Iowa Tobacco Cessation Program Evaluation …...Evaluation Iowa Tobacco Cessation Program : FY2010...

Iowa Tobacco Cessation Program Evaluation Annual Report: FY2010

Division of Tobacco Use Prevention and Control

Prepared by:

Center for Social and Behavioral Research

University of Northern Iowa

[Space Left Blank Intentionally]

Iowa Tobacco

Cessation Program

Evaluation:

FY2010

Prepared by

Disa L. Cornish

Gene M. Lutz

Center for Social and Behavioral Research

University of Northern Iowa

Prepared for

Iowa Department of Public Health

Division of Tobacco Use Prevention and Control

August 2010

ii

TUPC Mission Statement:

To establish a comprehensive partnership among state government, local

communities, and the people of Iowa to foster a social and legal climate in which

tobacco use becomes undesirable and unacceptable.

CSBR Mission Statement:

The Center for Social and Behavioral Research (CSBR) at the University of

Northern Iowa will be a leading academic organization dedicated to advancing,

applying and facilitating high standards of social and behavioral research practice

for a wide variety of audiences within the university and across community, state

and national arenas.

For further information, contact: Bonnie E. Mapes, Division Director, Tobacco Use Prevention and Control Iowa Department of Public Health, Lucas State Office Building 321 East 12th Street, Des Moines, IA 50319-0075 515-281-6225; [email protected] Disa L. Cornish, Program Evaluator, Center for Social and Behavioral Research University of Northern Iowa, 2304 College Street, Cedar Falls, IA 50614-0402 319-273-2105; [email protected]

The authors would like to acknowledge the contributions of staff members at the

Center for Social and Behavioral Research who assisted with aspects of data

collection, data management, questionnaire development, data analysis, and report

preparation: Mel Gonnerman, Thomas Turner, Mary Jane Crew, Rod Muilenburg,

Karen Dietzenbach, Nadia Kamanzi, Maria Koeppel, Drew Hage, Zach Chase, and

Tom Dirth.

iii

List of Tables ..................................................................................................................................v

List of Figures .............................................................................................................................. vii

I. Executive Summary .................................................................................................................1

II. Introduction ..............................................................................................................................3

III. Methodology (Evaluation Plan) ..............................................................................................5

Research Questions ..............................................................................................................5

Study Design ........................................................................................................................5

Data Sources ........................................................................................................................5

Defining Tobacco Use and Cessation ..................................................................................7

Report Notes ........................................................................................................................7

Protocol Changes .................................................................................................................7

IV. Main Findings: Follow-Up Interviews ...................................................................................9

Highlights .............................................................................................................................9

Response Rates ..................................................................................................................11

Demographic Characteristics .............................................................................................12

Tobacco Product Use and Cessation ..................................................................................15

Cigarette Smoking Cessation Rates by Demographic Characteristics ..............................18

Changes in Cigarette Smoking Behavior ...........................................................................21

Smokeless Tobacco Use ....................................................................................................24

Perceptions of Personal Tobacco Use ................................................................................29

Future Tobacco and Pharmacotherapy Use .......................................................................30

Motivation to Quit Using Tobacco ....................................................................................33

Deciding to Smoke .............................................................................................................35

Temptation to Smoke .........................................................................................................39

Challenges to Quitting Successfully ..................................................................................41

Attitudes and Beliefs ..........................................................................................................43

Quitline Program Usage .....................................................................................................44

Aspects of Quitline Coaching Experience .........................................................................46

Clinic Cessation Program Usage .......................................................................................49

Program Satisfaction ..........................................................................................................54

Previous Cessation Attempts .............................................................................................58

Low-Income Cigarette Smokers ........................................................................................61

Medicaid and Cessation .....................................................................................................62

V. Main Findings: Other Data Collection Methods .................................................................63

Highlights ...........................................................................................................................63

Secret Shopper Calls ..........................................................................................................65

Chart Reviews ....................................................................................................................66

Table of Contents

iv

VI. Summary and Conclusions ...................................................................................................69

Appendix A: Quitline Follow-Up Questionnaire ......................................................................73

Appendix B: Quitline Follow-Up Frequency Tables ................................................................91

Appendix C: Clinic Program Follow-Up Questionnaire ........................................................139

Appendix D: Clinic Program Follow-Up Frequency Tables..................................................153

Appendix E: Baseline and Overall Follow-Up Comparisons .................................................201

Appendix F: Cessation Rates by County .................................................................................207

Appendix G: FY2011 New Quitline Follow-Up Questionnaire .............................................213

v

Table 1: Quitline follow-up interview response rates ....................................................................11

Table 2: Clinic cessation follow-up interview response rates .......................................................11

Table 3: Quitline follow-up demographic characteristics ..............................................................13

Table 4: Clinic cessation follow-up demographic characteristics .................................................14

Table 5: Quitline respondents’ tobacco use from baseline to follow-up .......................................15

Table 6: Clinic cessation respondents’ tobacco use from baseline to follow-up ...........................16

Table 7: Quitline respondents’ tobacco cessation rates .................................................................17

Table 8: Clinic cessation respondents’ tobacco cessation rates .....................................................17

Table 9: Quitline respondents’ mean number of cigarettes per day ..............................................21

Table 10: Clinic respondents’ mean number of cigarettes per day ................................................21

Table 11: Quitline secret shopper calls ..........................................................................................65

Table 12: Clinic chart review demographic characteristics ...........................................................66

List of Tables

vi


vii

Figure 1: Smoking cessation rates across demographic characteristics, Quitline respondents ......19

Figure 2: Smoking cessation rates across demographic characteristics, clinic respondents ..........20

Figure 3: Number of cigarettes smoked per day, Quitline respondents .........................................22

Figure 4: Number of cigarettes smoked per day, clinic respondents .............................................22

Figure 5: Time before smoking first cigarette of the day, Quitline respondents ...........................23

Figure 6: Time before smoking first cigarette of the day, clinic respondents ...............................23

Figure 7: Tobacco use among Quitline respondents reporting a change in type of

product used from baseline to follow-up ................................................................................25

Figure 8: Tobacco use among clinic respondents reporting a change in type

of product used from baseline to follow-up ...........................................................................25

Figure 9: Change in use of cigarettes and SLT, Quitline respondents ...........................................26

Figure 10: Change in use of cigarettes and SLT, clinic respondents .............................................26

Figure 11: Changes in product use among users of cigarettes and SLT, Quitline respondents .....27

Figure 12: Changes in product use among users of cigarettes and SLT, clinic respondents .........28

Figure 13: Perception of changes in cigarette use, Quitline respondents ......................................29

Figure 14: Perception of changes in cigarette use, clinic respondents ..........................................29

Figure 15: Comparison of quit and not quit respondents on future use of tobacco and

pharmacotherapies ..................................................................................................................32

Figure 16: Perception of future tobacco use, Quitline respondents ...............................................30

Figure 17: Perception of future tobacco use, clinic respondents ...................................................30

Figure 18: Perception of future pharmacotherapy use, Quitline respondents ................................31

Figure 19: Perception of future pharmacotherapy use, clinic respondents ....................................31

List of Figures

viii

Figure 20: Motivation for quitting smoking, Quitline respondents ...............................................33

Figure 21: Motivation for quitting smoking, clinic respondents ...................................................34

Figure 22: Factors affecting the decision to smoke, Quitline respondents ....................................35

Figure 23: Factors affecting the decision to smoke, clinic respondents ........................................36

Figure 24: Enjoyable aspects of smoking, Quitline respondents ...................................................37

Figure 25: Enjoyable aspects of smoking, clinic respondents .......................................................38

Figure 26: Temptation to smoke, Quitline respondents .................................................................39

Figure 27: Temptation to smoke, clinic respondents .....................................................................40

Figure 28: Challenges to quitting, Quitline respondents ...............................................................41

Figure 29: Challenges to quitting, clinic respondents ....................................................................42

Figure 30: Beliefs about NRT, Quitline respondents.....................................................................43

Figure 31: Beliefs about NRT, clinic respondents .........................................................................43

Figure 32: Distribution of the number of respondents’ Quitline contacts .....................................44

Figure 33: Type of NRT received from Quitline Iowa ..................................................................45

Figure 34: Type of NRT received from Quitline Iowa, among those who received any NRT .....45

Figure 35: Elements of the Quitline coaching experience .............................................................46

Figure 36: Perceptions of quitting, cessation supports, and Quitline ............................................48

Figure 37: Types of counseling received by clinic program respondents (FY10) ........................50

Figure 38: Types of counseling received by clinic program respondents (Prior to FY10) ...........50

Figure 39: Distribution of number of times clinic respondents received

individual counseling ...............................................................................................................51


group counseling ......................................................................................................................51


Quitline Iowa counseling .........................................................................................................51

Figure 42: Distribution of number of times clinic respondents received NRT patches .................52

ix

Figure 43: Distribution of number of times clinic respondents received Chantix .........................53

Figure 44: Distribution of number of times clinic respondents received Wellbutrin ....................53

Figure 45: Perception of amount of NRT received among Quitline respondents..........................54

Figure 46: Perception of amount of NRT received among clinic respondents ..............................54

Figure 47: Perception of amount of counseling received among Quitline respondents ................55

Figure 48: Perception of amount of counseling received among clinic respondents ....................55

Figure 49: Likelihood of recommending Quitline services to others ............................................56

Figure 50: Likelihood of recommending clinic program services to others ..................................56

Figure 51: General satisfaction with Quitline services ..................................................................57

Figure 52: General satisfaction with clinic cessation program services ........................................57

Figure 53: Number of quit attempts during follow-up period among Quitline respondents .........58

Figure 54: Number of quit attempts during follow-up period among clinic respondents .............58

Figure 55: Use of pharmacotherapy during follow-up period among Quitline respondents .........59

Figure 56: Use of pharmacotherapy during follow-up period among clinic respondents .............59

Figure 57: Quit strategies used during follow-up period by Quitline respondents ........................60

Figure 58: Quit strategies used during follow-up period by clinic respondents ............................60

Figure 59: Any cigarette use in the past 30 days at baseline and follow-up,

Quitline respondents ................................................................................................................61

Figure 60: Any cigarette use in the past 30 days at baseline and follow-up,

clinic respondents.....................................................................................................................61

Figure 61: Cessation rates among Medicaid callers to Quitline Iowa ...........................................62

Figure 62: Percent of clinic visits at which smoking was recorded ...............................................67

x


1

PURPOSE AND METHODOLOGY

This report presents findings for the fiscal year 2010 (FY10) and cumulative findings for FY08,

FY09, and FY10 combined of the Tobacco Use Prevention and Control Program Evaluation

conducted by the Center for Social and Behavioral Research (CSBR) at the University of

Northern Iowa (UNI). Since 2008, this ongoing evaluation has assessed the Quitline Iowa and

the Iowa/Nebraska Primary Care Association (IA/NEPCA) clinic cessation programs that offer

counseling and limited pharmacotherapies at no cost to the participant. Quitline Iowa offers

telephone-based cessation counseling services as well as two weeks of free nicotine replacement

patches, gum, or lozenges. A program based in federally qualified health centers offers free

pharmacotherapy and accompanying cessation counseling to Iowa patients. The evaluation uses

three sources of data consisting of follow-up interviews with participants, secret shopper calls,

and medical chart reviews. Follow-up interviews are conducted at 3, 6, and 12 months after

program entry. Evaluation respondents are asked questions about their tobacco use when they

first called Quitline or entered the clinic program (referred to as “baseline” data) and about their

tobacco use at the time of the follow-up interview. Baseline data are retrospective and are

collected during the same interview as follow-up data.

MAIN FINDINGS (FOLLOW-UP INTERVIEWS)

Most Quitline and clinic respondents said they were smoking cigarettes at baseline, while 5% or

less of respondents said they used cigars, pipes, or smokeless tobacco. Use of all products

decreased from baseline to follow-up. In the Quitline sample, cigarette smoking cessation rates

in all three follow-up cohorts (3, 6, and 12 months) were approximately 20%. In the clinic

sample, cessation rates in all three cohorts ranged from 26% to 29%. In both the Quitline and

clinic samples, respondents who smoked cigarettes at baseline did not increase their use of

smokeless tobacco from baseline to follow-up.

The majority of respondents in both the Quitline Iowa and the clinic cessation samples who

smoked cigarettes at program entry reported their cigarette intake to be less at follow-up than at

baseline. However, most said it was likely that they would use tobacco products at some point

during the next year, in part because most respondents had not entirely quit using all tobacco.

Over half of all respondents in both the Quitline and the clinic cessation samples said it was

likely they would use pharmacotherapy products (nicotine replacement therapies or medications)

in the next year. Participants in both samples who had quit smoking were a) less likely than their

counterparts who had not quit to say they would use tobacco in the next year, and b) more likely

to think they would use pharmacotherapy in the next year.

In both program samples, the majority of respondents who were cigarette smokers at baseline

cited health reasons as a motivation for quitting. A greater percent of clinic respondents than

Executive Summary

2

Quitline respondents were satisfied with the amount of NRT they received from the program.

Quitline respondents and clinic respondents reported similar satisfaction with the amount of

counseling they received. Most participants in both program samples were generally satisfied

with the programs and would recommend program services to others trying to quit using tobacco

products.

During the follow-up period, Chantix was the most commonly used form of pharmacotherapy

among Quitline and clinic respondents. This was reported despite the fact that Quitline does not

offer Chantix to callers. Rather, Quitline respondents who used Chantix during the follow-up

period were most likely to be Medicaid clients who were receiving Chantix and Quitline

counseling as part of their Medicaid benefit. The method or strategy most commonly used by

respondents to quit using tobacco during the follow-up period was to gradually reduce their

consumption (“tapering down”).

MAIN FINDINGS (OTHER METHODS)

During the 2010 fiscal year, 153 secret shopper calls were placed to Quitline Iowa. Provider

protocol was found to be followed throughout most of these calls; e.g., consent to be contacted

for participation in the evaluation was asked in 82% of calls. During FY10, CSBR research staff

reviewed 907 charts at clinics (458 participant and 449 non-participant charts). Smoking status

was recorded to have been assessed at 94% of clinic visits among all charts reviewed.

SUMMARY AND CONCLUSIONS

The vast majority of participants in the Quitline Iowa and clinic cessation programs are trying to

quit smoking cigarettes rather than stop using other tobacco products. Results from the follow-up

interviews conducted with program participants suggest that cessation rates at 3, 6, and 12

months post intervention are approximately 20% among Quitline respondents and approximately

28% among clinic respondents. Individuals surveyed 3 months after they started one of the

programs said they quit smoking at a rate comparable to individuals surveyed at 6 and 12 months

after they start one of the programs; hence, the cessation rates remain relatively constant across

time. Secret shopper calls conducted with Quitline Iowa suggest that provider protocol is being

followed in the majority of calls. Chart review data show that tobacco use status was assessed at

93% of clinic visits among both participants and non-participants of the clinic cessation program

during FY2010. Nearly one-fourth (23%) of program participant charts documented that the

participant had quit smoking or using tobacco in the past six months.

The Quitline and clinic cessation programs are effectively supporting Iowans who want to quit

using tobacco products, particularly cigarettes. With a cigarette smoking cessation rate of

approximately 20-30% even one year after beginning a treatment program, it is clear that the

state-funded tobacco cessation programs are positively impacting smokers in Iowa. Findings

from follow-up interviews and chart reviews provide a similar picture of this positive impact.

3

The Iowa Department of Public Health (IDPH) Division of Tobacco Use Prevention and Control

(Tobacco Division) implements comprehensive tobacco control programming for the state.

Important strides in policy change have been made in the state, including a 2007 tax increase of

$1.00 to $1.36 per pack and the passage of a statewide Smokefree Air Act in 2008. In addition to

supporting policy changes, mass media messaging, and community-level interventions, the

Tobacco Division offers tobacco cessation services for Iowans.

Two state-funded cessation programs are offered to Iowans. Quitline Iowa (operated by National

Jewish Health in Denver, CO) offers telephone-based cessation counseling services as well as

two weeks of free nicotine replacement patches, gum, or lozenges. A program based in federally

qualified health centers offers free pharmacotherapy and accompanying cessation counseling to

Iowa patients in the Iowa/Nebraska Primary Care Association (IA/NEPCA). Patients of this

program (referred to as the “clinic” program) who use any pharmacotherapy other than the

medication Chantix are eligible for up to 12 weeks of pharmacotherapy plus counseling. Patients

taking Chantix who complete 12 continuous weeks of treatment may be eligible for an additional

12 weeks of pharmacotherapy plus counseling. These health centers are working to bring

cessation services to low-income Iowans and simultaneously to improve tobacco screening

protocols in the clinics. In addition, Iowa Medicaid includes tobacco cessation as a covered

benefit; Medicaid patients are required to receive Quitline counseling to receive

pharmacotherapies (such as Chantix and nicotine replacement patches or gum, among others) to

support tobacco cessation.

The Tobacco Division contracts with the University of Northern Iowa (UNI) Center for Social

and Behavioral Research (CSBR) to evaluate Quitline Iowa and the clinic program. The purpose

of this report is to present the findings of the fiscal year 2010 (FY10) Tobacco Cessation

Program Evaluation conducted by CSBR, and cumulative findings beginning with FY08. This is

the third such report created by CSBR and the second year of the evaluation. The primary goals

of the evaluation are: 1) to assess tobacco quit rates among participants of Quitline Iowa and the

clinic-based program; and 2) to assess client satisfaction, program consistency, and systems

change.

Introduction

4


5

Research Questions

The following research questions were developed to guide the evaluation activities.

Do the services offered by Quitline Iowa and the clinic program achieve acceptable rates

of tobacco cessation for those receiving the services?

Processes:

What are the behavioral and demographic characteristics of program

participants?

What are the rates of client satisfaction?

How is program participation characterized?

What contextual factors may be influencing results?

What is the degree of program fidelity?

Outcomes:

What are the quit rates of program participants?

What is the rate of tobacco use screening in healthcare settings? (the clinic

program)

Study Design

The study design is quasi-experimental with multiple post-tests. The evaluation includes both

process and outcome measures. Some elements are similar for both programs and others are

unique to each program. All evaluation activities were approved by the UNI Institutional Review

Board (IRB) for human research subjects protections.

Data Sources

Client Follow-Up Interviews

The primary purpose of the follow-up interviews is to assess changes in tobacco use (including

behavioral changes such as quit rates or reductions), program utilization, and program

satisfaction. Follow-up interviews are conducted only with consent of program participants. On a

monthly basis, NJH and IA/NEPCA provide CSBR with names and contact information of new

clients (enrolled in the prior month) who have actively consented to be contacted for follow-up

interviews. These groups of clients form the samples from which CSBR selects independent,

random samples (“cohorts”) for 3-, 6-, and 12-month follow-up interviews conducted via

computer assisted telephone interviewing (CATI) technology (See Appendix A for the Quitline

questionnaire and Appendix C for the clinic questionnaire).

Methodology (Evaluation Plan)

6

Secret Shopper Calls

Quitline Iowa is evaluated for fidelity through “secret shopper” calls to the hotline. The purpose

of these calls is to evaluate the extent to which Quitline Iowa counselors consent all callers for

follow-up evaluation and provide counseling consistent with protocols. The secret shopper call

protocol was developed using the IDPH TUPC Request for Proposals (RFP) and the NJH intake

and coaching protocols as guides. The RFP outlined minimum service criteria for successful

proposals, and the NJH protocol provided specific strategies to meet those criteria. During the

secret shopper calls, trained CSBR interviewers use mock identities (with mock contact

information). These mock identities are purposively determined to represent various caller

profiles across the evaluation period. NJH is provided with information about these calls after

they occur so they can be omitted from the Quitline data system.

Chart Reviews

For the clinic program a random sample of client charts are reviewed each year. This review is

conducted by the Program Evaluator or other CSBR staff at the IA/NEPCA service provider sites

in Iowa that are implementing the tobacco cessation/treatment program. Using a chart review

form based on the information collected and entered into each clinic’s i2iTracks system, the

evaluator completes approximately 800 chart reviews per full fiscal year (400 in November, 400

in May).

The number of charts collected at each individual clinic is determined through a sampling design

in which the proportion of charts reviewed at each clinic reflects the proportion of program

participants served at that clinic. For example, if a community health center serves 18% of the

total sample of program participants, then approximately 18% of the 800 charts reviewed each

year will come from that community health center. Charts of both participating and non-

participating clients are reviewed (approximately 50% of the reviewed charts are in each group).

No identifying information or information protected through HIPAA guidelines is collected.

There is not an individual-level linkage between the chart review data and the follow-up data.

Conclusions based upon information gathered through the chart review process are generalizable

at the system or population level only but not at the clinic level.

Service Provider Reports

NJH and IA/NEPCA submit monthly, quarterly, and annual reports to IDPH-TUPC, with copies

sent to CSBR. The Center collects and consolidates these reports for review, with the goal of

tracking trends in program participation and comparing programmatic data with evaluation data.

7

Defining Tobacco Use and Cessation

In the Tobacco Cessation Program Evaluation, current use of a tobacco product is defined as

having used the product on any days in the past 30 days (at baseline or follow-up), frequent use

is defined as having used the product on 20 or more of the past 30 days (at baseline or follow-

up), and cessation is defined as having used the product on zero days in the past 30 days (at

follow-up).

Report Notes

In this report, findings are divided into two main sections: (a) findings from the follow-up

interviews and (b) findings from other data collection methods. Findings from the follow-up

interviews are further divided into nine sub-sections. The first eight present descriptive findings

from the 3-, 6-, and 12-month follow-up cohort samples. The ninth sub-section presents results

of analyses which compare low-income and higher-income respondents on several indicators.

Evaluation respondents were asked questions about their tobacco use when they first called

Quitline or entered a clinic program and about their tobacco use at the time of the follow-up

interview. Responses about tobacco use when respondents first entered the programs are referred

to as “baseline” information throughout the report. Baseline data are retrospective and are

collected during the same interview as follow-up data.

Finally, results presented in this report reflect aggregate findings of all data collected since the

beginning of the evaluation. Rather than representing only those findings for data collected in

FY10, this report presents a more complete view of the Quitline Iowa and clinic cessation

programs by including data from all three years.

Protocol Changes

During the later portion of FY2010, CSBR worked with IDPH TUPC to modify the Tobacco

Cessation Program Evaluation for FY11. The two primary changes are 1) use of a new follow-up

interview questionnaire and data management protocol, and 2) ending the evaluation of the

clinic-based tobacco cessation program through the IA/NEPCA health centers.

On July 1, 2010, the evaluation protocol will change to follow the guidelines of the CDC ARRA

funding through the Communities Putting Prevention to Work State and Territories Initiative

(CPPW). The protocol change includes implementing a new follow-up questionnaire, linking all

intake and follow-up data, and participation in the CDC quitline data warehouse project. The

new data collection instrument can be found in Appendix G.

An additional change to the evaluation protocol is the elimination of follow-up evaluation calls

to IA/NEPCA clients and chart reviews at IA/NEPCA health centers.

8


9

Highlights

Response rates in both the Quitline Iowa respondent sample and the IA/NEPCA clinic

cessation respondent sample ranged between 25% and 46% in the 3-, 6-, and 12-month

follow-up cohorts.

Among both Quitline Iowa and clinic cessation respondents, approximately two-thirds

were female and most were White and non-Hispanic. Over half of respondents in both

samples rated their health as good, very good, or excellent.

Among Quitline respondents, cessation rates for all three follow-up cohorts were

approximately 20%; among clinic respondents, cessation rates were between 25% and

30%.

At baseline, most Quitline and clinic respondents said they smoked cigarettes, whereas

6% or less of respondents said they used cigars, pipes, or smokeless tobacco. Use of all

tobacco products decreased from baseline to follow-up.

Cessation rates varied across demographic characteristics. Males, respondents who did

not live with a smoker, non-Hispanic respondents, those with household incomes greater

than $40,000 per year, and those who reported being in good health were more likely to

quit smoking.

Among both Quitline and clinic respondents, the vast majority who said they were

cigarette smokers at baseline did not supplement or replace their cigarette use with

smokeless tobacco from baseline to follow-up.

Among respondents in both programs, the majority said they smoked less at follow-up

than they had when they first called Quitline or entered the clinic program.

Respondents were asked whether they would use tobacco products in the next year and

whether they would use pharmacotherapy products in the next year. The majority of

respondents in both the Quitline Iowa and the clinic cessation samples said it was likely

that they would use tobacco products and that they would use pharmacotherapy at some

point during the next year, in part because the majority were still smoking. Among

Main Findings: Follow-Up Interviews

10

respondents who had quit, most said it was unlikely they would use tobacco in the future,

but one in five said they would need pharmaceutical support to remain tobacco-free.

The most common reason cited as a motivation to quit smoking among respondents in

both samples was that smoking is bad for one’s health. Approximately one-fourth of

respondents also cited cigarettes being too expensive as a motivating factor.

Consistent with the amount of services offered, most clinic respondents than Quitline

respondents were satisfied with the amount of NRT they received from the program.

Quitline respondents and clinic respondents reported similar satisfaction with the amount

of counseling received. Most participants in both samples were generally satisfied with

the programs and would recommend program services to others trying to quit using

tobacco products.

Among Quitline respondents, 4,529 individuals (76%) said they used some form of

pharmacotherapy during the follow-up period. Of these, 44% used the NRT patch and

37% used Chantix. Although Quitline does not provide Chantix to callers, Medicaid

clients enrolled in Quitline counseling may receive Chantix as part of their Medicaid

cessation benefit.

Among clinic respondents, 901 individuals (87%) said they used some form of

pharmacotherapy during the follow-up period. Of these individuals, 73% used Chantix

and 14% used the NRT patch.

Most respondents in both programs used a specific method or strategy to help them quit

using tobacco. The most commonly used method was “tapering down” the amount of

tobacco used.

Larger proportions of low-income respondents than higher-income respondents reported

smoking in the past 30 days. In the clinic sample, the differences in frequency of cigarette

smoking were statistically significant at the 3- and 12-month follow-up compared to

baseline.

Cessation rates among Medicaid referrals to Quitline Iowa were similar to those in the

larger population of respondents.

11

Response Rates

Follow-up interview response rates were higher among Quitline participants than among clinic

participants (Tables 1 and 2). Response rates declined over time in both samples.

Table 1: Quitline follow-up interview response rates

April 1, 2008 – June 30, 2010

Overall 3-month cohort 6-month cohort 12-month cohort

Working phone

numbers dialed 16,399 4,446 5,086 6,867

Completed

interviews 5,938 2,059 1,879 2,000

Response rate 36.2% 46.3% 36.9% 29.1%

Table 2: Clinic cessation follow-up interview response rates

May 1, 2008 – June 30, 2010

Overall 3-month cohort 6-month cohort 12-month cohort

Working phone

numbers dialed 3,282 912 1,026 1,344

Completed

interviews 1,039 352 352 335

Response rate 31.7% 38.6% 34.3% 24.9%

12

Demographic Characteristics

Among Quitline and clinic respondents, the majority were female (65% and 62%, respectively),

White (93% and 91%, respectively), and non-Hispanic (98% in both samples; see Tables 3 and

4). Approximately half of respondents in Quitline and the clinic program (55% and 48%,

respectively) reported an annual household income of less than $20,000.

Among respondents in both programs, the distributions of demographic characteristics were

similar in the 3-, 6-, and 12-month cohorts (see Tables 3 and 4).

13

Table 3: Quitline follow-up demographic characteristics

April 1, 2008 – June 30, 2010

Measure Overall 3-month 6-month 12-month

Age (mean) 44.3 (SD = 13.4) 43.4 (13.5) 44.1 (12.2) 45.5 (13.2) Number

(N)

Percent

(%)

N % N % N %

Gender

Male 2090 35.2 704 34.2 680 36.2 706 35.3

Female 3848 64.8 1355 65.8 1199 63.8 1294 64.7

Race

White 5494 93.2 1887 92.0 1742 93.4 1865 94.2

African American or

Black 212 3.6 87 4.2 63 3.4 62 3.1

Asian 13 0.2 3 0.1 7 0.4 3 0.2

American Indian or

Alaskan Native 92 1.6 41 2.0 27 1.4 24 1.2

Native Hawaiian or

Pacific Islander 11 0.2 6 0.3 3 0.2 2 0.1

Other 73 1.2 26 1.3 23 1.2 24 1.2

Hispanic or Latino

Yes 112 1.9 41 2.0 33 1.8 38 1.9

No 5813 98.1 2014 98.0 1840 98.2 1959 98.1

Income

Less than $20,000 3068 54.7 1111 57.0 957 53.7 1000 53.3

$20,001 to $40,000 1409 25.1 472 24.2 455 25.5 482 25.7

$40,001 to $60,000 656 11.7 205 10.5 227 12.7 224 11.9

$60,001 to $80,000 282 5.0 97 5.0 84 4.7 101 5.4

$80,001 or more 192 3.4 65 3.3 58 3.3 69 3.7

General health

Excellent 394 6.7 129 6.3 134 7.2 131 6.6

Very Good 1103 18.7 382 18.6 345 18.4 376 18.9

Good 2123 35.9 724 35.3 673 36.0 726 36.5

Fair 1397 23.6 506 24.7 452 24.1 439 22.1

Poor 892 15.1 309 15.1 268 14.3 315 15.9

Insurance status

Private insurance 1683 28.3 507 24.6 554 30.0 622 31.6

Medicaid 1752 29.5 628 30.5 570 30.8 554 28.2

Medicare 807 13.6 234 11.4 258 14.0 315 16.0

Military 61 1.0 11 0.5 29 1.6 21 1.1

None 987 16.6 301 14.6 330 17.9 356 18.1

Other 346 5.8 140 6.8 107 5.8 99 5.0

14

Table 4: Clinic cessation follow-up demographic characteristics

May 1, 2008 – June 30, 2010

Measure Overall 3-month 6-month 12-month

Age (mean) 44.0 (SD = 11.4) 44.6 (11.3) 43.6 (11.6 44.0 (10.9) Number

(N)

Percent

(%)

N % N % N %

Gender

Male 318 38.0 141 40.5 117 35.8 60 37.0

Female 519 62.0 207 59.5 210 64.2 102 63.0

Race

White 931 90.6 310 89.3 317 91.1 304 91.3

African American or

Black 71 6.9 30 8.6 23 6.6 18 5.4

Asian 1 0.1 0 0.0 1 0.3 0 0.0

American Indian or

Alaskan Native 12 1.2 2 0.6 5 1.4 5 1.5

Native Hawaiian or

Pacific Islander 2 0.2 0 0.0 1 0.3 1 0.3

Other 11 1.1 5 1.4 1 0.3 5 1.5

Hispanic or Latino

Yes 24 2.3 9 2.6 6 1.7 9 2.7

No 1011 97.7 341 97.4 345 98.3 325 97.3

Income

Less than $20,000 472 48.2 169 51.4 165 49.1 138 43.8

$20,001 to $40,000 319 32.6 105 31.9 109 32.4 105 33.3

$40,001 to $60,000 119 12.1 31 9.4 39 11.6 49 15.6

$60,001 to $80,000 40 4.1 14 4.3 10 3.0 16 5.1

$80,001 or more 30 3.1 10 3.0 13 3.9 7 2.2

General health

Excellent 61 5.9 13 3.7 26 7.4 22 6.6

Very Good 229 22.1 80 22.8 68 19.4 81 24.3

Good 378 36.5 126 35.9 127 36.2 125 37.4

Fair 249 24.0 87 24.8 92 26.2 70 21.0

Poor 119 11.5 45 12.8 38 10.8 36 10.8

Insurance status

Private insurance 303 30.8 86 28.4 105 29.8 112 33.4

Medicaid 74 7.5 20 6.6 27 7.7 27 8.1

Medicare 77 7.8 23 7.6 27 7.7 27 8.1

Military health care 12 1.2 3 1.0 7 2.0 2 0.6

None 479 48.7 159 52.5 173 49.1 149 43.9

Other 39 4.0 12 4.0 10 2.8 17 5.1

15

Tobacco Product Use and Cessation

Baseline question: Think back to when you (first called Quitline/first started this program).

During the 30 days before your first call, on how many days did you smoke cigarettes?

Follow-up question: In the past 30 days, on how many days did you smoke cigarettes?

Findings:

Among all respondents, cigarettes were the most commonly used tobacco product.

Most Quitline and clinic respondents said they smoked cigarettes at baseline, whereas 6%

or less of respondents said they used cigars, pipes, or smokeless tobacco (Tables 5 and 6).

Use of all products decreased from baseline to follow-up. Reductions diminished over

time from the 3-month cohort to the 12-month cohort, although a much smaller

proportion of respondents smoked even at the 12-month follow-up than at baseline.

Table 5: Quitline respondents’ tobacco use from baseline to follow-up

Measure Baseline 3-month 6-month 12-month

Cigarettes

Any use in past 30 days 97.6 78.3 77.9 77.0

Frequent smoker

(20 days or more in the past 30) 92.8 59.2 63.8 67.9

Daily smoker

(30 days in the past 30) 90.7 52.2 58.5 63.2

Cigars


Frequent smoker


Daily smoker

(30 days in the past 30) 1.3 0.4 0.9 1.3

Pipe tobacco


Frequent smoker


Daily smoker

(30 days in the past 30) 0.9 0.2 0.3 0.4

Smokeless tobacco


Frequent user


Daily user

(30 days in the past 30) 2.2 0.9 1.0 1.6

Note. Baseline and follow-up results in this table are based on all respondents who completed a follow-up interview.

16

Table 6: Clinic cessation respondents’ tobacco use from baseline to follow-up


Cigarettes


Frequent smoker


Daily smoker

(30 days in the past 30) 94.9 41.8 57.7 57.6

Cigars


Frequent smoker


Daily smoker

(30 days in the past 30) 1.0 0.3 0.9 0.6

Pipe tobacco


Frequent smoker


Daily smoker

(30 days in the past 30) 0.7 0.0 0.3 0.3

Smokeless tobacco


Frequent user


Daily user

(30 days in the past 30) 1.1 0.3 0.3 0.6

Note. Baseline and follow-up results in this table are based on all respondents who completed a follow-up interview.

17

Cessation rates were determined by dividing the number of respondents who said they used a

particular tobacco product at follow-up by the number of respondents who said they used that

same product at baseline. Results represent all users of each product (not just exclusive users).

Cigarettes: In the Quitline sample, cessation rates in all three follow-up cohorts were

approximately 20%; in the clinic sample, cessation rates ranged between 26% and 29%

(Tables 7 and 8). Differences in rates between cohorts within each sample were not

statistically significant.

Cigars: In the Quitline sample, 63 of 108 cigar smokers (58%) quit in the 3-month cohort, 67 of

115 (58%) quit in the 6-month cohort, and 75 of 122 (62%) quit in the 12-month cohort.

Among clinic respondents, in the 3-month cohort, 14 of 24 cigar smokers (58%) quit,

whereas 5 of 12 people (42%) quit in the 6-month cohort and 7 of 11 people (64%) quit in

the 12-month cohort.

Pipe tobacco: In the Quitline sample, 24 of 34 pipe tobacco smokers (71%) quit in the 3-month

cohort, 24 of 33 (73%) quit in the 6-month cohort, and 16 of 28 (57%) quit in the 12-month

cohort. In the clinic sample, 3 people reported smoking pipe tobacco at baseline in the 3-

month cohort and all three quit (100%); 5 of 8 (62%) pipe tobacco smokers quit in the 6-

month cohort and 2 of 3 (67%) quit in the 12-month cohort.

Smokeless tobacco: In the Quitline sample, 44 of 91 SLT users (48%) quit in the 3-month

cohort, 36 of 81 (44%) quit in the 6-month cohort, and 37 of 80 (46%) quit in the 12-month

cohort. In the clinic sample, 8 of 12 SLT users (67%) quit in the 3-month cohort, 7 of 9

(78%) in the 6-month cohort, and 9 of 10 (90%) in the 12-month cohort.

Note: Results of analysis with sample sizes less than n = 50 can be quite unstable and should be interpreted with

caution.

Table 7: Quitline respondents’ tobacco cessation rates

Tobacco Product 3-month 6-month 12-month

N % N % N %

Cigarettes

Baseline users

Follow-up users

Cessation rate

1975

1579

20.1

1808

1436

20.6

1914

1508

21.2 Note: Based on those respondents with responses at both baseline and follow-up.

Table 8: Clinic cessation respondents’ tobacco cessation rates

Tobacco Product 3-month 6-month 12-month

N % N % N %

Cigarettes

Baseline users

Follow-up users

Cessation rate

345

246

28.7

347

253

26.7

328

235

28.4 Note: Based on those respondents with responses at both baseline and follow-up.

18

Cigarette Smoking Cessation Rates by Demographic

Characteristics

Cessation rates were compared across demographic characteristics among respondents who

reported smoking cigarettes at the time they started the programs.

Findings:

Among Quitline respondents, cessation rates were significantly higher among older

adults (65 years or older), males, respondents of non-Hispanic origin, those who do not

live with a smoker, those with higher incomes, and those who reported being in good

health (Figure 1). Variation was seen in cessation rates across racial groups, but these

differences were not statistically significant, and the sub-sample sizes were small.

Among clinic respondents, cessation rates were significantly higher among respondents

who do not live with a smoker, those with higher incomes, and those who reported being

in good health (Figure 2). Variation was seen in cessation rates across the other

demographic characteristics, but these differences were not statistically significant, and

the sub-sample sizes were small.

19

Figure 1: Smoking cessation rates across demographic characteristics, Quitline respondents

14%

16%

21%

27%

30%

31%

32%

29%

23%

16%

11%

9%

20%

23%

15%

21%

21%

12%

26%

14%

23%

19%

27%

21%

20%

19%

22%

17%

0% 20% 40% 60% 80%

Poor (n = 879)

Fair (n = 1,375)

Good (n = 2,068)

Very Good (n = 1,066)

Excellent (n = 379)

More than $80,000 (n = 170)

$60,000 to $80,000 (n = 264)

$40,000 to $60,000 (n = 631)

$20,000 to $40,000 (n = 1,384)

Less than $20,000 (n = 3,029)

Other (n = 73)

Native Hawaiian or Pacific Islander (n = 11)

American Indian or Alaska Native (n = 91)

Asian (n = 13)

African American or Black (n = 208)

White (n = 5,358)

Not Hispanic (n = 5,672)

Hispanic (n = 112)

Don’t live with smoker (n = 3,316)

Live with smoker (n = 2,479)

Male (n = 1,984)

Female (n = 3,812)

65+ (n = 343)

55-64 (n = 1,027)

45-54 (n = 1,648)

35-44 (n = 1,202)

25-34 (n = 1,151)

18-24 (n = 419)

Gender

Cohabitation

Hispanic

Race

Income

Health

Age Group

20

Figure 2: Smoking cessation rates across demographic characteristics, clinic respondents

14%

23%

29%

36%

43%

48%

48%

32%

31%

22%

18%

0%

25%

0%

24%

28%

28%

22%

36%

18%

31%

27%

50%

29%

28%

28%

30%

26%

0% 20% 40% 60% 80%

Poor (n = 118)

Fair (n = 248)

Good (n = 369)

Very Good (n = 225)

Excellent (n = 61)

More than $80,000 (n = 27)

$60,000 to $80,000 (n = 40)

$40,000 to $60,000 (n = 117)

$20,000 to $40,000 (n = 315)

Less than $20,000 (n = 468)

Other (n = 11)

Native Hawaiian or Pacific Islander (n = 2)

American Indian or Alaska Native (n = 12)

Asian (n = 1)

African American or Black (n = 67)

White (n = 920)

Not Hispanic (n = 997)

Hispanic (n = 23)

Don’t live with smoker (n = 561)

Live with smoker (n = 463)

Male (n = 311)

Female (n = 516)

65+ (n = 26)

55-64 (n = 127)

45-54 (n = 337)

35-44 (n = 183)

25-34 (n = 164)

18-24 (n = 46)

Gender

Cohabitation

Hispanic

Race

Income

Health

Age Group

21

Changes in Cigarette Smoking Behavior

Baseline question: Think back to when you (first called Quitline/first started this program). On

the average, on days when you smoked, about how many cigarettes did you smoke a day?

Follow-up question: On the average, on days when you smoked in the past 30 days, about how

many cigarettes did you smoke a day?

Findings:

In both the Quitline and clinic cessation samples, among respondents who reported

smoking cigarettes at baseline, there was a reduction from baseline to follow-up for all

cohorts in the number of cigarettes smoked per day of 22% to 43% (Tables 9 and 10).

At baseline, 64% of Quitline respondents who reported smoking cigarettes smoked one

pack or more per day. At follow-up, 34% of the 3-month cohort, 41% of the 6-month

cohort, and 46% of the 12-month cohort smoked one pack or more per day (Figure 3).

At baseline, 71% of clinic respondents who reported smoking cigarettes smoked one pack

or more per day. At follow-up, 33% of the 3-month cohort, 47% of the 6-month cohort,

and 43% of the 12-month cohort smoked one pack or more per day (Figure 4).

Table 9: Quitline respondents’ mean number of cigarettes per day


Mean number of cigarettes smoked

per day 21.3 13.7 15.3 16.5

Table 10: Clinic respondents’ mean number of cigarettes per day


Mean number of cigarettes smoked

per day 22.6 12.8 16.3 15.7

22

Figure 3: Number of cigarettes smoked per day, Quitline respondents (smokers at baseline)

Figure 4: Number of cigarettes smoked per day, clinic respondents (smokers at baseline)

9%

14%

19%

3%

12%

14%

17%

7%

32%

31%

30%

26%

32%

29%

25%

38%

9%

7%

5%

13%

5%

5%

4%

13%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month

Baseline

1 to 5 5 to 9 10 to 19 20 to 29 30 to 39 40 or more

13%

13%

27%

2%

13%

9%

18%

5%

32%

30%

23%

22%

29%

34%

24%

42%

8%

7%

5%

15%

6%

6%

4%

14%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month

Baseline

1 to 5 5 to 9 10 to 19 20 to 29 30 to 39 40 or more

23

Baseline question: Think about a typical morning back when you (first called Quitline/first

started the program). How soon after waking up did you first use any tobacco product?

Follow-up question: How soon after you wake up do you first use any tobacco products?

Findings:

In both the Quitline and clinic samples, a larger proportion of cigarette smokers had their

first daily tobacco use more than 60 minutes after waking at all follow-up intervals than

at baseline (Figures 5 and 6).

Among clinic respondents, the proportion of smokers who used tobacco within 5 minutes

of waking decreased from baseline to follow-up, especially among the 3-month cohort

(Figure 6).

Figure 5: Time before smoking first cigarette of the day, Quitline respondents

Figure 6: Time before smoking first cigarette of the day, clinic respondents

35%

31%

28%

45%

33%

31%

29%

32%

13%

12%

13%

11%

20%

25%

30%

12%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month

Baseline

Within 5 minutes of waking 6 to 30 minutes after waking31 to 60 minutes after waking More than 60 minutes after waking

32%

31%

27%

43%

27%

35%

25%

35%

15%

11%

12%

11%

26%

23%

36%

13%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month

Baseline

Within 5 minutes of waking 6 to 30 minutes after waking31 to 60 minutes after waking More than 60 minutes after waking

24

Smokeless Tobacco Use

Two composite variables (one for baseline responses and one for follow-up responses) were

created to cluster respondents into one of four groups at baseline and follow-up: those who

smoked cigarettes only, those who used smokeless tobacco (SLT) only, those who used both

cigarettes and SLT, and those who used neither cigarettes nor SLT (Figures 7 and 8). The two

composite variables were compared to examine changes in patterns of product use among users

of cigarettes and SLT (Figures 9 and 10).

Findings:

In general, respondents did not switch from cigarettes to SLT between program entry

(baseline) and follow-up. However, the percent of respondents who said they did not use

any tobacco products (they quit using tobacco) increased from 0% at baseline to 21% at

follow-up among Quitline respondents and from 0% to 30% among clinic respondents.

From baseline to follow-up, 22% of Quitline respondents said they changed the type of

tobacco product they used. Of these, 90% quit using both SLT and cigarettes, 6% quit

using SLT but kept smoking cigarettes, 3% became dual users of SLT and cigarettes, and

1% quit smoking cigarettes but kept using SLT (Figure 7).

From baseline to follow-up, 30% of clinic respondents said they changed the type of

tobacco product they used. Of these, 94% quit using both SLT and cigarettes, 4% quit

using SLT but kept smoking cigarettes, 2% became dual users of SLT and cigarettes, and

1% quit smoking cigarettes but kept using SLT (Figure 8).

In both program samples, most respondents who said they were cigarette smokers at

baseline did not supplement or replace their cigarette use with smokeless tobacco from

baseline to follow-up.

Among all Quitline respondents at baseline, 94% were exclusive users of cigarettes, 1%

were exclusive users of SLT, and 3% used both cigarettes and SLT. At follow-up, 76%

were exclusive users of cigarettes, less than 1% were exclusive users of SLT, and 2%

used both (Figure 9).

Among all Quitline respondents who used SLT exclusively at baseline (n = 73), about

one-third (n = 25) did not use cigarettes or SLT at follow-up. Among respondents who

smoked cigarettes exclusively at baseline (n = 5,579), 0.1% (n = 5) reported exclusive use

of SLT at follow-up and 0.7% (n = 37) reported using SLT in addition to cigarettes at

follow-up (Figure 11).

Among all clinic respondents at baseline, 96% were exclusive users of cigarettes, 1%

were exclusive users of SLT, and 2% used both cigarettes and SLT. At follow-up, 70%

were exclusive users of cigarettes, less than 1% were exclusive users of SLT, and 1%

used both (Figure 10).

Among all clinic respondents who used SLT exclusively at baseline (n = 7), six did not

use cigarettes or SLT at follow-up. Among respondents who smoked cigarettes

exclusively at baseline (n = 999), one person reported exclusive use of SLT at follow-up

and less than 1% (n = 5) reported using SLT in addition to cigarettes at follow-up (Figure

12).

Note: Respondents who used cigarettes, SLT, or both at baseline are included in these analyses.

25

Figure 7: Tobacco use among Quitline respondents reporting a change in type of product used

from baseline to follow-up

Figure 8: Tobacco use among clinic respondents reporting a change in type of product used

from baseline to follow-up

22%78%

Changed type of tobacco product used

No change in type of tobacco product used

1%3%

6%

90%

SLT only SLT and cigarettes

Cigarettes only None (quit tobacco)

30%70%

Changed type of tobacco product used

No change in type of tobacco product used

1% 2%4%

94%

SLT only SLT and cigarettes

Cigarettes only None (quit tobacco)

26

Figure 9: Change in use of cigarettes and SLT, Quitline respondents

Figure 10: Change in use of cigarettes and SLT, clinic respondents

94%

1% 3% 1%

Cigarettes only

SLT only

Cigarettes and SLT

Neither cigarettes

nor SLT (Quit)

76%

<1%

2%

21%

96%

1%2% 1%

Cigarettes only

SLT only

Cigarettes and SLT

Neither cigarettes

nor SLT (Quit)

70%<1%

1%

29%

Baseline to Follow-up

Baseline to Follow-up

27

Figure 11: Changes in product use among users of cigarettes and SLT, Quitline respondents

79%

0% <1%

21%

0%

20%

40%

60%

80%

100%

Cigarettes

only

SLT only Cigarettes and

SLT

Quit

3%

60%

3%

34%

0%

20%

40%

60%

80%

100%

Cigarettes

only


SLT

Quit

35%

2%

48%

17%

0%

20%

40%

60%

80%

100%

Cigarettes

only


SLT

Quit

In the Quitline sample,

among exclusive users

of cigarettes at baseline

(n = 5,579), less than 1%

used SLT exclusively or

in combination with

cigarettes at follow-up.



of SLT at baseline (n =

73), about 3% switched

to cigarettes and about

3% added cigarettes at

follow-up.


among users of both

cigarettes and SLT at

baseline (n = 188), about

2% used SLT exclusively

and 35% used cigarettes

exclusively at follow-up.

28

Figure 12: Changes in product use among users of cigarettes and SLT, clinic respondents

72%

0% <1%

28%

0%

20%

40%

60%

80%

100%

Cigarettes

only


SLT

Quit

0%

14%

0%

86%

0%

20%

40%

60%

80%

100%

Cigarettes

only


SLT

Quit

40%

4%

24%32%

0%

20%

40%

60%

80%

100%

Cigarettes

only


SLT

Quit

In the clinic sample,


of cigarettes at baseline

(n = 999), less than 1%

used SLT exclusively or

in combination with

cigarettes at follow-up.



of SLT at baseline (n =

7), none added cigarettes

or switched to cigarettes



among users of both

cigarettes and SLT at

baseline (n = 25), about

4% used SLT exclusively

and 40% used cigarettes


29

Perceptions of Personal Tobacco Use

Follow-up question: How does your current cigarette use compare to your use when you (first

called Quitline/first started the program)?

Findings:

In both the Quitline and the clinic samples, the majority of respondents characterized

their cigarette smoking at follow-up to be less than their smoking at baseline (Figures 13

and 14).

Three months after first calling Quitline Iowa, 69% of respondents who smoked

cigarettes around the time of their first call said they currently smoke somewhat less or a

lot less than they did before enrolling in the program. This proportion decreased in the 6-

and 12-month cohorts, to 62% and 58%, respectively.

Three months after enrolling in the clinic cessation program, 76% of respondents who

smoked cigarettes around the time of their first call said they currently smoke somewhat

less or a lot less. This proportion decreased to 68% in the 6 month and 64% in the 12

month cohorts.

Figure 13: Perception of changes in cigarette use, Quitline respondents

Figure 14: Perception of changes in cigarette use, clinic respondents

39%

42%

49%

19%

20%

20%

36%

34%

27%

4%

3%

2%

3%

2%

2%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month

A lot less Somewhat less About the same Somewhat more A lot more

51%

50%

62%

13%

18%

14%

29%

26%

19%

4%

4%

2%

3%

3%

2%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month

A lot less Somewhat less About the same Somewhat more A lot more

30

Future Tobacco and Pharmacotherapy Use

Respondents who had quit smoking cigarettes at follow-up were compared with those who had

not quit smoking cigarettes at follow-up to assess differences in perceptions of future use of

tobacco products and pharmacotherapies (Figure 15).

Findings:

Although most Quitline respondents who quit smoking said they did not think they would

use tobacco in the future, about one-fifth (21%) expected to need pharmaceutical support

to remain tobacco-free.

In both the Quitline and clinic samples, very few respondents who had quit smoking said

they were likely to use tobacco in the next year. Those who had quit smoking were less

likely than those who had not quit smoking at follow-up to say they would use tobacco

products in the next year.

Those who had quit smoking were less likely than non-quitters to say they would use any

pharmacotherapies to help them remain tobacco-free or quit smoking in the next year.

Figure 15: Comparison of quit and not quit respondents on future use of tobacco and

pharmacotherapies

6%

21%

3%

13%

81%78%

81%

71%

0%

20%

40%

60%

80%

100%

Future tobacco Pharmacotherapies Future tobacco Pharmacotherapies

Quitline respondents

Quit smoking

Have not quit smoking

Clinic respondents

Quit smoking

Have not quit smoking

31

Follow-up question: Do you think you will use tobacco any time during the next year?

Findings:

The majority of all respondents in both the Quitline Iowa and the clinic cessation samples

said they would likely use tobacco products at some point during the next year, in part

because most respondents had not entirely quit using tobacco (Figures 16 and 17).

Among Quitline respondents who said they smoked cigarettes around the time of their

first call to Quitline Iowa, respondents in the 6- and 12-month groups were more

pessimistic about their future tobacco use than in the 3-month group. Nearly six in ten

(59%) of the 3-month cohort said they would definitely or probably use tobacco products

in the next year; 68% of the 6-month cohort and 69% of the 12-month cohort responded

this way (Figure 16).

Among clinic respondents who said they smoked cigarettes around the time of their first

call to Quitline Iowa, 49% of respondents in the 3-month cohort, 65% of respondents in

the 6-month cohort, and 63% of respondents in the 12-month cohorts said they would

definitely or probably use tobacco products in the next year (Figure 17).

Figure 16: Perception of future tobacco use, Quitline respondents

Figure 17: Perception of future tobacco use, clinic respondents

17%

16%

18%

14%

16%

24%

33%

36%

34%

36%

32%

25%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month

Definitely not Probably not Probably yes Definitely yes

19%

18%

27%

18%

16%

24%

28%

28%

26%

35%

37%

23%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month


32

Follow-up question: Do you think you will use any kind of nicotine replacement therapy or

medication such as a patch, gum, lozenge, or pill at any time during the next year?

Findings:

Over half of all respondents in both the Quitline and the clinic cessation samples said

they would likely use pharmacotherapy products (nicotine replacement therapies or

medications) in the next year (Figures 18 and 19).

Among Quitline respondents, 69% of those in the 3-month cohort and 64% of those in

both the 6- and 12-month cohorts said they would definitely or probably use

pharmacotherapy products in the next year.

Among clinic respondents, 57% of those in the 3-month cohort, 53% of those in the 6-

month cohort, and 55% of those in the 12-month cohort said they would definitely or

probably use pharmacotherapy products in the next year.

Figure 18: Perception of future pharmacotherapy use, Quitline respondents

Figure 19: Perception of future pharmacotherapy use, clinic respondents

22%

21%

17%

14%

14%

14%

33%

33%

31%

31%

31%

38%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month


26%

25%

28%

19%

21%

16%

30%

30%

30%

25%

23%

27%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month


33

Motivation to Quit Using Tobacco

Follow-up question: Why did you decide to quit smoking cigarettes? (Select all that apply.)

Findings:

Among respondents who were cigarette smokers at baseline, the majority cited health

reasons (i.e., bad for health) as a motivation for quitting in both the Quitline sample

(61%) and the clinic sample (64%) (Figures 20 and 21).

Cigarettes being too expensive was cited as a motivating factor for quitting by 26% of

Quitline respondents and 26% of clinic respondents. A health event was cited as a

motivating factor for quitting by 13% of both Quitline and clinic respondents.

Figure 20: Motivation for quitting smoking, Quitline respondents (multiple responses possible)

0%

0%

1%

1%

1%

1%

2%

4%

7%

7%

8%

9%

13%

26%

61%

0% 20% 40% 60% 80% 100%

Media campaign

Availability of free or reduced NRT

Pregnant

Embarrassed to smoke

Employer policy

Too few places allow smoking

Followed advice of a health care professional

Wanted to be a better role model

Other

Health of others

Family or friends supported decision

Just don't like it anymore

Had a health event

Too expensive

Bad for health

34

Figure 21: Motivation for quitting smoking, clinic respondents (multiple responses possible)

0%

0%

0%

1%

1%

1%

2%

3%

6%

8%

9%

12%

13%

26%

64%

0% 20% 40% 60% 80% 100%

Availability of free or reduced NRT

Media campaign

Pregnant

Employer policy

Too few places allow smoking

Embarrassed to smoke

Wanted to be a better role model

Followed advice of a health care professional

Health of others

Other

Family or friends supported decision

Just don't like it anymore

Had a health event

Too expensive

Bad for health

35

Deciding to Smoke

Follow-up question: The following statements represent things some people like and don’t like

about smoking. Please tell me how important each one is to you when you’re deciding whether

or not to smoke.

Findings:

Among Quitline respondents who were still smoking at follow-up, 54% said the fact that

their smoking bothers other people was very important or extremely important to their

decision whether or not to smoke. Over half (52%) said the tension relief from smoking

was very or extremely important to their decision (Figure 22).

Among clinic respondents, 57% said the fact that their smoking bothers other people was

very important or extremely important to their decision whether or not to smoke. Over

half (54%) said the tension relief from smoking was very or extremely important to their

decision (Figure 23).

Figure 22: Factors affecting the decision to smoke, Quitline respondents

64%

52%

23%

29%

8%

16%

23%

23%

37%

28%

40%

30%

13%

25%

40%

43%

52%

54%

0% 20% 40% 60% 80% 100%

Smoking helps me concentrate and do better work

I'm embarrassed to have to smoke

I am relaxed and therefore more pleasant when

smoking

People think I'm foolish for ignoring the warnings

about cigarette smoking

Smoking cigarettes relieves tension

My cigarette smoking bothers other people

Not important Slightly or moderately important Very or extremely important

36

Figure 23: Factors affecting the decision to smoke, clinic respondents

67%

52%

26%

31%

6%

14%

20%

26%

39%

28%

38%

28%

13%

22%

36%

40%

56%

57%

0% 20% 40% 60% 80% 100%

Smoking helps me concentrate and do better

work

I'm embarrassed to have to smoke

I am relaxed and therefore more pleasant when

smoking

People think I'm foolish for ignoring the

warnings about cigarette smoking

Smoking cigarettes relieves tension

My cigarette smoking bothers other people

Not important Slightly or moderately important Very or extremely important

37

Follow-up question: Which of the following, if any, are things you like about smoking? Just tell

me yes or no for each one.

Findings:

The most common qualities that Quitline and clinic respondents who had not quit liked

about smoking were that it helped them deal with tension or stress (89%), helped them

relax (87%), helped them when they were upset or angry (83%), and helped them when

they were worried or anxious (82%) (Figures 24 and 25).

Figure 24: Enjoyable aspects of smoking, Quitline respondents

26%

30%

35%

40%

49%

65%

66%

82%

83%

87%

89%

0% 20% 40% 60% 80% 100%

It helps me control my weight

It helps me concentrate

I enjoy being around other smokers

I enjoy the taste

I enjoy the feeling of a cigarette in my hand

It helps me when I am feeling down or depressed

It's something to do when I'm bored

It helps me when I am worried or anxious

It helps me when I am upset or angry

It helps me relax

It helps me deal with tension or stress

38

Figure 25: Enjoyable aspects of smoking, clinic respondents

26%

30%

33%

40%

48%

60%

67%

79%

83%

85%

86%

0% 20% 40% 60% 80% 100%

It helps me concentrate

It helps me control my weight

I enjoy being around other smokers

I enjoy the taste

I enjoy the feeling of a cigarette in my hand

It helps me when I am feeling down or

depressed

It's something to do when I'm bored

It helps me when I am worried or anxious

It helps me when I am upset or angry

It helps me relax

It helps me deal with tension or stress

39

Temptation to Smoke

Follow-up question: The following situations lead some people to smoke. Please tell me how

tempted you may be to smoke in each situation.

Findings:

Among Quitline respondents who had not yet quit smoking at follow-up, 80% said they

were very or extremely tempted to smoke when anxious or stressed. About two-thirds said

they were very or extremely tempted first thing in the morning and when very angry or

upset (66% and 67%, respectively) (Figure 26).

Among clinic respondents, 83% said they were very or extremely tempted to smoke when

anxious or stressed. About two-thirds said they were very or extremely tempted when

very angry or upset (67%) (Figure 27).

Figure 26: Temptation to smoke, Quitline respondents

36%

26%

22%

19%

12%

9%

7%

10%

3%

40%

45%

39%

37%

32%

30%

26%

24%

17%

25%

29%

40%

44%

56%

61%

66%

67%

80%

0% 20% 40% 60% 80% 100%

When I feel I need a lift

When I realize I haven't smoked in a while

Over coffee while talking and relaxing

With my spouse or close friend who is smoking

With friends at a party

When things are not going my way and I am

frustrated

When I first get up in the morning

When I am very angry about someone or

something

When I am very anxious and stressed

Not at all tempted Slightly or moderately tempted Very or extremely tempted

40

Figure 27: Temptation to smoke, clinic respondents

40%

29%

23%

25%

12%

12%

12%

12%

4%

41%

51%

41%

37%

33%

29%

28%

22%

12%

19%

20%

36%

38%

55%

59%

60%

67%

83%

0% 20% 40% 60% 80% 100%

When I feel I need a lift

When I realize I haven't smoked in a while

With my spouse or close friend who is smoking

Over coffee while talking and relaxing

With friends at a party

When things are not going my way and I am

frustrated

When I first get up in the morning

When I am very angry about someone or

something

When I am very anxious and stressed

Not at all tempted Slightly or moderately tempted Very or extremely tempted

41

Challenges to Quitting Successfully

Follow-up question: Which of the following, if any, are some of the challenges to your quitting

successfully? Just tell me yes or no for each one.

Findings:

Among Quitline respondents who had not yet quit, the most commonly cited challenge to

quitting successfully was stress (87%), followed by strong cravings (83%) and becoming

irritable (76%) (Figure 28).

Among clinic respondents who had not yet quit, the most commonly cited challenges to

quitting were also stress (84%), strong cravings (79%), and becoming irritable (75%)

(Figure 29).

Figure 28: Challenges to quitting, Quitline respondents

32%

38%

38%

42%

48%

54%

54%

63%

63%

64%

76%

83%

87%

0% 20% 40% 60% 80% 100%

Unable to concentrate or focus

Lack of support from others

Gaining weight

People I live with smoke

Conflicts with family

People in my family smoke

I smoke when I drink alcohol

Many of my friends smoke

Other mood symptoms like sadness, anxiety, or

depression

It's just something I can't control

Becoming irritable

Strong cravings

Stress

42

Figure 29: Challenges to quitting, clinic respondents

26%

30%

39%

42%

46%

52%

55%

58%

60%

62%

75%

79%

84%

0% 20% 40% 60% 80% 100%

Unable to concentrate or focus

Lack of support from others

Gaining weight

Conflicts with family

People I live with smoke

People in my family smoke

Other mood symptoms like sadness, anxiety, or

depression

I smoke when I drink alcohol

It's just something I can't control

Many of my friends smoke

Becoming irritable

Strong cravings

Stress

43

Attitudes and Beliefs

Respondents were asked how strongly they agreed with three statements about NRT:

1. Nicotine replacement therapy like a patch, gum, or pill causes cancer.

2. Nicotine replacement therapy is helpful for people who want to quit using tobacco.

3. Nicotine replacement therapy is more dangerous than smoking cigarettes.

Findings:

Among all Quitline and clinic respondents, most said they disagreed or strongly

disagreed with the statement that NRT or pills cause cancer. Nearly all agreed or

strongly agreed that NRT is helpful for people who want to quit. Most respondents

disagreed or strongly disagreed with the statement that NRT is more dangerous than

smoking cigarettes (Figures 30 and 31).

Figure 30: Beliefs about NRT, Quitline respondents

Figure 31: Beliefs about NRT, clinic respondents

1%

36%

4%

5%

58%

11%

61%

5%

63%

33%

1%

22%

0% 20% 40% 60% 80% 100%

NRT is more dangerous

than smoking

NRT is helpful

NRT or pills cause

cancer

Strongly agree Agree Disagree Strongly disagree

2%

35%

2%

12%

58%

4%

66%

6%

61%

20%

1%

34%

0% 20% 40% 60% 80% 100%

NRT is more dangerous

than smoking

NRT is helpful

NRT or pills cause

cancer

Strongly agree Agree Disagree Strongly disagree

44

Quitline Program Usage

Quitline Contact

Follow-up question: How many times did you speak with a Quitline Iowa representative over

the phone?

Findings:

Nearly one in three (30%) respondents said they spoke with a Quitline representative

only once (Figure 32). The median number of calls was 2 and the mean (average) number

of calls was 3.

Figure 32: Distribution of the number of respondents’ Quitline contacts

30%

23%16%

10%6% 5%

2% 2% <1%3%

<1% 1% <1% <1% 3%

0%

20%

40%

60%

80%

100%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

45

Quitline NRT

Follow-up question: Which type of nicotine replacement therapy, if any, did you receive from

the Quitline?

Note: In February 2009, NRT lozenges were added to the response options of this question to

reflect the addition of this form of NRT to those available from Quitline Iowa.

Findings:

Among all Quitline respondents, more than one-third (38%) said they did not receive any

nicotine replacement therapy (Figure 33).

Among those who did receive NRT, 86% said they received patches, 13% received gum,

and <1%) received lozenges (Figure 34).

Figure 33: Type of NRT received from Quitline Iowa

Figure 34: Type of NRT received from Quitline Iowa, among those who received any NRT

53%

9%

<1%

38%Patches

Gum

Lozenges

None

86%

13%<1%

Patches

Gum

Lozenges

46

Aspects of the Quitline Coaching Experience

Follow-up question: Did the Quitline coach you spoke with help you to…

Findings:

More than two-thirds (69%) of Quitline respondents recalled talking with a coach about

their past quit experiences. Respondents also recalled setting a quit date (65%), working

to reduce their intake of tobacco (64%), and identifying what they don’t like about

smoking (63%) (Figure 35). Most did not recall discussing a plan to make their car

tobacco free or learning about the 3 A’s (Avoid, Alternatives, and Adjust).

Figure 35: Elements of the Quitline coaching experience

42%

48%

53%

54%

57%

62%

62%

63%

64%

65%

69%

0% 20% 40% 60% 80% 100%

Learn about the 3 A's (Avoid, Alternatives, and

Adjust)

Plan a way to make your car tobacco free

Learn about the five elements crucial to quitting

successfully

Plan a way to make your home tobacco free

Identify what you like about smoking

Develop a quit plan

Find ways to overcome roadblocks to quitting

Identify what you don't like about smoking

Reduce the amount of tobacco you use

Set a quit date

Talk about your past quit experiences

47

Perceptions of Quitline Respondents Still Smoking

Follow-up question: Please tell me how strongly you agree or disagree with the following

statements.

Findings:

Quitline respondents who were still smoking generally positive about eventually quitting

smoking successfully (Figure 36, next page). Most Quitline respondents said they would

keep trying to quit smoking (96%) and they will quit smoking within the next 5 years

(94%).

More than three-fourths (77%) of Quitline respondents who had not yet quit smoking said

they would need more free NRT to quit successfully.

In general, Quitline respondents who had not yet quit smoking were positive about their

experience with Quitline Iowa. A majority of respondents said the people at Quitline

listened carefully (82%), were helpful (78%), and cared about the callers (77%).

48

Figure 36: Perceptions of quitting, cessation supports, and Quitline

5%

6%

8%

24%

26%

21%

34%

5%

6%

7%

6%

16%

22%

1%

8%

15%

18%

20%

16%

31%

29%

20%

22%

35%

47%

51%

57%

48%

25%

28%

29%

31%

43%

55%

11%

36%

51%

49%

49%

53%

63%

67%

0% 20% 40% 60% 80% 100%

Using Quitline was difficult

Using Quitline was inconvenient for me

Calling Quitline did not make it easier for me

to quit

The people at Quitline cared about my success

The people at Quitline cared about me

The people at Quitline were helpful

The people at Quitline listened carefully to me

I’m never going to be able to quit with only

phone counseling

I think I would need to attend more group

meetings with other people who are trying …

I think I would need more face-to-face

coaching

I need face to face counseling to help me quit

I think I would need more frequent contact

I think I would need more free NRT

I don’t think I will ever quit smoking.

No matter how hard I try, I just can’t quit

smoking

By this time next year, I will no longer be

smoking

I just wasn’t ready to quit

I feel better prepared for my next quit attempt

Eventually cigarettes will get expensive and

I’ll quit

I think I will quit smoking within the next 5

years

I am going to keep trying to quit smoking

Strongly agree Agree

Perceptions of

quitting

Perceptions of

cessation

supports

Perceptions of

Quitline

49

Clinic Cessation Program Usage

Clinic program counseling

Follow-up question: How many times did you receive the following types of counseling?

Note: The three types of counseling are individual, group, and Quitline Iowa (telephonic). In

FY10, language in the follow-up questionnaire was modified to clarify for respondents that brief

provider interventions are included in the individual counseling category. Due to this language

change, a portion of the results in this section are divided into two categories: FY10 results and

prior results.

Findings:

Nearly six in ten (59%) clinic respondents interviewed in FY10 said they received only

individual counseling through the program. Over two in ten (22%) said they did not

receive any of the three types of counseling (Figure 37). Among clinic respondents

interviewed prior to FY10, nearly three in ten (28%) said they did not receive any

counseling through the program (Figure 38).

Among clinic respondents who said they received individual counseling (n = 625), 21%

received individual counseling once, 30% two or three times, and 17% four or five times

(Figure 39).

Among clinic respondents who said they received group counseling (n = 138), 17%

received group counseling once, 33% two or three times, and 20% four or five times

(Figure 40).

Among clinic respondents who said they received Quitline counseling (n = 131), 31%

received Quitline counseling once, 31% two or three times, and 16% four or five times

(Figure 41).

50

Figure 37: Types of counseling received by clinic program respondents (data collected in FY10)

Figure 38: Types of counseling received by clinic program respondents (data collected prior to

FY10)

59%

4% 2%5% 7%

0% 1%

22%

0%

20%

40%

60%

80%

100%

Individual

only

Group only Quitline

only

Individual

and group

Individual

and

Quitline

Quitline

and group

All three None

42%

8% 7% 6% 6%1% 1%

28%

0%

20%

40%

60%

80%

100%

Individual

only

Group only Quitline

only

Individual

and group

Individual

and

Quitline

Quitline

and group

All three None

51

Figure 39: Distribution of the number of times clinic respondents received individual counseling

Figure 40: Distribution of the number of times clinic respondents received group counseling

Figure 41: Distribution of the number of times clinic respondents received Quitline Iowa

counseling

21%15% 15% 12%

5%13%

1% 5%0% 4% 0% 4% 0% 0% 4%

0%

20%

40%

60%

80%

100%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

17% 16% 17% 14%6% 9%

0% 4% 1% 4% 1%8%

0% 0% 4%

0%

20%

40%

60%

80%

100%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

31%

19%12% 12%

4%9%

2%7%

0% 2% 0% 0% 0% 0% 3%

0%

20%

40%

60%

80%

100%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

52

Clinic Program Pharmacotherapy

Follow-up question: How many times did you go to the pharmacy to pick up (name of product)?

Note: In FY08 the pharmacotherapies offered were patches, gum, and a pill to help you quit. At

the beginning of FY09 this list was modified to be patches, gum, Chantix or varenicline,

Wellbutrin, Zyban, or bupropion, lozenge, and inhaler. Thus, responses are not based on

consistent respondent sample sizes because the proportions have different denominators. The

category a pill to help you quit was not included in analysis due to the small sample size (n =

46).

Findings:

Most clinic respondents (92%) said they received some form of pharmacotherapy through

the program.

Among those clinic respondents who said they received pharmacotherapy, 29% used

NRT patches at some point during their participation in the program. Of these, 43%

reported picking up only one prescription of NRT patches (see Figure 42 for the number

of times respondents said they picked up patches).

More than eight in ten clinic respondents (83%) picked up any prescriptions of Chantix

through the program (see Figure 43 for the number of times they picked up Chantix).

Less than 1% of clinic respondents who said they received any pharmacotherapy picked

up any prescriptions of Wellbutrin through the program (see Figure 44 for the number of

times they picked up Wellbutrin).

Less than 1% of clinic respondents who used pharmacotherapy reported picking up any

prescriptions of NRT gum, NRT lozenges, or NRT inhalers through the program (data

not shown due to small sample size).

Figure 42: Distribution of number of times clinic respondents received NRT patches (among

those who received patches; n = 277)

43%

18%12%

8% 5%14%

0%

20%

40%

60%

80%

100%

1 2 3 4 5 6

53

Figure 43: Distribution of number of times clinic respondents received Chantix (among those

who received Chantix; n = 758)

Figure 44: Distribution of number of times clinic respondents received Wellbutrin (among those

who received Wellbutrin; n = 78)

21% 20% 15%12%

5%14%

<1% 4% <1% 2% <1%6%

0%

20%

40%

60%

80%

100%

1 2 3 4 5 6 7 8 9 10 11 12

41%

24%

10% 12%3%

10%

0%

20%

40%

60%

80%

100%

1 2 3 4 5 6

54

Program Satisfaction

Follow-up question: Was the amount of nicotine replacement therapy you received from

(Quitline/the program) more than enough, just right, or not enough for you to quit successfully?

Findings:

Consistent with the actual amounts offered, larger proportions of clinic respondents than

Quitline respondents were satisfied with the amount of NRT they received through the

program (Figures 45 and 46).

Among Quitline respondents, nearly half of the 3- and 6-month cohorts (45% and 48%

respectively) said they did not receive enough NRT through the program. Slightly over

half (52%) of respondents in the 12-month cohort felt this way.

Among clinic respondents, 29% of the 3-month cohort, 40% of the 6-month cohort, and

41% of the 12-month cohort said they did not receive enough NRT.

Figure 45: Perception of amount of NRT received among Quitline respondents

Figure 46: Perception of amount of NRT received among clinic respondents

6%

8%

8%

27%

28%

30%

52%

48%

45%

15%

16%

18%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month

More than enough Just right Not enough Did not receive

13%

11%

15%

42%

40%

48%

41%

40%

29%

4%

9%

8%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month


55

Follow-up question: Was the amount of counseling you received from (Quitline/the program)

more than enough, just right, or not enough for you to quit successfully?

Findings:

Similar proportions (about half) of clinic respondents and Quitline respondents were

satisfied with the amount of counseling they received through the program (Figures 47

and 48).

Among Quitline respondents, one-third of the 3- and 6-month cohorts (32% and 36%,

respectively) said they did not receive enough counseling through the program. Over four

in ten (42%) respondents in the 12-month cohort felt this way.

Among clinic respondents, 25% of the 3-month cohort, 31% of the 6-month cohort, and

34% of the 12-month cohort said they did not receive enough counseling.

Figure 47: Perception of amount of counseling received among Quitline respondents

Figure 48: Perception of amount of counseling received among clinic respondents

8%

9%

9%

36%

41%

44%

42%

36%

32%

15%

14%

14%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month


12%

12%

10%

47%

48%

51%

34%

31%

25%

8%

8%

14%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month


56

Follow-up question: Would you recommend (Quitline/these) services to someone who was

trying to quit smoking?

Findings:

Among respondents in all three cohorts of both the Quitline and clinic cessation

respondents, the vast majority (86% to 96%) said they would recommend services of

their program to someone who was trying to quit (Figures 49 and 50).

Figure 49: Likelihood of recommending Quitline services to others

Figure 50: Likelihood of recommending clinic program services to others

89%

91%

92%

11%

8%

8%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month

Yes No

96%

95%

96%

4%

5%

4%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month

Yes No

57

Follow-up question: Overall, how would you rate your satisfaction with (Quitline Iowa/the

tobacco cessation/treatment program)?

Findings:

The majority of respondents (75% or greater) in both the Quitline and clinic cessation

programs were either very satisfied or satisfied with the programs (Figures 51 and 52).

Figure 51: General satisfaction with Quitline services

Figure 52: General satisfaction with clinic cessation program services

29%

33%

35%

48%

48%

47%

15%

13%

12%

8%

6%

6%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month

Very satisfied Satisfied Dissatisfied Very dissatisfied

38%

36%

44%

45%

43%

41%

13%

14%

11%

4%

6%

5%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month

Very satisfied Satisfied Dissatisfied Very dissatisfied

58

Previous Cessation Attempts

Follow-up question: During the past (3, 6 or 12 months), how many different times have you

stopped smoking or using other tobacco products for one day or longer because you were trying

to quit?

Findings:

For both programs, the proportion of all respondents who had made at least one quit

attempt during the follow-up period increased over time (Figures 53 and 54). By 12

months, most (77% to 79%) had made at least one quit attempt.

Figure 53: Number of quit attempts during follow-up period among Quitline respondents

Figure 54: Number of quit attempts during follow-up period among clinic respondents

21%

29%

35%

29%

28%

30%

40%

36%

30%

7%

5%

4%

3%

2%

1%

1%

0%

0%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month

0 1 2-5 6-10 11-20 More than 20

23%

26%

33%

41%

40%

40%

29%

28%

20%

5%

4%

5%

2%

0%

1%

1%

1%

0%

0% 20% 40% 60% 80% 100%

12-month

6-month

3-month

0 1 2-5 6-10 11-20 More than 20

59

Follow-up question: During the past (3, 6, or 12 months), did you use any of the following

medications to quit? (Select all that apply.)

Note: In the FY08 version of the questionnaire, response options were Nicotine gum, Nicotine

lozenge, Nicotine patch, Nicotine inhaler, Nicotine nasal spray, and a pill like Chantix or

bupropion. At the beginning of FY09 the questionnaire was modified to be Nicotine gum,

Nicotine lozenge, Nicotine patch, Nicotine inhaler, Nicotine nasal spray, Chantix or varenicline,

and Wellbutrin, Zyban, or bupropion.

Findings:

Among Quitline respondents, 4,529 individuals (76%) said they used some form of

pharmacotherapy during the follow-up period. Of these, 44% used the NRT patch and

37% used Chantix (Figure 55).

Among clinic respondents, 901 individuals (87%) said they used some form of

pharmacotherapy during the follow-up period. Of these individuals, 73% used Chantix

and 14% used the NRT patch (Figure 56).

Figure 55: Use of pharmacotherapy during follow-up period among Quitline respondents

Figure 56: Use of pharmacotherapy during follow-up period among clinic respondents

1%

0%

1%

8%

44%

7%

37%

0% 20% 40% 60% 80% 100%

A pill to help you quit

NRT nasal spray

NRT inhaler

NRT gum

NRT patch

Wellbutrin

Chantix

4%

0%

1%

1%

14%

6%

73%

0% 20% 40% 60% 80% 100%

A pill to help you quit

NRT nasal spray

NRT inhaler

NRT gum

NRT patch

Wellbutrin

Chantix

60

Follow-up question: During the past (3, 6, or 12 months), did you use any of the following

methods to quit? (Select all that apply.)

Note: In FY09, the response options for this question were modified slightly to include the

category self-help materials from Quitline. Thus, responses to this question are not based on

consistent sample sizes.

Findings:

Among Quitline respondents, 5,297 individuals (89%) said they used one of the methods

listed to help them quit using tobacco. Of these, tapering down was the most common

(63%; Figure 57).

Among clinic respondents, 890 individuals (86%) said they used one of the methods

listed to help them quit using tobacco. Of these, 63% used tapering down (Figure 58).

Figure 57: Quit strategies used during follow-up period by Quitline respondents

Figure 58: Quit strategies used during follow-up period by clinic respondents

4%

8%

0%

0%

3%

1%

0%

5%

16%

63%

0% 20% 40% 60% 80% 100%

Other

Quitline counseling

Individual counseling

Group counseling

Self-help materials from Quitline

Self-help site on the Internet

Any other self-help materials not on-line

Followed the advice of a health care provider

Quit cold turkey

Tapered down

2%

5%

1%

1%

0%

1%

16%

12%

63%

0% 20% 40% 60% 80% 100%

Quitline counseling

Individual counseling

Group counseling

Self-help materials from Quitline

Self-help site on the Internet

Any other self-help materials not on-line

Followed the advice of a health care provider

Quit cold turkey

Tapered down

61

Low-Income Cigarette Smokers

In both the Quitline and clinic samples, slightly over half of respondents reported an annual

household income from all sources of less than $20,000 (55% and 56%, respectively).

Note: Baseline results are based on the entire sample of all respondents. In comparison, follow-

up results are based on those respondents who reported smoking cigarettes at the time of their

first call to Quitline Iowa or the time of their first pick-up of a pharmacotherapy prescription

through the clinic cessation program.

Findings:

Overall, larger proportions of low-income respondents than higher-income respondents

reported smoking in the past 30 days (Figures 59 and 60). In the clinic sample, the

differences in frequency of cigarette smoking were statistically significant at the 3- and

12-month follow-up compared to baseline.

Figure 59: Any cigarette use in the past 30 days at baseline and follow-up, Quitline respondents

Figure 60: Any cigarette use in the past 30 days at baseline and follow-up, clinic respondents

99%

83% 84% 84%

96%

75% 75% 72%

0%

20%

40%

60%

80%

100%

Baseline 3-month 6-month 12-month

Low-income Higher-income

99%

78% 77% 80%

98%

64%70%

65%

0%

20%

40%

60%

80%

100%

Baseline 3-month 6-month 12-month

Low-income Higher-income

62

Medicaid and Cessation

Medicaid offers a tobacco cessation benefit to members in Iowa. Through this benefit, Medicaid

recipients are provided with free pharmacotherapy such as Chantix or NRT as long as they are

enrolled in Quitline telephone counseling. CSBR worked with IDPH, Medicaid, and National

Jewish Health to assess smoking cessation among Quitline callers who were receiving

counseling through the Medicaid benefit.

Two groups of follow-up respondents were examined to assess cessation among Medicaid

referrals to Quitline Iowa. The first group included follow-up respondents identified by National

Jewish Health as Medicaid referrals. The second group included respondents who were assumed

to be Medicaid referrals based on their responses to the following two questions:

Follow-up question: Which of the following best describes your own health insurance situation?

Follow-up question: Did Medicaid pay for any of the medication or nicotine replacement

therapy that you took to help you quit smoking in the last (3, 6 or 12) months?

Respondents who indicated that Medicaid was their insurance provider and that Medicaid paid

for their pharmacotherapy were classified as Medicaid referrals (i.e., Group 2).

Group 1: Respondents identified as Medicaid referrals by National Jewish Health

Among the follow-up interviews, 367 were identified as Medicaid fax referrals to Quitline Iowa.

Of these, 353 said they smoked cigarettes when they first called Quitline Iowa. Among these

cigarette smokers, 17% (n = 61) had quit smoking (Figure 61).

Group 2: Respondents assumed to be Medicaid referrals based on follow-up answers

Among the follow-up interviews, 1,160 respondents said they were both covered by Medicaid

and that Medicaid paid for their pharmacotherapy during the follow-up period. Of these, 1,133

said they smoked cigarettes when they first called Quitline Iowa. Among these cigarette

smokers, 21% (n = 238) had quit smoking (Figure 61).

Figure 61: Cessation rates among Medicaid callers to Quitline Iowa

17%

83%

21%

79%

0%

20%

40%

60%

80%

100%

Group 1 Quit Group 1 Not Quit Group 2 Quit Group 2 Not Quit

63

Highlights

153 secret shopper calls were placed to Quitline Iowa during FY10. Consent for

evaluation was asked in 82% of calls.

During FY10, CSBR research staff reviewed 907 charts at participating health centers

(458 participants and 449 non-participant charts). Smoking status was assessed at 94% of

clinic visits for all charts reviewed.

Main Findings: Other Data Collection Methods

64


65

Secret Shopper Calls

Research team members placed 153 secret shopper calls to Quitline Iowa during FY10. The

average time on hold before being able to speak with a Quitline representative was 25 seconds.

Consent for being included in the program evaluation was asked in 82% of secret shopper calls

(Table 11).

Select notes from secret shopper calls:

Calls placed during the lunch hour and in the evenings generally resulted in longer hold

times. When calling in the early morning, there was often no waiting time before

speaking with intake, and very little time waiting to speak with a coach. When calling

during the day, specifically around lunchtime, there was a longer wait to speak with both

intake and coaching. When calling in the evening, there was a longer wait to speak with

intake but usually there was no wait to speak with the coach.

The quality of calls (intake and coaching) varied depending on the individuals conducting

the intake and coaching, although in most cases protocol was followed and the calls were

conducted professionally.

Table 11: Quitline secret shopper calls

Measure Number (N) Percent (%)

Type of call

Information only

Intake only

Coaching

10

61

82

6.5

39.9

53.6

Demographic information assessed 143 100.0

Tobacco history assessed 143 100.0

Readiness to quit assessed 113 79.0

Contact information recorded 143 100.0

Provided general program information 145 95.4

Offered to send informational materials 136 88.9

Health history assessed 142 98.6

Enrolled in coaching program 143 100.0

Asked for consent to follow-up 117 81.8

Transferred to coach directly 81 56.6

Scheduled time to speak with coach 60 100.0

Scheduled next coaching session 80 97.6

66

Chart Reviews

One of the primary goals of the clinic cessation program is to create systems change. An

important component of this for tobacco control and prevention is screening for tobacco use in

the healthcare setting. To assess this goal and to explore characteristics of participants and non-

participants in the program, chart reviews were conducted in May 2008, November 2008, May

2009, November 2009, and May 2010. Since the initial implementation of the program in

February 2008, evaluation research staff members have reviewed 1,018 participant charts and

931 non-participant charts. During FY10, 907 charts were reviewed (458 participants and 449

non-participants).

Demographic findings among FY10 charts:

The majority of participants and non-participants whose charts were reviewed were

between 42 and 43 years old, were White, not of Hispanic origin, and English speakers

(Table 12).

Nearly one-fourth (23%) of program participant charts documented that the participant

had quit smoking or using tobacco in the past six months.

Associations between quit rates of participants and demographic characteristics showed

no significant differences based on gender, race, Hispanic ethnicity, or primary language.

Table 12: Clinic chart review demographic characteristics

Characteristic Participants Non-Participants

Age (mean) 42.3 years 42.7 years

Number % Number %

Gender

Male 430 43 351 38

Female 580 57 579 62

Pregnant* 6 1 22 4

Race

White 864 87 598 67

African American/ Black 85 9 99 11

Asian 1 <1 20 2

American Indian/Alaskan Native 8 1 2 <1

Native Hawaiian/Pacific Islander 0 0 3 <1

Other 33 3 165 19

Hispanic or Latino 36 4 168 20

Primary Language

English 980 98 746 83

Spanish 20 2 130 15

Other 1 <1 22 2 *Note. Proportion of pregnant respondents based only on female respondents.

67

Assessing smoking status at medical visits: The percentage of visits where smoking status was

recorded in the chart was assessed based on the ratio of the times smoking status was recorded

and the total number of medical visits recorded in the charts. For example, a chart containing five

records of smoking status during 10 medical visits would represent a 50% recording rate.

Findings:

In about 8 in 10 of the charts reviewed, smoking status was assessed at 100% of recorded

visits (Figure 62).

Overall, among all charts reviewed, the mean percent of visits at which smoking status

was recorded was 93%. Among program participants, smoking status was recorded at

97% of visits. Among non-participants, smoking status was recorded at 88% of visits.

Figure 62: Percent of clinic visits at which smoking status was recorded

3% 4% 5% 1%

87%

10% 9%3% 0%

78%

0%

20%

40%

60%

80%

100%

Less than 50% 50-74% 75-89% 90-99% 100%

Participants Non-participants

68


69

The vast majority of participants in the Quitline Iowa and clinic cessation programs are trying to

quit smoking cigarettes rather than stop using other tobacco products. Results from the follow-

up interviews conducted with program participants suggest that cessation rates at 3, 6, and

12 months post intervention are approximately 20% among Quitline respondents and

approximately 28% among clinic respondents. Individuals surveyed 3 months after they

started one of the programs quit smoking at a rate comparable to individuals surveyed at 6 and

12 months after they started one of the programs; i.e., the cessation rates remain relatively

constant across time.

Cessation rates did vary across demographic characteristics. Among Quitline respondents,

cessation rates were significantly higher among males, respondents of non-Hispanic origin, those

who do not live with a smoker, those with higher incomes, and those who reported being in good

health. Variation was seen in cessation rates across racial groups, but these differences were not

statistically significant, and the sub-sample sizes were small. Among clinic respondents,

cessation rates were significantly higher among respondents who do not live with a smoker,

those with higher incomes, and those who reported being in good health. Apparent variation was

seen in cessation rates across the other demographic characteristics, but as with the Quitline

respondents, these differences were not statistically significant, and the sub-sample sizes were

small.

A reduction in the number of cigarettes smoked per day may be evidence that a proportion of

Quitline and clinic respondents are in the process of quitting. Smokers in both program samples

reduced the number of cigarettes they smoked per day. The greatest difference was seen in the

interval between baseline and the 3-month follow-up cohort, rather than from baseline to either

the 6- or 12-month cohorts.

In general, there was very little change in which types of tobacco products were used from

program entry (baseline) to follow-up. However, the percent of respondents who said they did

not use any tobacco products increased from 0% at baseline to 21% at follow-up among Quitline

respondents and from 0% to 30% among clinic respondents. The majority of Quitline and clinic

respondents who changed the type of tobacco product they used during the follow-up period in

both the Quitline and clinic samples quit using smokeless tobacco and cigarettes. In both

samples, most respondents who said they were cigarette smokers at baseline did not supplement

or replace their cigarette use with smokeless tobacco from baseline to follow-up.

Between one-half and two-thirds of all respondents believed it was probable that they would use

tobacco products in the next year. The same proportion of respondents believed it was probable

that they would use pharmacotherapy in the next year. Most respondents who had quit smoking

Summary and Conclusions

70

believed their behavior change would last at least one year, but one in five believed they would

need pharmaceutical support to ensure that permanence.

Among both Quitline and clinic respondents, the most commonly mentioned motivator for

quitting were health reasons (i.e., smoking is bad for one’s health) and the expense of cigarettes.

That cigarette smoking bothers other people and cigarette smoking relieves tension were rated as

the two most important factors in the decision whether or not to smoke among respondents in

both the Quitline and clinic groups who had not yet quit smoking. Similarly, respondents who

had not yet quit smoking said the things they liked best about smoking were that it helps them

deal with tension or stress, helps them relax, and helps when they are upset or angry. Finally,

respondents in both groups who had not quit said they were most tempted to smoke when they

are anxious, stressed, or angry. These results suggest that those who quit are motivated to do so

for health reasons, but those who do not quit are drawn most strongly to the perceived calming

properties of a cigarette.

One-half of Quitline respondents said they spoke with a Quitline representative only one or two

times. Approximately six in ten respondents said they received NRT from Quitline, with nicotine

replacement patches being the most commonly received form. More than 60% of Quitline

respondents who had not yet quit smoking recalled the following aspects of their Quitline

coaching sessions: talking about past quit experiences, setting a quit date, reducing the amount of

tobacco used, identify negative things about smoking, finding ways to overcome roadblocks to

quitting, and developing a quit plan. Quitline respondents who had not yet quit smoking were

generally positive that they would eventually quit smoking successfully. In general, Quitline

respondents who had not yet quit smoking were positive about their experience with Quitline

Iowa. A majority of respondents said the people at Quitline listened carefully, were helpful, and

cared about the callers.

In FY10, language in the follow-up questionnaire was modified to clarify for respondents that

brief provider interventions are included in what is meant by “individual counseling.” Yet, nearly

six in ten (59%) clinic respondents interviewed in FY10 said they received only individual

counseling through the program. Over two in ten (22%) said they did not receive any of the three

types of counseling. Among clinic respondents interviewed prior to FY10, 28% said they did not

receive any counseling through the program. The decrease in the proportion of respondents who

said they did not receive counseling is a positive change, but still unexpectedly high. To receive

any pharmacotherapy, participants must also receive an accompanying counseling session (one

counseling session and one 2-week supply of pharmacotherapy constitute a completed “course”

and clinics are reimbursed for completed courses). A possible disconnect remains in how many

respondents define different types of counseling when being interviewed for the evaluation and

perhaps also how treatment providers define their counseling sessions.

In general, the majority of respondents in both the Quitline and clinic samples felt they had

received enough counseling through the respective programs. The exception is the 12-month

71

follow-up cohort among Quitline respondents, where only 44% said they had received enough

counseling. Quitline respondents were much more likely to say that they did not feel they had

received enough NRT through the program. Given that Quitline provides only two weeks of free

NRT to callers, it is not surprising that the majority of Quitline callers did not feel they received

enough NRT. Most respondents in both samples were likely to recommend the respective

programs to others who want to quit using tobacco and the majority of respondents were

generally satisfied with the services they received.

For both programs, the proportion of respondents who had made at least one quit attempt during

the follow-up period increased over time. By 12 months, over three-fourths of all respondents in

both the Quitline and clinic samples had made at least one quit attempt. After one year, 29% of

Quitline respondents had made only one quit attempt; 41% of clinic respondents had made only

one attempt.

Larger proportions of low-income respondents than higher-income respondents reported

smoking in the past 30 days. In the clinic sample, the differences in frequency of cigarette

smoking were statistically significant at the 3- and 12-month follow-up compared to baseline.

Cessation rates among Medicaid referrals to Quitline Iowa were similar to those in the larger

population of respondents.

Secret shopper calls conducted with Quitline Iowa suggest that provider protocol is being

followed in the majority of calls. Chart review data show that tobacco use status was assessed at

93% of clinic visits among both participants and non-participants of the clinic cessation program

during FY10. Nearly one-fourth (23%) of program participant charts documented that the

participant had quit smoking or using tobacco in the past six months. Associations between quit

rates of participants and demographic characteristics showed no significant differences based on

gender, race, Hispanic ethnicity, or primary language.

