Arizona Smokers’ Helpline Annual Report ASH ine Fiscal Year 2014 (July 2013 through June 2014) Youth Perceptions Diabetes Self-Management Coaching Public-Private Partnership Improving the Health of Arizonans through Technology Based Interventions ASHLine Annual Report, FY2014 ashline.org Spotlight on Evaluation 2014 Page 1 of 8 ASHLine Client and Community Youth Evaluation Youth Perceptions about Media Messages: More Hope, Less Fear To assist ASHLine in improving its services and media messages for youth (ages 15-23), focus groups and interviews were held in February and March 2014 with former youth clients and nonclient, community youth. Thirty-two youth participated in the evaluation—11 clients and 21 community youths. Client youth were interviewed in person and over the phone. Community youth participated via focus groups. This data brief emphasizes discussions held with focus group participants. Community youth discussed their perception of antitobacco media messages, including two ASHLine- Youth are not paying attention to the phone number at the end. I feel that something that would be a lot more effective would be something that would be not beating down smokers but may be empowering them to make that choice. 3. It is not immediately apparent to youth how or why calling a tobacco quit line would be helpful. They are skeptical they would not relate to a person over the phone. discussions, they provided recommendations for improving future ASHLine media messages. What I want to know is, how do you guys help? Youth are interested in messages that are informative and inspiring. Most want to quit, but are resistant to messages that focus on the negative consequences of smoking. Though participants readily acknowledged tobacco’s negative health effects, many expressed it helps them manage their stress and feel calmer. Thus, when messages only speak to the risks, youth tend to discredit them. Four themes emerged along these lines: 4. Participants want to hear stories from others, like them, who have quit. After watching ASHLine ads1, many felt they could relate to the youth portrayed in them, but the ads were missing details about what happens when youth use ASHLine. 1. Youth smokers do not relate to the majority of anti-tobacco messages they see. They view them as being hyperbolic, repetitive and irrelevant. They believe the messages promote fear instead of hope. Looking at an example and how, like, they achieved it and they did it, it kind of gives you feelings of, ‘okay I can do that too’. Recommendations: • They’re trying to scare you instead of telling you, like, what’s the good thing about quitting. • 2. Youth do not want to hear they have a problem or are at risk. They want to hear how to quit and what ASHLine offers. Quit messages should empower. Messages should stress that ‘you can quit’ more than ‘you should quit.’ ASHLine ads are not clear enough to be distinguished from other anti-tobacco ads. 1 ASHLine messages to youth should focus on how one quits and how ASHLine helps. Messages need to emphasize ASHLine offers hope and help, not just an edict to quit. Promote ASHLine to youth using social media and a dedicated website. Youth report being hesitant to call but are interested in stories and information. Direct them to a site that provides ASHLine ads “Only Smoke When” and “Brian” ASHLine Team Highlights 2014 Page 2 of 8 Summary of the Fiscal Year Fiscal Year 2014 was another strong year for ASHLine. The quitline received more than 17,300 calls and enrolled almost 11,000 Arizonans in the quit-tobacco coaching program. The proactive referral program remains strong as well, with more than 1,600 healthcare professionals referring more than 9,900 individuals to ASHLine services. Additionally, ASHLine recruited seven employers to participate in pilot projects to advance the PublicPrivate Partnership initiative. This year 10,824 enrolled in services with a higher percentage of clients opting into health coaching than ever before. Quit rates also showed a marked increase from FY2013. ASHLine Core Measures FY2013 FY2014 Incoming Calls 26,469 