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North American Quitline Consortium

July 2014

For quick navigation, please click on the titles below of the topics featured in this month's issue of Connections
  Time-Sensitive News

NAQC News

NAQC Publishes 2014 Update to Medications Quality Improvement Initiative Issue Paper!
The purpose of this NAQC Quality Improvement Initiative Issue Paper is to provide an update on the comprehensive review of the literature and practice related to the integration of tobacco cessation medications and quitline services that reflects additions to the evidence base and improvements in practice since the first publication (2009). The author discusses the major factors that must be considered in deciding if medications should be offered as part of quitline services, including topics such as cost-effectiveness analysis, choice of medication, determination of quantity of medication to provide and the method of distribution of medications that will be used. A new section on e-cigarettes appears in the update, as well as new content related to concurrent use of more than one type of tobacco to reflect the FDA’s new warning label regulations. Updated recommendations on key issues related to integration of medications into quitline services are provided by the author.
» learn more

NAQC Membership Drive Is Underway!
Thank you to each and every organization and individual who renewed their NAQC membership or joined as a new member! If you were unable to renew by the deadline, extension shave been offered until August 31, 2014. 
 
Your membership dues allow us to be more flexible as an organization in meeting your needs and also aid NAQC in overall organizational sustainability. We hope NAQC’s work in the past year has contributed to your success, and we look forward to launching great new products and membership benefits in the coming months!

For questions regarding membership, please contact Natalia Gromov at 800-398-5489 ext. 701 or membership@naquitline.org
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 Find more NAQC News in our Newsroom or go back to top.



Time-Sensitive News

SAVE THE DATE: July 23! It’s All Acute to Me: Expanding Opportunities for Cessation Counseling Beyond Primary Care!
This AAP Richmond Center webinar will focus on opportunities for tobacco cessation counseling outside the primary care setting. Opportunities for these discussions in the hospital setting will be discussed, as well as referring patients, clients, and families to local resources like the state quitline. Featured presenters include Susan Walley, MD, FAAP of the University of Alabama at Birmingham and Rachel Boykan, MD, FAAP, Stony Brook University. Contact richmondcenter@aap.org with questions.
Register today!
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DEADLINE AUGUST 8! 30-day Extension on Comment Period for Deeming!
FDA has published a notice in the Federal Register announcing a 30-day extension of the comment period for the proposed rule, 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. The proposed rule, which appeared in the Federal Register of April 25, 2014, is seeking comments on FDA's regulatory approach to electronic cigarettes and other tobacco products, proposed options for the regulation of cigars, pathways to market for proposed deemed tobacco products, and compliance dates for certain provisions, among other issues.  The comment period will now close on August 8, 2014.

The Campaign for Tobacco Free Kids has created a microsite that may be useful to NAQC members  --  http://regulateALLtobacco.org -- aimed at generating comments to the FDA deeming docket to counter the tens of thousands of comments being submitted by cigar lovers and vapers.  The site includes background info, talking points, fact sheets on cigars and e-cigarettes, and sample comments for parents, health care providers, concerned citizens and public health advocates. There are several click-through opportunities to submit comments directly into the deeming docket at Regulations.gov, along with some basic instructions on how to fill out the comment form. It is not branded with any logo (although it does state at the bottom that it was developed by CTFK so people know where it came from) and CTFK will not capture any names or know who clicks through to take action. The site has been tested in all major web browsers and has been designed to work on smartphones and tablets. 

SAVE THE DATES! UPCOMING NAQC WEBINARS!
NAQC has prepared a variety of educational webinars in the next coming months on topics ranging from texting to relapse prevention; from pregnant women to the Asian Smokers’ Quitline.  Please find the topics and dates below and don't forget to register!
July 16
12:30 – 2PM ET
Linking Quitlines with Internet Cessation Programming, Text Messaging and Social Networks  
How are new technologies helping people quit? What outcomes are quitlines trying to achieve by integrating these technologies with counseling services? What are the evidence and practice telling us? In this webinar, we will review the landscape of internet cessation programming, text messaging and social networks, and their impact on reach and effectiveness.
July 23 call on Quitline Services to Pregnant and Postpartum Women has been postponed until fall. 
August 27
12:30 – 2PM ET
The Asian Smokers’ Quitline
September 17
12:30 – 2PM ET
Innovations in Relapse Prevention: A Discussion of Strategies and Solutions 
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Tips Phase Two Launched on July 7!
The new 2014 Tips campaign ads began running nationally beginning this Monday, July 7th for 9 weeks, ending September 7th.Seven new, hard-hitting ads will launch across the United States on July 7th to highlight the harsh consequences of smoking and to prompt smokers to quit. Real people tell personal stories of illness and injury in the Tips ads. The new ads focus on conditions that have not been featured in previous ads, including severe gum disease, lung cancer, smoking during pregnancy and the health effects of smoking, combined with HIV.

