Maximize the access, use, and effectiveness of quitlines;
Provide leadership and a unified voice to promote quitlines; and
Offer a forum to link those interested in quitline operations.
NAQC's Strategic Goals:
GOAL 1: INCREASE THE USE OF QUITLINE SERVICES IN NORTH AMERICA
- Objective 1: By 2015, each quitline should achieve a reach of at least 6% of its total tobacco users.
In FY08, the reach of US and Canadian quitlines was about 1%, with a range up to 8%. The US Department of Health and Human Services’ Interagency Committee on Smoking and Health report (2004) proposes that well-funded quitlines, supported with a national campaign, can reach 10-15% of smokers each year. More recently, the CDC Best Practices for Comprehensive Tobacco Control Programs (2007 update) set as a goal that quitlines should reach 8% of smokers each year and deliver services to 6% of all smokers. To measure this objective, we propose using the newly developed NAQC standard measure for calculating reach [See NAQC Issue Paper: Measuring Reach of Quitline Programs
]; the standard measure focuses not on the number of calls to the quitline but instead on the number of clients who receive an evidence-based treatment (i.e., counseling or medications). In proposing this goal, the Board recommends that we strive to achieve the CDC target by 2015.
GOAL 2: INCREASE THE CAPACITY OF QUITLINE SERVICES IN NORTH AMERICA
Objective 2: By 2015, on average $2.19 per capita ($10.53 per smoker) should be invested in quitline services.
Justification: Currently, the median budget for state quitlines is $1,000,000 and provincial quitlines is $324,624 (2008 NAQC Annual Survey). The CDC Best Practices for Comprehensive Tobacco Control Programs (2007 update) set as a goal that quitlines should invest $3.49 per capita in cessation services, assuming 8% of tobacco users would be reached and 6% would receive services. After consulting with CDC, NAQC staff used the same methodology to calculate a budget goal of $498.7 million for quitlines in the US (about $2.19 per capita or $10.53 per smoker). The funding covers the cost of counseling plus two weeks of NRT for all callers and up to 4 weeks for callers without insurance and those Medicaid/Medicare beneficiaries. It assumes that 85% of callers will accept NRT. NAQC staff prepare detailed per capita, per smoker and total budget targets for each state and province. This funding level is consistent with objective one’s target for 2015 (i.e., reach of 6%).
GOAL 3: INCREASE THE QUALITY AND CULTURAL APPROPRIATENESS OF QUITLINES IN NORTH AMERICA
The objectives below for goal 3 are proxy measures of quality and cultural appropriateness of quitlines. They reflect current knowledge base and measurement abilities rather than a full assessment of quality. Over time, we would like to develop better measures, especially for cultural appropriateness.
Objective 3a: By 2015, each quitline should have an overall quit rate of at least 30%.
As noted above, NAQC hopes to develop better measures for the quality of quitlines over time. As with the reach goal (goal 1), the quality goal is intended to be aspirational and achievement is presumed linked to achievement of the capacity goal (goal 2). The target quit rate may be achieved through any combination of quitline services or medications, including innovative or promising new practices. It is important to note that quit rates are mediated by factors such as client socioeconomic status and co-morbidities, the intensity of services offered and accepted, and many other factors (See NAQC Issue Paper: Measuring Quit Rates
). Also, some quitline programs may elect to focus more on strategies such as media or quitline reach to stimulate quits and less on achieving higher quit rates. NAQC does not presently collect quit rate data from its members. To develop a target for objective 3a, we conducted a literature review of all published articles on quit rates for quitlines (2005-2008). The 15 relevant articles were used to establish ranges of quit rates for smokers who used quitline services. Going forward, NAQC will use 30-day point prevalence abstinence, responder rates, 7 months after the start of treatment. This is consistent with the new NAQC standard methodology for calculating quit rates. As we begin to collect real-world quit rate data, the objective may be modified to correspond to quitline practice.
Objective 3b: By 2015, each quitline should achieve a reach of 6% in priority populations:
American Indian (First Nations)
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
Justification: For objective 3b, NAQC assumed that delivering service to 6% of each priority population will only be possible if quitline services and promotions are culturally appropriate. As noted above, NAQC hopes to develop better measures of cultural appropriateness over time. We expanded the list of priority populations beyond those required by the U.S. federal government (OMB) to include communities recognized by the Centers for Disease Control and Prevention and the American Legacy Foundation as priority populations.