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Telephone counselling is an effective smoking cessation intervention and over the past decade smoking cessation quitlines have rapidly proliferated across North America, Europe, Asia, and elsewhere.1–8 Despite the increase in quitlines, the published data are limited and tend to focus on call volume, demographic breakdown of callers, and/or overall abstinence rates.1,4–6 Numerous factors, including but not limited to dependence, self efficacy, and stage of change, are predictive of quit attempts and abstinence. Recent research suggests that cigarette smoking behaviours have a strong seasonal component,9–11 with higher consumption and initiation in summer months and lower consumption and higher cessation in winter months. Possible reasons include—but are not limited to—the effect of weather, New Year resolutions, vacations, and tax increases.9,10
A better understanding of seasonality and smoking may be important for those planning, promoting, and evaluating smoking cessation services. We explored whether seasonality was related to stage of change among smokers who called NJQuitline, a state sponsored service in New Jersey, USA. Between 2002 and 2004, 4346 individuals desiring counselling called NJQuitline. During the initial assessment, callers’ “stage of change” was classified as follows: contemplation (planning to quit within six months), preparation (planning to quit next month), action (quit for less than six months), and maintenance (quit for six months or more). Upon enrolment, 1% reported they were in maintenance, 16% had recently quit smoking and were in the action stage, 71% were in preparation, and 13% were contemplative. It is common for a relatively high proportion of new users of telephone quitlines, as well as internet smoking cessation, to have already quit when they seek support.1,12 Indeed, in the present study, 16% of enrolees were in the action stage and had quit before calling. However, the proportion of those in the action stage varied over the year (fig 1). A fairly consistent pattern emerges across all three years; a higher proportion of enrolees reported being in the action stage in January, July, August, and December (18.9%, 17.2%, 20.0%, and 19.3% overall compared with 14.6% during the rest of the year). The findings indicate that among those who sought support from NJQuitline, stage of change was impacted by seasonal factors. These possible seasonal factors deserve discussion. The high proportion of clients in the action stage in January and December (winter months in the USA) is likely attributable to New Years resolutions and clean indoor air restrictions.9 The increases in July and August are likely explained by cigarette excise tax increases—New Jersey raised its cigarette excise tax in July for each of the years presented. Lastly, as shown in fig 1, there were other months with a higher proportion of clients in the action stage, some of these months (November 2002, March 2002, March 2003) correspond with paid state sponsored media campaigns4,7 which are tagged with the NJQuitline phone number.
Quitline administrators are familiar with the large increases in call volume that occur following media advertising, and according to the season. This study suggests that there are also important seasonal effects on caller stage of change and smoking status. These seasonal differences should be borne in mind when planning, promoting, and evaluating telephone quitlines.
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