Improving Reach:Making the Most of

Limited Funds

Julie Hare, Quitline CoordinatorAlabama Department of Public HealthTobacco Prevention & Control Branch

June 9, 2009

Our Quitline

Launched April 1, 2005

Vendor: Information and Quality Healthcare (IQH)

We provide counseling and up to four weeks of free NRT, if medically eligible, to any Alabama resident.

The Tobacco Problem in Alabama

� Adult prevalence rate -- 22.1% (2008 -- BRFSS)

� Youth prevalence rate -- 22.1% (2008 AL YTS)

The Numbers Are Worth Noting

� According to the Campaign for Tobacco-Free Kids’ website, Alabama is ranked 48th in the nation in per capita spending for tobacco prevention. Alabama’s 2009 budget for its tobacco prevention program is $2.3 million. The CDC-recommended amount is $56.7 million. Alabama spends just 4.1 percent of the CDC-recommended amount on tobacco prevention.

Alabama Tobacco QuitlineCDC Funding for 2009-2010

Quitline Funding –$199,959

This includes staff, fringe benefits, travel, telephone, rent, office supplies, postage and printing. There are NO funds for media.

Federal fiscal year is March 30 through March 29.

Alabama Tobacco QuitlineState Funding for 2008-2009

Quitline Funding –$175,000

This includes $150,000 for staffing and a special $25,000 appropriation for NRT.

State’s fiscal year is October 1 through September 30.

NCI’s Quitline Numbers

2009 calls to the Quitline

January -- 1,192February --1,013

March -- 1,583April -- 1,533

For 2004 – 2008, there were 42,079 calls to the Alabama Tobacco Quitline.

Promoting The Quitline

1. Free NRT

2. Area Coordinators3. Mini-grantees

4. Quitline Workgroup5. Partners

6. Youth Campaign7. Media

8. Communications Plan

FREE NRT

This has been our single most cost-effective way to drive calls to our Quitline.

When Alabama added extra NRT to itsofferings, calls consistently increased.

Because of word-of-mouth publicity, wespend less on advertising, while increasingservices to callers.

More NRT Added for Callers

� Beginning March 2007, tobacco users who call the Alabama Tobacco Quitline became eligible for four weeks of free nicotine patches. This was increased from two weeks (2006) to four weeks (2007).

� A statewide press release about the NRT caused an increase in the number of calls to the Quitline. Inquiries increased from 316 in February 2007 to 621 in March 2007. A media campaign increased that number to 1,005 in June 2007.

Tobacco Prevention Coordinators

Tobacco preventioncoordinator in each public health area

Tobacco Prevention Coordinators

� Train providers in Ask, Advise, Refer, Prescribe protocol (AARP)

� Localize press releases and disseminate to local media

� Solicit Success Stories in their areas� Promote cessation to worksites

� Identify local cessation services annually� Distribute Quitline cessation materials to

community

Our Mini-Grantees

� $30,000 annual grants awarded to 26 youth-serving organizations around the state

� Grant activities include:� Tobacco Prevention and Cessation Presentations� Youth Empowerment Program� LifeSkills Training Curriculum� School Tobacco Policy Review� Community Events� Media centered around the National Tobacco

Awareness Days to promote 1-800-Quit-Now

Examples of Creatives from Mini-Grantees

Tobacco Quitline Workgroup

� Workgroup composed of approximately 40 public and private organizations with a vested interest in the health of Alabamians

� First convened October 2004

Alabama Quitline Workgroup

� Roles and Responsibilities� Assist in promoting Quitline� Assist with evaluation plan� Assist with development of vendor RFP� Assist with evaluation of RFP� Provide cessation expertise

Getting the Workgroup to….Work.

� Hang large sheets of post-it paper on the walls.

� Label each sheet with different tasks.

--- Assist with printing--- Newsletters--- Provide NRT funds

--- Post on web site--- Link to Quitline site

Leveraging Quitline Workgroup Partnerships� Medical Association of the State of Alabama

president adopted Quitline as part of platform.

� Quitline Workgroup medical association partners (Alabama Academy of Family Physicians and MASA) give free booth space at conferences for Quitline promotion.

� Groups post information about Quitline in their newsletters and on Web sites.

Fax Referral System for Providers

� We have added the fax referral system for healthcare providers. Providers can print a fax form from our website, have the patient sign the consent form, send it to the Quitline, and the Quitline will contact their patient. The provider will receive a progress report (with the patient’s permission) on the patient’s attempt to quit.

