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 SurveyConducted 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 MethodsCompleted from October to December 2010

• Web-based survey with email and telephone follow-up: 1) General Information, hours, services offered2) Quitline budgets3) Funding sources4) Materials used5) Counselling services and protocols6) Promotion7) Utilization8) 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

$-

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

$140,000,000

$160,000,000

$180,000,000

$-

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

$1,600,000

$1,800,000

FY06 FY08 FY09 FY10

Tota

l Qui

tline

Bud

get (

sum

)

Med

ian

Qui

tline

Bud

get

Median quitline budget Total quitline budget (sum)

N=48

N=50

N=50

N=51

Median quitline budgets in Canada have decreased from FY09 – FY10

$-$1,000,000 $2,000,000 $3,000,000 $4,000,000 $5,000,000 $6,000,000 $7,000,000 $8,000,000

$-$50,000

$100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000

FY05 FY06 FY08 FY09 FY10

Tota

l Qui

tline

Bud

get (

sum

)

Med

ian

Qui

tline

Bud

get

Median quitline budget Total quitline budget (sum)

N=6N=9 N=9 N=10 N=9

US Spending per Smoker 2008-2010(services and medications)

$1.71 $1.78 $1.89

$- $0.20 $0.40 $0.60 $0.80 $1.00 $1.20 $1.40 $1.60 $1.80 $2.00

2008 2009 2010

N=45

N=49N=50

Canada Spending per Smoker (services), 2008-2010

$0.65 $0.77

$0.67

$- $0.20 $0.40 $0.60 $0.80 $1.00 $1.20 $1.40 $1.60 $1.80 $2.00

2008 2009 2010

N=8 N=9N=9

Funding Sources in FY10 and FY11US

FY10 (N=52)

US FY11

(N=52)Canada FY10

(N=10)Canada

FY11 (N=10)

Public sector/government Local government funds 0% 0% 0% 0% State/provincial general funds 25% 26% 100% 100% State/provincial dedicated tobacco tax funds 21% 24% 0% 0% State Medicaid program 4% 6% 0% 0% MSA funds 46% 45% 0% 0% Tobacco settlement funds (not MSA) 10% 8% 0% 0% Federal CDC- ARRA/Stimulus funds 52% 82% 0% 0% CDC - other (non-ARRA) funds 71% 73% 0% 0% Health Canada 0% 0% 60% 30% Other 2% 2% 0% 0%Private sector/non-government Third part reimbursement through healthcare institution 0% 0% 0% 0%

Third part reimbursement through insurance company 8% 8% 0% 0%

Charitable foundation 2% 2% 10% 30% For-profit company 0% 0% 10% 10% Non-governmental organization 2% 0% 20% 10% Employer organization 0% 0% 0% 0%Other 2% 2% 0% 0%

More US quitlines report receiving funds from CDC or MSA funds than any other source

14%

33%

39% 65

%8%

24%

0%

20%

40%

60%

80%

100%FY 09

FY 10

FY10: CDC (ARRA)

FY10: CDC (Other)

FY10: CDC (ARRA and Other)

FY 11

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 funds78%

64%54%

38%

27%19% 17%

4%

77% 76%

55%

69%

19%24%

19% 18%

4%

64% 63%

49%56%

32%

18%27%

3%0%

20%

40%

60%

80%

100% FY09 avg proportion of funds amongquitlines reporting each funding sourceFY10 avg proportion of funds amongquitlines reporting each funding sourceFY11 avg proportion of funds amongquitlines reporting each funding source

The majority of Canadian quitlines report receiving funds from provincial general funds

90%

60%

30%20%

10% 10%

100%

60%

20%10%

0%10%

100%

30%10%

30%

0%10%

0%

20%

40%

60%

80%

100%

120%FY 09

FY 10

FY 11

For Canadian quitlines, the highest proportion of funds come from provincial general funds

and Health Canada

70%

56%

14%

5%9%

69%

56%

0%8%

0%

57%

80%

0% 0%

14%

0%

20%

40%

60%

80%

100%

Health Canada State/Provincialgeneral funds

Local governmentfunds

Non-governmentalorganization

Other

FY 09 avg proportion of funds amongquitlines reporting each funding sourceFY 10 avg proportion of funds amongquitlines reporting each funding sourceFY 11 avg proportion of funds amongquitlines reporting each funding source

DESCRIPTION OF SERVICES

General Service Description FY1061 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

Phone counseling servicesUS

N = 52CAN 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)

US and Canadian quitlines provide interactive web-based programs to help tobacco users quit FY10

0%10%20%30%40%50%60%70%80%90%

100%

75% 73%65%

21%

58%

12%

80%90%

80% 80%90%

40%

USCanada

Methods Offered to Providers to Refer Patients to Quitlines in FY10

96%

46%

4% 0% 13%

100%

0% 10% 0%20%

0%

20%

40%

60%

80%

100%

Fax-referral Form Via Email Within EMR and transmit referral

electronically

Automatically pulled from EMR

Other method

US (N=52)Canada (N=10)

How many call attempts were made to make first contact with a fax- or 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

Quitlines made between 3 and 4 attempts to reach fax- or e-referred patients in FY10

Used a translation service for hearing clients FY10

10%

90%

64%

35%0%

20%

40%

60%

80%

100%

Yes No

Canada (N=10)

US (N=52)

How many times was the translation service used to provide counseling to hearing clients

N Missing Min Max Mean Median Sum

US (N=52) 29 23 0 999 61.79 3 1792Canada (N=10) 1 9 9 9 9.0 9 9

Number of times translation service used for counseling hearing clients FY10

Quitline used a third party translation service for deaf and hard-of-hearing clients FY10

10%

0% 0%

39%

52%

2%0%

20%

40%

60%

80%

100%

Video relay interpreter TTY relay CACommunication Assistant

Other translation service

Canada (N=10)US (N=52)

How many times was a third party translation service used to provide counseling to Deaf and Hard-of-hearing clientsN Missing Min Max Mean Median Sum

US (N=52) 24 28 0 1 0.17 0 4Canada (N=10) 1 9 0 0 0 0 0

Number of times translation service used for counseling deaf and hard-of-hearing clients FY10

Number of Calls of Counseling Service by Language FY10

N Missing Min Max Mean Median Sum

US (N=52)

English 39 13 0 40,281 8,210 4,750 320,180Spanish 48 4 0 2,582 215 46 10,329

Asian Languages

1 51 392 392 392 392 392

Canada (N=10))

English 7 3 190 5,899 1,273 439 8,911French 8 2 0 16,883 2,129 3 17,029

The figure below shows the organizations (n=15) that were the primary service provider of counseling services for US quitlines

US Primary Service Providers FY10

Free and Clear

National Jewish Health

JSI IQH Healthways ACS Mayo Other (1 each of 8 dif-

ferent providers)

0%

10%

20%

30%

40%

50%

60%

33%

12%

6% 6%2%

22%

4%

16%

53%

18%

6% 4% 4%0% 0%

16%

Start of YearEnd of Year

Canadian Service Providers FY10

60%

10% 10% 10% 10%

0%

20%

40%

60%

80%

100%

Canadian Cancer Society, Ontario

Division

Canadian Cancer Society and Conseil

québécois sur le tabac et la santé

Alberta Health Services

Sykes Assistance Services (SASC)

Lung Association of Newfoundland and

Labrador

% ofquitlinesreportingservice

provider

The majority of Canadian quitlines (60%) had counseling services provided by the Canadian Cancer Society, Ontario Division

1 1 1 1

MEDICATIONS

The number of US quitlines providing free medications has increased over time

FY 2006 FY 2008 FY 2009 FY 20100%

10%20%30%40%50%60%70%80%90%

100%

46%

70% 70%75%

Free Medication Provision – US Quitlines – FY10Free Meds

Type# Providing

Type of Free Meds

N (Providing

weeks data)

Median # of Weeks

Provided

Minimum # of Weeks

Maximum # of Weeks

Patch 39 39 4 2 12

Gum 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

PROMOTION AND OUTREACH

Types of Media/Promotions and Outreach Activities FY10&11, US Quitlines

FY10 (N=52) FY11 (N=52)Paid Media/Promotions TV 71% 85% Radio 63% 83% Newspaper ads 35% 44% Billboards 35% 48%

Online advertising 48% 65%Earned media 85% 83%Outreach Information display at health fairs, meetings, workshops, conferences 88% 87% Building healthcare referral networks 87% 96% Building other referral networks 77% 75%

Types of Media/Promotions and Outreach Activities FY10&11, US Quitlines (cont.)

FY10 (N=52) FY11 (N=52)Social Media Facebook 37% 62% Myspace 8% 14% Twitter 14% 25% Other 8% 8%Other 10% 12%

Types of Media/Promotions and Outreach Activities FY10&11, Canadian quitlines

FY10 (N=10) FY11 (N=10)

Paid Media/Promotions TV 70% 50%

Radio 60% 40%

Newspaper ads 60% 50%

Billboards 0% 10%

Online advertising 40% 70%

Earned media 70% 80%Outreach Information display at health fairs, meetings, workshops, conferences 100% 90%

Building healthcare referral networks 80% 100%

Building other referral networks 90% 90%

Types of Media/Promotions and Outreach Activities FY10&11, Canadian quitlines (cont.)

FY10 (N=10) FY11 (N=10)

Social Media Facebook 60% 70%

Myspace 10% 0%

Twitter 30% 30%

Other 10% 10%

Other 20% 20%

UTILIZATION

Utilization – Calls FY10Total Calls N Missing Min Max Median Mean Sum % of

total

US (N=52)

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%

Canada (N=10)

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%

Number of unique tobacco users FY10N Missing Min Max Median Mean Sum

US (N=52)

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

Canada (N=10)

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

Number of referrals received by the quitline in FY10

Total Calls N Missing Min Max Median Sum

US (N=52)

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

Canada (N=10)

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

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

US Canada0

1

2

3

4 3.5

0.621 1

Ratio of Total number of smokers calling to total number of referrals received

Total smokers callingTotal referrals received

33% of US fax referrals received counseling or medications (N=40)

Fax referrals RECEIVED

Fax referrals REACHED

Fax referrals REGISTERED

Fax referrals RECEIVED

COUNSELING or MEDS

0

10000

20000

30000

40000

50000

60000

7000058476

3319023889

1957357% 72% 82%

33%

Average number of minutes of counseling and number of counseling calls completed FY10

Total Calls N Missing Min Max Median Mean

US (N=52)

Minutes 38 14 8 60 29.5 28.0

Calls 41 11 1 5 2.1 2.2

Canada (N=10)

Minutes 3 7 5 20 15.0 13.2

Calls 3 7 3 4 3.7 3.6

US Promotional Reach FY 2005-2010

FY05 FY06 FY08 FY09 FY100

100,000

200,000

300,000

400,000

500,000

600,000

-0.20%

0.00%

0.20%

0.40%

0.60%

0.80%

1.00%

1.20%

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)

Num

ber o

f uni

que

toba

cco

user

s ca

lling

Rea

ch

Canada Promotional Reach FY 2005-2010

N=3

N=8 N=10N=9

N=8

Where are we now?FY10

ReachPromotional 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-FY10Canada N Min Max Mean Actual

2009 3 0.24% 1.90% 0.80% 0.37%2010 9 0.17% 1.79% 0.49% 0.31%

US N Min Max Mean Actual2009 46 0.05% 7.25% 1.57% 1.19%2010 50 0.05% 6.66% 1.45% 1.09%

$- $5.00 $10.00 $15.00 $20.00 $25.00 $30.00 0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

Spending per Smoker (Services and Medications)

Trea

tmen

t Rea

chUS Quitlines Treatment Reach and

Spending Per Smoker (svcs + meds) FY10

CDC recommendation: 6% reach, $10.53 per smoker

$- $2.00 $4.00 $6.00 $8.00 $10.00 $12.00 $14.00 $16.00

-1.0%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

Spending per Smoker (services budget)

Trea

tmen

t Rea

chCanada Quitlines Treatment Reach and

Spending Per Smoker FY10CDC recommendation: 6% reach, $10.53 per smoker

Additional Resource on ReachIncreasing 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/naqc_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 FY10US (median) N=21

95.3%

1.4%0.2%2.9% 0.2%

CigarettesCigarsPipeSmoklessOther

The majority of tobacco users receiving evidence-based treatment are everyday/daily

smokers FY10US (n=16) Canada (n=2)

86%

2% 12%

Everyday/ dailySomedays/ OccasionalNot at all

97%

1% 2%

Most tobacco users served with evidence-based services are female FY10

US (n=24) Canada (n=2)

38%

62%

MaleFemale

43%

57%

Utilization FY10 – AgeQuitline Callers

N Missing Min Max Mean Median

US* (N=52)

Mean 14 38 38 54 45 45Minimum 15 37 10 23 15 15Maximum 15 37 70 101 88 89

Canada** (N=10)

Mean 2 8 46 47 46 46Minimum 2 8 14 15 15 15Maximum 2 8 84 86 85 85

* 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

3%12%

43%

33%

10%

US (n=22)

< Grade 9

Grade 9-11, no degree

GED/HS degree

Some college or university

College or university degree

Level of Education – Canada FY10

17.0%

18.0%

4.0%7.0%

8.0%

24.0%

Canada (n=2)

< HS

HS diploma

Some post-secondaryeducation without degreeRegistered Apprenticeship

College, CEGEP

University degree

Utilization FY10–Ethnicity US

3%

97%

US (n=24)

Hispanic/ Latino

Not Hispanic/ Latino

Utilization FY10–Race US

72%

10%

3%2% 3% 1%0%

US (median)White

Black or AfricanAmericanHispanic or Latino

American Indian orAlaskan NativeOther

Asian

Native Hawaiian orPacific Islander92%

4.2%0.4%

0.1% 1.3% 2%

US (median) n=23White

Black or African American

American Indian orAlaskan Native

Asian

Native Hawaiian orPacific Islander

Other

Utilization FY10 – Sexual OrientationQuitline Number of Callers

N Missing Min Max Mean Median

US (N=52)

Straight 10 42 1264 21,807 8,354 7,616Gay 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

Insurance Status of Callers FY10

None, 44%

Gov't provided (Medicare,

Medicaid, etc), 34%

Private, 22%

US (n=21)

Canadian quitlines received proportionally more registrants for web-based cessation

services than US quitlines

US Canada0

1

2

3

4

1 1

3.3

1.2

Ratio of Registrants for Web-based Cessation Services to Phone-based Cessation Services

Registrants for web-based cessation servicesRegistrants for phone-based cessation services

EVALUATION

Evaluation FY1038 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 HealthAmerican 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 ResearchNorth American Quitline Consortium1300 Clay Street, Ste. 600Oakland, CA 94612Ph: 800-398-5489 x702Email: jsaul@naquitline.org