Highlights from the 2009 NAQC Annual Survey of Quitlines Prepared by: ERDU, Mignonne Guy, Jessie Saul, and the NAQC Annual Survey Workgroup July 22, 2010

Background of Annual Survey Conducted Annually , 2008, 2009 Research Partners: –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 Informs research and practice Is an iterative process

2009 Annual Survey Methods 2009 Survey completed in Two Waves Wave 1 -based with telephone follow-up: –Questions: 1) Quitline budgets, changes over time, impacts, 2) Funding sources, 3) Promotion and utilization of services, and 4) Surges in call volume and impacts Wave 2 web-based with telephone follow-up: –Questions: 1) General Information, hours, services offered, 2) Materials used, 3) Counselling services and protocols, 4) Utilization, and 5) Evaluation 63 quitline funders and their service providers were asked to respond: 53 US and Territories quitlines (100% Wave 1, 98% Wave 2) 10 Canadian quitlines (100% Wave 1 and 2)

BUDGET

For the first time, the median and total US quitline budgets decreased in FY10

Median quitline budgets in Canada have stayed relatively constant from FY05 – FY10

Median budget for services and medications US,

Median budget for services Canada,

The majority of US quitlines report receiving funds from CDC or MSA funds

For US quitlines, the highest proportion of funds come from MSA, general funds, and dedicated tobacco tax funds

The majority of Canadian quitlines report receiving funds from provincial general funds or Health Canada

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

DESCRIPTION OF SERVICES

General Service Description FY09 All quitlines responding reported having counseling services available at least five days per week for a minimum of eight hours per day 49 or 94% of US and 9 or 90% of Canadian quit lines also offered counseling service on at least one day of the weekend 13 quitlines (11 or 21% 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 77% of US (n=41) and 80% of Canadian (n=8) quitlines reported closing on holidays

All US and Canadian quitlines provide multiple proactive counseling sessions FY09 Phone counseling services US N = 53 CAN N = 10 % (n) % (n) Minimal/brief intervention—client-initiated —1-10 minutes 57% (30) 100% (10) Single session counseling more than 10 minutes—client-initiated 72% (38) 100% (10) Multiple sessions—client-initiated (i.e., reactive, client calls in for each follow up) 45% (24) 100% (10) Multiple sessions—counselor-initiated (i.e., proactive, cessation specialist / counselor / coach calls client for follow up) 100% (53) 100% (10)

More Canadian than US quitlines provide interactive web-based programs to help tobacco users quit FY09 Internet-based services US N = 53 CAN N = 10 % (n) % (n) Information about the quitline 72% (38) 80% (8) Information about tobacco cessation 74% (39) 80% (8) Self-directed web-based intervention to help tobacco users quit 42% (22) 70% (7) Automated messages 30% (16) 50% (5) Chat rooms 28% (15) 70% (7) Interactive counseling and/or messaging to cessation specialist/counselor/ coach to help tobacco users quit 28% (15) 40% (4)

Nearly all US and Canadian quitlines refer to other services, have fax referral programs, and mail information to tobacco users FY09 Other services US (n = 53) CAN (n = 10) % (n) % (n) Voice mail with call backs or mailed information or self-help resources 59% (31) 70% (7) Recorded messages for help with quitting (e.g., phone tree) 59% (31) 20% (2) Referral to other services 94% (50) 90% (9) Fax referral for healthcare providers and other referral sources 94% (50) 100% (10) Mailed information or self help resources (provided through the quitline) 83% (44) 90% (9) Text messaging to cell phones (integrated with telephone counseling) 2% (1) 10% (1) IVR (Interactive Voice Response) (integrated with telephone counseling) 2% (1) 20% (2) Other 15% (8) 0% (0)

Language of Counseling Service FY

US Primary Service Providers FY The figure below shows the organizations (n=17) that were the primary service provider of counseling services for US quitlines

Canadian Service Providers FY09 The majority of Canadian quitlines (60%) had counseling services provided by the Canadian Cancer Society, Ontario Division

Language of Cessation Materials FY

Specialized Materials for Special Populations FY09 51 US quitlines (96%) and 6 Canadian quitlines (60%) send specialized materials to special populations. These include:

Specialized Materials for Racial/Ethnic Populations FY09 76% of US and 10% of Canadian quitlines offers specialized materials to callers of racial/ethnic populations. These include:

MEDICATIONS

Provision of Quitting Medication FY09 PatchGumLozengeZybanChantix Nasal Spray Inhaler ANY Meds US (N=53) Provide free medication 76%60%42%4%2% 4%70% Provided discounted meds 8% 4%6%4% 8% Provided voucher to redeem meds 9%8% 6%8%6% 9% Canada (N=10) Provide free medication Provided discounted meds Provided voucher to redeem meds

