid agencies.192 These partnerships are an 

important foundation for improving Medicaid cessation 

coverage and promoting coverage to enrollees.

Cost-sharing partners also play a vital role in sustaining 

quitlines. Strong relationships with these partners are 

important to ensure they stay invested in supporting 

the quitline. Regular communication can build trust 

and program credibility. Staff can be available by phone, 

email, or in person to answer any questions and hold 

conference calls or webinars to highlight the impact 

of the partnership. Programs can also share data on 

quitline services, such as how many people have called, 

how many tried to quit, and how much money was 

saved.63 Sharing this information publicly can also lead 

to new partnerships. 

Supporting a Comprehensive Approach 

to Tobacco Control

Other population-wide interventions like smokefree 

laws, tobacco product price increases, and health 

communications campaigns can motivate people to quit 

using tobacco and increase cessation.7-9 Encouraging 

partners to support a comprehensive approach to 

tobacco control can maximize the impact of cessation 

efforts and strengthen partners’ commitment to help 

people quit.

Cessation l 44

HOW TO
PROVIDING SUPPORT

How Can Tobacco Control Programs Support 

Cessation Interventions?

Tobacco cessation interventions require the coordinated efforts of many partners. Programs can help support 

cessation interventions by taking the following actions:

Administrative Support

8 Gather information about the quality of cessation treatment and coverage in the state from the largest health 

systems, employers, and health plans

Build support for cessation interventions among state health department leadership, who can help 

communicate with leaders at partner organizations

Ensure staff and funding are in place to promote health system change, improve cessation coverage, and support 

state quitlines

Evaluate cessation interventions and share results with partners

Coordination & Collaboration

8 Lead by example, forming partnerships with the state Medicaid agency and the state employee benefits program

Engage diverse healthcare partners, such as health system leadership, primary care providers, specialists, nurses, 

dentists, pediatricians, and pharmacists, making the case for the importance of cessation for their patients

Reach out to health insurers and employers about the benefits of improving and promoting cessation coverage 

and supporting the state quitline

Take part in state and national partnership initiatives to bring new partners to the table, such as CDC’s 6|18 

Initiative

Implement health communications campaigns to promote cessation help available through providers, cessation 

coverage, and quitlines 

Training & Technical Assistance

8 Train healthcare providers and staff on best practices for delivering tobacco use treatment, including initial 

trainings for new staff and refresher courses for staff already trained once

Offer hands-on technical assistance to health systems, such as helping providers develop office protocols for 

treating tobacco use 

Incorporate cultural competence and treating tobacco use among diverse populations into trainings for quitline 

counselors and healthcare providers

Cessation l 45
CASE STUDIES

Oklahoma Case Study

Hospital initiative refers 26,000 to state quitline

Oklahoma identifies health care as an ideal setting to 

reach people who use tobacco

In 2009, Oklahoma’s smoking prevalence was one of the 

highest in the United States (25.5%).193 Knowing that 

Oklahoma hospitals admitted about 120,000 people 

who use tobacco each year, the Oklahoma tobacco 

control program saw an opportunity to reach more 

tobacco users by forming partnerships with health 

systems.194 In 2010, the state program collaborated 

with the Oklahoma Tobacco Settlement Endowment 

Trust (TSET) and the Oklahoma Hospital Association 

(OHA) to form the Hospitals Helping Patients Quit 

initiative. TSET funds the initiative as part of its Health 

Systems Initiative grant, which also promotes health 

systems change among Medicaid providers and statefunded mental health and substance use treatment 

centers. OHA serves as the initiative’s main contact with 

hospitals and works closely with them to make systems 

changes. To date, the initiative has worked with more 

than 50 hospitals throughout the state to systematically 

treat tobacco use. For example, the initiative has helped 

hospitals and clinics to:

• Screen every patient for tobacco use

• Integrate tobacco use treatment into clinical 

protocols

• Adopt and use electronic health records 

(EHRs) to treat tobacco use and refer patients 

to counseling 

• Help health systems implement tobacco-free 

campuses 

Logo for the Hospitals Helping Patients Quit program

Tobacco control program creates statewide 

infrastructure to support health systems change

The tobacco control program knew it could best 

support the work of Hospitals Helping Patients Quit 

by developing a strong cessation infrastructure at the 

state level. They created a statewide cessation leadership 

team to oversee efforts, such as coordinating available 

cessation benefits and aligning cessation messaging. 

The leadership team includes the tobacco control

program, TSET, and the Oklahoma Tobacco Research 

Center, a state quitline partner. The program also 

created a health systems change workgroup to bring 

all organizations working on health systems change 

to the same table, including those working in chronic 

disease. The workgroup has increased communication 

between groups, improved coordination, and prevented 

duplication of services. A separate workgroup for 

partners working with tribal nations shares resources 

and best practices.

The tobacco control program also holds monthly 

technical assistance meetings for OHA and health system 

partners. Tobacco control staff review work plans and 

strategies, discuss successes and challenges, and help the 

hospitals and clinics plan future activities. The initiative’s 

evaluator, Oklahoma University Health Sciences Center, 

also attends these meetings to help programs as they 

collect data and track outcomes. 

Oklahoma Hospital Association recruits hospital partners

The tobacco control program partnered with the 

Oklahoma Hospital Association to recruit hospitals to 

take part in the initiative. OHA had existing relationships 

with more than 135 hospitals across the state, built on 

nearly 100 years of strong support. OHA was able to 

leverage the trust it had built with hospitals to encourage 

them to join the initiative. Hospitals represented on its 

board were among the first to make systems changes. 

Eric Finley, OHA Health Improvement Coordinator, 

Cessation l 46
says, “When you do health systems change, trust is 

absolutely paramount. When you have that, it knocks 

down a lot of barriers and a lot of walls.”