The Quitline and clinic cessation programs are effectively supporting Iowans who want to quit

using tobacco products, particularly cigarettes. With a cigarette smoking cessation rate of

approximately 20-30% even one year after beginning a treatment program, it is clear that the

state-funded tobacco cessation programs are positively impacting smokers in Iowa. Findings

from follow-up interviews and chart reviews provide a similar picture of this positive impact:

About 1 in 5 Quitline and clinic respondents quit smoking.

The negative health consequences of smoking was by far the most common reason

respondents gave for trying to quit.

Regardless of whether or not they successfully quit, most respondents rated their

experience with Quitline Iowa and the clinic program positively.

72


73

Appendix A

Quitline Follow-Up

Questionnaire

74

[Space left blank intentionally]

75

SECTION 1: Prior to, first call, and during program

During this interview, I’m going to ask you questions about your tobacco use and experience

with Quitline.

Q1a-d. Think back to when you first called Quitline (show: 3, 6, or 12 months ago). During the

30 days before your first call, on how many days did you

a. Smoke cigarettes?

b. Smoke cigars?

c. Smoke tobacco in pipes?

d. Use chew or smokeless tobacco?

0-30. Number of days

77. Don’t know/Not sure

99. Refused

Note: If Q1a = 0 skp Q3

Q2. On the average, on days when you smoked, about how many cigarettes did you smoke a

day? (Note to interviewer: 1 pack=20 cigarettes. Verify 61 or more cigarettes.)

1-180. Number of cigarettes____

666. Less than one cigarette per day


999. Refused

Q3. Think about a typical morning back when you first called Quitline. How soon after waking

up did you first use any tobacco product?

1. Within 5 minutes of waking

2. 6-30 minutes after waking


4. More than 60 minutes after waking


9. Refused

76

Note: If Q1a = 0 skp Q4b

Q4a. Why did you decide to quit smoking cigarettes? [SELECT ALL THAT APPLY]

11. It is bad for my health

12. I had a health event like a heart attack or diagnosis

13. It was getting too expensive

14. Nicotine replacement therapy (like a patch, gum, or pill) was available for free or

at reduced cost

15. Family or friends wanted me to

16. Concerned about the health or well-being of others

17. Motivation from media campaign in newspapers, on television, or online

18. Employer/Workplace policy

19. Just didn't like it anymore

20. Too few places allow smoking

21. Recommended by a healthcare professional

22. Embarrassed to smoke

23. Pregnant

24. Wanted to be a good role model

66. Other [Specify]

77. Don’t know/Not Sure

99. Refused

C: If Q1b=0 and Q1c=0 and Q1d=0 skp Q5

Q4b. Why did you decide to quit using tobacco products?




14. Nicotine replacement therapy (like a patch, gum, or pill) was available for free or

at reduced cost






20. Too few places allow it


22. Embarrassed to use tobacco products

23. Pregnant


66. Other [Specify]


99. Refused

77

Q5. How many times did you speak with a Quitline Iowa representative over the phone?

(Interviewer note: if respondent isn’t sure, ask them to give their best guess of a single

number)

1-15. Number of times (15=15+)


99. Refused

Q6. Which type of nicotine replacement therapy, if any, did you receive from the Quitline?

(Interviewer note: if respondent answers anything other than patch, gum, or lozenge, such as

Chantix, confirm that they did not receive patch, gum, or lozenge and enter “8”)

(Read 1 – 3)

1. Patch

2. Gum

3. Lozenges

8. I did not receive nicotine replacement therapy from Quitline


9. Refused

SECTION 2: Current tobacco use

Now I’ll ask some questions about your current cigarette and tobacco use.

Q7a-d. In the past 30 days, on how many days did you…


b. Smoke cigars?





99. Refused

Note: If Q7a = 0 skp Q9

Q8. On the average, on days when you smoked during the past 30 days, about how many

cigarettes did you smoke a day? (Note to interviewer: 1 pack=20 cigarettes. Verify 61 or more

cigarettes.)




999. Refused

78

Note: If Q7a=0 and Q7b=0 and Q7c=0 and Q7d=0 skp Q10a

Q9. How soon after you wake up do you first use any tobacco products?






9. Refused

Note: if Q1a = 0 and Q7a =0 skp Q10b

Q10a. How does your current cigarette use compare to your use when you first called Quitline?

Do you currently smoke…

1. A lot less,

2. Somewhat less,

3. About the same number,

4. Somewhat more, or

5. A lot more cigarettes now?


9. Refused

Note: if Q1b = 0 and Q7b =0 skp Q10c

Q10b. How does your current cigar use compare to your use when you first called Quitline? Do

you currently smoke…

1. A lot less,

2. Somewhat less,



5. A lot more cigars now?


9. Refused

79

Note: if Q1c = 0 and Q7c =0 skp Q10d

Q10c. How does your current pipe use compare to your use when you first called Quitline? Do


1. A lot less,

2. Somewhat less,



5. A lot more pipe bowls now?


9. Refused

Note: if Q1d = 0 and Q7d =0 skp Q11a

Q10d. How does your current chew use compare to your use when you first called Quitline? Do

you currently chew…

1. A lot less,

2. Somewhat less,

3. About the same amount,


5. A lot more now?


9. Refused

SECTION 3: Quit attempts/Cessation

Now I’m going to ask a few questions about your past attempts to quit using tobacco products.

Q11a. During the past (3, 6 or 12 months), how many different times have you stopped

smoking or using other tobacco products for one day or longer because you were trying to quit?

0-365. Number of times


999. Refused

Note: if Q7a>0 or Q7b>0 or Q7c>0 or Q7d>0 skp Q12

Q11b. When did you quit using tobacco products?

[Interviewer: Probe for exact date, but enter 01 for MM and/or DD, when respondent is

not specific enough]

Day/Month/Year

01011999. DON’T KNOW/NOT SURE & REFUSED

80

Q12. During the past (3, 6 or 12 months), did you use any of the following medications to quit?

Just tell me yes or no for each one. (Read 11-17 and select all that apply)

11. Nicotine gum

12. Nicotine lozenge

13. Nicotine patch

14. Nicotine inhaler

15. Nicotine nasal spray

16. Chantix or varenicline

17. Wellbutrin, Zyban, or Bupropion

66. Other [Specify]

88. None


99. Refused

Note: if any Q12 = Yes, go to Q12a

Note: if any Q12 = No, go to Q12b

Q12a. How helpful was this medication for you to quit or reduce your tobacco use? Was it…

1. Very helpful

2. Somewhat helpful

3. Not at all helpful


9. Refused

Q12b. How helpful do you think it would be if you used this medication to help you quit or

reduce your tobacco use?

1. Very helpful

2. Somewhat helpful



9. Refused

81

Q13. In the past (3, 6, or 12 months), did you use any of the following methods to quit? (Read

11-19 and select all that apply)

11. Quitline telephone counseling

12. Individual, face to face counseling

13. Group, face to face

14. Self-help materials from Quitline

15. Any other self-help materials not on the internet

16. A self-help site on the Internet (like QuitNet)

17. Followed advice from physician/other healthcare provider

18. Cold turkey

19. Tapering down (gradually reducing the number of cigarettes you smoke)

66. Other [Specify]

88. None


99. Refused

Note: if any Q13 = Yes, go to Q13a

Note: if any Q13 = No, go to Q13b

Q13a. How helpful was this method for you to quit or reduce your tobacco use? Was it…

1. Very helpful

2. Somewhat helpful



9. Refused

Q13b. How helpful do you think it would be if you used this method to help you quit or reduce

your tobacco use?

1. Very helpful

2. Somewhat helpful



9. Refused

82

Q14. During the last (3, 6 or 12 months), what is the longest period of time you did not smoke

cigarettes or use any other tobacco products?

101-107. Days

201-252. Weeks

301-312. Months


888. Respondent has not gone one day or longer without tobacco

999. Refused

Q15. Do you think you will use tobacco anytime during the next year? [READ 1-4]

1. Definitely yes

2. Probably yes

3. Probably not

4. Definitely not


9. Refused

Q16. Do you think you will use any kind of nicotine replacement therapy or medication to help

you quit such as a patch, gum, lozenge, or pill at anytime during the next year? [READ 1-4]

1. Definitely yes

2. Probably yes

3. Probably not

4. Definitely not


9. Refused

Please respond to the following statements by telling me if you strongly agree, agree, disagree, or

strongly disagree.

Q17. Nicotine replacement therapy like a patch, gum, or pill causes cancer.

1. Strongly agree

2. Agree

3. Disagree

4. Strongly disagree

7. Don’t know/not sure

9. Refused

83

Q18. Nicotine replacement therapy is helpful for people who want to quit using tobacco.

1. Strongly agree

2. Agree

3. Disagree



9. Refused

Q19. Nicotine replacement therapy is more dangerous than smoking cigarettes.

1. Strongly agree

2. Agree

3. Disagree



9. Refused

SECTION 4: Services

Q20. Was the amount of nicotine replacement therapy you received from Quitline more than

enough, just right, or not enough for you to quit successfully?

1. More than enough

2. Just right

3. Not enough

4. Did not receive NRT


9. Refused

Q21. Was the amount of counseling you received from Quitline more than enough, just right, or

not enough for you to quit successfully?

1. More than enough

2. Just right

3. Not enough

4. Did not receive counseling


9. Refused/No answer

84

Q22. Would you recommend Quitline services to someone who was trying to quit smoking?

1. Yes

2. No


9. Refused

Q23. Overall, how would you rate your satisfaction with Quitline Iowa? Were you…

1. Very satisfied,

2. Satisfied,

3. Dissatisfied, or

4. Very dissatisfied?


9. Refused

SECTION 6: Demographics

Read: Now I’m going to ask a few questions about you.

Q24. Do you live with a smoker?

1. Yes

2. No


9. Refused

Q25. Are you Hispanic or Latino?

1. Yes

2. No


9. Refused

85

Q26. Which of the following would you say best represents your race?

1. White or Caucasian

2. Black or African American

3. Asian

4. American Indian or Alaska Native

5. Native Hawaiian or Pacific Islander

6. Other: [specify]


9. Refused

Q27. Is your annual household income from all sources…

[READ AS APPROPRIATE]

1. Less than $20,000,

2. $20,001 - $40,000,

3. $40,001 - $60,000,

4. $60,001 - $80,000, or

5. $80,001 or more?


9. Refused

Q28. Would you say that in general your health is…

1. Excellent,

2. Very good,

3. Good,

4. Fair, or

5. Poor?


9. Refused

Q29. What is your zip code?

__ __ __ __ __ (5 digit zip code)

77777 Don’t know/Not sure

99999 Refused

86

Q30. Which of the following best describes your own health insurance situation?

1. Private insurance (self-pay or through employer)

2. Medicaid

3. Medicare

4. Military health care (includes veterans)

5. No health insurance

6. Other: [specify:______________________]


9. Refused

Q31. Did Medicaid pay for any of the medication or nicotine replacement therapy that you took

to help you quit smoking in the last (3, 6 or 12) months?

1. Yes

2. No


9. Refused

Q32. Were you referred to Quitline by your doctor or another healthcare provider?

1. Yes

2. No


9. Refused

Note: if Q7a=0, skp FINAL STATEMENT

87

SECTION 7: Current Smokers Only

Read: Earlier you told me that you have smoked cigarettes on at least one of the past 30 days.

Now I’m going to ask you some questions about your current smoking.

NQ1. The following statements represent things some people like and don’t like about smoking.

Please tell me how important each one is to you when you’re deciding whether or not to smoke.

a. Smoking cigarettes relieves tension.

b. I’m embarrassed to have to smoke.

c. Smoking helps me concentrate and do better work.

d. My cigarette smoking bothers other people.

e. I am relaxed and therefore more pleasant when smoking.

f. People think I’m foolish for ignoring the warnings about cigarette smoking.

Would you say this is…

1. Not important,

2. Slightly important,

3. Moderately important,

4. Very important, or

5. Extremely important to your decision to smoke?

9. Refused

NQ2. The following situations lead some people to smoke. Please tell me how tempted you may

be to smoke in each situation.

a. With friends at a party.

b. When I first get up in the morning.

c. When I am very anxious and stressed.

d. Over coffee while talking and relaxing.

e. When I feel I need a lift.

f. When I am very angry about someone or something.

g. With my spouse or close friend who is smoking.

h. When I realize I haven’t smoked in a while.

i. When things are not going my way and I am frustrated.

Would you say…

1. Not at all tempted,

2. Not very tempted,

3. Moderately tempted,

4. Very tempted, or

5. Extremely tempted?

9. Refused

88

NQ3. Which of the following, if any, are things you like about smoking? Just tell me yes or no

for each one.

a. It helps me relax

b. It helps me deal with tension or stress

c. It helps me when I am upset or angry

d. It’s something to do when I’m bored

e. I enjoy the taste

f. It helps me when I am feeling down or depressed

g. It helps me concentrate

h. It helps me control my weight

i. It helps me when I am worried or anxious

j. I enjoy being around other smokers

k. I enjoy the feeling of a cigarette in my hand

1. Yes

2. No


9. Refused

NQ4. Which of the following, if any, are some of the challenges to your quitting successfully?

Just tell me yes or no for each one.

a. People I live with smoke

b. Strong cravings

c. Stress

d. Unable to concentrate or focus

e. People in my family smoke

f. Gaining weight

g. Becoming irritable

h. Other mood symptoms like sadness, anxiety, or depression

i. Conflicts with family

j. It’s just something I can’t control

k. I smoke when I drink alcohol

l. Many of my friends smoke

m. Lack of support from others

1. Yes

2. No


9. Refused

89

NQ5a. A Quitline coach is someone who works with you over the phone to help you quit using

tobacco products by offering suggestions and strategies to deal with cravings and other

challenges to quitting successfully. Have you worked with a Quitline coach over the phone?

1. Yes

2. No


9. Refused

Note: if NQ5a > 1, skp to NQ6

NQ5. Did the Quitline coach you spoke with help you to…

a. Set a quit date?

b. Talk about your past quit experiences?

c. Find ways to overcome roadblocks to quitting?

d. Reduce the amount of tobacco you use?

e. Learn about the five elements crucial to quitting successfully?

f. Develop a quit plan?

g. Plan a way to make your home tobacco free?

h. Plan a way to make your car tobacco free?

i. Identify what you like about smoking?

j. Identify what you don’t like about smoking?

k. Learn about the 3 A’s (Avoid, Alternatives, and Adjust)?

1. Yes

2. No


9. Refused

NQ6. Please tell me how strongly you agree or disagree with the following statements.

a. The people at Quitline listened carefully to what I said.

b. The people at Quitline cared about me.

c. The people at Quitline cared about whether my quit attempt was successful.

d. Using Quitline was inconvenient for me.

e. Using Quitline was difficult.

f. The people at Quitline were helpful.

g. I feel better prepared for my next quit attempt because I used Quitline.

h. Calling Quitline did not make it easier for me to quit using tobacco products.

i. The Quitline services were good, I just wasn’t ready to quit.

j. To be able to quit, I think I would need more frequent contact with a Quitline

coach.

k. To be able to quit, I think I would need to attend more group meetings with other

people who are trying to quit.

90

l. To be able to quit, I think I would need more face-to-face coaching.

m. To be able to quit, I think I would need more free NRT.

n. I’m never going to be able to quit if I only have counseling by phone.

t. No matter how hard I try, I just can’t quit smoking.

u. Eventually cigarettes will just get too expensive, and I’ll have to quit.

p. I am going to keep trying to quit smoking.

s. By this time next year, I will no longer be smoking cigarettes.

q. I think I will quit smoking within the next 5 years.

r. I don’t think I will ever quit smoking.

o. I need face to face counseling to help me quit smoking.

Would you say you…

1. Strongly agree,

2. Agree,

3. Disagree, or

4. Strongly disagree?


9. Refused

FINAL STATEMENT

That’s all the questions I have. The answers of all the participants interviewed will be combined

to describe people’s experiences with the program and to guide its future development. If you

have questions about this survey you may call Disa Cornish at (319) 273-2105. Thank you for

your time and cooperation with this survey. Good-bye.

[INTERVIEWER: HANG UP THE PHONE]

91

Appendix B

Quitline Follow-Up

Frequency Tables

92


93

Table B-1

Q1. Think back to when you first called Quitline. During the 30 days before your first

call, on how many days did you…

Q1a. Smoke cigarettes Number Overall % Valid %

None 142 2.4 2.4

1 to 4 62 1.0 1.1

5 to 9 72 1.2 1.2

10 to 14 65 1.1 1.1

15 to 19 80 1.3 1.4

20 to 24 67 1.1 1.1

25 or more 5374 90.5 91.7

Don’t know/Not sure 76 1.3 -

Not asked/No response - - -

Q1b. Smoke cigars Number Overall % Valid %

None 5569 93.8 94.1

1 to 4 183 3.1 3.1

5 to 9 48 0.8 0.8

10 to 14 16 0.3 0.3

15 to 19 16 0.3 0.3

20 to 24 7 0.1 0.1

25 or more 81 1.4 1.4


Not asked/No response 1 0.0 -

94

Table B-1 (Continued)

Q1. Think back to when you first called Quitline. During the 30 days before your

first call, on how many days did you…

Q1c. Smoke tobacco in

pipes Number Overall % Valid %

None 5828 98.1 98.4

1 to 4 19 0.3 0.3

5 to 9 10 0.2 0.2

10 to 14 6 0.1 0.1

15 to 19 5 0.1 0.1

20 to 24 1 0.0 0.0

25 or more 54 0.9 0.9



Q1d. Use chew or

smokeless tobacco Number Overall % Valid %

None 5676 95.6 95.7

1 to 4 47 0.8 0.8

5 to 9 25 0.4 0.4

10 to 14 22 0.4 0.4

15 to 19 21 0.4 0.4

20 to 24 8 0.1 0.1

25 or more 130 2.2 2.2



95

Table B-2

Q2. On the average, on days when you smoked, about how many cigarettes did you

smoke a day?

Number Overall % Valid %

Less than 5 162 2.7 2.8

5 to 9 399 6.7 6.9

10 to 19 1496 25.2 25.9

20 to 29 2222 37.4 38.4

30 to 39 739 12.4 12.8

40 or more 763 12.8 13.2



Table B-3

Q3. Think about a typical morning back when you first called Quitline. How soon

after waking up did you first use any tobacco product?


Within 5 minutes 2624 44.2 44.6

6-30 minutes 1906 32.1 32.4

31-60 minutes 637 10.7 10.8

More than 60 minutes 719 12.1 12.2



96

Table B-4

Q4a. Why did you decide to quit smoking cigarettes? (select all that apply)


It is bad for my health 3561 60.0 61.4

I had a health event like a heart attack or

diagnosis 756 12.7 13.0

It was getting too expensive 1516 25.5 26.2

NRT was available for free or at reduced cost 14 0.2 0.2

Family or friends wanted me to 478 8.0 8.2

Concerned about the health or well-being of

others 424 7.1 7.3

Motivation from media campaign in

newspapers, on television, or online 8 0.1 0.1

Employer/workplace policy 42 0.7 0.7

Just didn’t like it anymore 528 8.9 9.1

Too few places allow smoking 59 1.0 1.0

Recommended by a healthcare professional 134 2.3 2.3

Embarrassed to smoke 32 0.5 0.6

Pregnant 42 0.7 0.7

Wanted to be a good role model 208 3.5 3.6

Other reason(s) 422 7.1 7.3



97

Table B-5

Q4b. Why did you decide to quit using tobacco products? (select all that apply)



I had a health event like a heart attack or

diagnosis 45 0.8 7.2




Concerned about the health or well-being of

others 36 0.6 5.7

Motivation from media campaign in newspapers,

on television, or online 1 0.0 0.2



Too few places allow it 9 0.2 1.4


Embarrassed to use tobacco products 6 0.1 1.0

Pregnant 1 0.0 0.2





98

Table B-6

Q5. How many times did you speak with a Quitline Iowa

representative over the phone?


1 1689 28.4 29.9

2 1283 21.6 22.7

3 877 14.8 15.5

4 540 9.1 9.6

5 351 5.9 6.2

6 263 4.4 4.7

7 88 1.5 1.6

8 103 1.7 1.8

9 22 0.4 0.4

10 153 2.6 2.7

11 12 0.2 0.2

12 79 1.3 1.4

13 4 0.1 0.1

14 7 0.1 0.1

15 179 3.0 3.2

Don’t

know/Not

sure

274 4.6 -

Not

asked/No

response

14 0.2 -

99

Table B-7

Q6. Which type of NRT, if any, did you receive from the Quitline?


None 1381 23.3 23.4

Patch 3134 52.8 53.1

Gum 488 8.2 8.3

Lozenges 904 15.2 15.3



100

Table B-8

Q7. In the past 30 days, on how many days did you…


None 1315 22.1 22.3

1 to 4 280 4.7 4.7

5 to 9 180 3.0 3.0

10 to 14 193 3.3 3.3

15 to 19 185 3.1 3.1

20 to 24 151 2.5 2.6

25 or more 3605 60.7 61.0




None 5721 96.3 96.4

1 to 4 104 1.8 1.8

5 to 9 27 0.5 0.5

10 to 14 13 0.2 0.2

15 to 19 11 0.2 0.2

20 to 24 2 0.0 0.0

25 or more 54 0.9 0.9



101





None 5895 99.3 99.3

1 to 4 17 0.3 0.3

5 to 9 2 0.0 0.0

10 to 14 2 0.0 0.0

15 to 19 1 0.0 0.0

20 to 24 3 0.1 0.1

25 or more 17 0.3 0.3



Q7d. Use chew or


None 5756 96.9 97.0

1 to 4 44 0.7 0.7

5 to 9 29 0.5 0.5

10 to 14 13 0.2 0.2

15 to 19 20 0.3 0.3

20 to 24 5 0.1 0.1

25 or more 70 1.2 1.2



102

Table B-9

Q8. On the average, on days when you smoked during the past 30 days, about how



Less than 1 per day 623 10.5 13.6

1 to 5 657 11.1 14.3

5 to 9 1440 24.3 31.3

10 to 19 1312 22.1 28.5

20 to 29 324 5.5 7.0

30 to 39 224 3.8 4.9

40 or more 17 0.3 0.4



Table B-10




6-30 minutes 1452 24.5 31.1

31-60 minutes 589 9.9 12.6


Don’t know/Not sure 52 .9 -


103

Table B-11

Q10a. How does your current cigarette use compare to your use when you first

called Quitline? Do you currently smoke…


A lot less 2499 42.1 43.2

Somewhat less 1124 18.9 19.4

About the same number 1872 31.5 32.3

Somewhat more 181 3.0 3.1

A lot more 113 1.9 2.0



Table B-12

Q10b. How does your current cigar use compare to your use when you first called

Quitline? Do you currently smoke…


A lot less 234 3.9 55.7




A lot more 12 0.2 2.9



104

Table B-13

Q10c. How does your current pipe use compare to your use when you first called

Quitline? Do you currently smoke…


A lot less 73 1.2 70.9




A lot more 3 0.1 2.9



Table B-14

Q10d. How does your current chew use compare to your use when you first called

Quitline? Do you currently chew…


A lot less 150 2.5 50.3




A lot more 19 0.3 6.4



105

Table B-15

Q11a. During the past (3, 6, or 12 months), how many different times have

you stopped smoking or using other tobacco products for one day or longer

because you were trying to quit?


