Ask' Advise' Refer'

1
Spend 30 seconds, Save a Life.

• Quit Lines as a Tobacco Cessation Treatment
  Service

2
Tobacco Timeline

• 1964 - first Surgeon Generals Report released
  linking cigarettes with lung cancer
• 1965 - first warning label appeared on a pack of
  cigarettes
• 1971 - Cigarette advertising banned on radio/TV
• 1988 - Smoking banned on all flights
• 2003 - Delegates from 171 nations approve the
  worlds first international tobacco control
  treaty

3
Facts about Tobacco

• Leading cause of preventable death and disease in
  the United States
• Its not just a habit, its an addiction
• Effective, evidence-based treatments are
  available and should be offered to all
• Nicotine Replacement Products are available over
  the counter, they work!

4
The Grim Statistics

• 46 million Americans smoke
• 70 of smokers say they want to quit
• Smokers are more likely to quit if advised to do
  so by health professionals
• Yet many health professionals never ascertain
  their patients smoking status nor help them quit

5
Adult Smoking Prevalence

• 1 Kentucky
• 27.5
• Highest smoking rate
• 2 West Virginia
• 26.8
• Second highest smoking rate
• 5 Ohio
• 25.8
• Fifth highest smoking rate

US 20.8
BRFSS 2004
6
Comparative Causes of Annual Deaths in the United
States
Number of Deaths (thousands)
AIDS Alcohol Motor Homicide
Drug Suicide Smoking
Vehicle
Induced
Source CDC
7
Tobacco Use as a Risk Factor for Heart Disease
and Stroke

• Evidence is sufficient to infer a causal
  relationship between smoking and . . .
• Abdominal aortic aneurysm
• Atherosclerosis
• Cerebrovascular disease (stroke)
• Coronary heart disease
• Coronary heart disease and stroke are the primary
  types of cardiovascular disease caused by smoking

2004 Surgeon Generals Report
8
Risk Factor, continued

• Cigarette smoking has been associated with sudden
  cardiac death of all types in both men and women
• Toxins in the blood from smoking cigarettes
  contributes to the development of atherosclerosis
• Low-tar, low-nicotine cigarettes does NOT reduce
  the risks

9
Why refer a cardiac patient to a tobacco quit
line?

• Smoking causes coronary heart disease, the
  leading cause of death in the US
• Smoking is a major cause of stroke, the third
  leading cause of death in the US
• Cigarette smoking affects the patients recovery
  time, healing process, quality of life, and
  contributes to the problem being treated

10
Tobacco Quit Lines

• US DHHS announced a federal initiative to create
  a national network of tobacco cessation quit
  lines
• All tobacco users in the U.S. linked to services
  and information on quitting
• 1-800-QUIT NOW, portal number operated by NCI
• Callers routed to state-based quit lines by their
  area code

11
Whats a Quit Line?

• A free, statewide, telephone-based tobacco
  cessation service
• Provides information to tobacco users and
  non-tobacco users
• tobacco dependence and its treatment
• dangers of secondhand smoke
• other tobacco-related information
• may include advice for family and friends on
  helping a tobacco user quit, and support for a
  quit attempt.
• Offer counseling programs for tobacco users who
  are ready to quit

12
Structure of Quit Lines

• Reactive quit lines
• provide a one-time counseling session to callers
• Proactive quit lines
• often provide counseling during the initial call
• schedule 3-5 follow-up calls to support quitting
  process

13
Are quit lines effective?

• Yes!
• Multiple scientific reviews established that
  proactive telephone counseling through quit lines
  is an effective cessation method
• U.S. Public Health Service Clinical Practice
  Guidelines Guide to Community Preventive
  Services
• Both recommend quit lines as an effective method
  to help people stop smoking.
• State-managed quit lines form a national tobacco
  quit line network, which is a federal initiative
  recommended in the National Action Plan for
  Tobacco Cessation.

14
Quit Line Services

• Individualized telephone counseling
• Mailed self-help materials (QuitKits) or
  informational materials
• Recorded messages
• Some Quit Lines Provision of Nicotine
  Replacement Products at low or no cost
• Referral to local programs and community services

15
Why offer Quit Lines?

• Effective cessation treatment
• Overcome barriers smokers face
• Accessibility
• Transportation
• Availability
• Services are free to callers
• Eliminate need for cessation class to form
• Child care isnt needed
• Convenient
• Reach rural and underserved areas where services
  may be lacking

16
Who can call?

• Varies by state and protocols
• Most states do not offer services lt 18 yrs of age
• Any one who wants to stop smoking, using spit
  tobacco
• Pregnant women
• Friend, family member who want to help someone
  stop smoking
• Health care professionals
• Businesses, industries, organizations

17
What are the hours?

• 24 hour voicemail available
• Monday through Friday
• Kentucky (9am-9pm Eastern Time)
• Ohio (9am 9pm Eastern Time)
• West Virginia (8am 8pm Eastern Time)
• Some weekend hours
• Ohio, Saturday and Sunday (10am-630pm)

18
Who answers the phone?

• States contract with qualified telephone quit
  line vendors
• Intake specialists
• Answer incoming calls
• Obtain preliminary information
• Quit Line counselors
• Specialize in tobacco cessation treatment
• Masters level counselors
• Continuous training, quality assurance

19
What happens on a call?

• Callers name, phone number, address,
  city/state/zip are collected
• Where did they hear about the QL?
• Referral source identified
• Pregnancy protocol addressed
• Years using tobacco, age started, brand used
• Identify Nicotine dependence
• Spit tobacco protocol

