Results from the 2009 NAQC Annual Survey of Quitlines Prepared by: ERDU, Mignonne Guy, Jessie Saul, and the NAQC Annual Survey Workgroup June 30, 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

US Quitline Budgets FY09 (N=53) Budget CategoryNMissing Median (Min – Max) Sum Total503 $1,681,961 ($77,218 – 17,869,238) $122,887,769 Services512 $787,978 ($52,218 – 4,596,928) $55,847,009 Medications3914 $225,000 ($0 – 5,862,815) $19,917,311 Evaluation3716 $75,000 ($0 – 451,432) $3,310,924 Media/promotions458 $404,915 ($0 – 9,000,000) $39,433,161 Outreach3419 $49,592 ($0 – 1,816,750) $8,017,232 Other2132 $0 ($0 – 380,000) $1,470,311 Tobacco control458 $9,500,000 ($206,570 – 84,363,000) $604,472,737

Canadian Quitline Budgets FY09 (N=10) Budget CategoryNMissingMedianSum Total100$218,200$6,869,910 Services100$160,990$3,488,181 Medications19$0$12,000 Evaluation64$3,000$391,000 Media/promotions82$55,750$1,195,603 Outreach82$84,624$4,087,156 Other55$40,000$708,000 Tobacco control55$2,400,000$93,510,000

US Quitline Budgets FY10 (N=53) Budget CategoryNMissing Median (Min – Max) Sum Total503 $1,336,680 ($45,000 – 20,547,542) $114,330,597 Services503 $729,690 ($40,000 – 4,685,335) $52,637,682 Medications4211 $300,000 ($0 – 4,500,000) $22,468,547 Evaluation3617 $52,682 ($0 – 451,433) $3,236,845 Media/promotion467 $264,500 ($0 – 4,818,000) $25,933,125 Outreach3122 $34,750 ($0 – 720,000) $3,916,105 Other2231 $0 ($0 – 463,039) $1,016,601 Tobacco control449 $7,283,505 ($206,570 – 68,002,700) $503,835,153

Canadian Quitline Budgets FY10 (N=10) Budget CategoryNMissingMedianSum Total100$202,000$7,531,403 Services100$161,550$3,627,774 Medications37$0 Evaluation55$3,000$368,000 Media/ promotions 91$60,000$1,650,511 Outreach82$92,532$4,315,718 Other55$15,000$569,400 Tobacco control55$2,400,000$73,899,000

Impact of change in budget from FY09 to FY10 US (N=52)Canada (N=10) No Impact42%50% Eligibility criteria for counseling will change6%0% Number of counseling sessions will change4%0% Counseling protocol will change6%20% Amount or type of NRT provided per caller will change27%0% Eligibility criteria for NRT will change15%0% Promotional budget will change42%40% Types of promotion will change29%20% Targets for promotion will change17%10% Other21%10%

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,

Funding Sources in FY09 US (N=52)Canada (N=10) Public sector/government Local government funds 0%10% State/provincial general funds 23%90% State/provincial dedicated tobacco tax funds 19%0% State Medicaid program 6%0% MSA funds 50%0% Tobacco settlement funds (not MSA) 6%0% Federal CDC 90%0% Health Canada 0%60% Other 0% Private sector/non-government Third part reimbursement through healthcare institution 0% Third part reimbursement through insurance company 6%0% Charitable foundation 2%20% For-profit company 0%10% Non-governmental organization 2%30% Employer organization 0% Other 8%0%

Funding Sources in FY10 US (N=52)Canada (N=10) Public sector/government Local government funds 0%10% State/provincial general funds 29%80% State/provincial dedicated tobacco tax funds 15%0% State Medicaid program 4%0% MSA funds 48%0% Tobacco settlement funds (not MSA) 6%0% Federal CDC 81%0% Health Canada 0%60% Other 0% Private sector/non-government Third part reimbursement through healthcare institution 0% Third part reimbursement through insurance company 8%0% Charitable foundation 4%20% For-profit company 0%10% Non-governmental organization 2%30% Employer organization 0% Other 8%0%

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

Funds by Different Sources FY09 – US (N=53) NMissingMinMaxMedianSum Local government funds State/provincial general funds State/provincial dedicated tobacco tax funds State Medicaid program MSA funds Tobacco settlement funds (not MSA) Federal – CDC Private sector/non- government Other

