Tamatha Thomas-Haase, MPA Manager, Training and Program Services

1. The Role of Quitlines in Comprehensive Tobacco Cessation: Where are We Now; Where are We Going; and How do We Get There? Tamatha Thomas-Haase, MPA Manager, Training and Program Services North American Quitline Consortium

2. Components of Comprehensive Tobacco Cessation Program • Policy activities that encourage tobacco users to quit • Delivery system for evidence based services

3. Goals of Presentation • Describe national trends • Show current status on quit rates and reach • Describe strategies for increasing reach

4. National Trends: 2009 NAQC Annual Survey Findings • 343,996 incoming calls from unique tobacco users (n=39) • $960,000 = Median state quitline budget (services & medications) • Down from 2009 = $985,000 • In 2009, a median of $1.95 was spent per adult smoker on services and medications (n=51, range $0.14-$20.81); mean = $3.13

5. National Trends: 2009 NAQC Annual Survey Findings • All states offer proactive counseling services • Services available at least 5 days/week; at least 8 hours/day • 22 states offered self-directed web-based interventions • 15 states offered interactive counseling and/or email messaging • 40 states provided free medication to at least select callers • 50 states offer fax referral

6. National Trends: 2009 NAQC Annual Survey Conclusions • Strong correlation between expenditures for counseling and medication services per adult smoker and reach…we’ll come back to this! • Less strong correlation between media expenditures per adult smoker and reach • Quitlines could serve more tobacco users with increased funding

7. Quit Rates and Reach: National Goals and Current Status • Definitions: • Quit Rate: the proportion of all tobacco users who received at least one evidence-based service from a quitline who are quit at 7-months after start service began • Reach: the proportion of all tobacco users in the state who receive at least one evidence-based treatment from the quitline (treatment reach)

8. Quit Rates and Reach: National Goals • 2004: The US Interagency Committee on Smoking and Health estimated that quitlines could reach up to 15% smokers each year. • 2007: CDC’s Update on Best Practices set a goal for quitlines to reach 8% of tobacco users each year and deliver services to 6%. • 2008: Partnership for Prevention set a goal to reach 50% of all tobacco users with cessation services by 2015 and 100% by 2020. • 2009: NAQC released its goals for 2015: • Increase service reach to at least 6% • Increase quit rates to at least 30% • Increase per capita (and per smoker) quitline funding to $2.19 (and $10.53)

9. Where are we now?Quitline Quit Rates from Published Literature* • *Data are from peer-reviewed published literature, 2005-2008. Source: NAQC. Review of U.S. Quitlines Quit Rates, 2009

10. Where are we now?Promotional Reach and Treatment Reach

11. Promotional Reach and spending benchmarking – US FY09

12. Treatment Reach and spending benchmarking – US FY09

13. US Quitlines Promotional Reach and Spending per Smoker FY09 CDC recommendation: 8% reach, $10.53 per smoker

14. US Quitlines Treatment Reach and Spending Per Smoker FY09 CDC recommendation: 6% reach, $10.53 per smoker

15. 8 Strategies for Increasing Reach • NAQC review of literature and practice: • TV advertising still most effective strategy • Other cost-effective media options • Online advertising offers great potential • Building referral systems/health system changes • NRT increases call volume • Quit and Win contests raise awareness • Linking ad campaigns and policy changes • Mixed data on message tailoring for special populations

16. Building Referral Networks • Literature-based learnings: • Provider fax-referrals: Need good quitline support, easy to use process and quick fill-out forms. • 3 A’s – Ask, advise and assess (then refer to quitline). Providers need to believe in the service! • Partnerships – health system changes work best when the quitline partners with and supports the organization undergoing change.

17. Building Referral Networks • CA – increased non-media referrals by advertising the quitline to medical providers, local health depts, schools, friends and families (~200 calls increased to over 1,600). • OH – used direct marketing to providers, outreach to 51 hospitals (with stipend and training) and academic detailing to increase fax referral from 69 to over 400/month. • WI – used outreach specialists for academic detailing. 25% of direct calls are referred by health care providers; fax referral accounted for 56% of calls in 2008. • NC – used fax challenges and provider education to increase fax referrals from 43 in July 2008 to 371 in July 2010…AND 47% of referrals receive services!

19. QuitlineNC Call Volume 2009 1 - 25 101 - 150 301 - 500 26 - 50 151 - 200 501 - 700 51 - 100 201 - 300 701 - 744

20. Callers by Gender

21. Callers by Age

22. Callers by Race

23. Take Home Strategies • It is important to: • Know what you are promoting and believe in it! • Listen • Learn • Share • Have an outreach component that includes diverse providers and healthcare systems. Where are those who smoke the most and have the least access to care going for healthcare services?