PUBLIC HEALTH DISTRICT MILLENNIUM TOBACCO CESSATION PROGRAM

Transcription

1 PUBLIC HEALTH DISTRICT MILLENNIUM TOBACCO CESSATION PROGRAM FISCAL YEAR 2015 EVALUATION REPORT Janet Reis, PhD, Principal Investigator Lisa MacKenzie, MHS, Research Associate Sophia Brasil, Research Assistant August 2015 Center for Health Policy Boise State University 1910 University Dr. Boise, ID Phone: Web:

2 2 TABLE OF CONTENTS Executive Summary... 3 Introduction... 5 Description of the Millennium Tobacco Cessation Program... 6 Description of FY 2015 Participants... 6 Tobacco Cessation Program Outcomes... 8 E-cigarette Tobacco Cessation Program Outcomes Comparison of Outcomes for FY 2001 through FY 2015 Participants Evaluation Design Longitudinal Outcomes of the Tobacco Cessation Program Location of Tobacco Cessation Program and Participants Economic Analysis Conclusion References Appendix A: Map of Participants by City of Service Appendix B: Map of Participants by County of Residence Appendix C: Follow-up Interview Attempts at Two Months and Six Months FY Appendix D: Two-Months and Six-Months Follow-up Results FY FY Appendix E: FY 2014 Follow-up Interview Attempts at Seven-Months TABLE INDEX Table 1: Number of Participants Starting the Program: Age Distribution by Health - FY Table 2: Number of Participants Starting the Program by Gender by Health - FY Table 3: Number of Pregnant Participants Starting the Program by Health - FY Table 4: Tobacco Cessation Program Outcomes by Target Population Groups - FY Total participants starting and completing the program... 8 Table 5: Tobacco Cessation Program Outcomes by Target Population Groups - FY Total participants starting but not completing the program... 8 Table 6: Tobacco Cessation Program Outcomes by All Target Population Groups - FY Total participants starting the program, completed and not completed combined... 9 Table 7: Number of Participants Using E-Cigarettes: Age Distribution by Health - FY Table 8: Number of Participants Using E-Cigarettes by Gender by Health - FY Table 9: Number of Pregnant Participants Using E-Cigarettes by Health - FY Table 10: E-Cigarettes Tobacco Cessation Program Outcomes by Target Population Groups - FY Total participants starting and completing the program Table 11: E-Cigarettes Tobacco Cessation Program Outcomes by Target Population Groups - FY Total participants starting but not completing the program Table 12: E-Cigarettes Tobacco Cessation Program Outcomes by All Target Population Groups - FY Total participants starting the program, completed and not completed combined Table 13: Comparison of Program Outcomes for FY FY Table 14: Program Outcomes for FY FY Table 15: Follow-up Interview Attempts at One-Month and Seven-Month for FY Table 16: One-Month and Seven-Month Follow-up Results for FY Table 17: Follow-up Interview Attempts at One-Month and Seven-Months for FY FY Table 18: One-Month and Seven-Month Follow-up Results FY FY Table 19: Counties Where Tobacco Cessation Classes Were Held, by Health - FY Table 20: Counties Where Tobacco Cessation Classes Where Participants Lived, by Health - FY Table 21: Follow-up Interview Attempts at Two-Months and Six-Months FY Table 22: Two-Months and Six-Months Follow-up Results FY FY Table 23: Seven-Month Follow-up Results at the end of FY 2014 compared to completion of FY 2014 Follow-up Calls... 24

3 3 EXECUTIVE SUMMARY The Millennium Tobacco Cessation program, facilitated by Idaho s seven public health districts, has provided tobacco cessation counseling to 25,583 Idahoans in the fifteen years it has been evaluated (in fiscal year (FY) 2010, no data were collected by BSU). The FY 2015 evaluation report describes the evaluation process and summarizes the results of the Millennium Fund Tobacco Cessation Program s fifteenth year in operation. The evaluation is focused on process and outcome monitoring of the Millennium Tobacco Cessation services conducted by the seven public health districts and their partners. KEY FINDINGS: The program has continued to accomplish the four main objectives specified by the public health districts. The objectives have been met as evidenced by: 1) Offer tobacco cessation programs in each district that fit standardized criteria for best practices including, but not limited to; the American Cancer Society, Idaho Prenatal Smoking Cessation Program (IPSCP), the Centers for Disease Control and Prevention, the American Heart Association, and the American Lung Association. 2) Conduct at least one tobacco cessation program in at least one-half of the counties within the district boundaries. Services were provided in 39 of Idaho s 44 counties (89%). Beginning FY 2007, data on county of residence of program participants was captured. The programs in 2015 served individuals who self-reported residence in 41 of Idaho s 44 counties (93%). 3) Conduct tobacco cessation services specifically designed for pregnant women and teens. Pregnant women comprised 16% (333) of the total participants starting the program (2,127) and 45% (960) youth (< 18) of the total 2,127 participants who started the program in FY ) Provide the independence for each public health district to determine the program(s) to be offered and to recruit instructors. Of the 2,127 persons starting a health district tobacco cessation program in FY 2015, 1,220 (57%) persons completed it. Looking at the three major participant groups, 419 adults (50% of adults starting program), 634 youth (66% of youth starting program), and 167 pregnant (50% pregnant women starting program) completed the program. Completion of a program was defined as attending a minimum of four sessions. Overall, 659 persons out of 2,127 persons (31%) reported quitting tobacco during the program whether or not they completed the minimum of four classes. Of those participants (2,127) starting the program, 180 (22%) adults, 406 (42%) youth, and 73

