comparison of four cessation programs: what works best ? for whom?

Comparison of Four Cessation Programs:

What Works Best?For Whom?

Comparison of Four Cessation Programs:What Works Best? For Whom?

Presenters:Presenters:

Ann H. Wendling, MD MPH Ann H. Wendling, MD MPH

Anne E. Betzner, MA Anne E. Betzner, MA

Julie A. Rainey, BAJulie A. Rainey, BA

Barbara A. Schillo, PhDBarbara A. Schillo, PhD

Additional Contributors:Additional Contributors:

Michael G. Luxenberg, PhDMichael G. Luxenberg, PhD

Lawrence C. An, MDLawrence C. An, MD

Annette Kavanaugh, MSAnnette Kavanaugh, MS

Sharrilyn Evered, PhDSharrilyn Evered, PhD

Acknowledgement of Collaborating Vendors

Helpline: Free & Clear, Inc.

Website: QuitNet.com, Inc.

Treatment Centers:

Affiliated Community Medical CenterSt. Mary's Duluth Clinic

Northwest Medical Center

Work Sites: Park Nicollet Institute

Professional Data Analysts, Inc.

Learner Outcomes:

• Understand key program components of MPAAT’s Understand key program components of MPAAT’s telephone helpline, website, treatment center, and telephone helpline, website, treatment center, and workplace cessation programs. workplace cessation programs.

• Understand cessation outcomes for each program in Understand cessation outcomes for each program in terms of the populations served and the degree to terms of the populations served and the degree to which clients utilized key services. which clients utilized key services.

• Assess the effectiveness of four program types for Assess the effectiveness of four program types for their own populations, and have a standard of their own populations, and have a standard of comparison for similar cessation programs. comparison for similar cessation programs.


Minnesota Partnership for Action Against Tobacco (MPAAT)

• Established in 1998 as 501(c)3 as part of Established in 1998 as 501(c)3 as part of Minnesota’s tobacco settlementMinnesota’s tobacco settlement

• Funded by Ramsey County District Court Funded by Ramsey County District Court with 3% of settlement ($202 million)with 3% of settlement ($202 million)

• MPAAT has awarded more than $20 MPAAT has awarded more than $20 million in program grants and contractsmillion in program grants and contracts


How is Minnesota different from other states?

• MPAAT is not located within or funded by the MPAAT is not located within or funded by the State Department of HealthState Department of Health

• MPAAT funds may not supplant benefits of MPAAT funds may not supplant benefits of other programs or health plansother programs or health plans

• MPAAT maintains partnership with health MPAAT maintains partnership with health plans to provide helpline serviceplans to provide helpline service


MPAAT Resources

www.mpaat.org


Cessation services provided by MPAATCessation services provided by MPAAT

• QUITPLAN Helpline 1-888-354-PLANQUITPLAN Helpline 1-888-354-PLAN

• quitplan.comquitplan.com

• QUITPLAN CentersQUITPLAN Centers

• QUITPLAN at WorkQUITPLAN at Work

• QUITPLAN Community-tailored ProgramsQUITPLAN Community-tailored Programs


Helpline Goals

• Provide a multi-call proactive phone Provide a multi-call proactive phone counseling program to uninsured or counseling program to uninsured or underinsured Minnesotansunderinsured Minnesotans

• Connect Minnesotans who have access to Connect Minnesotans who have access to telephone counseling to their health planstelephone counseling to their health plans

• Create systems changes/sustainabilityCreate systems changes/sustainability


Uninsured and Underinsured

• Uninsured = no insurance at all (not even Uninsured = no insurance at all (not even state public programs)state public programs)

• Underinsured = insurance does not include Underinsured = insurance does not include tobacco cessation counseling and/or NRT tobacco cessation counseling and/or NRT


Health Plan Partners (7)

• Blue Cross Blue Shield of MinnesotaBlue Cross Blue Shield of Minnesota

• HealthPartnersHealthPartners

• Mayo Health PlanMayo Health Plan

• Medica Medica

• Metropolitan Health PlanMetropolitan Health Plan

• PreferredOne Community Health PlanPreferredOne Community Health Plan

• UCareUCare


Helpline Process

Calls to Helpline• Paid media• Targeted promotions• Referrals

Health plan helpline, possible NRT

MPAAT-funded phone numberMPAAT-funded phone number1-888-354-PLAN1-888-354-PLAN

Is phone counseling available through health insurer?