OHA took every opportunity to start conversations with 

hospitals about promoting cessation. When programs 

reached out to OHA with other requests, such as help 

meeting clinical performance measures, OHA suggested 

they make health systems changes to reduce tobacco 

use too. Promoting successes also helped OHA recruit 

hospitals. They presented early results at state and 

national conferences, involving hospital representatives 

in presentations when possible. The presentations 

showed potential partners that their peer hospitals were 

making changes to promote cessation, that the model 

works, and that OHA is an experienced partner who 

can help them succeed. Highlighting past successes also 

helped ease concerns voiced by some partners about 

time commitment and workload. 

Oklahoma tailors strategies to needs of diverse 

health systems 

Oklahoma’s hospital partners each had different levels 

of readiness and priorities for health systems change. 

Finley says, “When you’ve worked with one healthcare 

system, you’ve worked with only one healthcare 

system.” To meet the needs of each hospital, Oklahoma 

began with a recommended approach and then tailored 

strategies as needed. This also helped prevent hospitals 

from having to start over from scratch after making 

partial changes. For smaller clinics and health centers 

unable to adopt all of the recommended changes right 

away, OHA staff helped create a timeline and make 

changes in stages. OHA also encouraged hospitals to 

pursue their own health systems change ideas. 

Customizing health systems change was especially 

important to Oklahoma’s work with tribal health 

systems. Oklahoma also focused on practicing cultural 

sensitivity and finding key champions. For example, the 

tobacco control program collaborated with the Office 

of the Tribal Liaison, which has helped the department 

understand tribal hierarchy and find the best people to 

engage. Their efforts paid off—health systems change 

partner Chickasaw Nation Medical Center was the first 

tribal hospital in the U.S. to implement bi-directional 

quitline referral, enabling providers to refer patients to 

the quitline and receive information back to follow up 

with patients. 

“ When you do health systems 

change, trust is absolutely 

paramount. When you have that, 

it knocks down a lot of barriers 

and a lot of walls. ”

— Eric Finley

Oklahoma plans to expand health systems changes to 

new partners

The Hospitals Helping Patients Quit initiative has helped 

over 50 Oklahoma hospitals and clinics refer more than 

26,000 patients to the state quitline. It is estimated to 

have saved millions of dollars in healthcare costs.195

Finley credits Oklahoma’s success to building trust with 

health systems and considering their individual needs 

and resources for systems change. He recommends that 

other states look for a partner that has credibility with 

healthcare partners and take the time to understand each 

health system’s strengths and weaknesses.

Looking ahead, OHA is developing a quality 

improvement tool to help hospitals sustain health 

systems changes. The tobacco control program is 

also focused on increasing health systems change 

coordination within the state health department. For 

example, the program is also partnering with the state 

chronic disease division and hopes to incorporate 

tobacco use questions into cancer screenings. 

Oklahoma also plans to expand Hospitals Helping 

Patients Quit to rural health systems. Because rural 

providers often lack staff and information technology 

resources for systems change, the tobacco control 

program has collaborated with a health information 

technology (IT) contractor to help smaller health 

systems build tobacco use treatment into EHRs. Former 

Oklahoma Tobacco Use Prevention Manager Christin 

Kirchenbauer says, “We realize that smaller health 

systems may not have the resources or capacity to make 

these large-level changes, but we want to make sure we 

are serving all of Oklahoma.”

Cessation l 47

CASE STUDIES
Rhode Island Case Study

Rhode Island increases access to cessation treatment through diverse partnerships

State law requires health plans to cover cessation

In 2009, Rhode 

Island began 

requiring by 

law that private 

health plans 

cover cessation 

counseling 

and all FDAapproved cessation 

medications. Plans 

also had to include 

clinical practice 

guidelines in the definition of cessation treatment 

and report to the Department of Health on cessation 

coverage every year.196 It also opened an opportunity 

for the Rhode Island tobacco control program to 

form partnerships with the state Medicaid program, 

the state’s major health plans, and the state Employee 

Benefit Office to close gaps in cessation services. To 

further strengthen these partnerships, Rhode Island’s 

tobacco control program joined the CDC’s 6|18 

Initiative and the Centers for Medicare and Medicaid 

Services’ State Innovation Models (SIM) Initiative.

Rhode Island forms partnerships to improve 

cessation coverage

The tobacco control program began work to improve 

cessation insurance coverage by focusing on coverage 

for state employees. The program formed a partnership 

with the state employee benefits office to promote the 

quitline and the availability of employee cessation 

coverage. The program also formed the Rhode Island 

Tobacco Cessation Council, bringing together health 

plan representatives, community stakeholders, and 

healthcare professionals to focus on cessation issues. 

The program also developed a cessation coverage 

survey to learn more about coverage offered by the 

state’s largest health plans and help them meet the new 

state regulations. View the survey on the Department’s 

web page.

Having a broad group of partners helped the program 

make sense of the complicated data collected from the 

survey. With input from the partners, the program 

used the data to create tables of the cessation coverage 

offered by major private plans, traditional fee-forservice Medicaid plans, and Medicaid managed care 

plans. The tables also describe barriers to accessing 

coverage, such as deductibles, limits on length of 

treatment, and copays. The tobacco control program 

made the information publicly available online 

and in print (links to the tables are available on the 

Department’s web page). They also shared it with 

community health organizations, providers, and 

federally qualified health centers. 

Rhode Island adopts a State Innovation Model and joins 

CDC’s 6|18 Initiative to expand partnerships 

Although the program’s early work with the Council 

created momentum for cessation, Rhode Island wanted 

to do more. Tobacco Cessation Manager Dana McCants 

Derisier said, “We were at our limit on where we were 

taking cessation. There are so many opportunities that 

we have when we really look for them.” In 2015, Rhode 

Island received a SIM test grant from the Centers for 

Medicare and Medicaid Services to improve the way 

health care is delivered and paid for. SIM partners 

included state agency leaders, insurers, community 

agency staff, and representatives from health systems. 

