1. Arizona Adult Tobacco Survey Response to Health Professional Query Behavior Richard S. Porter, MS Bob Leischow, MPH Arizona Department of Health Services

2. Background 1994, the Tobacco Tax and Health Care Act voter approved –increased the sales tax on tobacco products –allocated a portion of the revenues for tobacco control activities 1995, Arizona Department of Health Services established the Tobacco Education and Prevention Program (TEPP)

3. Surveillance 1996, TEPP conducted the Arizona Adult Tobacco Survey to establish prevalence of tobacco use among 6,000 adults 18 years and older. 1999, a follow-up adult survey was conducted among 4,898 adults. CASRO Rate: 1996- 83.4% 1999- 74.6%

4. Methodology Samples randomly drawn from residential telephone numbers and administered using a Computer Assisted Telephone Interview (CATI) system Administered in both English and Spanish Information collected on tobacco use, quitting behavior, impact of cost on use, ETS, health professional counseling practices, tobacco knowledge, media, and demographics Data analysis completed using weighted data

5. Demographic Profile of Survey Sample

6. Limitations Statewide surveillance data does not establish a direct causal relationship between the TEPP efforts and adult prevalence rates. However, there is only one (1) statewide tobacco control program in Arizona. The ACTEV project is analyzing cessation data at the local and state levels. The Arizona Smokers’ Helpline is determining quit rates among those clients who have entered their cessation counseling services. The media campaign continues to evaluate their effectiveness at the local and state levels. Survey excluded those households without a telephone. However, the sample size was large enough to draw general conclusions.

7. * Statistically Significant

8. Questions asked of Adult Respondents 1. In the last 12 months did a medical practitioner such as a doctor, a nurse practitioner, or a physicians assistant discuss smoking with you at all? 2. In the last 12 months did a medical practitioner such as a doctor, a nurse practitioner, or a physicians assistant advise you to stop smoking? 3. Did you try to quit when a medical practitioner advised you to stop smoking? 4. In the last 12 months did a dental professional such as a dentist or dental hygienist discuss smoking with you at all? 5. In the last 12 months did a dental professional such as a dentist or dental hygienist advise you to stop smoking? 6. Did you try to quit when a dental professional advised you to stop smoking?

9. Responses of Adults to the Medical Practitioner Questions 1996 1999 (n=1,670) (n=1,249) Question % (95% CI) % (95% CI) p value In last year did MD, Nurse practitioner 30.9 ± 2.8 43.7 ± 3.7 <.001 or PA ask you about smoking? If yes, did they advise you to stop smoking? 81.3 ± 4.0 83.9 ± 4.0.379 Tried to quit when 30.0 ± 5.4 31.0 ± 5.7.747 advised

10. Responses of Adults to the Dental Practitioner Questions 1996 1999 (n=1,670) (n=1,249) Question % (95% CI) % (95% CI) p value In last year did a Dentist ask you 13.7 ± 2.231.6 ± 5.4 <.001 about smoking? If yes, did they advise you to stop smoking? 72.1 ± 7.8 78.9 ± 6.8.022 Tried to quit when 24.6 ± 8.3 22.6 ± 9.5.625 advised

11. Conclusions Among adult smokers in Arizona there was a significant increase in the proportion of Medical practitioners who asked about smoking in 1999 compared to 1996. Dentists asked their smoking patients more often about smoking in 1999 compared to 1996. Patients who were asked about smoking were advised 70-80% of the time to quit. The Arizona Health Care Partnership sponsored by TEPP appears to be having some positive effect on Medical Professionals behavior.

12. TEPP Structure Community-based “local projects” Media campaign “Statewide projects” –Arizona Tobacco Information Network (ATIN) –Arizona Cessation Training and Evaluation (ACTEV) Pilot Projects –Women, Infant and Children cessation project –“CHAMPS” Peer-led prevention project

13. Local projects Media campaign “Statewide Projects” -Az Tobacco Information Network -Az Cessation Training and Evaluation Integrated efforts: Pilot Projects: *CHAMPS *WIC

14. Local Projects Coalition building and maintenance Prevention –School-based, community-based, youth access Cessation –Youth, adults, health care providers, preg/postpartum women and partners Creating Tobacco Free Environments –Homes, schools, workplaces, public places

15. Arizona Health Care Partnership Sponsored and administered by the AzTEPP Goal: Integrate comprehensive, innovative, and evidence- based tobacco prevention and cessation into Arizona healthcare systems. Member representation (partial list): –Managed care organizations –Pharmacies –Medical associations –VA –Arizona Health Care Cost Containment System (state Medicaid agency) –Foundation for Cardiovascular Health –Universities –Arizona Department of Health Services

16. Health Care Systems - Training Based on the Public Health Services Guideline for Treating Tobacco Use and Dependence Designed to educate and assist health care clinicians, administrators, and purchasers of health care in the development and implementation of tobacco cessation policies and procedures into systems.

17. Speakers’ Bureau – Training Goal: To train Arizona healthcare professionals in the application of best practices in tobacco control within healthcare and clinic settings. CME/CEU approved by a number of professional associations. Member representation (partial list): –American Cancer Society –Arizona Health Care Cost Containment System –Arizona Latin-American Medical Association –Community-based organizations –Managed care organizations –Hospitals –Maricopa County Office of Oral Health –VA –Arizona Department of Health Services