Yes No

MPAAT-funded phone counseling, possible NRT


May 2001 - May 2001 - Began servicesBegan services

Sept. 2002 - Sept. 2002 - Initially provided NRTInitially provided NRTAllowed any Minnesotan to enroll with Allowed any Minnesotan to enroll with resulting duplication of servicesresulting duplication of services

August 2003August 2003 - Changed scripting to - Changed scripting to improve triage and split NRT shipmentimprove triage and split NRT shipment

Evolution of Helpline Services


Evolution of Helpline Services

June 2004 - PresentJune 2004 - Present

Health plan systems changes initiatedHealth plan systems changes initiated

Began collecting health plan identification Began collecting health plan identification numbersnumbers

Further adjusted scripting to triage clientsFurther adjusted scripting to triage clients


Helpline Volumes 2001-2005

• 34,970 calls requested some service 34,970 calls requested some service

• 7,246 callers were triaged to health plans7,246 callers were triaged to health plans • 16,306 enrolled in multi-call counseling16,306 enrolled in multi-call counseling

• 13,071 participants received nicotine patches 13,071 participants received nicotine patches or gum or gum


Addressing Challenges

• Health plan membersHealth plan members

• Copays, Rx requirements, deductiblesCopays, Rx requirements, deductibles

• Not all health plan members have NRTNot all health plan members have NRT

• Self-report of NRT benefitsSelf-report of NRT benefits


www.quitplan.com

• Provides interactive cessation advice and Provides interactive cessation advice and social support at all stages of readiness to social support at all stages of readiness to quitquit

• Available to ALL Minnesotans, regardless of Available to ALL Minnesotans, regardless of health plan coveragehealth plan coverage

• Over 11,000 Minnesotans have enrolled Over 11,000 Minnesotans have enrolled since August 2003since August 2003

• No free NRTNo free NRT


QUITPLANSM at Work

• Provide five session group counseling at Provide five session group counseling at worksitesworksites

• Provide service to at least 50 worksitesProvide service to at least 50 worksitesa year, five worksites in each region of the a year, five worksites in each region of the state, and multiple diverse sectorsstate, and multiple diverse sectors

• Employees ready to quit are eligibleEmployees ready to quit are eligible

• NRT available to un- and underinsuredNRT available to un- and underinsured


Face-to-face Programs January 2004 – Present

• QUITPLAN CentersQUITPLAN Centers• Over 950 clients Over 950 clients

• QUITPLAN at WorkQUITPLAN at Work• Over 650 clientsOver 650 clients• Recent high demand post ordinance Recent high demand post ordinance

implementationimplementation


QUITPLAN Community-tailored Programs

• Culturally tailored cessation programs serving Culturally tailored cessation programs serving priority communities:priority communities:• African-AmericanAfrican-American• Somali and OromoSomali and Oromo• Southeast AsianSoutheast Asian• Chicano LatinoChicano Latino• GLBTGLBT

• Community participatory evaluation modelCommunity participatory evaluation model


650

950

11,000

16,300

0 5000 10000 15000 20000

Helpline (4 years)

Website (18 months)

Centers (18 months)

Worksite (18 months)

(Community tailored programs are being evaluated separately.)

Numbers Served by QUITPLAN Programs


Methodology

Rx

website

helpline treatment center

worksite


Scope of the Evaluation

• ProcessProcess Track services provided and to whom; Track services provided and to whom;

participant satisfactionparticipant satisfaction• Outcome evaluationOutcome evaluation

Participant outcomesParticipant outcomes


Today’s Presentation

• Who goes to each program?Who goes to each program? Demographics and tobacco use and Demographics and tobacco use and

quit history for each programquit history for each program Demographic “user profiles” or Demographic “user profiles” or

clustersclusters Tobacco use and quit history “user Tobacco use and quit history “user

profiles” or clustersprofiles” or clusters


Today’s Presentation

• Who goes to each program?Who goes to each program? Demographics and tobacco use and Demographics and tobacco use and

quit history for each programquit history for each program Demographic “user profiles” or clustersDemographic “user profiles” or clusters Tobacco use and quit history “user Tobacco use and quit history “user

profiles” or clustersprofiles” or clusters• How effective is each program?How effective is each program?• For whom?For whom?