Funds by Different Sources FY09 – Canada (N=10) NMissingMinMaxMedianSum Local government funds State/provincial general funds State/provincial dedicated tobacco tax funds State Medicaid program MSA funds Tobacco settlement funds (not MSA) Federal – Health Canada Private sector/non- government Other

Funds by Different Sources FY10 – US (N=53) NMissingMinMaxMedianSum Local government funds State/provincial general funds State/provincial dedicated tobacco tax funds State Medicaid program MSA funds Tobacco settlement funds (not MSA) Federal – CDC Private sector/non- government Other Quitlines were asked to report the proportion of total funds provided by different funding sources

Funds by Different Sources FY10 – Canada (N=10) NMissingMinMaxMedianSum Local government funds State/provincial general funds State/provincial dedicated tobacco tax funds State Medicaid program MSA funds Tobacco settlement funds (not MSA) Federal – Health Canada Private sector/non- government Other Quitlines were asked to report the proportion of total funds provided by different funding sources

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)

Quitline Services Provided in FY10

FY09 Web Based Cessation Services in Your State Not Offered by the Quitline US (N=53)

FY09 Other Cessation Services in Your State Not Offered by the Quitline – US (N=53)

FY09 Web Based Provincial Cessation Services Not Offered by the Quitline Canada (N=10)

FY09 Other Provincial Cessation Services Not Offered by the Quitline – Canada (N=10)

Language of Counseling Service FY

Hours Per Week of Counseling Service Availability by Language FY09 NMissingMin hrs/wk Max hrs/wk Median hrs/wk US (N=53) English Spanish Cantonese15274 Mandarin Korean15274 Vietnamese15274 Canada (N=10) English French557278

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:

Promotions/Outreach for Priority/Specialized Populations FY

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:

Specialized Counseling Protocols FY09 94% of US and 90% of Canadian quitlines use specialized counseling protocols for special populations. These include:

Eligibility Criteria for Counseling FY09 94% of US and 80% of Canadian quitlines have eligibility criteria for callers to receive counseling. These include:

Eligibility Criteria for Counseling FY10 98% of US and 100% of Canadian quitlines have ‘resident of state or province’ as an eligibility criterion for callers to receive counseling. Other criteria include:

Eligibility Criteria for Different Levels of Service FY09 20 US quitlines (38%) and 7 Canadian quitlines (70%) have different eligibility criteria for different levels of service Open-ended responses described eligibility criteria for differing level of service including: Increased sessions depending on readiness to quit (n=12, US and n=6, Canada) Increased sessions for pregnant women (n=7, US) Increased sessions for youth (n=4, US) Increased sessions for uninsured or Medicaid/Medicare/VA/IHS insured (n=8, US) Employee or dependent of the public service (n=1, Canada)

MEDICATIONS

Provision of Quitting Medication FY09 PatchGumLozengeZybanChantixNasal Spray InhalerANY 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

Provision of Information about Quitting Medication FY09 PatchGumLozengeZybanChantixNasal SprayInhaler US (N=53) Provided info about using meds 96%94%91%87%83%49% Referred to organization that provides meds 45%42%38%32%36%17% Provided info about accessing meds 36%34%28%30%38%23%21% Canada (N=10) Provided info about using meds 100% 20%100% Referred to organization that provides meds 20% 10%20%10%20% Provided info about accessing meds 50% 10%20%10%-20%

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

Eligibility Criteria for Free Medications FY09, US (N=53)

Provision of Quitting Medication FY10 PatchGumLozengeZybanChantixNasal Spray InhalerANY Meds US (N=52) Provide free medication 79%60%42%6%4%2% -- Provided discounted meds 4% 2%4%2% -- Referred to organization that provide free/discounted products 21%--17%--15%--6%-- Provided voucher to redeem meds 4%2% 4%6%2% -- Provided info to use medication 75%--67%--60%--52%-- Provided info about accessing free/reduced-cost meds 29%--23%--23%--15%--

Provision of Quitting Medication FY10 PatchGumLozengeZybanChantixNasal Spray InhalerANY Meds Canada (N=10) Provide free medication -- Provided discounted meds -- Referred to organization that provide free/discounted products 20%--10%--10%--10%-- Provided voucher to redeem meds 100%--100%--90%--90%-- Provided info to use medication -- Provided info about accessing free/reduced-cost meds 50%--20%--30%--20%--

