When Renee Haapanen makes her rounds as a gas meter reader, she no longer needs a smoke break. Two years ago, she turned to California's free telephone counseling for help to quit smoking.
Now she recommends the California Smokers' Helpline to her friends.
"I knew it wouldn't be easy. And it was so worth it," said the 39-year-old from Ventura, who was motivated by high blood pressure, a friend who had quit and her wish to avoid wrinkles.
A study of California's "quitline" in Thursday's New England Journal of Medicine shows that telephone counseling works for those who want to kick the habit.
Tests done before the free service actually started showed the technique was effective. But researchers at the University of California at San Diego, which runs the state's quitline, wanted to see if that was true once the program was in operation.
They reported that smokers who were counseled stopped smoking at twice the rate of those who did not get such help.
"These statewide telephone counseling services really help people," said researcher Shu-Hong Zhu, who directs the help line. "All they have to do is pick up the phone."
Thirty-two states have followed California's example and set up quitlines, most in the last three years. Some are using their share of the 1998 national tobacco settlement to pay for them.
States like telephone services because they reach more people than group programs, are available nights and weekends, and spare participants from having to find transportation or day care, said Angela Geiger, director of 10 state quitlines that the American Cancer Society runs from Austin, Texas.
"Quitting smoking is really, really hard. So we've tried to make these quitlines as easy as possible for the person trying to quit," she said.
To test the California service, the researchers enrolled 3,282 callers in the study. All received a packet of self-help information in the mail. One group received an average of three counseling sessions. A second group only got counseling if they called back as instructed.
After a month, 21 percent of those who got counseling had quit, compared with 10 percent of those who did not get counseling. Many smokers relapsed, and after a year, the rates had dropped to 8 percent and 4 percent.
Dr. Steven A. Schroeder of the Robert Wood Johnson Foundation said states without quitlines should use tobacco settlement money to start one.
Another study in the journal found that most states used little of their settlement money in 2001 — about 6 percent — for tobacco-control programs.
"I think it's an investment that pays off and it's truly in the spirit of the agreement," said Schroeder, president and chief executive officer of the health-care foundation.
Quitlines generally provide callers with self-help materials and a series of counseling sessions. South Dakota goes further, paying for nicotine gum and patches or medication to help smokers quit.
The response has been phenomenal, with 6,000 calls in the first eight months, said Laurie Gill of the South Dakota Department of Health.
One of those callers three months ago was Crystal Statler. Statler, 29, said her counselor suggested ways to fight off the urge to smoke when she is at work in a bar. She used the free nicotine patches and medication.
"It's such a great program. It was completely free and what I needed," she said.