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Results from the 2008 NAQC Annual Survey: Quitline Services and Funding

This presentation provides an overview of the findings from the 2008 NAQC Annual Survey, focusing on quitline services offered and funding sources. The data highlights the service providers, funding sources, budgets, and utilization rates of quitlines in the US and Canada.

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Results from the 2008 NAQC Annual Survey: Quitline Services and Funding

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  1. Draft Results from the 2008 NAQC Annual Survey Prepared by: ERDU May 5, 2009

  2. Overview: • The following slides present results from the 2008 NAQC Annual Survey for Survey Workgroup review • Any changes or edits recommended will be incorporated into the final presentation to be used at the NAQC Annual Conference in June 2009

  3. Background of Annual Survey • Conducted Annually 2004-2006, 2008 • Research Partners: • 2008 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

  4. 2008 Annual Survey Methods • 63 quitline funders and their service providers were asked to respond: • 53 US and Territories quitlines • 10 Canadian quitlines • Reporting was for Fiscal Year 2008 • Web-based completion Winter 2008 • Follow-up with quitlines thru January 2009 • Data cleaning thru March 2009 • 100% response rate

  5. General Service Description • All quitlines reported having counseling services available at least five days per week for a minimum of eight hours per day • 46 US and 8 Canadian quitlines also offered counseling service on at least one day of the weekend • 13 quitlines (12 US, 1 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 • 72% of US and 80% of Canadian quitlines reported closing on holidays

  6. Quitline Services Offered

  7. Existing Cessation Services Separate from the Quitline – US(N=53) 26 25 4 4 10 11 22 21 5 9 6 2 1 2

  8. Existing Cessation Services Separate from the Quitline – Canada (N=10) 7 7 6 3 5 5 4 3 6 4 2 2 2 2

  9. Language of Counseling Service 51 8 9 2 1 1 1 1

  10. US Primary Service Providers • The figure below shows the organizations (n=18) that were the primary service provider of counseling services for US quitlines. Percent of Quitlines Reporting Service Provider 17 12 5 3 3

  11. Canadian Service Providers • The majority of Canadian quitlines (60%) had counseling services provided by the Canadian Cancer Society, Ontario Division. 6 Percent of Quitlines Reporting Service Provider 1 1 1 1

  12. Number of Funding Sources – US (N=53) 28 Number of Quitlines 14 6 4 1

  13. Number of Funding Sources – Canada(N=10) 5 4 Number of Quitlines 1

  14. US Funding Sources Respondents were asked to identify the types of funders that supported their quitlines. The number and percentage of US quitlines reporting each type of funding source is shown in the figure below. 41 24 20 12 2 3 2 3 1 1 *In 2008 the Centers for Disease Control and Prevention provided quitline supplemental funding to all U.S. states and territories but one; data reported here indicate states that used supplemental funding for quitline services (counseling and medications).

  15. Canadian Funding Sources • Respondents were asked to identify the types of funders that supported their quitlines. The number and percentage of Canadian quitlines reporting each type of funding source is shown in the figure below. 10 6 1 1

  16. US Quitline Budgets

  17. Canadian Quitline Budgets

  18. Spending per Smoker • The smoking population was calculated for each state or province using adult population (18+ US BRFSS, 15+ Canada Statcan) and smoking prevalence (18+ US BRFSS, 15+ Canada CTUMS) estimates for 2007 • The Services and Medications Budget reported per quitline was then divided by the number of smokers in each state/province • The mean spending per smoker for US quitlines was $3.33, (median =$1.33), with a range from $0.08 to $24.05 (N=45, N=25 also provided Meds budget) • The mean spending per smoker for Canadian quitlines was $0.60, (median =$0.53), with a range from $0.13 to $1.66 (N=8) *Canadian Quitlines reported no Medications Budget so spending per smoker is for Services only • CDC Best Practices for Comprehensive Tobacco Control Programs - 2007 recommends spending of $10.53 per adult smoker ($2.19 per capita – adults) for quitline services and medications*

  19. Relationship Between Service Spending and Utilization Reach CDC calculates that quitlines funded at the recommended level of $10.53 per adult smoker could serve 6% of smokers with counseling, and assumes 85% of those served would accept free NRT (CDC, 2007)

  20. Relationship Between Media Spending and Utilization Reach

  21. Language of Cessation Materials 10 10 52 51 2 2 1 1 1 1 4 4 2 3 3 3 2 1 1

  22. Specialized Materials for Special Populations • 52 US quitlines (98%) and 4 Canadian quitlines (40%) send specialized materials to special populations. These include: 52 50 41 40 24 22 3 3 2 2 2 10 2 8 7 1 1 1 4 3 2

  23. Specialized Materials for Non-tobacco Users • 100% of US and 90% of Canadian quitlines send materials to callers who are not tobacco users or recent quitters. These include: 53 51 9 8 3 13

  24. First Counseling Encounter - US • Typical Intake/Enrollment • 25 could separate out Intake/Enrollment • Range: 7 to 30 minutes, median =15 minutes • Typical Assessment • 36 could separate out Assessment • Range: 7 to 45 minutes, median =10 minutes • Typical first Counseling session • 51 could separate out first Counseling session • Range: 10 to 45 minutes, median =30 minutes

