nys smokers’ quitline maximizing quitline reach nys smokers’ quitline maximizing quitline reach...

NYS Smokers’ QuitlineNYS Smokers’ Quitline Maximizing Quitline ReachMaximizing Quitline Reach

Ann Wendland, MSLAnn Wendland, MSLNYSDOH Tobacco Control Program NYSDOH Tobacco Control Program

NYSSQL & NRT Programs ManagerNYSSQL & NRT Programs Manageramw06@health.state.ny.usamw06@health.state.ny.us

Paula CelestinoPaula CelestinoRoswell Park Cancer InstituteRoswell Park Cancer Institute

NYSSQL Project DirectorNYSSQL Project DirectorPaula.Celestino@roswellpark.orgPaula.Celestino@roswellpark.org

New York State New York State Tobacco ControlTobacco Control ProgramProgram

Goal: Reduce adult smoking prevalence to 12% Goal: Reduce adult smoking prevalence to 12% Current 2008: Adult smoking prevalence: 16.7% Current 2008: Adult smoking prevalence: 16.7%

Currently 2.5 million smokers in NYS

= 1 million fewer = 1 million fewer smokers in New Yorkerssmokers in New Yorkers

NY TCP 3 Key Programmatic StrategiesNYS Quitline functions one component of the broader NYS TCPNYS Quitline functions one component of the broader NYS TCP

Statewide and Community

action

Public Health communication

Cessation

interventions

Statewide and Community Action…to change the community environment to support a tobacco-free norm, change community attitudes about tobacco, and de-normalize tobacco use

Taxes Clean Indoor & Outdoor polices/laws Smoke-Free Dwellings Reduce Tobacco Access Reduce or Remove Retail Tobacco Advertising

Public Health Communication –to motivate tobacco users to stop, promote smoke-free homes, expose tobacco industry propaganda, deglamorize tobacco use, and educate community members and decision makers about tobacco control

NYTCP Strategies Using Media

Paid advertising on television, radio, print, Internet, and other venues to

educate New Yorkers about the health risks of tobacco use and the dangers of secondhand smoke (SHS)

motivate smokers to quit; and promote adoption of smoke-free homes and environments

Public relations and media advocacy (e.g., press releases, communications with decision makers) to

increase coverage and discussion of tobacco control issues and events in the news media; and

supplement paid advertising

Percentage of Adult Smokers Who Made at Least One Quit Attempt During the Past 12 Months by

Recall of NY TCP Ads, ATS 2003–2008

62.2%58.5%

51.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Did not recall any NYTCPads

Confirmed recall of anyNYTCP ad

Confirmed recall of Cessationads

Health Systems Change Referral Networks Quitline NRT Distribution Program FQHC initiative

Cessation Interventionsto establish and maintain systems changes that promote cessation, increase access to and delivery of evidence based cessation services, and motivate individual tobacco users to quit successfully

Health Care Organization and Provider Awareness of Cessation Resources in New York State

Health Care Organization and Provider Study (HCOPS) 2004–2005 and 2007

46.9%

61.0%

79.7%

53.4%

72.9% 71.7%

95.5%

87.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Cessation Centers Medicaid benefit Quitline NRT starter kit

Organizational awareness Provider awareness2005 2007

Influences on Quit Attempts in the Past 12 Months (Odds Ratios), ATS

……NYSSQL Service Goal…NYSSQL Service Goal…

Extend NYS’ Extend NYS’ population health model to the population health model to the Quitline and function within its comprehensive Quitline and function within its comprehensive

TCP approach to advance the goal of TCP approach to advance the goal of reducing adult smoking prevalence.reducing adult smoking prevalence.

2 Key Ingredients to reduce prevalence 2 Key Ingredients to reduce prevalence

Reach X Efficacy = ImpactReach X Efficacy = Impact

PopulationPopulation + evidence-based service + evidence-based service

= = ImpactImpact

2010 Goal: 2010 Goal: Reduce adult smoking prevalence to 12% Reduce adult smoking prevalence to 12%

Ready to Quit within 30 days:

Quit coaching in English or Spanish (other languages available through translators) plus free quit materials

Two week starter kit of Nicotine Replacement Therapy (NRT), choice of patch gum or lozenge

NRT check callback- verify delivery One scheduled coaching callback

Already Quit:

Relapse prevention coaching and support materials

Not Ready to Quit within 30 days:

Brief ‘5 R's’ coaching and support materials

Web-based services: NRT application Web-based community support Tailored programming (winter 2009)

Services

NYS Strategies to Increase Quitline Reach

Link policy change media (earned & paid) with Quitline

Run Hard Hitting Paid Media tagged with Quitline/Quitsite• TV • Radio• Print• Internet• Collateral Media Outlets

Free 2 week NRT starter kit

Build Referral Networks

Quitline Infrastructure & efficiency

Media

NYS Annual media campaigns since 2004 NYC Annual media campaigns since

2003 Concurrently run ads in multi-media

venues (TV, Print, radio, internet) Strategically placed (type of ads and

timing of ads)