The partners identified cessation as a priority 

intervention and helped the tobacco control program 

connect with stakeholders, take part in statewide 

meetings, and coordinate cessation services statewide. 

The tobacco control program also successfully applied to 

become part of CDC’s 6|18 Initiative. The Initiative 

works with healthcare insurers and providers to 

collaboratively implement evidence-based interventions 

for common, costly health conditions, including tobacco 

use. The 6|18 Initiative helped the program turn 

occasional contacts into active partnerships to help 

reduce tobacco-related disparities. For example, before 

joining 6|18, the program had only a loose relationship 

Cessation l 48

CASE STUDIES
with state Medicaid staff, meeting with them yearly to 

discuss immediate needs. The Initiative brought the state 

tobacco control program and the state Medicaid program 

together to develop a joint action plan to improve access 

to cessation treatments among state Medicaid enrollees. 

Joint participation in this effort fostered a much closer 

relationship between the two agencies.

The Rhode Island tobacco control program meets regularly with state and national partners to identify common 

interests, plan strategies, and stay updated on trends 

These stronger partnerships taught Rhode Island the 

importance of broadening its network of partners 

and reaching out to people and organizations with 

common goals. McCants Derisier recommends other 

state programs look for partners that are doing similar 

work: “On a statewide level, align with what is already 

being done so you don’t have to reinvent the wheel.” She 

added that national partnerships like 6|18 “took us to 

another level,” helping Rhode Island get a sense of what 

is happening around the nation. State-level groups that 

support tobacco control have also played an important 

advisory role, providing input from concerned citizens, 

youth, and public health colleagues. Rhode Island’s 

program meets regularly with members of the Tobacco 

Free Rhode Island network to stay updated on trends 

and innovative projects. 

Program plans to expand 

partnerships to support state 

quitlines and promote health 

systems change

According to McCants 

Derisier, strong partnerships 

are critical to sustain and 

grow cessation interventions. 

As health care continues to 

evolve, Rhode Island’s tobacco 

control program is focused 

on maintaining strong 

relationships with partners. 

Using information from the 

coverage tables, the program 

plans to work with partners 

to create an infographic to 

promote available cessation coverage to the public. 

The program is also working with the state Medicaid 

program to collect data on why Medicaid cessation 

services are underused. They hope to use the data to 

identify trends and ways to improve use of evidencebased cessation treatments. 

Rhode Island also plans to work with partners to increase 

the use of electronic health records (EHRs) in cessation 

treatment. The program plans to develop an e-referral 

system between the state quitline and health systems.

“There are so many opportunities 

that we have when we really look 

for them. ” 

 — Dana McCants Derisier

Cessation l 49

CASE STUDIES
CASE FOR INVESTMENT

Why Invest in Cessation Interventions?

Cessation interventions make it easier for people to get the help they need to quit using tobacco. They are the 

fastest way to reduce the disease, disability, and death caused by tobacco use.1

 They also maximize the impact of 

other tobacco control strategies and promote national healthcare goals to improve quality and reduce cost. Tobacco 

control programs and partners can use the information in this section to educate decision makers and other leaders 

about why promoting health systems change, improving cessation coverage, and supporting state quitlines are 

essential strategies of a comprehensive tobacco control program.

History and Adoption

By the 1980s, the public health and medical community 

had recognized smoking as an addiction driven by 

nicotine and had begun to develop effective cessation 

treatments.24 Telephone cessation services also began 

to grow rapidly. California launched the first publicly 

funded state telephone quitline in 1992, and by 2006, 

all 50 states, the District of Columbia, and Puerto Rico 

offered quitlines.12,30

As effective cessation treatments became more widely 

available, there was also growing recognition of the 

need for healthcare providers to treat tobacco use.31

The 2008 U.S. Public Health Service clinical practice 

guideline concluded that tobacco dependence is a 

chronic disease that often takes repeated intervention.19 

It was also one of the first guidelines to recommend 

that insurers cover cessation and that health systems 

identify and treat every patient who uses tobacco.19

Today, the healthcare system is undergoing a 

transformation to improve quality of care and reduce 

costs. Federal healthcare reforms have increased the 

use of electronic health records (EHRs) and improved 

insurance coverage for cessation.34,35

The internet, email, chat, text messaging, and mobile 

apps have also created more ways to reach tobacco 

users with cessation interventions.37 Since 2012, CDC 

has aired Tips From Former Smokers®, the first federally 

funded national tobacco education campaign, and 

provided supplemental funding to quitlines to meet 

the resulting increased demand for cessation services. 

Designed to motivate people who smoke to quit and 

direct them to cessation assistance, the campaign has 

resulted in over nine million quit attempts and over a 

half million successful quits in just three years.38

Scientific Evidence

Promoting health systems change, improving cessation 

coverage, and supporting state quitlines are proven 

strategies to help people who smoke quit. Even brief 

cessation interventions by healthcare providers (less than 

three minutes) can increase quit rates.19 They can also 

increase the likelihood that people not yet ready to quit 

smoking will try in the future.19 Systems changes, such as 

integrating cessation reminders into EHRs, make it more 

likely that providers will treat tobacco use.19

Comprehensive cessation coverage increases the 

number of people who try to quit smoking, use 

evidence-based treatment, and quit successfully.1,19,46

It can also support health systems change by making 

it easier for patients to access treatment.1

 Improving 

coverage, especially for Medicaid enrollees, can also 

increase cessation and reduce tobacco use among those 

who face the greatest barriers to quitting.1

State quitlines are highly effective and widely 

accessible.1,19 Using quitlines increases the chance of 

quitting successfully.19 Combining quitline counseling 

with medication is more effective than using either 

alone.19 With adequate and sustained resources, state 

quitlines also have the potential to reach large numbers 

of tobacco users.1 They are especially important to 

reach those who might face challenges getting help in 

other ways, such as people without health insurance or 

with inadequate coverage.

