Comparison of Four Cessation Programs: What Works Best ? For Whom?

1. Comparison of Four Cessation Programs: What Works Best?For Whom?

2. Comparison of Four Cessation Programs:What Works Best? For Whom? Acknowledgement of Collaborating Vendors Helpline: Free & Clear, Inc. Website: QuitNet.com, Inc. Treatment Centers: Affiliated Community Medical Center St. Mary's Duluth Clinic Northwest Medical Center Work Sites: Park Nicollet Institute Presenters: Ann H. Wendling, MD MPH Anne E. Betzner, MA Julie A. Rainey, BA Barbara A. Schillo, PhD Additional Contributors: Michael G. Luxenberg, PhD Lawrence C. An, MD Annette Kavanaugh, MS Sharrilyn Evered, PhD

3. Learner Outcomes: • Understand key program components of MPAAT’s telephone helpline, website, treatment center, and workplace cessation programs. • Understand cessation outcomes for each program in terms of the populations served and the degree to which clients utilized key services. • Assess the effectiveness of four program types for their own populations, and have a standard of comparison for similar cessation programs. Professional Data Analysts, Inc.

4. Minnesota Partnership for Action Against Tobacco (MPAAT) • Established in 1998 as 501(c)3 as part of Minnesota’s tobacco settlement • Funded by Ramsey County District Court with 3% of settlement ($202 million) • MPAAT has awarded more than $20 million in program grants and contracts Professional Data Analysts, Inc.

5. How is Minnesota different from other states? • MPAAT is not located within or funded by the State Department of Health • MPAAT funds may not supplant benefits of other programs or health plans • MPAAT maintains partnership with health plans to provide helpline service Professional Data Analysts, Inc.

6. MPAAT Resources www.mpaat.org Professional Data Analysts, Inc.

7. Cessation services provided by MPAAT • QUITPLAN Helpline 1-888-354-PLAN • quitplan.com • QUITPLAN Centers • QUITPLAN at Work • QUITPLAN Community-tailored Programs Professional Data Analysts, Inc.

8. Helpline Goals • Provide a multi-call proactive phone counseling program to uninsured or underinsured Minnesotans • Connect Minnesotans who have access to telephone counseling to their health plans • Create systems changes/sustainability Professional Data Analysts, Inc.

9. Uninsured and Underinsured • Uninsured = no insurance at all (not even state public programs) • Underinsured = insurance does not include tobacco cessation counseling and/or NRT Professional Data Analysts, Inc.

10. Health Plan Partners (7) • Blue Cross Blue Shield of Minnesota • HealthPartners • Mayo Health Plan • Medica • Metropolitan Health Plan • PreferredOne Community Health Plan • UCare Professional Data Analysts, Inc.

11. Helpline Process • Paid media• Targeted promotions• Referrals Calls to Helpline MPAAT-funded phone number1-888-354-PLAN Is phone counseling available through health insurer? Yes No Health plan helpline, possible NRT MPAAT-funded phone counseling, possible NRT Professional Data Analysts, Inc.

12. Evolution of Helpline Services May 2001 - Began services Sept. 2002 - Initially provided NRT Allowed any Minnesotan to enroll with resulting duplication of services August 2003 - Changed scripting to improve triage and split NRT shipment Professional Data Analysts, Inc.

13. Evolution of Helpline Services June 2004 - Present Health plan systems changes initiated Began collecting health plan identification numbers Further adjusted scripting to triage clients Professional Data Analysts, Inc.

14. Helpline Volumes 2001-2005 • 34,970 calls requested some service • 7,246 callers were triaged to health plans • 16,306 enrolled in multi-call counseling • 13,071 participants received nicotine patches or gum Professional Data Analysts, Inc.

15. Addressing Challenges • Health plan members • Copays, Rx requirements, deductibles • Not all health plan members have NRT • Self-report of NRT benefits Professional Data Analysts, Inc.

16. www.quitplan.com • Provides interactive cessation advice and social support at all stages of readiness to quit • Available to ALL Minnesotans, regardless of health plan coverage • Over 11,000 Minnesotans have enrolled since August 2003 • No free NRT Professional Data Analysts, Inc.

17. QUITPLANSM at Work • Provide five session group counseling at worksites • Provide service to at least 50 worksitesa year, five worksites in each region of the state, and multiple diverse sectors • Employees ready to quit are eligible • NRT available to un- and underinsured Professional Data Analysts, Inc.

18. Face-to-face Programs January 2004 – Present • QUITPLAN Centers • Over 950 clients • QUITPLAN at Work • Over 650 clients • Recent high demand post ordinance implementation Professional Data Analysts, Inc.

19. QUITPLAN Community-tailored Programs • Culturally tailored cessation programs serving priority communities: • African-American • Somali and Oromo • Southeast Asian • Chicano Latino • GLBT • Community participatory evaluation model Professional Data Analysts, Inc.