� Stability of call volume� Patients who want to quit

Fax Referral Form

Medical Clearance Form

Partners

� Women, Infants & Children� Alabama Comprehensive Cancer Control Coalition� Diabetes Branch� State Personnel� State Employees Insurance Board� Medicaid� Steps – Steps to a Healthier Alabama� Asthma Branch� Alabama State Nurses Association� Alabama Perinatal Program� Strategic Alliance for Health� HIV/AIDS� Cardiovascular Branch� Family Health Services� Health Promotion/Video Services� ALL Kids

Teen Cessation Program

MySpace Page:http://www.myspace.com/alquitnow

Pregnant Teen Cessation Poster

Pregnant Teen Cessation Posters

Pumping up the volume

What else are we doing to increase calls to the Tobacco Quitline?

Quitline Media Campaign

“Quitting Takes Practice,” a 30-second commercial was used in a PSA campaign. This ad is from the MCRC database. The Kurtz character was developed in California in 1990 and has proved very successful in tobacco cessation campaigns.

MVR – Most Valuable ResourceMedia Campaign Resource Center

Quitline Post-it (newspapers)

Sticky note campaign ran in seven major newspapers on the Sunday before Father’s Day. Campaign cost $37,000 and generated 1,005 inquiries to the Quitline that month.

May: 537 June: 1,005 July: 496

Quitline poster

Quitline Business Cards

More Quitline Media

� Baseball Game Day Announcements promoting the Quitline at colleges and universities around the state

� Full page ad in tournament booklet for Alabama A&M Golf tournament

Website Redesigned

Quitline Quit Kit Redesigned

1. Cardiovascular Branch/ADPH -- Presentation at Healthy Worksites workshop

2. On Media in Mobile produced and ran PSA on Lifetime cable channel promoting healthy hearts and Quitline

3. Alabama Chapter, American College of Cardiology –logo on Quitline easels

4. Family Health Services – Quitline logo on tobacco cost calculators to be given to social workers to give to new mothers for program, Plan First and Patient First

5. Charter Cable gave thousands of dollars worth of bonus ads once we began running campaign with them

More Partnerships

Partnership – American College of Cardiology, Alabama Chapter

Cardiology/Secondhand Smoke Forums Around The State

Partnerships with Other States

Success Stories

ADPH Statewide Press Releases

Sample Press ReleaseFor release: May 29, 2008For more information, contact: Name, Tobacco Prevention Coordinator

Name of Health Dept.Phone Number

Tobacco Coordinator Helps Pregnant Teens, Youth, Quit TobaccoPregnant teenagers in this area are smoking at a rate lower than the state average, but the number is still too high, said (Your full Name), tobacco prevention coordinator for the state’s Public Health Area (Number), which is (Name) County. (Your last name) is working with Laarni Cox, Alabama Department of Public Health youth tobacco cessation coordinator, in promoting a new program to reach tobacco-using youth and pregnant teens.ADPH has launched a new webpage for teens on MySpace, http://www.myspace.com/alquitnow as well as printed posters and pamphlets referring teens and pregnant teens to the Alabama Tobacco Quitline for help. The Quitline, 1-800-Quit-Now, provides free counseling to callers, (Your last name) said. Teens can receive a quit kit which helps them develop their personalized quit plan. Teens who agree to counseling and complete the program will receive a $25 gift card.Approximately 13 percent of pregnant teens smoke statewide. In (Name) County, the number is (number), (Your last name) said. In 2006, of the (Total number of 10-19 year olds) 10-19-year-olds who gave birth in this county, (Number that smoked during their pregnancy) of them said they smoked during their pregnancies. Statistics are from the “Selected Maternal and Child Health Statistics Alabama 2006,” from the Center for Health Statistics, Alabama Department of Public Health. Smoking during pregnancy can cause a number of problems such as miscarriage, ectopic pregnancy and premature rupture of membranes. There is a strong link between tobacco use during pregnancy and pre-term deliveries, low birthweight, stillbirth, neonatal and perinatal mortality. Area high school students grades 9-12 are using tobacco at high rates too, (Your last name) said. In Alabama, nearly 27 percent of high school students smoke, according to the Campaign for Tobacco Free Kids website. Contact (Your last name) at (Your phone number) for more information about the teen/teen pregnancy tobacco cessation program.

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Sample Letter to the Editor November 1, 2008

Dear Editor: On this, the American Cancer Society's 33rd annual Great American Smokeout, we suggest that smokers set aside the idea of quitting for their kids or their spouses or their parents, anddo it for themselves.

The Alabama Department of Public Health encourages smokers as well as nonsmokers to recognize the American Cancer Society’s (ACS) Great American Smokeout Thursday, November 20. The Great American Smokeout challenges smokers to give up cigarettes for one day. This is also the fourth Great American Smokeout for the Alabama Department of Public Health’s Tobacco Quitline, 1-800-Quit-Now. The Quitline (1-800-784-8669) provides free counseling services and up to four weeks of free nicotine patches for medically eligible Alabamians who want to quit smoking and/or chewing tobacco.