The Tips campaign Web site CDC.gov/tips has been updated with the new ads, information and many new resources.  
» learn more

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Tobacco Control

New Case Study on the Success of Federal Employees Health Benefits (FEHB) Coverage for Tobacco Cessation!
On July 7th, the Office of Personnel Management and Partnership for Prevention released a new report on provision of tobacco cessation coverage to federal employees. The findings in the recently released“Federal Employees Health Benefits Tobacco Cessation: Case Study” can assist states and their partners in engaging insurance plans and employers to provide comprehensive evidence-based tobacco cessation benefits.  The case study findings clearly demonstrate that providing cessation coverage to employees is doable, cost-effective and reduces tobacco use among employees.
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NEW JOURNAL ARTICLE: INTERMEDIATE CESSATION OUTCOMES AMONG QUITLINE CALLERS  DURING A NATIONAL TOBACCO EDUCATION CAMPAIGN!
In an article released yesterday in the journal, Nicotine and Tobacco Research, researchers used quitline data from 23 states to examine changes in enrollment, service utilization, quit attempts and self-reported quitting for 7 days or longer during CDC’s 2012 Tips From Former Smokers campaign versus a similar time period in 2011. Authors also assessed whether the Tips campaign’s impact differed by state tobacco control funding.
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New Report Details How Tobacco Companies Have Made Cigarettes More Addictive, More Attractive to Kids and More Deadly!
Design changes and chemical additives introduced by tobacco companies in recent decades have made cigarettes more addictive, more attractive to kids and even more deadly, according to a report issued today by the Campaign for Tobacco-Free Kids.
 
The report, titled Designed for Addiction, details how tobacco companies purposely design cigarettes to make tobacco smoke smoother, less harsh and more appealing to new users, especially kids, and to create and sustain addiction to nicotine.  
» learn more

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Research
 
Am J Public Health. 2014 Jun 12:e1-e9. [Epub ahead of print]
Socioeconomic Disparities in Telephone-Based Treatment of Tobacco Dependence.
Varghese M, Sheffer C, Stitzer M, Landes R, Brackman SL, Munn T.

Socioeconomic disparities in tobacco dependence treatment outcomes from a free, proactive telephone counseling quitline were examined. Methods. Cognitive-behavioral treatment and nicotine patches were delivered to 6626 smokers and socioeconomic differences in demographic, clinical, environmental, and treatment use factors were examined. Logistic regressions and generalized estimating equations (GEE) were used to model abstinence and account for socioeconomic differences in the models. Results. The odds of achieving long-term abstinence differed by socioeconomic status (SES). In the GEE model, the odds of abstinence for the highest SES participants were 1.75 times those of the lowest SES participants. Logistic regression models revealed no treatment outcome disparity at the end of treatment, but significant disparities 3 and 6 months after treatment. Conclusions. Although quitlines often increase access to treatment for some lower SES smokers, significant socioeconomic disparities in treatment outcomes raise questions about whether current approaches are contributing to tobacco-related socioeconomic health disparities. Strategies to improve treatment outcomes for lower SES smokers might include novel methods to address multiple factors associated with socioeconomic disparities. (Am J Public Health. Published online ahead of print June 12, 2014: e1-e9. doi:10.2105/AJPH.2014.301951).
 
Nicotine Tob Res. 2014 Jul;16(7):992-9. doi: 10.1093/ntr/ntu025.
Evaluating the Effect of Access to Free Medication to Quit Smoking: A Clinical Trial Testing the Role of Motivation.
Jardin BF, Cropsey KL, Wahlquist AE, Gray KM, Silvestri GA, Cummings KM, Carpenter MJ.

