Highlights from the 2009 NAQC Annual Survey

of Quitlines

Prepared by: ERDU, Mignonne Guy, Jessie Saul, and the NAQC Annual Survey Workgroup

July 22, 2010

Background of Annual Survey

Conducted Annually 2004-2006, 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 email-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

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, 2005-2010

Median budget for servicesCanada, 2005-2010

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

DESCRIPTION OF SERVICES

General Service Description FY09All 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

USN = 53

CAN N = 10

%(n)

%(n)

Minimal/brief intervention—client-initiated —1-10 minutes57%(30)

100%(10)

Single session counseling more than 10 minutes—client-initiated72%(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

USN = 53

CANN = 10

%(n)

%(n)

Information about the quitline72%(38)

80%(8)

Information about tobacco cessation74%(39)

80%(8)

Self-directed web-based intervention to help tobacco users quit42%(22)

70%(7)

Automated email messages30%(16)

50%(5)

Chat rooms28%(15)

70%(7)

Interactive counseling and/or email 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 resources59%(31)

70%(7)

Recorded messages for help with quitting (e.g., phone tree)59%(31)

20%(2)

Referral to other services94%(50)

90%(9)

Fax referral for healthcare providers and other referral sources94%(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)

Other15%(8)

0%(0)

Language of Counseling Service FY09

52 1051

1

8

2 11 11

US Primary Service Providers FY09

12

63 3

17

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

6

1 1 1 1

1 1 1 1

Language of Cessation Materials FY09

52

111

11

51

11

9

10

Specialized Materials for Special Populations FY09

51 US quitlines (96%) and 6 Canadian quitlines (60%) send specialized materials to special populations. These include:

6

2

3

21

21

3 3

11

2

51 49

41 40

2025

11 1066

15 1

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:

1214

37

1

1 11

MEDICATIONS

Provision of Quitting Medication FY09

Patch Gum Lozenge Zyban ChantixNasal Spray

InhalerANY Meds

US (N=53)

Provide free medication 76% 60% 42% 4% 2% 2% 4% 70%

Provided discounted meds 8% 8% 8% 4% 6% 4% 4% 8%

Provided voucher to redeem meds 9% 8% 8% 6% 8% 6% 6% 9%

Canada (N=10)

Provide free medication - - - - - - - -

Provided discounted meds - - - - - - - -

Provided voucher to redeem meds - - - - - - - -

Free Medication ProvisionUS 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 40 39 4 2 10

Gum 32 31 4 2 8

Lozenge 22 22 6 2 12

Zyban 2 2 10 8 12

Inhaler 2 2 5 2 8

Chantix 1 1 12 12 12

Nasal Spray

1 1 8 8 8

Provision of Quitting Medication FY10

Patch Gum Lozenge Zyban ChantixNasal Spray

Inhaler

US (N=53)

Provide free medication 79% 60% 42% 6% 4% 2% 2%

Provided discounted meds 4% 4% 4% 2% 4% 2% 2%

Provided voucher to redeem meds 4% 2% 2% 4% 6% 2% 2%

Canada (N=10)

Provide free medication - - - - - - -

Provided discounted meds - - - - - - -

Provided voucher to redeem meds - - - - - - -

Free NRT Eligibility CriteriaUS (N=52), FY10

Of the 52 US quitlines providing some form of free meds, the eligibility criteria included:

7

3833

PROMOTION AND OUTREACH

Types of Media/Promotions and Outreach Activities FY09-10, US Quitlines

FY09 (N=52) FY10 (N=52)

Paid Media/Promotions

TV 73% 58%

Radio 62% 65%

Newspaper ads 40% 35%

Billboards 35% 25%

Online advertising 40% 52%

Earned media 73% 73%

Outreach

Information display at health fairs, meetings, workshops, conferences

88% 85%

Building healthcare referral networks 79% 88%

Building other referral networks 75% 77%

Other 25% 31%

Types of Media/Promotions and Outreach Activities FY09-10, Canadian quitlines

FY09 (N=10) FY10 (N=10)

Paid Media/Promotions

TV 70% 80%

Radio 60% 50%

Newspaper ads 70% 60%

Billboards 10% 10%

Online advertising 70% 80%

Earned media 90% 100%

Outreach

Information display at health fairs, meetings, workshops, conferences

100% 90%

Building healthcare referral networks 100% 100%

Building other referral networks 80% 100%

Other 30% 60%

Promotions/Outreach for Priority/Specialized Populations FY10

3431

276

UTILIZATION

US Promotional Reach FY 2005-2009

Canada Promotional Reach FY 2005-2009

Where are we now?

FY09 Reach

Promotional Reach

(# of tobacco users completing an intake)

Median (N)

Treatment Reach

(# receiving evidence based services)

Median (N)

US 1.2% (49) 0.7% (46)

Canada 0.3% (9) 0.3% (3)

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

The majority of quitline callers are cigarette users FY09

US (median) Canada (median)

The majority of quitline callers are everyday/daily smokers FY09

US (median) Canada (median)

Most quitline callers are female FY09

US (median) Canada (median)

Utilization FY09 – Level of Education US

Utilization FY09– Ethnicity and Race US

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 15 28

4 months after registration/first contact 11 21

6 months after registration/first contact 12 23

7 months after registration/first contact 34 62

12 months after registration/first contact 13 25

13 months after registration/first contact 13 25

Other 2 4

Canada (N=10)

7 months after registration/first contact 1 10

Other 2 20

Evaluation – Sampling Criteria FY09

US (N=53) Canada (N=10)

Sample all those who… N % N %

Call (regardless of reason) 6 11 - -

Are current tobacco users at first call 29 55 2 20

Are former tobacco users at first call 19 36 1 10

Are 18 years and older 24 45 1 10

Register for counseling 20 38 - -

Receive counseling (begin first call) 16 30 1 10

Receive medications 7 13 - -

Consent to follow-up 31 59 2 20

Set a quit date 3 6 1 10

Complete all counseling session 3 6 - -

ADDITIONAL INFORMATION AND RESOURCES

2009 Annual Survey Web Page

http://www.naquitline.org/?page=survey2009

Using Annual Survey Data

http://www.naquitline.org/?page=surveyrequestdata

NEW! Quitline Map

www.naquitline.org, click on “About

Quitlines/Quitline Map”

NEW! Revised Quitline ProfilesSame information•Phone numbers•Hours of operation•Languages•Services offered•Materials provided•Medications•Service provider•Eligibility

New information•Provider (e.g., fax) referral information

•Smoke-free laws•Tobacco tax rates•Quitline metrics (reach, spending per smoker, quit rate)

•Context for quitline metrics

New controls for profiles

• Each quitline will be able to edit most profile fields in real-time

• Launch and training for new profiles in Fall, 2010

SURVEY FEEDBACK AND QUESTIONS

• Feedback from members about FY09 survey process, suggestions for 2010 survey

• 2010 survey timeline:• Finalize survey by July 31• Launch in October 2010• Data collection Oct-Nov 2010

For more information on the survey or on NAQC’s data request and review process, please contact;

Jessie Saul, Ph.D.Director of ResearchNorth American Quitline Consortium3030 N. Central Ave, Ste 602Phoenix, AZ 85012Ph: 602.279-2719Email: jsaul@naquitline.org