Effectiveness of telephone counseling and quitlines in tobacco cessation: A systematic review and meta-analysis.

OBJECTIVES

To evaluate the effectiveness of telephone counselling, including quitlines, for tobacco cessation and to compare outcomes between randomized controlled trials (RCTs) and observational studies across diverse populations and settings.

STUDY

DESIGN

Systematic review and meta-analysis

METHODS

We systematically searched PubMed, EMBASE, Scopus, Cochrane Library, and ScienceDirect for English-language studies (2002-2025). Eligible studies included RCTs, non-randomized trials, and observational studies of individuals using any form of tobacco. The primary outcome was continuous abstinence; secondary outcomes included 7-day and 30-day point prevalence abstinence. Risk of bias was assessed using the Cochrane RoB-2 and Newcastle-Ottawa Scale; certainty of evidence was rated with GRADE. PROSPERO registration: CRD42023418243.

RESULTS

Thirty-six studies (RCTs=25; observational=11) were included. Across RCTs, telephone counselling increased continuous abstinence by 43% (RR = 1.43; 95% CI: 1.11-1.84; I² = 48%). 7-day PPA improved by 45% (RR = 1.45; 95% CI: 1.13-1.86; I² = 74%), while 30-day PPA (4 RCTs) also showed benefit (RR = 1.37; 95% CI: 1.14-1.65). Subgroup analyses demonstrated consistent effects across biochemical and self-reported verification. Observational studies reported 7-day PPA ranging from 2.6%-67.4%, 30-day PPA around 20.5%, and mean quit rates of 35.5%, with higher cessation among those completing ≥ 3 counselling sessions. Meta-regression indicated that differences between RCT and observational estimates were driven by follow-up duration, not study design.

CONCLUSIONS

Telephone counselling significantly increases quit rates across populations, with evidence from both trial and real-world settings. Scaling up quitline services, particularly in low- and middle-income countries, should be prioritized to strengthen global tobacco control efforts.