20. Numbers Served by QUITPLAN Programs Helpline (4 years) Website (18 months) Centers (18 months) Worksite (18 months) (Community tailored programs are being evaluated separately.) Professional Data Analysts, Inc.

21. Rx Methodology worksite website helpline treatment center Professional Data Analysts, Inc.

22. Scope of the Evaluation • Process • Track services provided and to whom; participant satisfaction • Outcome evaluation • Participant outcomes Professional Data Analysts, Inc.

23. Today’s Presentation • Who goes to each program? • Demographics and tobacco use and quit history for each program • Demographic “user profiles” or clusters • Tobacco use and quit history “user profiles” or clusters Professional Data Analysts, Inc.

24. Today’s Presentation • Who goes to each program? • Demographics and tobacco use and quit history for each program • Demographic “user profiles” or clusters • Tobacco use and quit history “user profiles” or clusters • How effective is each program? • For whom? Professional Data Analysts, Inc.

25. Evaluation Methods: Intake • Intake Form at Registration • Demographic information, tobacco use and quit history, confidence quitting Professional Data Analysts, Inc.

26. Quit Survey Methodology • Quit Survey administered 6 months after registration • Tobacco use, pharmacotherapy use, utilization • Telephone survey • Dual methodology for Website Professional Data Analysts, Inc.

27. Consent Rates to Date 366/457 292/351 685/1139 296/301 • Helpline used a more passive, general consent process than the other interventions Professional Data Analysts, Inc.

28. Response Rates to Date 36.8% Phone 41.3% Online 257/366 230/292 535/685 219/296 Professional Data Analysts, Inc.

29. Using MATS to Compare to Intervention Samples of Smokers The Minnesota AdultTobacco Survey (MATS) used a sampleof 1,850 smokers. Survey data was collected collaboratively with MPAAT, Blue Cross Blue Shield of Minnesota, the Minnesota Department of Health, and the University of Minnesota. Estimated: 660,000 smokers in Minnesota Professional Data Analysts, Inc.

30. Rx Who Uses the QUITPLAN Programs? worksite website helpline treatment center Professional Data Analysts, Inc.

31. Gender * Significantly different than MATS (p ≤ .05) Professional Data Analysts, Inc.

32. Mean Age * Significantly different than MATS (p ≤ .05) Professional Data Analysts, Inc.

33. Education * Significantly different than MATS (p ≤ .05) Professional Data Analysts, Inc.

34. Employment Status * Significantly different than MATS (p ≤ .05) Professional Data Analysts, Inc.

35. Insurance Status * Significantly different than MATS (p ≤ .05) Professional Data Analysts, Inc.

36. Are there demographic “user profiles”? • K-Means Cluster analysis • 6 groups emerged • Determined by distance between and within clusters, meaningfulness of clusters, and parsimony • All participants fall into one group only Professional Data Analysts, Inc.

37. Gen X - Gen Y • 40% male • Younger (18-40) • Few college grads (15%) • All unemployed • None married • Highest rate of uninsured (1/3) • Racially more diverse (12% nonwhite) Professional Data Analysts, Inc.

38. Ms. Executive • All female • 25 - 50 years old • High proportion of college grads (59%) • All employed • ½ married • 90% white Professional Data Analysts, Inc.

39. Working Women • All female • 41 - 60 years old • Almost no college grads (7%) • All employed • ½ married • 90% white Professional Data Analysts, Inc.

40. Hard Luck • 36% men; 64% women • All 41+ years old • High proportion with HS or less ed (40%) • All unemployed • ½ married • More uninsured (¼) • 90% white Professional Data Analysts, Inc.

41. Mr. Executive • All male • 31 - 60 years old • High proportion of college grads (59%) • All employed • 2/3 married • 90% white Professional Data Analysts, Inc.

42. Blue Collar Workers • Mostly male • Broad age range (18-50) • Lowest education of all groups (75% HS or less) • All employed • 1/3 married • More uninsured (1/4) • 90% white Professional Data Analysts, Inc.

43. Proportion of Participants in Each Demographic Cluster Weighted so that each intervention is 25% Professional Data Analysts, Inc.

44. Who Uses the Helpline? Professional Data Analysts, Inc.

45. Who Uses the Centers? Professional Data Analysts, Inc.

46. Who Uses QUITPLAN at Work? Professional Data Analysts, Inc.

47. Who Uses the Website? Professional Data Analysts, Inc.

48. Who Uses Each Program? Tobacco Use and Quit History

49. Time to First Cigarette * Significantly different than MATS (p ≤ .05) Professional Data Analysts, Inc.

50. Daily Smokers * Significantly different than MATS (p ≤ .05) Professional Data Analysts, Inc.