public health district millennium tobacco cessation program
TRANSCRIPT
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 83725-1800
Phone: 208-426-5947
Web: http://hs.boisestate.edu/chp/
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 ..................................................................................................... 10
Comparison of Outcomes for FY 2001 through FY 2015 Participants........................................................................ 12
Evaluation Design........................................................................................................................................................ 13
Longitudinal Outcomes of the Tobacco Cessation Program ....................................................................................... 13
Location of Tobacco Cessation Program and Participants .......................................................................................... 16
Economic Analysis ...................................................................................................................................................... 17
Conclusion ................................................................................................................................................................... 18
References ................................................................................................................................................................... 19
Appendix A: Map of Participants by City of Service .................................................................................................. 21
Appendix B: Map of Participants by County of Residence ......................................................................................... 22
Appendix C: Follow-up Interview Attempts at Two Months and Six Months FY 2001-2012 .................................... 23
Appendix D: Two-Months and Six-Months Follow-up Results FY 2001 - FY 2012 .................................................. 23
Appendix E: FY 2014 Follow-up Interview Attempts at Seven-Months .................................................................... 24
TABLE INDEX
Table 1: Number of Participants Starting the Program: Age Distribution by Health District - FY 2015 ..................... 7
Table 2: Number of Participants Starting the Program by Gender by Health District - FY 2015 ................................ 7
Table 3: Number of Pregnant Participants Starting the Program by Health District - FY 2015 ................................... 7
Table 4: Tobacco Cessation Program Outcomes by Target Population Groups - FY 2015. Total participants
starting and completing the program ............................................................................................................................. 8
Table 5: Tobacco Cessation Program Outcomes by Target Population Groups - FY 2015. Total participants
starting but not completing the program ....................................................................................................................... 8
Table 6: Tobacco Cessation Program Outcomes by All Target Population Groups - FY 2015.
Total participants starting the program, completed and not completed combined ....................................................... 9
Table 7: Number of Participants Using E-Cigarettes: Age Distribution by Health District - FY 2015 ...................... 10
Table 8: Number of Participants Using E-Cigarettes by Gender by Health District - FY 2015 ................................. 10
Table 9: Number of Pregnant Participants Using E-Cigarettes by Health District - FY 2015 .................................... 10
Table 10: E-Cigarettes Tobacco Cessation Program Outcomes by Target Population Groups - FY 2015. Total
participants starting and completing the program ....................................................................................................... 11
Table 11: E-Cigarettes Tobacco Cessation Program Outcomes by Target Population Groups - FY 2015. Total
participants starting but not completing the program ................................................................................................. 11
Table 12: E-Cigarettes Tobacco Cessation Program Outcomes by All Target Population Groups - FY 2015.
Total participants starting the program, completed and not completed combined ..................................................... 11
Table 13: Comparison of Program Outcomes for FY 2001 - FY 2015 ....................................................................... 12
Table 14: Program Outcomes for FY 2001 - FY 2015 ............................................................................................... 13
Table 15: Follow-up Interview Attempts at One-Month and Seven-Month for FY 2015 .......................................... 14
Table 16: One-Month and Seven-Month Follow-up Results for FY 2015 ................................................................. 14
Table 17: Follow-up Interview Attempts at One-Month and Seven-Months for FY 2001 - FY 2015 ........................ 15
Table 18: One-Month and Seven-Month Follow-up Results FY 2001 - FY 2015 ...................................................... 15
Table 19: Counties Where Tobacco Cessation Classes Were Held, by Health District - FY 2015 ............................ 16
Table 20: Counties Where Tobacco Cessation Classes Where Participants Lived, by Health District - FY 2015 ..... 16
Table 21: Follow-up Interview Attempts at Two-Months and Six-Months FY 2001-12 ........................................... 23
Table 22: Two-Months and Six-Months Follow-up Results FY 2001 - FY 2012 ...................................................... 23
Table 23: Seven-Month Follow-up Results at the end of FY 2014 compared to completion of FY 2014
Follow-up Calls .......................................................................................................................................................... 24
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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 2015.
4) 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
(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
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 2016.