4 4 (22%) pregnant women stopped using tobacco at some point in their program experience. The total expenditure for the program was $750,000 provided by the Millennium Fund, approximately $353 per participant (2,127 participants). An average of $3,390 in annual economic costs is saved for each youth or adult who stops smoking. 1,2,3 This estimate includes productivity losses and smoking attributable medical expenses per the 2002 CDC analysis. The anticipated savings in reduced health care and other economic costs are as follows: Youth and adults (quitters) $2,234,010 (659 persons x $3,390/person) While individuals continued to use tobacco, another 663 (31%) persons out of 2,127 persons reduced the amount of tobacco used, consisting of 297 adults, 279 youth, and 87 pregnant women. The percent reduced within each group was 36% for adults, 29% for youth, and 26% for pregnant women. The evaluation provides an opportunity for the public health districts and the legislature to make informed decisions concerning the effectiveness of this program.

5 5 HEALTH DISTRICT MILLENNIUM TOBACCO CESSATION PROGRAM FISCAL YEAR 2015 EVALUATION REPORT INTRODUCTION Background on Tobacco Cessation Program Effectiveness The tobacco epidemic causes six million deaths worldwide each year and is the number one cause of sickness and death in the United States. 4 The risk of heart attack, stroke, and various cancers decrease significantly in a person within one to five years of quitting smoking. 5 Every year, more than 40% of smokers make an attempt to quit smoking, but more assistance is needed to ensure these attempts are successful in the long-term. 6 Individuals who participate in tobacco cessation interventions are significantly more likely to quit tobacco use and to remain smoke-free than those who do not receive tobacco cessation services. 7 Across national controlled evaluations of tobacco cessation programs, there was an average quit rate between 15% and 19% directly at the end of the program. 8 In a separate analysis of controlled tobacco cessation interventions, there was a long-term abstinence rate of 12.5% of participants who reported being abstinent for at least 30 days. 7 In both cases, the participants assigned to the tobacco cessation programs had significantly higher quit rates and abstinence rates than those who were in the control group. Tobacco Cessation Program and Youth According to the American Lung Association, more than 68% of people who smoke began smoking when they were under 18 years of age. 9 Decreasing youth tobacco use is essential to preventing serious complications and more severe tobacco addictions later on in life. It is notable that interventions customized for youth tobacco cessation that produce positive results are typically ones that target the issues of why youth started smoking in the first place. 10 These programs address topics such as depression, stress, and conflict. 7 There are significant obstacles, however, to researching the effectiveness of youth tobacco cessation programs. Recruitment of large sample sizes of youth participants due to privacy concerns, Institutional Review Board (IRB) requirements, and availability for follow-up are all considerable issues in this area of research. 8 Future research should address these challenges in order to advance knowledge of youth behaviors in tobacco cessation programs. One method that seems promising in reaching those who would otherwise not be able to access services, as well as increasing follow-up responses for youth is SMS USA, a text-based cessation service. 11 This method of contact will be tested with Idaho youth in Fiscal Year Financial Impact The promotion of comprehensive tobacco cessation services results in savings for current smokers, Medicaid programs, and employers. With the national average price of a package of cigarettes around $5.58, an individual spends over $1,500 a year on cigarettes considering that the average smoker inhales 13 to 16 cigarettes per day. 12 Considering these figures, a tobacco user stands to save a substantial amount of money by abstaining from cigarette use. Similarly,