Tobacco use represents a significant health threat. It is responsible for more than 400,000 deaths each year. In Alabama alone, 7,000 people die annually from tobacco-related causes. Approximately 22.5 percent of Alabama adults are regular smokers. Nearly 10,600 Alabama youth become daily smokers every year.

Sincerely,

Name, TitleTobacco Prevention and Control Montgomery County Health Department

Quitline’s New Year’s Resolution Press ReleaseThis PR should be printed on your letterheadDec. 29, 2007 (Or whatever date you choose)FOR IMMEDIATE RELEASECONTACT: Your name, TITLE HERE

Your phone numberYour email address

Free Help in Resolution To Stop SmokingAlabamians making a New Year’s resolution to stop smoking in 2008 have free help available.The Alabama Department of Public Health offers a free telephone-based tobacco cessation service that provides free counseling and four weeks of free nicotine patches, if medically eligible. The Alabama Tobacco Quitline – 1-800-Quit-Now – is available Monday through Friday from 8 a.m. to 8 p.m. Calls placed after these hours or on weekends or holidays will be returned the next business day.

“Quitting tobacco is the most important thing you can do for yourself and your family,” said your name, tobacco control coordinator for the (Fill this in here -- city or county or area name). “Counselors from the Quitline can help you make and keep a plan to stop smoking.”

Tobacco use is the single most preventable cause of death in the United States. Each year, more than 7,400 Alabamians die from smoking-related causes. According to the Centers for Disease Control and Prevention, for every person that dies, 20 people are suffering from at least one serious tobacco-related illness.

Master’s level counselors from the Quitline work individually with callers to help them formulate a specific plan to stop smoking. Nearly all counselors are certified tobacco cessation treatment specialists. A Spanish-speaking counselor is available and translator services can be used for those who speak other languages. Those medically eligible who agree to counseling can receive four weeks of free nicotine patches.

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Upcoming Projects

� National Institute of Health grant-- Peer Referral Project/University of Alabama in

Birmingham working with our Quitline

� Statewide Diabetes Conference-- Tobacco and Diabetes

� Quitline Workgroup Meeting

� Making the Case for Medicaid Funding of the Quitline

Communications Plan -- DRAFT

Communication Plan (DRAFT)

OverviewThe purpose of this plan is to outline the earned and paid media campaigns funded through the Alabama Department of Public Health’s Tobacco Prevention and Control Program. Although the Program’s financial resources amount to approximately 4.1 percent of the Best Practice recommendation of $56.7 million per year, a strong core of experienced state, regional and local tobacco control staff and grantees makes effective earned media campaigns possible. Earned media campaigns are defined as the strategic dissemination of messages using a combination of radio, television and print media outlets to achieve a defined outcome without the use of paid advertising. In addition to earned and paid media campaigns, the program communicates with grantees and partners via in-person meetings, e-mail, teleconferences and through web pages. Infrastructure

The Program infrastructure includes nine central office staff with content expertise, two ADPH divisions with technical production capability, 11 full time regional tobacco control coordinators (see appendix ?) and 27 local grantees with establishedlocal media relationships. Each grant year, the tobacco control coordinators meet with staff from television, radio and newspapers to determine submission protocols and to establish working relationships with staff covering health and policy issuesin their target cities. This information is shared with the ADPH Social Marketing, which in turn provides: technical assistance on scripts and talent for public service announcements (PSAs); conducting effective focus groups; design of the program brand, web site and MySpace page; surveillance of earned media efforts using the Metro Monitor (system that tracks tobacco stories on broadcast news) and Magnolia Clipping service (statewide clipping service that captures tobacco stories); media campaign planning assistance with MedStat (a marketing software program that assists with demographic and geographic targeting) and the state’s Media Directory; and information on community events. The ADPH Video Communications Division provides production capability to record television and radio PSAs.

Tobacco control coordinators also conduct annual key informant surveys (see appendix ?) to assess decision makers’beliefs, attitudes and voting behavior on tobacco-related issues. A minimum of ten surveys are conducted in each target city. This information is compiled and shared with local tobacco control coalition partners to assist in the development of local strategic plans. Tobacco control coordinators and mini-grantees submit monthly media reports that also capture tobacco-related stories. This information is compiled into the Media Tracking System by the program’s Media Director. The Media Director also created and manages the Media Center. The Media Center includes:

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H1 HP2JHARE, 5/26/2009

Alabama Tobacco Quitline

Julie HareAlabama Tobacco Quitline Coordinator

Alabama Department of Public HealthBureau of Health Promotion and Chronic DiseaseTobacco Prevention and Control Branch201 Monroe Street, Suite 1274Montgomery, AL 36104

(334) 206-3830JulieHare@adph.state.al.us

Na-na-na-na. Na-na-na-na.Hey, hey-ey.Good-bye.

1-800-Quit-Now

Alabama Tobacco Quitline