California Smoker`s Helpline and CPCA Clinics October 12, 2011

California Smoker’s Helpline and
CPCA Clinics
October 12, 2011
Kirsten Hansen
Center for Tobacco Cessation
Kristin Harms
California Smokers’ Helpline
Overview
 Smoking Prevalence
 Smokers and Quit Attempts
 Guidelines and Measures
 California Smokers’ Helpline Services
 Center for Tobacco Cessation Services
Who Smokes?
 California adult smoking prevalence is 11.9%
~ 4 million smokers
• Low socio-economic status – 19.2%
Race/Ethnicity
Men
Women
African American
18.4%
14.9%
Hispanic
16.8%
6.2%
White
13.3%
11.2%
Asian/Pacific Islander
8.4%
4.0%
California Department of Public Health, California Tobacco Control Program, April 2011
Smokers with Behavioral Health Disorders
 Rates of smoking are 2-4 times higher than
among the general population¹
 About 41% of people with mental illness smoke²
 60% of current smokers report having had a
mental health diagnosis sometime in their
lifetime¹
1. Kalman, 2005 2. Lasser, 2000, 3. Breslau, 2003
Smokers & Quit Attempts
 The majority of smokers want to quit1
• 48% intend to quit in the next 6 months or
sooner
 The majority of those who try do so
without assistance1
 It takes, on average, 12-14 attempts to
quit successfully2
1. California Adult Tobacco Survey, 2008
2. Zhu (Sept., 2007) Oceania Tobacco Control Conference, Auckland, NZ
Clinical Practice Guidelines
 Comprehensive, evidence-based
approach for smoking cessation
 Updated version released in 2008 by
the U.S. Public Health Service
 Systematic approach to tobacco for all
health care facilities
The Team Approach
Ask:
Systematically identify all tobacco users at every visit
Advise:
Assess:
Advise smokers to quit
Assess each smoker’s willingness to quit
Refer
to the California
Smokers’ Helpline
Assist:
Assist smokers with a quit plan
Arrange:
Arrange follow-up contact
The Helpline provides behavior
modification counseling (quit
plan and quit date)
The Helpline provides 5 followup calls – timing is based on the
probability of relapse.
HRSA 2011 UDS Clinical Measures
 Four new measures added:
• Tobacco use assessment and cessation
counseling pair
• Weight assessment and counseling for children and
adolescents
• Adult weight screening and follow-up
• Asthma – pharmacological treatment
 Two existing measures modified:
• Vaccines for children updated to current standards
• Hemoglobin A1C goals for diabetics expanded
8
UDS Quality of Care Measures
 Tobacco use assessment
• IF patients are routinely queried about their tobacco
use (including smokeless tobacco) THEN providers will
be able to intervene more quickly and effectively and
reduce the incidence of cancer, asthma, emphysema,
and other tobacco related illnesses
 Tobacco use intervention
• IF tobacco users are provided with an effective mix of
counseling and pharmacologic intervention THEN
tobacco users will be more likely to quit smoking and
will therefore have a lower incidence of cancer, asthma,
emphysema, and other tobacco related illnesses
Tobacco Measure #1: ASK
 Percent of patients in universe queried about
tobacco use in the measurement year or the
prior year.
• Requires documentation that provider or
support staff asked patient if they used
tobacco and the patient’s response.
For more information:
http://bphc.hrsa.gov/healthcenterdatastatistics/reporting/video/index.html
Tobacco Measure #2:
ADVISE and REFER
 Percent of universe of known tobacco users
who received tobacco use intervention during
the measurement year or the prior year
• Requires documentation that provider (or
appropriate support staff):
 Provided tobacco cessation counseling and/or
 Provided pharmacological intervention – i.e., a
prescription was written or a drug dispensed
CMS & Meaningful Use
 To qualify for federal incentive payments
under the American Recovery and
Reinvestment Act (ARRA), provider must
demonstrate “meaningful use” of an
Electronic Health Record system.
 Meaningful use is demonstrated by a set of
criteria established in the federal regulations,
which are broken into “core” and “menu”
objectives.
Meaningful Use – Core Objective
 Record smoking status for patients 13
years of age or older
Meaningful Use – Menu Objective
 Preventive Care and Screening Measure
Pair:
• Tobacco use assessment for patients aged
18 years and older
• Tobacco cessation intervention for patients
aged 18 years and older identified as
tobacco users
HRSA, CMS and the Helpline
 Referral to a quitline, such as the
Helpline, meets the definition of
“tobacco cessation counseling” and
“tobacco cessation intervention”
California Smokers’ Helpline
 A free, statewide, telephone-based tobacco cessation
program
 Established in 1992 by UCSD researchers
 Funded by Propositions 99 & 10
 Experimentally validated behavioral counseling
protocols
 Proven to double a smoker’s chance of success
 Open Monday – Friday 7:00am – 9:00pm, Saturday
9:00am – 1:00pm
 Has served over 500,000 Californians
 6 languages
Populations Served
 Adults




