Background and challenges to implementation:
Smoking cessation workshops were added to the Israel Basket of Health Services in 2010, however a quitline service wasn´t included. In 2013 Clalit Health Services established a pilot project testing a proactive counseling quitline. The service includes six individual counseling provided by cessation counselors, offered in five languages, tailored and cultural adapted. The service is free of charge, participants are given instructions about cessation medication and a tool kit is send by mail.

Intervention or response:

Goals: To evaluate the effectiveness of the program, in terms of smoking cessation and maintenance; understand the barriers to smoking cessation and the reasons for dropping out before the end of the process; understand the factors that drive success for improvement and adaptation of the quitline, according to a needs assessment.
Methods: Telephone interviews were conducted among 400 participants who received counseling, using a structured questionnaire, one year following counseling.

Results and lessons learnt:
Counseling was provided mainly in Hebrew (75%), Russian and Arabic. Of the participants who completed the counseling- 77.7% quit smoking and with a one-year continuous abstinence rate of 39.2%. A significant correlation was found between the duration of participation in telephone counseling and the rate of smoking following one year (p< 0.001). Cessation was associated with education and income (p=0.02 and p=0.03, respectively). Among those who relapsed, 50% relapsed within 3 months, due to stress, tension and life/family problems (55%). Telephone consultation was noted as the leading factor for cessation and maintenance (74%). About 90% expressed "satisfaction" to "high-satisfaction" with the quitline.

Conclusions and key recommendations:
This service provides an effective method for cessation and complements the workshops. The results suggest the need to examine reasons for dropout and relapse prevention, such as adding periodical support. In addition, special populations were identified as in need of more intensive support. It´s important to include quitline in the Israel basket of health services.