301

457

351

1139

0 400 800 1200

Helpline

Center

Work

Website

Number of Respondents

Evaluation Methods: Intake

• Intake Form at Intake Form at RegistrationRegistration• Demographic Demographic

information, information, tobacco use and tobacco use and quit history, quit history, confidence confidence quittingquitting


Quit Survey Methodology

• Quit Survey administered 6 months Quit Survey administered 6 months after registrationafter registration• Tobacco use, pharmacotherapy use, Tobacco use, pharmacotherapy use,

utilizationutilization• Telephone surveyTelephone survey• Dual methodology for WebsiteDual methodology for Website


Consent Rates to Date

98.3%

80.1% 83.2%

60.1%

0%

25%

50%

75%

100%

Helpline Treatmentcenter

Worksite Website

366/457 292/351 685/1139 296/301

Helpline used a more passive, general consent process than the other interventions


Response Rates to Date

74.0%70.2%

78.8% 78.1%

0%

25%

50%

75%

100%

Helpline Treatmentcenter

Worksite Website

257/366 230/292 535/685 219/296

36.8%Phone

41.3%Online


Using MATS to Compare to Intervention Samples of Smokers

The Minnesota AdultThe Minnesota AdultTobacco Survey Tobacco Survey (MATS) (MATS) used a sampleused a sampleof 1,850 smokers.of 1,850 smokers.

Survey data was collected collaboratively with MPAAT, Survey data was collected collaboratively with MPAAT, Blue Cross Blue Shield of Minnesota, the Minnesota Blue Cross Blue Shield of Minnesota, the Minnesota Department of Health, and the University of Minnesota.Department of Health, and the University of Minnesota.

Estimated: 660,000 Estimated: 660,000 smokers in Minnesotasmokers in Minnesota


Who Uses the QUITPLAN Programs?

Rx

website

helpline treatment center

worksite


% Female

59.0% 59.0% 53.4%65.3%

37.1%

0%

25%

50%

75%

100%

Helpline * Centers * Work * Website * MATS

Gender

* Significantly different than MATS (p ≤ .05)


Mean Age in Years

42.6 43.8 41.8 38.0 39.8

0

20

40

60

80


Mean Age



0%

25%

50%

75%

100%

Helpline Centers * Work * Website * MATS

HS or less Some college College grad+

Education



% Employed

47.0%

64.1%

98.6%

75.6% 77.8%

0%

25%

50%

75%

100%

Helpline * Centers * Work * Website MATS

Employment Status



% Insured

59.8%

92.1% 93.2%86.5% 88.1%

0%

25%

50%

75%

100%


Insurance Status



Are there demographic “user profiles”?

• K-Means Cluster analysis K-Means Cluster analysis

• 6 groups emerged6 groups emerged

• Determined by distance between and Determined by distance between and within clusters, meaningfulness of within clusters, meaningfulness of clusters, and parsimonyclusters, and parsimony

• All participants fall into one group onlyAll participants fall into one group only


Gen X - Gen Y

• 40% male

• Younger (18-40)

• Few college grads (15%)

• All unemployed

• None married

• Highest rate of uninsured (1/3)

• Racially more diverse (12% nonwhite)


Ms. Executive

• All femaleAll female• 25 - 50 years old25 - 50 years old• High proportion of High proportion of

college grads (59%)college grads (59%)• All employedAll employed• ½ married½ married• 90% white90% white


Working Women

• All femaleAll female• 41 - 60 years old41 - 60 years old• Almost no college Almost no college

grads (7%)grads (7%)• All employedAll employed• ½ married½ married• 90% white90% white


• 36% men; 64% 36% men; 64% womenwomen

• All 41+ years oldAll 41+ years old• High proportion with High proportion with

HS or less ed (40%)HS or less ed (40%)• All unemployedAll unemployed• ½ married½ married• More uninsured (¼)More uninsured (¼)• 90% white90% white

Hard Luck


Mr. Executive

• All maleAll male• 31 - 60 years old31 - 60 years old• High proportion of High proportion of

college grads (59%)college grads (59%)• All employedAll employed• 2/3 married2/3 married• 90% white90% white


Blue Collar Workers

• Mostly maleMostly male• Broad age range (18-50)Broad age range (18-50)• Lowest education of all Lowest education of all

groups (75% HS or less)groups (75% HS or less)• All employedAll employed• 1/3 married1/3 married• More uninsured (1/4)More uninsured (1/4)• 90% white90% white


Proportion of Participants in Each Demographic Cluster

Demographic Demographic ClustersClusters Gen XGen X

Gen YGen Y

Ms. Ms. ExecutiveExecutive

Working Working WomenWomen

Hard Hard LuckLuck

Mr. Mr. ExecutiveExecutive

Blue Blue Collar Collar

WorkersWorkers

% of % of participants participants

11.911.9 22.322.3 18.718.7 16.016.0 17.317.3 13.813.8

Weighted so that each intervention is 25%


Who Uses the Helpline?