17,328 # Referrals 10,518 9,974 # Enrolled 14,214 10,824 # Info Only 3,157 561 30% 37% Quit Rate Community Development Team Key Accomplishments FY2014: • Intake Type Information Only 5% Spearheaded the development of countyPlans” to guide referral development activities and structure technical assistance an ongoing partnership among ASHLine, Enrolled 95% • Initiated a multi-phase systems change project with a large, multi-state health network/ • Completed the training phase for an ongoing • services for adults with Serious Mental Illness (SMI) Recruited seven employers to participate in pilot projects to advance the Public-Private Partnership (PPP) Initiative ASHLine Annual Report, FY2014 ashline.org ASHLine Team Highlights 2014 This year, the Community Development Team focused on three primary objectives: (1) Advancing the PPP initiative by recruiting employers to participate in pilots with ASHLine (for more information, see Public-Private Partnerships); (2) Developing a more structured approach to partnering with county health departments to guide referral development work statewide; and (3) Continuing to shift our emphasis toward systems-level work with healthcare organizations. Page 3 of 8 Community Development and Enrollment Teams FY2013 FY2014 # Referrals 10,518 9,974 % Reached 53% 47% % Reached who Enrolled 56% 64% 715 791 1,269 1,645 # Unique Locations # Unique Agents To support these objectives, the Community Development Team began developing several new suites of assessment tool designed to capture current progress toward implementation of U.S. Public Health Service recommended tobacco systems strategies; revised Ask, Advise, Refer (AAR) trainings for both medical and behavioral professionals that incorporate new information on e-cigarettes; and re-designed provider information folders for distribution during trainings. In addition, the Manager of Community Development oversaw the work of an undergraduate University of Arizona intern who completed a project evaluating conversational elements of Number of Referrals by Service Provider Type Medical Practice 2,207 Hospital, Acute Care 1,933 Behavioral Health 1,647 Community Health Center 1,316 WIC 924 County Health Department 704 Community Group 353 Well-Woman Health Check 174 Health Insurance Group 155 Dental Practice 151 Worksite 103 IHS/Tribal 103 School/University 65 Hospital, Rehabilitation/Specialty 54 Pharmacy 31 Long-Term Care Facility 26 DOD/VA 15 0 ASHLine Annual Report, FY2014 500 1,000 1,500 2,000 2,500 ashline.org ASHLine Team Highlights 2014 Page 4 of 8 Enrollment Team Key Accomplishments FY2014: • Completed a unit re-organization, including hiring as well as appointing a Manager of Referral & • Reached Referrals Enrollment Rate Not Enrolled 36% Processed nearly 10,000 fax and web-based referrals • made within 24 hours of referral receipt Enrolled 64% Fiscal Year 2014 marked the transition of the Referral Call Team into the Enrollment Team. This shift signaled an expansion of duties from processing referrals and enrolling clients to providing immediate support to new callers in the early stages of the behavior change process. The purpose of this intervention is to engage tobacco users in the quit process from the earliest contact and bridge the gap from the initial intake call to Development to ensure seamless processing of all fax and electronic referrals submitted to ASHLine, monitor ASHLine Annual Report, FY2014 ashline.org ASHLine Team Highlights 2014 Page 5 of 8 Coaching Team Key Accomplishments FY2014: • • • Completed data analysis and evaluation training with the Manager coaches’ skills in interpreting client in-program and outcomes data Initiated a pilot study addressing chronic disease-related behavior change for clients. This project involved clients with diabetes interested in support for their diabetes self-management in conjunction with tobacco cessation coaching. Completed qualitative research for youth tobacco-cessation efforts. How Helpful was Coaching in Your Efforts to Quit Tobacco? 70% 60% 60% 50% 40% 30% 30% 20% 10% 10% 0% Very Helpful Somewhat Helpful Not Helpful population. In conjunction with the Manager of Evaluation & Research, the Coaching Team completed training on interpretation and utilization of client data in an effort to optimize the coaching process and behavioral support strategies. This exercise will be ongoing and provide a platform for assessing impact and using data to modify protocols in order to achieve greater life-improvement behavior change in our clients. While this work will primarily focus on tobacco cessation, ultimately these efforts will be used to support a cluster of health behaviors important to individual and public health. Coaching FY2013 New Episodes % Receiving 1+ Coaching Calls Avg # Coaching Sessions/Exited Episode % Using Meds ASHLine Annual Report, FY2014 14,300 88% 3.9 52% FY2014 10,711 episode created 79% intake date 3.9 episode exited 60% episode created ashline.org ASHLine Team Highlights 2014 Page 6 of 8 Evaluation Team Key Accomplishments FY2014: • • • • • Led the process of developing and implementing the Diabetes Protocol Conducted focus groups among youth, Arizona Health Care Cost Containment System diabetics Submitted three grant proposals Continued to provide support for internal and external data requests This past year, the Evaluation & Research Team led the process of developing and implementing the diabetes protocol. This project was completed with the help of a University of Arizona Master of Public Health process entailed creating a database and user interface for outcomes and process data collection. This system the diabetes coaches throughout the year to conduct a formal process evaluation. Members of both teams met numerous times to evaluate assignment, program invitation, coaching, and data collection processes. A report Zuckerman College of Public Health Internship Conference. Changes were made to the diabetes protocol based on the initial evaluation, and a second revision of the diabetes database is underway. This establishment and preliminary success of the diabetes protocol has paved the way for ASHLine’s attempt to expand lifestyle coaching to include hypertension and obesity. We also conducted focus groups to better understand the high smoking rates and low treatment-seeking rates of youth, AHCCCS, and tailor behavioral support models. and Prevention. recurring and ad hoc basis. ASHLine Annual Report, FY2014 ashline.org ASHLine Team Highlights 2014 Page 7 of 8 Survey Team Key Accomplishments FY2014: Survey Team • • • • assist each other during high call volume Created follow-up survey for medication management to survey how providers, coaches, FY2013 FY2014 7-Month Quit Rate 30% 37% Response Rate 50% 49% Developed a new process for identifying clients currently enrolled in ASHLine services multiple roles. responsibilities to help answer phones, enroll clients, and administer callback surveys. Furthermore, a followrecommendations for integrating behavioral health medications and tobacco cessation medications. think they have exited from the program because the ASHLine Survey Team has contacted them for a follow-up. current survey call. 7-Month Follow-up Survey 60% 50% 40% 49% 37% 30% 20% 10% 0% Response Rate ASHLine Annual Report, FY2014 Quit Rate ashline.org ASHLine Team Highlights 2014 Page 8 of 8 Quality Improvement Team Key Accomplishments FY2014: • • Developed strategies to address lower relative quit rates of low-income and behavioral health clients lifecycle of referring organizations The focus of the Quality Improvement Team this year was to develop protocols to address the disparate program completion rate of low-income and behavioral health clients. New protocols were created from a multidisciplinary team of staff members with expertise in community development, evaluation, and low-income used to inform protocol development. The Quality Improvement Team also began working on characterizing the lifecycle of referring organizations. This project will help ASHLine identify which types of events support and sustain optimal levels of referrals to the ASHLine among provider organizations. Public-Private Partnership Initiative Key Accomplishments FY2014: • • • • ASHLine established pilot projects with seven employers across Arizona to provide tobacco cessation services for employees wanting to avoid a tobacco surcharge Delivered trainings to approximately 250 staff on ASHLine services and the AAR brief intervention process at PPP target organizations (employers, insurers, insurance brokers) to ensure long-term sustainability. to become a paid service provider under the tobacco cessation provisions outlined in the Affordable Care Act of whom opted to begin referring their employees to ASHLine for support to quit tobacco. ASHLine received a of employees referred among these organizations enrolled in ASHLine services. Five of the seven employers partnering with ASHLine expressed interest in developing tailored programs for their employees (e.g. minimum the employees referred took a coaching call and 67% of the employees who enrolled successfully completed Arizona Department of Health Services (ADHS) to conduct outreach to leadership among a number of insurance providers and insurance brokers across the state. Trainings were delivered addressing information on ASHLine services and the AAR brief intervention process to approximately 250 individuals ranging from decision makers this momentum and begin working toward laying the groundwork for the infrastructural changes required to successfully establish cost-sharing partnerships with partner organizations. ASHLine Annual Report, FY2014 ashline.org Arizona Smokers’ Helpline Annual Report Appendix ASH ine Fiscal Year 2014 (July 2013 through June 2014) Arizona Smokers’ Helpline Tucson, AZ 85721 Phone: (800) 556-6222 Fax: (520) 318-7222 info@ashline.org Arizona Smokers’ Helpline July 31, 2014 Appendix: FY2014 Statistics and Demographics Referrals to ASHLine Services Table 1. Number of Unique Referring Locations and Referring Agents Count 4 Referring Locations 4 Referring Agents 791 1,645 Table 2. Number of Referrals by County County Referrals Apache 38 0.4% Cochise 209 2.1% Coconino 444 4.5% Gila 76 0.8% Graham 89 0.9% Greenlee 22 0.2% La Paz 44 0.4% Maricopa 4,715 47.3% Mohave 467 4.7% Navajo Percent of Total 88 0.9% Pima 3,015 30.2% Pinal 188 1.9% Santa Cruz 102 1.0% Yavapai 337 3.4% Yuma 128 1.3% Unknown 12 0.1% Out of State 0 0.0% Refused 0 0.0% Total Page 1 of 30 9,974 100.0% ASHLine Annual Report, FY2014 ashline.org Arizona Smokers’ Helpline July 31, 2014 Figure 1. Number of Referrals by County Referrals by County Maricopa 4,715 Pima 3,015 Mohave 467 Coconino 444 Yavapai 337 Cochise 209 Pinal 188 Yuma 128 Santa Cruz 102 Graham 89 Navajo 88 Gila 76 La Paz 44 Apache 38 Greenlee 22 0 Page 2 of 30 500 1,000 1,500 2,000 2,500 3,000 ASHLine Annual Report, FY2014 3,500 4,000 4,500 5,000 ashline.org July 31, 2014 Arizona Smokers’ Helpline Table 3. Number of Referrals by Service Provider Type Location Type Referrals 22 Behavioral Health 1,647 16.5% 353 3.5% 1,316 13.2% 1 0.0% County Health Department 704 7.1% DOD/VA 15 0.2% Dental Practice 151 1.5% Health Insurance Group 155 1.6% 1,933 19.4% Hospital, Rehabilitation/Specialty 54 0.5% IHS/Tribal 638 103 1.0% Long-Term Care Facility 26 0.3% 2,207 22.1% Pharmacy 31 0.3% Project Reach 0 0.0% School/University 65 0.7% WIC 924 9.3% Well-Woman Health Check 174 1.7% 14 Worksite 103 1.0% 7 Unknown 12 0.1% 18 21 6 19 8 15 16 23 11 13 9 24 10 5 12 20 17 Community Group Community Health Center Correction/Probation Hospital, Acute Care Medical Practice Total Page 3 of 30 9,974 Percent of Total 100.0% ASHLine Annual Report, FY2014 ashline.org July 31, 2014 Arizona Smokers’ Helpline Figure 2. Number of Referrals by Service Provider Type Referrals by Service Provider Type 2,207 Medical Practice 1,933 Hospital, Acute Care 1,647 Behavioral Health 1,316 Community Health Center 924 WIC 704 County Health Department 353 Community Group 174 Well-Woman Health Check Health Insurance Group 155 Dental Practice 151 Worksite 103 IHS/Tribal IHS/Tribal 638 103 School/University 65 Hospital, Rehabilitation/Specialty 54 Pharmacy 31 Long-Term Care Facility 26 DOD/VA 15 0 Page 4 of 30 500 1,000 ASHLine Annual Report, FY2014 1,500 2,000 2,500 ashline.org July 31, 2014 Arizona Smokers’ Helpline Table 4. Referrals by County and Intake Type 100 101 102 Enrolled Information Only 5 Apache 6 Cochise 13 1 14 62 4 66 7 Coconino 8 Gila 155 3 158 24 0 24 9 Graham 10 Greenlee 30 2 32 9 0 9 11 La Paz 12 Maricopa 14 1 15 1,670 37 1,707 13 Mohave 14 Navajo 189 6 195 37 0 37 15 Pima 16 Pinal 998 20 1,018 83 1 84 17 Santa Cruz 18 Yavapai 52 0 52 131 2 133 51 3 54 6 0 6 County 19 Yuma 4 Unknown Total #N/A Out of State 0 0 0 #N/A Refused 0 0 0 3,524 80 3,604 Total Page 5 of 30 ASHLine Annual Report, FY2014 ashline.org Arizona Smokers’ Helpline July 31, 2014 Table 5. Number of Referrals by County and Service Provider Type BH Comm Grp FQHC Correction/ Probation Apache 6 0 13 0 9 0 0 0 0 0 5 0 1 0 0 0 4 0 0 0 38 Cochise 20 3 18 0 31 0 14 0 80 0 0 0 18 0 0 3 13 9 0 0 209 Coconino 12 4 105 0 103 0 6 0 144 2 7 0 45 0 0 0 8 8 0 0 444 Gila 21 0 0 0 5 0 0 0 42 0 0 0 7 0 0 0 1 0 0 0 76 Graham 1 0 8 0 22 1 0 0 47 0 0 0 10 0 0 0 0 0 0 0 89 Greenlee 0 0 10 1 7 0 0 0 0 0 0 0 3 0 0 0 1 0 0 0 22 La Paz 5 0 0 0 36 0 0 0 2 0 1 0 0 0 0 0 0 0 0 0 44 County County Hlth Dept DOD/VA Dental Practice Hlth Ins Grp Hosp, Acute Care Hosp, Rehab/ Specialty Tribal Long-Term Care Facility Medical Practice Pharmacy Project Reach School WIC WWHC Worksite Unknown Total 542 129 342 0 151 1 114 118 776 47 7 26 1,505 10 0 44 782 64 57 0 4,715 Mohave 32 1 62 0 83 0 0 1 121 0 6 0 114 0 0 0 3 9 35 0 467 Navajo 2 0 37 0 10 0 2 0 2 0 1 0 19 0 0 0 10 5 0 0 88 Pima 889 201 530 0 130 13 10 36 628 0 76 0 395 21 0 16 33 27 10 0 3,015 Pinal 29 0 70 0 19 0 0 0 1 0 0 0 37 0 0 0 4 27 1 0 188 8 0 75 0 0 0 0 0 5 0 0 0 0 0 0 0 0 14 0 0 102 Yavapai 47 0 35 0 90 0 0 0 79 0 0 0 10 0 0 2 63 11 0 0 337 Yuma Maricopa Santa Cruz 33 15 11 0 8 0 5 0 6 5 0 0 43 0 0 0 2 0 0 0 128 Unknown 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12 12 Out of State 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Refused 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,647 353 1,316 1 704 15 151 155 1,933 54 103 26 2,207 31 0 65 924 174 103 12 9,974 Grand Total Page 6 of 30 ASHLine Annual Report, FY2014 ashline.org Arizona Smokers’ Helpline July 31, 2014 Intake Table 6. Intake 4 Figure 3. Intake Type 7 8 Enrolled Information Only Total 10,824 561 11,385 Intake Type Information Only 5% Enrolled 95% Page 7 of 30 ASHLine Annual Report, FY2014 ashline.org Arizona Smokers’ Helpline July 31, 2014 Table 7. Intake by County County Enrolled Information Only 59 3 62 233 10 243 6 Coconino 11 Gila 245 7 252 112 2 114 9 Graham 15 Greenlee 70 3 73 23 0 23 11 La Paz 1 Maricopa 30 2 32 6,104 110 6,214 543 13 556 158 2 160 1,920 37 1,957 516 7 523 85 1 86 464 11 475 206 7 213 3 5 8 Refused 5 21 26 Unknown 48 320 368 10,824 561 11,385 9 Apache 5 Cochise 3 Mohave 11 Navajo 2 Pima 6 Pinal 14 Santa Cruz 4 Yavapai 6 Yuma Out of State Total Page 8 of 30 Total ASHLine Annual Report, FY2014 ashline.org Arizona Smokers’ Helpline July 31, 2014 Figure 4. Intake by County, Information Only Information Only Maricopa 51% Pima 17% Santa Cruz 0.5% La Paz 0.9% Mohave 6% Yavapai 5.1% Cochise 4.7% Apache 1.4% Yuma 3.3% Pinal 3.3% Coconino 3.3% Gila 0.9% Navajo 0.9% Graham 1.4% Greenlee = 0% Page 9 of 30 ASHLine Annual Report, FY2014 ashline.org Arizona Smokers’ Helpline July 31, 2014 Figure 5. Intake by County, Enrolled Enrolled Maricopa 57% Pima 18% Greenlee 0.2% Mohave 5.0% La Paz 0.3% Pinal 4.8% Page 10 of 30 Apache 0.5% Yavapai 4.3% Coconino 2.3% Cochise 2.2% Navajo Gila Yuma 1.5% 1.0% 1.9% ASHLine Annual Report, FY2014 Santa Cruz 0.8% Graham 0.7% ashline.org July 31, 2014 Arizona Smokers’ Helpline Demographics and Other Characteristics of ASHLine Clients Gender Table 8. Gender Figure 6. Gender by Intake 13 14 Enrolled Information Only Total 4 Male 5 Female 4,539 61 4,600 6,187 83 6,270 6 Missing Total 98 417 515 10,824 561 11,385 Gender Gender 7,000 6,187 6,270 6,000 5,000 4,539 4,600 4,000 3,000 2,000 1,000 61 0 Enrolled 83 Information Only Male Total Female Females continue to use ASHLine services at a higher rate than males despite higher smoking rates in males. Page 11 of 30 ASHLine Annual Report, FY2014 ashline.org July 31, 2014 Arizona Smokers’ Helpline Race Table 9. Race Race 4 White 5 Black or African American Figure 7. Race by Intake 16 17 Enrolled Information Only Total 7,851 108 7,959 Race 874 5 879 6 Asian 7 Hawaiian 61 0 61 11 0 11 8,000 8 American Indian 9 Multiracial 230 0 230 242 2 244 7,000 179 2 181 6,000 1,376 444 1,820 10,824 561 11,385 5,000 10 Other Race 11 Unknown Total 9,000 7,851 7,959 4,000 3,000 1,597 2,000 1,606 1,000 108 0 Enrolled 9 Information Only White Total Non-White ASHLine enrollment among clients who classify themselves as White are higher than that of clients who classify themselves as a racial minority. A greater focus needs to be placed on reaching out to clients of other racial groups. Page 12 of 30 ASHLine Annual Report, FY2014 ashline.org July 31, 2014 Hispanic Arizona Smokers’ Helpline 19 20 Enrolled Information Only Total 4 Yes 5 No 1,942 14 1,956 6,763 104 6,867 6 Unknown Total 2,119 443 2,562 10,824 561 11,385 Hispanic Identification 8,000 6,867 6,763 7,000 6,000 5,000 4,000 3,000 1,956 1,942 2,000 1,000 104 14 0 Enrolled Information Only Yes Total No Hispanics represent ~17% of clients served; the majority opt for coaching with <1% requesting information only. Page 13 of 30 ASHLine Annual Report, FY2014 ashline.org Arizona Smokers’ Helpline July 31, 2014 Age Table 11. Age Group Figure 9. Age Group by Intake 75 Enrolled 76 Information Only 29 3 32 628 8 636 5 25-34 6 35-44 1,524 17 1,541 1,766 18 1,784 7 45-54 8 55-64 2,846 33 2,879 4,000 2,579 36 2,615 3,500 9 65-79 10 80+ 1,307 17 1,324 87 1 88 Age Group 11 Less than 18 4 18-24 12 Missing Total Total Age Group 5,000 4,663 4,612 4,500 3,000 58 428 486 2,500 10,824 561 11,385 2,000 2,579 2,152 2,615 2,177 1,412 1,394 1,500 1,000 500 25 0 Enrolled 51 36 18 Information Only 18-34 35-54 55-64 Total 65+ Enrollment among clients who are between the ages of 35 - 64 is higher than those younger than 35 or older than 65. ASHLine is evaluating ways to reach out to young adults and the elderly to improve their enrollment numbers. Page 14 of 30 ASHLine Annual Report, FY2014 ashline.org July 31, 2014 Arizona Smokers’ Helpline Education Table 12. Education Education 4 College Degree 5 Some College 6 Technical or Trade School 7 High School Diploma 8 GED 9 Grade 9-11 (no diploma) 10 Grade 8 or less 11 Missing Total Figure 10. Education by Intake 55 56 Enrolled Information Only Total 2,039 5 2,044 3,162 14 3,176 450 2 452 2,622 59 2,681 589 2 591 1,291 7 1,298 452 1 453 219 471 690 10,824 561 11,385 Education 6,000 5,672 5,651 5,000 4,000 3,272 3,211 3,000 1,751 1,743 2,000 1,000 21 0 Enrolled Post-High School 61 8 Information Only High School/GED Total Less than High School ASHLine enrollment numbers are higher among clients who have earned a post-high school education than those with just a high school/GED or less than high school education. Tobacco use prevalence is higher among those with a high school or less education, compared to those with a post-high school education. Future media and outreach should focus on low education and low-income populations. Page 15 of 30 ASHLine Annual Report, FY2014 ashline.org July 31, 2014 Arizona Smokers’ Helpline Language Table 13. Home Language Home Language 5 Primarily English 6 Primarily Spanish Figure 11. Home Language by Intake Enrolled Information Only Total 9,587 98 9,685 519 4 523 7 English and Spanish 8 Other 476 2 478 92 2 94 9 Refused 4 Missing 21 33 54 129 422 551 Total 10,824 561 11,385 Home Language 12,000 10,000 9,685 9,587 8,000 6,000 4,000 2,000 523 478 519 476 98 0 Enrolled Primarily English Page 16 of 30 ASHLine Annual Report, FY2014 4 2 Information Only Primarily Spanish Total English and Spanish ashline.org July 31, 2014 Arizona Smokers’ Helpline Table 14. Mode of Entry into ASHLine Mode of Entry Figure 12. Mode of Entry into ASHLine Enrolled Information Only Total 4 Call 5 QuitFax 7,275 481 7,756 3,549 80 3,629 Total 10,824 561 11,385 Mode of Entry QuitFax 32% Call 68% While most clients enter through the 1-800 number, ASHLine experienced a 12% increase in the percentage of clients entering via QuitFax in FY2014, a system designed to increase engagement of healthcare providers and community partners in making ASHLine referrals. Page 17 of 30 ASHLine Annual Report, FY2014 ashline.org July 31, 2014 Arizona Smokers’ Helpline Table 15. How Clients Heard about ASHLine How did you hear about ASHLine? 