• No results found

Wisconsin Tobacco Quit Line

N/A
N/A
Protected

Academic year: 2021

Share "Wisconsin Tobacco Quit Line"

Copied!
37
0
0

Loading.... (view fulltext now)

Full text

(1)

Wisconsin Tobacco Quit Lin

e

Evaluation of the Provision of Free Nicotine Replacement Therapy

Prepared for:

Wisconsin Department of Health Services, Division of Public Health, Bureau of

Community Health Promotion, Tobacco Prevention and Control Program

(2)

ACKNOWLEDGEMENTS

This evaluation was conducted by the University of Wisconsin Carbone Cancer Center, Tobacco Surveillance and Evaluation Program, at the request of the Wisconsin Department of Health Services, Division of Public Health, Bureau of Community Health Promotion, Wisconsin Tobacco Prevention and Control Program.

The evaluation was supported by the Wisconsin Department of Health Services, Division of Public Health, Bureau of Community Health Promotion, Wisconsin Tobacco Prevention and Control Program.

Review of the survey instrument and helpful feedback was provided by the Wisconsin Center for Tobacco Research and Intervention

Quit Line registration and call data were provided by Free & Clear, Inc.

For additional copies of this report, visit our website http://www.medsch.wisc.edu/mep/ or contact:

Karen Palmersheim, Ph.D.

University of Wisconsin Carbone Cancer Center 370 WARF 610 N. Walnut St. Madison, WI 53726 608-262-2825 kapalmersheim@uwcarbone.wisc.edu TABLE OF CONTENTS Executive Summary ………... 1 Introduction ……… 3 Methods ……….. 4 Results ……… 6 Discussion ……… 14 Limitations ………... 16 Conclusions ……….. 17 References ……… 18 Appendix ……….. 20

(3)

EXECUTIVE SUMMARY

A program evaluation study was conducted in effort to assess the utility of adding free nicotine replacement therapy (NRT) as an adjunctive therapy to telephone counseling offered by

theWisconsin Tobacco Quit Line. Assessment of the impact of the added free NRT component was accomplished by comparing a sample of 2008 Quit Line callers, most of whom were offered the free NRT in conjunction with Quit Line coaching, to a sample of 2007 callers, who were generally offered the standard Quit Line coaching services. Key findings of the evaluation are as follows.

 Thirty-day quit rates at 7 months post-registration were 28.6% for the 2007 callers and 28.2% for the 2008 callers.

 Among callers who were not 30-day abstinent at 7 months, the average longest quit attempt was 23 days among the 2007 callers, and 25 days among the 2008 callers.  About half of the 2007 callers (49.0%) and nearly three-fourths of the 2008 callers

(72.7%) reported using NRT during the 7-month post-registration period.

 Callers who reported using any NRT were slightly more likely to be 30-day abstinent than those who did not use NRT (29.8% vs. 27.6% for the 2007 group, and 29.3% vs. 25.5% for the 2008 group, respectively).

 Approximately three-fourths of the callers in each group rated their health as being a very important reason for calling the Quit Line. The second most common reason identified as very important was to save money.

 Approximately three-fourths of the 2008 callers placed some importance on the free NRT in their decision to call the Quit Line, ranging from 39% reporting it was “extremely important” to 10% reporting it was “slightly important”; 24% stated that it was “not important at all”.

 Almost 80% of the 2008 callers reported that the January 1, 2008 cigarette price increase played a part in their decision to call the Quit Line, ranging from 45% stating it was “extremely important” to 9% stating it was “slightly important”; 21% reported stated it was “not important at all”.

 Approximately two-thirds of the 2007 callers reported that the January 1, 2008 cigarette price increase played a part in motivating them to quit using tobacco, and/or not start smoking again, ranging from 29% stating it was “extremely important” to 11% stating it was “slightly important”; 35% stated it was “not important at all”.

(4)

 Callers enrolled in the multi-call program were more likely to be 30-day abstinent at 7 months compared to those enrolled in the one-call program. The observed difference for the 2007 callers was statistically significant (31.3% vs. 22.3%). The difference for the 2008 callers was not statistically significant (28.8% vs. 24.2%).

 Among callers enrolled in the multi-call program, those who completed 4 or more calls were significantly more likely to be 30-day abstinent at 7 months compared to those who did not complete at least 4 calls (37.6% vs. 27.7%, for the 2007 callers; 36.6% vs. 25.6%, for the 2008 callers).

 A higher percentage of 2008 callers reported they were “very satisfied” with the Quit Line compared to 2007 callers (47.1% vs. 38.8%).

 90% of the 2008 callers and 86% of the 2007 callers said they would recommend the Quit Line to a friend.

(5)

INTRODUCTION

The state of Wisconsin has sponsored the Wisconsin Tobacco Quit Line service since 2001, which offers both reactive counseling to callers and proactive counseling after referral from a healthcare provider. The Quit Line is overseen by the University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) and supported by the Tobacco Prevention and Control Program of the Wisconsin Division of Public Health. Its daily operations are managed by Free & Clear, Inc.

Individuals who register with the Quit Line for cessation services are encouraged to commit to: receiving four counseling calls, creating an individual plan for quitting, and setting a quit date. Callers who are not able to commit to multiple calls receive condensed services in one call. Registered callers can also call the Quit Line between 7 a.m. and 11 p.m. daily to speak to a counselor.

Previous studies have revealed that telephone counseling can aid smokers interested in quitting. 1-7

There is also evidence that nicotine replacement therapy (NRT) used alone,8-9 and in

combination with telephone counseling,10-15 can help improve quit rates. These findings have been shown for 30-day abstinence,4,12-14 as well as 7-day abstinence,5,11,15 at 6-month follow-up. Moreover, the provision of free NRT through a state quit line has recently been associated with increased quit line utilization.15

In effort to enhance utilization of the Wisconsin Tobacco Quit Line and facilitate caller cessation, Wisconsin decided to add NRT to the State’s quit line service as an adjunct to

telephone cessation counseling. On December 17, 2007, the UW-CTRI and Free & Clear, Inc., via support from the Wisconsin Division of Public Health, began offering a free, 2-week supply of NRT (nicotine patches, gum, or lozenges) to eligible callers. The free NRT incentive

continued through December of 2008. During that time, most adult tobacco users were eligible to receive the free 2-week pack of NRT if they were willing to register for the Quit Line’s multi-call program. Callers who had a recent heart attack, recent stroke, irregular heartbeat, angina, skin patch reaction, dental/jaw problems, were pregnant or breastfeeding, were less than 18 years of age and those with high blood pressure who were not on medication were not eligible to receive the free NRT. [In 2007, a limited number of eligible callers were offered free

introductory NRT as supported by their employers. In addition, military personnel that served in Iraq and Afghanistan were offered free NRT as a part of a program called Operation Quit

Tobacco.]

