Rehab services are expensive for low-income smokers

Telephone quitlines offer free and effective treatment for tobacco dependence, but for low-income smokers who only have a cell phone and don’t have unlimited minutes, calls to the quitline may take a substantial portion of their cell minutes for the month, according to a new study.

The researchers didn’t ask smokers if this limitation affected whether or not they used the quitlines, but estimated for how many smokers this might potentially be an issue based on phone ownership and service plans.

Quitlines are available in Mexico, Canada, and all 50 U.S. states, Puerto Rico, Guam, and the District of Columbia, according to the North American Quitline Consortium. They connect callers with health care professionals at treatment centers who may provide medications as well as counseling.

Across the U.S., anyone can call 1-800-QUIT-NOW toll free at any time. “Quitlines are very effective,” and some states now have their own number as well, said lead author Dr. Steven L. Bernstein of Yale School of Medicine in New Haven, Connecticut.

“The money to support them comes from within the state, they’re open seven days per week, and most states will offer you services in languages other than English as well,” he told Reuters Health by phone. “The only real problem is they are underused. Not enough doctors, and smokers, know about them.”

The researchers surveyed 773 smokers visiting an urban emergency department in 2013. Almost three-quarters were low-income smokers, determined by insurance status including Medicaid coverage and no insurance.

All the low-income smokers had at least one phone. Nine percent had a land line only, 63% had only a cell phone, and 28% had both. Most cell phone owners had unlimited monthly plans, but about 35% had limited plans, with 24% having less than 250 calling minutes per month.

An earlier study showed that half of quitline users call at least once a month for about 28 minutes, but some call three or four times per month for 45 minutes to over an hour at a time.

Heavier quitline users could be using up to 30% of their 250 monthly cell minutes, Bernstein’s team reported online February 26 in Nicotine and Tobacco Research.

"Given the data they present it seems plausible that the cost of calls could be a barrier to quitline use, but they don’t attempt to answer that directly," said Lindsay Stead, managing editor of the Cochrane Tobacco Addiction Group, who was not part of the new study.

"For smokers who would like to use a quitline, cost would seem one obvious barrier," Stead told Reuters Health by email. “You may be inhibited from using it because you don’t want to burn those minutes,” Bernstein said.

He and his team researched other emergency health services and found that all phones, regardless of type or calling plan or availability of minutes, will patch through a call to 911.

“It doesn’t matter how many minutes you have, that one always goes through,” he said. But the same is not generally true for quitlines or suicide hotlines, as far as he was able to gather from other researchers in the field.

“There may be very important health related uses of cell phones that probably should be exempted from peoples’ plans,” Bernstein said.