6 6 savings in Medicaid programs are attributable to decreased hospitalizations for cardiovascular conditions. In a recent study a cost-benefit analysis computed an estimated net savings of $388 annually per smoker on Medicaid. 13 The analysis concluded that for each $1 spent on tobacco cessation services and outreach, there is an associated $3.12 savings in Medicaid expenses. 12 In addition, the financial benefit to employers who offer coverage for tobacco cessation programs is estimated to be $3,400 per year. This is a result of an increase in productivity, fewer absences, and reduced cases of illness. 14 Idaho s Health Millennium Tobacco Cessation Program Following the successful establishment of the statewide tobacco cessation program in FY 2001, the Idaho tobacco cessation program has been continued during FYs This annual report describes the evaluation process and gives the results of the Millennium Fund Tobacco Cessation program s fifteenth year ( ). During year fifteen of the evaluation, the public health districts continued to focus on the four specified objectives outlined at the inception of the program. The objectives are to: 1. Offer tobacco cessation programs in each health district that meet the criteria for model practices of successful tobacco cessation programs, 2. Conduct at least one tobacco cessation class in at least half the counties served by each of the health districts, 3. Offer special classes designed for pregnant women and teens, and 4. Allow each health district the independence to choose their own program(s) (as long as it fits the model practices criteria) and their own tobacco cessation instructors. DESCRIPTION OF THE MILLENNIUM TOBACCO CESSATION PROGRAM Tobacco Cessation programs funded through the Millennium Fund are required to meet the best practices of tobacco cessation programs gleaned from the professional literature. The rationale for requiring that programs use best practice methods is to assure that any program receiving funding has been tested as effective in reducing the use of tobacco. Tobacco cessation programs must: have multiple sessions (at least four), and contain educational counseling on nicotine addiction, consequences of tobacco use, benefits of being tobacco-free, combating withdrawal symptoms, stress management techniques, nutrition and exercise, social support, techniques for dealing with relapse, different quitting techniques, strategies for coping with urges, and promotion of Idaho s Quitline and quitnow.net, and other Idaho resources. DESCRIPTION OF FY 2015 PARTICIPANTS During FY 2015, 2,127 persons enrolled in tobacco cessation classes sponsored by the public health districts and paid for by the Millennium Fund. Of those enrolled, 1,077 were female and

7 7 1,050 were male. Among the 1,077 female participants, 333 were pregnant (31%). The largest number of participants enrolled were in the under 18 (981), followed by the (471), and then the age group (410) (Table 1). The fewest number of participants came from the 65 and older age group (32). Overall, 16 participants did not list age. Table 1: Number of Participants Starting the Program: Age Distribution by Health - FY 2015 I II III IV V VI VII Total < Age Unknown Total ,127 Note: Count of youth includes the number of pregnant adolescents < 18. Table 2: Number of Participants Starting the Program by Gender by Health - FY 2015 I II III IV V VI VII Total Male ,050 Female ,077 Total ,127 Table 3: Number of Pregnant Participants Starting the Program by Health - FY 2015 I II III IV V VI VII Total Pregnant % of all female participants 24% 77% 20% 21% 73% 40% 16% 31% Total Baby last 6 weeks

8 8 TOBACCO CESSATION PROGRAM OUTCOMES Outcomes for priority target groups of pregnant females and youth Because pregnant women and youth under 18 years of age are two of the priority target population groups for the tobacco cessation intervention, results are also tabulated on the outcomes for those individuals (Tables 4, 5, 6, and Figure 1). Tables 7-12 are similar results but only show e-cigarette usage participants. Note Tables 4-6 and Figure 1 also include e-cigarette usage as this was an additional question to determine count. Table 4: Tobacco Cessation Program Outcomes by Target Population Groups - FY Total participants starting and completing the program Total of participants starting and completing the program (% of total) Quit Tobacco (% of Pop Grp) Reduced number of cigarettes used (% of Pop Grp) Pregnant 167 (14%) 56 (34%) 44 (26%) Youth (< 18) 634 (52%) 351 (55%) 198 (31%) Adult 419 (34%) 152 (36%) 218 (52%) Total 1,220 (100%) 559 (46%) 460 (38%) Note: Count of youth excludes the number of pregnant women < 18. Table 5: Tobacco Cessation Program Outcomes by Target Population Groups - FY Total participants starting but not completing the program Total of participants starting but not completing the program (% of total) Quit Tobacco (% Pop Grp) Reduced number of cigarettes used (% Pop Grp) Pregnant 166 (18%) 17 (10%) 43 (26%) Youth (< 18) 326 (36%) 55 (17%) 81 (25%) Adult 415 (46%) 28 (7%) 79 (19%) Total 907 (100%) 100 (11%) 203 (22%) Note: Count of youth excludes the number of pregnant women < 18.

