Do proactive or opt-out referrals connect more people to stop-smoking support?

01

Who makes the first connection, and what can be refused?

A fictional patient receives a leaflet and is expected to call a service. Another fictional patient agrees to a staff member arranging contact with that service. The difference is who carries out the connection, not that the second person has already joined or quit. Proactive referral can include sending a referral, arranging an appointment or connecting a call; passive signposting leaves the patient to initiate contact.

The review distinguishes opt-in—explicit agreement before referral—from opt-out, where referral is the default unless the patient declines. These describe an arrangement, not permission to secretly share information. The responsible service must explain the hand-off and applicable information-handling requirements. A person should be able to ask who will contact them, what information will be passed, and how to decline or change the arrangement. This website makes no referral and receives no contact details.

[1]

02

The evidence supports reach, without making every referral a quit

The review was published online in 2022 and in a 2023 issue; its search ended in January 2021. Five randomized trials comparing enrolment all used opt-in electronic referrals and found more enrolment than passive referral. Four had low study-quality scores, largely because reporting lacked important details. The wider review also covered implementation, including staff training and prompts. Outcomes and settings varied too much for a single pooled effect. It cannot tell every reader the probability of being reached or successfully quitting.

Only a small part of that review concerned opt-out systems. Its enrolment comparisons do not establish that opt-out beats opt-in everywhere, and its effectiveness question was enrolment, not smoking abstinence. A new study, published online in November 2025 and in a January 2026 issue, examined SMS opt-out invitations from general practices in Nottinghamshire. The study reports an association with an increase in the number reporting 28-day abstinence. It was an interrupted time-series analysis, not a randomized trial, and the self-referral comparison came from a different practice arrangement. This is not proof of a universal default-setting effect, verified long-term quitting or a personal guarantee.

The newer study also separates people invited, contactable people who confirmed smoking, booked appointments and people reporting abstinence. The denominator changes between these stages. Counting an unanswered call as contact, or a transmitted referral as attendance, would obscure where the connection actually stopped. A difficulty completing the hand-off is not a diagnosis of unwillingness to quit.

[1][2]

03

A useful question after a referral: what happens next?

With the responsible clinic or service, clarify whether the referral was only offered or actually sent, who is expected to make the next contact, and how to confirm its status if nothing happens. Ask about the channel, availability, costs and refusal options without assuming every system works the same way. A reminder in a clinician's record is not itself a completed hand-off; enrolment is not evidence that sessions were attended or that smoking stopped.

For independent support in England, NHS local Stop Smoking Services are an official starting point. Elsewhere use qualified local services and confirm their arrangements. Use the verified service's own contact route for personal matters—not this website. Do not submit a phone number, appointment record or smoking history here. This page explains access to support; it does not arrange care or choose a treatment.

[1][2][3]

04

What to keep in mind

• Proactive describes who initiates the connection; opt-in and opt-out describe different defaults.
• Ask what stage is complete, who acts next and how to decline—not just whether a referral exists.