Cessation l 50
Cost 

Tobacco use is the leading cause of preventable death 

and disease in the United States.12 Smoking-related 

illness in the U.S. costs approximately $300 billion 

a year, including nearly $170 billion in medical 

care for adults and more than $156 billion in lost 

productivity.163,197 Quitting smoking lowers healthcare 

costs. If just 1 in 10 people who smoke cigarettes quit, 

healthcare spending would drop by $63 billion the 

following year.198

Helping people quit using tobacco is a smart investment 

for employers and states. Cessation coverage costs 

employers very little—less than $0.10 per member 

per month.100 In fact, covering cessation treatment 

saves employers money by lowering healthcare 

costs, improving productivity, and reducing missed 

work days.19,20 The savings can add up quickly; lower 

healthcare costs alone can save employers money in less 

than two years.20

Massachusetts’s experience shows how investing 

in cessation can improve health and reduce costs. 

In 2006, Massachusetts began providing evidencebased cessation coverage with reduced barriers for 

all adult Medicaid enrollees. For every dollar spent 

on program costs, the state saved $3.12 in medical 

expenses.49 Within the first two years, hospitalizations 

for heart attacks and other heart disease diagnoses also 

decreased by nearly half among Medicaid smokers who 

used the benefit.48

Sustainability

Investing in cessation can have a lasting effect on public 

health. Population-wide cessation interventions are 

able to reach many people to make the greatest impact 

on health.1 They also address many other critical 

community health needs, such as substance use, mental 

health, pregnancy and child health, and cancer.13

Cessation interventions create a strong infrastructure 

of trained staff, dedicated resources, and lasting health 

systems changes to support quitting. As programs 

pursue cessation interventions, they form partnerships 

with health care, insurance, and business that bring 

new perspectives and resources to tobacco control 

efforts. These partnerships raise awareness about 

the importance of tobacco control efforts and create 

champions that can carry out tobacco control work for 

years to come.

Cessation interventions also help pave the way for 

smooth implementation of population-wide strategies 

such as comprehensive smokefree laws and tobacco 

product price increases.1 By maximizing the impact of 

tobacco control programs, cessation interventions help 

make the case for continuing tobacco control efforts.

Cessation l 51

CASE FOR INVESTMENT
RESOURCES

Tobacco Prevention 

and Control

About Electronic Cigarettes (E-Cigarettes)

Publisher: Centers for Disease Control and Prevention

Summary: Information on e-cigarette components, health 

risks, and potential use as a quit smoking aid 

http://bit.ly/cdc_aboutecigarettes

Best Practices for Comprehensive Tobacco Control 

Programs—2014

Publisher: Centers for Disease Control and Prevention

Summary: Strategies and funding recommendations to 

plan and implement state tobacco control programs 

http://bit.ly/bp_2014

Best Practices User Guide: Health Communications 

in Tobacco Prevention and Control (2018)

Publisher: Centers for Disease Control and Prevention

Summary: Steps that state tobacco control staff 

and partners can take to develop effective health 

communications

http://bit.ly/cdc_communications

Best Practices User Guide: Program Infrastructure 

in Tobacco Prevention and Control (2017)

Publisher: Centers for Disease Control and Prevention

Summary: Steps that state tobacco control staff and 

partners can take to build strong program infrastructure

http://bit.ly/cdc_programinfrastructure

Best Practices User Guide: Youth Engagement in 

Tobacco Prevention and Control (2019)

Publisher: Centers for Disease Control and Prevention

Summary: Steps that state tobacco control staff and 

partners can take to create meaningful opportunities for 

youth to contribute to tobacco control efforts

http://bit.ly/cdc_youthengagement

Behavioral Risk Factor Surveillance System (BRFSS)

Publisher: Centers for Disease Control and Prevention

Summary: Tobacco use prevalence and other health 

data collected from the BRFSS annual nationwide 

telephone survey 

https://www.cdc.gov/brfss

Electronic Cigarettes – What’s the Bottom Line? 

Publisher: Centers for Disease Control and Prevention 

Summary: Graphic summary on the health effects of 

e-cigarettes 

http://bit.ly/cdc_bottomline

E-cigarettes Shaped Like USB Flash Drives: 

Information for Parents, Educators, and Health 

Care Providers

Publisher: Centers for Disease Control and Prevention 

Summary: Graphic summary on the history and health 

effects of USB-shaped e-cigarettes

http://bit.ly/cdc_ecigarettesUSB

Electronic Nicotine Delivery Systems (2019)

Publisher: American Academy of Pediatrics

Summary: Facts about e-cigarettes and links to resources 

for healthcare providers

http://bit.ly/aap_ends

The Facts on E-cigarette Use Among Youth and 

Young Adults (2019)

Publisher: U.S. Surgeon General

Summary: Findings from the 2016 U.S. Surgeon General 

Report on e-cigarette use among youth and young adults

https://e-cigarettes.surgeongeneral.gov

The Health Consequences of Smoking—50 Years of 

Progress: A Report of the Surgeon General (2014)

Publisher: U.S. Department of Health and Human Services

Summary: Overview of the progress made to reduce 

tobacco use over the last 50 years and the continued 

burden of tobacco-related death and disease

http://bit.ly/sgr_2014

Cessation l 52
National Survey on Drug Use and Health

Publisher: Substance Abuse and Mental Health Services 

Administration

Summary: Health data on tobacco, alcohol, and drug use, 

mental health topics

http://bit.ly/nsduh

Program Sustainability Assessment Tool (2012)

Publisher: Center for Public Health Systems Science

Summary: Tool to assess programs’ sustainability and 

create a sustainability action plan

https://sustaintool.org

Public Health Consequences of E-cigarettes (2018)

Publisher: The National Academies of Sciences, 

Engineering, and Medicine 

Summary: Comprehensive report examining the 

use of e-cigarettes, their health consequences, and 

recommendations for future research

http://bit.ly/nasem_ecigarettes

Surveillance and Evaluation Resources (2018)

Publisher: Centers for Disease Control and Prevention

Summary: Resources to plan, carry out, and communicate 

findings from tobacco control evaluations

http://bit.ly/cdc_surveillanceandeval

The Three Buckets of Prevention (2016)

Publisher: Journal of Public Health Management and 

Practice

Author: Auerbach J

Summary: Overview of the CDC’s Three Buckets of 

Prevention population health and prevention framework

http://bit.ly/cdc_3buckets

Cessation

Ask-Advise-Connect

Publisher: JAMA Network

Authors: Vidrine J, Shete S, Cao Y, et al. 

