Transcript US Quitlines – FY10

Results from the
2010 NAQC Annual Survey
of Quitlines
Prepared by: Westat, Jessie Saul,
and the NAQC Annual Survey Workgroup
July 11, 2011
-
Background of Annual Survey
Conducted Annually 2004-2006, 2008-2010
• Research Partners:
– 2010 Westat
– 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
2010 Annual Survey Methods
Completed from October to December 2010
• Web-based survey with email and telephone follow-up:
1)
2)
3)
4)
5)
6)
7)
8)
General Information, hours, services offered
Quitline budgets
Funding sources
Materials used
Counselling services and protocols
Promotion
Utilization
Evaluation
65 quitline funders and their service providers were asked
to respond; 52 of 53 US quitlines responded; 10 of 12
Canadian quitlines responded.
BUDGET
Budget Summary
• Budgets declined for the first time in FY10
• The primary impacts of the decline were a
decrease in media, promotions, and
outreach; and a decrease in the number of
tobacco users served.
• The level of services stayed relatively
constant from FY09 to FY10
• Median services budgets increased in the
US but decreased in Canada from FY09 to
FY10
For the first time, the median and total US
quitline budgets decreased slightly in FY10
Total quitline budget (sum)
$1,800,000
$180,000,000
$1,600,000
$160,000,000
$1,400,000
$140,000,000
$1,200,000
$120,000,000
$1,000,000
$100,000,000
$800,000
$600,000
$400,000
$80,000,000
N=50
N=50
N=51
$60,000,000
$40,000,000
N=48
$200,000
$20,000,000
$-
$-
FY06
FY08
FY09
FY10
Total Quitline Budget (sum)
Median Quitline Budget
Median quitline budget
Median quitline budgets in Canada have
decreased from FY09 – FY10
Total quitline budget (sum)
$400,000
$8,000,000
$350,000
$7,000,000
$300,000
$6,000,000
$250,000
$5,000,000
$200,000
$4,000,000
$150,000
$3,000,000
$100,000
$50,000
N=6
N=9
N=9
N=10
N=9
$2,000,000
$1,000,000
$-
$-
FY05
FY06
FY08
FY09
FY10
Total Quitline Budget (sum)
Median Quitline Budget
Median quitline budget
US Spending per Smoker 2008-2010
(services and medications)
$2.00
$1.80
$1.60
$1.40
$1.20
$1.00
$0.80
$0.60
$0.40
$0.20
$-
$1.71
$1.78
N=50
$1.89
N=49
N=45
2008
2009
2010
Canada Spending per Smoker (services),
2008-2010
$2.00
$1.80
$1.60
$1.40
$1.20
$1.00
$0.80
$0.60
$0.40
$0.20
$-
$0.77
$0.67
$0.65
N=8
2008
N=9
2009
N=9
2010
Funding Sources in FY10 and FY11
Public sector/government
Local government funds
State/provincial general funds
State/provincial dedicated tobacco tax
funds
State Medicaid program
MSA funds
Tobacco settlement funds (not MSA)
Federal
CDC- ARRA/Stimulus funds
CDC - other (non-ARRA) funds
Health Canada
Other
Private sector/non-government
Third part reimbursement through
healthcare institution
Third part reimbursement through
insurance company
Charitable foundation
For-profit company
Non-governmental organization
Employer organization
Other
US
FY10
(N=52)
US
FY11
(N=52)
Canada
FY10
(N=10)
Canada
FY11
(N=10)
0%
25%
0%
26%
0%
100%
0%
100%
21%
24%
0%
0%
4%
46%
10%
6%
45%
8%
0%
0%
0%
0%
0%
0%
52%
71%
0%
2%
82%
73%
0%
2%
0%
0%
60%
0%
0%
0%
30%
0%
0%
0%
0%
0%
8%
8%
0%
0%
2%
0%
2%
0%
2%
2%
0%
0%
0%
2%
10%
10%
20%
0%
0%
30%
10%
10%
0%
0%
More US quitlines report receiving funds from
CDC or MSA funds than any other source
100%
60%
20%
0%
39%
40%
8% 24%