Free Medication Provision US Quitlines, FY09 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 Zyban Inhaler22528 Chantix1112 Nasal Spray 11888

Provision of Quitting Medication FY10 PatchGumLozengeZybanChantix Nasal Spray Inhaler US (N=53) Provide free medication 79%60%42%6%4%2% Provided discounted meds 4% 2%4%2% Provided voucher to redeem meds 4%2% 4%6%2% Canada (N=10) Provide free medication Provided discounted meds Provided voucher to redeem meds

Free NRT Eligibility Criteria US (N=52), FY10 Of the 52 US quitlines providing some form of free meds, the eligibility criteria included:

PROMOTION AND OUTREACH

Types of Media/Promotions and Outreach Activities FY09-10, US Quitlines FY09 (N=52)FY10 (N=52) Paid Media/Promotions TV73%58% Radio62%65% Newspaper ads40%35% Billboards35%25% Online advertising40%52% Earned media73% Outreach Information display at health fairs, meetings, workshops, conferences 88%85% Building healthcare referral networks79%88% Building other referral networks75%77% Other25%31%

Types of Media/Promotions and Outreach Activities FY09-10, Canadian quitlines FY09 (N=10)FY10 (N=10) Paid Media/Promotions TV70%80% Radio60%50% Newspaper ads70%60% Billboards10% Online advertising70%80% Earned media90%100% Outreach Information display at health fairs, meetings, workshops, conferences 100%90% Building healthcare referral networks100% Building other referral networks80%100% Other30%60%

Promotions/Outreach for Priority/Specialized Populations FY

UTILIZATION

US Promotional Reach FY

Canada Promotional Reach FY

Where are we now? 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)

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

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

The majority of quitline callers are cigarette users FY09 US (median)Canada (median)

The majority of quitline callers are everyday/daily smokers FY09 US (median)Canada (median)

Most quitline callers are female FY09 US (median)Canada (median)

Utilization FY09 – Level of Education US

Utilization FY09– Ethnicity and Race US

Insurance Status of Callers FY09

EVALUATION

Evaluation FY09 50 US quitlines (94%) and 4 Canadian quitlines (40%) conduct follow-up evaluations Most quitlines have follow-up evaluation conducted by: staff other than quitline staff (e.g., internal evaluation unit) (US n=24; Canada n=1), an outside evaluation firm (US n=18; Canada n=2) Next most commonly cited was evaluation conducted by: quitline staff (US n=13; Canada n=1) the funding agency (US n=4) an other source (US n=2)

Evaluation FY09 The types of evaluation data collected by those quitlines that conduct follow-up evaluations include: Customer satisfaction: US (94%, 50), Canada (40%, 4) Quitting outcome: US (94%, 50), Canada (30%, 3) Staff performance: US (70%, 37), Canada (10%, 1)

Evaluation – Sampling Strategy FY09 The sampling strategy used by Quitlines for follow-up evaluations include: Random sampling: US (53%, 28), Canada (10%, 1) Census Sampling (all callers): US (45%, 24), Canada (10%, 1) Continuous sampling (year-round): US (26%, 14), Canada (10%, 1) Cohort sampling (time-limited): US (8%, 4), Canada (10%, 1) Periodic sampling (within one year or across multiple years): US (6%, 3), Canada (10%, 1)

Evaluation – Sampling Time Points FY09 N% US (N=53) 3 months after registration/first contact months after registration/first contact months after registration/first contact months after registration/first contact months after registration/first contact months after registration/first contact1325 Other24 Canada (N=10) 7 months after registration/first contact110 Other220

Evaluation – Sampling Criteria FY09 US (N=53)Canada (N=10) Sample all those who…N%N% Call (regardless of reason)611-- Are current tobacco users at first call Are former tobacco users at first call Are 18 years and older Register for counseling Receive counseling (begin first call) Receive medications713-- Consent to follow-up Set a quit date36110 Complete all counseling session36--

ADDITIONAL INFORMATION AND RESOURCES

2009 Annual Survey Web Page

Using Annual Survey Data

NEW! Quitline Map click on “About Quitlines/Quitline Map”

NEW! Revised Quitline Profiles Same information Phone numbers Hours of operation Languages Services offered Materials provided Medications Service provider Eligibility New information Provider (e.g., fax) referral information Smoke-free laws Tobacco tax rates Quitline metrics (reach, spending per smoker, quit rate) Context for quitline metrics

New controls for profiles Each quitline will be able to edit most profile fields in real-time Launch and training for new profiles in Fall, 2010

SURVEY FEEDBACK AND QUESTIONS Feedback from members about FY09 survey process, suggestions for 2010 survey 2010 survey timeline: Finalize survey by July 31 Launch in October 2010 Data collection Oct-Nov 2010

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 3030 N. Central Ave, Ste 602 Phoenix, AZ Ph: