ASHLine 2012 Highlights
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Participated in the first national tobacco cessation media
campaign with significant increase in calls that boosted the
already successful “Real Quitters” campaign.
Completed a comprehensive assessment of all hospitals in
the State to examine current successes and opportunities to
engage more service providers in the mission of tobacco
cessation through referrals to the ASHLine.
Completed the CPPW grant focusing on a systems change to
increase the use of the ASHLine through policy change and
referral enhancement at provider sites leading to a 10 fold
increase in behavioral health referrals.
Developed an integrated data and analysis sharing
partnership with BTCD to report findings of interest from the
data collected at the ASHLine.

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THE ARIZONA SMOKERS’ HELPLINE

ASHLine Annual Report
Fiscal Year 2012 (July 2011 through June 2012)
Summary of the Fiscal Year
Fiscal year 2012 was another strong year for ASHLine.
The quitline received more than 27,600 calls and
enrolled almost 11,400 Arizonans in the quit tobacco
coaching program. Additionally, ASHLine provided
more than 4,600 clients with self-help information.
The proactive referral program remains strong as
well, with more than 1,700 individuals referring more
than 12,500 persons to ASHLine services.

FY 2012
Incoming Calls
# Referrals
# Enrolled
# Info Only
Quit Rate

27,606
12,550
11,394
4,673
33%

ASHLine’s Referral Development Team successfully completed a needs assessment with most of
Arizona’s acute care hospitals, identifying areas of strength as well as areas for growth. The team was
able to provide technical assistance to locations and maintain strong working relationships with all of
ASHLine’s referral partners.
The Referral Call Team made tremendous efforts to evaluate the effectiveness of their call protocols
and, as a result, was able to successfully increase compliance. Despite the growth in the number of
referrals and, therefore, the number of clients to call to enroll in services, the Referral Call Team was
able to increase their reach of referred clients over their reach rate for fiscal year 2011. During FY 2011,
the referral call reach rate was 48%. This increased to 55% in FY 2012. In addition, the rate of enrollment
for clients reached increased from 44% in 2011 to 46% in 2012. The increase in the reach rate and the
enrollment rate indicate that more Arizonans are being successfully referred to and enrolled in ASHLine
services.

Type of Service Provision
4,673
29%

11,394
71%
Enrolled in Coaching

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Information Only

Coaching services at ASHLine provide clients with
support during their quit attempt. Of clients who
enrolled in services, 88% received at least one
coaching call and for those who stayed with the
coaching program for more than 90 days, 67%
achieved 90 days abstinent. ASHLine coaches received
high marks on the Client Satisfaction Survey with 86%
of clients indicating that the coaching was helpful and
88% indicating that their coach had a positive
influence on their quit attempt.
The Callback Team spent much of the fiscal year
refining methods for increasing re-enrollments in
ASHLine services for clients who were not quit at

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follow-up. Implementing such processes led to increases in re-enrollments. Additionally, the team
implemented new processes aimed at increasing response rate. Finally, the Callback Team began
refining the Client Satisfaction Survey and continued to provide data to staff members to improve
services.
Throughout the year, the Evaluation Team engaged in rigorous analyses to implement the revised
ASHLine Evaluation Plan. ASHLine also prepared and submitted evaluation reports for peer reviewed
publication and developed projects for external funding. Finally, ASHLine has continued its participation
in a national evaluation project that is comparing the effectiveness of phone and web tobacco cessation
interventions.

Referral Development Team
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Completed an annual assessment with
# Referrals
12,550
hospitals in the state assessing for
# Unique Locations
784
systems change focused on tobacco
# Unique Agents
1,704
policy, staff training, and implementation
of protocols that include referral for
telephone or web-bases tobacco cessation services.
o Developed a tailored plan with each participating system for ASHLine supported systems
change activities/capacities.
Completed a webinar series. The topics of the series were electronic health records and
meaningful use, billing for tobacco interventions, and accreditation emphasizing how ASHLine
can help with meeting the requirements of each topic.
Hosted a behavioral health summit as part of CME certification with University of Arizona
College of Medicine.
Piloted customized online referral guide with behavioral health organizations.
o The guide was developed in conjunction with La Frontera to address a specific training
need. The guide was then used with COPE for WebQuit trainings.
Piloted a standardized version of the Ask, Advise, Refer (AAR) In-Service and collected feedback
from training participants to evaluate the new
version of the in-service.
Number of Referrals
Evaluated the effectiveness of using customized
14,000
12,550
QuitFax referral forms which included a place to
11,400
12,000
insert discharge date.

