Problem/Objective: Evidence-based guidelines for tobacco dependence treatment are well known. States are implementing these guidelines with quitlines as a primary strategy spending about 10% of tobacco control funds annually on quitlines. States also fund initiatives to implement other guideline recommendations e.g. through health systems, Medicaid programs, and employers. But little is known about implementation of these initiatives.

Methods: In summer, 2006, the Tobacco Cessation Leadership Network sponsored a state, online survey, with assistance from the Tobacco Technical Assistance Consortium. The survey assessed implementation of 23 separate cessation initiatives (in addition to quitlines).

Results: Of 38 states responding, 68% reported partially or fully implementing at least half of the 23 initiatives. Most common were distribution of free NRT, in-person cessation counseling, and integrating cessation services with chronic disease, maternal/child health programs, and within priority populations. States reported an average of 11 partners contributing to implementation. The greatest challenges were working with business, health professionals, and youth. Seven variables were identified that may influence higher vs. lower implementation: program maturity, funding, leadership priorities, partnerships, program challenges, program advocates, and policies (tobacco taxes and ETS). Of these, only more program advocates was significantly associated with higher implementation (p=.01). States with higher implementation were also likely to have more partnerships (65% vs. 35%) and to have successfully advocated for higher tobacco taxes (59% vs. 41%).

Conclusions: There is growing consensus about implementation but state approaches are diverse. Strong advocates and partnerships are especially important. Programs would benefit from more of these relationships.