In order to assess the utility of adding free NRT to the State’s quit line service, the Wisconsin Division of Public Health requested the Tobacco Surveillance and Evaluation Program (of the UW Paul P. Carbone Comprehensive Cancer Center) conduct a program evaluation study. The aims of the evaluation were to assess the impact of the additional program component on factors associated with program effectiveness (i.e., caller reach, quitting behavior, caller satisfaction).

(6)

Assessment of the impact of the added free NRT component was accomplished by comparing a sample of 2008 Quit Line callers, most of whom were offered the free NRT in conjunction with Quit Line coaching, to a sample of 2007 callers, who were generally offered the standard Quit Line coaching services. Data for the evaluation were accessed, in part, from the Minimal Data Set (MDS) provided by Free & Clear, Inc. Additional data were collected via a survey

developed by the Tobacco Surveillance and Evaluation Program, with helpful feedback provided by the UW-CTRI and the Division of Public Health. This report summarizes the findings of the evaluation.

METHODS

Sampling Procedures

The sampling frames for the evaluation study included tobacco users that registered with the Wisconsin Tobacco Quit Line between January 1 and April 30, of each 2007 and 2008. In effort to control for seasonal affects, the sampling frames were stratified by month, with the goal of surveying 250 callers from each month. The University of Wisconsin Survey Center (UWSC) was contracted to administer the survey via a telephone interview. Sample was drawn in random replicates of 50 from each month of callers (Note: Due to large caller volume during January of 2008, random replicates of 100 were drawn). The drawn cases were sent advance letters

explaining the study and inviting the Quit Line callers to participate. Interviewers then made up to 20 attempts to contact each selected Quit Line caller via telephone, confirm his/her name and Quit Line registration date, and complete an interview. Cases that resulted in bad addresses, wrong numbers, disconnected numbers, or faxes were referred to tracing, where efforts were made to find new contact information. The UWSC completed interviews with 927 of the 2007 callers. After removing attempted cases that were unable to participate due to death, physical incapacity, or other issues, those considered ineligible, and those for whom valid contact

information could not be verified, the resulting response rate for participation was 56.5%. 1,025 interviews were completed with 2008 callers, reflecting a response rate of 52.0%.

Data

Registration and Call Data

Data collected at the time callers registered with the Quit Line were provided by Free & Clear, Inc. The data included information on demographic background, smoking history, current tobacco use, level of addiction, readiness to quit, health conditions that may contraindicate NRT use, and for women, whether they were pregnant of breastfeeding. Information on type of program registration (one-call or multi-call), calls completed (type of call and date completed), and provision of NRT (NRT type, dosage, and amount sent) were also made available by Free & Clear, Inc.

(7)

Survey Instruments

Separate, but similar survey instruments were constructed for the 2007 and 2008 callers. Data on a few additional demographic variables were collected (household income and employment status). Callers were asked about their tobacco use at the time of interview, their tobacco use during the 7th month after they registered with the Quit Line, quit attempts, methods used to try to quit using tobacco, reasons for wanting to quit and for contacting the Quit Line, and general satisfaction with the Quit Line service. Additional questions focused on callers’ receipt of NRT from the Quit Line and other sources, and their utilization of the NRT. Information on how NRT users paid for NRT, type of health insurance coverage, and provision of NRT by their health insurance provider was also obtained.

Analytical Samples

We limited our analytical samples to adult, cigarette smokers who requested an intervention from the Wisconsin Quit Line service. In addition, we limited the female participants to those who were not pregnant or breastfeeding at the time of registration with the Quit Line. Of the 924 surveys completed with the 2007 callers, 16 cases were eliminated due to the caller being pregnant or breastfeeding at the time of their registration (1.7%). 24 cases were eliminated because there was no evidence that the caller was a cigarette smoker (2.6%). Of the 1,025 surveys completed with the 2008 callers, 15 were eliminated because the callers were listed as pregnant or breastfeeding at the time of their initial registration (1.4%). One caller that was solely a pipe smoker was also eliminated (0.1%). Thus, analyses for this study included 884 2007 callers and 1,009 2008 callers.

Outcomes

The primary behavioral outcome of interest in the current study was 30-day abstinence during the 7th month after the caller registered with the Quit Line service. The 30-daypoint prevalence measure has been suggested as a more stable measure than 7-daypoint prevalence.2 In addition, the study design required retrospectively assessing the 7-month quit status of the 2007 Quit Line callers. The research team determined that retrospectively asking participants about their

abstinence during a specific month would result in more reliable information than asking about a specific week. Further, the 30-daypoint prevalence measure has been suggested as a preferable measure to continuous abstinence because many successful long-term quitters: 1) takesome period of time before they set an initial quit date; and/or 2) report slips during the first few months after quitting.2

A secondary behavioral outcome of interest was the average longest quit attempt achieved by those who were not 30-day abstinent at 7 months post-registration. In addition, caller volume and characteristics are briefly presented for each month of the study period.

Process outcomes of interest included receipt of free NRT from the Quit Line service, utilization of NRT during the 7-month post-registration period, reasons for registering with the Quit Line, level of contact with the Quit Line, and satisfaction with the Quit Line service. Additional information on how callers paid for health care and NRT, caller knowledge of health care

(8)

coverage for NRT, and how they heard about the Wisconsin Tobacco Quit Line are provided for the interested reader in the appendix section of this report. Further, a comparison of the study participants’ demographic and baseline tobacco use characteristics, relative to the sample pool from which they were drawn, is included in the appendix.

Statistical Analysis

Independent samples two tailed t-tests were used to test differences between the 2007 and 2008 callers. Chi-square tests were employed for within year comparison of quit rates between callers who used or received NRT and those who did not.

RESULTS

Sample characteristics for the 2007 and 2008 callers are displayed in Table 1.

Descriptive analyses revealed that the obtained samples of 2007 and 2008 callers were very similar in terms of demographic backgrounds. While a slightly greater proportion of the 2007 callers were unable to work, and a slightly greater proportion of the 2008 callers were employed for wages, these differences were not statistically significant (using a cutoff of p<.05). The two samples were also similar with regards to factors associated with tobacco use reported at the time of Quit Line registration, with a few exceptions. A greater percentage of the 2008 callers

smoked within the first five minutes after waking compared to the 2007 callers; though, this difference was not statistically significant. Comparison of stage of readiness to quit, however, did reveal significant differences. A greater percentage of callers in the 2007 sample were in the action and contemplation stages of readiness to quit as compared to the 2008 callers, while a greater percentage of the 2008 callers were in the preparation stage.

(9)

Table 1. Demographics, Tobacco Use and Stage of Readiness to Quit, by Group 2007 Callers (n=884) 2008 Callers (n=1,009) Registration Month January 27.9% 25.1% February 26.8% 25.5% March 25.7% 24.8% April 19.6% 24.7% Age (years) Minimum 18 18 Maximum 81 87 Mean 46.6 47.2 Median 48 48 Gender Female 57.6% 57.7% Race/Ethnicity White 83.9% 86.9% Other 14.3% 12.5%

Hispanic, any race 1.9% 1.6%

Education

Less than high school 11.1% 11.1%

High school diploma/ GED 37.6% 39.1%

Some college/Associates degree 31.9% 31.2%

College or University degree 17.5% 17.9%

Household Income <$10,000 8.1% 6.4% $10,000 - 14,999 8.7% 8.9% $15,000 - 19,999 8.9% 9.1% $20,000 - 24,999 18.4% 18.2% $25,000 - 34,999 18.4% 20.8% $35,000 - 49,999 13.0% 14.7% $50,000 - 74,999 10.7% 8.8% $75,000 or greater 6.3% 4.8%

(10)

Table 1. Demographics, Tobacco Use and Stage of Readiness to Quit, by Group 2007 Callers (n=884) 2008 Callers (n=1,009) Employment Status

Employed for wages 46.0% 50.2%

Self-employed 8.0% 6.3%

Out of work < 1 year 4.1% 4.7%

Out of work > 1 year 3.3% 4.3%

Homemaker 4.3% 5.3%

Student 2.0% 1.9%

Retired 15.3% 13.4%

Unable to work 16.5% 13.4%

# Cigarettes Smoked Per Day

Minimum 0 0

Maximum 80 60

Mean 19.1 18.6

Median 20 20

Time to 1st Cigarette after Waking

Smoke <= 5 minutes 39.0% 43.6%

Smoke 6-30 minutes 31.7% 31.5%

Smoke 31-60 minutes 9.6% 11.6%

Smoke > 60 minutes 14.5% 12.0%

Use of Other Tobacco 2.7% 2.0%

Stage of Readiness to Quit

Precontemplation 0.2% 0.0%

Contemplation** 2.8% 1.0%

Preparation*** 85.0% 94.5%

Action*** 11.5% 4.4%

Maintenance 0.1% 0.1%

Note:Comparison of 2007 Callers to 2008 Callers; Independent samples t-test, 2-tailed *p <.05, **p<.01, ***p<.001

(11)

Thirty-day quit rates at 7 months post-registration were 28.6% for the 2007 callers and 28.2% for the 2008 callers (Table 2). This difference was not statistically significant. Additional analysis of data on the callers who were not 30-day abstinent at 7 months revealed a slightly greater average “longest quit attempt” among the 2008 callers (25 days) than the 2007 callers (23 days); though, the difference was not statistically significant.

Table 2. Abstinence from Cigarette Use - 7 Months Post-Registration, by Group 2007 Callers

(n=884)

2008 Callers

(n=1,009) p-valuec

30-day abstinencea 28.6% 28.2% .850

Average longest quit attemptb 23 days 25 days .405

a

No cigarette smoking during the previous 30 days; Callers with missing or inconsistent data were excluded b

Longest quit attempt of callers that were not 30-day abstinent at 7 months c

Comparison of 2007 Callers to 2008 Callers; Independent samples t-test, 2-tailed

Examination of Quit Line data revealed that Free & Clear, Inc. sent nicotine replacement therapy to a small proportion of the 2007 callers (7.6%) and to a large proportion of the 2008 callers (80.7%) (Table 3). The follow-up survey data revealed that approximately half of the 2007 callers (49.0%) and nearly three-fourths of the 2008 callers (72.7%) reported having used NRT during the 7-month period.

Table 3. Use of Nicotine Replacement Therapy, by Group

2007 Callers (n=884)

2008 Callers (n=1,009)

Free & Clear sent caller NRTa 7.6% 80.7%

Caller indicated that they used some form of NRT in

attempting to quit during the first 7 months 49.0% 72.7%

c

Caller has condition where NRT would not be

recommendedb 0.2% 1.0%

a

Free & Clear 2007 and 2008 data b

Free & Clear 2007 and 2008 data, defined as: recent heart attack, recent stroke, irregular heartbeat, angina, skin patch reaction, dental mouth/jaw problems and high blood pressure w/no medication c

Not all 2008 callers that received NRT from Free & Clear used it. Some 2008 callers that did not receive NRT from Free & Clear reported that they obtained NRT from other sources.

(12)

Further investigation of quit rates, relative to NRT use during the 7-month period, found that callers who reported using NRT were slightly more likely to be 30-day abstinent than those who did not use NRT (29.8% vs. 27.6% for the 2007 group, and 29.3% vs. 25.5% for the 2008 group, respectively) (Table 4). However, the differences were not statistically significant.

Additionally, the within-year quit rates between callers who received free NRT from the Quit Line and those who did not were not significantly different. Though, the number receiving free NRT in 2007 was relatively small.

Table 4. Abstinence from Cigarette Usea - 7 Months Post-Registration, by Group, Free NRT Receipt,

and NRT Use

2007 Callers

(n=884) p-valueb

2008 Callers

(n=1,009) p-valueb

Overall 30-day abstinence 28.6% (d=865) 28.2% (d=1,008)

Received free NRT

Yes 31.8% (d=66) 29.2% (d=813)

No 28.4% (d=799) .556 24.6% (d=195) .207

Used NRT during the first 7 months

Yes 29.8% (d=423) 29.3% (d=733)

No 27.6% (d=442) .477 25.5% (d=275) .223

a

No cigarette smoking during the previous 30 days; Callers with missing or inconsistent data were excluded b

Quit ratecomparison within year; Compared those who received or used NRT to those who did not; Chi-square test

Note: d = denominator

A series of questions assessed the level of importance callers placed upon common reasons for calling the Quit Line. Data displayed in Table 5 show the percentage of callers that reported a particular reason as being “very important” in their decision to call the Quit Line.

Approximately three-fourths of the callers in each group (75.9% of 2007 callers and 74.9% of 2008 callers) rated their health as being a very important reason for calling the Quit Line. The second most common reason identified as very important was to save money. The reason least often identified as being very important was harder to smoke in public places. The percentage of callers identifying each reason as being very important was similar in the two groups.

(13)

Table 5. Percent of Callers Who Rated Reason as "Extremely Important"* in Their Initial Decision to Register with the Quit Line, by Group

2007 Callers (n=884)

2008 Callers (n=1,009)

Free cessation counseling 32.5% 30.5%

Your health 75.9% 74.9%

Somebody else's health 35.4% 32.4%

To save money 51.1% 54.0%

Family or friends wanted them to quit 49.0% 43.3%

Harder to smoke in public places 21.4% 21.3%

* Callers were asked how important each reason was in their decision to call the Quit Line using a 4-point Likert scale, ranging from “extremely important” to “not important at all”.

The 2008 callers were asked about the importance of the free NRT offer in their decision to call the Quit Line. Approximately three-fourths of them placed some importance on the free NRT, ranging from 39.1% reporting it was “extremely important” to 10.1% reporting it was “slightly important”. 24.0% of the 2008 callers stated that it was “not important at all” (Table 6).

Table 6. Importance of Free NRT in Initial Decision to Register with the Quit Line: 2008 Callers

2008 Callers (n=1,009)

Extremely Important 39.1%

Moderately Important 26.3%

Slightly Important 10.1%

Not at all important 24.0%

The 2008 callers were also asked about the level of importance the January 1, 2008 cigarette price increase played in their decision to call the Quit Line. Almost 80% of them reported that it did have some level of importance in their decision, ranging from 45.3% stating it was

“extremely important” to 9.2% stating it was “slightly important”. 20.6% of the 2008 callers reported that the price increase was “not important at all” (Table 7).

(14)

Table 7. Importance of January 1, 2008 Cigarette Price Increase in Initial Decision to Register with the Quit Line: 2008 Callers

2008 Callers (n=1,009)

Extremely Important 45.3%

Moderately Important 24.7%

Slightly Important 9.2%

Not at all important 20.6%

The 2007 callers were asked a parallel question with regards to the January 1, 2008 cigarette price increase. Given the timing of the price increase relative to their registration with the Quit Line, they were asked how important the price increase was in motivating them to quit using tobacco, and/or to not start smoking again. Approximately two-thirds of them reported that it was a factor in their decision to quit using tobacco or to stay tobacco-free, ranging from 29.2% stating it was “extremely important” to 10.6% stating it was “slightly important”. 34.8% of the 2007 callers reported that the price increase was “not important at all” (Table 8).

Table 8. Importance of January 1, 2008 Cigarette Price Increase in Motivating Callers to Quit or Not Start Smoking Again: 2007 Callers

2007 Callers (n=884)

Extremely Important 29.2%

Moderately Important 22.3%

Slightly Important 10.6%

Not at all important 34.8%

I was not tobacco free 2.5%

Type and level of caller contact with the Quit Line during the 7-month period following their registration date was also examined (Table 9). The average number of calls was slightly greater among the 2008 callers (2.7) than the 2007 callers (2.5). This coincides with a greater

percentage of the 2008 callers being registered for the multi-call program (88.1%), compared to the 2007 group (71.0%). However, among those callers enrolled in the multi-call program, a greater percentage of the 2007 callers completed four or more scheduled counseling calls compared to 2008 callers (36.0% vs. 29.5%, respectively).

Within year analysis of 30-day abstinence among callers in the multi-call program revealed that callers who completed 4 or more calls were significantly more likely to be abstinent at 7 months compared to those who did not complete at least 4 calls (37.6% vs. 27.7%, for the 2007 callers; 36.6% vs. 25.6%, for the 2008 callers). Within year analysis comparing type of program

(15)

enrollment revealed that callers enrolled in the multi-call program were more likely to be 30-day abstinent at 7 months compared to those enrolled in the one-call program. The observed

difference for the 2007 callers was significant (31.3% vs. 22.3%). The difference for the 2008 callers was not significant (28.8% vs. 24.2%).

Table 9. Caller Contacta with the Quit Line and Abstinence at 7 Months Post-Registration

2007 Callers

(n= 884) p-value

2008 Callers

(n= 1,009) p-value

Average number of callsb 2.5 2.7

Percent of callers who registered for the

multi-call program 71.0% 88.1%

Average number of scheduled counseling calls completed by callers in multi-call

programc

2.95 2.76 Percent of callers in multi-call program who

completed four or more scheduled counseling callsc

36.0% 29.5% 30-day abstinence among callers enrolled in

multi-call program 31.3% 28.8%

30-day abstinence among callers enrolled in multi-call program who completed four or more scheduled counseling calls

37.6% .012d 36.6% .001d

30-day abstinence of callers enrolled in multi-call program who did not complete four or more scheduled counseling calls

27.7% 25.6%

Percent of callers who registered for the

one-call program 29.0% 11.9%

30-day abstinence among callers enrolled in

one-call program 22.3% .008

e

24.2% .287e

a

Includes contact callers had with the Quit Line from the date of their registration (used for selection into the study by the UWSC) through 7 months post-registration. Data are from Free & Clear, Inc.

b

Includes assessment call, scheduled counseling calls, and ad hoc calls; One-call program was counted as one call. For scheduled counseling calls, only one call per caller per day was counted. For adhoc calls, more than one call per day was allowed. Registration calls, call attempts where the caller was not reached, and

materials only calls were excluded. c

Some callers registered with the Quit Line more than once during the 7-month period examined in this evaluation. We combined calls across registrations within the evaluation period.

d

Within year Chi-square tests for 30-day abstinence among callers in the multi-call program who completed 4 or more calls vs. those who did not.

e

Within year Chi-square tests for 30-day abstinence among callers in the multi-call program vs. those in the one-call program.

(16)

Table 10 presents data on caller satisfaction with the Quit Line service. A higher percentage of 2008 callers reported they were “very satisfied” with the Quit Line compared to 2007 callers (47.1% vs. 38.8%). Concomitantly, a greater percentage of the 2007 callers said they were “somewhat satisfied” with the Quit Line than 2008 callers (25.0% vs. 18.0%). When asked if they would recommend the Quit Line to a friend, 90.3% of the 2008 callers said “yes”, while 86.0% of the 2007 callers responded affirmatively.

Table 10. Caller Satisfaction with the Quit Line, by Group

2007 Callers (n=884) 2008 Callers (n=1,009)

Level of Satisfaction with Quit line

Very Satisfied 38.8% 47.1%

Mostly Satisfied 25.3% 25.6%

Somewhat Satisfied 25.0% 18.0%

Not at all Satisfied 9.8% 8.2%

Recommend Quit Line to a Friend

Yes 86.0% 90.3%

No 13.2% 9.1%

DISCUSSION

The Wisconsin Tobacco Quit Line experienced an increase in caller volume during January through April of 2008, relative to each respective month of 2007 (see Appendix D1 through D4). In particular, caller volume was exponentially greater during January, 2008, than it was during January of the previous year. Thus, the offer of free nicotine replacement therapy may have had a positive impact on smokers’ decision to call the Quit Line. In fact, approximately three-fourths of the 2008 callers placed some importance on the free NRT, with 39% reporting it was

“extremely important”. However, our ability to determine the extent to which observed outcomes are attributable to the Quit Line’s free NRT component is complicated by the state’s introduction of another major initiative which took place shortly after the implementation of the free NRT program. A one dollar increase in Wisconsin’s excise tax on a pack of cigarettes took place on January 1, 2008. This price increase may also have played a role in the observed caller volume increase. Previous studies suggest an increase in cigarette price encourages cessation among established smokers.20 Nearly 80% of the 2008 callers in the current study reported that the January 1st price increase did hold some level of importance in their initial decision to contact the Quit Line, with 45% stating it was “extremely important”. Further, more than half of the 2008 callers reported that saving money was as an extremely important reason for calling the Quit Line. Thus, the concurrent timing of events may have synergistically influenced smokers’ decisions to make a serious quit attempt, and call the Quit Line for assistance. This may be especially true for the month of January, during which time New Year’s resolutions to quit smoking are commonplace.

(17)

A key behavioral outcome of interest in the current study was 30-day point prevalence abstinence at 7 months after registration with the Wisconsin Tobacco Quit Line. Analyses revealed that approximately 28% of both the 2007 callers and the 2008 callers reported being abstinent at 7 months. Thus, these findings suggest that the added program component of free nicotine replacement therapy, available to 2008 callers, did not provide an advantage for successful 30-day abstinence for users of the Wisconsin Quit Line service, as may have been expected apriori.

Previous studies have suggested the addition of free nicotine replacement therapy, as an adjunct to telephone counseling, can improve quit rates. For comparison with the current study, similar quit line evaluation studies, examining comparable treatment options and reporting 30-day point prevalence abstinence approximately 7 months after registration with a telephone quit line intervention service, are briefly presented.

For example, Swartz et al.14 conducted a study examining 30-day abstinence of Maine Tobacco Helpline callers, 5-7 months after callers requested services. They found 23.4% of the callers that received counseling only (n = 107) were abstinent, compared to 35.7% of the callers that received counseling plus NRT (n = 345). 63% of the callers receiving NRT received 14 to 30 days supply of NRT, and 35% acquired 31 to 60 days supply. In another observational study of cohortsof callers to the Minnesota QUITPLAN, An et al.12 assessed 30-day abstinence 6 months afterprogram registration with the state helpline, before and after the addition of access to free NRT. 17.6% of the pre-NRT sample (n=216), and 31.1% of the post NRT sample (n=219), reported being abstinent at follow-up. Callers registering for a multiple call program were eligible for an 8-week supply of NRT.

A more recently published study by Fellows et al.13 examined the cost effectiveness of Oregon’s “free patch initiative”. Their findings revealed a significant difference in 30-day abstinence at 6-month follow-up, with quit line callers receiving free NRT more likely to be abstinent (29.7%) than callers that did not receive the free NRT (16.4%). Participants in the Oregon free patch initiative received a two-week supply of NRT from the Quit Line. Callers with insurance

coverage were encouraged to obtain additional patches from their health care providers. Further, some insurers added NRT as a covered benefit for quit line recipients during the initiative. The Oregon service was different from Wisconsin’s service in that it was “limited to a single in-depth call and a mailed quit kit” due to fiscal constraints.

Though the 2008 callers’ 30-day abstinence rate in the current study was not significantly

different from that reported by the 2007 callers, it was not dissimilar to the quit rates reported for comparable treatment groups in previous studies. Perhaps more remarkable is the relatively high prevalence of 30-day abstinence found among the 2007 Quit Line callers in the current study when compared to the comparable treatment groups in previous studies. These findings may suggest the Wisconsin Tobacco Quit Line’s normal and customary service (telephone counseling alone) is of high quality, when compared to similar intervention approaches of other quit line services. In addition, according to an evaluation conducted approximately one year after the establishment of the Wisconsin Quit Line, quit rates at 6 months for persons that utilized the service were higher than rates reported by the U.S. Department of Health and Human Services for individuals who quit with no form of assistance or with self-help materials only.16

(18)

With regards to utilization of the normal and customary services of the Quit Line service, the current study revealed that callers enrolled in the multi-call program were more likely to be 30-day abstinent at 7 months compared to those enrolled in the one-call program. In addition, among callers enrolled in the multi-call program, those who completed 4 or more calls were significantly more likely to be 30-day abstinent at 7 months compared to those who did not complete at least 4 calls. These findings, which suggest that increased contact with counselors at the Quit Line provides an important mechanism of support for persons trying to quit smoking, adds supporting evidence to previous findings.

LIMITATIONS

There are a number of limitations to be considered when reviewing the findings presented in the current report. Quit status was assessed using self-report, and biochemical confirmation was not performed. Though, this method is not uncommon in outcome studies of telephone counseling smoking cessation treatment.

As with many studies, recall can be a problem for respondents. To enhance respondent recall, survey questions were customized for each caller relative to the timing of their registration with the Quit Line. For example, callers who registered on January 1st of 2007 were asked about their quit status during August of 2007, as opposed to being asked about whether they were quit seven months after they registered with the Quit Line. This issue, particularly for the 2007 sample, was another reason a 30-day point prevalence measure was chosen instead of a 7-day point prevalence measure. The research team determined it would be easier for callers to recall their behavior when asked to think about a monthly period as opposed to isolating a specific week.

Additional survey questions examined callers’ smoking status during the 30 days immediately prior to their interview. Analyses revealed that 29% of the 2007 callers reported being abstinent (data not shown). Further, we assessed continuous abstinence during the first 7 months after registration with the Quit Line. Continuous abstinence was reported by 11.7% of the 2007 callers and 12.3% of the 2008 callers (data not shown). Ex-smokers’ ability to recall complete (continuous) abstinence for the entire time period would likely be easier, in comparison to relapsers’ ability to pin-point a briefer, more specific time during which they were previously abstinent. Collectively, the findings suggest that the 2007 callers were doing as well as the 2008 callers with regards to quitting.

Another factor complicating our analysis is the allowance for multiple Quit Line registrations per caller per year. At the time of study design, the research team held the understanding that callers were only allowed to register with the quit line once in a given 12-month period. However, upon analysis of the data, it became apparent that some callers registered a number of times over the period of a few months in their attempts to quit. In light of this fact, contact with the Quit Line was assessed by including an assessment call, and all counseling calls and ad hoc calls callers had with the Quit Line from the date of their registration (used for selection into the study by the UWSC) through 7 months post-registration.

(19)

Our findings may also be complicated by the relatively high independent utilization of NRT among the 2007 callers. While almost three-quarters of the 2008 callers reporting using some form of NRT during the 7-month post-registration period, half of the 2007 callers also reported doing so. Thus, a great many individuals that are trying to quit smoking, with assistance from the Wisconsin Tobacco Quit Line, are also utilizing adjunctive therapies such as NRT. Within-year examination of 30-day abstinence, relative to any NRT use during the 7 months after

registration, did reveal that callers using NRT were slightly more likely to be abstinent than those that did not use NRT. However, the differences were not statistically significant.

Additional analysis for the current study revealed that many individuals obtained NRT products on their own — either by purchasing it themselves or through their insurance provider (see Appendix A). Interestingly, when asked whether their insurance covered NRT products,

approximately one-half of the callers said “no”, one-fourth said “yes”, and another one-fourth of the callers reported that they did not know. Thus, an opportunity to assist callers in learning that their health insurance will pay for NRT products may exist.

CONCLUSIONS

In sum, the current study did not find significantly different 30-day abstinent rates relative to the additional program component whereby eligible callers could receive a free 2-week supply of NRT. However, our findings did reveal quit rates comparable to those published in a number of previous studies—particularly with regards to estimated 30-day abstinent rates among persons engaging in telephone counseling in conjunction with the use of nicotine replacement therapy. Further, quit rates among callers that registered with the Wisconsin Tobacco Quit Line prior to the free nicotine replacement therapy offer were generally higher than those reported in previous comparable studies. In addition, findings from the current study revealed that callers who had greater contact with the Quit Line service were more likely to be abstinent at follow-up, reinforcing the importance of support during the process of quitting, which is know to be a difficult one.

(20)

REFERENCES

1. Borland R, Segan CJ, Livingston PM, Owen N. The effectiveness of callback counseling for smoking cessation: a randomized trial. Addiction.2001;96:881-9.

2. Hollis J, McAfee T, Fellows J, Zbikowski S, Stark M, Riedlinger K. The effectiveness and cost effectiveness of telephone counseling and the nicotine patch in a state tobacco quitline. Tobacco Control. 2007;16(Supplement 1):i53-i59.

3. Lichtenstein E, Glasgow RE, Lando HA, Ossip-Klein DJ, Boles, SM. Telephone counseling for smoking cessation: rationales and meta-analytic review of evidence. Health Education Research. 1996;11(2):243-57.

4. Rabius V, Pike KJ, Hunter J, Wiatrek D, McAlister AL. Effects of frequency and duration in telephone counseling for smoking cessation. Tobacco Control. 2007;16(Supplement 1):i71-i74. 5. Smith PM, Cameron R, McDonald PW, Kawash B, Madill C, Brown KS. Telephone

counseling for population-based smoking cessation. American Journal of Health Behavior. 2004;28(3):231–41.

6. Zhu SH, Stretch V, Balabanis M, Rosbrook BP, Sadler G, Pierce JP. Telephone counseling for smoking cessation: effects of single session and multiple-session interventions. Journal of

Consulting and Clinical Psychology. 1996;64:202–11.

7. Osinubi OY, Moline J, Rovner E, Sinha S, Perez-Lugo M, Demissie K, et al. A pilot study of telephone-based smoking cessation intervention in asbestos workers. Journal of Occupational and Environmental Medicine. 2003;45(5):569-74.

8. Fiore MC, Smith SS, Jorenby DE, Baker TB. The effectiveness of the nicotine patch for smoking cessation. A meta-analysis. JAMA. 1994;271(24):1940-7.

9. Tang JL, Law M, Wald N. How effective is nicotine replacement therapy in helping people to stop smoking? BMJ. 1994;6920:21–26.

10. Macleod ZR, Charles MA, Arnaldi VC, Adams IM. Telephone counseling as an adjunct to nicotine patches in smoking cessation: a randomised controlled trial. MJA. 2003; 179: 349–352. 11. Solomon LJ, Scharoun GM, Flynn BS, Secker-Walker RH, Sepinwall D. Free nicotine patches plus proactive telephone peer support to help low-income women stop smoking. Preventive Medicine. 2000;31:68–74.

12. An LC, Schillo BA, Kavanaugh AM, Lachter RB, Luxenberg MG, Wendling AH, et al. Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy. Tobacco Control. 2006;15:286-293.

13. Fellows JL, Bush T, McAfee T, Dickerson J. Cost effectiveness of the Oregon quitline "free patch initiative". Tobacco Control 2007;16(Supplement 1):i47-i52.

(21)

14. Swartz SH, Cowan TM, Klayman JE, Welton MT, Leonard BA. Use and effectiveness of tobacco telephone counseling and nicotine therapy in Maine. American Journal of Preventive Medicine. 2005;29(4) 288-294.

15. Tinkelman D, Wilson SM, Willett J, Sweeney CT. Offering free NRT through a tobacco quitline: impact on utilisation and quit rates. Tobacco Control. 2007;16;i42-i46.

16. Zbikowski SM , McAfee T, O’Hara A, Yepassi-Zembrou P. Wisconsin Tobacco Quit Line Quit Survey Report Year 1. Center for Health Promotion, Group Health Cooperative, 2002.

17. Wisconsin Tobacco Quit Line 3-Month Follow-up Evaluation, 2007.

18. Zaza S, Briss PA, Harris KW, eds. The Guide to Community Preventive Services: What Works to Promote Health? New York: Oxford University Press; 2005.

(22)
(23)

Appendix A. Method of Payment for NRT and Health Care, and Knowledge of Provider Coverage of NRT, by Group

2007 Callers (n=884)

2008 Callers (n=1,009)

How paid for NRT?a (Of those who used NRT)

(Can say yes to more than 1 option)b

Employer Paid Health Insurance 16.4% 12.3%

Private Pay Health Insurance 12.6% 10.6%

Medicare 10.2% 7.4% Medicaid 11.9% 6.0% BadgerCare 5.1% 3.7% Own money 64.0% 77.4% Free 31.8% 11.1% Other 15.4% 11.1%

Does your Health Insurance pay for NRT?

Yes 27.3% 21.1%

No 49.7% 53.4%

Don't Know 22.7% 25.5%

Refused 0.2% 0.0%

When you go to the Doctor how is it paid for? (Can say yes to more than 1 option)b

Employer Paid Health Insurance 44.7% 47.8%

Private Pay Health Insurance 12.7% 14.1%

Medicare 19.5% 19.7%

Medicaid 13.2% 11.2%

BadgerCare 5.1% 6.1%

Other 15.2% 15.7%

Do Not Have Insurance 6.4% 8.1%

a The 2008 survey asked ifcallers obtained additional NRT, and if so, how they paid for the additional NRT b Percent Totals can exceed 100% due to option of answering yes in multiple categories

(24)

Appendix B1. How Callers Heard About the Quit Line*, by Group 2007 Callers (n=884) 2008 Callers (n=1,009) Percent Cell Count Percent Cell Count How Heard About

Family/ Friend 6.2% 55 28.4% 287 Health Professional 26.7% 236 12.2% 123 TV/Commercial 37.4% 331 10.7% 108 TV/News 0.5% 4 8.8% 89 Past Caller 3.4% 30 7.1% 72 Newspaper/Magazine 1.8% 16 5.5% 55 Brochure/Newsletter/Flyer 6.7% 59 5.3% 53 Employer/Worksite 1.1% 10 3.8% 38 Quit Report 0.5% 4 3.6% 36 Other 4.1% 36 3.5% 35 Community Organization 1.8% 16 2.4% 24 Health Department 3.2% 28 2.0% 20 Website 1.5% 13 2.0% 20 Radio 1.1% 10 0.9% 9

Does Not Remember 0.7% 6 0.8% 8

Cigarette Pack 0.6% 5 0.6% 6 Health Insurance 0.8% 7 0.5% 5 Not Collected 0.5% 4 0.5% 5 School 0.3% 3 0.5% 5 Outdoor Ad 0.5% 4 0.3% 3 Postcard 0.0% 0 0.3% 3 Re-enrollment 0.0% 0 0.3% 3 First Breath 0.0% 0 0.1% 1 Research Study/Project 0.3% 3 0.1% 1 Legislator Newsletter 0.1% 1 0.0% 0 Refused 0.1% 1 0.0% 0 UW-CTRI Employee 0.2% 2 0.0% 0

(25)

Appendix B2. Caller Entry Method into the Quit Line System*, by Group 2007 Callers

(n=884)

2008 Callers (n=1,009) Percent Cell Count Percent Cell

Count Entry Method – From F&C data

Inbound English Phone Call 82.6% 730 95.3% 962

Registration Short Form 0.3% 3 2.9% 29

Program Lookup Tool 0.0% 0 0.9% 9

Re-enrollment Offer 0.0% 0 0.5% 5

Warm Transfer From Partner 0.0% 0 0.3% 3

Fax Referral 16.4% 145 0.1% 1

Client Services 0.3% 3 0.0% 0

Electronic Consult 0.1% 1 0.0% 0

Inbound Spanish Phone Call 0.2% 2 0.0% 0

(26)

Appendix C1. Demographics, Tobacco Use and Stage of Readiness to Quit: Comparison of 2007 Sample Pool to 2007 Sample

2007 Sample Pool (n=2,887)* 2007 Sample (n=884) Age (years) Minimum 18 18 Maximum 84 81 Mean 42.1 46.5 Median 43 48 Gender Female 57.5% 57.5% Race/Ethnicity White 75.4% 83.9% Other 23.4% 14.2%

Hispanic, any race 3.2% 1.9%

Education

Less than high school 16.0% 11.0%

High school diploma/ GED 39.5% 37.5%

Some college/Associates Degree 30.1% 31.9%

College or University Degree 13.1% 17.5%

# Cigarettes Smoked Per Day (registration)

Minimum 0 0

Maximum 80 80

Mean 19.0 19.0

Median 20 20

Time to 1st Cigarette after Waking

Smoke <= 5 minutes 46.2% 39.0%

Smoke 6-30 minutes 27.3% 31.6%

Smoke 31-60 minutes 10.0% 9.6%

Smoke > 60 minutes 11.6% 14.4%

Use of Other Tobacco 2.7% 2.7%

(27)

Stage of Readiness to Quit Precontemplation 0.1% 0.2% Contemplation 2.3% 2.8% Preparation 88.4% 84.9% Action 8.7% 11.5% Maintenance 0.2% 0.1%

* The sample pool consisted of callers that registered with the Quit Line during January-April of 2007 who were cigarette smokers, wanted an intervention, were not pregnant or breastfeeding at the time of registration, and were 18 years of age or older. The pool (n=2,887) includes the 884 members of the 2007 sample.

(28)

Appendix C2. Demographics, Tobacco Use and Stage of Readiness to Quit: Comparison of 2008 Sample Pool to 2008 Sample

2008 Sample Pool (n=15,201)* 2008 Sample (n=1,009) Age (years) Minimum 18 18 Maximum 92 87 Mean 44.9 47.1 Median 46 48 Gender Female 59.2% 57.6% Race/Ethnicity White 86.9% 86.9% Other 12.3% 12.4%

Hispanic, Any Race 2.2% 1.5%

Education

Less than high school 12.4% 11.1%

High school diploma/ GED 44.3% 39.1%

Some college/Associates Degree 29.1% 31.2%

College or University Degree 13.5% 17.9%

# Cigarettes Smoked Per Day (registration)

Minimum 0 0

Maximum 80 60

Mean 19.5 18.6

Median 20 20

Time to 1st Cigarette after Waking

Smoke <= 5 minutes 44.9% 43.6%

Smoke 6-30 minutes 30.5% 31.5%

Smoke 31-60 minutes 11.5% 11.5%

Smoke > 60 minutes 10.5% 11.9%

Use of Other Tobacco 2.5% 2.0%

(29)

Stage of Readiness to Quit Precontemplation 0.2% 0% Contemplation 1.2% 0.9% Preparation 92.3% 94.5% Action 5.9% 4.3% Maintenance 0.3% 0.09%

* The sample pool consisted of callers that registered with the Quit Line during January-April of 2008 who were cigarette smokers, wanted an intervention, were not pregnant or breastfeeding at the time of registration, and were 18 years of age or older. The sample pool (n= 15,201) includes the 1,009 members of the 2008 sample.

(30)

Appendix D1. Caller Volume, Demographics, Tobacco Use and Stage of Readiness to Quit: Comparison of January 2007 Quit Line Registrations* to January 2008 Quit Line Registrations*

January 2007 Registrations (n=880) January 2008 Registrations (n=12,089) Age (years) Minimum 18 13 Maximum 80 92 Mean 41.8 45.2 Median 43 46 Gender Female 56.7% 59.5% Race/Ethnicity White 80.1% 88.6% Other 18.6% 10.6%

Hispanic, Any Race 3.1% 2.0%

Education

Less than high school 17.8% 11.7%

High school diploma/ GED 37.8% 44.7%

Some college/Associates Degree 28.2% 29.1%

College or University Degree 14.5% 13.5%

# Cigarettes Smoked Per Day (registration)

Minimum 0 0

Maximum 80 80

Mean 19.3 19.5

Median 20 20

Time to 1st Cigarette after Waking

Smoke <= 5 minutes 46.3% 44.2%

Smoke 6-30 minutes 28.0% 31.2%

Smoke 31-60 minutes 10.0% 11.7%

Smoke > 60 minutes 10.0% 10.4%

Use of Other Tobacco 4.9% 3.8%

(31)

Stage of Readiness to Quit Precontemplation 0.2% 0.1% Contemplation 2.0% 1.1% Preparation 87.2% 92.5% Action 9.4% 5.6% Maintenance 0.5% 0.3%

* The sample pool consisted of callers that registered with the Quit Line during January of each respective year as a tobacco user who wanted an intervention. Only the first registration within the year was used for the measure. All users, including those less than 18 years old, pregnant and breastfeeding women, and non-cigarette users were included.

(32)

Appendix D2. Caller Volume, Demographics, Tobacco Use and Stage of Readiness to Quit: Comparison of February 2007 Quit Line Registrations* to February 2008 Quit Line Registrations*

February 2007 Registrations (n=840) February 2008 Registrations (n=1,597) Age (years) Minimum 18 15 Maximum 79 84 Mean 41.8 43.0 Median 41 44 Gender Female 59.3% 56.8% Race/Ethnicity White 74.0% 84.2% Other 24.3% 14.9%

Hispanic, Any Race 3.8% 2.6%

Education

Less than high school 17.4% 13.9%

High school diploma/ GED 38.5% 42.8%

Some college/Associates Degree 30.4% 26.5%

College or University Degree 12.3% 15.0%

# Cigarettes Smoked Per Day (registration)

Minimum 0 0

Maximum 80 80

Mean 18.8 18.3

Median 20 20

Time to 1st Cigarette after Waking

Smoke <= 5 minutes 46.3% 43.4%

Smoke 6-30 minutes 25.8% 29.5%

Smoke 31-60 minutes 10.1% 12.8%

Smoke > 60 minutes 13.5% 11.0%

Use of Other Tobacco 4.8% 5.7%

(33)

Stage of Readiness to Quit Precontemplation 0.0% 0.3% Contemplation 1.1% 1.4% Preparation 91.0% 90.6% Action 7.6% 7.1% Maintenance 0.1% 0.3%

* The sample pool consisted of callers that registered with the Quit Line during February of each respective year as a tobacco user who wanted an intervention. Only the first registration within the year was used for the measure. All users, including those less than 18 years old, pregnant and breastfeeding women, and non-cigarette users were included.

(34)

Appendix D3. Caller Volume, Demographics, Tobacco Use and Stage of Readiness to Quit: Comparison of March 2007 Quit Line Registrations* to March 2008 Quit Line Registrations*

March 2007 Registrations (n=750) March 2008 Registrations (n=1,207) Age (years) Minimum 18 14 Maximum 84 84 Mean 41.8 42.8 Median 42 44 Gender Female 58.0% 55.7% Race/Ethnicity White 73.7% 79.7% Other 24.8% 19.1%

Hispanic, Any Race 3.5% 2.6%

Education

Less than high school 13.1% 14.3%

High school diploma/ GED 39.7% 40.1%

Some college/Associates Degree 32.1% 30.2%

College or University Degree 13.6% 13.9%

# Cigarettes Smoked Per Day (registration)

Minimum 0 0

Maximum 60 80

Mean 17.8 18.1

Median 20 20

Time to 1st Cigarette after Waking

Smoke <= 5 minutes 43.6% 48.0%

Smoke 6-30 minutes 27.3% 26..%

Smoke 31-60 minutes 11.1% 9.2%

Smoke > 60 minutes 12.4% 12.2%

Use of Other Tobacco 5.5% 4.8%

(35)

Stage of Readiness to Quit Precontemplation 0.3% 0.3% Contemplation 2.8% 1.7% Preparation 88.1% 91.0% Action 8.1% 6.4% Maintenance 0.3% 0.4%

* The sample pool consisted of callers that registered with the Quit Line during March of each respective year as a tobacco user who wanted an intervention. Only the first registration within the year was used for the measure. All users, including those less than 18 years old, pregnant and breastfeeding women, and non-cigarette users were included.

(36)

Appendix D4. Caller Volume, Demographics, Tobacco Use and Stage of Readiness to Quit: Comparison of April 2007 Quit Line Registrations* to April 2008 Quit Line Registrations*

April 2007 Registrations (n=617) April 2008 Registrations (n=862) Age (years) Minimum 18 13 Maximum 81 87 Mean 40.7 41.9 Median 41 42 Gender Female 57.7% 57.9% Race/Ethnicity White 72.6% 78.4% Other 26.3% 20.1%

Hispanic, Any Race 2.3% 4.3%

Education

Less than high school 16.0% 15.0%

High school diploma/ GED 40.2% 40.3%

Some college/Associates Degree 28.0% 29.8 %

College or University Degree 14.6% 12.9%

# Cigarettes Smoked Per Day (registration)

Minimum 0 0

Maximum 70 60

Mean 18.3 17.5

Median 20 20

Time to 1st Cigarette after Waking

Smoke <= 5 minutes 45.5% 44.2%

Smoke 6-30 minutes 27.9% 26.9%

Smoke 31-60 minutes 10.9% 11.6%

Smoke > 60 minutes 12.5% 12.6%

Use of Other Tobacco 5.0% 5.2%

(37)

Stage of Readiness to Quit Precontemplation 0.0% 0.1% Contemplation 3.9% 1.2% Preparation 88.0% 91.3% Action 7.8% 7.0% Maintenance 0.0% 0.1 %

* The sample pool consisted of callers that registered with the Quit Line during April of each respective year as a tobacco user who wanted an intervention. Only the first registration within the year was used for the measure. All users, including those less than 18 years old, pregnant and breastfeeding women, and non-cigarette users were included.

References

Related documents

He has published five collections of poetry, including Ripening (Ohio University Press, 1984), Possible Debris (Cleveland State University Press, 1988), and Mill and Smoke

Assessment of blood enterovirus testing in pediatric populations with fever without source, sepsis-like disease, or suspected meningitis: a prospective, multicentre,

The State Department of Alcohol and Drug Programs (DADP) allocates the General and Perinatal Drug Medi- Cal State General Funds among the counties to meet the State’s cost for

Outpatient Services ODF &amp; IOT Partial Hospitalization Residential Services At Least 1 Level of Service Additional ASAM Levels Withdrawal Management At Least 1 Level of

19% serve a county. Fourteen per cent of the centers provide service for adjoining states in addition to the states in which they are located; usually these adjoining states have

(Received for publication Dec.. This was fed at levels providing approximately 1 30 cal./kg. Feedings in the tween periods were identical with those on control periods except

Administered by the Orange County Health Care Agency, Behavioral Health Services, Residential Care office, the Shelter Plus Care program provides rental assistance to persons who

This paper proposes the fundamental basis for the development of a 3d virtual world based Library using OpenSim, and facing the integration of a virtual