9 9 Table 6 demonstrates the females who were pregnant (333), 167 (50%) completed the tobacco cessation program, 73(22%) quit tobacco, and 87(26%) reduced the number of cigarettes they used. Youth under 18 years of age had a quit rate of 42% and an additional 29% of youth reduced the number of cigarettes used. Table 6: Tobacco Cessation Program Outcomes by All Target Population Groups - FY Total participants starting the program, completed and not completed combined Total of participants starting the program (% of total) Completed program Quit Tobacco (% Pop Grp) Reduced number of cigarettes used (% Pop Grp) Pregnant 333 (16%) 167 (50%) 73 (22%) 87 (26%) Youth (< 18) 960 (45%) 634 (66%) 406 (42%) 279 (29%) Adult 834 (39%) 419 (50%) 180 (22%) 297 (36%) Total 2,127 (100%) 1,220 (57%) 659 (31%) 663 (31%) Note: Count of youth excludes the number of pregnant women < 18. Figure 1: Number who started Tobacco Cessation classes, completed the cessation course, quit tobacco use, and reduced tobacco use FY 2015 (N=1,220) Pregnant Youth (< 18) Adult

10 10 E-CIGARETTE TOBACCO CESSATION PROGRAM OUTCOMES The following tables include E-cigarettes Tobacco Cessation information. During the FY15 additional data was collected to include the count of E-cigarettes users that have participated in Tobacco Cessation programs. Table 7: Number of Participants Using E-Cigarettes: Age Distribution by Health FY 2015 I II III IV V VI VII Total < Age Unknown Total ,363 Note: Data is E-Cig use ONLY. Count of youth includes the number of pregnant adolescents < 18. Table 8: Number of Participants Using E-Cigarettes by Gender by Health - FY 2015 I II III IV V VI VII Total Male Female Total ,363 Note: Data is E-Cig use ONLY. Count of youth includes the number of pregnant adolescents < 18. Table 9: Number of Pregnant Participants Using E-Cigarettes by Health - FY 2015 I II III IV V VI VII Total Pregnant % of all female participants 18% 66% 13% 3% 46% 19% 22% 20% Total Note: Data is E-Cig use ONLY. Count of youth includes the number of pregnant adolescents < 18.

11 11 Table 10: E-Cigarettes Tobacco Cessation Program Outcomes by Target Population Groups - FY Total participants starting and completing the program Total of participants starting and completing the program (% of total) Quit Tobacco (% of Pop Grp) Reduced number of cigarettes used (% of Pop Grp) Pregnant 58 (7%) 26 (45%) 19 (33%) Youth (< 18) 486 (61%) 256 (53%) 160 (33%) Adult 253 (32%) 82 (32%) 148 (58%) Total 797 (100%) 364 (30%) 327 (27%) Note: Data is E-Cig use ONLY. Count of youth excludes the number of pregnant women < 18. Table 11: E-Cigarettes Tobacco Cessation Program Outcomes by Target Population Groups - FY Total participants starting but not completing the program Total of participants starting but not completing the program (% of total) Reduced number of cigarettes used (% Pop Grp) Quit Tobacco (% Pop Grp) Pregnant 62 (11%) 4 (6%) 22 (35%) Youth (< 18) 249 (44%) 42 (17%) 66 (27%) Adult 255 (45%) 15 (6%) 62 (24%) Total 566 (100%) 61 (11%) 150 (27%) Note: Data is E-Cig use ONLY. Count of youth excludes the number of pregnant women < 18. Table 12: E-Cigarettes Tobacco Cessation Program Outcomes by All Target Population Groups FY Total participants starting the program, completed and not completed combined Total of participants starting but not completing the program (% of total participants) Total of participants completing the program(% of total participants) Total of All participants quitting tobacco (% of All participants) Total of All participants reducing number of cigarettes used (% of All participants) Pregnant 62 (11%) 58 (7%) 30 (2%) 41 (3%) Youth (< 18) 249 (44%) 486 (61%) 298 (22%) 226 (17%) Adult 255 (45%) 253 (32%) 97 (7%) 210 (15%) Total 566 (100%) 797 (37%) 425 (31%) 477 (35%) Note: Data is E-Cig use ONLY. Count of youth excludes the number of pregnant women < 18. Status for participants could have reported do not know or no change. Relevant data to the outcomes are shown in this table and do not reflect the do not know and no change answers.