FY 10
FY10: CDC (ARRA)
FY10: CDC (Other)
FY10: CDC (ARRA and Other)
FY 11
65%
80%
33% 14%
FY 09
FY11: CDC (ARRA)
FY11: CDC (Other)
FY11: CDC (ARRA and Other)
For US quitlines, the highest proportion of funds
come from MSA, general funds, state tobacco
taxes, and non-MSA tobacco settlement funds
100%
80%
FY09 avg proportion of funds among
quitlines reporting each funding source
78%77%
64%
60%
40%
76%
FY10 avg proportion of funds among
quitlines reporting each funding source
69%
64% 63%
FY11 avg proportion of funds among
quitlines reporting each funding source
56%
54%55%
49%
38%
32%
19%
20%
27%24%
18%
19%
19%
27%
18%
17%
4%4%3%
0%
The majority of Canadian quitlines report
receiving funds from provincial general funds
120%
100%
100%100%
90%
FY 09
FY 10
80%
FY 11
60%60%
60%
40%
20%
0%
30%
30%
20%
10%
30%
20%
10%
10%
0% 0%
10%10%10%
For Canadian quitlines, the highest proportion
of funds come from provincial general funds
and Health Canada
100%
FY 09 avg proportion of funds among
quitlines reporting each funding source
80%
FY 10 avg proportion of funds among
quitlines reporting each funding source
80%
70%69%
60%
57%
FY 11 avg proportion of funds among
quitlines reporting each funding source
56%56%
40%
20%
14%
14%
5%
0% 0%
9%
8%
0%
0%
0%
Health Canada
State/Provincial
general funds
Local government
funds
Non-governmental
organization
Other
DESCRIPTION OF SERVICES
General Service Description FY10
61 or 98% of quitlines responding reported having
counseling services available at least five days per week
for a minimum of eight hours per day
48 or 92% of US and 8 or 80% of Canadian quit lines also
offered counseling service on at least one day of the
weekend
28 quitlines (26 or 50% 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
96% of US (n=50) and 80% of Canadian (n=8) quitlines
reported closing on holidays
Most US and Canadian quitlines provide
multiple proactive counseling sessions FY10
US
N = 52
CAN
N = 10
%
(n)
%
(n)
Minimal/brief intervention—client-initiated —1-10 minutes
33%
(17)
100%
(10)
Single session counseling more than 10 minutes—client-initiated
71%
(37)
100%
(10)
Multiple sessions—client-initiated (i.e., reactive, client calls in for
each follow up)
42%
(22)
100%
(10)
Multiple sessions—counselor-initiated (i.e., proactive, cessation
specialist / counselor / coach calls client for follow up)
92%
(48)
100%
(10)
Phone counseling services
US and Canadian quitlines provide interactive web-based
programs to help tobacco users quit FY10
100%
90%
90%
90%
80%
80%
75%
70%
80%
80%
73%
65%
58%
60%
50%
40%
40%
US
Canada
30%
21%
20%
12%
10%
0%
Info about the
quitline
Info about tobacco Self-directed webAutomated email
cessation services based intervention to
messages
help tobacco users
quit
Chat rooms
Interactive
counseling and/or
email messaging to
cessation
specialist/counselor/
coach to help
tobacco users quit
Methods Offered to Providers to Refer
Patients to Quitlines in FY10
100%
96%
US (N=52)
Canada (N=10)
100%
80%
60%
40%
46%
20%
20%
0%
4%
10%
0%
0%
13%
0%
Fax-referral Form
Via Email
Within EMR and
transmit referral
electronically
Automatically
pulled from EMR
Other method
Quitlines made between 3 and 4 attempts to
reach fax- or e-referred patients in FY10