0 times 1611 27.1 27.9

1 time 1740 29.3 30.2

2 to 5 times 1971 33.2 34.2

6 to 10 times 290 4.9 5.0

11 to 20 times 109 1.8 1.9

More than 20 times 50 0.8 0.9



Table B-16

Q12. During the past (3, 6, or 12 months), did you use any of the following

medications to quit? (select all that apply)


Nicotine gum 348 5.9 5.9

Nicotine lozenge 85 1.4 1.4

Nicotine patch 1994 33.6 33.6

Nicotine inhaler 37 0.6 0.6

Nicotine nasal spray 3 0.1 0.1

Chantix or varenicline 1670 28.1 28.1

Wellbutrin, Zyban, or

Bupropion 308 5.2 5.2

A pill to help you quit 63 1.1 1.1

Other medication 21 0.4 0.4

None 1409 23.7 23.7



106

Table B-17

Q13. During the past (3, 6, or 12 months), did you use any of the following methods

to quit? (select all that apply)


Quitline telephone

counseling 400 6.7 7.6

Individual face-to-face


Group, face-to-face 9 0.2 0.2

Self-help materials from

Quitline 154 2.6 2.9

A self-help site on the

Internet (like QuitNet) 26 0.4 0.5

Any other self-help

materials not on the

internet

19 0.3 0.4

Followed advice from

physician/other healthcare

provider

285 4.8 5.4

Cold turkey 860 14.5 16.2

Tapering down 3320 55.9 62.7

Other method(s) 205 3.5 3.9



107

Table B-18

Q14. During the past (3, 6, or 12 months), what is the longest period of time

you did not smoke cigarettes or use any other tobacco products?


1 day 445 7.5 9.5

2 to 6 days (less than 1 week) 1135 19.1 24.1

1 to 4 weeks (less than 1 month) 1168 19.7 24.8

5 to 8 weeks (less than 2 months) 503 8.5 10.7


3 to 6 months 651 11.0 13.8

6 months or longer 471 7.9 10.0

Have not gone 1 day or longer

without tobacco

1148 19.3 -



108

Table B-19

Q15. Do you think you will use tobacco anytime during the next year?


Definitely yes 1794 30.2 31.0

Probably yes 1976 33.3 34.2

Probably not 1038 17.5 18.0

Definitely not 972 16.4 16.8



Table B-20

Q16. Do you think you will use any kind of nicotine replacement therapy or

medication to help you quit such as a patch, gum, lozenge, or pill at anytime during

the next year?








109

Table B-21

Q17. Nicotine replacement therapy like a patch, gum, or pill causes cancer


Strongly agree 172 2.9 3.6

Agree 538 9.1 11.2

Disagree 3013 50.7 62.9

Strongly disagree 1069 18.0 22.3



Table B-22

Q18. Nicotine replacement therapy is helpful for people who want to quit using

tobacco



Agree 3364 56.7 58.3

Disagree 277 4.7 4.8




110

Table B-23

Q19. Nicotine replacement therapy is more dangerous than smoking cigarettes



Agree 258 4.3 4.7

Disagree 3334 56.1 60.7




Table B-24

Q20. Was the amount of NRT you received from Quitline more than enough, just

right, or not enough for you to quit successfully?

Among All Participants


More than enough 403 6.8 7.1

Just right 1581 26.6 28.0

Not enough 2731 46.0 48.4

Did not receive NRT 924 15.6 16.4



111

Table B-25

Q21. Was the amount of counseling you received from Quitline more than enough,

just right, or not enough for you to quit successfully?




Just right 2329 39.2 40.4

Not enough 2120 35.7 36.7

Did not receive counseling 811 13.7 14.1



Table B-26

Q22. Would you recommend Quitline services to someone who was trying to quit

smoking?


Yes 5294 89.2 90.6

No 549 9.2 9.4



112

Table B-27

Q23. Overall, how would you rate your satisfaction with Quitline Iowa?

Were you…


Very satisfied 1852 31.2 32.0

Satisfied 2776 46.7 47.9

Dissatisfied 770 13.0 13.3

Very dissatisfied 394 6.6 6.8



Table B-28



Yes 2511 42.3 42.3

No 3426 57.7 57.7



Table B-29



Yes 112 1.9 1.9

No 5813 97.9 98.1



113

Table B-30



White or Caucasian 5494 92.5 93.2

Black or African American 212 3.6 3.6

Asian 13 0.2 0.2

American Indian or Alaska Native 92 1.5 1.6

Native Hawaiian or Pacific Islander 11 0.2 0.2

Other 73 1.2 1.2



Table B-31



Less than $20,000 3068 51.7 54.7

$20,001 - $40,000 1409 23.7 25.1

$40,001 - $60,000 656 11.0 11.7

$60,001 - $80,000 282 4.7 5.0

$80,001 or more 192 3.2 3.4



114

Table B-32



Excellent 394 6.6 6.7

Very good 1103 18.6 18.7

Good 2123 35.8 35.9

Fair 1397 23.5 23.6

Poor 892 15.0 15.1



Table B-33



Private insurance 1683 28.3 29.9

Medicaid 1752 29.5 31.1

Medicare 807 13.6 14.3

Military health care 61 1.0 1.1

No health insurance 987 16.6 17.5

Other 346 5.8 6.1



115

Table B-34

Q31. Did Medicaid pay for any of the medication or nicotine replacement

therapy that you took to help you quit smoking in the last (3, 6, or 12) months?


Yes 1834 30.9 33.0

No 3724 62.7 67.0



Table B-35

Q32. Were you referred to Quitline by your doctor or another healthcare

provider?


Yes 2535 42.7 44.9

No 3116 52.5 55.1



116

Table B-36



NQ1a. Smoking cigarettes relieves tension Number Overall % Valid %

Not important 146 2.5 7.9

Slightly important 236 4.0 12.8

Moderately important 505 8.5 27.5

Very important 590 9.9 32.1

Extremely important 362 6.1 19.7

Quit within the last 30 days 7 0.1 -


Refused 2 0.0 -

Not asked 4075 68.6 -

NQ1b. I’m embarrassed to have to smoke Number Overall % Valid %








Refused 2 0.0 -

Not asked 4075 68.6 -

NQ1c. Smoking helps me concentrate and do better work Number Overall % Valid %








Refused 2 0.0 -

Not asked 4075 68.6 -

117




NQ1d. My cigarette smoking bothers other people Number Overall % Valid %








Refused 3 0.1 -

Not asked 4075 68.6 -

NQ1e. I am relaxed and more pleasant when smoking Number Overall % Valid %








Refused 1 0.0 -

Not asked 4075 68.6 -

NQ1f. People think I’m foolish for ignoring the warnings

about cigarette smoking Number Overall % Valid %








Refused 2 0.0 -


118

Table B-37

NQ2. The following situations lead some people to smoke.

Please tell me how tempted you may be to smoke in each situation.

NQ2a. With friends at a party Number Overall % Valid %

Not at all tempted 221 3.7 12.3

Not very tempted 114 1.9 6.3

Moderately tempted 468 7.9 26.0

Very tempted 492 8.3 27.3

Extremely tempted 506 8.5 28.1



Refused 3 0.1 -

Not asked 4081 68.7 -

NQ2b. When I first get up in the morning Number Overall % Valid %








Refused 1 0.0 -

Not asked 4081 68.7 -

NQ2c. When I am very anxious and stressed Number Overall % Valid %








Refused 3 0.1 -

Not asked 4081 68.7 -

119




NQ2d. Over coffee while talking and relaxing Number Overall % Valid %








Refused 5 0.1 -

Not asked 4081 68.7 -

NQ2e. When I feel I need a lift Number Overall % Valid %








Refused 2 0.0 -

Not asked 4081 68.7 -

NQ2f. When I am very angry about someone or something Number Overall % Valid %








Refused 3 0.1 -

Not asked 4081 68.7 -

120




NQ2g. With my spouse or close friend who is smoking Number Overall % Valid %








Refused 3 0.1 -

Not asked 4075 68.6 -

NQ2h. When I realize I haven’t smoked in a while Number Overall % Valid %








Refused 3 0.1 -

Not asked 4075 68.6 -

NQ2i. When things are not going my way and I am frustrated Number Overall % Valid %








Refused 2 0.0 -

Not asked 4075 68.6 -

121

Table B-38

NQ3. Which of the following, if any, are things you like about smoking?


NQ3a. It helps me relax Number Overall % Valid %

Yes 1609 27.1 86.9

No 242 4.1 13.1



Refused 1 0.0 -

Not asked 4075 68.6 -

NQ3b. It helps me deal with tension or stress Number Overall % Valid %

Yes 1650 27.8 89.2

No 200 3.4 10.8



Refused 1 0.0 -

Not asked 4075 68.6 -

NQ3c. It helps me when I am upset or angry Number Overall % Valid %

Yes 1531 25.8 82.6

No 323 5.4 17.4



Refused 1 0.0 -

Not asked 4075 68.6 -

NQ3d. It’s something to do when I’m bored Number Overall % Valid %

Yes 1223 20.6 66.1

No 626 10.5 33.9



Refused 1 0.0 -

Not asked 4075 68.6 -

122




NQ3e. I enjoy the taste Number Overall % Valid %

Yes 728 12.3 39.6

No 1111 18.7 60.4



Refused 1 0.0 -

Not asked 4075 68.6 -

NQ3f. It helps me when I am feeling down or depressed Number Overall % Valid %

Yes 1203 20.3 65.2

No 641 10.8 34.8



Refused 1 0.0 -

Not asked 4075 68.6 -

NQ3g. It helps me concentrate Number Overall % Valid %

Yes 553 9.3 30.0

No 1290 21.7 70.0



Refused 1 0.0 -

Not asked 4075 68.6 -

NQ3h. It helps me control my weight Number Overall % Valid %

Yes 477 8.0 26.1

No 1354 22.8 73.9



Refused 1 0.0 -

Not asked 4075 68.6 -

123




NQ3i. It helps me when I am worried or anxious Number Overall % Valid %

Yes 1515 25.5 82.0

No 332 5.6 18.0



Refused 1 0.0 -

Not asked 4075 68.6 -

NQ3j. I enjoy being around other smokers Number Overall % Valid %

Yes 628 10.6 35.2

No 1157 19.5 64.8



Refused 2 0.0 -

Not asked 4075 68.6 -

NQ3k. I enjoy the feeling of a cigarette in my hand Number Overall % Valid %

Yes 900 15.2 49.2

No 928 15.6 50.8



Refused 2 0.0 -

Not asked 4075 68.6 -

124

Table B-39



NQ4a. People I live with smoke Number Overall % Valid %

Yes 773 13.0 41.8

No 1077 18.1 58.2



Refused 1 0.0 -

Not asked 4079 68.7 -

NQ4b. Strong cravings Number Overall % Valid %

Yes 1525 25.7 82.7

No 318 5.4 17.3



Refused 1 0.0 -

Not asked 4079 68.7 -

NQ4c. Stress Number Overall % Valid %

Yes 1603 27.0 86.8

No 244 4.1 13.2



Refused 1 0.0 -

Not asked 4079 68.7 -

NQ4d. Unable to concentrate or focus Number Overall % Valid %

Yes 584 9.8 31.7

No 1258 21.2 68.3



Refused 1 0.0 -

Not asked 4079 68.7 -

125




NQ4e. People in my family smoke Number Overall % Valid %

Yes 1007 17.0 54.5

No 842 14.2 45.5



Refused 1 0.0 -

Not asked 4079 68.7 -

NQ4f. Gaining weight Number Overall % Valid %

Yes 699 11.8 37.9

No 1146 19.3 62.1



Refused 2 0.0 -

Not asked 4079 68.7 -

NQ4g. Becoming irritable Number Overall % Valid %

Yes 1396 23.5 75.6

No 450 7.6 24.4



Refused 2 0.0 -

Not asked 4079 68.7 -

NQ4h. Other mood symptoms like sadness, anxiety, or

depression Number Overall % Valid %

Yes 1154 19.4 62.8

No 683 11.5 37.2



Refused 2 0.0 -

Not asked 4079 68.7 -

126




NQ4i. Conflicts with family Number Overall % Valid %

Yes 881 14.8 47.8

No 964 16.2 52.2



Refused 2 0.0 -

Not asked 4079 68.7 -

NQ4j. It’s just something I can’t control Number Overall % Valid %

Yes 1166 19.6 63.6

No 668 11.2 36.4



Refused 2 0.0 -

Not asked 4079 68.7 -

NQ4k. I smoke when I drink alcohol Number Overall % Valid %

Yes 1003 16.9 54.4

No 840 14.1 45.6



Refused 2 0.0 -

Not asked 4079 68.7 -

NQ4l. Many of my friends smoke Number Overall % Valid %

Yes 1162 19.6 62.9

No 684 11.5 37.1



Refused 2 0.0 -

Not asked 4075 68.6 -

127




NQ4m. Lack of support from others Number Overall % Valid %

Yes 692 11.7 37.5

No 1154 19.4 62.5



Refused 2 0.0 -

Not asked 4075 68.6 -

128

Table B-40


NQ5a. Set a quit date? Number Overall % Valid %

Yes 922 5.7 65.3

No 490 3.0 34.7

Quit within the last 30 days 5 .0 –

Don’t know/Not sure 50 .3 –

Refused 0 0.0 –

Not asked 4471 75.3 –

NQ5b. Talk about your past quit experiences? Number Overall % Valid %

Yes 975 16.4 69.1

No 436 7.3 30.9

Quit within the last 30 days 5 0.1 –

Don’t know/Not sure 51 0.9 –

Refused 0 0.0 –

Not asked 4471 75.3 –

NQ5c. Find ways to overcome roadblocks to quitting? Number Overall % Valid %

Yes 872 14.7 61.8

No 539 9.1 38.2



Refused 0 0.0 –

Not asked 4471 75.3 –

NQ5d. Reduce the amount of tobacco you use? Number Overall % Valid %

Yes 932 15.7 64.3

No 517 8.7 35.7



Refused 1 0.0 –

Not asked 4471 75.3 –

129



NQ5e. Learn about the five elements crucial to quitting

successfully? Number Overall % Valid %

Yes 722 12.2 53.2

No 634 10.7 46.8



Refused 0 0.0 –

Not asked 4471 75.3 –

NQ5f. Develop a quit plan? Number Overall % Valid %

Yes 881 14.8 62.0

No 540 9.1 38.0



Refused 0 0.0 –

Not asked 4471 75.3 –

NQ5g. Plan a way to make your home tobacco free? Number Overall % Valid %

Yes 769 13.0 54.3

No 646 10.9 45.7



Refused 0 0.0 –

Not asked 4471 75.3 –

NQ5h. Plan a way to make your car tobacco free? Number Overall % Valid %

Yes 682 11.5 48.0

No 739 12.4 52.0



Refused 0 0.0 –

Not asked 4471 75.3 –

130



NQ5i. Identify what you like about smoking? Number Overall % Valid %

Yes 784 13.2 56.6

No 602 10.1 43.4



Refused 1 0.0 –

Not asked 4471 75.3 –

NQ5j. Identify what you don’t like about smoking? Number Overall % Valid %

Yes 887 14.9 62.9

No 523 8.8 37.1



Refused 1 0.0 –

Not asked 4471 75.3 –

NQ5k. Learn about the 3 A’s (Avoid, Alternatives, and

Adjust)? Number Overall % Valid %

Yes 579 9.8 42.1

No 796 13.4 57.9



Refused 1 0.0 –

Not asked 4471 75.3 –

131

Table B-41


NQ6a. The people at Quitline listened carefully to what I said Number Overall % Valid %


Agree 847 14.3 47.6

Disagree 200 3.4 11.2




Refused 4 0.1 –

Not asked 4077 68.7 –

NQ6b. The people at Quitline cared about me Number Overall % Valid %


Agree 901 15.2 51.2

Disagree 273 4.6 15.5




Refused 6 0.1 –

Not asked 4077 68.7 –

NQ6c. The people at Quitline cared about whether my quit

attempt was successful Number Overall % Valid %


Agree 833 14.0 47.5

Disagree 347 5.8 19.8




Refused 5 0.1 –

Not asked 4077 68.7 –

132



NQ6d. Using Quitline was inconvenient for me Number Overall % Valid %


Agree 397 6.7 22.1

Disagree 1015 17.1 56.5




Refused 2 0.0 –

Not asked 4077 68.7 –

NQ6e. Using Quitline was difficult Number Overall % Valid %


Agree 359 6.0 19.9

Disagree 1078 18.2 59.6




Refused 3 0.1 –

Not asked 4077 68.7 –

NQ6f. The people at Quitline were helpful Number Overall % Valid %


Agree 1011 17.0 56.8

Disagree 283 4.8 15.9




Refused 5 0.1 –

Not asked 4077 68.7 –

133



NQ6g. I feel better prepared for my next quit attempt because

I used Quitline Number Overall % Valid %


Agree 885 14.9 49.4

Disagree 434 7.3 24.2




Refused 4 0.1 –

Not asked 4077 68.7 –

NQ6h. Calling Quitline did not make it easier for me to quit

using tobacco products Number Overall % Valid %


Agree 619 10.4 35.0

Disagree 797 13.4 45.0




Refused 3 0.1 –

Not asked 4077 68.7 –

NQ6i. The Quitline services were good, I just wasn’t ready to

quit Number Overall % Valid %


Agree 874 14.7 49.4

Disagree 445 7.5 25.2




Refused 5 0.1 –

Not asked 4077 68.7 –

134



NQ6j. To be able to quit, I think I would need more frequent

contact with a Quitline coach Number Overall % Valid %


Agree 771 13.0 43.0

Disagree 659 11.1 36.7




Refused 3 0.1 –

Not asked 4077 68.7 –

NQ6k. To be able to quit, I think I would need to attend more

group meetings with other people who are trying to quit Number Overall % Valid %


Agree 494 8.3 27.5

Disagree 1011 17.0 56.2




Refused 4 0.1 –

Not asked 4077 68.7 –

NQ6l. To be able to quit, I think I would need more face-to-

face coaching Number Overall % Valid %


Agree 523 8.8 29.0

Disagree 1032 17.4 57.3




Refused 4 0.1 –

Not asked 4075 68.6 –

135



NQ6m. To be able to quit, I think I would need more free

NRT Number Overall % Valid %


Agree 988 16.6 54.8

Disagree 372 6.3 20.6




Refused 4 0.1 –

Not asked 4075 68.6 –

NQ6n. I’m never going to be able to quit if I only have

counseling by phone Number Overall % Valid %


Agree 443 7.5 25.1

Disagree 1055 17.8 59.9




Refused 4 0.1 –

Not asked 4075 68.6 –

NQ6o. I need face to face counseling to help me quit smoking Number Overall % Valid %


Agree 544 9.2 30.3

Disagree 1013 17.1 56.5




Refused 6 0.1 –

Not asked 4075 68.6 –

136



NQ6p. I am going to keep trying to quit smoking Number Overall % Valid %


Agree 1228 20.7 67.3

Disagree 72 1.2 3.9

Strongly disagree 7 0.1 .4



Refused 6 0.1 –

Not asked 4075 68.6 –

NQ6q. I think I will quit smoking within the next 5 years Number Overall % Valid %


Agree 1096 18.5 62.7

Disagree 97 1.6 5.5




Refused 8 0.1 –

Not asked 4075 68.6 –

NQ6r. I don’t think I will ever quit smoking Number Overall % Valid %


Agree 191 3.2 10.7

Disagree 1199 20.2 67.2




Refused 9 0.2 –

Not asked 4075 68.6 –

137



NQ6s. By this time next year, I will no longer be smoking

cigarettes Number Overall % Valid %


Agree 821 13.8 50.6

Disagree 456 7.7 28.1




Refused 8 0.1 –

Not asked 4075 68.6 –

NQ6t. No matter how hard I try, I just can’t quit smoking Number Overall % Valid %


Agree 650 10.9 36.1

Disagree 883 14.9 49.0




Refused 4 0.1 –

Not asked 4075 68.6 –

NQ6u. Eventually cigarettes will just get too expensive, and

I’ll have to quit Number Overall % Valid %


Agree 958 16.1 52.7

Disagree 505 8.5 27.8




Refused 5 0.1 –

Not asked 4075 68.6 –

138


139

Appendix C

Clinic Program Follow-Up

Questionnaire

140


141

SECTION 1: Prior to, first call, and during program

During this interview, I’m going to ask you questions about your tobacco use and experience with the

tobacco cessation/treatment program.

Q1a-d. Think back to when you first started this program. During the 30 days before you first started this

program, on how many days did you…


b. Smoke cigars?





99. Refused

Note: If Q1a = 0, Skip to Q3

Q2. On the average, on days when you smoked, about how many cigarettes did you smoke a day?


(Interviewer Note: 1 pack=20 cigarettes. Verify 61 or more cigarettes.)



999. Refused

Q3. Think about a typical morning back when you first started the program. How soon after waking up

did you first use any tobacco product?






9. Refused

142

Note: If Q1a = 0, Skip to Q4b

Q4a. Why did you decide to quit smoking cigarettes? [SELECT ALL THAT APPLY]




14. Nicotine replacement therapy (like a patch, gum, or pill) was available for free or at reduced

cost









23. Pregnant


67. Other [Specify]


99. Refused

Note: If Q1b = 0 and Q1c = 0 and Q1d = 0, Skip to Q5

Q4b. Why did you decide to quit using tobacco products? [SELECT ALL THAT APPLY]




14. Nicotine replacement therapy (like a patch, gum, or pill) was available for free or at reduced

cost









23. Pregnant


66. Other [Specify]


99. Refused

143

Q5a-c. How many times did you receive the following types of counseling?

a. Individual counseling

b. Group counseling

c. Quitline counseling

0-15. Number of times (15 = 15+)


99. Refused

Q6a-f. While enrolled in the tobacco cessation program, how many times did you go to the pharmacy or

clinic to pick up nicotine patches? [ASKED IN ORDER: A, B, C, F, D, E]

(Interviewer note: If the respondent can’t remember, ask them to give their best guess. Each time

they pick up medications, it is a 2 week supply. Ex: 1 time equals 2 weeks, 2 times equals 4 weeks

and so on. If they say more than 6 times, double check if they mean number of weeks or number of

pick-ups.)

a. Nicotine patches

b. Nicotine gum

c. Chantix or varenicline

d. Nicotine lozenges

e. Nicotine inhaler

f. Wellbutrin, Zyban, or bupropion?

[ ] = TIMES (0-6)


99. Refused

SECTION 2: Current tobacco use Now I’ll ask some questions about your current cigarette and tobacco use.

Q7a-d. In the past 30 days, on how many days did you…


b. Smoke cigars?





99. Refused

144

Note: If Q7a = 0, Skip to Q9

Q8. On the average, on days when you smoked during the past 30 days, about how many cigarettes did

you smoke a day?


