1. BluePrint for Health® stop-smoking program: Quit Outcomes Nina L. Alesci, M.P.H. Blue Cross and Blue Shield of Minnesota* Center for Tobacco Reduction and Health Improvement December 11, 2003 *an independent licensee of the Blue Cross and Blue Shield Association

2. Center for Tobacco Reduction & Health Improvement Presentation Outline  Brief Program Overview u Program components u Recruitment campaign  Outcomes: 12-month follow-up study u Evaluation methods u Results u Implications

3. Center for Tobacco Reduction & Health Improvement Smoking Prevalence by Blue Cross Population Source: 1999 Blue Cross Adult Tobacco Prevalence Survey

4. Center for Tobacco Reduction & Health Improvement Overview: stop-smoking program  Phone-based smoking cessation counseling  Six-month program  Behavior counseling provided by trained cessation specialists  Vendor: Behavioral Solutions, LLC in Princeton, NJ with call center in Rochester, NY  Launched in June 2000  Over 18,000 participants to date

5. Center for Tobacco Reduction & Health Improvement Counseling Options  Phone u Counseling and personalized guide: 4 Baseline 4 One month 4 Three months 4 Six months u 3 day post quit call u Self help manual  Mail-based option available

6. Center for Tobacco Reduction & Health Improvement Key Program Features  Proven scientific outcomes  Expert system-based counseling  Population-based: for all smokers not just the ready to quit  Stages of change: organizing concept based on levels of readiness to quit

7. Center for Tobacco Reduction & Health Improvement Population-based Recruitment  Mass Media: u 3 televised ads (2 new ads in Fall 2003)  Designed to attract those not ready to quit right away Key Messages u “We can work with that.” u “Quit in your own way, at your own pace.”

8. Center for Tobacco Reduction & Health Improvement Stages of Change: definitions  Precontemplation: not thinking about quitting smoking in the next 6 months  Contemplation: planning to quit smoking in the next 6 months  Preparation: planning to quit in the next month and have also tried quitting in the past 12 months  Action: quit smoking less than 6 months ago  Maintenance: quit smoking more than 6 months ago

9. Center for Tobacco Reduction & Health Improvement Recruitment: A Broad Cross-section of Smokers

10. Center for Tobacco Reduction & Health Improvement Outcomes Evaluation: 12-month Follow-up Study  Primary Objectives: u To detect proportion of participants who quit 12 months after first counseling session  Secondary Objectives: To detect... u Non-quitters’ changes in readiness to quit (i.e. stages of change), quit attempts, reduction u Use of pharmacological aids

11. Center for Tobacco Reduction & Health Improvement 12 month outcomes study: Summary and Implications  Over 3000 new non-smokers…and counting.  Several times more success quitting than general population.  Quit support medications double success.  The more sessions, the better.  The program works—ready or not!  “We can work with that” works!

12. Center for Tobacco Reduction & Health Improvement Methods:  Study Design: u Pretest Posttest, without control group  Respondents: u Census of 2,456 participants starting May- Sept. 2001 4 Participants: at least 1 counseling call u Included regardless of program completion u Receive $10 “thank-you” check in advance letter

13. Center for Tobacco Reduction & Health Improvement Methods:  Data collection: May to Sept. 2002 u 5-minute telephone interviews u Clearwater Research  Instruments: u Enrollment: demographics, smoking behavior u Follow-up: smoking status, quit attempts, Rx use  Analysis: u Response rate: 75.4%, N=1,496

14. Center for Tobacco Reduction & Health Improvement Results: Percent who quit  18.4% quit at follow-up. u Point prevalence quit: not smoking cigarettes, even a puff, in the past 7 days and not currently using other forms of tobacco u 12 months after baseline counseling session  Context: An estimated 2.5% of smokers nationwide quit yearly.

15. Center for Tobacco Reduction & Health Improvement Results: Increased Effectiveness with Medications  41% of respondents used cessation medications, such as Zyban or NRT.  This group was 1.8 times as likely to have quit one year later than those using only phone counseling.

16. Center for Tobacco Reduction & Health Improvement Results: Dose-response effect Quits by number of phone counseling sessions

17. Center for Tobacco Reduction & Health Improvement Stages of Change  Precontemplation - not ready  Contemplation - getting ready  Preparation - ready  Action - quitting  Maintenance - staying quit

18. Center for Tobacco Reduction & Health Improvement Results: Increased Success with Increased Readiness

19. Center for Tobacco Reduction & Health Improvement Results: Success among those not ready to quit  Unique media campaign & program… u 53% of all participants began as contemplators, or not ready to quit. u Attracts  9,500 participants not reached by traditional quit lines.  …leads to a new group of nonsmokers. u 40% of successful quitters began as contemplators. u Helps additional over 1,300 smokers quit.

20. Center for Tobacco Reduction & Health Improvement 12 month outcomes study: Summary and Implications  Over 3000 new non-smokers…and counting.  Several times more success quitting than general population.  Quit support medications double success.  The more sessions, the better.  The program works—ready or not!  “We can work with that” works!

21. Center for Tobacco Reduction & Health Improvement Emerging Developments Planned change - early 2004:  For members with NRT OTC coverage, replacing current prescription requirement with documented participation in BluePrint for Health® stop-smoking program

22. Center for Tobacco Reduction & Health Improvement Emerging Developments: Recruitment  New ad agency: Crispin Porter Bogusky, Miami, Florida u 2 new ads combine “why to quit” and “how to quit” message  Smoking Cessation Referrals in Pharmacies (“SCRIPS”) pilot  “Healthy Start” outbound calls to pregnant smokers who agree to be called  Mass mailing to past participants & those filing claims for cessation medications

23. Center for Tobacco Reduction & Health Improvement We make a healthy difference in people’s lives. Our Purpose