Maine Case Study

Comprehensive Treatment of Tobacco Dependence in Maine

Evaluation

Type(s) of Evaluation Planned or Conducted and Status

What is the status of your evaluation?

• In Progress
• Completed

Do you address process evaluation?

The following table is an example of a number of process measurements used in program management.

Characteristics of Tobacco Users Provided Services by the Maine HelpLine January 2003 through December 2004

Characteristic*	Tobacco Users Serviced by HelpLine N	%	Adult Smokers in Maine† N	%
Statewide	12,479		207,661
Age (yrs)
18-24	1321	10.7%	41,668	20.3%
25-44	5294	43.0%	86,659	42.1%
45-64	4940	40.2%	59,251	28.8%
65+	744	6.0%	18,158	8.8%
Gender
Female	7235	58.4%	94,342	45.4%
Male	5152	41.6%	113,319	54.6%
Highest Education
< High School	1,518	13.0%	31,972	15.4%
H.S. grad, GED	5,522	47.2%	93,780	45.2%
Some college	3,229	27.6%	54,471	26.2%
College or higher	1,424	12.2%	27,300	13.2%
Health Insurance
No Coverage	3,083	26.2%	36,896	17.9%
Medicaid	2,432	20.7%	33,143	16.1%
Commercial/Other	5,271	44.9%	112,682	54.6%
Medicare	964	8.2%	23,556	11.4%
Region of Residence
Northern Maine	987	8.1%	21,988	10.6%
Western	1,895	15.5%	31,311	15.1%
East Central	2,292	18.7%	40,615	19.6%
West Central	2,321	19.0%	37,119	17.9%
Mid-Coast	867	7.1%	16,984	8.2%
Southern	3,875	31.7%	59,644	28.7%

Footnotes

* For all major demographic categories, there was a significant difference in the distribution of HelpLine callers, compared to the distribution among smokers statewide (X2 p<0.001).

† Smoking estimates are those derived from in the 2003–2004 Maine Adult Tobacco Survey, using weighted measures for adults in each demographic group and the smoking prevalence in that group.

Do you address outcome evaluation?

The Center for Outcomes Research and Evaluation (CORE), in collaboration with CTI, develops and conducts all evaluations of the PTM Tobacco Treatment Initiative. CORE, a division of the Maine Medical Center Research Institute, brings together investigators, epidemiologists, and statisticians with experience in methodology, study design, health services research, and analyses.

Briefly describe the evaluation design.

To examine the effect of the HelpLine on quitting tobacco, samples of callers are surveyed by telephone six months after receiving HelpLine services. It was felt that 6-month HelpLine quit rates offer the best time interval for long-term quit rate outcome assessment. Less than 6 months would be too short a timeframe while one year would introduce problems with loss to follow-up of HelpLine callers. Consecutive, cross-sectional samples of callers are surveyed twice per year. The results of each sample are examined individually as well as combined with previously surveyed cohorts. Measures used include the following:

Since receiving assistance from the HelpLine:

• Number of Serious Quit Attempts
• Longest time abstinent from tobacco
• Strategies used during longest quit attempt
• 7-day and 30-day abstinence at 6 months
• Confidence in staying quit, if abstinent
• When last used tobacco
• Type and quantity of tobacco used in last 30 days
• Seriously considering quitting now, if smoking
• Demographic characteristics of callers

Data Collection Methods

Telephone Interview/Survey

Data Source

• Adult Tobacco Survey (ATS)
• Behavioral Risk Factor Surveillance System (BRFSS)
• Media Evaluation Survey
• Quitline Call Monitoring
• Other: Helpline Software Database, 2000 US Census to estimate number of smokers.

Range of Intended Outcomes

• Behavior Change
• Policy Change
• Increased Knowledge
• Attitude Change
• Change in Media Coverage/Framing of Issue
• Other:

List key evaluation findings and/or conclusions for each intended outcome.

• Behavior change—decrease in number of smokers in Maine, quit rates among callers use services.
• Policy change—increase in private health plan benefit coverage for tobacco cessation treatment.
• Change in media coverage—historically, the media has been focused on delivery of an anti-tobacco message (ie., the subtle message from this approach is that "smokers are bad"). It is important to understand that tobacco addiction is a condition requiring treatment rather than a personality flaw. Our goal should be to build a demand for services by emphasizing that these services are good and helpful rather than a "sentence" of some sort. The promotion of the Helpline has been a prominent element of the media campaign.
• Treatment specialist capacity building—one of the important intended program outcomes is expanding the number of available treatment specialists available throughout the state.
• Community access to treatment—the Helpline is one part of a comprehensive approach, with plans to expand access to NRT from specialists in local communities throughout the state.

The first HelpLine Quit Surveys included a sample of 72 smokers who called the Helpline between August–October 2001. The second survey included 300 smokers who called and received counseling during December 2001 and January 2002 have shown that approximately 21% of callers provided any degree of counseling by a HelpLine Specialist are not smoking six months following their first call to the HelpLine.

Six-Month Quit Rate* Among All HelpLine Callers Survey (N=300)
	N	%	95% C.I.
All Callers (N=300)	46	15.3%	11.2–19.4%
Provided Self-Help Only (N=107)	13	12.2%	6.0–18.4%
Provided Counseling (N=193)	33	17.1%	11.8–22.4%

Footnotes

* No smoking, not even a puff, in the past 7 days

Were evaluation findings and/or conclusions disseminated to policy and/or program intervention stakeholders?

In February-April, 2003, a summary of 2002 outcomes for the Quit Line HelpLine and for the medication voucher program was prepared and disseminated.

Briefly describe how evaluation findings and/or conclusions were used to inform program planning or development?

Program evaluation measures are examined closely and used to modify any changes in the delivery of services. The data is also shared with the Partnership for Tobacco Free Maine (PTM) and other PTM contractors, so that the information can be used to inform other PTM-related program components.

One example of how the data affected policy in the first year, calls from Northern Maine were observed to be lower than expected compared to the state average. Feedback of this information to PTM and the media contractor resulted in changes in regional advertising and promotion. One year later, the call volume from the northern counties had increased significantly.

Evaluation Notes

N/A