How many call attempts were made to make first contact with a faxor electronically-referred patient
N
Missing
Min
Max
Mean
US (N=52)
50
2
3
5
3.4
Canada (N=10)
10
0
3
5
3.9
Used a translation service for hearing clients
FY10
100%
80%
90%
60%
US (N=52)
64%
40%
20%
Canada (N=10)
35%
10%
0%
Yes
No
Number of times translation service used for
counseling hearing clients FY10
How many times was the translation service used to provide counseling to hearing
clients
N
Missing
Min
Max
Median
Sum
Mean
US (N=52)
29
23
0
999
61.79
3
1792
Canada (N=10)
1
9
9
9
9.0
9
9
Quitline used a third party translation service
for deaf and hard-of-hearing clients FY10
100%
Canada (N=10)
US (N=52)
80%
60%
52%
39%
40%
20%
10%
0%
0%
Video relay interpreter
TTY relay CA
Communication Assistant
0%
2%
Other translation service
Number of times translation service used for
counseling deaf and hard-of-hearing clients FY10
How many times was a third party translation service used to provide counseling to
Deaf and Hard-of-hearing clients
N
Missing
Min
Max
Median
Sum
Mean
US (N=52)
24
28
0
1
0.17
0
4
Canada (N=10)
1
9
0
0
0
0
0
Number of Calls of Counseling Service
by Language FY10
N
Missing
Min
Max
Mean
Median
Sum
English
39
13
0
40,281
8,210
4,750
320,180
Spanish
48
4
0
2,582
215
46
10,329
Asian
Languages
1
51
392
392
392
392
392
US (N=52)
)
Canada (N=10)
English
7
3
190
5,899
1,273
439
8,911
French
8
2
0
16,883
2,129
3
17,029
US Primary Service Providers FY10
The figure below shows the organizations (n=15) that were the
primary service provider of counseling services for US quitlines
60%
53%
50%
40%
Start of Year
End of Year
33%
30%
22%
18%
20%
16% 16%
12%
10%
6% 6%
6%
4%
2%
4%
0%
Free and
Clear
National
Jewish
Health
JSI
IQH
Healthways
4%
0%
ACS
0%
Mayo
Other (1 each
of 8 different
providers)
Canadian Service Providers FY10
The majority of Canadian quitlines (60%) had counseling services
provided by the Canadian Cancer Society, Ontario Division
100%
80%
% of
quitlines
reporting
service
provider
60%
60%
40%
20%
10%
10%
10%
10%
0%
Canadian Cancer Canadian Cancer
Society, Ontario Society and Conseil
1
Division
québécois
sur le
tabac et la santé
Alberta Health
Services
1
Sykes Assistance Lung Association of
Services (SASC) Newfoundland and
1
1
Labrador
MEDICATIONS
The number of US quitlines providing free
medications has increased over time
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
70%
70%
FY 2008
FY 2009
75%
46%
FY 2006
FY 2010
Free Medication Provision – US Quitlines – FY10
Free Meds
Type
# Providing
Type of Free
Meds
Patch
39
Gum
N
Median # of
Weeks
Provided
Minimum #
of Weeks
Maximum #
of Weeks
39
4
2
12
34
34
4
2
12
Lozenge
20
20
8
2
12
Bupropion
2
2
10
8
12
Inhaler
1
1
8
8
8
Varenicline
2
2
10
8
12
Nasal
Spray
1
1
8
8
8
(Providing
weeks data)
PROMOTION AND OUTREACH
Types of Media/Promotions and Outreach
Activities FY10&11, US Quitlines
FY10 (N=52)
FY11 (N=52)
TV
71%
85%
Radio
63%
83%
Newspaper ads
35%
44%
Billboards
35%
48%
Online advertising
48%
65%
85%
83%
Information display at health fairs,
meetings, workshops, conferences
88%
87%
Building healthcare referral networks
87%
96%
Building other referral networks
77%
75%
Paid Media/Promotions
Earned media
Outreach
Types of Media/Promotions and Outreach
Activities FY10&11, US Quitlines (cont.)