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
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 District 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 2002-2015. This annual
report describes the evaluation process and gives the results of the Millennium Fund Tobacco
Cessation program’s fifteenth year (2014-2015). 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
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 18-24
(471), and then the 25-44 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 District - FY 2015
District
I
District
II
District
III
District
IV
District
V
District
VI
District
VII Total
< 18 119 8 208 247 63 62 274 981
18-24 56 42 181 35 41 46 70 471
25-44 82 32 50 41 47 58 100 410
45-64 38 18 51 39 6 32 33 217
65+ 3 4 15 3 0 7 0 32
Age Unknown 7 0 1 1 0 6 1 16
Total 305 104 506 366 157 211 478 2,127
Note: Count of youth includes the number of pregnant adolescents < 18.
Table 2: Number of Participants Starting the Program by Gender
by Health District - FY 2015
District
I
District
II
District
III
District
IV
District
V
District
VI
District
VII Total
Male 125 26 301 221 56 94 227 1,050
Female 180 78 205 145 101 117 251 1,077
Total 305 104 506 366 157 211 478 2,127
Table 3: Number of Pregnant Participants Starting the Program by Health District - FY 2015
District
I
District
II
District
III
District
IV
District
V
District
VI
District
VII Total
Pregnant 43 60 40 30 74 47 39 333
% of all female
participants 24% 77% 20% 21% 73% 40% 16% 31%
Total 43 60 40 30 74 47 39 333
Baby last 6
weeks 4 0 1 0 3 7 0 15
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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 2015. 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 2015. 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
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 2015.
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.
0
200
400
600
800
1000
333
167 56 17
44 43
960
634
351
55
198
81
834
419
152 28
218
79
Pregnant Youth (< 18) Adult
Figure 1: Number who started Tobacco Cessation classes, completed
the cessation course, quit tobacco use, and reduced tobacco use – FY
2015 (N=1,220)
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 District –
FY 2015
District
I
District
II
District
III
District
IV
District
V
District
VI
District
VII Total
< 18 85 7 189 172 45 50 195 743
18-24 26 14 150 19 14 21 55 299
25-44 41 11 27 16 16 25 62 198
45-64 15 9 36 16 3 14 13 106
65+ 1 2 5 1 0 3 0 12
Age Unknown 2 0 1 0 0 1 1 5
Total 170 43 408 224 78 114 326 1,363
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 District - FY 2015
District
I
District
II
District
III
District
IV
District
V
District
VI
District
VII Total
Male 79 14 259 147 43 67 152 761
Female 91 29 149 77 35 47 174 602
Total 170 43 408 224 78 114 326 1,363
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 District - FY 2015
District
I
District
II
District
III
District
IV
District
V
District
VI
District
VII Total
Pregnant 16 19 20 2 16 9 38 120
% of all female
participants 18% 66% 13% 3% 46% 19% 22% 20%
Total 16 19 20 2 16 9 38 120
Note: Data is E-Cig use ONLY. Count of youth includes the number of pregnant adolescents < 18.
11
Table 10: E-Cigarettes Tobacco Cessation Program Outcomes by Target Population Groups - FY
2015. 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
2015. 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 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 2015. 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
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 2001 - FY 2015
Fiscal
Year Total Participants
Completed
program Quit Smoking
Still using, but
reduced number
of cigarettes
used
2001 1,477 855 (58%) 351 (24%) 409 (28%)
2002 2,099 1,336 (64%) 718 (34%) 778 (37%)
2003 1,747 1,141 (65%) 622 (36%) 710 (41%)
2004 1,743 1,163 (67%) 572 (33%) 713 (41%)
2005 2,097 1,289 (61%) 810 (39%) 781 (37%)
2006 1,457 922 (63%) 532 (37%) 590 (40%)
2007 2,227 1,447 (65%) 810 (36%) 895 (40%)
2008 2,045 1,423 (70%) 754 (37%) 854 (42%)
2009 2,326 1,616 (69%) 853 (37%) 1,004 (43%)
2010* 0 0 (0%) 0 (0%) 0 (0%)
2011 1,639 976 (60%) 673 (41%) 569 (35%)
2012 1506 934 (62%) 537 (36%) 548 (36%)
2013 1,381 869 (63%) 425 (31%) 540 (39%)
2014 1,712 1,014 (59%) 602 (35%) 548 (32%)
2015 2,127 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
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 2001 - 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 2001-12. All participants were called again at the six-month follow-
up unless they asked to be removed from the call list.
