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A groundbreaking partnership between Kick It California, a tobacco quitline run by the University of California San Diego (UCSD), and local 211 information and referral agencies has shown remarkable success in connecting low-income tobacco users to cessation services. Between 2021 and 2023, over 55,000 individuals received referrals for tobacco cessation, according to new research from the UCSD Herbert Wertheim School of Public Health and Human Longevity Science and the UCSD Moores Cancer Center.
The findings, published in Nicotine & Tobacco Research, highlight how collaboration between quitlines and 211 services can effectively tackle socioeconomic disparities in tobacco use.
“We knew 211 agencies primarily serve people facing economic hardship, and tobacco use is more prevalent in low-income communities,” said Shu-Hong Zhu, Ph.D., professor at the Herbert Wertheim School of Public Health and senior author of the study. “With just a little encouragement and a modest incentive, we believed many 211 clients who smoke would accept a referral to the quitline and access the support they need.”
A report from the U.S. Surgeon General in 2024 revealed that smoking is more than twice as common among individuals living in poverty compared to those not in poverty. Quitlines, which offer free phone-based counseling for smoking, vaping, and other tobacco use, are a vital tool for addressing tobacco-related health issues. However, they are often underused.
211 services, which connect Californians to essential health and human services, reached over 2.1 million people in 2022 alone. By partnering with 13 211 agencies across California, researchers were able to identify tobacco users and offer them a referral to Kick It California, alongside a $20 incentive for completing a counseling session.
The study’s key findings include:
- Between April 2021 and December 2023, 55,151 individuals were referred to Kick It California through this program.
- Participants referred by 211 were more than twice as likely to enroll in quitline services than those referred by health care clinics, and they were more likely to complete a first counseling session.
- 211-referred participants completed an average number of sessions similar to clinic-referred and self-referred participants, without additional incentives beyond the initial $20.
- All three groups had comparable success rates in quitting.
“This demonstrated that 211 participants were not just motivated by the money,” said Zhu. “Once they began the counseling process, they were as committed as any other group, with similar success in quitting.”
The program reached not only low-income tobacco users but also those from other groups disproportionately affected by tobacco use. Compared to those referred by health care clinics or who self-referred, 211 participants were more likely to be female, LGBTQ, Black or multiracial, younger, less educated, and insured by Medicaid. Many also had mental health conditions, which are known to complicate the quitting process.
“Partnering with 211 helped the quitline reach large numbers of tobacco users, particularly those from underserved populations,” said Zhu. “Seven out of 10 211-referred individuals had a mental health condition, making quitting even more challenging for them.”
The researchers believe that if 211 agencies across the U.S. referred their tobacco-using clients at the same rate as those in the study, approximately 64,000 additional individuals could receive tobacco cessation treatment annually.
“211 agencies exist to help people access social services, so it’s no surprise they can connect people with evidence-based cessation services,” said Zhu. “This approach could be a game-changer in reducing the tobacco burden across the nation.”
Additional authors of the study include Emily Aughinbaugh, Andrea Pratt, Yue-Lin Zhuang, Ding Wang, Antonio Mayoral, and Christopher Anderson at the UCSD Moores Cancer Center, along with Tonia Hagaman from the California Tobacco Prevention Program at the California Department of Public Health.
For more information, refer to the study: Increasing a Quitline’s Reach to Low-Income Tobacco Users Through 211 Agencies, Nicotine & Tobacco Research (2025), DOI: 10.1093/ntr/ntae294.