CPPW Grant Summary
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FY 2012

ASHLine partnered with the Regional Behavioral
Health Authorities in Maricopa County
(Magellan) and Southern Arizona (Community
Partnership of Southern Arizona) in order to
target Behavioral Health (BH) facilities in an

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10,000
8,000
6,000
4,000
2,000
FY 2011

FY 2012

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THE ARIZONA SMOKERS’ HELPLINE

effort to increase access to tobacco cessation services to Arizonans in the public mental health
system, a population with a disproportionately high use of tobacco.
More than 150 meetings, trainings, and other events have been conducted at the BH facilities
that were part of the grant.
The total number of referrals received from BH locations was 1,065 which is a growth of 182
times the number of referrals received from the targeted BH facilities prior to the initiative.

Referral Call Team
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FY 2012

Protocol adherence increased this
# Referrals
12,550
fiscal year as more sophisticated
% Reached
55%
systems for compliance were
% Reached who Enrolled
46%
developed.
o WebQuit now includes a new
color-coded system for
Referral Reach Rate
identifying out of compliance calls.
o The Referral Call team began to
include “HOLD” in referral notes to
indicate a client’s preference for calls
Referrals
outside of the time frame specified in
Not
Reached
the protocol. These calls would no
Referrals
45%
longer be recorded as out of
Reached
55%
compliance.
Evaluated whether adherence to protocol
increased the client reach rate.
Evaluated whether there was a relationship
Referrals Reached Referrals Not Reached
between SRS scores for intake and a client
taking his or her first coaching call.

Coaching Team
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88% of clients had at least 1 coaching
call. The average coaching call for
reached clients was 11 minutes long.
Clients who received coaching had an
average of 75.3 “most days quit”.
88.3% of clients polled in the
Customer Satisfaction survey said their
coach had a positive impact on their
quit attempt, 86.4% said overall
coaching was helpful to them.

FY 2012
New Episodes
Avg # Coaching Sessions
(for reached episodes)
Avg # Coaching Sessions
(for all episodes)
30-Days Quit (Clients in
program at least 30 days)

11,381
4.5
3.9
32%

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Staffing efficiency procedures were improved to maintain outcome measures with fewer
coaches.
Major revision/refinement of internal coaching and intake process reports and clinical indicator
reports to better manage process measures connected to outcomes. Staff supervision
procedures were revised to increase utilization of QI data in day-to-day staff performance. Callmonitoring tool was developed.
Refreshment of Ning social website, 240% increase in content posting.

Callback
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FY 2012

New scheduling protocols were
Quit Rate
33%
implemented based on the results of
Response Rate
49%
quality improvement analyses.
Client Satisfaction
84%
Re-enrollments were increased.
New processes were integrated into
Callback protocols to increase response
rate.
Developed a revision process and Implemented feedback changes to the Client Satisfaction
Survey.
7-Month Follow-up Survey
New performance benchmarks were
47%
implemented in order to increase the quality of
50%
the work of the team.
45%
40%
Surveyed clients, coaches, and providers on the
33%
35%
Behavioral Health Initiative.
30%
Removed callback sampling from the 13 month
25%
list when staff reallocation to other surveys was
20%
permitted when RTI took over 7 month callback
15%
(RTI is conducting these surveys as part of their
10%
5%
investigation comparing ph one and web
0%
behavioral support. They send us the data they
Quit Rate
Response Rate
collected on a biweekly basis).

Evaluation
Program Evaluation
• Implemented the ASHLine evaluation plan. Examples of analysis are:
o Evaluated the relationship between promotional reach and quitline calls.
o Evaluated the effect of ASHLine coaching by comparing clients who received both
medication and coaching to those receiving only medication.
o Estimated the effect of behavioral support services by comparing quit rates between
clients receiving only medications and clients receiving both medications and coaching
services.

