1. Arizona Department of Health Services - Tobacco Education and Prevention Program Evaluating Cessation Among Clients Receiving Intensive Treatment at the Arizona Smokers’ Helpline Thomas M. Wentzel, Ph.D., Pamela Powers, MPH, and James Ranger-Moore, Ph.D. Network for Information and Counseling Mel & Enid Zuckerman Arizona College of Public Health National Conference on Tobacco or Health, San Francisco, CA November 20, 2002

2. Arizona Department of Health Services - Tobacco Education and Prevention Program Overview  Tobacco control in Arizona  Helpline services, clients, and evaluation  Cessation evaluation methodology  Cessation analysis  Conclusions

3. Arizona Department of Health Services - Tobacco Education and Prevention Program Arizona  6th Largest State  114,000 Sq. Miles  5.3 Million People  ~750,000 Smokers (18.3% Adults, 1999)

4. Arizona Department of Health Services - Tobacco Education and Prevention Program Tobacco Control in Arizona  Comprehensive system funded by tobacco tax ($0.58/pack before, and $1.18/pack after November 2002) –15 Community-based tobacco control projects –11 Tribal Projects –Statewide Services: Helpline, Internet Services, Training and TA, Policy Tracking, Media, Evaluation  Visit www.TEPP.org for additional details

5. Arizona Department of Health Services - Tobacco Education and Prevention Program Helpline Services  Proactive telephone counseling  Mailed self-help publications  Information and referral to local services  Pre-recorded voicemail quit tips  Automated FAX on demand quit tips  Cessation technical assistance  www.ASHLine.org with interactive decision-making tools and E-mail

6. Arizona Department of Health Services - Tobacco Education and Prevention Program Helpline Clients  Information Only (One-Time Intensive)  Information and Referral  Counseling (Multi-Session Intensive)  Currently Quit at Intake  Calling for Another –Friend or relative –Healthcare Provider –Human Resources

7. Arizona Department of Health Services - Tobacco Education and Prevention Program Helpline Evaluation Measures  Analyses of ASH clientele (age, ethnicity, gender, and language distribution)  Analyses of media impact on clientele  Process evaluation to monitor counselor productivity and adherence to protocols  Ongoing programmatic quality control  Quit rates for all clients (counseling, information, currently quit)  Cost per client analyses

8. Arizona Department of Health Services - Tobacco Education and Prevention Program Cessation Evaluation: Design  Clients provide evaluation consent –73% of information clients, 91% of counseling clients  Evaluation instrument gathers data on: –Quit measures (ever quit for 24 hours, 3-, 6-, and 12- month continuous abstinence, 30-day prevalence) –Use of NRT and other treatments –Participation in other quit-tobacco programs –Helpline program satisfaction  Surveys are scheduled 4, 7, and 13 months after program intake

9. Arizona Department of Health Services - Tobacco Education and Prevention Program Cessation Evaluation: Quit Measures  Our records indicate that you initially contacted the Helpline on __/__/__. Since that date, were you able to quit using tobacco for at least 24 hours? r Nor Yes (ever quit for 24 hours) –Date of first successful 24-hr quit: __/__/__ (C.A.) –Since that quit date, have you used any tobacco products at all? r Nor Yes (C.A.)

10. Arizona Department of Health Services - Tobacco Education and Prevention Program Cessation Evaluation: Quit Measures  After your successful quit attempt, when did you start using tobacco products again? __/__/__ (C.A.)  Since you started using tobacco again, what tobacco products did you use, and, on the days you used them, how much did you use on average? –Cigarettes, Chew, Cigars, Pipe, Snuff  Have you used any tobacco products in the last 30 days? r No r Yes

11. Arizona Department of Health Services - Tobacco Education and Prevention Program Cessation Analysis  Re-enrollment in services –7.0% of clients re-enroll within 13 months of intake  Further surveys on the prior service are cancelled –2.8% of clients re-enroll within 4 months of intake  All surveys on the prior service are cancelled  Clients are excluded from analysis  Since May 2001, 4000+ surveys have been conducted on 2500+ consented clients who called the Helpline for themselves

12. Arizona Department of Health Services - Tobacco Education and Prevention Program Cessation Analysis  1 year (intake 3/5/01–3/4/02): 2796 clients –Provided consent, called the Helpline for themselves  1735 (62%) of these clients were contacted and surveyed at least once –1308 surveyed at 4 months –1107 surveyed at 7 months, 354 for the 1 st time –486 surveyed at 13 months, 73 for the 1 st time  ~40% of 13-month surveys remain to be conducted  12-month continuous abstinence and 30-day prevalence at 13 months are not yet reportable

13. Arizona Department of Health Services - Tobacco Education and Prevention Program Cessation Analysis  Client Demographics

14. Arizona Department of Health Services - Tobacco Education and Prevention Program Cessation Analysis: Quit Rates by Client Service –Significant differences between one-session & multi- session, not-quit & quit at intake, for all quit rates

15. Arizona Department of Health Services - Tobacco Education and Prevention Program Cessation Analysis: Quit Rates by Gender – No significant differences by gender for all quit rates

16. Arizona Department of Health Services - Tobacco Education and Prevention Program Cessation Analysis: Use of Pharmacotherapy

17. Arizona Department of Health Services - Tobacco Education and Prevention Program Cessation Analysis: Other Measures  Participation in other cessation programs –16% of surveyed clients contacted other cessation programs, participated in 73% of them, and finished 47% –Clients found 57% of programs helpful, 24% not helpful  Helpline satisfaction: Of those responding... –86% thought their counselor’s advice was useful –90% felt counselor cared about them and their progress –92% felt counselor was knowledgeable about tobacco –92% rated overall services good or excellent –94% would refer a friend or relative

18. Arizona Department of Health Services - Tobacco Education and Prevention Program Cessation Analysis: Future Directions  Quit rates –Demographics such as gender, age, education, access to health care, and ethnicity, especially acculturated vs. non-acculturated Hispanics –Predictors of success: use of pharmacotherapy, reasons for quitting, readiness to quit, level of addiction, tobacco use history, social support, etc. –Re-enrollment in services or participation in other programs  Expand analyses to clients attending community-based cessation programs

19. Arizona Department of Health Services - Tobacco Education and Prevention Program Conclusions  Quit rates are important outcome measures of phone-based cessation –Define quit rates precisely  Design intake and evaluation instruments to ensure that quit rates can be definitively calculated and interpreted  Quit rates show that the Arizona Smokers’ Helpline provides effective treatment  No lack of further topics to explore!

20. Arizona Department of Health Services - Tobacco Education and Prevention Program Arizona Smokers’ Helpline 1-800-55-66-222 www.ASHLine.org Slides available at: www.TEPP.org/presentations/index.html Mel & Enid Zuckerman Arizona College of Public Health University of Arizona, Tucson, Arizona