1. Understanding Characteristics of Callers to Vermont’s Quit line after Expansion of NRT Presented by: Todd Hill, LiCSW, LADC Jason Roberts, MPH Vermont Department of Health

2. Vermont Department of Health Tobacco Cessation Quit Line Services provided through the American Cancer Society – Austin, TX Began Operation in March 2001 Set up as the portal for all cessation services in the State of Vermont Referrals to local community resources for counseling and NRT Available to all Vermonters, free of charge

3. Vermont Department of Health Hospital Bases Cessation Services Non competitive grant that allows for a cessation program coordinator to be available in every one of Vermont’s 14 hospitals. Primary responsibilities include: Providing cessation classes at the hospital and at community sites based upon the Fresh Start model Provide individual support for those who request it Providing cessation information and motivational interviewing to those inpatients who are current smokers Administer our statewide NRT benefit

5. Vermont Department of Health’s NRT subsidy program “Quit Bucks” Multi-layered program that provides free or reduced price NRT to every Vermonter Started in April of 2001 Initially gave NRT to those Vermonters without health insurance, our expanded Medicaid program called VHAP, and Medicare members. The Pilot Payer Project brought private insurance companies into the program on a trail basis in January of 2003.

6. Quit Bucks (continued) Included only those members who were employed by companies who have fully insured plans. Companies who use health insurance organizations for administrative benefits only negotiate for only those services they would like to have included “Self Insured Companies”. This would mean re-negotiating with all the companies involved in these plans. Has been renewed in 2004 and again in 2005.

7. How It Works Smokers contact the hospital in their area. Smokers must be enrolled in a class, counseling or be receiving counseling through the Quit Line. Quit Line e-mails hospitals when a smoker completes a session with them Hospital screens for pre-existing conditions. If they endorse that they have a pre-existing condition of High Blood Pressure, Osteoporosis, Heart Disease, Respiratory problems, Depression, Eating Disorders, or are if they are pregnant, they are asked to consult with their doctor before starting on NRT.

8. How it Works (continued) They are then given a coupon redeemable for a two week supply at a local pharmacy. This covers the full cost of NRT for the uninsured, and Medicare recipients. Those involved in fully insured private plans have a $20 co pay. Medicaid recipients are able to access NRT with a prescription from their doctor.

9. Adding another benefit layer We received an additional $100,000 from the Office of the Attorney General specifically designated to help those people who had a co-payment or did not receive any benefit. There was much concern about if we had the capacity to deal with the callers, given experiences with NRT benefits in other states. Along with that there was a lot of discussion on what types of advertising that we should use to notify Vermonters. The media plan included a press conference with the Attorney General as well as incorporating a about the expanded benefit into a statewide household mailing that we had previously planned. The new program is called Quit Bills.

10. Goals for the Promotion of NRT Expansion Have more Vermonters use more NRT for a longer period of time with their quit attempt. The Vermonters with no current coverage will utilize the new benefit More Vermonters also enroll in counseling. Encourage more Vermonters who may not be as ready to quit smoking make an attempt to do so. Reach the 18-24 age group. More calls coming from the Southern Tier. Increase Quit Rates.

12. Cost of Promotion Cost per call direct mailing - $48.69 Cost per call TV/radio ads – $365.03 Total production and advertising costs (TV/radio) - $175,000 Total production costs (Post card)$50,000

14. May-03144 Jun-03112 Jul-03117 Aug-0383 Sep-03116 Oct-03109 Nov-03139 Dec-03115 Jan-04279 Feb-04148 Mar-04127 Apr-04102 May-04577 Jun-04446 Jul-04137 Vermont Quit Line Monthly Call Volume

16. How did callers state they heard about Quit Line? May 2003 to June 2004: 17% Doctor, 16% TV ad, 10% mailing May and June 2004: 35% mail, 15% news story, 6% TV ad

19. May 2003 to April 2004: 39% aged 45+ (ave age 41.0) May and June 2004: 49% aged 45+ (ave age 44.3) Age stratification for May and June 2004 18-248% of callers, 20% of smokers (according to VT BRFSS 2004) 25-4443% of callers, 42% of smokers (according to VT BRFSS 2004) 45-6442% of callers, 32% of smokers (according to VT BRFSS 2004) 65+ 8% of callers, 6% of smokers (according to VT BRFSS 2004) Age Characteristics of smokers who called

21. Overall the Utilization of the Quit Buck program is up. In 2003 the average person used 3.4 Quit Bucks. In 2004 the average person used 3.7. From June 2004 to March 31, 2005, 826 people have used a Quit Bill. 60% are using it for a co payment and 40% are using it for a discount. This follows along the lines of the ratios for the general population covered under these plans. 2187 Quit Bills have been issued. 2.7 per person NRT Utilization

22. Quit Rates While the quit rates are preliminary to this point, we are seeing that those enrolled in the May/June 2004 period (n=1023) have an approximated 2% higher quit rate than for the period of May 2003 to April 2004 (n=1591). Historically 3 month 48 hour point prevalence is around 25%. Early p-tests also show that this is not a statistically significant increase.

24. Self Efficacy Initial Self Efficacy measures at intake, asking the question, “On a scale of 1 -100, how likely are you to quit smoking in this attempt?” For callers enrolling May 1, 2003 to April 30, 2004 (n=1591): Average=55.7 For callers enrolling May 1, 2004 to June 30, 2004 (n= 1023): Average=58.2

25. Have more Vermonters use more NRT for a longer period of time with their quit attempt. The Vermonters with no current coverage will utilize the new benefit More Vermonters also enroll in counseling. Encourage more Vermonters who may not be as ready to quit smoking make an attempt to do so. Reach the 18-24 age group. More calls coming from the Southern Tier. Increase Quit Rates. Goals for the Promotion of NRT Expansion

26. Lessons Learned Postcard mailing is a very cost effective way to promote Quit Lines. Smokers are willing to enter into counseling to access NRT. A free NRT promotion does not have to break the bank. (Only 40% of the monies from the Attorney General have been spent to this point.)