Evaluating the Impact of the National Tobacco Quitline Network Paula A. Keller, MPH Linda A. Bailey, JD, MHS Shu-Hong Zhu, PhD Michael C. Fiore, MD, MPH

Acknowledgements UW-CTRI: – Michael C. Fiore, MD, MPH – Timothy B. Baker, PhD – Paula A. Keller, MPH – Kalsea Koss North American Quitline Consortium: – Linda A. Bailey, JD, MHS University of California-San Diego: – Shu-Hong Zhu, PhD Funding: – Survey: American Legacy Foundation – Analysis: Robert Wood Johnson Foundation Grant #52570 and National Cancer Institute Grant # 5 P30 CA

Goals Review events at national level that led to this study Describe research questions and methodology Share baseline findings

Background 2002: Subcommittee on Cessation of the Interagency Committee on Smoking and Health formed – Charged with making evidence-based recommendations to dramatically reduce tobacco use in the U.S. 2003: Subcommittee recommends a national quitline network providing counseling and medications

Background (continued) 2004: DHHS launches National Network of Tobacco Cessation Quitlines – Goal: All US residents have access to quitline services – CDC: Grants to the states to build capacity or enhance existing services – NCI: Funding of a national portal number ( QUITNOW); enhance CIS cessation services to serve as a “safety net” for states without quitlines

Background (continued) State concerns about the new federal initiative – Supplanting or duplicating existing state services – Perception that a large new federal investment would result in states eliminating quitline funding – Sustainability given lack of dedicated funding CDC and NCI carefully designed the initiative to try to address state concerns

Research Questions How are US quitlines organized, financed and promoted? How are states using the CDC National Tobacco Quitline Network funding? What state-level factors are associated with state decision making regarding quitlines? How do quitlines compare to the quitline network outlined by the Subcommittee on Cessation?

Methods North American Quitline Consortium (NAQC) survey of state quitlines Survey ed to state tobacco control programs and DC (n=51) Follow-up conducted by NAQC; 1 non- responder (98% response rate)

US Quitline Organization, 2004 May 31, 2004: 38 state quitlines Funding entity – predominantly state government (89.5%) Funding source – MSA funds (68.4%) Most commonly reported operating entity (e.g., organization providing services) – 39.5% - non-governmental organization (e.g., American Cancer Society, Center for Health Promotion) – 26.3% - health care institution – 13.2% - university

Quitline Funding Median funding (range) Median per capita funding (range) Quitline Operations (n=35) $500,000 ($45,000- $3,800,000) $0.14 ($0.01-$1.10) Quitline Promotion (n=33) $325,000 ($0- $3,750,000) $0.09 ($0-$1.08) Note: Excludes missing data.

Quitline Services Most commonly reported services (n=38) – 97.4% - mailed information/self-help materials – 89.5% - proactive counseling – 89.2% - referrals to other cessation services – 62.2% - reactive counseling – Just under 50% of states have established eligibility criteria for receiving counseling (e.g., ready to quit within a certain time period)

Quitline Services (continued) Smoking cessation medications (n=38) – 21.1% provide at no cost – 16.2% provide at low cost – Eligibility criteria for receiving free or low-cost medications are common (e.g., uninsured) Multiple language services (n=38) – 57.2% provide Spanish language services – 28.9% provide services in multiple languages through translation services or language line

Quitline Promotion Most commonly reported promotional strategies (n=38): – 97.4% - Brochures/fact sheets – 94.7% - Posters/flyers – 94.6% - Radio advertising – 86.8% - Television Most commonly reported indicators for measuring promotional strategies (n=37): – 100% - Call volume – 91.9% - Asking how callers heard about the quitline

Limitations Survey of state quitlines only (other quitlines were not included) Initial NAQC survey designed to obtain feedback for DHHS regional meetings, not a rigorous research evaluation Lack of standardized data collection and reporting

Conclusions 74.5% of states provided quitline services at the time of the survey (2004) Wide variation in quitline funding (both operations and promotion) Relatively high congruence in the types of services most commonly provided across state quitlines Eligibility criteria for receiving services are common