FY10 (N=52)
FY11 (N=52)
Facebook
37%
62%
Myspace
8%
14%
Twitter
14%
25%
Other
8%
8%
10%
12%
Social Media
Other
Types of Media/Promotions and Outreach
Activities FY10&11, Canadian quitlines
FY10 (N=10)
FY11 (N=10)
TV
70%
50%
Radio
60%
40%
Newspaper ads
60%
50%
Billboards
0%
10%
Online advertising
40%
70%
70%
80%
Information display at health fairs,
meetings, workshops, conferences
100%
90%
Building healthcare referral networks
80%
100%
Building other referral networks
90%
90%
Paid Media/Promotions
Earned media
Outreach
Types of Media/Promotions and Outreach
Activities FY10&11, Canadian quitlines (cont.)
FY10 (N=10)
FY11 (N=10)
Facebook
60%
70%
Myspace
10%
0%
Twitter
30%
30%
Other
10%
10%
20%
20%
Social Media
Other
UTILIZATION
Utilization – Calls FY10
N
Missing
Min
Max
Median
Mean
Sum
% of
total
Answered live
49
3
236
104,573
8,868
15,704
769,497
83%
Went to voicemail
47
5
7
13,657
131
774
36,385
4%
Pre-recorded message
33
19
0
2,797
0
128
4,237
0.5%
Hung up or abandoned
48
4
48
27,294
965
2,222
106,641
11.5%
Total
50
2
316
121,371
10,054
18,563
928,146
100%
Answered live
9
1
221
11,439
746
2,727
24,544
93%
Went to voicemail
2
8
67
147
107
107
214
1%
Pre-recorded message
7
3
0
479
0
68
479
2%
Hung up or abandoned
9
1
4
388
45
104
932
4%
Total
9
1
453
11,577
784
2,935
26,421
100%
Total Calls
US (N=52)
Canada (N=10)
Number of unique
tobacco users FY10
N
Missing
Min
Max
Median
Mean
Sum
Total unique users
48
4
125
72,837
5,610
9,150
439,185
Smokers calling for
self
47
5
141
80,296
4,711
8,701
408,947
Other users calling for
self
46
6
5
2,780
272
458
21,067
Total unique users
8
2
139
4,852
322
1,273
10,180
Smokers calling for
self
8
2
137
4,543
320
1,230
9,842
Other users calling for
self
7
3
0
12
1
4
31
US (N=52)
Canada (N=10)
Number of referrals received by the
quitline in FY10
Total Calls
N
Missing
Min
Max
Median
Sum
Fax referrals
49
3
0
10,036
692
75,887
EMR referrals
41
11
0
0
0
0
Other referrals
44
8
0
6874
110
25,629
Total
47
5
41
16,910
899
96,485
Fax referrals
7
3
23
1,555
298
3,931
EMR referrals
8
2
0
0
0
0
Other referrals
8
2
0
8,812
1,207
9,656
Total
9
1
23
10,603
1,740
15,656
US
(N=52)
Canada (N=10)
In FY10, US quitlines received 3.5 times as many
direct calls from smokers as referrals;
Canadian quitlines received 1.5 times as many
referrals as direct calls from smokers
Ratio of Total number of smokers calling to total
number of referrals received
4
3.5
3
2
1
1
0.62
1
0
US
Canada
Total smokers calling
Total referrals received
33% of US fax referrals received
counseling or medications (N=40)
70000
60000
58476
50000
33%
40000
33190
30000
20000
23889
57%
72%
19573
82%
10000
0
Fax referrals
RECEIVED
Fax referrals
REACHED
Fax referrals
REGISTERED
Fax referrals
RECEIVED
COUNSELING or
MEDS
Average number of minutes of counseling and
number of counseling calls completed FY10
Total Calls
N
Missing
Min
Max
Median Mean
Minutes
38
14
8
60
29.5
28.0
Calls
41
11
1
5
2.1
2.2
Minutes
3
7
5
20
15.0
13.2
Calls
3
7
3
4
3.7
3.6
US (N=52)
Canada (N=10)
600,000
1.20%
500,000
1.00%
400,000
0.80%
300,000
0.60%
200,000
0.40%
100,000
0.20%
0
0.00%
FY05
FY06
FY08
FY09
FY10
Number of unique tobacco users (sum)
Reach (unique tobacco users calling divided by estimated number of smokers in the state
or territory using 2009 BRFSS)
Reach
Number of unique tobacco users calling
US Promotional Reach
FY 2005-2010
Canada Promotional Reach
FY 2005-2010
N=8
N=9
N=10
N=8
N=3
Where are we now?
