ENQ conference Rome, 10/11 December 2007 Marc Willemsen, Sander Bot, Regina van der Meer Which types of smokers get which service?

ENQ conference Rome, 10/11 December 2007

Marc Willemsen, Sander Bot, Regina van der Meer

Which types of smokers get which service?

STUDIES

• (Cost-)effectiveness of quitlines

• Treatment / service <–> characteristics of callers

• Quitline tel. on cigaret packs -> call volumes

• HELP campaign -> call volumes

The 9 Participating Quit Lines

• Denmark

• Germany

• Ireland

• Italy

• The Netherlands

• Norway

• Portugal

• United Kingdom• France

STOP-Line Counselling

German Cancer Research Unit

The National Smokers Quitline

Lega Italiana per la lotte contro iI tumo

STIVORO

Directorate for Health and Social Affairs

Instituto Nacional de Cardiologia

Preventiva)

QUIT UK

Insititut National de Prévention et

d’Education pour la Santé

ESCHER Objectives

• Develop an evidence base for European quitlines

• Collect basic data that are usefull for all countries involved and are of interest to the EU

• Strengthen the position of the quitlines

• Take advantage of natural variation between countries (compare quitlines in natural settings)

Which smokers get the most effective treatment from quitlines?

Type of treatment

Literature sent Booklets or leaflets on quitting

Basic information Objective / neutral information about facts, consequences of stopping smoking, craving etc. (quick call)

Specific informationObjective / neutral information about cessation methods (pharmacotherapy), referral to outside services or referral to health professional

AdviceRecommendations on how to quit smoking, eg., what would be the best method to quit or recommendation to see health professional

CounsellingCaller-centred and person-tailored, in-depth, motivational interaction

Hypotheses

1. Heavy smokers more likely to receive counselling + get

specific info on pharmacotherapy

2. Lower educated callers more likely to receive counselling, less

likely to receive brief advice or written materials

3. Callers in action stage more likely to get counselling or

advice, less likely to be referred to outside help

4. Referred callers more likely to get counselling

Method

In each country, during a period of 12 months (February 2005 – April

2006) up to 500 smokers were recruited.

Subjects: “every caller who calls for telephone support for smoking

cessation”.

Data collected by the counsellors during the first contact (intake).

Logistic regression, controlling for country. Method = enter 7 services.

Check country x treatment interactions.

Country Number of respondents

Denmark 425

France 619

Germany 180

Ireland 494

Italy 520

Netherlands 493

Norway 534

Portugal 123

United Kingdom 500

Total 3.888

76,2

14,2

16,9

45

51,3

64

46

Counselling

Referred to healthprofessional

Referred to outsideservice

Info about Pharmaco

Advice on how toquit

Basic info (quick call)

Written materials

%

Services provided to callers

DM FR GE IR IT NE NO PT UK ALL

% low educated 26.1 35.9 25.4 22.1 33.2 27.9 20.8 36.1 38.5 29.3

% heavy smoker

55.5 46.4 48.9 48.5 46.3 58.0 39.3 47.2 46.3 48.3

% action stage

32.0 33.0 23.3 38.5 11.3 31.4 41.4 32.5 35.8 31.8

Copied tel. nr. from cig. pack

27.8 30.7 - - - 12.0 18.7 - - 22.5

Referral by health prof.

14.1 13.6 - 6.1 3.8 14.0 11.6 4.9 12.0 10.1

Heavy smokers (HSI >=3)

No association with counselling (contrary to hypothesis) (75% vs. 78%; ns)

More likely to get information about pharmacotherapy (OR=1.27; 95%CI=1.10-1.47) (hypothesis confirmed)

More often referred to a health professional (OR=1.32; 95CI=1.08-1.60).

Consistent across 9 quitlines

0

10

20

30

40

50

informationpharmacotherapy

referral to healthprofessional

heavy smoker lighter smoker

Low education callers

Not more likely to receive counselling (hypothesis rejected)

No relationship with receiving brief advice or written materials.

(hypothesis rejected).

Low educated

More information on pharmacotherapy(OR=1.18; 95%CI =1.01-1.38)

Consistent across 9 quitlines

0

10

20

30

40

50

low educated higher educated

Low educated: shorter calls

Percentage having a ‘long call’

(>20 minutes)

22,8

31

0

5

10

15

20

25

30

35

Low educated Higher educated

Action stage

More likely:

Advice1

Counselling 2

(Hypothesis confirmed)

1 French, German, Irish quitlines;

2 Italian, Dutch quitlines

83

6669

53

0102030405060708090

advice counselling

action preparation

Action stage

Less likely:

Referral to outside help3

(hypothesis confirmed)

Referral to health

professional4

3 Danish, German, Italian, Portuguese,

English quitlines;

4 Irish, Portuguese

812

41

31

05

1015202530354045

outside help health professional

action preparation

How were callers referred to the quitline?

self-referral; 69,9

family, friends; 9,5

other; 10,5

health professional;

10,1

Callers referred by a health professionalcompared to other referrals

Heavy smokers (53% vs 43%)

Low educated (35% vs 29%)

Callers referred by a health professional

More likely get counselling (hypothesis confirmed) (81% vs 74%)

More likely information on pharmacotherapy (50% vs 38%)

Less likely brief advice (48% vs 54%) and literature (41% vs 49%)

All quitlines, except Danish, French, English (in these countries: more likely to

be further referred to medical professional: 38% vs 10%).

Conclusions

The most effective quitline service (counselling) was provided

to higher educated smokers, callers in action stage of change,

and callers who were referred by a health professional.

Callers who were referred by a health professional more likely

to be low educated and heavy smoker

Although many low educated callers received information

about pharmacotherapy, low educated smokers came of badly

in terms of counselling (less likely + shorter calls).

Conclusions

In contrast to the US and Australia, in these nine European quitlines, only 10% of contacts were referrals from health care providers.

European quitlines should be better integrated into the health care system.

Thanks for your attention!

Contact: [email protected]