12 12 COMPARISON OF OUTCOMES FOR FY 2001 THROUGH FY 2015 PARTICIPANTS Table 13 compares the program outcomes for the aggregate of FY 2001 through FY 2015 participants by population group. Of the 25,583 individuals who enrolled in programs during those fifteen years, 63% (16,205) completed the program and 35% (8,918) quit smoking. While not quitting, another 38% (9,602) used fewer cigarettes after the program than before. Examination of the previous five years of program activity shows an average of stable trends in these outcomes. Table 13: Comparison of Program Outcomes for FY FY 2015 Fiscal Year Total Participants Completed program Quit Smoking Still using, but reduced number of cigarettes used , (58%) 351 (24%) 409 (28%) ,099 1,336 (64%) 718 (34%) 778 (37%) ,747 1,141 (65%) 622 (36%) 710 (41%) ,743 1,163 (67%) 572 (33%) 713 (41%) ,097 1,289 (61%) 810 (39%) 781 (37%) , (63%) 532 (37%) 590 (40%) ,227 1,447 (65%) 810 (36%) 895 (40%) ,045 1,423 (70%) 754 (37%) 854 (42%) ,326 1,616 (69%) 853 (37%) 1,004 (43%) 2010* 0 0 (0%) 0 (0%) 0 (0%) , (60%) 673 (41%) 569 (35%) (62%) 537 (36%) 548 (36%) , (63%) 425 (31%) 540 (39%) ,712 1,014 (59%) 602 (35%) 548 (32%) ,127 1,220 (57%) 659 (31%) 663 (31%) Total 25,583 (100%) 16,205 (63%) 8,918 (35%) 9,602 (38%) *No data were collected in FY 2010 under the previous management of the evaluation team.

13 13 Table 14 shows that of all of the groups, youth had the highest percentage that completed the program (69%). Youth also had the highest percentage of participants who quit tobacco (46%). The group with the highest percentage of reduced tobacco use was adult at (40%). Table 14: Program Outcomes for FY FY 2015* Total of participants starting the program Percentage of participants completing program Percentage of participants quit tobacco Percentage of participants reducing amount of tobacco use Pregnant 4,126 (16%) 2,300 (56%) 1,109 (27%) 1,511 (37%) Youth (< 18) 7,580 (30%) 5,200 (69%) 3,460 (46%) 2,486 (33%) Adult 13,892 (54%) 8,716 (63%) 4,351 (31%) 5,607 (40%) Total 25,598** 16,216 (63%) 8,920 (35%) 9,604 (38%) *Excludes FY 2010 data as no data were collected. **Earlier reports reflect an error of omission of participants. Differences in totals between Tables 13 and 14 are due to the error of omission from earlier reports of participants. EVALUATION DESIGN The Center for Health Policy (CHP) at Boise State University conducts an evaluation of the tobacco cessation program. Program reports and participant data forms were collected by each public health district tobacco cessation coordinator or tobacco cessation contractor and sent to Boise State University for entry, analysis, and storage. LONGITUDINAL OUTCOMES OF THE TOBACCO CESSATION PROGRAM From 2001 to 2012 adult participants were asked to consent to follow-up by providing a name and telephone number for two and six-month follow-up phone calls. At the two-month time period, three attempts were made to contact each participant. At the six-month time period, five attempts were made to contact each participant. Appendix C and D reports the results of these follow-up phone calls from All participants were called again at the six-month followup unless they asked to be removed from the call list.

14 14 Results for FY 2015 are shown in Table 15 and Table 16. The follow-up period was changed to one and seven-months and the process for the follow-up calls remained the same as previous years. Table 15: Follow-up Interview Attempts at One-Month and Seven-Months for FY 2015 Total Eligible for interview Interviews completed Maximum # of attempts made Declined interview Phone number not current Follow-up One- Month (32%) 158 (30%) 79 (15%) 128 (24%) Seven- Months (34%) 36 (13%) 60 (22%) 83 (31%) Note: Maximum # of attempts = # of phone calls made. Status for participants could have reported no change. Relevant data to the outcomes are shown in this table and do not reflect the no change answer. Table 16: One-Month and Seven-Month Follow-up Results for FY 2015 Quit Number interviewed Still Quit Relapsed Following Program Still Reduced One- Month 170 (32%) 37 (22%) 16 (9%) 21 (12%) 46 (27%) Seven- Months 92 (34%) 11 (12%) 5 (5%) 9 (10%) 19 (21%) Note: Status for participants could have reported no change. Relevant data to the outcomes are shown in this table and do not reflect the no change answer. Figure 2: Participant status at one-month and seven-months after the end of the program, FY % 80% 60% 40% 20% 0% 29% 52% 22% 12% 12% 10% 27% 21% 9% 5% One-month follow-up Seven-month follow-up No Change Still Quit Quit after Program Still Reduced Relapsed