• English
• Spanish
• Chinese (Mandarin and Cantonese)
• Korean
• Vietnamese
Teens
Pregnant/nursing women
Chew/spit tobacco users
Non-tobacco using clients (proxy)
Helpline Services




Self-help materials
Referral to local cessation programs
Web site: www.nobutts.org
Individual telephone counseling
• Delivered by trained counseling staff
• Individualized
• Consists of an initial session and up to 5 follow-up
sessions with the same counselor
• Proactive
What Happens in Each Call?
 Initial session (30 to 40 minutes)
• Build self-confidence
• Create individualized plan
• Motivate quit attempts
 Up to 5 follow-up sessions with same
counselor (10 minutes each)
• Convey support and accountability
• Help prevent relapse
100
Relapse-Sensitive Scheduling
Percent abstinent
80
60
40
20
0
01 3
7
14
Days after quitting
30
Zhu & Pierce (1995), Prof. Psych. Res.& Practice, 26, 624-625
Helpline Intervention Summary
 Motivation: Identify a strong reason
 Confidence: Bolster belief in ability
 Skills: Develop a solid plan
 Self-Image: Adopt a new view of self
 Perseverance: Keep trying
A Randomized,
Controlled Trial
Follow-Up Evaluation
Multiple
Counseling
Motivate
smokers
to call
Single
Counseling
Self-Help
3
Zhu et al. (1996), JCCP, 64, 202-211
6
Months
12
Abstinence by Group
100
Multiple Counseling
Single Counseling
Self-Help
Percent abstinent
80
60
40
20
0
0
30
60
90 120 150 180 210 240 270 300 330 360
Days after quitting
Zhu et al. (1996), JCCP, 64, 202-211
Benefits of Telephone Counseling
for Smokers
 Easy access
 Convenient
• No childcare arrangements
• No transportation challenges
 Semi-anonymity
 Individualized treatment
Zhu et al. (1996), J. Couns. and Development, 75, 93-102
2010 Helpline Caller Demographic Profile
Age
Education
K-12 or less
HS diploma
Some college
Graduate
Gender
Female
Male
24% 13 or younger
28% 14-17
44% 18-24
<1%
<1%
6%
2% 25-44
33%
45-64
48%
54% 65+
46%
5%
2010 Helpline Caller Demographic Profile
Ethnicity
White
African-American
Hispanic/Latino
Multi-racial
Asian/Pacific Islander
American Indian
Other
1. 2007 California Health Interview Survey
Helpline
Callers
54%
16%
14%
8%
3%
2%
3%
Smoking & Chronic Disease
Has High
Blood
Pressure
Has Had a
Heart
Attack
Has Had a
Stroke
Has Diabetes
% of
Helpline
Callers1
30.6%
5.0%
5.0%
12.0%
% of CA
Daily
Smokers2
23.2%
5.0%
16.7%
5.9%
1. California Smokers’ Helpline 2009
2. California Health Information Survey 2007
2010 Helpline Caller Demographic Profile
Heard About
Insurance Status
Health Care Provider
48% Public insurance
62%
Media
30% Private insurance 12%
Family/Friend
11% No insurance
Other
11%
26%
2010 Health Care Provider Referrals
Clinic/Drs. Office
Hospital
Pharmacy
Health Ins.
Helpline Referral Options
 For smokers who want to be contacted by
the Helpline:
• Two-way call
• Fax referral
• Electronic referral
 For smokers who prefer to contact the
Helpline:
• Gold Card
• Regale Salud Card
• Brochures
Free Helpline Materials
Order free materials at www.nobutts.org
Center for Tobacco Cessation
 Provide trainings and technical assistance to
increase capacity for tobacco cessation
 Services include:
• Trainings (webinars and in-person)
• Information and materials
• Technical assistance
For more information:
www.CenterForCessation.org
Center for Tobacco Cessation
 Provide trainings and technical assistance to
increase capacity for tobacco cessation
 Services include:
• Trainings (webinars and in-person)
• Information and materials
• Technical assistance
For more information:
www.CenterForCessation.org
Contact Information
Kristin Harms
kharms@ucsd.edu
858-300-1011
www.nobutts.org
Kirsten Hansen
k3hansen@ucsd.edu
858-300-1012
www.centerforcessation.org
Thank You!
Please take our short survey:
Http://www.surveymonkey.com/s/S85XP8P