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
Follow-up
Total Eligible
for interview
Interviews
completed
Maximum # of
attempts made
Declined
interview
Phone
number not
current
One-
Month 535 170 (32%) 158 (30%) 79 (15%) 128 (24%)
Seven-
Months 271 92 (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
Number
interviewed Still Quit Relapsed
Quit
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.
0%
20%
40%
60%
80%
100%
9% 5%
27% 21%
12%
10%
22%
12%
29%
52% No Change
Still Quit
Quit after Program
Still Reduced
Relapsed
Seven-month follow-up One-month follow-up
Figure 2: Participant status at one-month and seven-months after the end
of the program, FY 15
15
Results for the cumulative FYs are shown in Tables 17 and 18.
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.
0%
20%
40%
60%
80%
100%
13% 16%
26% 25%
15% 17%
20% 16%
26% 25% No Change
Still Quit
Quit after Program
Still Reduced
Relapsed
Six/Seven-Month Follow-up
Table 17: Follow-up Interview Attempts at One-Month and Seven-Month
for FY 2001 - FY 2015
Follow-up
Total Eligible
for interview
Interviews
completed
Maximum #
of attempts
made
Declined
interview
Phone
number
not
current
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 2001 - 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%)
One/Two-Month Follow-up
Figure 3: Participant status at one-month (or two-month) and
seven-month (or six-month) after the end of the program, FY
2001-2015
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 2015.
Table 19: Counties Where Tobacco Cessation Classes Were Held, by Health District - FY
2015
Panhandle District Health Benewah, Bonner, Boundary, Kootenai,
Shoshone
North Central District Health Clearwater, Idaho, Latah, Lewis, Nez
Perce
Southwest District Health Canyon, Gem, Payette, Washington
Central District Health Ada, Boise, Elmore, Valley
South Central Public Health District Cassia, Gooding, Jerome, Minidoka, Twin
Falls
Southeastern District Health Bannock, Bear Lake, Bingham, Butte,
Caribou, Franklin, Oneida, Power
Eastern Idaho Public Health District Bonneville, Clark, Custer, Fremont,
Jefferson, Lemhi, Madison, Teton
Table 20: Counties Where Tobacco Cessation Classes Where Participants Lived, by Health
District - FY 2015
Panhandle District Health Benewah, Bonner, Boundary, Canyon,
Kootenai, Shoshone
17
North Central District Health Clearwater, Idaho, Latah, Lewis, Nez
Perce
Southwest District Health
Ada, Blaine, Boise, Canyon, Elmore, Gem,
Jerome, Minidoka, Owyhee, Payette, Twin
Falls, Union, Washington
Central District Health Ada, Boise, Canyon, Elmore, Gem, Valley
South Central Public Health District Cassia, Gooding, Jerome, Minidoka, Twin
Falls
Southeastern District Health
Ada, Bannock, Bear Lake, Bingham,
Bonneville, Butte, Caribou, Franklin,
Idaho, Oneida, Power, Teton
Eastern Idaho Public Health District
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
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.15-18
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 Districts 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 Districts 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 Districts 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, 2014 20-21
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
REFERENCES
1. Centers for Disease Control and Prevention (CDC). Annual smoking-attributable
mortality, year of potential life lost, and economic costs—United States, 1995-1999.
Morbidity and Mortality Weekly Report 2002; 51(14): 300-303.
2. Centers for Disease Control and Prevention. Smoking-Attributable Mortality, Years of
Potential Life Lost, and Productivity Losses—United States, 2000–2004. Morbidity and
Mortality Weekly Report 2008; 57(45):1226–8.
3. Health Costs of Smokers vs Former Smokers vs Non-Smokers. 2008.
http://www.tobaccofreekids.org/research/factsheets/pdf/0327.pdf
4. 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-S59.
5. 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; 2010.
6. 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):
102-111.
7. 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; 51.
8. 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): 487-512.
9. American Lung Association. Children and Teens. 2010. Retrieved July 14, 2015, from
http://www.lung.org/stop-smoking/about-smoking/facts-figures/children-teens-and-
tobacco.html?referrer=https://www.google.com/
10. Stanton, A., & Grimshaw, G. Tobacco Cessation Interventions for Young People
(Review). The Cochrane Collaboration, 2013.
