QuitlineNC Funding

Surgeon General’s Report Tobacco use in NC Deaths in North Carolina from Smoking 14,200 adults who die each year from their own smoking 180,000 youth under 18 in NC will ultimately die prematurely from smoking “Smoking is a major cause of cardiovascular disease (CVD), which is the single largest cause of death in the US. Smoking causes one out three deaths from CVD.” Surgeon General’s Report Source: Campaign for Tobacco-Free Kids. Toll of Tobacco in North Carolina 2016. <http://www.tobaccofreekids.org/facts_issues/toll_us/north_carolina>.

“Tobacco is either Pay Now or Pay (much more) Later”… Smoking-related Monetary Costs in NC $3.81 billion in annual health care costs in NC caused by smoking $931.4 million in Medicaid costs in NC caused by smoking

What Works? A Combination of Counseling and Medications Tobacco Treatment: Varenicline -Or- Combination Nicotine Replacement Therapy (NRT) Nicotine Patch to Treat addiction Nicotine Gum or other fast- acting NRT for break-through cravings At least 8-12 weeks is recommended Counseling: In-person Telephone Group Counseling At least four sessions is best plus Varenicline is called Chantix in the marketplace. NRT is Nicotine Replacement Therapy

6 Month Quit Rates Comparison The first bar in this graph is from national data on quit rates from physician advice to quit smoking with no other tobacco treatment interventions. The three lower bars in this graph represent recent data is from the independent evaluation of QuitlineNC. *Fiore, Treating Tobacco Use and Dependence, Clinical Practice Guidelines 2008 Update ** Alere Wellbeing and TPEP, QuitlineNC Comprehensive Evaluation Reports ***State Health Plan for Teachers & State Employees, Evaluation Report, 2017 Responder rates at 30 days point prevalence

QuitlineNC Can Offer these Services with a Strong Return on Investment Evidence-based tobacco treatment services to anyone from NC who wants to quit smoking/tobacco use, including quitting e-cigarettes Quit Coaching is available 24/7 in different forms (e.g. Phone, Texting, Web coach, Spanish Language, etc.) Evidence-based, proactive 4-call program to all callers 10-call proactive coaching program for pregnant/postpartum women for additional coaching/support Can provide combination nicotine-replacement therapy This is standard of care for treating tobacco addiction Return on investment is between $3 and $4 saved for every $1 invested. Bigger ROI if folks use the full service. Evidence-based tobacco treatment services to any North Carolina resident who needs help quitting smoking/tobacco use, including quitting e-cigarettes Quit Coaching is available 24/7 in different forms, which can be used separately or together, to help any tobacco user give up tobacco (e.g. Phone, Web coach, Spanish Language, etc.) Evidence-based, proactive 4-call program to all callers 10-call proactive coaching program for pregnant and postpartum women for additional coaching and support Can provide combination nicotine-replacement therapy (standard of care for treating tobacco addiction)

Current QuitlineNC Capacity Demand for QuitlineNC Services Continues to Exceed Funding Current QuitlineNC Funding Current QuitlineNC Capacity Recurring state funding at $1.35 million $267,000 from Medicaid Federal Financial Participation (FFP) QuitlineNC is the #1 Referral source for NC providers who want to help their patients quit About 28% of QuitlineNC callers are on Medicaid Most tobacco users want to quit. 63% of NC tobacco users tried to quit in 2015! QuitlineNC can treat 14,000 tobacco users with current state funding (0.93% of total tobacco smokers) TPCB has had to cut services for insured callers to a much less effective 1-call program and no NRT since 2016 to avoid running out of funds. CDC recommends that Quitlines work to reach 8% of tobacco users. SC has $5million for tobacco cessation (and they are a much smaller state). Because demand continues to exceed funding available, QuitlineNC must scale back services to less than the most effective services in order to keep the QuitlineNC open for business all year. Thus, since 2016, North Carolinians who want help quitting that have health insurance only get ONE CALL, so that the limited resources can be available for Medicaid and the Uninsured.

QuitlineNC Funding Proposal Direct tobacco cessation services $2,127,000 Community education funding $850,000 Evaluation, accountability, and data management $290,000 $3,000,000 Total Request: Expand state QuitlineNC funds in NC by $3,000,000 for a total of: $4,350,000 NOTE: Training for clinical providers ($250,000 in Recurring funds) was in the 2017-17 budget for You Quit Two Quit This would increase reach to 1.64% of tobacco users in NC, treating an additional 9,000 tobacco users It would also help promote tobacco cessation in NC communities

Happy QuitlineNC Callers: 93% satisfaction rate for ten years! More than half are very satisfied. "I really wish every state had this program. I am really, really amazed by this program." DB, Wake “My blood pressure is down, my blood sugar is better, and I got to avoid taking insulin.” LN, Forsyth “I have been quit for a year …and I wanted to call to thank you guys for helping me. “ HE, Rutherford Patients are very satisfied. These are comments from Quitline participants in the past four months.

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