Tobacco use continues to be the leading cause of death and disease in the United States; more than 440,000 people in this country die of tobacco-related diseases each year. Fortunately, cessation of tobacco use can reduce the risk of tobacco-related disease, even among those who have used tobacco for decades. Cessation also saves money; tobacco use is estimated to cost the nation close to $157 billion annually in excess medical expenses and lost productivity. Cessation rates, however, have been low. One recent national survey indicates that about 41% of smokers try to quit smoking each year, but only 4.7% maintain abstinence for at least 3 months. An increase in either the percentage of tobacco users making quit attempts or in the success rate for such attempts can lead to a higher overall cessation rate. Traditional cessation programs have mostly focused on the latter, assisting those who are trying to quit and actively seek help in doing so. They have not often sought to increase the rate of quit attempts in the general population. In other words, traditional cessation programs have adopted a clinical rather than a public health approach. Over the past decade, however, there has been an effort to adopt a more public health-oriented approach to cessation, that is, one that is concerned not only with the cessation rate of the individuals who seek help to quit, but with that of all tobacco users in the population. In this approach, cessation becomes an integral part of a comprehensive tobacco control program, by making help available for those who seek it, and by actively promoting cessation in the general population. Telephone-based tobacco cessation services, commonly known as quitlines, have shown the potential to address both of these aims. This publication was prepared by the U.S. Department of Health and Human Services under the direction of the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, in response to a growing interest in telephone-based tobacco cessation services commonly known as quitlines. It is intended to help state health departments, health care organizations, and employers to contract for and monitor telephone-based tobacco cessation services. It is also intended to help states, health care organizations, and quitline operators enhance existing quitline services, and to inform those who are interested in learning more about population-based approaches to tobacco cessation. The scientific literature contains little information about contracting for and operating quitline services. The information and recommendations presented in this publication are therefore based primarily on the expert opinions of a panel of tobacco control professionals who have experience with statewide quitlines.