(Interviewer Note: 1 pack=20 cigarettes. Verify 61 or more cigarettes.)



999. Refused

Note: If Q7a = 0 and Q7b = 0 and Q7c = 0 and Q7d = 0, Skip to Q10a







9. Refused

Note: If Q1a = 0 and Q7a = 0, Skip to Q10b

Q10a. How does your current cigarette use compare to your use when you first started the program? Do


1. A lot less,

2. Somewhat less,



5. A lot more cigarettes now?


9. Refused

Note: If Q1b = 0 and Q7b = 0, Skip to Q10c

Q10b. How does your current cigar use compare to your use when you first started the program? Do you

currently smoke…

1. A lot less,

2. Somewhat less,



5. A lot more cigars now?


9. Refused

145

Note: If Q1c = 0 and Q7c = 0, Skip to Q10d

Q10c. How does your current pipe use compare to your use when you first started the program? Do you

currently smoke…

1. A lot less,

2. Somewhat less,



5. A lot more pipe bowls now?


9. Refused

Note: If Q1d = 0 and Q7d = 0, Skip to Q11a

Q10d. How does your current chew use compare to your use when you first started the program? Do you

currently chew…

1. A lot less,

2. Somewhat less,

3. About the same amount,


5. A lot more now?


9. Refused

SECTION 3: Quit attempts/Cessation

Now I’m going to ask a few questions about your past attempts to quit using tobacco products.

Q11a. During the past (3, 6 or 12 months), how many different times have you stopped smoking or using

other tobacco products for one day or longer because you were trying to quit?

0-365. Number of times


999. Refused

146

Note: If Q7a > 0 or Q7b > 0 or Q7c > 0 or Q7d > 0, Skip to Q12

Q11b. When did you quit using tobacco products?

(Interviewer Note: Probe for exact date, but enter 01 for MM and/or DD when respondent is not

specific enough)

Day/Month/Year

01011999. Don’t Know/Not Sure & Refused

Q12. During the past (3, 6 or 12 months), did you use any of the following medications to quit? [READ

11-17, SELECT ALL THAT APPLY]

11. Nicotine gum

12. Nicotine lozenge

13. Nicotine patch

14. Nicotine inhaler

15. Nicotine nasal spray

16. Chantix or varenicline

17. Wellbutrin, Zyban, or Bupropion

66. Other [Specify]

88. None


99. Refused

Note: If any Q12 = Yes, go to Q12a. If any Q12 = No, go to Q12b

Q12a. How helpful was this medication for you to quit or reduce your tobacco use? Was it…

1. Very helpful

2. Somewhat helpful



9. Refused

Q12b. How helpful do you think it would be if you used this medication to help you quit or reduce your

tobacco use?

1. Very helpful

2. Somewhat helpful



9. Refused

147

Q13. In the past (3, 6, or 12 months), did you use any of the following methods to quit?

[READ 11-19, SELECT ALL THAT APPLY]

11. Quitline telephone counseling

12. Individual, face to face counseling

13. Group, face to face

14. Self-help materials from Quitline

15. Any other self-help materials not on the internet

16. A self-help site on the Internet (like QuitNet)

17. Followed advice from physician/other healthcare provider

18. Cold turkey

19. Tapering down (gradually reducing the number of cigarettes you smoke)

66. Other [Specify]

88. None


99. Refused

Note: If any Q13 = Yes, go to Q13a. If any Q13 = No, go to Q13b

Q13a. How helpful was this method for you to quit or reduce your tobacco use? Was it…

1. Very helpful

2. Somewhat helpful



9. Refused

Q13b. How helpful do you think it would be if you used this method to help you quit or reduce your

tobacco use?

1. Very helpful

2. Somewhat helpful



9. Refused

Q14. During the last (3, 6 or 12 months), what is the longest period of time you did not smoke cigarettes

or use any other tobacco products?

101-107. Days

201-252. Weeks

301-312. Months


888. Respondent has not gone one day or longer without tobacco

999. Refused

148

Q15. Do you think you will use tobacco anytime during the next year? [READ 1-4]

1. Definitely yes

2. Probably yes

3. Probably not

4. Definitely not


9. Refused

Q16. Do you think you will use any kind of nicotine replacement therapy or medication such as a patch,

gum, lozenge, or pill at anytime during the next year? [READ 1-4]

1. Definitely yes

2. Probably yes

3. Probably not

4. Definitely not


9. Refused

Please respond to the following statements by telling me if you strongly agree, agree, disagree, or strongly

disagree.

Q17. Nicotine replacement therapy like a patch, gum, or pill causes cancer.

1. Strongly agree

2. Agree

3. Disagree



9. Refused

Q18. Nicotine replacement therapy is helpful for people who want to quit using tobacco.

1. Strongly agree

2. Agree

3. Disagree



9. Refused

149

Q19. Nicotine replacement therapy is more dangerous than smoking cigarettes.

1. Strongly agree

2. Agree

3. Disagree



9. Refused

SECTION 4: Services

Q20. Was the amount of nicotine replacement therapy you received from the program more than enough,

just right, or not enough for you to quit successfully?

1. More than enough

2. Just right

3. Not enough

4. Did not receive NRT



Q21. Was the amount of counseling you received from the program more than enough, just right, or not

enough for you to quit successfully?

1. More than enough

2. Just right

3. Not enough

4. Did not receive counseling



Q22. Would you recommend these services to someone who was trying to quit smoking?

1. Yes

2. No


9. Refused

150

Q23. Overall, how would you rate your satisfaction with the tobacco cessation/treatment program? Were

you…

1. Very satisfied,

2. Satisfied,

3. Dissatisfied, or

4. Very dissatisfied?


9. Refused

SECTION 6: Demographics

Now I’m going to ask a few questions about you.


1. Yes

2. No


9. Refused


1. Yes

2. No


9. Refused


1. White or Caucasian

2. Black or African American

3. Asian

4. American Indian or Alaska Native

5. Native Hawaiian or Pacific Islander

6. Other: [specify]?


9. Refused

151

Q27. Is your annual household income from all sources: [READ AS APPROPRIATE]

1. Less than $20,000,

2. $20,001 - $40,000,

3. $40,001 - $60,000,

4. $60,001 - $80,000, or

5. $80,001 or more?

7. Don't know/Not sure

9. Refused


1. Excellent,

2. Very good,

3. Good,

4. Fair, or

5. Poor?


9. Refused

Q29. What is your zip code?

__ __ __ __ __ (5 digit zip code)

77777. Don’t know

99999. Refused


1. Private insurance (self-pay or through employer)

2. Medicaid

3. Medicare

4. Military health care (includes veterans)

5. No health insurance

6. Other [Specify]


9. Refused

152

Q31. Did Medicaid pay for any of the medication or nicotine replacement therapy that you took to help

you quit smoking in the last (3, 6 or 12) months?

1. Yes

2. No


9. Refused

FINAL STATEMENT

That’s all the questions I have. The answers of all the participants interviewed will be combined to

describe people’s experiences with the program and to guide its future development. If you have

questions about this survey you may call Disa Cornish at (319) 273-2105. Thank you for your time and

cooperation with this survey. Good-bye.

153

Appendix D

Clinic Program Follow-Up

Frequency Tables

154


155

Table D-1

Q1. Think back to when you first started this program. During the 30 days before

you started this program, on how many days did you…


None 15 1.4 1.4

1 to 4 2 0.2 0.2

5 to 9 9 0.9 0.9

10 to 14 8 0.8 0.8

15 to 19 7 0.7 0.7

20 to 24 10 1.0 1.0

25 or more 984 94.7 95.1




None 991 95.4 95.5

1 to 4 24 2.3 2.3

5 to 9 7 0.7 0.7

10 to 14 4 0.4 0.4

15 to 19 2 0.2 0.2

20 to 24 1 0.1 0.1

25 or more 9 0.9 0.9



156

Table D-1 (Continued)

Q1. Think back to when you first started this program. During the 30 days before

started this program, on how many days did you…



None 1024 98.6 98.7

1 to 4 3 0.3 0.3

5 to 9 2 0.2 0.2

10 to 14 1 0.1 0.1

15 to 19 1 0.1 0.1

20 to 24 0 0.0 0.0

25 or more 7 0.7 0.7



Q1d. Use chew or


None 1007 96.9 97.0

1 to 4 9 0.9 0.9

5 to 9 3 0.3 0.3

10 to 14 5 0.5 0.5

15 to 19 2 0.2 0.2

20 to 24 1 0.1 0.1

25 or more 11 1.1 1.1



157

Table D-2

Q2. On the average, on days when you smoked, about how many cigarettes did you

smoke a day?


Less than 5 21 2.0 2.1

5 to 9 51 4.9 5.0

10 to 19 225 21.7 22.0

20 to 29 425 40.9 41.6

30 to 39 152 14.6 14.9

40 or more 148 14.2 14.5



Table D-3

Q3. Think about a typical morning back when you first started the program.

How soon after waking up did you first use any tobacco product?



6-30 minutes 328 31.6 31.9

31-60 minutes 112 10.8 10.9




158

Table D-4

Q4a. Why did you decide to quit smoking cigarettes? (select all that apply)



I had a health event like a heart attack or diagnosis 133 12.8 13.0


NRT was available for free or at reduced cost 4 .4 0.4


Concerned about the health or well-being of others 65 6.3 6.3

Motivation from media campaign in newspapers, on

television, or online 3 0.3 0.3



Too few places allow smoking 7 0.7 0.7



Pregnant 1 0.1 0.1



Don’t know/Not sure 2 0.2 0.2

Not asked/No response 0 0.0 0.0

159

Table D-5

Q4b. Why did you decide to quit using tobacco products? (select all that apply)



I had a health event like a heart attack or diagnosis 6 0.6 7.4




Concerned about the health or well-being of others 4 0.4 4.9

Motivation from media campaign in newspapers, on

television, or online 0 0.0 0.0



Too few places allow it 0 0.0 0.0



Pregnant 0 0.0 0.0



Don’t know/Not sure 3 0.3 3.7

Not asked/No response 1 0.1 1.2

160

Table D-6

Q5. How many times did you receive the following types of counseling?

Q5a. Individual Counseling Number Overall % Valid %

None 381 36.7 37.9

1-3 316 30.4 31.4

4-5 110 10.6 10.9

6 or more 199 19.2 19.8



Q5b. Group Counseling Number Overall % Valid %

None 898 86.4 86.7

1-3 69 6.6 6.7

4-5 28 2.7 2.7

6 or more 41 3.9 4.0



Q5c. Quitline Counseling Number Overall % Valid %

None 904 87.0 87.3

1-3 81 7.8 7.8

4-5 21 2.0 2.0

6 or more 29 2.8 2.8



161

Table D-7

Q6. While enrolled in the tobacco cessation program, how many times did you

go to the pharmacy or clinic to pick up…

Q6a. Nicotine Patches Number Overall % Valid %

0 363 34.9 69.7

1 76 7.3 14.6

2 32 3.1 6.1

3 12 1.2 2.3

4 11 1.1 2.1

5 6 0.6 1.2

6 21 2.0 4.0



Q6b. Nicotine Gum Number Overall % Valid %

0 463 44.6 87.9

1 57 5.5 10.8

2 5 0.5 0.9

3 0 0.0 0.0

4 1 0.1 0.2

5 0 0.0 0.0

6 1 0.1 0.2



162




Q6c. Chantix or varenicline Number Overall % Valid %

0 109 10.5 23.0

1 64 6.2 13.5

2 56 5.4 11.8

3 45 4.3 9.5

4 51 4.9 10.8

5 18 1.7 3.8

6 62 6.0 13.1

7 4 0.4 0.8

8 15 1.4 3.2

9 3 0.3 0.6

10 8 0.8 1.7

11 1 0.1 0.2

12 38 3.7 8.0



Q6d. Nicotine Lozenges Number Overall % Valid %

0 471 45.3 89.4

1 54 5.2 10.2

2 2 0.2 0.4

3 0 0.0 0.0

4 0 0.0 0.0

5 0 0.0 0.0

6 0 0.0 0.0



163




Q6e. Nicotine Inhaler Number Overall % Valid %

0 474 45.6 89.9

1 50 4.8 9.5

2 3 0.3 0.6

3 0 0.0 0.0

4 0 0.0 0.0

5 0 0.0 0.0

6 0 0.0 0.0



Q6f. Wellbutrin, Zyban, or

bupropion Number Overall % Valid %

0 905 87.1 92.1

1 32 3.1 3.3

2 19 1.8 1.9

3 8 0.8 0.8

4 9 0.9 0.9

5 2 0.2 0.2

6 8 0.8 0.8



164

Table D-8



None 299 28.8 28.8

1 to 4 53 5.1 5.1

5 to 9 35 3.4 3.4

10 to 14 35 3.4 3.4

15 to 19 27 2.6 2.6

20 to 24 28 2.7 2.7

25 or more 560 53.9 54.0




None 1011 97.3 97.3

1 to 4 14 1.3 1.3

5 to 9 5 0.5 0.5

10 to 14 0 0.0 0.0

15 to 19 1 0.1 0.1

20 to 24 1 0.1 0.1

25 or more 7 0.7 0.7



165


Q7. In the past 30 days, on how many days did you use the following tobacco

products?



None 1034 99.5 99.5

1 to 4 1 0.1 0.1

5 to 9 1 0.1 0.1

10 to 14 0 0.0 0.0

15 to 19 1 0.1 0.1

20 to 24 0 0.0 0.0

25 or more 2 0.2 0.2



Q7d. Use chew or


None 1025 98.7 98.7

1 to 4 9 0.9 0.9

5 to 9 0 0.0 0.0

10 to 14 1 0.1 0.1

15 to 19 0 0.0 0.0

20 to 24 0 0.0 0.0

25 or more 4 0.4 0.4



166

Table D-9

Q8. On the average, on days when you smoked during the past 30 days, about how



Less than 5 129 12.4 17.6

5 to 9 97 9.3 13.3

10 to 19 206 19.8 28.1

20 to 29 211 20.3 28.8

30 to 39 49 4.7 6.7

40 or more 40 3.8 5.5

Less than 1 per day 4 0.4 -



Table D-10




6-30 minutes 217 20.9 29.2

31-60 minutes 95 9.1 12.8




167

Table D-11

Q10a. How does your current cigarette use compare to your use when you first

started the program? Do you currently smoke…


A lot less 555 53.4 54.3




A lot more 24 2.3 2.3



Table D-12

Q10b. How does your current cigar use compare to your use when you first



A lot less 33 3.2 60.0







168

Table D-13

Q10c. How does your current pipe use compare to your use when you first



A lot less 9 .9 64.3






Not asked/No Response 1024 98.6 -

Table D-14

Q10d. How does your current chew use compare to your use when you first

started the program? Do you currently chew…


A lot less 25 2.4 69.4







169

Table D-15

Q11a. During the past (3, 6, or 12 months), how many different times have

you stopped smoking or using other tobacco products for one day or longer

because you were trying to quit?


0 times 279 26.9 27.4

1 time 413 39.7 40.5

2 to 5 times 262 25.2 25.7

6 to 10 times 48 4.6 4.7

11 to 20 times 10 1.0 1.0

More than 20 times 7 0.7 0.7



Table D-16

Q12. During the past (3, 6, or 12 months), did you use any of the following

medications to quit? (select all that apply)


Nicotine gum 9 0.9 0.9

Nicotine lozenge 2 0.2 0.2

Nicotine patch 128 12.3 12.3

Nicotine inhaler 10 1.0 1.0

Nicotine nasal spray 1 0.1 0.1

Chantix or varenicline 659 63.4 63.4

Wellbutrin, Zyban, or

Bupropion 58 5.6 5.6

A pill to help you quit 33 3.2 3.2

Other medication 1 0.1 0.1

None 138 13.3 13.3



170

Table D-17

Q13. In the past (3, 6, or 12 months), did you use any of the following methods to

quit? (select all that apply)


Quitline telephone


Individual, face-to-face


Group, face-to-face 10 1.0 1.1

Self-help materials from

Quitline 6 0.6 0.7

A self-help site on the

Internet (like QuitNet) 3 0.3 0.3

Any other self-help

materials not on the internet 6 0.6 0.7

Followed advice from

physician/other healthcare

provider

143 13.8 16.1

Cold turkey 107 10.3 12.0

Tapering down 559 53.8 62.8

Other method(s) 23 2.2 -

None 126 12.1 -



171

Table D-18

Q14. During the past (3, 6, or 12 months), what is the longest period of time

you did not smoke cigarettes or use any other tobacco products?


1 day 51 4.9 6.0

2 to 6 days (less than 1 week) 177 17.0 20.9

1 to 4 weeks (less than 1 month) 158 15.2 18.7



3 to 6 months 152 14.6 17.9

6 months or longer 127 12.2 15.0

Have not gone 1 day or longer

without tobacco

186 17.9 -



Table D-19

Q15. Do you think you will use tobacco anytime during the next year?








172

Table D-20

Q16. Do you think you will use any kind of nicotine replacement therapy or

medication such as a patch, gum, lozenge, or pill at anytime during the next year?








Table D-21

Q17. Nicotine replacement therapy like a patch, gum, or pill causes cancer



Agree 98 9.4 11.8

Disagree 551 53.0 66.1




Table D-22

Q18. Nicotine replacement therapy is helpful for people who want to quit using

tobacco



Agree 582 56.0 57.8

Disagree 56 5.4 5.6




173

Table D-23

Q19. Nicotine replacement therapy is more dangerous than smoking cigarettes



Agree 40 3.8 4.2

Disagree 582 56.0 60.6




Table D-24

Q20. Was the amount of NRT you received from the program more than enough, just

right, or not enough for you to quit successfully?




Just right 428 41.2 43.1

Not enough 363 34.9 36.6

Did not receive NRT 72 6.9 7.3



174

Table D-25

Q21. Was the amount of counseling you received from the program more than

enough, just right, or not enough for you to quit successfully?




Just right 496 47.7 48.6

Not enough 306 29.5 30.0

Did not receive counseling 104 10.0 10.2



Table D-26

Q22. Would you recommend these services to someone who was trying to quit

smoking?


Yes 988 95.1 95.8

No 43 4.1 4.2


Not asked/No Response 0 0.0 -

175

Table D-27

Q23. Overall, how would you rate your satisfaction with the tobacco

cessation/treatment program? Were you…


Very satisfied 401 38.6 39.4

Satisfied 437 42.1 42.9

Dissatisfied 130 12.5 12.8

Very dissatisfied 50 4.8 4.9



Table D-28



Yes 469 45.1 45.1

No 570 54.9 54.9



Table D-29



Yes 24 2.3 2.3

No 1011 97.3 97.7



176

Table D-30



White or Caucasian 931 89.6 90.6

Black or African American 71 6.8 6.9

Asian 1 0.1 0.1

American Indian or Alaska Native 12 1.2 1.2

Native Hawaiian or Pacific Islander 2 0.2 0.2

Other 11 1.1 1.1



Table D-31



Less than $20,000 472 45.4 48.2

$20,001 - $40,000 319 30.7 32.6

$40,001 - $60,000 119 11.5 12.1

$60,001 - $80,000 40 3.8 4.1

$80,001 or more 30 2.9 3.1



177

Table D-32



Excellent 61 5.9 5.9

Very good 229 22.0 22.1

Good 378 36.4 36.5

Fair 249 24.0 24.0

Poor 119 11.5 11.5



Table D-33



Private insurance 303 29.2 30.8

Medicaid 74 7.1 7.5

Medicare 77 7.4 7.8

Military health care 12 1.2 1.2

No health insurance 479 46.1 48.7

Other 39 3.8 4.0



178

Table D-34

Q31. Did Medicaid pay for any of the medication or nicotine replacement

therapy that you took to help you quit smoking in the last (3, 6, or 12) months?


Yes 108 10.4 12.1

No 785 75.6 87.9



179

Table B-36



NQ1a. Smoking cigarettes relieves tension Number Overall % Valid %








Not asked/No response 728 70.1 –

NQ1b. I’m embarrassed to have to smoke Number Overall % Valid %









NQ1c. Smoking helps me concentrate and do better

work Number Overall % Valid %









180




NQ1d. My cigarette smoking bothers other people Number Overall % Valid %









NQ1e. I am relaxed and more pleasant when smoking Number Overall % Valid %









NQ1f. People think I’m foolish for ignoring the

warnings about smoking Number Overall % Valid %









181

Table B-37



NQ2a. With friends at a party Number Overall % Valid %









NQ2b. When I first get up in the morning Number Overall % Valid %









NQ2c. When I am very anxious and stressed Number Overall % Valid %









182




NQ2d. Over coffee while talking and relaxing Number Overall % Valid %






Quit within the last 30 days 1 0.1

Don’t know/Not sure 0 0.0

Not asked/No response 729 70.2

NQ2e. When I feel I need a lift Number Overall % Valid %









NQ2f. When I am very angry about someone or

something Number Overall % Valid %









183




NQ2g. With my spouse or close friend who is smoking Number Overall % Valid %









NQ2h. When I realize I haven’t smoked in a while Number Overall % Valid %









NQ2i. When things are not going my way and I am

frustrated Number Overall % Valid %









184

Table B-38


for each one.

NQ3a. It helps me relax Number Overall % Valid %

Yes 263 25.3 84.8

No 47 4.5 15.2




NQ3b. It helps me deal with tension or stress Number Overall % Valid %

Yes 265 25.5 85.8

No 44 4.2 14.2




NQ3c. It helps me when I am upset or angry Number Overall % Valid %

Yes 256 24.6 82.8

No 53 5.1 17.2




NQ3d. It’s something to do when I’m bored Number Overall % Valid %

Yes 205 19.7 66.6

No 103 9.9 33.4




185



for each one.

NQ3e. I enjoy the taste Number Overall % Valid %

Yes 121 11.6 39.5

No 185 17.8 60.5

Quit within the last 30 days 1 0.1

Don’t know/Not sure 4 0.4

Not asked/No response 728 70.1

NQ3f. It helps me when I am feeling down or

depressed Number Overall % Valid %

Yes 185 17.8 60.1

No 123 11.8 39.9




NQ3g. It helps me concentrate Number Overall % Valid %

Yes 81 7.8 26.2

No 228 21.9 73.8




NQ3h. It helps me control my weight Number Overall % Valid %

Yes 90 8.7 29.6

No 214 20.6 70.4




186



for each one.

