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

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

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

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

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 messaging 40 states provided free medication to at least select callers 50 states offer fax referral

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

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)

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 : 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)

Where are we now? Quitline Quit Rates from Published Literature* *Data are from peer-reviewed published literature, Source: NAQC. Review of U.S. Quitlines Quit Rates, 2009 NRT Provided as Part of Quitline Counseling Service 7-day point prevalence abstinence30-day point prevalence abstinence Responder Rate 26%-39%30%-36% Intention to treat rate (Assumes that those callers who cannot be located are smoking) 16%-25%14%-24% NRT Not Provided as Part of Quitline Counseling Service 7-day point prevalence abstinence30-day point prevalence abstinence Responder Rate 6%-27%16%-23% Intention to treat rate (Assumes that those callers who cannot be located are smoking) 9%-21%8%-13%

Where are we now? Promotional Reach and Treatment Reach FY09 Reach Promotional Reach (# of tobacco users completing an intake) Median (N) Treatment Reach (# receiving evidence based services) Median (N) US1.2% (49)0.7% (46) Canada0.3% (9)0.3% (3)

Promotional Reach and spending benchmarking – US FY09

Treatment Reach and spending benchmarking – US FY09

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

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

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

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.

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 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!

QuitlineNC Call Volume

Callers by Gender

Callers by Age

Callers by Race

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?