Although the majority of smokers are ambivalent about quitting, few treatments specifically target smokers lacking motivation to quit in the near future. Most existing interventions are instead predicated on the belief that active treatments should only be distributed to smokers interested in quitting, a largely untested assumption. METHODS: In the current clinical trial (N = 157), motivated smokers wanting to quit in the next 30 days were given a 2-week nicotine replacement therapy (NRT) sample and a referral to a quitline (Group MNQ), while unmotivated smokers were randomized to receive the same treatment (Group UNQ) or a quitline referral only (Group UQ). Participants were tracked via telephone for 3 months to assess quitting behaviors and smoking reduction. RESULTS: Groups significantly differed across all comparisons with regard to incidence of any quit attempt (MNQ: 77%, UNQ: 40%, UQ: 18%, p < .05) and any 24-hr quit attempts (62%, 32%, 16%, p < .05). Clinically meaningful differences emerged in the rates of floating (19%, 17%, 6%) and point prevalence abstinence (17%, 15%, 5%). Compared to participants in Group UQ (11%), a greater proportion of participants in Group MNQ (48%, p = .01) and Group UNQ (31%, p = .01) reduced their daily cigarette consumption by at least half. Proxy measures of cessation readiness (e.g., motivation) favored participants receiving active forms of treatment. CONCLUSIONS: Providing NRT samples engaged both motivated and unmotivated smokers into the quitting process and produced positive changes in smoking outcomes. This suggests that motivation should not be considered a necessary precondition to receiving treatment.
 
Tob Induc Dis. 2014 Jun 3;12(1):9. doi: 10.1186/1617-9625-12-9.
Effectiveness of Proactive and Reactive Services at the Swedish National Tobacco Quitline in a Randomized Trial.
Nohlert E, Ohrvik J, Helgason AR.

The Swedish National Tobacco Quitline (SNTQ), which has both a proactive and a reactive service, has successfully provided tobacco cessation support since 1998. As there is a demand for an increase in national cessation support, and because the quitline works under funding constraints, it is crucial to identify the most clinically effective and cost-effective service. A randomized controlled trial was performed to compare the effectiveness of the high-intensity proactive service with the low-intensity reactive service at the SNTQ. METHODS: Those who called the SNTQ for smoking or tobacco cessation from February 2009 to September 2010 were randomized to proactive service (even dates) and reactive service (odd dates). Data were collected through postal questionnaires at baseline and after 12 months. Those who replied to the baseline questionnaire constituted the study base. Outcome measures were self-reported point prevalence and 6-month continuous abstinence at the 12-month follow-up. Intention-to-treat (ITT) and responder-only analyses were performed. RESULTS: The study base consisted of 586 persons, and 59% completed the 12-month follow-up. Neither ITT- nor responder-only analyses showed any differences in outcome between proactive and reactive service. Point prevalence was 27% and continuous abstinence was 21% in analyses treating non-responders as smokers, and 47% and 35%, respectively, in responder-only analyses. CONCLUSION: Reactive service may be used as the standard procedure to optimize resource utilization at the SNTQ. However, further research is needed to assess effectiveness in different subgroups of clients.
 
J Occup Environ Med. 2014 Jul;56(7):765-70. doi: 10.1097/JOM.0000000000000174.
Group Purchasing of Workplace Health Promotion Services for Small Employers.
Harris JR, Hammerback KR, Hannon PA, McDowell J, Katzman A, Clegg-Thorp C, Gallagher J.

Small employers are underserved with workplace health promotion services, so we explored the potential for group purchasing of these services. METHODS: We conducted semistructured telephone interviews of member organizations serving small employers, as well as workplace health promotion vendors, in Washington State. RESULTS: We interviewed 22 employer organizations (chambers of commerce, trade associations, and an insurance trust) and vendors (of fitness facilities, healthy vending machines, fresh produce delivery, weight management services, and tobacco cessation quitlines). Both cautiously supported the idea of group purchasing but felt that small employers' workplace health promotion demand must increase first. Vendors providing off-site services, for example, quitline, found group purchasing more feasible than vendors providing on-site services, for example, produce delivery. CONCLUSIONS: Employer member organizations are well-positioned to group purchase workplace health promotion services; vendors are receptive if there is potential profit.
 
Tob Control. 2014 Jun 11. pii: tobaccocontrol-2013-051520. doi: 10.1136/tobaccocontrol-2013-051520. [Epub ahead of print]
An Evaluation of Usage Patterns, Effectiveness and Cost of the National Smoking Cessation Quitline in Thailand.
Meeyai A, Yunibhand J, Punkrajang P, Pitayarangsarit S.

Telephone-based smoking cessation services (quitlines) offering counseling for smoking cessation without nicotine replacement therapy may be important components of tobacco control efforts in low and middle income countries, but evaluations in such resource-limited settings are lacking. We aimed to evaluate the usage, effectiveness and cost of the Thailand National Quitline (TNQ). METHODS: Analysis of retrospective data for callers to the TNQ between 2009 and 2012 and a follow-up survey in 1161 randomly selected callers. RESULTS:
Between 2009 and 2012 there were 116 862 callers to the TNQ; 36 927 received counseling and at least one follow-up call. Compared with smokers in the general population, callers were younger, more highly educated, more likely to be students, and more likely to smoke cigarettes rather than roll-your-own tobacco. Continuous abstinence rates at 1, 3 and 6 months after calling were 49.9%, 38.0% and 33.1%. The predicted rate at 12 months was 19.54% (95% CI 14.55 to 26.24). Average cost per completed counseling was $31 and the average cost per quitter was $253. Assuming all (and two-thirds) TNQ callers who succeed in quitting would have failed to quit without the assistance of the TNQ, cumulative life years saved (LYS) for the 4-year period were 57 238 (36 733) giving a cost per LYS of $32 (50) (about 7.93 LYS per quitter) and an estimated return on investment over 4 years of 9.01 (5.78). CONCLUSIONS: A low-cost quitline without nicotine replacement therapy is a promising model for smoking cessation services and likely to offer good value for money in Thailand.
 
MMWR Morb Mortal Wkly Rep. 2014 Jun 27;63(25):542-7.
Tobacco Product Use Among Adults - United States, 2012-2013. 
Agaku IT, King BA, Husten CG, Bunnell R, Ambrose BK, Hu SS, Holder-Hayes E, Day HR; Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Despite significant declines in cigarette smoking among U.S. adults over the past five decades, progress has slowed in recent years, and the prevalence of use of other tobacco products such as cigars and smokeless tobacco has not changed. Additionally, the prevalence of use of emerging products, including electronic cigarettes (e-cigarettes), has rapidly increased. This report provides the most recent national estimates of tobacco use among adults aged ≥18 years, using data from the 2012-2013 National Adult Tobacco Survey (NATS). The findings indicate that 21.3% of U.S. adults used a tobacco product every day or some days, and 25.2% used a tobacco product every day, some days, or rarely. Population-level interventions focused on the diversity of tobacco product use, including tobacco price increases, high-impact antitobacco mass media campaigns, comprehensive smoke-free laws, and enhanced access to help quitting, in conjunction with Food and Drug Administration (FDA) regulation of tobacco products, are critical to reducing tobacco-related diseases and deaths in the United States.
 
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Announcements

Pfizer Provides E-coupons for Chantix!
Pfizer is making an e-coupon available for use by quitlines. Quitlines may email the coupon to any smokers who are trying to quit and who would like to use varenicline. For additional information, please contact Shah, Niralee by email (Niralee.Shah@pfizer.com) or by phone at 212-733-1283.

Geographic Health Equity Symposium on July 25, 2014!
Geographic Health Equity Symposium is a free event taking place in Orlando, FL  and is hosted by the Geographic Health Equity Alliance. The flyer with additional information is located at the link below. 
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Funding for Connections is provided solely through a cooperative agreement from the Centers for Disease Control and Prevention (1U58DP004967-01). We thank them for their support of this publication. Information and links are provided solely as a service to NAQC members and partners and do not constitute an endorsement of any organization by NAQC, nor should any be inferred.
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