title: Cell Phone Ownership and Service Plans Among Low-Income Smokers: The Hidden Cost of Quitlines.
abstract: Quitlines (QLs) are free, effective sources of treatment for tobacco dependence. Although the QL number is toll-free, the use of cell phones as the sole source of telephony may impose an unintended cost, in terms of cell minutes.
  
  
  
  To quantify the use of cell-only telephony among self-pay or Medicaid smokers, assess their calling plans, and estimate the impact of a typical course of QL counseling.
  
  
  
  A survey of smokers age at least 18 years visiting an American urban emergency department from April to July, 2013.
  
  
  
  Seven-hundred seventy-three smokers were surveyed, of whom 563 (72.8%) were low-income, defined as having Medicaid or no insurance. All low-income smokers had at least one phone: 48 (8.5%) reported land-lines only, 159 (28.2%) land-lines and cells, and 356 (63.2%) cells only. Of the cell phone owners, monthly calling plans provided unlimited minutes for 339/515 (65.8%), at most 250 minutes for 124 (24.1%), and more than 250 minutes for 52 (10.0%). Another recent trial found that QL users make a median of 1 call lasting 28 minutes, with the 75th and 90th percentiles of calls and minutes at 3 and 4 calls, and 48 and 73.6 minutes, respectively. Thus, robust use of QL services could consume 11%-29% of a low-income smoker's typical 250 monthly cell minutes.
  
  
  
  Among low-income smokers, cell phones are often the sole telephone. Robust use of the QL may impose a substantial burden on low-income smokers' calling plans, and therefore deter use of the QL. Exempting calls to QLs from counting against smokers' plans may help promote QL utilization.
  
  
  
  Low-income individuals have high rates of smoking, and are more likely to own only cell phones, not landlines, for telephone access. Because cell phone calling plans often have limited numbers of monthly minutes, cell-only individuals may have to spend a substantial proportion of their monthly minutes on QL services. This may act as a deterrent to using an otherwise free, effective means of treatment for tobacco dependence. Exempting QLs from monthly calling plans may improve access for low-income smokers.
authors.affiliation: Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT; Department of Health Policy, Yale School of Public Health, New Haven, CT; Steven.bernstein@yale.edu.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Bernstein
authors.affiliation: Department of Emergency Medicine, Yale School of Medicine, New Haven, CT;
authors.forename: June-Marie
authors.initials: JM
authors.lastname: Rosner
authors.affiliation: Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Toll
mesh_terms: D000328:Adult; D040421:Cell Phone / Q000191:economics* / Q000706:statistics & numerical data; D003237:Connecticut; D003376:Counseling; D005260:Female; D015277:Hotlines; D006801:Humans; D008297:Male; D011203:Poverty; D016540:Smoking Cessation / Q000191:economics* / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D014481:United States