Summary: Evaluation of the Ask-Advise-Connect model 

for brief tobacco use treatment

http://bit.ly/vidrine_AAC

The Brief Tobacco Intervention

Publisher: Centers for Disease Control and Prevention

Summary: Pocket guide for healthcare providers 

describing two tobacco use treatment models: the 5As 

and Ask-Advise-Refer

http://bit.ly/cdc_briefintervention

Cessation Materials for State Tobacco Control 

Programs (2018)

Publisher: Centers for Disease Control and Prevention

Summary: A comprehensive list of resources to promote 

health systems change, improve cessation coverage, and 

support state quitlines

http://bit.ly/cdc_statematerials

Promoting Quitting Among Adults and Young 

People: Outcome Indicators for Comprehensive 

Tobacco Control Programs—2015

Publisher: Centers for Disease Control and Prevention

Summary: Outcome indicators for tobacco control 

programs to plan and evaluate cessation interventions 

http://bit.ly/cdc_outcomes

Quitting Smoking Among Adults—United States, 

2000–2015 (2017)

Publisher: Morbidity and Mortality Weekly Report

Authors: Babb S, Malarcher A, Schauer G, Asman K, 

Jamal A

Summary: National data on smokers’ interest in quitting, 

receipt of advice from a health professional, use of 

evidence-based treatments, and cessation

http://bit.ly/babb_quitting

Cessation l 53

RESOURCES
Return on Investment for Tobacco Cessation (2016)

Publisher: ClearWay Minnesota

Summary: Fact sheet on the cost-effectiveness of 

cessation treatment for health systems, employers, 

insurers, and states

http://bit.ly/clearway_ROI

Smokefree.gov

Publisher: U.S. Department of Health and Human Services

Summary: Tools and resources for people trying to quit 

smoking or stay tobacco free, with links for veterans, 

women, teens, senior citizens, and Spanish-speakers

https://smokefree.gov/

Smoking Cessation: A Report of the Surgeon 

General (2020)

Publisher: U.S. Department of Health and Human 

Services

Summary: The importance of tobacco cessation and the 

Surgeon General’s recommendations for cessation 

services

http://bit.ly/SGR_Cessation

Tips From Former Smokers® (2018)

Publisher: Centers for Disease Control and Prevention

Summary: Stories and materials from Tips From Former 

Smokers®, the first national tobacco education campaign

https://www.cdc.gov/tobacco/campaign/tips

Tobacco-Free Living in Psychiatric Settings: A 

Best-Practices Toolkit Promoting Wellness and 

Recovery (2010)

Publisher: National Association of State Mental Health 

Program Directors

Summary: Step-by-step guidance to create smokefree 

mental health treatment centers

http://bit.ly/samhsa_tobaccofreeliving

Tobacco Smoking Cessation in Adults, 

Including Pregnant Women: Behavioral and 

Pharmacotherapy Interventions (2015)

Publisher: U.S. Preventive Services Task Force

Summary: Updated recommendations on clinical 

interventions to treat tobacco use

http://bit.ly/uspstf_cessation

Treating Tobacco Use and Dependence Clinical 

Practice Guideline: 2008 Update

Publisher: Agency for Healthcare Research and Quality

Summary: 2008 update to the Clinical Practice Guideline 

on treating tobacco use

http://bit.ly/ahrq_guideline

Promoting Health 

Systems Change

Academic Detailing: Frequently Asked Questions 

(2014)

Publisher: Centers for Disease Control and Prevention

Summary: Answers to common questions about using 

academic detailing to train health care staff to treat 

tobacco use

http://bit.ly/cdc_academicdetailing

Access to Tobacco Cessation Medication through 

Pharmacists (2017)

Publisher: Tobacco Control Network

Summary: State approaches to engage pharmacists in 

promoting cessation 

http://bit.ly/tcn_pharmacists

Billing Guide for Tobacco Screening and Cessation 

(2018)

Publisher: American Lung Association

Summary: An overview of cessation coverage and how to 

bill for cessation treatment

http://bit.ly/ala_billing

Cessation l 54

RESOURCES
Clinical Sustainability Assessment Tool (2019)

Publisher: Center for Public Health Systems Science

Summary: Free online tool to assess the sustainability 

capacity of clinical practices, such as integrating 

tobacco use treatment into routine care

https://sustaintool.org/csat

Clinical Tobacco Cessation Resources (2019)

Publisher: American Academy of Pediatrics

Summary: Resources for healthcare providers to talk to 

patients about tobacco use, understand cessation billing 

and coding, and find training opportunities

http://bit.ly/aap_clinicalcessation

Electronic Health Records (EHR) & Tobacco

Publisher: University of Wisconsin Center for Tobacco 

Research & Intervention

Summary: Information and links to more resources about 

integrating tobacco use treatment into EHR systems 

http://bit.ly/uw_ehr

Facilitators of Health Systems Change for Tobacco 

Dependence Treatment: A Qualitative Study of 

Stakeholders’ Perceptions (2014)