  25. First Counseling Encounter - Canada • Typical Intake/Enrollment • 2 could separate out Intake/Enrollment • Range: 5 to 25 minutes, median =15 minutes • Typical Assessment • 9 could separate out Assessment • Range: 4 to 15 minutes, median =5 minutes • Typical first Counseling session • 10 could separate out first Counseling session • Range: 5 to 45 minutes, median =15 minutes

  26. Median Minutes of First Counseling Encounter – US and Canada N=51 Minutes N=25 N=2 N=10 N=36 N=9

  27. Counseling Intervention Protocols • Respondents were asked whether their quitline has a counseling protocol that dictates a certain number of sessions. The number who responded yes and a summary of the session protocols are shown in the first three rows below. The last two rows show the number of quitlines that do not dictate a certain number of sessions, and the maximum number of calls allowed for each.

  28. Timing of Counseling Sessions 8 24 21 6 1 1 1 1

  29. Specialized Counseling Protocols • 94% of US and 90% of Canadian quitlines use specialized counseling protocols for special populations. These include: 50 8 43 35 26 21 19 18 18 18 17 16 16 2 2 2 2 1 1 1 1 1

  30. Eligibility Criteria for Counseling • 87% of US and 60% of Canadian quitlines have eligibility criteria for callers to receive counseling. These include: 40 6 33 25 4 4 3 3 2 2

  31. Eligibility Criteria for Different Levels of Service • 18 US quitlines (34%) and 7 Canadian quitlines (70%) have different eligibility criteria for different levels of service • Open-ended responses described eligibility criteria for differing level of service including: • Increased sessions depending on readiness to quit (n=10, US and n=6, Canada) • Increased sessions for pregnant women (n=6, US) • Increased sessions for youth (n=4, US) • Increased sessions for uninsured or Medicaid/Medicare/VA/IHS insured (n=5, US)

  32. Provision of Quitting Medication

  33. Provision of Information about Quitting Medication

  34. Free Medication Provision – US Quitlines

  35. US Free Medications Eligibility Criteria • Of the 37 US quitlines providing some form of free meds, the following number used eligibility criteria which included: 35 35 34 27 27 Percent of 37 quitlines with free meds citing each meds eligibility criteria 13 8 7 6 5 5 5 3

  36. Utilization - Calls

  37. Utilization – Unique Tobacco Users

  38. Utilization – Received Service

  39. UtilizationProxy Calls and Proactive Referrals

  40. Insurance Status of Callers • 45 US quitlines (85%) reported that they collect information on the insurance status of callers who receive services. The numbers of three types of insurance quitlines collect include:

  41. Staff Training • All quitlines train cessation specialists/counselors before they counsel clients. Training includes:

  42. Supervision of Cessation Counselors • All quitlines indicated they had a procedure for supervising cessation counselors. Types of supervision include:

  43. Evaluation • 52 US quitlines (98%) and 3 Canadian quitlines (30%) conduct follow-up evaluations • Most quitlines have follow-up evaluation conducted internally by; • quitline staff (US n=20; Canada n=1) • staff other than quitline staff (e.g., internal evaluation unit) (US n=20; Canada n=1) • Next most commonly cited was evaluation conducted by; • an outside evaluation firm (US n=13; Canada n=1), • an Other source (US n=5) • the Funding Agency (US n=3)

  44. Evaluation • The types of evaluation data collected by those quitlines that conduct follow-up evaluations include; • Customer satisfaction: US (94%, 50), Canada (30%, 3) • Staff performance: US (66%, 35), Canada (10%, 1) • Quitting outcome: US (98%, 52), Canada (20%, 2)

  45. Treatment Reach • Data provided by quitlines should be put into the context of the size of the smoking population within each state/province by calculating reach • Treatment reach is defined as “the proportion of the target population who receive an evidence-based treatment from a quitline” (NAQC, 2009, p 1) • Only 2 Canadian quitlines were able to report the number of tobacco users who received service • Prevalence estimates available are only for smokers (BRFSS, CTUMS), not all tobacco users • As a result, treatment reach can not be adequately calculated at this time • However, utilization reach, “the proportion of a population who use a service” (NAQC, 2009, p 2) can be calculated for smokers, at least for the US

  46. Utilization Reach for Smokers • The smoking population was calculated for each state or province using adult population (18+ US BRFSS, 15+ Canada Statcan) and smoking prevalence (18+ US BRFSS, 15+ Canada CTUMS) estimates for 2007 • 41 US and 3 Canadian quitlines reported the total number of smokers calling for self during FY08 • The mean utilization reach for the 3 Canadian quitlines was 0.44% (median=0.38%) • The mean utilization reach for 40 US quitlines was 1.3% (median=0.7%), with a range of 0.1% to 5.2% *Utilization reach could not be calculated for 1 US quitline reporting the number of smokers calling for self because no smoking prevalence data was available for this territory.

  47. 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

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