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

Reduced-Cost NRT Eligibility Criteria US (N=6), FY10 Of the 6 US quitlines providing some form of reduced-cost NRT, the eligibility criteria included:

PROMOTION AND OUTREACH

Promotions and Referral Networks to Increase Reach to Tobacco Users FY09

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, conferences88%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, conferences100%90% Building healthcare referral networks100% Building other referral networks80%100% Other30%60%

UTILIZATION

Number of referrals received by the quitline in FY09 Other includes web referrals, “click to call”, online ads Total CallsNMissingMinMaxMedianSum% of total US (N=53) Fax referrals % Other referrals % Total % Canada (N=10) Fax referrals % Other referrals % Total %

Utilization – Calls FY09 Total Calls NMissingMinMaxMedianSum% of total US (N=53) Answered live % Went to voic % Hung up or abandoned % Total % Canada (N=10) Answered live % Went to voic % Hung up or abandoned % Total %

Number of unique tobacco users FY09 NMissingMinMaxMedianSum US (N=53) Canada (N=10)

U.S. Quitlines Utilization – Received Service FY09 Tobacco Users Who Received Service NMissingMedian (Min,Max)Sum US (N=53) Self-help Materials (0,12087)50602 Any amount of counseling (65,26992) Medication received (0,9378) Total served with evidence-based services (counseling or meds) (81,159635)485225

Canadian Quitlines Utilization – Received Service FY09 Tobacco Users Who Received Service NMissingMedian (Min,Max) Sum Canada (N=10) Self-help Materials (71,301)372 Any amount of counseling (1347,1612)4404 Medication received 3700 Total served with evidence-based services (counseling or meds) (1347,1612)4404

US Promotional Reach FY

Canada Promotional Reach FY

Where are we now? FY09 ReachPromotional reach (# of tobacco users completing an intake) Median (N) Treatment reach (# receiving evidence based services) Median (N) U.S.1.2% (49)0.7% (46) Canada0.3% (9)0.3% (3)

Promotional reach CanadaNMinMaxMeanMedian %1.97%1.16%1.06% %2.7%0.75%0.49% %0.94%0.52%0.54% %1.37%0.38%0.27% USNMinMaxMeanMedian %4.28%0.99%0.50% %5.8%1.10%0.68% %5.92%1.66%0.89% %9.84%1.89%1.18%

Treatment Reach FY09 CanadaNMinMaxMeanMedian %1.90%0.80%0.27% USNMinMaxMeanMedian %7.25%1.57%0.68%

Promotional Reach and spending benchmarking – US FY09

Treatment reach and spending benchmarking – US FY09

Promotional Reach and spending benchmarking – Canada FY09

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

Demand Greater Than Capacity for Service Delivery FY

#78 Surge in Call Volume in FY

Impact of Surge in Call Volume FY09 US (N=36)Canada (N=2) No Impact31%100% Eligibility criteria for counseling changed8%-- Number of counseling sessions changed8%-- Counseling protocol changed25%-- Amount or type of NRT provided per caller changed17%-- Eligibility criteria for NRT changed3%-- Promotional budget changed6%-- Types of promotion changed17%-- Targets for promotion changed6%-- Other31%--

Utilization FY09 – Callers by Type of Tobacco Use QuitlineNumber of Callers NMissingMinMaxMeanMedian US (N=53) Cigarette Cigar Pipe Smokeless Other Canada (N=10) Cigarette Cigar Pipe Smokeless

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

Utilization FY09 – Amount of Tobacco Used Cigarettes per Day QuitlineCaller Cigarettes per Day NMissingMinMaxMeanMedian US* (N=53) Mean Minimum Maximum Canada** (N=10) Mean Minimum Maximum * For the US, the number of smokers on which the mean, minimum and maximum were based ranged from a low of 20 to a high of 140,140. **For Canada, the number of smokers on which the mean, minimum and maximum were based ranged from a low of 596 to a high of 2,561.