Publisher: ClearWay Minnesota

Authors: Jansen A, Capesius T, Lachter R, Greenseid L, 

Keller P

Summary: Results of ClearWay Minnesota’s efforts to 

promote cessation in four health systems

http://bit.ly/clearway_facilitators

Foundations and Strategies of Tobacco Control

Publisher: Colorado State Tobacco Education & 

Prevention Partnership

Summary: Free online training on a variety of tobacco 

control topics, including promoting health systems 

change

https://www.tobaccocontrolco.org

A Guide to Facilitating Health Systems Change

Publisher: Centers for Disease Control and Prevention

Summary: Guidance for states on promoting health systems 

changes to prevent and manage heart disease and stroke

http://bit.ly/cdc_guidetoHSC

Health IT Playbook (2018)

Publisher: HealthIT.gov

Summary: Information on how to select and implement 

EHRs

http://bit.ly/healthit_playbook

Healthcare Provider Reminder Systems, Provider 

Education, and Patient Education: Working with 

Healthcare Delivery Systems to Improve the Delivery 

of Tobacco-Use Treatments to Patients (2009)

Publisher: Partnership for Prevention

Summary: Step-by-step instructions, checklists, and tools 

to promote health systems change

http://bit.ly/pfp_hsc

HEDIS & Performance Measurement (2018)

Publisher: National Committee for Quality Assurance

Summary: Measures, data, and reports from the Healthcare 

Effectiveness Data and Information Set (HEDIS)

http://www.ncqa.org/hedis-quality-measurement

Help Your Patients Quit Tobacco Use: An 

Implementation Guide for Community Health 

Centers (2013)

Publisher: Legacy and Partnership for Prevention

Summary: Steps to integrate tobacco use treatment into 

community health centers

http://bit.ly/legacy_implementationguide

How to Make the Case for Tobacco (2017)

Publisher: American Lung Association

Summary: Talking points on the link between reducing 

tobacco use and addressing other important 

community health needs

http://bit.ly/ala_makethecase

Cessation l 55

RESOURCES
Hospital Community Benefits and Tobacco 

Cessation: A Toolkit

Publisher: American Lung Association

Summary: Information on how to use hospital Community 

Health Needs Assessments to promote cessation

http://bit.ly/ala_benefitstoolkit

Integrating Tobacco Cessation into Electronic 

Health Records (2015)

Publisher: American Academy of Family Physicians

Summary: Sample tobacco use template for EHRs

http://bit.ly/aafp_cessationehr

The Joint Commission (2019)

Publisher: The Joint Commission

Summary: Standards and reports from The Joint 

Commission accrediting body for hospitals and 

healthcare organizations

https://www.jointcommission.org

Model for Improvement (2019)

Publisher: Institute for Healthcare Improvement

Summary: Overview of the Model for Improvement and 

Plan-Do-Study-Act cycle for testing small changes

http://bit.ly/ihi_modelforimprovement

More Than the 5 A’s: Implementing a Commercial 

Tobacco Cessation Intervention in Tribal 

Communities (2014)

Publisher: Red Star Innovations

Summary: Step-by-step plan to integrate the 5As model 

of tobacco use treatment into tribal health promotion 

programs

http://bit.ly/redstar_tribalcessation

Primary Care Associations (2018)

Publisher: Health Resources & Services Administration

Health Center Program

Summary: Map with links to Primary Care Association 

websites for all 50 states and Puerto Rico

http://bit.ly/hrsa_primarycare

Providers Overview

Publisher: University of Wisconsin Center for Tobacco 

Research and Intervention

Summary: Educational materials for healthcare providers 

on tobacco use treatment guidelines, EHRs, billing 

codes, and other cessation topics

http://bit.ly/uw_providers

Q&A with Harvard Vanguard Medical Associates 

and Atrius Health about Health Systems Change to 

Address Smoking

Publisher: Centers for Disease Control and Prevention

Summary: Activities and results from a health systems 

change initiative in Massachusetts 

http://bit.ly/cdc_smokinghsc

Quality Improvement Organizations Directories

Publisher: QualityNet

Summary: List of regional Quality Improvement 

Organizations 

http://bit.ly/cmms_QIO

Quality Payment Program

Publisher: Centers for Medicare & Medicaid Services

Summary: Overview of the Quality Payment Program 

which reimburses providers for services to Medicare 

patients, including tobacco use treatment 

https://qpp.cms.gov/about/qpp-overview 

Rx for Change (2019)

Publisher: University of California, San Francisco

Summary: Free online training for healthcare providers 

on treating tobacco use

http://rxforchange.ucsf.edu

Tobacco Cessation Change Package: A Million 

Hearts® Action Guide

Publisher: U.S. Department of Health and Human Services

Summary: Strategies and resources for healthcare 

professionals to integrate tobacco treatment into 

clinical care

http://bit.ly/millionhearts_changepackage

Cessation l 56

RESOURCES
Tobacco Health Systems Change Starter Toolkit 

for Clinics (2018)

Publisher: ClearWay Minnesota

Summary: Tips and tools to make health systems changes

http://bit.ly/clearway_hsctoolkit

Tobacco Treatment Training (2019)

Publisher: University of Wisconsin Center for Tobacco 

Research and Intervention

Summary: Free online training for healthcare providers on 

treating tobacco use, including comprehensive training 

for mental health and substance use providers

http://bit.ly/uw_training

Treating Tobacco Dependence Practice Manual: A 

Systems Change Approach (2017)

Publisher: American Academy of Family Physicians

Summary: Tips and templates for healthcare providers who 

want to make tobacco health systems changes

http://bit.ly/aafp_practicemanual

Using Health Systems Change to Increase Tobacco 

Cessation: What Can State Tobacco Control 

Programs Do? Frequently Asked Questions (FAQ)

Publisher: Centers for Disease Control and Prevention

Summary: Answers to common questions about how tobacco 

control programs can support health systems change

http://bit.ly/cdc_hscfaq

Smoking Cessation Leadership Center Webinars

Publisher: University of California, San Francisco 

Smoking Cessation Leadership Center

Summary: Webinars proving training and technical 

assistance to enhance cessation efforts in health systems, 

many of which offer free continuing education credits

http://bit.ly/sclc_webinars

Improving Coverage

Affordable Care Act Tobacco Cessation Guidance 

Toolkit (2017)