6 Survey Team 8 Work 9 Website 10 TV 12 Radio 13 Newspaper 15 County Health Department (Local Project) 16 Healthcare facility Enrolled Information Only Total 810 23 833 173 2 175 298 12 310 3,156 246 3,402 245 6 251 11 1 12 59 0 59 809 20 829 17 Health Insurance 18 Former Client 104 8 112 589 15 604 19 Brochures (Flyers) 20 Family or Friends 118 6 124 1,024 21 1,045 2,540 118 2,658 21 Doctor 22 Dentist 39 3 42 23 Community Organization 24 Church 253 4 257 3 3 6 Social Service Agency 0 0 0 11 Regional Behavioral Health Authority 14 My School 16 0 16 2 0 2 25 My Child's School 7 Pharmacist 2 0 2 7 1 8 5 Call It Quits App CIGnal 2 0 2 0 0 0 If other source, please describe 0 0 0 26 Unknown 4 Missing 148 11 159 416 61 Total 10,824 561 477 11,385 While television advertising reaches a larger number of clients who eventually enroll in ASHLine, these data also show an important role of physicians in advocating tobacco cessation. Page 18 of 30 ASHLine Annual Report, FY2014 ashline.org Arizona Smokers’ Helpline July 31, 2014 Table 16. How Clients Heard about ASHLine, collapsed groups How did you hear about ASHLine? Enrolled 4 Community Organizations 5 Family or Friends 6 Former Client 7 Healthcare Provider 8 Media 9 Other Information Only Total 315 7 322 1,024 21 1,045 589 15 604 3,515 150 3,665 3,830 271 4,101 1,551 97 1,648 Figure 13. How Clients Heard about ASHLine, collapsed groups Media 3,830 271 3,515 Healthcare Provider 150 1,551 Other 97 1,024 Family or Friends 21 589 Former Client 15 315 Community Organizations 7 0 500 1000 1500 Enrolled Page 19 of 30 2000 2500 3000 3500 Information Only ASHLine Annual Report, FY2014 4000 4500 The media campaigns and referral systems generate the most enrollments. ASHLine can increase enrollments from other sources by expanding community partnership. ashline.org July 31, 2014 Arizona Smokers’ Helpline Cigarettes Smoked Daily Average Table 17. Average Number of Cigarettes per Day Month Figure 14. Average Number of Cigarettes per Day for ASHLine Enrollees Avg Cigs/Day 12 Jul-13 17.51 11 Aug-13 17.54 10 Sep-13 16.80 9 Oct-13 17.34 8 Nov-13 17.79 7 Dec-13 17.01 6 Jan-14 16.30 5 Feb-14 16.62 4 Mar-14 16.39 3 Apr-14 16.23 2 May-14 16.67 1 Jun-14 17.85 Page 20 of 30 Average Cigarettes per Day for ASHLine Enrollees 25.00 20.00 15.00 17.51 17.34 17.54 16.80 17.01 17.79 16.62 16.30 17.85 16.23 16.39 16.67 10.00 5.00 0.00 ASHLine Annual Report, FY2014 ashline.org July 31, 2014 Arizona Smokers’ Helpline Insurance Table 18. Insurance Status of ASHLine Enrollees Insurance Enrolled 4 AHCCCS 5 None 2,716 6 Other 7 Unknown 4,935 Total Figure 15. Insurance Status of ASHLine Enrollees 3,075 Insurance Status of ASHLine Enrollees Other 46% AHCCCS 25% 98 10,824 None 29% In FY2014 almost 30% of ASHLine clients reported they did not have health insurance. With expanded enrollment through the Affordable Care Act we Page 21 of 30 ASHLine Annual Report, FY2014 ashline.org July 31, 2014 Arizona Smokers’ Helpline Table 19. AHCCCS Insurance Plans of ASHLine Enrollees AHCCCS Insurance Enrolled 24 AZ Physicians-IPA (APIPA) 15 Bridgeway - Acute & LTC 163 7 Care1st Health Plan Arizona, Inc. 14 CMDP (DES Comprehensive Medical and Dental Program) 122 Cochise Health Systems 9 CRS – UnitedHealthcare Community Plan 17 CRS – UnitedHealthcare Community Plan - Fully Integrated 16 CRS – UnitedHealthcare Community Plan - Partial Acute 21 1 0 30 4 3 Department of Development Disabilities - Capstone Health Plan 0 Department of Development Disabilities - RX America 0 6 Evercare Select 5 Health Choice Arizona 13 Health Net of Arizona 23 Maricopa Health Plan 4 Mercy Care Plan 11 Mercy Care Plan – Acute 10 Mercy Care Plan – LTC 22 Phoenix Health Plan-010299 (PHP) 3 378 32 142 580 16 3 180 21 Pima Health System Pinal/Gila 1 20 SCAN-LTC (Senior Care