Demographic Demographic ClustersClusters

HelplineHelpline

Gen XGen X

Gen YGen Y



Hard Hard LuckLuck


Blue Blue Collar Collar WorkersWorkers

% of % of participantsparticipants

18.218.2 9.59.5 14.214.2 34.8 7.47.4 15.915.9


Who Uses the Centers?


CentersCenters

Gen XGen X

Gen YGen Y



Hard Hard LuckLuck




10.410.4 19.719.7 17.517.5 25.1 14.814.8 12.612.6


Who Uses QUITPLAN at Work?


WorkWork

Gen XGen X

Gen YGen Y



Hard Hard LuckLuck




1.41.4 22.9 28.4 0.70.7 25.0 21.6


Who Uses the Website?


WebWeb

Gen XGen X

Gen YGen Y



Hard Hard LuckLuck




14.514.5 29.1 17.117.1 9.59.5 19.619.6 10.410.4

Who Uses Each Program?

Tobacco Use and Quit HistoryTobacco Use and Quit History


% Smoked within 30 Minutes of Waking

80.9% 80.7%68.9% 72.3%

46.1%

0%

25%

50%

75%

100%


Time to First Cigarette



% Daily Smokers

90.5% 86.8% 86.8%75.3% 74.3%

0%

25%

50%

75%

100%


Daily Smokers



0%

25%

50%

75%

100%


Light (<15 cigs/day)

Moderate (15-24 cigs/day)

Heavy (25+ cigs/day)

Smoking Intensity



% Who Attempted to Quit

55.6%48.9% 50.2%

65.1%55.7%

0%

25%

50%

75%

100%

Helpline Center * Work Website * MATS

Quit Attempt in Last Year



% Yes

19.4%26.6% 27.2%

16.9%

0%

25%

50%

75%

100%

Helpline Centers Work Website

Ever Quit for a Year or More?


Are there tobacco use/quit history “user profiles”?

• Six groups emergedSix groups emerged

• Determined by distance between and Determined by distance between and within clusters, meaningfulness of within clusters, meaningfulness of clusters, and parsimonyclusters, and parsimony

• From lighter to heavier smokersFrom lighter to heavier smokers


Lighter Smokers

• Light smokers (82%)Light smokers (82%)• ½ are daily smokers ½ are daily smokers

(fewest of all clusters)(fewest of all clusters)• Only 1/3 highly addictedOnly 1/3 highly addicted• All recent quit for 30+ All recent quit for 30+

daysdays• None 1-yr quitNone 1-yr quit

#1#1

Poised to Quit #2#2

• Light to moderate Light to moderate smokers (50%/50%)smokers (50%/50%)

• About ½ smoke daily About ½ smoke daily • About ½ highly About ½ highly

addictedaddicted• All recent quit for 30+ All recent quit for 30+

daysdays• All 1-yr quitAll 1-yr quit


• Light smokers (82%)Light smokers (82%)• ½ smoke daily ½ smoke daily • Only 1/3 highly addictedOnly 1/3 highly addicted• All recent quit for 30+ All recent quit for 30+

daysdays• None 1-yr quitNone 1-yr quit

#1#1

Poised to Quit #2#2


• About ½ smoke daily About ½ smoke daily • About ½ highly About ½ highly

addictedaddicted• All recent quit for 30+ All recent quit for 30+

daysdays• All 1-yr quitAll 1-yr quit

Lighter Smokers


Moderates


• Some heavy Some heavy smokers (20%)smokers (20%)

• All daily smokersAll daily smokers• ¾ highly addicted¾ highly addicted• None have recent None have recent

quitquit• All have 1-year quitAll have 1-year quit

#3#3


Rookie Quitters

• Moderate to heavy Moderate to heavy smokers (50%/30%)smokers (50%/30%)

• All smoke dailyAll smoke daily• 85% highly addicted85% highly addicted• No recent quitNo recent quit• No 1-year quitNo 1-year quit

#4#4

Second Chance

#5#5

• Moderate to heavy Moderate to heavy smokers (70%/30%)smokers (70%/30%)

• All smoke dailyAll smoke daily• 90% highly addicted90% highly addicted• All recent quit, most All recent quit, most

<30 days<30 days• No 1-year quitNo 1-year quit


Heaviest

• Moderate to heavy Moderate to heavy (50%/40%)(50%/40%)

• 80% daily smokers80% daily smokers• 93% highly addicted93% highly addicted• All recent quit, most All recent quit, most

for <30 daysfor <30 days• Few 1-year quitFew 1-year quit

#6#6


Proportion of Participants in Each Tobacco Use / Quit History Cluster

Tobacco Use Tobacco Use / Quit History / Quit History ClustersClusters

11 22 33 44 55 66


17.817.8 9.09.0 10.510.5 29.8 20.420.4 12.512.5

Weighted so that each intervention is 25%

Lighter Smokers

Poised to Quit

Mod-erates

Rookie Quitters

Second Chance

Heaviest


Who Used the Helpline?