11. 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
12. Berlin, L. Do Smokers Know How Much They Spend on Cigarettes? – Daily Finance.
2012. Retrieved July 14, 2015, from http://www.dailyfinance.com/2011/06/22/do-
smokers-know-how-they-much-spend-on-cigarettes/
13. 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): 699-709.
15. Idaho Department of Health and Welfare (IDHW). Idaho tobacco prevention and control
program, n.d.; http://www.healthandwelfare.idaho.gov/?TabId=324
16. Wyoming Department of Health. Wyoming quit tobacco program, 2013;
https://wyo.quitlogix.org/
17. Montana Public Health and Human Services. Montana tobacco quit line, 2014;
http://www.dphhs.mt.gov/mtupp/quitlinefactsheet.shtml
18. Nevada Tobacco Users Helpline, n.d.;
http://www.livingtobaccofree.com/Default.aspx?id=index
19. Utah Department of Health. Utah tobacco cessation resources directory county resources,
n.d.; http://www.tobaccofreeutah.org/ut_tob_res_dir-county.html
20. 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; 2014.
http://www.regulations.gov/#!documentDetail;D=FDA-2014-N-0189-20870
21. U.S. Food and Drug Administration (FDA). Electronic Cigarettes (e-Cigarettes). Public
Health Focus, 2014. http://www.fda.gov/newsevents/publichealthfocus/ucm172906.htm
21
APPENDIX A: MAP OF COUNTY WHERE SERVICES WERE PROVIDED IN FY 2015
Millenium Tobacco Cessation
Total Participants- FY15
(301)
(104)
(506)
(366)
(157)
(211)
(478)
· AMERICAN FALLS
· ARCO
· BLACKFOOT
· BOISE
· BURLEY
CALDWELL ·
· COEUR D ALENE
DRIGGS ·
· EMMETT
· GOODING
· GRANGEVILLE
· BONNERS FERRY
· HAYDEN
· IDAHO CITY
· IDAHO FALLS
· JEROME
· KAMIAH
· KELLOGG
· LEWISTON
MALAD CITY ·
· MC CALL
· MERIDIANMIDDLETON ·
MONTPELIER ·
· MOSCOW
· MOUNTAIN HOME
NAMPA ·
· OROFINO
· PAYETTE
PLUMMER ·
· POCATELLO
· POST FALLS
· PRESTON
· REXBURG
RIGBY ·
· SAINT ANTHONY
· PRIEST RIVER
· SAINT MARIES
· SALMON
· SANDPOINT
TWIN FALLS ·
· WEISER
· SODA SPRING
355
132
4
47
27
1
16
363
21
3475
1
16
2
15
1
9
23
847
1
6
5
9
196
15
7
4
9
15
64
9
17
12
21
7
116
1
7
22
APPENDIX B: MAP OF COUNTY OF RESIDENCE FOR PARTICIPANTS IN FY 2015
Millenium Tobacco Cessation Program
County of Residence of Participants- FY15
(304)
(112)
(509)
(379)
(169)
(241)
(389)
Ada 362
Adams 1
Bannock 127
Bear Lake 4
Benewah 47
Bingham 60
Blaine 3
Bonner 17
Bonneville 279
Boundary 20
Canyon 455
Caribou 2
Cassia 21
Clearwater 15
Custer 1
Elmore 13
Franklin 23
Fremont 71
Gem 13
Gooding 4
Idaho 12
Jefferson 10
Jerome 22
Kootenai 198
Boise 3
Latah 18
Lemhi 8
Lewis 5
Madison 22
Minidoka 12
Nez Perce 62
Oneida 9
Owyhee 4
Payette 27
Power 13
Shoshone 22
Teton 9
Twin Falls 107
Valley 1
Washington 9
Butte 3
(Known, Unknown)
23
APPENDIX C: Follow-up Interview Attempts at Two-Months and Six-Months FY 2001-
2012
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 2001- FY 2012
Follow-
up
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 2001 - 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 2001 - 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
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
Number
interviewed Still Quit Relapsed
Quit
Following
Program
Still
Reduced Seven-Month
(FY14 Annual
Report) 89 15 (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 2014. 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.