Action Network - Long Term Care) 8 UnitedHealthcare Community Plan 2 12 UnitedHealthcare Community Plan - Acute UnitedHealthcare Community Plan - LTC 19 University Family Care (UFC) Yavapai Co LTC 25 No Response/Refused Not Applicable 18 Not Sure Total Page 22 of 30 0 319 8 0 204 0 6 0 498 2,716 ASHLine Annual Report, FY2014 ashline.org July 31, 2014 Arizona Smokers’ Helpline Coaching Table 20. Clients Reached for Coaching 68 Figure 16. Clients Reached for Coaching 69 Count 5 At Least 1 Coaching Call 4 Unable to Reach Total Reached for Coaching 8,514 2,197 10,711 Unable to Reach 21% At Least 1 Coaching Call 79% or including alternate contact numbers will increase the number of clients who can be reached. Page 23 of 30 ASHLine Annual Report, FY2014 ashline.org July 31, 2014 Arizona Smokers’ Helpline Medication Table 21. Clients Who Used Medications During Quit 68 Figure 17. Clients Who Used Medications During Quit 72 Count 5 Used Medications 4 Did Not Use Medications Total 3,761 2,465 6,226 Medication Use Did Not Use Medications 40% Used Medications 60% Evidence shows clients who use medication and coaching have the highest quit rate. ASHLine is currently looking into ways to increase medication access for tobacco users trying to quit who request medication. Page 24 of 30 ASHLine Annual Report, FY2014 ashline.org July 31, 2014 Arizona Smokers’ Helpline Figure 18. 7-Month Quit Rates for ASHLine Enrollees Quit Rate Measured at 7 Months Post Program Enrollement 50% 40% % Quit 39% 37% 33% 30% 20% 10% 0% Abstinence 7-Day Point Prevalence 30-Day Point Prevalence The three quit rates reported continue to be higher than those reported by other quitlines across the U.S. Page 25 of 30 ASHLine Annual Report, FY2014 ashline.org July 31, 2014 Arizona Smokers’ Helpline Figure 19. Quit Rate Comparison between FY2013 and FY2014 Quit Rate Comparison Between FY2013 and FY2014 (7 Month Post-Program Enrollment) 50% 40% 30% 33% 39% 33% 37% 30% 27% 20% 10% 0% Abstinence 7-Day Point Prevalence FY2013 7-Month 30-Day Point Prevalence FY2014 7-Month coaching among those who did use ASHLine services. Page 26 of 30 ASHLine Annual Report, FY2014 ashline.org July 31, 2014 Arizona Smokers’ Helpline Table 22. Eligible Clients Who Enrolled in ASHLine Quit Tobacco Medication Program Eligible Clients who Enrolled in ASHLine Quit Tobacco Medication Program 5 No 6 Yes Total Count 817 3,623 4,440 Figure 20. Eligible Clients Who Enrolled in ASHLine Quit Tobacco Medication Program Eligible Clients who Enrolled in ASHLine Quit Tobacco Medication Program No 18% Yes 82% Page 27 of 30 ASHLine Annual Report, FY2014 ashline.org July 31, 2014 Arizona Smokers’ Helpline Table 23. Received Quit Tobacco Medication Received Quit Tobacco Medication 5 No 6 Yes Total Figure 21. Received Quit Tobacco Medication Count Received Quit Tobacco Medication 113 3,492 No 3% 3,605 Yes 97% Page 28 of 30 ASHLine Annual Report, FY2014 ashline.org July 31, 2014 Arizona Smokers’ Helpline Table 24. Importance of Access to Coaching in Decision to Quit How important was the offer of quit coaching in your decision to quit tobacco? 7 Very Important 8 Moderately Important 9 Unimportant 10 Don't Know Total Figure 22. Importance of Access to Coaching in Decision to Quit How important was the offer of coaching in your decision to quit? Count 2,337 2,107 2,500 591 328 2,337 2,107 2,000 5,363 1,500 1,000 591 500 328 0 Very Important Page 29 of 30 ASHLine Annual Report, FY2014 Moderately Important Unimportant Don't Know ashline.org July 31, 2014 Arizona Smokers’ Helpline Table 25. Coaching was Helpful in Efforts to Quit How helpful was coaching in your efforts to quit tobacco? 7 Very Helpful 8 Somewhat Helpful Figure 23. Coaching was Helpful in Efforts to Quit How helpful was coaching in your efforts to quit? Count 2,674 1,356 9 Not Helpful 10 I didn't receive any coaching 452 11 I don't know Total 132 743 5,357 3,000 2,674 2,500 2,000 1,356 1,500 1,000 452 500 132 0 Very Helpful Somewhat Helpful Not Helpful I don't know Coaching continues to play a central role in quit success. Page 30 of 30 ASHLine Annual Report, FY2014 ashline.org