HelplineHelpline

11 22 33 44 55 66


13.113.1 7.67.6 12.8 23.823.8 27.9 14.8

Lighter Smokers

Poised to Quit

Mod-erates

Rookie Quitters

Second Chance

Heaviest


Who Used the Centers?


CentersCenters

11 22 33 44 55 66


11.211.2 7.7 15.615.6 35.5 19.1 10.910.9

Lighter Smokers

Poised to Quit

Mod-erates

Rookie Quitters

Second Chance

Heaviest

Rx


Who Used QUITPLAN at Work?


WorkWork

11 22 33 44 55 66


15.115.1 10.3 15.415.4 33.6 16.1 9.6

Lighter Smokers

Poised to Quit

Mod-erates

Rookie Quitters

Second Chance

Heaviest


Who Used the Website?


WebWeb

11 22 33 44 55 66


24.424.4 9.89.8 4.8 27.7 19.719.7 13.6

Lighter Smokers

Poised to Quit

Mod-erates

Rookie Quitters

Second Chance

HeaviestSmokers


Programs Serve Different Tobacco / Quit Groups


11 22 33 44 55 66

HelplineHelpline

CentersCenters

WorkWork

WebWeb

Lighter Smokers

Poised to Quit

Mod-erates

Rookie Quitters

Second Chance

Heaviest


Summary

• QUITPLAN participants can be QUITPLAN participants can be described by clusters based on described by clusters based on demographics and tobacco use.demographics and tobacco use.

• QUITPLAN programs serve QUITPLAN programs serve demographic and tobacco use groups demographic and tobacco use groups that differ in important ways.that differ in important ways.


Summary

The Centers serve the Hard The Centers serve the Hard Luck demographic group and Luck demographic group and the Rookie Quitter tobacco the Rookie Quitter tobacco use group most frequently.use group most frequently.

Rx

The Helpline serves the Hard The Helpline serves the Hard Luck demographic group and Luck demographic group and the Second Chance tobacco the Second Chance tobacco use group most frequently.use group most frequently.


Summary

The Website serves Ms. The Website serves Ms. Executive and Rookie Executive and Rookie Quitters most frequently.Quitters most frequently.

QUITPLAN at Work serves all QUITPLAN at Work serves all employed demographic groups employed demographic groups and the Rookie Quitter tobacco and the Rookie Quitter tobacco use group most frequentlyuse group most frequently

Results at Six Months

How effective is each cessation How effective is each cessation program?program?


Desired Outcomes at Six Months

• Quit attempt of at least 24 hours Quit attempt of at least 24 hours

• 7-day point prevalence7-day point prevalence

• 30-day point prevalence 30-day point prevalence


Cautions in Interpreting Results

•Evaluation, not a clinical trial

•Participants not randomly assigned

•No comparison or control group

•Observations of what occurred in these real-life programs

•Caution in generalizing results to other populations


Calculating Quit Rates

Artificially high quit rate:Artificially high quit rate:

““Quitters” / Respondents = Quit rateQuitters” / Respondents = Quit rate

Intention to treat rateIntention to treat rate::

““Quitters” / (Respondents + Nonrespondents) Quitters” / (Respondents + Nonrespondents) = ITT Rate= ITT Rate


The majority of participants successfully quit for at least 24 hours

62.5%68.6%63.7%65.5%

0%

25%

50%

75%

100%


24-Hour Abstinence during Past Six Months for Each Program (Intent to Treat Rate)


Used No Tobacco in Past 7 Days

15.6%18.5%

22.1%26.7%

0%

20%

40%

60%

80%

100%


7 Day Point Prevalence at Six Months, Intent-to-Treat Rates


11.8%14.7%

19.4%24.0%

0%

20%

40%

60%

80%

100%


30-Day Point Prevalence at Six Months, Intent-to-Treat Rates

Used No Tobacco in Past 30 Days

Which programs work best for whom?