Utilization FY09 – Amount of Tobacco Used Cigars per week QuitlineCaller Cigars per Week NMissingMinMaxMeanMedian US* (N=53) Mean Minimum Maximum Canada** (N=10) Mean Minimum Maximum * For the US, the number of cigar smokers on which the mean, minimum and maximum were based ranged from a low of 0 to a high of 997. **For Canada, the number of cigar smokers on which the mean, minimum and maximum were based ranged from a low of 2 to a high of 26.

Utilization FY09 – Amount of Tobacco Used Pipes per Week QuitlineCaller Pipes per Week NMissingMinMaxMeanMedian US* (N=53) Mean Minimum Maximum Canada** (N=10) Mean Minimum Maximum * For the US, the number of pipe smokers on which the mean, minimum and maximum were based ranged from a low of 0 to a high of 140. **For Canada, the number of pipe smokers on which the mean, minimum and maximum were based ranged from a low of 0 to a high of 3.

Utilization FY09 – Amount of Tobacco Used Tins per Week (Smokeless) QuitlineCaller Tins per Week NMissingMinMaxMeanMedian US* (N=53) Mean Minimum Maximum Canada** (N=10) Mean Minimum Maximum * For the US, the number of smokeless users on which the mean, minimum and maximum were based ranged from a low of 0 to a high of **For Canada, the number of smokeless users on which the mean, minimum and maximum were based ranged from a low of 2 to a high of 10.

Utilization FY09 – Cigarette Users Only Frequency of Smoking QuitlineNumber of Callers NMissingMinMaxMeanMedian US (N=53) Everyday/daily Someday/Occasional Not at all Of not at all, # quit <30 days Canada (N=10) Everyday/daily Someday/Occasional Not at all Of not at all, # quit <30 days

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

Utilization FY09 – Time to First Cigarette QuitlineNumber of Callers NMissingMinMaxMeanMedian US (N=53) Within 5 minutes minutes minutes >60 minutes Canada (N=10) Within 5 minutes minutes minutes >60 minutes

Utilization FY09– Gender QuitlineNumber of Callers NMissingMinMaxMeanMedian US (N=53) Male Female Canada (N=10) Male Female

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

Utilization FY09 – Age QuitlineCallers NMissingMinMaxMeanMedian US* (N=53) Mean Minimum Maximum Canada** (N=10) Mean Minimum Maximum * For the US, the number of callers on which the mean, minimum and maximum age were based ranged from a low of 178 to a high of 142,541. **For Canada, the number of callers on which the mean, minimum and maximum age were based ranged from a low of 622 to a high of 3,714.

Utilization FY09 – Level of Education US QuitlineNumber of Callers NMissingMinMaxMeanMedian US (N=53) < grade Grade 9-11, no degree GED/HS degree Some college or university College or university degree

Utilization FY09 – Level of Education US

Utilization FY09 – Level of Education Canada QuitlineNumber of Callers NMissingMinMaxMeanMedian Canada (N=10) < HS HS diploma Technical or trade school (including some college) College or university degree (includes technical or trade school certificate)

Utilization FY09– Ethnicity and Race US QuitlineNumber of Callers NMissingMinMaxMeanMedian US (N=53) Hispanic or Latino White Black or African American Asian Native Hawaiian or Pacific Islander American Indian or Alaskan Native Other

Utilization FY09– Ethnicity and Race US

Utilization FY09 – Race Canada QuitlineNumber of Callers NMissingMinMaxMeanMedian Canada (N=10) Canadian (English or French Canadian) Aboriginal (Native Indian, Métis, Inuit) British (English, Irish, Scottish, Welsh) European Asian Other

Utilization FY09 – Sexual Orientation QuitlineNumber of Callers NMissingMinMaxMeanMedian US (N=53) Straight Gay or lesbian Bisexual Transgender Other

Utilization FY09–Registrants for Web-based Services NMissingMinMaxMeanMedian US (N=53) Registrants for web-based cessation services integrated with the quitline Registrants for web-based cessation services NOT integrated with the quitline Canada (N=10) Registrants for web-based cessation services integrated with the quitline 1931 Registrants for web-based cessation services NOT integrated with the quitline

Insurance Status of Callers FY09 QuitlineNumber of Callers Insurance TypeNMissingMinMaxMeanMedian US (N=53) None Gov’t Provided (Medicare, Medicaid, etc.) Private US quitlines (93%) reported that they collect information on the insurance status of callers who receive services. The types of insurance quitlines collect information about include:

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--

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: