What Does the Independent Evaluation Tell Us About Getting Smokers To Quit?

Transcription

1 What Does the Independent Evaluation Tell Us About Getting Smokers To Quit? Presented by Matthew C. Farrelly, PhD RTI International Presented to NYS Cessation Center Collaborative Call September 3, Cornwallis Road P.O. Box Research Triangle Park, NC Phone Fax RTI International is a trade name of Research Triangle Institute

2 Disclosure I have no real or perceived vested interests that relate to this presentation nor do I have any relationships with pharmaceutical companies, biomedical device manufacturers, and/or other corporations whose products or services are related to pertinent therapeutic areas. 2

3 Overview Who is the most/least likely to smoke, quit, and quit successfully What are evidence-based strategies to help smokers quit How often and how do smokers in New York quit? Trends in cessation outcomes Description of common cessation strategies Some barriers to successful quitting I have no relevant financial relationships to disclose Presentation objectives see attached 3

4 Objectives Identify who is the most likely and least likely to smoke, quit and quit successfully. Define evidence based strategies for health care providers to increase cessation attempts. Identify one enhancement in their standard of care based on the information provided in this presentation. 4

5 Who Smokes in New York?

6 Smoking Prevalence by Gender % 8 0 % Smoking Prevalence 6 0 % 4 0 % 2 0 % % % % % 0 % F e m a le S m o k in g P re va le n c e M a le P e rc e n ta g e o f S m o k in g P o p u la t io n 6

7 Quitting by Gender % 8 0 % 6 0 % % % 4 0 % 2 0 % % % 0 % F e m a le M a le M a d e a Q u it A t t e m p t in t h e P a s t Y e a r M a in t a in e d Q u it A t t e m p t fo r a t L e a s t 6 M o n t h s in t h e P a s t Y e a r 7

8 Smoking Prevalence by Age 100% 80% Smoking Prevalence 60% 40% 20% 23.3% 17.2% 19.6% 32.5% 17.3% 42.7% 7.8% 7.6% 0% S m ok ing P revalenc e P erc entage of S m ok ing P opulation 8

9 Quitting by Age % 8 0 % 6 0 % % % % % % 4 0 % 2 0 % % % % 0 % M a d e a Q u it A t te m p t in th e P a s t Y e a r M a in t a in e d Q u it A t t e m p t fo r a t L e a s t 6 M o n t h s in t h e P a s t Y e a r 9

10 Smoking Prevalence by Race/Ethnicity 100% Smoking Prevalence 80% 60% 40% 20% 0% 66.6% 17.5% 15.5% 17.3% 17.5% 15.2% 22.2% 21.7% 7.9% 1.8% 1.0% 0.3% Hispanic White African American Asian American Indian/Alaska Native Native Haw aiian/pacific Islander Smoking Prevalence Percentage of Smoking Population 10

11 Cessation by Race/Ethnicity 100% 80% 60% 40% 20% 0% 53.5% 44.7% 22.7% 24.1% 56.2% 15.0% 42.0% 32.1% 52.9% 2.8% Hispanic White African American Asian American Indian/Alaska Native Made a Quit Attempt in the Past Year Maintained Quit Attempt for at Least 6 Months in the Past Year 56.0% 7.2% Native Haw aiian/pacific Islander 11

12 Smoking Prevalence by Location % 8 0 % Smoking Prevalence 6 0 % 4 0 % 2 0 % % % % % % % 0 % C it y c e n t e r o f M S A O t h e r a re a s o f M S A N o t in M S A S m o k in g P re va le n c e P e rc e n t a g e o f S m o k in g P o p u la t io n 12

13 Cessation by Location % 8 0 % 6 0 % 4 0 % 2 0 % % % % % % % 0 % C it y c e n t e r o f M S A O t h e r a re a s o f M S A N o t in M S A M a d e a Q u it A t t e m p t in t h e P a s t Y e a r M a in t a in e d Q u it A t t e m p t fo r a t L e a s t 6 M o n t h s in t h e P a s t Y e a r 13

14 Smoking Prevalence by Education 100% Smoking Prevalence 80% 60% 40% 20% 0% 27.2% 24.1% Less than high school 34.0% 26.0% 22.8% 29.6% 12.7% 9.0% High school Some college College graduate 8.8% 3.3% Post-graduate training Smoking Prevalence Percentage of Smoking Population 14

15 Cessation by Education 100% 80% 60% 50.2% 48.4% 45.8% 44.2% 55.1% 40% 20% 14.9% 18.2% 21.5% 28.5% 34.0% 0% Less than high school High school Some college College graduate Post-graduate training Made a Quit Attempt in the Past Year Maintained Quit Attempt for at Least 6 Months in the Past 15

16 Smoking Prevalence by Insurance Status % 8 0 % Smoking Prevalence 6 0 % 4 0 % 2 0 % % % % 8. 7 % % % % % 0 % P riva t e M e d ic a re M e d ic a id N o n e S m o k in g P re va le n c e P e rc e n t a g e o f S m o k in g P o p u la t io n 16

17 Cessation by Insurance Status % 8 0 % 6 0 % % % % % 4 0 % % % 2 0 % % % 0 % P riva te M e d ic a re M e d ic a id N o n e M a d e a Q u it A t t e m p t in th e P a s t Y e a r M a in ta in e d Q u it A t te m p t fo r a t L e a s t 6 M o n t h s in th e P a s t Y e a r 17

18 Smoking Status by Mental Health Status % Smoking Prevalence 8 0 % 6 0 % 4 0 % 2 0 % % % % % 0 % N o re p o rt e d m e n t a l h e a lt h p ro b le m s S e lf-re p o rt e d m e n t a l h e a lt h p ro b le m s S m o k in g P re va le n c e P e rc e n t a g e o f S m o k in g P o p u la t io n 18

19 Cessation by Mental Health Status % 8 0 % 6 0 % % % 4 0 % 2 0 % % % 0 % N o re p o rt e d m e n t a l h e a lt h p ro b le m s S e lf-re p o rt e d m e n t a l h e a lt h p ro b le m s M a d e a Q u it A t t e m p t in t h e P a s t Y e a r M a in t a in e d Q u it A t t e m p t fo r a t L e a s t 6 M o n t h s in t h e P a s t Y e a r 19

20 Smoking Prevalence by Sexual Orientation 100% Smoking Prevalence 80% 60% 40% 20% 18.0% 49.7% 15.4% 45.8% 25.4% 27.0% 28.7% 0% Heterosexual male Heterosexual female 1.6% 1.0% 1.9% Gay male Lesbian Bisexual male/female Smoking Prevalence Percentage of Smoking Population 20

21 Implications There are significant differences in the prevalence of smoking and cessation behaviors across demographic groups To reach the 2010 goal of reducing statewide smoking rates, progress must be made in the groups that represent the greatest number of smokers These differences highlight possible opportunities to target and possibly tailor interventions Important to gather evidence that existing evidence-based interventions are not effective with a given population group before tailoring 21

22 What Helps Smokers Quit?

23 What does the evidence say about promoting cessation? Increasing the price of tobacco Multi-component quitlines Reducing client out-of-pocket costs for effective cessation therapies Provider reminder systems, w/ and w/out provider education Smoking bans Mass media campaigns when combined with other interventions Community mobilization when combined with other interventions 23

24 Cigarette Excise Taxes and Prices Higher cigarette prices are associated with Lower prevalence of smoking 2% drop for 10% increase in price Lower daily cigarette consumption 2% drop among continuing smokers for a 10% increase in price Higher cigarette excise taxes passed on in higher prices--$1.25 increase in price for a $1.00 increase in tax However, several factors can mitigate effectiveness of higher prices 24

25 Quitlines Strong evidence base for quitlines Help smokers quit Place for healthcare providers to refer patients Option to make NRT available Used by relatively small % of smokers (3-5%) Television, radio, print and direct mail can all be effective in driving calls to quitline Spreading the word about free NRT also very effective 25

26 New York Smokers Quitline Provides a wide range of services, including free NRT High customer satisfaction-92% very satisfied Use of the Quitline has increased steadily over time Mass media most important driver of calls to Quitline 26

27 Awareness of the Quitline 100% 80% 60% 40% 55.4% 56.3% 56.0% 49.4% 50.3% 49.7% 47.9% 49.0% 48.7% 57.9% 56.3% 66.5% 20% 0% Overall* Nonsmokers* Smokers* 27

28 Quitline Call Volume, Q to Q ,000 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 - Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q

29 Growing Importance of Quitsite 70,000 60,000 50,000 Total Quitsite Visits Total Incoming Calls 40,000 30,000 20,000 10,000 - Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr

30 Healthcare provider reminder systems Strong evidence base for reminder systems with and without provider education What is less clear from evidence is how to encourage Adoption of reminder systems Delivery of provider education Cessation Centers focus on policy change to promote systems to cue providers 30

31 Healthcare Provider Support for Cessation 100% 91.9% 87.0% 89.1% 87.7% 90.4% Ask 80% 60% 40% 20% 0% 100% 80% % 77.0% 76.6% 79.7% 69.9% Advise 60% 40% 20% 0%

32 Healthcare Provider Support for Cessation 100% Assist 80% 60% 40% 37.4% 38.0% 43.8% 44.6% 50.2% 20% 0%

33 Tobacco Countermarketing Evidence that mass media campaigns combined with other interventions are effective in reducing smoking Awareness of NYTCP television advertisements associated with Stronger anti-tobacco attitudes Increased likelihood of making a quit attempt Smokers differ in their readiness to quit Those ready to quit was help in how to quit and stay quit Those less ready to quit need reasons to quit Smokers less ready to quit need powerful messages to prompt them to quit graphic images, emotional stories Others respond well to a range of messages 33

34 100% 80% 70.9% 60% 40% 47.6% 36.8% 39.3% 56.1% 56.4% 26.2% 20% 0% Any Q NYTCP Advertisement (N=1010) Vacuum Cleaner (N=1006) Truck Industry Documents (N=1004) Byron Holton (N=1,010) Eating You Alive - NYC (N=837) Every Cigarette Is Doing You Damage (N=502) Branded Nicotine (N=504) Q NYTCP Advertisements 100% 80% 60% Very Powerful Somewhat Powerful Makes me want to quit 40% 20% 21.7% 12.5% 15.8% 24.7% 40.8% 26.4% 9.8% 0% 34 Any Q NYTCP Advertisement (N=1009) Vacuum Cleaner (N=1008) Truck Industry Documents (N=1006) Byron Holton (N=1,009) Q NYTCP Advertisements Eating You Alive (N=834) Every Cigarette Is Doing You Damage (N=502) Branded Nicotine (N=502)

35 Smoking Bans Significant literature that shows that banning smoke in the workplace Reduces exposure to SHS Reduces tobacco use Growing literature for restrictions in bars and restaurants Reduced exposure among hospitality workers No adverse impact on business Home rules on smoking effective Reduces exposure May promote cessation 35

36 Percentage of Adults Who Live in Smoke-free Homes by Smoking Status, ATS % 80% 78.4% 80.4% 81.2% 80.3% 74.1% 73.2% 68.3% 71.0% 60% 40% 29.3% 28.0% 28.1% 38.9% 20% 0% Overall* Nonsmokers Smokers* 36

37 How and Why do New York Smokers Quit?

38 Percentage of Adult Smokers Who Made a Quit Attempt in the Past 12 Months, ATS % 80% 60% 46.3% 46.3% 49.4% 54.1% 60.0% 40% 20% 0%

39 Distribution of Smokers by Interest in Quitting, ATS % 80% 60% 45.4% 40% 20% 12.8% 13.5% 28.3% 0% Not at all A little Somewhat A lot 39

40 Strategies Used by Current Smokers to Quit Smoking, ATS % 80% Not evidence -based Evidencebased 60% 44.1% 40% 30.4% 29.1% 20% 4.8% 5.0% 5.1% 0% Giving Up Cigarettes All at Once Use Medication Like the Nicotine Patch, Nicotine Gum Attend a stopsmoking clinic, cessation class, or support group Get counseling Get help from a free telephone quit line Used other resources 40

41 Reasons Current Smokers Give for Trying to Quit Smoking, ATS % 89.7% 94.1% 80% 60% 50.0% 65.0% 67.8% 62.9% 55.9% 40% 25.1% 20% 0% The cost of cigarettes Concern for current health Concern for future health Smoking is prohibited in buildings Effect on other people's health Encouragement from friends and family Setting an example for children Recommended by health care professional 41

42 Where from here? Tax increase in June will have an impact on cessation Curbing tax evasion would also promote cessation by increasing the effective price smokers pay Policy change in others is likely to be incremental Tobacco countermarketing will continue to drive smokers to quitline, encourage quitting, and help change attitudes as long as it reaches a high % of smokers Address smokers gaps in knowledge and misperceptions Greater involvement by healthcare providers and provider organizations to do more to support smoking cessation 42