A partnership between Kick It California, a tobacco quitline operated by University of California San Diego, and local 211 information and referral agencies resulted in more than 55,000 new referrals for tobacco cessation services between 2021 and 2023, report researchers at the UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science and UC San Diego Moores Cancer Center.
The results, published in Nicotine & Tobacco Research, demonstrate how quitlines and 211 agencies can collaborate effectively to help address socioeconomic disparities in tobacco use.
“We already knew that 211 agencies primarily serve people experiencing economic hardship, and we also knew that tobacco use is most concentrated in low-income populations,” said Shu-Hong Zhu, Ph.D., a professor at the Herbert Wertheim School of Public Health and senior author of the study. “We thought that with a little nudge and a modest incentive, many 211 clients who use tobacco would accept a referral to the quitline to access the services they need to quit.”
According to a 2024 report from the U.S. Surgeon General, smoking among men and women living in poverty is more than twice as common compared to those not living in poverty. Quitlines are one essential public health tool to mitigate the threat of tobacco-related disease and death, and they provide phone-based counseling to help people quit smoking, vaping or other tobacco use. While quitline services are free, they are often underutilized.
211 services, on the other hand, have much broader reach. In 2022 alone, Californians accessed 211 services more than 2.1 million times to connect to vital health and human services. By partnering with thirteen 211 agencies across the state, the research team was able to identify 211 clients who use tobacco and offer them a referral to Kick It California. The 211 agencies also offered callers a $20 incentive for completing a counseling session.
The study’s key findings were:
Between April 2021 and December 2023, 55,151 individuals were referred to Kick it California through this incentive program.
211-referred participants were more than twice as likely to enroll in quitline services compared to those referred by a health care clinic. They were also more likely to complete a first counseling session.
On average, 211-referred participants completed the same number of sessions as clinic-referred and self-referred participants without any further incentives beyond the initial $20.
All three groups had similar success rates when it came to actually quitting.
“This showed us that 211 participants were not just in it for the money,” said Zhu. “Once they got started with the counseling and quitting process, they were just as active as other participants and just as many were successful in quitting.”
In addition to low-income tobacco users, the program was also able to reach other populations affected disproportionately by tobacco use. Comparing 211 participants to those referred by health care clinics and those who called in on their own, the researchers found that 211 participants were more likely to be female, LGBTQ, Black or multiracial, younger, less educated, and Medicaid-insured. They were also more likely to have a mental health condition, co-use cigarettes with other forms of tobacco, and co-use tobacco and cannabis.
“Partnering with 211 not only helped the quitline reach large numbers of tobacco users,” said Zhu. “It also helped us reach many groups disproportionately impacted by tobacco. For example, 7 in 10 of those referred to the quitline had a mental health condition, such as depression or anxiety, which can make it much more challenging for people to quit.”
The findings demonstrate how quitlines and 211 agencies can collaborate effectively to help low-income tobacco users quit. The researchers estimated that if 211 agencies across the United States referred their tobacco-using clients at the same rate as the agencies in this study, about 64,000 additional individuals would receive tobacco cessation treatment each year.
“211 agencies exist to help people access social services, so it shouldn’t come as a surprise that they can help people access evidence-based cessation services,” said Zhu. “In the long term, this could be an incredibly powerful strategy for reducing the burden of tobacco usage in the United States.”
Additional study authors include Emily Aughinbaugh, Andrea Pratt, Yue-Lin Zhuang, Ding Wang, Antonio Mayoral, and Christopher Anderson at UC San Diego Moores Cancer Center, and Tonia Hagaman at the California Tobacco Prevention Program of the California Department of Public Health.
More information:
Shu-Hong Zhu et al, Increasing a Quitline’s Reach to Low-Income Tobacco Users Through 211 Agencies, Nicotine and Tobacco Research (2025). DOI: 10.1093/ntr/ntae294
Provided by
University of California – San Diego
Citation:
Innovative partnership helps low-income tobacco users quit (2025, January 14)