NQ3i. It helps me when I am worried or anxious Number Overall % Valid %

Yes 242 23.3 78.3

No 67 6.4 21.7




NQ3j. I enjoy being around other smokers Number Overall % Valid %

Yes 98 9.4 32.7

No 202 19.4 67.3




NQ3k. I enjoy the feeling of a cigarette in my hand Number Over.0all % Valid %

Yes 146 14.1 47.7

No 160 15.4 52.3




187

Table B-39



NQ4a. People I live with smoke Number Overall % Valid %

Yes 142 13.7 45.8

No 168 16.2 54.2




NQ4b. Strong cravings Number Overall % Valid %

Yes 245 23.6 79.0

No 65 6.3 21.0




NQ4c. Stress Number Overall % Valid %

Yes 260 25.0 83.9

No 50 4.8 16.1




NQ4d. Unable to concentrate or focus Number Overall % Valid %

Yes 81 7.8 26.1

No 229 22.0 73.9




188




NQ4e. People in my family smoke Number Overall % Valid %

Yes 160 15.4 51.6

No 150 14.4 48.4




NQ4f. Gaining weight Number Overall % Valid %

Yes 121 11.6 39.0

No 189 18.2 61.0




NQ4g. Becoming irritable Number Overall % Valid %

Yes 231 22.2 75.0

No 77 7.4 25.0




NQ4h. Other mood symptoms like sadness, anxiety,

or depression Number Overall % Valid %

Yes 170 16.4 54.8

No 140 13.5 45.2




189




NQ4i. Conflicts with family Number Overall % Valid %

Yes 128 12.3 41.4

No 181 17.4 58.6




NQ4j. It’s just something I can’t control Number Overall % Valid %

Yes 185 17.8 60.1

No 123 11.8 39.9




NQ4k. I smoke when I drink alcohol Number Overall % Valid %

Yes 179 17.2 57.7

No 131 12.6 42.3




NQ4l. Many of my friends smoke Number Overall % Valid %

Yes 191 18.4 61.8

No 118 11.4 38.2




190




NQ4m. Lack of support from others Number Overall % Valid %

Yes 93 9.0 30.1

No 216 20.8 69.9




191

Table B-40


NQ5a. Set a quit date? Number Overall % Valid %

Yes 196 18.9 64.1

No 110 10.6 35.9




NQ5b. Talk about your past quit experiences? Number Overall % Valid %

Yes 198 19.1 64.9

No 107 10.3 35.1




NQ5c. Find ways to overcome roadblocks to

quitting? Number Overall % Valid %

Yes 179 17.2 59.1

No 124 11.9 40.9




NQ5d. Reduce the amount of tobacco you use? Number Overall % Valid %

Yes 212 20.4 69.1

No 95 9.1 30.9




192



NQ5e. Learn about the five elements crucial to

quitting successfully? Number Overall % Valid %

Yes 132 12.7 45.4

No 159 15.3 54.6




NQ5f. Develop a quit plan? Number Overall % Valid %

Yes 177 17.0 58.0

No 128 12.3 42.0




NQ5g. Plan a way to make your home tobacco

free? Number Overall % Valid %

Yes 138 13.3 45.0

No 169 16.3 55.0




NQ5h. Plan a way to make your car tobacco free? Number Overall % Valid %

Yes 126 12.1 40.6

No 184 17.7 59.4




193



NQ5i. Identify what you like about smoking? Number Overall % Valid %

Yes 146 14.1 47.6

No 161 15.5 52.4




NQ5j. Identify what you don’t like about smoking? Number Overall % Valid %

Yes 165 15.9 53.9

No 141 13.6 46.1




NQ5k. Learn about the 3 A’s (Avoid, Alternatives,

and Adjust)? Number Overall % Valid %

Yes 92 8.9 30.6

No 209 20.1 69.4




194

Table B-41


NQ6a. The people at Quitline listened carefully to

what I said Number Overall % Valid %


Agree 159 15.3 51.3






NQ6b. The people at Quitline cared about me Number Overall % Valid %


Agree 173 16.7 56.9






NQ6c. The people at Quitline cared about whether

my quit attempt was successful Number Overall % Valid %


Agree 164 15.8 54.3






195



NQ6d. Using Quitline was inconvenient for me Number Overall % Valid %


Agree 175 16.8 57.4






NQ6e. Using Quitline was difficult Number Overall % Valid %


Agree 64 6.2 20.8

Disagree 179 17.2 58.3





NQ6f. The people at Quitline were helpful Number Overall % Valid %


Agree 72 6.9 23.5

Disagree 181 17.4 59.2





196



NQ6g. I feel better prepared for my next quit

attempt because I used Quitline Number Overall % Valid %


Agree 177 17.0 58.6






NQ6h. Calling Quitline did not make it easier for

me to quit using tobacco products Number Overall % Valid %


Agree 75 7.2 24.8

Disagree 153 14.7 50.5





NQ6i. The Quitline services were good, I just

wasn’t ready to quit Number Overall % Valid %


Agree 142 13.7 48.0






197



NQ6j. To be able to quit, I think I would need more

frequent contact with a Quitline coach Number Overall % Valid %


Agree 122 11.7 40.7

Disagree 136 13.1 45.3





NQ6k. To be able to quit, I think I would need to

attend more group meetings with other people who

are trying to quit



Agree 89 8.6 29.6

Disagree 165 15.9 54.8





NQ6l. To be able to quit, I think I would need more

face-to-face coaching Number Overall % Valid %


Agree 104 10.0 34.2

Disagree 167 16.1 54.9





198



NQ6m. To be able to quit, I think I would need

more free NRT Number Overall % Valid %


Agree 163 15.7 55.3






NQ6n. I’m never going to be able to quit if I only

have counseling by phone Number Overall % Valid %


Agree 80 7.7 27.1

Disagree 167 16.1 56.6





NQ6o. I need face to face counseling to help me quit

smoking Number Overall % Valid %


Agree 118 11.4 38.9

Disagree 150 14.4 49.5





199



NQ6p. I am going to keep trying to quit smoking Number Overall % Valid %


Agree 209 20.1 68.3

Disagree 17 1.6 5.6





NQ6q. I think I will quit smoking within the next 5

years Number Overall % Valid %


Agree 196 18.9 66.2

Disagree 20 1.9 6.8





NQ6r. I don’t think I will ever quit smoking Number Overall % Valid %


Agree 24 2.3 8.0

Disagree 212 20.4 70.9





200



NQ6s. By this time next year, I will no longer be

smoking cigarettes Number Overall % Valid %


Agree 137 13.2 50.4






NQ6t. No matter how hard I try, I just can’t quit

smoking Number Overall % Valid %


Agree 99 9.5 33.1

Disagree 154 14.8 51.5





NQ6u. Eventually cigarettes will just get too

expensive, and I’ll have to quit Number Overall % Valid %


Agree 167 16.1 54.9






201

Appendix E

Baseline and Overall Follow-Up

Comparisons

202


203

Table E1: Quitline Cessation Respondents’ Tobacco Use at Baseline and Follow-Up

Measure Baseline % Overall Follow-Up %

Cigarettes

Any use in past 30 days 97.6 77.7

Frequent smoker

(20 days or more in the past 30) 92.8 63.6

Daily smoker

(30 days in the past 30) 90.7 57.9

Cigars


Frequent smoker


Daily smoker

(30 days in the past 30) 1.3 0.8

Pipe tobacco


Frequent smoker


Daily smoker


Smokeless tobacco


Frequent user


Daily user


204

Table E2: Clinic Cessation Respondents’ Tobacco Use at Baseline and Follow-Up

Measure Baseline % Overall Follow-Up %

Cigarettes


Frequent smoker


Daily smoker

(30 days in the past 30) 94.9 52.3

Cigars


Frequent smoker


Daily smoker


Pipe tobacco


Frequent smoker


Daily smoker


Smokeless tobacco


Frequent user


Daily user


205

Table E3: Quitline Cessation Respondents’ Number of Cigarettes per Day

at Baseline and Follow-Up

Number per Day Baseline % Overall Follow-Up %

1 to 5 cigarettes 2.8 13.6





40 or more cigarettes 13.2 4.9

Less than 1 cigarette per day 0.0 0.4

Table E4: Clinic Cessation Respondents’ Number of Cigarettes per Day


Number per Day Baseline % Overall Follow-Up %






40 or more cigarettes 14.5 5.5

Less than 1 cigarette per day 0.0 0.0

Table E5: Quitline Cessation Respondents’ Amount of Time After Waking Used Tobacco


Baseline % Overall Follow-Up %

Within 5 minutes of waking 44.6 31.1

6 to 30 minutes after waking 32.4 31.1


More than 60 minutes after waking 12.2 25.2

Table E6: Clinic Cessation Respondents’ Amount of Time After Waking Used Tobacco


Baseline % Overall Follow-Up %

Within 5 minutes of waking 43.6 29.6



More than 60 minutes after waking 13.6 28.5

206


207

Appendix F

Cessation Rates by County

208


209

Cessation Rates by County: Quitline Respondents

County Total Called Total Quit County Total Called Total Quit

Adair 23 7 (30%) Jefferson 54 5 (9%)

Adams 12 2 (17%) Johnson 121 29 (24%)

Allamakee 17 4 (24%) Jones 37 10 (27%)

Appanoose 70 9 (13%) Keokuk 34 6 (18%)

Audubon 10 4 (40%) Kossuth 28 7 (25%)

Benton 45 6 (13%) Lee 92 15 (16%)

Blackhawk 268 43 (16%) Linn 347 73 (21%)

Boone 46 7 (15%) Louisa 19 3 (16%)

Bremer 34 13 (38%) Lucas 47 7 (15%)

Buchanan 42 12 (29%) Lyon 17 4 (24%)

Buena Vista 20 1 (5%) Madison 29 8 (28%)

Butler 40 10 (25%) Mahaska 62 14 (23%)

Calhoun 21 2 (10%) Marion 74 18 (24%)

Carroll 21 2 (10%) Marshall 76 20 (26%)

Cass 34 7 (21%) Mills 30 3 (10%)

Cedar 33 11 (33%) Mitchell 2 0 (0%)

Cerro Gordo 96 13 (14%) Monona 18 4 (22%)

Cherokee 24 7 (29%) Monroe 35 6 (17%)

Chickasaw 19 0 (0%) Montgomery 25 4 (16%)

Clarke 22 9 (41%) Muscatine 88 14 (16%)

Clay 29 8 (28%) Obrien 21 4 (19%)

Clayton 37 11 (30%) Osceola 19 7 (37%)

Clinton 116 22 (19%) Page 24 2 (8%)

Crawford 29 5 (17%) Palo Alto 16 6 (38%)

Dallas 72 16 (22%) Plymouth 22 4 (18%)

Davis 18 6 (33%) Pocahontas 15 1 (7%)

Decatur 32 8(25%) Polk 815 179 (22%)

Delaware 40 10 (25%) Pottawattamie 108 28 (26%)

Des Moines 118 32 (27%) Poweshiek 37 9 (24%)

Dickinson 23 6 (26%) Ringgold 18 1 (6%)

Dubuque 146 31 (21%) Sac 11 4 (36%)

Emmet 15 3 (20%) Scott 253 48 (19%)

Fayette 59 8 (14%) Shelby 26 8 (31%)

Floyd 42 9 (21%) Sioux 29 8 (28%)

Franklin 15 3 (20%) Story 69 13 (19%)

Fremont 5 0 (0%) Tama 29 9 (31%)

Greene 28 5 (18%) Taylor 14 3 (21%)

Grundy 18 5 (28%) Union 29 10 (35%)

Guthrie 28 3 (11%) Van Buren 12 2 (17%)

Hamilton 34 5 (15%) Wapello 126 34 (27%)

Hancock 24 5 (21%) Warren 76 16 (21%)

Hardin 24 4 (17%) Washington 33 6 (18%)

210

Cessation Rates by County: Quitline Respondents (Continued)


Harrison 27 6 (22%) Wayne 27 7 (26%)

Henry 38 6 (16%) Webster 92 10 (11%)

Howard 10 1 (10%) Winnebago 8 1 (13%)

Humboldt 17 4 (24%) Winneshiek 15 2 (13%)

Ida 3 1 (33%) Woodbury 189 27 (14%)

Iowa 15 3 (20%) Worth 16 4 (25%)

Jackson 34 4 (12%) Wright 35 10 (29%)

Jasper 96 19 (20%)

211

Cessation Rate by County: Clinic Respondents


Appanoose 4 1 (25%) Jones 1 1 (100%)

Benton 1 1 (100%) Keokuk 11 3 (27%)

Black Hawk 158 35 (22%) Lee 30 11 (37%)

Bremer 1 0 (0%) Linn 15 2 (13%)

Buchanan 6 1 (17%) Louisa 2 0 (0%)

Buena Vista 63 30 (48%) Lucas 1 1 (100%)

Butler 10 5 (50%) Mahaska 9 4 (44%)

Calhoun 5 0 (0%) Marion 1 0 (0%)

Cherokee 2 1 (50%) Marshall 24 6 (25%)

Chickasaw 1 0 (0%) Mills 2 0 (0%)

Clay 8 5 (63%) Monroe 2 0 (0%)

Clinton 2 0 (0%) Montgomery 1 0 (0%)

Crawford 1 0 (0%) Obrien 1 0 (0%)

Dallas 3 3 (100%) Pocahontas 3 1 (33%)

Davis 2 1 (50%) Polk 90 34 (38%)

Decatur 15 3 (20%) Pottawattamie 72 21 (29%)

Delaware 2 1 (50%) Sac 21 10 (48%)

Des Moines 49 11 (22%) Scott 90 11 (12%)

Dubuque 21 7 (33%) Shelby 2 0 (0%)

Fayette 1 0 (0%) Sioux 1 0 (0%)

Fremont 1 1 (100%) Tama 1 1 (100%)

Grundy 2 0 (0%) Union 1 1 (100%)

Hamilton 1 0 (0%) Van Buren 1 0 (0%)

Hardin 2 0 (0%) Wapello 65 20 (31%)

Harrison 2 1 (50%) Warren 3 0 (0%)

Henry 4 3 (75%) Washington 2 0 (0%)

Humboldt 5 2 (40%) Wayne 2 2 (100%)

Ida 4 3 (75%) Winneshiek 5 2 (40%)

Jackson 2 2 (100%) Woodbury 83 16 (19%)

Jefferson 8 0 (0%) Worth 1 0 (0%)

Johnson 1 1 (100%)

212


213

Appendix G

FY2011 – New Quitline

Follow-Up Questionnaire

214


215

SF1. Overall, how satisfied were you with the service you received from the Quitline? Were

you…

1. Very satisfied,

2. Mostly satisfied,

3. Somewhat satisfied, or

4. Not at all satisfied?

7. Don’t know

9. Refused

OF1c. If a friend were in need of similar help, would you recommend the Quitline to him/her?

Would you say…

1. Yes, definitely,

2. Yes, I think so,

3. No, I don’t think so, or

4. No, definitely not?

7. Don’t know

9. Refused

SF2. Have you smoked any cigarettes or used other tobacco, even a puff or pinch, in the last 30

days?

1. Yes

2. No SKIP TO SF9

7. Don’t know SKIP TO SF9

9. Refused SKIP TO SF9

OF3. Have you smoked any cigarettes or used other tobacco, even a puff or pinch, in the last 7

days?

1. Yes

2. No

7. Don’t know

9. Refused

216

SF4. What types of tobacco have you used in the past 30 days? Have you used…

a. Cigarettes?

b. Cigars, cigarillos, or little cigars?

c. Pipe? [This is a traditional pipe, not a water pipe or hookah]

d. Chewing tobacco, snuff, or dip such as Skoal, Copenhagen, Grizzly, Red Man, or

Day’s Work?

e. Other?

1. Yes

2. No

7. Don’t know

9. Refused

OF4e1. What types of other products do you use? [Select all that apply]

01. Bidis

02. Kreteks

03. Tobacco pouches or “Snus”

04. Tobacco orbs

05. Tobacco strips

06. Water pipes or hookahs

07. Other [Specify]

77. Don’t know

99. Refused

IF SF4a <1> SKIP TO SF5b

SF5a. Do you currently smoke cigarettes everyday, some days, or not at all?

[Note: “currently” refers to right now, today.]

1. Everyday SKIP TO SF6a

2. Some days

3. Not at all SKIP TO SF5b

7. Don’t know

9. Refused

OF5a1. How many days did you smoke in the last 30 days?

[ ] = number of days {1 – 30}

77. Don’t know

99. Refused

217

F6a. How many cigarettes do you smoke per day on the days that you smoke?

[If caller says over 100, confirm 20 cigarettes = 1 pack. If caller cannot identify a specific

number probe: “Give me your best guess, it is ok if it is not perfect.”]

[ ] = number of cigarettes {1 – 140}

777. Don’t know

999. Refused

IF SF4b <1> SKIP TO SF5c

SF5b. Do you currently smoke cigars, cigarillos, or little cigars everyday, some days, or not at

all?


1. Everyday SKIP TO SF6b

2. Some days

3. Not at all SKIP TO SF5c

7. Don’t know

9. Refused

OF5b1. How many days did you smoke in the last 30 days?


77. Don’t know

99. Refused

SF6b. How many cigars, cigarillos, or little cigars do you smoke per week during the weeks that

you smoke?

[If caller cannot identify a specific number probe: “Give me your best guess, it is ok if it is not

perfect.”]

[ ] = number of cigars, cigarillos, or little cigars {1 – 140}

777. Don’t know

999. Refused

IF SF4c <1> SKIP TO SF5d

SF5c. Do you currently smoke a pipe everyday, some days, or not at all?


1. Everyday SKIP TO SF6c

2. Some days

3. Not at all SKIP TO SF5d

7. Don’t know

9. Refused

218

OF5c1. How many days did you smoke in the last 30 days?


77. Don’t know

99. Refused

SF6c. How many pipes do you smoke per week during the weeks that you smoke?


perfect.”]

[ ] = number of pipes {1 – 140}

777. Don’t know

999. Refused

IF SF4d <1> SKIP TO SF5e

SF5d. Do you currently use chewing tobacco, snuff, or dip everyday, some days, or not at all?


1. Everyday SKIP TO SF6d

2. Some days

3. Not at all SKIP TO SF5e

7. Don’t know

9. Refused

OF5d1. How many days did you chew in the last 30 days?


77. Don’t know

99. Refused

SF6d. How many pouches or tins do you use per week during the weeks that you use tobacco?


perfect.”]

[ ] = number of pouches or tins {1 – 140}

777. Don’t know

999. Refused

219

IF SF4e <1> SKIP TO SF7

SF5e. Do you currently use other tobacco products everyday, some days, or not at all?


1. Everyday SKIP TO SF6e

2. Some days

3. Not at all SKIP TO SF7

7. Don’t know

9. Refused

OF5e. How many days did you use other tobacco products in the last 30 days?


77. Don’t know

99. Refused

SF6e1-7. How many [OTHER TOBACCO PRODUCT] do you use per week during the weeks

that you use tobacco?


perfect.”]

[ ] = number of [UNIT] {1 – 140}

777. Don’t know

999. Refused

IF SF4a <1> SKIP TO OF71

SF7. How soon after you wake up do you smoke your first cigarettes?

1. Within 5 minutes

2. 6 to 30 minutes

3. 31 to 60 minutes

4. More than 60 minutes

7. Don’t know

9. Refused

220

IF SF4b,c,d,or e <1> SKIP TO SF8a OF71. How soon after you wake up do you use tobacco other than cigarettes?

1. Within 5 minutes

2. 6 to 30 minutes

3. 31 to 60 minutes

4. More than 60 minutes

7. Don’t know

9. Refused

IF SF4a <1> SKIP TO SF8b

SF8a. Do you intend to quit using cigarettes within the next 30 days?

1. Yes

2. No

7. Don’t know

9. Refused

IF SF4b <1> SKIP TO SF8c SF8b. Do you intend to quit using cigars, cigarillos, or little cigars within the next 30 days?

1. Yes

2. No

7. Don’t know

9. Refused

IF SF4c <1> SKIP TO SF8d SF8c. Do you intend to quit using a pipe within the next 30 days?

1. Yes

2. No

7. Don’t know

9. Refused

IF SF4d <1> SKIP TO SF8e SF8d. Do you intend to quit using chewing tobacco, snuff, or dip within the next 30 days?

1. Yes

2. No

7. Don’t know

9. Refused

221

IF SF4e1-7 <1> SKIP TO SF9 SF8e1-7. Do you intend to quit using [OTHER TOBACCO PRODUCT] within the next 30

days?

1. Yes

2. No

7. Don’t know

9. Refused

SF9. Since you first called the quitline on [INTAKE DATE], seven months ago, did you stop

using tobacco for 24 hours or longer because you were trying to quit?

1. Yes

2. No SKIP TO OF10

7. Don’t know

9. Refused

OF91. How many times did you stop using tobacco for 24 hours or longer? For example, if you

stopped for 2 days and started smoking again, and then stopped for a week and started smoking

again, that counts as 2 quits.

[Interviewer: only intentional quit periods should be counted.]

[ ] = number of quits {1 – 76}

76. 76 or more

77. Don’t know

99. Refused

OF10. When was the last time you used any type of tobacco, even a puff or pinch?

MM/DD/YYYY

01/01/1999. Don’t know or Refused

SF11. Since you first called the quitline seven months ago, have you used any of the following

products or medications to help you quit?

[Read and select all that apply.]

01. Nicotine patches,

02. Nicotine gum,

03. Nicotine lozenges,

04. Nicotine spray,

05. Nicotine inhaler,

06. Zyban, also called Wellbutrin or bupropion,

222

07. Chantix, also called varenicline,

08. Other medications to help you quit? [Specify]

66. No products or medication

77. Don’t know

99. Refused

SF12. Other than the quitline or medications, did you use any other kinds of assistance to help

you quit over the past seven months, such as advice from a health professional, or other kinds of

quitting assistance?

[Interviewer: Let respondent free-respond and prompt with response categories if needed.]

01. Advice from a health professional

02. Website [Specify]

03. Telephone program [Specify]

04. Counseling program [Specify]

05. Self-help materials [Specify]

06. Something else [Specify]

66. No other assistance

77. Don’t know

99. Refused

IF SF2<1> AND SF4A<1>, SKIP TO WQ1a


a. The people at Quitline listened carefully to what I said.

c. The people at Quitline cared about whether my quit attempt was successful.

d. Using Quitline was inconvenient for me.

f. The people at Quitline were helpful.

g. I feel better prepared for my next quit attempt because I used Quitline.

h. Calling Quitline did not make it easier for me to quit using tobacco products.

i. The Quitline services were good, I just wasn’t ready to quit.

j. To be able to quit, I think I would need more frequent contact with a Quitline coach.

l. To be able to quit, I think I would need more face-to-face coaching.

m. To be able to quit, I think I would need more free NRT.

t. No matter how hard I try, I just can’t quit smoking.

p. I am going to keep trying to quit smoking.

s. By this time next year, I will no longer be smoking cigarettes.

223

Would you say you…

1. Strongly agree,

2. Agree,

3. Disagree, or

4. Strongly disagree?


9. Refused

8. Respondent has quit within the last 30 days

WQ1a. Have you visited the Quitline Iowa website, www.quitlineiowa.org?

1. Yes

2. No SKIP TO CLOSE

7. Don’t know SKIP TO CLOSE

9. Refused SKIP TO CLOSE

WQ1b. On a scale of 1 to 5, 1 being not at all helpful and 5 being extremely helpful, how helpful

was the information on the Quitline Iowa website?

[ ] = rating

7. Don’t know

9. Refused

CLOSE

That’s all the questions I have. The answers of all the participants interviewed will be combined

to describe people’s experiences with the program and to guide its future development. If you

have questions about this survey you may call Disa Cornish at (319) 273-2105. Thank you for

your time and cooperation with this survey. Good-bye.

Iowa Tobacco Cessation Program Evaluation …...Evaluation Iowa Tobacco Cessation Program : FY2010...

Documents

Transcript of Iowa Tobacco Cessation Program Evaluation …...Evaluation Iowa Tobacco Cessation Program : FY2010...