Results from the 2010 NAQC Annual Survey of Quitlines Prepared by: Westat, Jessie Saul, and the NAQC Annual Survey Workgroup July 11,

Background of Annual Survey Conducted Annually , Research Partners: –2010 Westat –2008 and 2009 Evaluation, Research and Development Unit, University of Arizona –2006 Center for Tobacco Research and Intervention, University of Wisconsin –2005 University of California, San Diego –2004 Tobacco Technical Assistance Consortium

2010 Annual Survey Methods Completed from October to December 2010 Web-based survey with and telephone follow-up: 1)General Information, hours, services offered 2)Quitline budgets 3)Funding sources 4)Materials used 5)Counselling services and protocols 6)Promotion 7)Utilization 8)Evaluation 65 quitline funders and their service providers were asked to respond; 52 of 53 US quitlines responded; 10 of 12 Canadian quitlines responded.

BUDGET

Budget Summary Budgets declined for the first time in FY10 The primary impacts of the decline were a decrease in media, promotions, and outreach; and a decrease in the number of tobacco users served. The level of services stayed relatively constant from FY09 to FY10 Median services budgets increased in the US but decreased in Canada from FY09 to FY10

For the first time, the median and total US quitline budgets decreased slightly in FY10 N=48 N=50 N=51

Median quitline budgets in Canada have decreased from FY09 – FY10 N=6 N=9 N=10N=9

US Spending per Smoker (services and medications) N=45 N=49 N=50

Canada Spending per Smoker (services), N=8 N=9

Funding Sources in FY10 and FY11 US FY10 (N=52) US FY11 (N=52) Canada FY10 (N=10) Canada FY11 (N=10) Public sector/government Local government funds 0% State/provincial general funds 25%26%100% State/provincial dedicated tobacco tax funds 21%24%0% State Medicaid program 4%6%0% MSA funds 46%45%0% Tobacco settlement funds (not MSA) 10%8%0% Federal CDC- ARRA/Stimulus funds 52%82%0% CDC - other (non-ARRA) funds 71%73%0% Health Canada 0% 60%30% Other 2% 0% Private sector/non-government Third part reimbursement through healthcare institution 0% Third part reimbursement through insurance company 8% 0% Charitable foundation 2% 10%30% For-profit company 0% 10% Non-governmental organization 2%0%20%10% Employer organization 0% Other2% 0%

More US quitlines report receiving funds from CDC or MSA funds than any other source

For US quitlines, the highest proportion of funds come from MSA, general funds, state tobacco taxes, and non-MSA tobacco settlement funds

The majority of Canadian quitlines report receiving funds from provincial general funds

For Canadian quitlines, the highest proportion of funds come from provincial general funds and Health Canada

DESCRIPTION OF SERVICES

General Service Description FY10 61 or 98% of quitlines responding reported having counseling services available at least five days per week for a minimum of eight hours per day 48 or 92% of US and 8 or 80% of Canadian quit lines also offered counseling service on at least one day of the weekend 28 quitlines (26 or 50% of US and 2 or 20% of Canadian) reported having live pick-up of incoming calls (may or may not have counseling services available) 24 hours a day, 7 days a week 96% of US (n=50) and 80% of Canadian (n=8) quitlines reported closing on holidays

Most US and Canadian quitlines provide multiple proactive counseling sessions FY10 Phone counseling services US N = 52 CAN N = 10 % (n) % (n) Minimal/brief intervention—client-initiated —1-10 minutes 33% (17) 100% (10) Single session counseling more than 10 minutes—client-initiated 71% (37) 100% (10) Multiple sessions—client-initiated (i.e., reactive, client calls in for each follow up) 42% (22) 100% (10) Multiple sessions—counselor-initiated (i.e., proactive, cessation specialist / counselor / coach calls client for follow up) 92% (48) 100% (10)

US and Canadian quitlines provide interactive web-based programs to help tobacco users quit FY10

Methods Offered to Providers to Refer Patients to Quitlines in FY10

How many call attempts were made to make first contact with a fax- or electronically-referred patient NMissingMinMaxMean US (N=52) Canada (N=10) Quitlines made between 3 and 4 attempts to reach fax- or e-referred patients in FY10