15 15 Results for the cumulative FYs are shown in Tables 17 and 18. Table 17: Follow-up Interview Attempts at One-Month and Seven-Month for FY FY 2015 Total Eligible for interview Interviews completed Maximum # of attempts made Declined interview Phone number not current Follow-up One or Two Month 7,957 3,738 (47%) 2,675 (34%) 186 (2%) 940 (12%) Six or Seven Months 5,861 3,017 (51%) 1,297 (22%) 235 (4%) 907 (15%) Note: Maximum # of attempts = # of phone calls made. Status for participants could have reported no change. Relevant data to the outcomes are shown in this table and do not reflect the no change answer. Table 18: One-Month and Seven-Month Follow-up Results FY FY 2015 Number interviewed Still Quit Relapsed Quit Following Program Still Reduced One- Month 3,738 (47%) 742 (20%) 486 (13%) 579 (15%) 965 (26%) Seven- Months 3,017 (51%) 493 (16%) 481 (16%) 523 (17%) 756 (25%) Note: Status for participants could have reported no change. Relevant data to the outcomes are shown in this table and do not reflect the no change answer. 100% 80% 60% 40% 20% 0% Figure 3: Participant status at one-month (or two-month) and seven-month (or six-month) after the end of the program, FY % 25% No Change 20% 16% 15% 17% 26% 25% 13% 16% One/Two-Month Follow-up Six/Seven-Month Follow-up Still Quit Quit after Program Still Reduced Relapsed

16 16 LOCATION OF TOBACCO CESSATION PROGRAMS AND PARTICIPANTS One of the objectives of the program is to offer cessation services in at least half of the counties a public health district serves each year. Table 19 below shows that this objective was met as services were offered in 39 of the 44 counties in Idaho. In FY 2015, residents of 41 counties participated in tobacco cessation programs (Table 20). Appendix A and B indicate the cities and counties where services were provided in FY Table 19: Counties Where Tobacco Cessation Classes Were Held, by Health - FY 2015 Panhandle Health North Central Health Benewah, Bonner, Boundary, Kootenai, Shoshone Clearwater, Idaho, Latah, Lewis, Nez Perce Southwest Health Canyon, Gem, Payette, Washington Central Health Ada, Boise, Elmore, Valley South Central Public Health Southeastern Health Eastern Idaho Public Health Cassia, Gooding, Jerome, Minidoka, Twin Falls Bannock, Bear Lake, Bingham, Butte, Caribou, Franklin, Oneida, Power Bonneville, Clark, Custer, Fremont, Jefferson, Lemhi, Madison, Teton Table 20: Counties Where Tobacco Cessation Classes Where Participants Lived, by Health - FY 2015 Panhandle Health Benewah, Bonner, Boundary, Canyon, Kootenai, Shoshone

17 17 North Central Health Southwest Health Central Health Clearwater, Idaho, Latah, Lewis, Nez Perce Ada, Blaine, Boise, Canyon, Elmore, Gem, Jerome, Minidoka, Owyhee, Payette, Twin Falls, Union, Washington Ada, Boise, Canyon, Elmore, Gem, Valley South Central Public Health Southeastern Health Eastern Idaho Public Health Cassia, Gooding, Jerome, Minidoka, Twin Falls Ada, Bannock, Bear Lake, Bingham, Bonneville, Butte, Caribou, Franklin, Idaho, Oneida, Power, Teton Ada, Adams, Bannock, Bingham, Bonneville, Canyon, Custer, Elmore, Fremont, Gooding, Idaho, Jefferson, Lemhi, Madison, Multnomah, Nez Perce, Owyhee, Payette, Teton ECONOMIC ANALYSIS An average of $3,390 in annual economic costs is saved for each youth or adult who stops smoking. 1,2,3 This estimate includes productivity losses and smoking attributable medical expenses per the 2002 CDC analysis. The anticipated savings in reduced health care and other economic costs are as follows: Youth and adults (quitters) $2,234,010 (659 persons x $3,390/person) The total expenditure for the program was $750,000 provided by the Millennium Fund, approximately $353 per participant (2,127 participants).