Publisher: American Lung Association

Summary: Fact sheets, templates, and webinar materials to 

understand federal requirements for cessation coverage

http://bit.ly/ala_acatoolkit

Approaches to Promoting Tobacco Cessation 

Coverage: Promising Practices and Lessons Learned

Publisher: American Lung Association

Summary: Strategies used by five states to promote 

Medicaid cessation coverage

http://bit.ly/ala_promotingcoverage

Case Study: The Effect of Expanding Cessation 

Coverage—The Massachusetts Medicaid 

Cessation Benefit

Publisher: Centers for Disease Control and Prevention

Summary: Case study of how expanding Massachusetts’s 

Medicaid cessation benefit improved health and saved 

money

http://bit.ly/cdc_MAcasestudy

Helping Smokers Quit: Tobacco Cessation 

Coverage 2014

Publisher: American Lung Association

Summary: State trends in comprehensive cessation 

coverage

http://bit.ly/ala_cessation

Medicaid Managed Care and Comprehensive 

Cessation Coverage: A Recommended Approach for 

State Tobacco Control Programs? (2014)

Publisher: North American Quitline Consortium

Summary: Brief of a roundtable on challenges and lessons 

learned working to improve cessation coverage with 

Medicaid Managed Care Organizations

http://bit.ly/naqc_comprehensivecoverage

Cessation l 57

RESOURCES
Medicaid Tobacco Cessation Coverage in 

Oklahoma: A Case Study in Leveraging Systems 

and Partnerships

Publisher: American Lung Association

Summary: Challenges and lessons learned improving 

cessation coverage in the Oklahoma Medicaid program

http://bit.ly/cdc_medicaidOK

A Resource Center for Implementing CDC’s 6|18 

Initiative (2018)

Publisher: Center for Health Care Strategies, Inc.

Summary: Overview of CDC’s 6|18 Initiative, state 

activities, and implementation tools

http://www.618resources.chcs.org

The Return on Investment of a Medicaid Tobacco 

Cessation Program in Massachusetts (2012)

Publisher: PLOS ONE

Authors: Richard P, West K, Ku L

Summary: The cost savings of comprehensive Medicaid 

cessation coverage in Massachusetts

http://bit.ly/richard_roiMA

ROI Calculator

Publisher: America’s Health Insurance Plans

Summary: Online tool for health insurers and employers 

to calculate return on investment for cessation 

interventions

http://bit.ly/ahip_ROIcalculator

STATE System Medicaid Coverage of Tobacco 

Cessation Treatments Fact Sheet (2018)

Publisher: Centers for Disease Control and Prevention

Summary: Fact sheet on Medicaid cessation coverage in 

each state

http://bit.ly/state_medicaid

State Tobacco Cessation Coverage Database (2019)

Publisher: American Lung Association

Summary: Cessation coverage required under public, 

private, marketplace, and state employee health plans

http://bit.ly/ala_coveragedatabase

Talk to Your Patients

Publisher: New York State

Summary: Information for Medicaid healthcare providers 

to increase awareness of covered cessation benefits 

https://talktoyourpatients.health.ny.gov

Tobacco Cessation Treatment: What is Covered? 

(2018)

Publisher: American Lung Association

Summary: Cessation requirements of different health 

insurance plans under the Affordable Care Act

http://bit.ly/ala_cessationtreatment

Tobacco Use and Secondhand Smoke Exposure: 

Reducing Out-of-Pocket Costs for Evidence-Based 

Cessation Treatments (2012)

Publisher: Community Guide

Summary: Effectiveness of reducing costs for evidencebased cessation treatment on increasing cessation

http://bit.ly/communityguide_reducingcosts

Supporting State 

Quitlines

802Quits (2019)

Publisher: Vermont Department of Health

Summary: Quitting resources for healthcare providers and 

tobacco users from the Vermont quitline

https://802quits.org/

Asian Smokers’ Quitline

Publisher: Asian Smokers’ Quitline

Summary: Resources for people who smoke, family and 

friends, healthcare providers, and state programs about 

the Asian Smokers’ Quitline

http://www.asiansmokersquitline.org/

Cessation l 58

RESOURCES
CDC’s Guiding Principles for Public-Private 

Partnerships: A Tool to Support Engagement to 

Achieve Public Health Goals (2018)

Publisher: Centers for Disease Control and Prevention

Summary: Steps to create public-private partnerships

http://bit.ly/cdc_partnerships

Cessation Treatment and E-cigarettes: A Report on 

Current Literature and Quitline Practices (2014)

Publisher: North American Quitline Consortium

Summary: Information on how quitlines respond to 

questions about e-cigarettes

http://bit.ly/naqc_ecigarettes

Conducting Quitline Evaluations: A Workbook for 

Tobacco Control Professionals (2015)

Publisher: Centers for Disease Control and Prevention

Summary: Guidance on evaluating quitlines

http://bit.ly/cdc_quitlineevals

Five Reasons Why Calling a Quitline Can Be Key to 

Your Success (2018)

Publisher: Centers for Disease Control and Prevention

Summary: Guidance for people who smoke on the 

benefits of quitlines

http://bit.ly/cdc_fivereasons

Increasing Reach of Tobacco Cessation Quitlines: 

A Review of the Literature and Promising 

Practices (2009)

Publisher: North American Quitline Consortium

Authors: Bronar C, Saul J

Summary: Strategies to increase quitline reach

http://bit.ly/naqc_increasingreach

Minimal Data Set (2012)

Publisher: North American Quitline Consortium

Summary: Measures for evaluating caller satisfaction and 

effectiveness of quitline services

http://bit.ly/naqc_minimaldataset

National Quitline Data Warehouse (2018)

