Overview of the Conference
- Bringing quitline providers, researchers, and funders together.
- Working conference. Plenary sessions are a preparation for workgroups.
- Summary of issues and/or recommendations for future research and service needs will come from these workgroups.
- CDC is doing a quitline resource guide and is hoping to use some of the information from this conference.
- Lead to establishment of a consortium of quitlines?
A Survey of Quitlines in North America
- Shu-Hong Zhu
- University of California, San Diego
Thank you!
Data
- Twenty-nine statewide quitlines in U.S.
- Large MCO’s (covering >500,000 lives)
- Province-wide quitlines in Canada
Theory
Diffusion of Innovation
[D]
[D]
[D]
[D]
[D]
Characteristics of Innovation that Facilitate Adoption
# 1: Relative Advantage
[D]
Relative Advantage (Cont.)
- Easier for media campaign that promotes cessation.
- Financially feasible to provide multi-lingual service.
- For earlier adopters such as California, however, it was critical that telephone counseling was found, through a large randomized trial, to be comparable to group clinic in efficacy.
Characteristics of Innovation that Facilitate Adoption
# 2: Observability
[D]
[D]
[D]
The ease of tagging a quitline phone number onto the media campaign also makes the quitline a highly visible program that represents giving something back to smokers who pay the tax.
Obvious Advantages Do Not Guarantee Adoption
Re-invention .in the Process of Diffusion
Range of Service (Statewide Quitlines)
- Mailed materials 100%
- Referral 97%
- Taped messages 32%
- Web chat 42%
- Reactive counseling 90%
- Proactive counseling 87%
- Dispensing NRT/Zyban 25%
- Helping obtain NRT/Zyban 43%
Service for Special Populations
- Teen smokers 46%
- Pregnant smokers 90%
- Smokeless tobacco users 63%
- Medicaid 50%
Counseling Protocol
|
| Length of counseling sessions |
Range (Minutes) |
Mean (Minutes) |
Median (Minutes) |
|
| Reactive counseling (n=24) |
8 - 60 |
22 |
21.5 |
| Proactive counseling (n=23) |
12.5 - 60 |
27 |
25 |
| Proactive follow up (n=22) |
5 - 27.5 |
17.7 |
17.5 |
Number of sessions (Data not useable)
|
[D]
Staffing
- Staffing: confusing answers
- Working hours
- mean 29.6 hours.
- median 30 hours.
Promotion
- Media Promotion
- 88% have an agency outside the quitline conduct media campaign
- Smaller quitlines do their own media promotion
- Budget information for media campaign is not good.
Promotion (Cont.)
|
| |
Mean %
from 140,255 callers |
Range % |
| Mass Media |
63.5 |
0.5 – 100 |
| Brochure/poster |
3.4 |
0 – 20.0 |
| Family/Friends |
6.6 |
0 - 17.5 |
| Healthcare Providers |
13.2 |
0 - 31.6 |
| Schools |
0.4 |
0 - 4.0 |
| Others |
12.9 |
0 - 47 |
|
| Unidentified |
66,124 |
Research and Evaluation
- Research components (n=29) 69%
- Several groups are conducting various randomized trials
- Quitlines being evaluated (n=29) 90%
- This includes quitting outcome and satisfaction
[D]
[D]
Two Discernable Models, plus one
- Based on clinical protocols from randomized trials on proactive counseling, the programs make modification slowly to adapt to new needs, trying to increase the volume of service while preserving what is proven.
- The programs emphasize reaching more smokers, almost considering proactive counseling too expensive, and stressing the benefits of reactive counseling with increasing reach.
- Mixture of the two, making various decisions regarding the service protocol in response to changing needs and often in negotiation with funding agency.
- Many quitlines are expanding (or thinking of expanding) their service to include interventions that have not been fully tested.
Percent of Adult Smokers in Each State Calling the Quitline (Annual Rate)
- Version 1: 0.1 – 2.1%
- Version 2: 0.1 – 5.0%
[D]
Summary and Topics for Discussion
- Quitline is currently being adopted at a high rate, and for good reasons.
- What are the issues now? What are the dangers?
- Re-invention is a part of the adoption process.
- How can we ensure the effectiveness of the modified services?
- Meanwhile, can we capitalize on the fact that most quitlines are doing some sort of evaluation and there is existing variation across programs?
- Quitlines reach thousands of smokers each year. But that’s still a small segment of the total smoking population. What should be expected of the quitlines?
- Quitlines are often an integral part of a comprehensive approach to smoking cessation. But much research is needed to examine its role/effects in such a framework.
Acknowledgments
Diana Padgett
Christopher Anderson
Mary Ann Nguyen
Scott Leischow
Patty Dill
Nancy Accetta
Abby Rosenthal
Deborah Ossip-Klein
Acknowledgment (Cont.)
Christopher Anderson, Mark Attridge, Jeannie Boness,.David Bullwinkle, Paula Celestino, Michael Cummings,.Janis M. Daue, Elizabeth Fildes, Angela Geiger, Amber Jaworsky, Pamela Luckett, Michael Mark, Caren Massari, Tim McAfee, Paul McDonald, Ani O'Hara, Barbara Perry, Pamela Powers, Vance Rabius, Tammy Renzello, Abby Rosenthal, Pat Reynaga, Diane Ruesch, Stacy Sokol, Amber Thornton, Sara Tifft
Acknowledgment (Cont.)
California Department of Health Services,
Tobacco Control Section, Grant # 00-90605.
A Historical Background
- Research literature
- Dubren (1977) taped messages: a randomized trial
- Shiffman et al. (1982) former smokers: observational study
- Ossip-Klein, et al. (1991), Orleans et al. (1991): large randomized trials as part of NCI RFA testing self-help approach.
- Service
- In 1986-87, NCI’s Cancer Information Service (CIS) conducted a media campaign to promote their toll-free number as a smoking cessation service, with staff trained for cessation counseling.
[D]