18 18 CONCLUSION The four main objectives as noted below were accomplished: Continue tobacco cessation programs in each district that fit standardized criteria for best practices developed by the American Cancer Society, the Centers for Disease Control and Prevention, the American Heart Association, and the American Lung Association. Conduct at least one tobacco cessation course in at least half of the counties served within the district boundaries. It is noteworthy that Idaho s Public Health tobacco cessation services are more comprehensive than the adjoining states of Montana, Wyoming, Nevada, which limit tobacco cessation services to help call lines and online resources Idaho is similar to Utah which offers a range of Public Health-sponsored tobacco cessation services within the state. 19 Conduct services designed for pregnant women and teens. More specifically this was accomplished by utilizing the Supplemental Nutrition Program for Pregnant Women, Infants, and Children (WIC) to reach pregnant women and incorporating tobacco cessation into the curriculum for those women who use tobacco. Teens were often targeted in classes held in schools or held for teens that had been referred to the classes by the youth court program or by school administration (policy violators). Provide the independence for each health district to determine the program(s) they wanted to offer and to recruit instructors. In terms of upcoming public health challenges, the Idaho Public Health s are aware of the use of e-cigarettes by citizens within their districts and issues regarding the health impact of these products. In order to start to understand trends in use of e-cigarettes, the s added the following question to FY 2015 participant information form. Have you ever used E- cigarettes? Yes or No. Responses to this question have been included in this annual report and have been analyzed by participant gender, age, pregnancy status and other participant characteristics. Additionally, the s will monitor the status of e-cigarette products as determined by the U.S. Food and Drug Administration (FDA) review of comments received by August 8, and subsequent rulings. At the beginning of FY 2016 the public health districts will be implementing a text and online survey capability for the follow-up phone calls in an attempt to increase the response rate.

19 19 REFERENCES 1. Centers for Disease Control and Prevention (CDC). Annual smoking-attributable mortality, year of potential life lost, and economic costs United States, Morbidity and Mortality Weekly Report 2002; 51(14): Centers for Disease Control and Prevention. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses United States, Morbidity and Mortality Weekly Report 2008; 57(45): Health Costs of Smokers vs Former Smokers vs Non-Smokers Mishra G, Kulkarni S, Majmudar P, Gupta S, Shastri S. Community-based tobacco cessation program among women in Mumbai, India. Indian Journal Of Cancer, 2014; 51:S54-S U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Shiffman, S., Brockwell, S., Pillitteri, J., Gitchell, J. Use of Smoking-Cessation Treatments in the United States. American Journal of Preventive Medicine, 2008; 34(2): Curry, S., Mermelstein, R., Emery, S., Sporer, A., Berbaum, M., Campbell, R., Flay, B., & Warnecke, R. A National Evaluation of Community-Based Youth Cessation Programs: End of Program and Twelve-Month Outcomes. American Journal of Community Psychology, 2013; Curry, S., Mermelstein, R., Sporer, A., Emery, S., Berbaum, M., Campbell, R., Carusi,C., & Warnecke, R. A national evaluation of community-based youth cessation programs: design and implementation. Evaluation Review, 2010; 34(6): American Lung Association. Children and Teens Retrieved July 14, 2015, from Stanton, A., & Grimshaw, G. Tobacco Cessation Interventions for Young People (Review). The Cochrane Collaboration, Ybarra, M., Holtrop, J., Prescott, T., Rahbar, M., & Strong, D. Pilot RCT Results of Stop My Smoking USA: A Text Messaging Based Smoking Cessation Program for Young Adults. Nicotine & Tobacco Research. 2013

20 Berlin, L. Do Smokers Know How Much They Spend on Cigarettes? Daily Finance Retrieved July 14, 2015, from Richard, P., West, K., & Leighton, K. The Return on Investment of a Medicaid Tobacco Cessation Program in Massachusetts. Plos One, 2012; 7(1). 14. Volpp, K., Troxel, A., Pauly, M., Glick, H., Puig, A., Asch, D., &... Audrain-McGovern, J. A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation. New England Journal Of Medicine, 2009; 360(7): Idaho Department of Health and Welfare (IDHW). Idaho tobacco prevention and control program, n.d.; Wyoming Department of Health. Wyoming quit tobacco program, 2013; Montana Public Health and Human Services. Montana tobacco quit line, 2014; Nevada Tobacco Users Helpline, n.d.; Utah Department of Health. Utah tobacco cessation resources directory county resources, n.d.; Kux L. Deeming tobacco products to be subject to the Federal Food, Drug and Cosmetic Act as amended by the family smoking prevention and tobacco control act; regulations on the sale and distribution of tobacco products and required warning statements for tobacco products; extension of comment period, Regulations.gov; U.S. Food and Drug Administration (FDA). Electronic Cigarettes (e-cigarettes). Public Health Focus,

21 21 APPENDIX A: MAP OF COUNTY WHERE SERVICES WERE PROVIDED IN FY 2015 Millenium Tobacco Cessation BONNERS FERRY 21 Total Participants- FY15 16 SANDPOINT PRIEST RIVER PLUMMER POST FALLS HAYDEN COEUR D ALENE MOSCOW 15 LEWISTON SAINT MARIES 4 OROFINO KELLOGG KAMIAH (301) (104) (506) (366) (157) (211) (478) GRANGEVILLE 6 SALMON MC CALL WEISER PAYETTE 17 MIDDLETON CALDWELL NAMPA EMMETT IDAHO CITY MERIDIAN BOISE 1 1 MOUNTAIN HOME 9 1 GOODING JEROME TWIN FALLS BURLEY ARCO AMERICAN FALLS 12 MALAD CITY 9 5 REXBURG DRIGGS RIGBY IDAHO FALLS BLACKFOOT POCATELLO SAINT ANTHONY 84 SODA SPRING MONTPELIER PRESTON