Used a translation service for hearing clients FY10

How many times was the translation service used to provide counseling to hearing clients NMissingMinMax Mean MedianSum US (N=52) Canada (N=10) Number of times translation service used for counseling hearing clients FY10

Quitline used a third party translation service for deaf and hard-of-hearing clients FY10

How many times was a third party translation service used to provide counseling to Deaf and Hard-of-hearing clients NMissingMinMax Mean MedianSum US (N=52) Canada (N=10) Number of times translation service used for counseling deaf and hard-of-hearing clients FY10

Number of Calls of Counseling Service by Language FY10 NMissingMinMaxMeanMedianSum US (N=52) English ,2818,2104,750320,180 Spanish48402, ,329 Asian Languages Canada (N=10) ) English731905,8991, ,911 French82016,8832,129317,029

The figure below shows the organizations (n=15) that were the primary service provider of counseling services for US quitlines US Primary Service Providers FY10

Canadian Service Providers FY10 The majority of Canadian quitlines (60%) had counseling services provided by the Canadian Cancer Society, Ontario Division 1111

MEDICATIONS

The number of US quitlines providing free medications has increased over time

Free Medication Provision – US Quitlines – FY10 Free Meds Type # Providing Type of Free Meds N (Providing weeks data) Median # of Weeks Provided Minimum # of Weeks Maximum # of Weeks Patch Gum Lozenge Bupropion Inhaler11888 Varenicline Nasal Spray 11888

PROMOTION AND OUTREACH

Types of Media/Promotions and Outreach Activities FY10&11, US Quitlines FY10 (N=52)FY11 (N=52) Paid Media/Promotions TV71%85% Radio63%83% Newspaper ads35%44% Billboards35%48% Online advertising48%65% Earned media85%83% Outreach Information display at health fairs, meetings, workshops, conferences88%87% Building healthcare referral networks87%96% Building other referral networks77%75%

Types of Media/Promotions and Outreach Activities FY10&11, US Quitlines (cont.) FY10 (N=52)FY11 (N=52) Social Media Facebook37%62% Myspace8%14% Twitter14%25% Other8% Other10%12%

Types of Media/Promotions and Outreach Activities FY10&11, Canadian quitlines FY10 (N=10)FY11 (N=10) Paid Media/Promotions TV70%50% Radio60%40% Newspaper ads60%50% Billboards0%10% Online advertising40%70% Earned media70%80% Outreach Information display at health fairs, meetings, workshops, conferences100%90% Building healthcare referral networks80%100% Building other referral networks90%

Types of Media/Promotions and Outreach Activities FY10&11, Canadian quitlines (cont.) FY10 (N=10)FY11 (N=10) Social Media Facebook60%70% Myspace10%0% Twitter30% Other10% Other20%

UTILIZATION

Utilization – Calls FY10 Total Calls NMissingMinMaxMedianMeanSum% of total US (N=52) Answered live ,5738,86815,704769,49783% Went to voic , ,3854% Pre-recorded message , ,2370.5% Hung up or abandoned , ,222106, % Total ,37110,05418,563928,146100% Canada (N=10) Answered live , ,72724,54493% Went to voic % Pre-recorded message % Hung up or abandoned % Total , ,93526,421100%

Number of unique tobacco users FY10 NMissingMinMaxMedianMeanSum US (N=52) Total unique users ,8375,6109,150439,185 Smokers calling for self ,2964,7118,701408,947 Other users calling for self 46652, ,067 Canada (N=10) Total unique users , ,27310,180 Smokers calling for self , ,2309,842 Other users calling for self

Number of referrals received by the quitline in FY10 Total CallsNMissingMinMaxMedianSum US (N=52) Fax referrals , ,887 EMR referrals Other referrals ,629 Total , ,485 Canada (N=10) Fax referrals 73231, ,931 EMR referrals Other referrals 8208,8121,2079,656 Total ,6031,74015,656

In FY10, US quitlines received 3.5 times as many direct calls from smokers as referrals; Canadian quitlines received 1.5 times as many referrals as direct calls from smokers

33% of US fax referrals received counseling or medications (N=40) 57% 72% 82% 33%

Average number of minutes of counseling and number of counseling calls completed FY10 Total CallsNMissingMinMaxMedianMean US (N=52) Minutes Calls Canada (N=10) Minutes Calls