Is there a relationship between cessation and: Is there a relationship between cessation and:

• Tobacco use/quit history

• Demographics

• Program utilization

• Pharmacotherapy use

Do people with different tobacco use patterns quit at different rates at each of the programs?

Tobacco Use/Quit History


LightestLightest Poised to Poised to Quit Quit

ModMod Rookie Rookie quittersquitters

Second Second chancechance

HeaviestHeaviest

28.928.9 40.940.9 43.243.2 26.126.1 21.021.0 14.014.0

7-Day Abstinence Rates (ITT) at Six Months for Each Cluster

Helpline produces high quit rates for a variety of smoking types, from light to heavy, with and without a quit history.

Participants in the heaviest use group do not fare as well.


LightestLightest Light -Light -Mod Mod



HeaviestHeaviest

28.928.9 40.940.9 43.243.2 26.126.1 21.021.0 14.014.0


Helpline produces high quit rates for a variety of smoking types, from light to heavy, with and without a quit history.

Helpline users in the heaviest use group do not fare as well.

Includes 50% of all Helpline participants


LightestLightest Light-ModLight-Mod ModMod Rookie Rookie quittersquitters


HeaviestHeaviest

34.1 35.7 29.8 18.518.5 18.618.6 7.57.5


Centers show the highest quit rates in the light and moderate tobacco use clusters.

Rx


LightestLightest Light-ModLight-Mod ModMod Rookie Rookie quittersquitters


HeaviestHeaviest

34.1 35.7 29.8 18.518.5 18.618.6 7.57.5

Centers show the highest quit rates in the light and moderate tobacco use clusters.

Rx

1/3 of all Center participants fall within these clusters.


1/3 of Center participants are “rookie quitters”


Social Social smokerssmokers

Light-ModLight-Mod ModMod Rookie Rookie quittersquitters


HeaviestHeaviest

18.218.2 26.726.7 31.131.1 12.212.2 10.610.6 25.025.0

Work program shows strong results with three clusters, one light, one moderate and the heaviest group.




Light-ModLight-Mod ModMod Rookie Rookie quittersquitters


HeaviestHeaviest

18.218.2 26.726.7 31.131.1 12.212.2 10.610.6 25.025.0

Work program shows strong results with three clusters, one light, one moderate and the heaviest group.


“Rookie quitters” are the largest cluster (1/3 of all Work participants)

Only 10% of Work participants are the “heaviest” users.

Website participants did not have statistically significant differences in the quit rates of tobacco use groups.

Quit rates ranged from 10% to 22%.



Light-Light-ModMod



HeaviestHeaviest

HelplineHelpline

CentersCenters

WorkWork

WebWebNSNS

Programs have success with different tobacco use groups.

Quit rates20% - 29.9%

Quit rates 30% or higher

Do different demographic groups quit at different rates at each of the programs?

Demographics


Gen X – Gen X –

Gen YGen Y



Hard LuckHard Luck Mr. ExecutiveMr. Executive Blue Collar Blue Collar WorkersWorkers

5.35.3 19.419.4 28.128.1 20.720.7 33.333.3 21.721.7

Demographic ClustersDemographic Clusters

Centers highest rates are seen in the demographic clusters with older age groups.



Gen X – Gen X –

Gen YGen Y



Hard LuckHard Luck Mr. ExecutiveMr. Executive Blue Collar Blue Collar WorkersWorkers

5.35.3 19.419.4 28.128.1 20.720.7 33.333.3 21.721.7


Centers highest rates are seen in the demographic clusters with older age groups.


10% 20% 70% of all Center participants


These QUITPLAN programs did not have significant differences in quit rates for different demographic clusters.

The conclusion is that the programs have about equal success with all demographic groups.

However, the smoking and quit history clusters have varying levels of success, depending on the program.

Helpline, Work and Website


How do participants make use of available program services?

How is level of use related to cessation at each of the programs?

Utilization


Programs have mixed patterns of utilization

Level of Utilization by Program

0%

25%

50%

75%

100%


Low Medium High


Participants Using More Program Services Have Higher Quit Rates

7-Day Abstinence at Six Months (respondents only) by Utilization Level

0%

25%

50%

75%

100%

Helpline * Centers * Worksite Website *

Low Utilization Moderate UtilizationHigh Utilization

* p < .05


Pharmacotherapy Use

How is pharmacotherapy used by QUITPLAN participants?

How is use of medications related to cessation?


Used Meds* to Help Quit?