20
Call, continued

• of quit attempts, methods previously used
• Questions concerning readiness to quit
• Support from family, friends
• Health care provider information
• Smoking in household, other smokers, smoking
  allowed indoors

21
Call, continued again

• Set a projected quit date
• Form an Action plan (Quit Plan)
• Initial treatment goals
• Speak to a counselor now for first step
• Mail information, Quit Kit
• Schedule next calls

22
Referrals

• Referral source identified on all calls
• Fax Referral system may be used
• Allows providers to refer to Quit Lines
• Patient reports sent back to provider on
  patients quit attempt, can maintain in chart
• Providers need to provide intervention with
  referral, Quit Lines provide extensive counseling
• Method varies by state, HIPAA compliance standards

23
Referrals, continued

• Patient signs consent form
• Contact information is required
• Provider office faxes form to Quit Line
• Quit Line places first call
• Proactive call to patient
• Providers will receive a report from the Quit
  Line
• Some states have very active physician and
  medical office groups participating and competing
  for of referrals
• For example comparing of referrals from area
  hospitals to see who has the most callers

24
(No Transcript)
25
(No Transcript)
26
(No Transcript)
27
Reasons for Not Helping Patients Quit

• 1. Too busy
• 2. Lack of expertise
• 3. No financial incentive
• 4. Most smokers cant/wont quit
• 5. Stigmatizing smokers
• 6. Respect for privacy
• 7. Negative message might scare away patients
• 8. I smoke myself

28
Spend 30 seconds, Save a Life.

• You can make the most of the time you have with
  your patient AND include information on tobacco
  cessation
• How does this work?

29
Heres how easy . . .

• Ask. Do you smoke? Find out about your clients
  smoking status.
• Advise. You need to quit, its the most
  important thing you can do for your health.
  Explain the benefits of being smoke-free, and let
  them know they need to stop.
• Refer. Here is a phone number. Calling the quit
  line will more then double your chance of being
  smoke-free 1-800-QUIT NOW (1-800-784-8669)

30
Benefits of Being Smoke Free

• Within
• 20 Minutes - Blood Pressure and pulse rate
  decrease.8 Hours - Carbon monoxide and oxygen
  levels in blood return to normal.1 Day - The
  likelihood of a heart attack decreases.2 Days -
  Nerve endings regenerate sense of smell and
  taste are enhanced.2 Weeks - Circulation
  improves and lung function increases.1-9 Months
  - Coughing, sinus congestion, fatigue and
  shortness of breath decrease.

31
Even More Benefits . . .

• 1 Year - The likelihood of heart attack is
  cut in half.5 Years - Stroke risk is reduced to
  the same levels as a non-smoker.10 Years - Risk
  of dying from lung cancer is about half that of a
  current smoker.15 Years - Risk of coronary heart
  disease and death become roughly equivalent to
  those who have never smoked.

32
Do you recommend quit lines instead of other
cessation services?

• Quit Lines are ONE part of a comprehensive
  network of cessation services
• Quit Lines make great partners, form good
  collaborations
• Often link or refer callers to local or regional
  programs
• Quit Lines increase the number of people who
  attempt to stop using tobacco, increase number of
  those who are successful

33
Quit Line Evaluation Research

• North American Quitline Consortium
• unite health departments, quitline service
  providers, researchers and national organizations
  in the United States and Canada to enable these
  quitline professionals to learn from each other
  and to improve quitline services
• Minimal Data Set (MDS)
• All quit lines speak the same language, same
  definition of terms
• Opportunity to aggregate nationwide data for
  analysis

34
Ohios NRT Program

• Announced July 12, 2005
• Public/Private partnership
• Callers must be enrolled in quit line counseling
  program
• Participating health insurers, verify policy
• If eligible, caller receives up to 8 weeks of
  Nicoderm patch
• http//www.standohio.org/news/release.asp?id637

35
Resources

• North American Quitline Consortium
  www.naquitline.org
• Centers for Disease Control and Prevention
  www.cdc.gov/tobacco/quitlines
• www.smokefree.gov
• Smoking Cessation Leadership Center
• http//smokingcessationleadership.ucsf.edu/
• Surgeon Generals Report 2004, Fact Sheet -
  Smoking Among Adults Coronary Heart Disease and
  Stroke
• http//www.cdc.gov/tobacco/sgr/sgr_2004/Factsheets
  /3.htm

36
State Quit Line Program Contacts

• Kentucky (1-800-QUIT NOW)
• RaeAnne Davis, MSPH
• Kentucky Tobacco and Cessation Program
• 275 E. Main Street, HS2WE
• Frankfort KY 40621
• [phone] ext. 3858
• RaeAnne.Davis_at_ky.gov
• Ohio (1-800-QUIT NOW)
• Michael Renner, Executive Director
• Ohio Tobacco Use Prevention and Control
  Foundation
• 300 E Broad St., Suite 310Columbus, Ohio 43215
• [phone]
• mrenner_at_standohio.org

• West Virginia
• (1-877-Y-NOTQUIT)
• West Virginia Division of Tobacco Prevention
• Department of Health and Human ServicesBureau
  for Public Health
• 350 Capitol Street, Room 206
• Charleston, WV 25301-3715
• [phone]
• WV Quit Line Vendor
• Partners in Corporate Health, LLC
• 1191 Pineview Drive, Suite F
• Morgantown, WV 26505
• [phone]
• pch_at_partnersincorphealth.com