US Promotional Reach FY

Canada Promotional Reach FY N=3 N=8 N=10N=9 N=8

Where are we now? FY10 Reach Promotional reach (# of unique tobacco users calling) Reach (N) Registration reach (# of tobacco users completing an intake) Reach (N) Treatment reach (# receiving evidence based services) Reach (N) U.S.1.15% (48)1.30% (52)1.09% (51) Canada0.21% (9)0.51% (3)0.31% (9)

Treatment Reach FY09-FY10 CanadaNMinMaxMeanActual %1.90%0.80%0.37% %1.79%0.49%0.31% USNMinMaxMeanActual %7.25%1.57%1.19% %6.66%1.45%1.09%

US Quitlines Treatment Reach and Spending Per Smoker (svcs + meds) FY10 CDC recommendation: 6% reach, $10.53 per smoker

Canada Quitlines Treatment Reach and Spending Per Smoker FY10 CDC recommendation: 6% reach, $10.53 per smoker

Additional Resource on Reach Increasing Reach of Tobacco Cessation QuitlinesIncreasing Reach of Tobacco Cessation Quitlines (2009) This technical assistance paper provides a comprehensive review of the current literature on a wide variety of strategies to increase reach of tobacco cessation quitlines. Additionally, several examples from practice are included. The paper also highlights recommendations for quitline reach and funding levels from key government and health agencies, highlighting the need to increase reach to more tobacco users to save lives and direct medical costs. Available at c_issuepaper_increasingre.pdf c_issuepaper_increasingre.pdf

Quit Rate Data 30 quitlines (of 65) provided quit rate data NAQC is following up with those that did not Further info will be provided on whether and how quit rate data will be added to the Quitline Metrics section of the profiles Current plan: report on quit rate in profiles, each quitline can opt out, all contextual factors will be posted in the “context” field

Survey Data Dissemination Process Late July Reach and spending benchmarking info sent to members Late July 2011 – Quitline Profile Updates Fall 2011 – Quit Rate information shared with members

WHO IS CALLING QUITLINES?

The majority of tobacco users receiving evidence-based services are cigarette users FY10 US (median) N=21

The majority of tobacco users receiving evidence-based treatment are everyday/daily smokers FY10 US (n=16) Canada (n=2)

Most tobacco users served with evidence- based services are female FY10 US (n=24)Canada (n=2)

Utilization FY10 – Age QuitlineCallers NMissingMinMaxMeanMedian US* (N=52) Mean Minimum Maximum Canada** (N=10) Mean Minimum Maximum * For the US, the number of callers on which the mean, minimum and maximum age were based ranged from a low of 123 to a high of 98,350. **For Canada, the number of callers on which the mean, minimum and maximum age were based ranged from a low of 1,189 to a high of 1,189.

Utilization FY10 – Level of Education US

Level of Education – Canada FY10

Utilization FY10–Ethnicity US

Utilization FY10–Race US

Utilization FY10 – Sexual Orientation QuitlineNumber of Callers NMissingMinMaxMeanMedian US (N=52) Straight ,8078,3547,616 Gay or lesbian Bisexual Transgender Other Refused Missing ,

Insurance Status of Callers FY10

Canadian quitlines received proportionally more registrants for web-based cessation services than US quitlines

EVALUATION

Evaluation FY10 38 US quitlines (73%) and 2 Canadian quitlines (20%) conducted follow-up evaluations in FY10 Most quitlines had follow-up evaluation conducted by: staff other than quitline staff (e.g., internal evaluation unit) (US n=20; Canada n=0), an outside evaluation firm (US n=15; Canada n=1) Next most commonly cited was evaluation conducted by: quitline staff (US n=5; Canada n=1) the funding agency (US n=1) an other source (US n=1)

Funding Sources for the FY 2010 NAQC Annual Survey of Quitlines Centers for Disease Control and Prevention, Office on Smoking and Health American Legacy Foundation NAQC Membership Dues

Recommended Citation: North American Quitline Consortium Results from the 2010 NAQC Annual Survey of Quitlines. Webinar presentation July Available at

For more information on the survey or on NAQC’s data request and review process, please contact; Jessie Saul, Ph.D. Director of Research North American Quitline Consortium 1300 Clay Street, Ste. 600 Oakland, CA Ph: x702