OLYMPIA -- Washington might set up the nation's most ambitious -- and expensive -- anti-smoking telephone hot line if the state's share of the national tobacco settlement survives Initiative 695 budget cuts.

Health officials recently proposed spending about $2 million a year on a toll-free "quit line." Mary Selecky, secretary of the state Department of Health, said Washington's hot line also would be the nation's most intensive. "What we're talking about now is much more comprehensive," Selecky said. Money is just starting to roll in from the state's tobacco settlement, which is expected to bring in $323 million over two years. Last year, the Legislature set aside $100 million for tobacco use prevention and gave the state Health Department about $620,000 to have a research council study ways to spend it. But just as the research council unveiled its $52.1 million, two-year tobacco prevention proposal, lawmakers last month began talking about diverting settlement money to fill budget gaps created by Initiative 695's repeal of the motor-vehicle excise tax. Selecky, Attorney General Christine Gregoire and several legislators have vowed to protect the money. The council recommended that most of the money go to community programs and prevention, including $8 million per year on ads and billboards geared to prevention. As for cessation programs, the biggest chunk of the money would go to the telephone service, which would counsel smokers on how to quit and where to get help, officials said. In a typical 45-minute call, counselors would interview smokers about their habits and experiences with tobacco and refer them to services available through their insurers and communities. The counselor would later send the smoker written materials and call back several times over following months. Some smokers may be eligible for nicotine replacement therapy, such as nicotine patches. Federal health officials have found that quit lines work, said Corinne Husten a medical officer with the Centers for Disease Control and Prevention. "The advantages of it are that it's a way to provide intensive counseling to smokers," said Husten, who added that it is convenient because smokers don't need to take time off work or get a baby sitter to take the more common cessation classes. While many insurers run their own quit lines, among states, only California, Arizona, Oregon and Massachusetts do so, Husten said. "They're expensive to set up and maintain," she said. However, several states plan to start such services soon. States tend to spend 17 cents to 20 cents per adult on such lines, Husten said. By comparison, Washington would spend 47 cents per adult. "(Washington is) providing a higher level of services than any of the other states are providing," Husten said. Other states offer only referral services or comprehensive services to a portion of callers, said Karen Krueger, a public health consultant with the state Health Department. Washington will offer comprehensive help to all callers, she said. Krueger said the program would be a bargain, particularly because it would serve rural areas that typically have limited health care services. "It's a relatively inexpensive service that's tailored to the individual client and is delivered at a time that is convenient to the client," Krueger said. "One of the things that's really important about the quit line is that it's where we expect we would see the most immediate impact on health," Krueger added. The quit line could target people who need it most, such as pregnant women, which "would be a pretty quick return on the investment." Washington allocates no state tax money for tobacco use prevention programs, but does spend about $1.4 million in federal money per year to fight tobacco, she said. In addition, about $900,000 per year from state retail license fees goes to community programs targeting youth. Oregon officials are pleased with the early returns for the help line that state started just over a year ago, said Nancy Clarke, a health system liaison for the Oregon Health Division. Funded through tobacco taxes, that program costs about $750,000 per year. "We find in a rural state and in a busy decade, phone is a very, very good way to reach people and to help people," Clarke said. Oregon conducted a small survey of callers about six months after starting the service, Clarke said. About 84 percent of the callers quit for a day or more, and one-third kicked the habit for at least 30 days. The CDC's Husten said there has been enough time to study California's quit line, established in 1990, to know that program works. Several years ago, studies showed that callers to the California help line were twice as likely to kick the habit if they received telephone counseling, compared with those who got only a packet of information in the mail. Because of demand for the services, California boosted its quit line funding this year to $2.3 million from $1.6 million, said Paul Hunting, health program specialist with the California Department of Health Services. Funded through a tobacco tax, that amounts to a little less than 10 cents per year for every adult Californian. As for Washington state, if the Legislature does go after its tobacco use prevention funding, the Health Department's Krueger hopes lawmakers leave enough to establish at least a scaled-down program.

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