Publisher: Centers for Disease Control and Prevention

Summary: Data on quitline services and caller 

demographics from all 50 states

http://bit.ly/cdc_datawarehouse

Public-Private Partnership Initiative

Publisher: North American Quitline Consortium

Summary: Initiative to help states form cost-saving 

partnerships with private and public insurers

http://bit.ly/naqc_partnership

Quality Improvement Initiative Issue Paper: 

Quitline Referral Systems (2013)

Publisher: North American Quitline Consortium

Summary: Types of referral systems and how they work

http://bit.ly/naqc_qii

Quit Your Way (2018)

Publisher: Tobacco Free Florida

Summary: Online portal for Tobacco Free Florida’s 

quitline with links to telephone, group, and web-based 

services

http://tobaccofreeflorida.com/quityourway

Quitline Services: Current Practice and Evidence 

Base (2016)

Publisher: North American Quitline Consortium

Summary: Strategies to implement and evaluate quitlines, 

including telephone and web-based services

http://bit.ly/naqc_evidence

Smokefree Apps

Publisher: Smokefree.gov

Summary: Online portal for QuitGuide and QuitSTART 

cessation smartphone apps

https://smokefree.gov/tools-tips/apps

Smokefree TXT

Publisher: Smokefree.gov

Summary: Online portal for the national text messaging 

cessation program, SmokefreeTXT

https://smokefree.gov/smokefreeTXT

Cessation l 59

RESOURCES
Tobacco Use and Secondhand Smoke Exposure: 

Quitline Interventions (2012)

Publisher: Community Guide 

Summary: Effectiveness of quitlines on increasing cessation

http://bit.ly/communityguide_quitlines

Web-Based Services (2018)

Publisher: North American Quitline Consortium

Summary: List of web-based cessation services each state 

quitline provides

http://bit.ly/naqc_webbased

Reducing Disparities

Best Practices User Guide: Health Equity in Tobacco 

Prevention and Control (2015)

Publisher: Centers for Disease Control and Prevention

Summary: Steps that state tobacco control staff and 

partners can take to promote health equity and reduce 

tobacco-related disparities

http://bit.ly/cdc_healthequity

Guide to Providing Effective Communication and 

Language Assistance Services(2018)

Publisher: U.S. Department of Health & Human Services

Summary: Guidance for healthcare providers and 

administrators on effectively communicating with 

patients from diverse cultures

https://hclsig.thinkculturalhealth.hhs.gov

Implementing Tobacco Cessation Programs in 

Substance Use Disorder Treatment Settings (2018)

Publisher: Substance Abuse and Mental Health Services 

Administration

Summary: A guide for program directors and providers 

on how to incorporate tobacco cessation into substance 

use treatment programs

http://bit.ly/samhsa_cessation

Networking2Save: CDC’s National Network 

Approach to Preventing and Controlling Tobaccorelated Cancers in Special Populations

Publisher: Centers for Disease Control and Prevention

Summary: Consortium of national networks focused on 

tobacco-related disparities in priority populations

http://bit.ly/cdc_networking2save

Quitlines and Priority Populations: An Update 

on Our Progress to Reach and Serve Those Most 

Impacted by Tobacco’s Harm (2016)

Publisher: North American Quitline Consortium

Summary: Promising practices to reach priority 

populations with quitline services

http://bit.ly/naqc_prioritypopulations

Smokefree Policies in Multi-Unit Housing (2019)

Publisher: American Lung Association

Summary: Tools and resources to help housing properties 

go smokefree

http://bit.ly/ala_smokefreehousing

Case Studies 

OKLAHOMA

Advancing Tobacco Treatment: Oklahoma Hospital 

Tobacco Cessation Systems Program (2018)

Publisher: Oklahoma Hospital Association

Summary: Overview and resources for the Hospitals 

Helping Patients Quit Initiative

http://bit.ly/OHA_cessationprogram

Cessation Systems Coordination (2019)

Publisher: Oklahoma State Department of Health

Summary: Home page for the Oklahoma tobacco control 

program’s cessation systems initiatives

http://bit.ly/OK_cessationsystems

Cessation l 60

RESOURCES
Health Systems Initiative (2019)

Publisher: Oklahoma Tobacco Settlement Endowment 

Trust (TSET)

Summary: Overview of the projects funded by the TSET 

Health Systems Initiative

http://bit.ly/tset_healthsystems

Partnering to Create a Tobacco-Free Culture

Publisher: Oklahoma Hospital Association

Summary: Step-by-step manual on promoting health 

systems change in hospitals 

http://bit.ly/OHA_tobaccofree

RHODE ISLAND

RI Health Plan 2018 Annual Report Form on 

Tobacco Cessation Benefits (2018)

Publisher: Rhode Island Department of Health

Summary: Form for health plans to report cessation 

coverage data

http://bit.ly/RI_2018reportform

Tobacco Control Program (2019)

Publisher: Rhode Island Department of Health

Summary: Home page of the Rhode Island tobacco control 

program 

http://bit.ly/RI_TCP

Tobacco Information for Providers (2019)

Publisher: Rhode Island Department of Health

Summary: Guidance for Rhode Island healthcare 

providers with links to tables describing coverage 

provided under Medicaid and private health plans

http://health.ri.gov/healthrisks/tobacco/for/providers

Cessation l 61

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This document was produced for the Centers for Disease Control and Prevention by the 

Center for Public Health Systems Science at the Brown School at Washington University 

in St. Louis.

Suggested citation:

Centers for Disease Control and Prevention. Best Practices User Guide: Cessation in Tobacco 

Prevention and Control. Atlanta: U.S. Department of Health and Human Services, Centers for 

Disease Control and Prevention, National Center for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health, 2020. 

Ordering information:

To download or order copies of this report, go to www.cdc.gov/tobacco or to order single copies, 

call toll-free 1-800-CDC-INFO or 1-800-232-4636.

More information:

For more information about tobacco control and prevention, visit CDC’s Smoking & Tobacco Use 

website at www.cdc.gov/tobacco.