FY10
Reach
Promotional
reach (# of
unique
tobacco users
calling)
Reach (N)
Registration
reach (# of
tobacco users
completing an
intake)
Reach (N)
Treatment
reach (#
receiving
evidence
based
services)
Reach (N)
U.S.
1.15% (48)
1.30% (52)
1.09% (51)
Canada
0.21% (9)
0.51% (3)
0.31% (9)
Treatment Reach FY09-FY10
Canada
2009
2010
N
3
9
Min
0.24%
0.17%
Max
1.90%
1.79%
Mean
0.80%
0.49%
Actual
0.37%
0.31%
US
2009
2010
N
46
50
Min
0.05%
0.05%
Max
7.25%
6.66%
Mean
1.57%
1.45%
Actual
1.19%
1.09%
US Quitlines Treatment Reach and
Spending Per Smoker (svcs + meds) FY10
7.00%
CDC recommendation: 6% reach, $10.53 per smoker
6.00%
Treatment Reach
5.00%
4.00%
3.00%
2.00%
1.00%
0.00%
$-
$5.00
$10.00
$15.00
$20.00
Spending per Smoker (Services and Medications)
$25.00
$30.00
Canada Quitlines Treatment Reach and
Spending Per Smoker FY10
6.0%
CDC recommendation: 6% reach, $10.53 per smoker
Treatment Reach
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
$-
$2.00
$4.00
$6.00
$8.00
$10.00
$12.00
Spending per Smoker (services budget)
$14.00
$16.00
Additional Resource on Reach
Increasing Reach of Tobacco Cessation Quitlines (2009)
This technical assistance paper provides a comprehensive
review of the current literature on a wide variety of strategies
to increase reach of tobacco cessation quitlines. Additionally,
several examples from practice are included. The paper also
highlights recommendations for quitline reach and funding
levels from key government and health agencies, highlighting
the need to increase reach to more tobacco users to save
lives and direct medical costs. Available at
http://www.naquitline.org/resource/resmgr/issue_papers/naq
c_issuepaper_increasingre.pdf
Quit Rate Data
• 30 quitlines (of 65) provided quit rate data
• NAQC is following up with those that did not
• Further info will be provided on whether and
how quit rate data will be added to the
Quitline Metrics section of the profiles
• Current plan: report on quit rate in profiles,
each quitline can opt out, all contextual
factors will be posted in the “context” field
Survey Data Dissemination Process
• Late July 2011 - Reach and spending
benchmarking info sent to members
• Late July 2011 – Quitline Profile Updates
email
• Fall 2011 – Quit Rate information shared
with members
WHO IS CALLING QUITLINES?