Media Campaigns & Tax Increases& Call Volume

Annual Call Volume: June 2007- M ay 2008

01,0002,0003,0004,0005,0006,0007,0008,0009,00010,00011,00012,00013,00014,00015,000

NYSDO H Re ady to Q uit Sm oking

J uly 16 - Sept 17, 2007

Gangre ne /Didn 't Liste nNYSDO H

Nov 12 - Dec 16, 2007

Se condhand Sm oke C am paign

Sept 17 - Nov 1, 2007

Q uitting Isn 't EasyNYSDO H

J an 21 - M ar 8, 2008

NYC Patch & Gum Give away

A pril 16 - M ay 9, 2008

NRT Offer

Offer of free NRT drives calls/web applications

Promote offer through Ads Earned media Direct mail Email notices NYS TC Partners Network

NYC NRT offer announcement April 2003

NYC Patch Program, April 2nd - May 14th, 2003Total Number of people from NYC who dialed the Quitline Number

41,1

8223

6,84

099

,558

5,87

796

93,

010

1,52

61,

258

1,32

699

138

925

174

984

487

580

15,

374

1,26

967

42,

034

1,02

599

385

679

939

130

187

481

070

566

159

51,

984

287

894

862

636

611

2,34

21,

238

428

1,36

891

061

3

0

50,000

100,000

150,000

200,000

250,000

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Online NRT Since July 2006Online NRT Since July 2006

0

2000

4000

6000

8000

10000

12000

14000

16000

18000Ju

l-06

Au

g-0

6

Sep

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Dec

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g-0

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Sep

-08

Oct

-08

No

v-08

Dec

-08

Jan

-09

Feb

-09

Web Phone

Added Enhancement to NYSSQL NRT Services Added Enhancement to NYSSQL NRT Services via Online Registration: Jan. 1, 2008 - Currentvia Online Registration: Jan. 1, 2008 - Current

12

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NRT via Online Registration

NRT via Phone Interviews

100% increase in Enhancement of Services

38%47%

46%

43%

54%

73%

69%

82%

39%

Average Daily NRTRegistrations per Hour

Referral Networks

19 Regional Cessation Centers 28 Community Partnerships Statewide umbrella groups Health Plans Health Care Providers Local Health Departments

0

100

200

300

400

500

600

700

800

Jan-08 Mar-08 May-08 Jul-08 Sep-08 Nov-08 Jan-09 Mar-09 May-09 Jul-09 Sep-09

NYSSQL Fax-to-Quit ReferralsJan 2008 –Sept 2009

No. of Referrals

How & Why these strategies helped maximize reach

Comprehensive approach addresses social norms,attitudes and beliefs, promotes education and awarenessand offers assistance.

Consequently smoking-related behaviors in NYhave changed over time:

Increase in smoke-free homes and cars Increase in use of Quitline Increase in number of individuals trying to quit

Significantly higher than national average Average number cigarettes smoked per day decreased

Percentage of Adult Smokers WhoHave Heard of the New York State Smokers’

Quitline, Adult Tobacco Survey (ATS) 2003–2008

0

10,000

20,000

30,000

40,000

50,000

Jan-00 Jan-01 Jan-02 Jan-03 Jan-04 Jan-05 Jan-06 Jan-07 Jan-08

NYC Free NRT

Growth since 2004 Call volume up 94%

NRT shipments up 277% Hits to website up 550% (since 2006)

NYS starts free NRT

Mass media campaigns

Lessons Learned

Focus–group tested ads Loss framed ads result in larger call spikes Secondhand smoke ads can sustainably drive

calls when content triggers loss emotions Loading ads on Mon, Tues & Wed Awareness of phone & web-based offer of NRT Sustainability & reliability drives returning clients

and word of mouth referrals

Notable Challenges to date

Approval Process for Campaigns Controversial ads Balancing push & pull ads and ad

saturation Balancing call volume with Quitline

capacity NRT supply

Moving forward

Continuing evaluations of reach, ads/program impact (RTI)

Implementation of media messages and online cessation study

Continue to build cost-efficient Quitline/Quitsite services to expand capacity

If a state wants to increase their reach, what is your best advice?

Comprehensive tobacco programming High sensation value ads Build referral networks Offer NRT Quitline as a population health model Balance degree of service in order to

maximize reach and build capacity Sustainability

Contact Information

Paula CelestinoPaula CelestinoPaula.Celestino@RoswellPark.org Paula.Celestino@RoswellPark.org

(716) 845-8817 (716) 845-8817

Ann Wendland, MSLAnn Wendland, MSLamw06@health.state.ny.usamw06@health.state.ny.us

(585) 423-8151 (585) 423-8151

New York State Smokers' Quitline New York State Smokers' Quitline Roswell Park Cancer Institute Roswell Park Cancer Institute Elm & Carlton Sts.Elm & Carlton Sts.Buffalo, NY 14263Buffalo, NY 14263Fax: 716-845-4135Fax: 716-845-4135