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Analyzed archival data from medication promotion to compare quit rates for clients
using ASHLine services and clients taking in-person cessation classes.
Data Briefs sent to the state for monthly dissemination. Topics included outcomes of the
ASHLine evaluation plan, such as the use of ASHLine by elderly, comorbid, and non- and underinsured clients.
Participated in NAQC Public-Private Initiative with BTCD. The Evaluation Team helped to gather
preliminary information about potential partners in the state.
Reworked the ASHLine evaluation plan to incorporate new additions to the strategic plan.
Evaluated different types of client characteristics that are predictive of program success and
sustained tobacco cessation. This process also identifies characteristics of clients most at risk to
drop out of the program or be unable to set a quit date or maintain quit.
Established a strong connection between process measures, such as time in program and call
duration, with outcome measures, such as quit rate and reduction in tobacco use. Such results
show that our process is in accord with and contributes to our defined outcomes goals of
helping Arizonans quit smoking.
Began preliminary data collection for the effect of pharmacist intervention in helping ASHLine
clients organize and adhere to their medication requirements.
Provided Ad Hoc analysis for:
o WIC
o Project Reach
o Coaching versus WebQuit
o Diabetes Self Management Programs
o Co-morbidity of ASHLine clients
o ASHLine Call Volume and Quit Rates
o Demographics of clients reached versus not reached for coaching
o CPSA and Magellan Regional Behavioral Health Authorities
o Various county health departments
Referral reports specific to Behavioral Health, both for BTCD and the RBHAs.
Quarterly reporting to National Quitline Data Warehouse (NQDW).
Trained all of the county partners’ staff members to use WebQuit to record outreach activities
and to make online referrals.
Customized monthly reports about referral number by location type for Maricopa County
Monthly meeting with Maricopa County to provide technical assistance
Monthly Referral report to the Inter-Tribal Council of Arizona
Developed new monthly reports for coaching include:
o Client satisfaction aggregate ratings report
o Client satisfaction coaching ratings by coach report
o Client satisfaction verbatim open-ended questions by coach report
o Coaching process report (coaching calls)
o Coaching intake report (report about doing intake)
o Clinical indicators
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Quality Improvement
• ASHLine data Quality Assurance Plan was initiated.
• Developed new quality improvement metrics for the Coaching, Referral Development, Referral
Call, and Callback units.
• Established method for evaluating protocols with prospective methods and data.
• Completed QI analysis for ASHLine units. Some examples include:
o Does increased adherence to the call protocol increase the percent reached?
o Is there a correlation between SRS scores and the percent of clients who take the first
coaching call?
o Does using a new introduction script increase the likelihood of a Client enrolling in
ASHLine services?
o Does the frequency of contacts increase referrals?
o Does the type of event impact referrals?
o Pilot AAR in-service
o Pilot webinar series
o Database sweeps for duplicate locations on an ongoing basis
o New coaching quality measures will begin to look at increasing the effectiveness of
client retention
o Monitoring coaching process with calls per client and evaluating risk
• Coaching Team QI-Subcommittee for formed to activate QI improvements/recommendations:
o The coaching questions on the Customer Satisfaction Survey were revised to more
accurately track and manage customer’s desires with regard to their coaching
experience.
o Conducted a focused exploration of client satisfaction with regard to frequency of
coaching calls.
Publications and Presentations
• Published paper on the effect of referral location type on enrollment rates and quit rates.
• Presented a novel program evaluation method using ASHLine data at the American Evaluation
Association
• Developing a paper investigating the effect of the client-coach alliance on client quit rates,
above and beyond standard ASHLine training
• Investigation on the effect of location type (hospitals, PCP offices, community health centers) on
referrals and client success in the ASHLine
• Submitted re-worked evaluation of the effect of individual coach differences on quit rates.
• Evaluation Team was coauthor on a poster of national quitline data presented with NAQC
Director of Research, Jessie Saul, at the Society for Research on Nicotine and Tobacco Annual
Conference.
• An update to the NAQC 2007 descriptive paper on US and Canadian quitlines was prepared for
publication

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National Media Campaign
In the middle of March 2012, the Centers for Disease Control launched an aggressive national campaign,
advertising the services of the state quitlines through the national quitline, 1-800-QuitNow. In the week
prior to the campaign, ASHLine received 51 calls through the national line, accounting for 12.5% of the
incoming calls. ASHLine saw an increase in the proportion of calls coming through 1-800-QuitNow. The
proportion of calls varied from week to week, ranging from a low of 23.9% to a high of 71.5% of calls
coming from 1-800-QuitNow (see Figure 1).
Figure 1. Proportion of ASHLine calls from the national quitline

Number of Incoming Calls

Proportion of ASHLine Calls from 1-800-QuitNow
900

90%

750
600
450

46%

300
150

71%

62%
39%
24%

28%

39%

39%

70%

48%
35%

42%

51%

13%

50%
30%
10%

Calls to ASHLine

Calls from QuitNow

% QuitNow

Overall, calls from Arizonans to the national quitline were very low, accounting for less than 1% of the
calls to the national line. Arguably, the low proportion of calls to the national line is due to ASHLine’s
ongoing media presence in the state. That said, the influence of the national campaign on the number of
calls from Arizonans to the national quitline was strong. There was substantial growth in the number of
calls to the national line. As Figure 2 shows, the growth from the baseline week (March 11) ranged from
211% to more than 625% growth in calls to the national line from Arizonans.
Figure 2. Percent growth for calls received from the national quitline

Percent Growth in Calls Received from 1-800-QuitNow
700%
600%
500%
400%
300%
200%
100%

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627.5%
466.7%398.0%

464.7%
309.8%

288.2%

211.8%

282.4%

368.6%

439.2% 482.4%
290.2%

100.0%

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