1. Arizona Department of Health Services - Tobacco Education and Prevention Program Proactive Referrals: Increasing Cessation Recruitment by Building Collaborations Pamela Powers, MPH; Robert Leischow, MPH; Mary Gilles, MD; Rebecca Ruiz-McGill; Amy Dye; Susan Larsen; James Ranger-Moore, Ph.D. Network for Information and Counseling - Arizona Smokers’ Helpline Mel & Enid Zuckerman Arizona College of Public Health National Conference on Tobacco or Health Boston, Mass., Dec. 11, 2003

2. Arizona Department of Health Services - Tobacco Education and Prevention Program Tobacco Control in Arizona  Comprehensive system funded by tobacco tax ($1.18) –15 Community-based tobacco control projects –11 Tribal Projects –Statewide Services: Helpline, Information Technology and Internet Services, Training and TA, Policy Tracking, Media, Evaluation  Visit www.TEPP.org for additional details

3. Arizona Department of Health Services - Tobacco Education and Prevention Program Arizona Smokers’ Helpline  Created in 1995 at the University of Arizona  Funded by ADHS/TEPP to provide: –Bilingual proactive telephone counseling –Bilingual mailed self-help publications –Information and referral to local services –Reduced cost for NRT or Zyban –Pre-recorded voicemail and FAX quit tips –Cessation technical assistance –www.ASHLine.org with interactive decision-making tools and E-mail

4. Arizona Department of Health Services - Tobacco Education and Prevention Program Levels of Service Based Upon Client Choice  Questions Only  Information Only  Information and Referral  Counseling  Currently Quit  Calling for Another –Friend or relative –Healthcare provider –Human Resources

5. Arizona Department of Health Services - Tobacco Education and Prevention Program Statewide Recruitment Efforts Traditional Paid Advertising FY 98-99, FY 99-00, FY 00-01

6. Arizona Department of Health Services - Tobacco Education and Prevention Program  Paid Advertising –Television –Radio –Newspaper  Referrals –Friends, family, former clients –Community-based tobacco projects –Healthcare providers, Worksites –Community Events What motivates people to seek quit-tobacco services? Interruption Marketing Permission Marketing –Billboards –Telephone book

7. Arizona Department of Health Services - Tobacco Education and Prevention Program Multiple TV Ad Campaigns Effective TV advertising increased Helpline calls from 500/quarter to 500/week

8. Arizona Department of Health Services - Tobacco Education and Prevention Program Statewide Recruitment Efforts Budget Cuts Brought Changes in Strategy Promoting Referrals FY 01-02, FY 02-03

9. Arizona Department of Health Services - Tobacco Education and Prevention Program Public Relations & Outreach  Public Relations –News and feature story placement –Guest appearances on radio and TV talk shows –Speakers’ Bureaus –Newsletters and trade publications –Sponsorships –Listserv promotions  Outreach –Targeted initiatives with specific groups –Direct mail incentives to referring agencies

10. Arizona Department of Health Services - Tobacco Education and Prevention Program Proactive Referral Networks  Community projects –Pilot project: referrals from Mohave County make up 68% of the proactive community referrals (FY 01-02)  WIC clinics –Pilot project: recruitment from Mohave County WIC increased 340% in 3 quarters

11. Arizona Department of Health Services - Tobacco Education and Prevention Program Proactive Referral  Outside agency conducts brief intervention  Gains client consent for Helpline call  Faxes referral to Helpline  Helpline calls, recruits client into services, does intake form Proactive Referrals

12. Arizona Department of Health Services - Tobacco Education and Prevention Program Proactive Referral System: Vision & Goals  Vision: –To create a uniform manner in which to refer clients to free, research-based, quit-tobacco services.  Goals: –Increase access to services statewide –Increase cessation recruitment statewide –Build relationships with healthcare practitioners (HCPs) –Build relationships with Women, Infant, and Children clinics (WIC)

13. Arizona Department of Health Services - Tobacco Education and Prevention Program Proactive Referral System: Vision & Goals  Goals (continued): –Increase awareness of tobacco tax-funded services –Create system changes within healthcare –Provide a mechanism for evaluation of productivity and cost effectiveness of training and referral system –Decrease the prevalence of tobacco use

14. Arizona Department of Health Services - Tobacco Education and Prevention Program Smokers’ Helpline: Referral Hub

15. Arizona Department of Health Services - Tobacco Education and Prevention Program Healthcare Provider Outreach

16. Arizona Department of Health Services - Tobacco Education and Prevention Program Provider Advice to Quit  Most Americans see doctor annually  Physician advice to quit is a powerful motivator-- even advice as brief as 3 minutes can make a difference  5 “A’s”: every office visit, every patient –Ask if patient smokes –Assess readiness to quit –Advise to quit –Assist in quitting/finding services –Arrange for cessation services

17. Arizona Department of Health Services - Tobacco Education and Prevention Program Healthcare Provider Outreach  Give healthcare providers the tools they need on an ongoing basis –Basic cessation intervention training (5As) –Collateral materials for waiting room –Strategies to change systems (chart stickers, referral forms, NRT benefits, free cessation services, training, incentives) –Outcome results per referral

18. Arizona Department of Health Services - Tobacco Education and Prevention Program Healthcare Provider Outreach  Distribute aggregate client data to MCOs  Mail tailored packets MCO clients  Mail thank-you letters, incentives, and publications to referring HCPs

19. Arizona Department of Health Services - Tobacco Education and Prevention Program Recruitment Results Are healthcare providers using the proactive referral system? Have changes in recruitment strategies influenced client characteristics?

20. Arizona Department of Health Services - Tobacco Education and Prevention Program Recruitment Strategies

21. Arizona Department of Health Services - Tobacco Education and Prevention Program Who calls the Helpline?

22. Arizona Department of Health Services - Tobacco Education and Prevention Program Helpline Recruitment Sources

23. Arizona Department of Health Services - Tobacco Education and Prevention Program Referral Results

24. Arizona Department of Health Services - Tobacco Education and Prevention Program Referral Results

25. Arizona Department of Health Services - Tobacco Education and Prevention Program Referral Results  Healthcare providers (HCPs) are more likely to use proactive referral system than county health departments  Although Speakers’ Bureau training and other outreach activities have reached hundreds of HCPs, only a core group uses the system. (113 HCPs of 2,555 in database)  Acceptance of proactive referral system continues to grow

26. Arizona Department of Health Services - Tobacco Education and Prevention Program Services

27. Call Language

28. Arizona Department of Health Services - Tobacco Education and Prevention Program Hispanic Ethnicity

29. Arizona Department of Health Services - Tobacco Education and Prevention Program Health Insurance

30. Arizona Department of Health Services - Tobacco Education and Prevention Program Gender

31. Future Analyses  Further investigate changes in clientele and recruitment (i.e., age, pregnancy status, WIC status, education)  Track and evaluate proactive referrals –What are the most productive referral sources? –How can the process be changes to increase recruitment of low SES clients?  How with discounted NRT provision change recruitment in the future?

32. Arizona Department of Health Services - Tobacco Education and Prevention Program Arizona Smokers’ Helpline 1-800-55-66-222 For cessation counseling: www.ASHLine.org For additional evaluation information: www.TEPP.org/evaluation Mel & Enid Zuckerman Arizona College of Public Health Tucson, Arizona