22 22 APPENDIX B: MAP OF COUNTY OF RESIDENCE FOR PARTICIPANTS IN FY 2015 Millenium Tobacco Cessation Program Boundary 20 County of Residence of Participants- FY15 Bonner 17 Kootenai 198 Benewah 47 Latah 18 Nez Perce 62 Lewis 5 Shoshone 22 Clearwater 15 Idaho 12 (Known, Unknown) (304) (112) (509) (379) (169) (241) (389) Adams 1 Valley 1 Lemhi 8 Washington 9 Payette 27 Gem 13 Canyon 455 Ada 362 Owyhee 4 Boise 3 Elmore 13 Gooding 4 Twin Falls 107 Custer 1 Jerome 22 Blaine 3 Minidoka 12 Cassia 21 Butte 3 Jefferson 10 Bingham 60 Power 13 Oneida 9 Bannock 127 Bonneville 279 Franklin 23 Fremont 71 Madison 22 Caribou 2 Teton 9 Bear Lake 4

23 23 APPENDIX C: Follow-up Interview Attempts at Two-Months and Six-Months FY Table 21 shows that 3,309 two-month follow-up phone interviews have been completed. The number of participants reached represented slightly less than one-half of those eligible to be contacted (49%). The greatest obstacle to completing more interviews was due to the 34% of the population who were not able to be reached after three attempts. Of the 6,761 participants eligible at two-months, 5,403 (80%) were called at the six-month follow-up. Overall, 53% of the calls made at the six-month follow-up were completed. By six-months, 15% of the phone numbers provided at the time of the cessation program were no longer current. Table 21: Follow-up Interview Attempts at Two-Months and Six-Months FY FY 2012 Followup Total Eligible for interview Interviews completed Maximum # of attempts made Declined interview Phone number not current Two- Months 6,761 3,309 (49%) 2,320 (34%) 67 (1%) 687 (10%) Six- Months 5,403 2,855 (53%) 1,219 (23%) 167 (3%) 828 (15%) Note: Based on cases eligible for follow-up. Status for participants could have reported no change. Relevant data to the outcomes are shown in this table and do not reflect the no change answer. APPENDIX D: Two-Months and Six-Months Follow-up Results FY FY 2012 As shown in Table 22 below, 20% (648) of 3,309 individuals interviewed for follow-up at two-months following the program were still quit (i.e., they had quit tobacco by the end of the program and were still quit at one-month after). Another 16% (519), quit following the program. Individuals still reduced (i.e., they had reduced the amount of tobacco used by the end of the program and continued to use tobacco less at two-months) included 840 persons (25%). Also shown in Table 22, 16% (468) of 2,855 individuals interviewed for follow-up at six months following the program were still quit. Another 18% (505) quit following the program. Individuals who still reduced included 713 persons (25%). Table 22: Two-Months and Six-Months Follow-up Results FY FY 2012 Number interviewed (of Total Eligible for Interview) Still Quit (of Number of Completed Interviews) Relapsed (of Number of Completed Interviews) Quit Following Program ( of Number of Completed Interviews) Still Reduced (of Number of Completed Interviews) Two- Months 3,309 (49%) 648 (20%) 432 (13%) 519 (16%) 840 (25%) Six- Months 2,855 (53%) 468 (16%) 447 (16%) 505 (18%) 713 (25%) Note: Based on cases eligible for follow-up. Status for participants could have reported no change. Relevant data to the outcomes are shown in this table and do not reflect the no change answer.

24 24 APPENDIX E: FY 2014 Follow-up Interview Attempts at Seven-Months As a continuation to FY 2014 the seven-month follow-up phone calls were continued in an effort to increase the number of interviewed completed 7-months after the FY 2014 report was completed. Table 23: Seven-Month Follow-up Results at the end of FY 2014 compared to completion of FY 2014 Follow-up Calls Quit Number interviewed Still Quit Relapsed Following Program Still Reduced Seven-Month (FY14 Annual Report) (17%) 9 (10%) 7 (8%) 21 (24%) Seven-Months (FY14 after Seven-Month Continuation of calls) 145 (25%) 20 (14%) 23 (16%) 15 (10%) 36 (25%) Note: This data is a continuation of follow-up phone calls from FY Status for participants could have reported no change. Relevant data to the outcomes are shown in this table and do not reflect the no change answer.