November, 2005 Iowa Department of Public Health. Tobacco Use in Iowa Approximately 4,600 tobacco- related deaths annually 20% of high school students.

November, 2005

Iowa Department of Public Health

Tobacco Use in Iowa

Approximately 4,600 tobacco-related deaths annually

20% of high school students are current smokers (2004 IYTS)

20.3% of adults are current smokers (2004 IATS)

Annual health care costs directly caused by smoking - $937 million

Intervention Model for Patients Willing to Discuss Quitting

ASK about tobacco use

ADVISE to quit

REFER patient to cessation resources This step relieves a

practitioner of responsibility for the final 3 A’s (Assess, Assist, Arrange)

Step 1: Ask

Systematically ask every patient about tobacco use at every visit.

Determine if patient is current, former, or never tobacco user.

Determine what form of tobacco is used.

Determine frequency of use. Document tobacco use

status in the medical record.

Step 2: Advise

In a clear, strong, and personalized manner, urge every tobacco user to quit.

Tobacco users who have failed in previous quit attempts can be assured that most people make repeated attempts before they are successful.

Employ the teachable moment: link visit findings with advice.

Step 3: Refer

Assess if patient is willing to discuss quitting

Assist those who are willing by providing information about Quitline Iowa

Use proactive referral Request written permission to fax

contact information to Quitline Iowa

Inform the patient that Quitline Iowa program staff will provide follow-up

Follow-up at next visit – repeat process if necessary

Fax Referral Program

Efficient method for referring patients who smoke to effective cessation services

Research indicates that physician referral of patients to smoking cessation programs is associated with a significantly higher participation rate than simply telling patients they should stop smoking

Alleviates some of the problems posed by limited time and resources

Takes the burden of initiating services off of the patient

How Fax Referral Works

1. HCP/clinician identifies patient as a smoker willing to discuss quitting

2. HCP/clinician educates patient on services of Quitline Iowa

3. Patient completes information on fax referral form providing consent for HCP/clinician to release information to Quitline Iowa to initiate counseling

4. Based on times provided by patient, Quitline Iowa staff contact patient to begin cessation counseling

5. Quitline Iowa provides feedback to HCP/clinician on status of patient – check-off box on fax referral form

Quitline Iowa Benefits

Effective, research-based cessation resource

Less time spent on tobacco cessation counseling during patient appointments

Increase in the number of patients who receive cessation counseling and who ultimately quit

No additional investment in materials, training, or other programs needed

What is Quitline Iowa?

Toll-free hotline available to all Iowans, including pregnant women and teens

Staffed 8 a.m. to midnight, seven days a week

Services in English & Spanish

Interpreters available for most other languages

TDD line, 1-866-822-2857

Offers Comprehensive and Intensive counseling programs; tailored to client’s needs

Who Provides Quitline Iowa Services?

Operated by the Iowa Tobacco Research Center in the Department of Community and Behavioral Health, University of Iowa John Lowe, DrPH, FAHPA,

FAAHBDirector, ITRC

Mary Aquilino, Ph.D., MSN, FNPDeputy Director, ITRC

Funded by the Division of Tobacco Use Prevention & Control, Iowa Department of Public Health

Quitline Iowa Staff

Quitline Iowa currently employs 11 part-time counselors (FTE=2.93).

Graduate students in counseling psychology, rehabilitation counseling, health education, nursing and related fields

Professional therapists and educators

New counselors receive comprehensive training in treatment of tobacco dependence, motivational interviewing and cognitive behavioral therapy techniques.

Counselors receive continuing education through training sessions, monthly meetings and materials such as research articles and tip sheets.

Other staff include program coordinator, training coordinator/advanced counselor, program manager, research assistant and half-time database manager.

Quitline Iowa Services

Counseling treatment for tobacco users who want to quit

Information for friends, family and others concerned about someone’s tobacco use

Educational and self-help materials for anyone interested in quitting

Referrals to local tobacco cessation programs and services.

NRT coupon programs to provide financial assistance for smokers, available by county residency or health services providers

Transtheoretical Model and Stages of Change

PRECONTEMPLATION: Not thinking of quitting, does not see a problem

CONTEMPLATION: Examines smoking and potential to quit in a risk-reward analysis

PREPARATION: Makes a commitment to quit and develops a quit plan

ACTION: Has quit smoking (for under 6 months) and is implementing a quit plan

MAINTENANCE: Has been smoke free for an extended period of time (over 6 months) and all associated changes are consolidated into lifestyle

Prochaska and DiClemente, (1984)

Quitline Iowa Cessation Programs

Comprehensive Program Assess stage of change Create quit plan if applicable Mail materials Follow up at 1, 2, 4 weeks

Intensive Program Intake questionnaire One-on-one counseling in up to

10 sessions Excellent for heavy smokers

Effectiveness of Quitlines

Research indicates smokers who receive telephone cessation counseling double their chances of staying quit; e.g.:

Zhu, et al., 2002. Evidence of real-world effectiveness of a telephone quitline for smokers. New England Journal of Medicine

Borland, et al., 2001. The effectiveness of callback counseling for smoking cessation: a randomized trial. Addiction

A meta-analysis of 27 studies of the efficacy of telephone quitlines indicates that proactive telephone counseling is more effective compared to interventions without personal contact, such as self-help materials.

Stead, et al., 2003—Cochrane Database of Systemic Reviews

A study of NRT added to quitline counseling indicates that the combination increases the likelihood of quitting.

Zhu, et al., 2000. Telephone counseling as adjuvant treatment for nicotine replacement therapy in a "real-world" setting.Preventive Medicine

Quitline Iowa Results

Quitline Iowa quit rates: FY 2005 FY 2004

Smoke free for any period (24 hours or more)

73% 58%

Smoke free for 30 days or more

40% 39%

For More Information

Esther Baker, Program Coordinator Phone: 319-384-4845 Fax: 319-384-4841 E-mail: [email protected]

Jeanie Kimbel, Training Coordinator Phone: (319) 384-4842 Fax: (319) 384-4841 E-mail: [email protected]

@ 2005 The University of Iowa. All rights reserved.