1. NYS Smokers’ Quitline Maximizing Quitline Reach NYS Smokers’ Quitline Maximizing Quitline Reach Ann Wendland, MSL NYSDOH Tobacco Control Program NYSSQL & NRT Programs Manager amw06@health.state.ny.us Paula Celestino Roswell Park Cancer Institute NYSSQL Project Director Paula.Celestino@roswellpark.org

2. New York State Tobacco Control Program New York State Tobacco Control Program  Goal: Reduce adult smoking prevalence to 12%  Current 2008: Adult smoking prevalence: 16.7% Currently 2.5 million smokers in NYS = 1 million fewer smokers in New Yorkers

3. NY TCP 3 Key Programmatic Strategies NYS Quitline functions one component of the broader NYS TCP Statewide and Community action Public Health communication Cessation interventions

4. Statewide and Community Action… to change the community environment to support a tobacco-free norm, change community attitudes about tobacco, and de-normalize tobacco use   Taxes   Clean Indoor & Outdoor polices/laws   Smoke-Free Dwellings   Reduce Tobacco Access   Reduce or Remove Retail Tobacco Advertising

5. Public Health Communication – to motivate tobacco users to stop, promote smoke-free homes, expose tobacco industry propaganda, deglamorize tobacco use, and educate community members and decision makers about tobacco control

6. NYTCP Strategies Using Media   Paid advertising on television, radio, print, Internet, and other venues to educate New Yorkers about the health risks of tobacco use and the dangers of secondhand smoke (SHS) motivate smokers to quit; and promote adoption of smoke-free homes and environments   Public relations and media advocacy (e.g., press releases, communications with decision makers) to increase coverage and discussion of tobacco control issues and events in the news media; and supplement paid advertising

7. Percentage of Adult Smokers Who Made at Least One Quit Attempt During the Past 12 Months by Recall of NY TCP Ads, ATS 2003–2008

8.  Health Systems Change  Referral Networks  Quitline  NRT Distribution Program  FQHC initiative Cessation Interventions to establish and maintain systems changes that promote cessation, increase access to and delivery of evidence based cessation services, and motivate individual tobacco users to quit successfully

9. Health Care Organization and Provider Awareness of Cessation Resources in New York State Health Care Organization and Provider Study (HCOPS) 2004–2005 and 2007

10. Influences on Quit Attempts in the Past 12 Months (Odds Ratios), ATS

11. …NYSSQL Service Goal… Extend NYS’ population health model to the Quitline and function within its comprehensive TCP approach to advance the goal of reducing adult smoking prevalence.

12. 2 Key Ingredients to reduce prevalence Reach X Efficacy = Impact Population + evidence-based service = Impact 2010 Goal: Reduce adult smoking prevalence to 12%

13. Ready to Quit within 30 days:   Quit coaching in English or Spanish (other languages available through translators) plus free quit materials   Two week starter kit of Nicotine Replacement Therapy (NRT), choice of patch gum or lozenge   NRT check callback- verify delivery   One scheduled coaching callback Already Quit:   Relapse prevention coaching and support materials Not Ready to Quit within 30 days:   Brief ‘5 R's’ coaching and support materials Web-based services:   NRT application   Web-based community support   Tailored programming (winter 2009) Services

14. NYS Strategies to Increase Quitline Reach Link policy change media (earned & paid) with Quitline Run Hard Hitting Paid Media tagged with Quitline/Quitsite TV Radio Print Internet Collateral Media Outlets Free 2 week NRT starter kit Build Referral Networks Quitline Infrastructure & efficiency

15. Media   NYS Annual media campaigns since 2004   NYC Annual media campaigns since 2003   Concurrently run ads in multi-media venues (TV, Print, radio, internet)   Strategically placed (type of ads and timing of ads)

16. Media Campaigns & Tax Increases & Call Volume

17. NRT Offer   Offer of free NRT drives calls/web applications   Promote offer through Ads Earned media Direct mail Email notices NYS TC Partners Network

18. NYC NRT offer announcement April 2003

19. Online NRT Since July 2006

20. Added Enhancement to NYSSQL NRT Services via Online Registration: Jan. 1, 2008 - Current Average Daily NRT Registrations per Hour

21. Referral Networks   19 Regional Cessation Centers   28 Community Partnerships   Statewide umbrella groups   Health Plans   Health Care Providers   Local Health Departments

23. How & Why these strategies helped maximize reach Comprehensive approach addresses social norms, attitudes and beliefs, promotes education and awareness and offers assistance. Consequently smoking-related behaviors in NY have changed over time:  Increase in smoke-free homes and cars  Increase in use of Quitline  Increase in number of individuals trying to quit Significantly higher than national average  Average number cigarettes smoked per day decreased

24. Percentage of Adult Smokers Who Have Heard of the New York State Smokers’ Quitline, Adult Tobacco Survey (ATS) 2003–2008

25. NYC Free NRT Growth since 2004 Call volume up 94% NRT shipments up 277% Hits to website up 550% (since 2006) NYS starts free NRT Mass media campaigns

26. Lessons Learned   Focus–group tested ads   Loss framed ads result in larger call spikes   Secondhand smoke ads can sustainably drive calls when content triggers loss emotions   Loading ads on Mon, Tues & Wed   Awareness of phone & web-based offer of NRT   Sustainability & reliability drives returning clients and word of mouth referrals

27. Notable Challenges to date   Approval Process for Campaigns   Controversial ads   Balancing push & pull ads and ad saturation   Balancing call volume with Quitline capacity   NRT supply

28. Moving forward   Continuing evaluations of reach, ads/program impact (RTI)   Implementation of media messages and online cessation study   Continue to build cost-efficient Quitline/Quitsite services to expand capacity

29. If a state wants to increase their reach, what is your best advice?   Comprehensive tobacco programming   High sensation value ads   Build referral networks   Offer NRT   Quitline as a population health model   Balance degree of service in order to maximize reach and build capacity   Sustainability

30. Contact Information Paula Celestino Paula.Celestino@RoswellPark.org (716) 845-8817 Ann Wendland, MSL amw06@health.state.ny.us (585) 423-8151 New York State Smokers' Quitline Roswell Park Cancer Institute Elm & Carlton Sts. Buffalo, NY 14263 Fax: 716-845-4135