The majority of tobacco users receiving
evidence-based services are
cigarette users FY10
US (median) N=21
0.2% 2.9% 0.2%
1.4%
Cigarettes
Cigars
Pipe
Smokless
Other
95.3%
The majority of tobacco users receiving
evidence-based treatment are everyday/daily
smokers FY10
US (n=16)
Canada (n=2)
1% 2%
2%
12%
Everyday/
daily
Somedays/
Occasional
Not at all
97%
86%
Most tobacco users served with evidencebased services are female FY10
US (n=24)
Canada (n=2)
38%
43%
Male
Female
57%
62%
Utilization FY10 – Age
Quitline
Callers
N
Missing
Min
Max
Mean
Median
Mean
14
38
38
54
45
45
Minimum
15
37
10
23
15
15
Maximum
15
37
70
101
88
89
Mean
2
8
46
47
46
46
Minimum
2
8
14
15
15
15
Maximum
2
8
84
86
85
85
US* (N=52)
Canada** (N=10)
* For the US, the number of callers on which the mean, minimum and maximum age were based ranged from a low of 123 to a high of 98,350.
**For Canada, the number of callers on which the mean, minimum and maximum age were based ranged from a low of 1,189 to a high of 1,189.
Utilization FY10 – Level of Education US
US (n=22)
10%
3%
12%
< Grade 9
Grade 9-11, no degree
GED/HS degree
33%
Some college or university
College or university degree
43%
Level of Education – Canada FY10
Canada (n=2)
17.0%
< HS
24.0%
HS diploma
Some post-secondary
education without degree
Registered Apprenticeship
College, CEGEP
18.0%
8.0%
7.0%
4.0%
University degree
Utilization FY10–Ethnicity US
US (n=24)
3%
Hispanic/ Latino
Not Hispanic/ Latino
97%
Utilization FY10–Race US
US (median)
US (median) n=23
3% 0%
1%
2%0.1% 1.3%
2%
3% 0.4%
4.2%
White
White
Black or African
Black American
or African American
Hispanic or Latino
10%
American Indian or
Alaskan
Native Indian or
American
Asian Alaskan Native
Other
Native Hawaiian or
Asian
Pacific Islander
72%
92%
OtherNative Hawaiian or
Pacific Islander
Utilization FY10 – Sexual Orientation
Quitline
Number of Callers
N
Missing
Min
Max
Mean
Median
Straight
10
42
1264
21,807
8,354
7,616
Gay or lesbian
10
42
39
679
234
209
Bisexual
10
42
21
473
161
113
Transgender
7
45
2
17
9
11
Other
7
45
0
77
14
2
Refused
7
45
0
545
117
19
Missing
7
45
20
11,980
1939
142
US (N=52)
Insurance Status of Callers FY10
US (n=21)
Private, 22%
None, 44%
Gov't provided
(Medicare,
Medicaid, etc),
34%
Canadian quitlines received proportionally
more registrants for web-based cessation
services than US quitlines
Ratio of Registrants for Web-based Cessation
Services to Phone-based Cessation Services
4
3.3
3
2
1
1
1
1.2
0
US
Canada
Registrants for webbased cessation services
Registrants for phonebased cessation services
EVALUATION
Evaluation FY10
38 US quitlines (73%) and 2 Canadian quitlines (20%)
conducted follow-up evaluations in FY10
Most quitlines had follow-up evaluation conducted by:
• staff other than quitline staff (e.g., internal evaluation unit)
(US n=20; Canada n=0),
• an outside evaluation firm (US n=15; Canada n=1)
Next most commonly cited was evaluation conducted
by:
• quitline staff (US n=5; Canada n=1)
• the funding agency (US n=1)
• an other source (US n=1)
Funding Sources for the FY 2010
NAQC Annual Survey of Quitlines
Centers for Disease Control and Prevention,
Office on Smoking and Health
American Legacy Foundation
NAQC Membership Dues
Recommended Citation:
North American Quitline Consortium. 2011. Results
from the 2010 NAQC Annual Survey of Quitlines.
Webinar presentation July 2011. Available at
http://www.naquitline.org/?page=survey2010.
For more information on the survey or on
NAQC’s data request and review process,
please contact;
Jessie Saul, Ph.D.
Director of Research
North American Quitline Consortium
1300 Clay Street, Ste. 600
Oakland, CA 94612
Ph: 800-398-5489 x702
Email: [email protected]