• Vast majority of Vast majority of Helpline and Center Helpline and Center participants used participants used medsmeds

• Over half of Over half of QUITPLAN at Work QUITPLAN at Work and quitplan.com and quitplan.com diddid

52%

61%

87%

92%

0% 25% 50% 75% 100%

Website

Work

Centers

Helpline

% Used Meds

* Includes use of one or more medication: Zyban/Wellbutrin/buproprion, nicotine patch, gum, inhaler, lozenge or nasal spray.


Type of Medications Used

4%

55%

75%

37%31%

12%11%5%7%

33%

13% 8%

0%

25%

50%

75%

100%


NRT only Zyban only NRT and Zyban


Pharmacotherapy Users have Higher Quit Rates

30%34% 30%25%

17%22%

14%17%

0%

25%

50%

75%

100%

7-Day Point Prevalence 30-Day Point Prevalence

NRT + Zyban NRT Only Zyban only None


NRT NRT Use?Use?

Social Social SmokersSmokers

Light-ModLight-Mod ModeratesModerates Rookie Rookie QuittersQuitters

Second Second ChanceChance

Heaviest Heaviest

NoNo 25.025.0 22.622.6 26.126.1 11.511.5 12.512.5 20.420.4

YesYes 37.537.5 43.143.1 45.245.2 29.029.0 24.424.4 19.619.6

Diff.Diff. +12.5 +20.5 +19.1 +17.5 +11.9 -0.8

NRT Alone Is Helpful for all except the heaviest users.

Tobacco Use ClustersTobacco Use Clusters

7-Day Abstinence Rates (respondents only)

at Six Months for Each Cluster



NRT NRT Use?Use?

Gen X – Gen X –

Gen YGen Y



Hard LuckHard Luck Mr. Mr. ExecutiveExecutive

Blue Blue Collar Collar

WorkersWorkers

NoNo 18.518.5 19.519.5 18.518.5 9.69.6 16.116.1 22.922.9YesYes 26.426.4 27.027.0 32.032.0 37.237.2 34.834.8 27.527.5Diff.Diff. +7.9+7.9 +7.5+7.5 +13.5 +27.6 +18.7 +4.6+4.6

NRT Use is helpful to all demographic groups, especially “Hard Luck” group.

! ! !7-Day Abstinence Rates (respondents only)

at Six Months for Each Cluster


Putting it all together…..

What is the unique contribution of each of these factors to cessation?

Demographic profiles

Tobacco use profiles

Program type

Confidence in successful quit

Pharmacotherapy useUtilization


Logistic Regression Results

Demographic profiles: Not significant

Tobacco use profiles: Moderates 1.7 times and Light-Moderates 1.4 times more likely to quit

Heaviest 1.7 times more likely to be smoking

Confidence in Those with highest confidence are 2.2 times successful quit: more likely to quit

Program type: Not significant

Utilization: High utilization: 2.6 times more likely to quit Medium utilization: 1.9 times more likely to quit

Pharmacotherapy use: NRT users 1.8 times more likely to quit than non-usersZyban users 1.4 more likely than non-users


Summary of Results

• All four QUITPLAN programs are effective at helping participants quit tobacco.

• Tobacco use profiles: The four programs have differing levels of success depending on tobacco use profiles.

• Demographic profiles: For Centers, quit rates are high for all groups except Gen X – Gen Y. In all other programs, quit rates for demographic groups do not differ.

• Participants who use more of the available program services are more likely to quit.


Summary of Results

• Participants who use medications are more likely to quit.

• NRT has a differential benefit depending on the demographic profile (all groups benefit from NRT; especially the Hard Luck group)

• NRT is beneficial for all tobacco use profiles except the heaviest smokers.

• Tobacco/Quit history, Confidence, Utilization and Pharmacotherapy contribute to cessation holding all other variables constant.


Why conduct a synthesis evaluation?

• MPAAT invests significant resources in cessation servicesMPAAT invests significant resources in cessation services• These is a need to synthesize:These is a need to synthesize:

• Answer overall questions about the initiativeAnswer overall questions about the initiative• Answer common questions asked about each individual Answer common questions asked about each individual

interventionintervention• This allows MPAAT This allows MPAAT

• Conduct continuous quality improvement of each Conduct continuous quality improvement of each programprogram

• Assess overall return on investment Assess overall return on investment • Make information decisions about future resource Make information decisions about future resource

allocationallocation


Why conduct a synthesis evaluation?

• Allows MPAAT to assess the degree to which the Allows MPAAT to assess the degree to which the services delivered meet cessation goals:services delivered meet cessation goals:• Ensure assistance to all tobacco users in Ensure assistance to all tobacco users in

MinnesotaMinnesota• Provide a full range of evidence-based Provide a full range of evidence-based

cessation servicescessation services• Ensure access to counseling and NRT without Ensure access to counseling and NRT without

regard to ability to payregard to ability to pay• Reach populations and communities with the Reach populations and communities with the

highest tobacco use rates and poor access to highest tobacco use rates and poor access to health carehealth care


Limitations in Using Synthesis Evaluation Results

• Limits in comparing servicesLimits in comparing services• Each component delivers cessation counseling Each component delivers cessation counseling

differently (face to face or remotely, and by differently (face to face or remotely, and by group or individual)group or individual)

• These methods vary in intensity for the These methods vary in intensity for the participantsparticipants

• Findings do not equate to results from clinical trialsFindings do not equate to results from clinical trials• Self selection of services and intensity of useSelf selection of services and intensity of use• Real world, real services, real timeReal world, real services, real time


What do we know about the initiative based on the synthesis evaluation?

• Who is using MPAAT’s intervention services?Who is using MPAAT’s intervention services?• We are serving a wide range of Minnesota We are serving a wide range of Minnesota

tobacco users tobacco users • Each demographic and clinical cluster is well-Each demographic and clinical cluster is well-

served by one or more program served by one or more program • Collectively across programs, we are serving Collectively across programs, we are serving

MN tobacco usersMN tobacco users• How are they using these services?How are they using these services?

• Participants are using the services with Participants are using the services with varying levels of intensityvarying levels of intensity


What do we know about the initiative based on the synthesis evaluation?

How effective are our services?How effective are our services?

Using QUITPLAN services increases the chance of a successful Using QUITPLAN services increases the chance of a successful quitquit Need to examine why the four programs have differing levels of Need to examine why the four programs have differing levels of

success depending on tobacco use profilessuccess depending on tobacco use profiles

Participants using more program services have higher quit ratesParticipants using more program services have higher quit rates Need to examine ways to increase program intensity Need to examine ways to increase program intensity

Pharmacotherapy users have higher quit ratesPharmacotherapy users have higher quit rates Need to examine ways to further reduce barriers to NRTNeed to examine ways to further reduce barriers to NRT Need to consider where targeting resources to make NRT more Need to consider where targeting resources to make NRT more

accessible will have the greatest impactaccessible will have the greatest impact


What do we know about each individual evaluation based on the synthesis evaluation?

• HelplineHelpline• Serves the greatest number of demographic and Serves the greatest number of demographic and

clinical clustersclinical clusters• Good reach - over 16,000+ served in 4 year period Good reach - over 16,000+ served in 4 year period • Highest quit ratesHighest quit rates

• WebsiteWebsite• Serves younger, lighter smokersServes younger, lighter smokers• Highest reach – over 11,000+ served in 18 month Highest reach – over 11,000+ served in 18 month

periodperiod• Quit rates lower but still effective Quit rates lower but still effective


What do we know about each individual evaluation based on the synthesis evaluation?

• Treatment Centers Treatment Centers • Appeals to heavier smokers; broad reach across the Appeals to heavier smokers; broad reach across the

demographic clustersdemographic clusters• Relatively fewer servedRelatively fewer served• Quit rates highQuit rates high

• WorksitesWorksites• Though numbers are few, serves well the heaviest Though numbers are few, serves well the heaviest

smokerssmokers• Overall, higher level of intensity of use of services Overall, higher level of intensity of use of services • Relatively fewer servedRelatively fewer served• Quit rates high Quit rates high


Future Directions• Interpret findings as they relate to program goalsInterpret findings as they relate to program goals

• Refine services; expand where necessaryRefine services; expand where necessary

• Continue to evaluate and assess resource Continue to evaluate and assess resource allocationsallocations

• Conduct additional research to enhance the use of Conduct additional research to enhance the use of services and improve outcomesservices and improve outcomes

• Enhance utilization ratesEnhance utilization rates

• Increase access to and use of NRTIncrease access to and use of NRT


For Additional Information

Dr. Ann WendlingDr. Ann Wendling

MPAATMPAAT

952-767-1411952-767-1411

[email protected]@mpaat.org

comparison of four cessation programs: what works best ? for whom?

Documents

health insurer

health plansmpaat

mpaatquitplan helpline

cessation outcomes

workplace cessation

similar cessation programs

telephone counseling

presenthealth plan systems