Okay – so let’s say you DO have the support of policy makers (thanks to Jennifer Singleterry’s tips in last week’s blog). What other partnerships might be important in moving forward with quitline sustainability efforts? Anyone? Anyone? Bueller…

Yes! Public-private partnerships! To tell us a little more about what makes quitlines a powerful tool in building public-private partnerships we asked David Zauche, Senior Program Officer for Partnership for Prevention and also a new addition to NAQC’s Advisory Council, to weigh in. Here is what David had to say:

"How do tobacco cessation quitlines bring value to public-private partnerships (P3’s)? To answer that question it would help to know just how such a partnership is defined. But this is not as easy as it sounds - many definitions exist. A common strain among definitions seems to be:

Public-private partnerships are cooperative ventures between public agencies and the private sector through which the skills and assets of each are shared for the common good. This generally involves an allocation of resources for the delivery of a public service, for which both partners share in the recognition.

P3’s have become very popular in the U.S. in the past two decades, though they have existed for hundreds of years. These partnerships have benefited the public in a variety of sectors including transportation, schools, energy, and urban development. Governments all over the world are dealing with enormous budget shortfalls and they are increasingly turning to P3 models to deliver services. This is certainly true in the health care sector. In fact, P3’s have become a valuable public health tool at the community level.

There are many good examples of successful P3’s that impact public health and some are specific to the tobacco control realm. For example, the Department of Health and Human Services’ (HHS) Million Hearts initiative aims to prevent one million heart attacks and strokes in the next five years, improving Americans’ health and increasing productivity. The CDC’s Thomas Frieden, MD wrote, "Through this public-private partnership, Million Hearts focuses on the areas that will save the most lives. It leverages and aligns current investments and is a great example of getting more health value from our existing health investments.” Many different partners have joined forces including the American Heart Association, the American Medical Association, the American Nurses Association and Walgreens. HHS will target more than $200 million in new and refocused investments to achieve the goals of Million Hearts.

Some other examples:

In Oklahoma, Integris Health partnered with the Oklahoma Hospital Association, the state department of health, and the state tobacco settlement endowment trust to institute a hospital tobacco treatment program. As a result, tobacco-free campuses were established; tobacco cessation assistance is provided to employees and family members; physicians take an active role in helping their patients quit; and patients are referred to 1-800-QUIT NOW for quitline assistance after the hospital intervention.

In Colorado, a Tobacco Cessation and Sustainability Partnership was formed to support health plans in providing evidence-based tobacco cessation interventions and to build a framework to sustain the state’s quitline. These key stakeholders from health plans, state agencies, the clinical community, and the advocacy community engaged in a collaborative process to educate purchasers about the value of providing tobacco cessation benefits.

In Massachusetts, a partnership developed between eight commercial Medicaid health plans and the Massachusetts Department of Public Health. Provider representatives from the health plans delivered a tobacco cessation kit called Quitworks door-to-door to thousands of practices. Patients enrolled in QuitWorks were offered free proactive counseling. The program linked 12,000 health care providers and their patients to proactive telephone counseling

So, back to the original question – why would a quitline make a good partner in public health? Well, there are many reasons.

• Tobacco cessation works. Smokers may have to try and fail before they succeed, but tens of millions of Americans have successfully quit.
• Quitlines work. Effectiveness rates have been documented in the 2008 Public Health Service guideline and elsewhere. But many quitlines face severe financial handicaps which limit hours of operation, services, promotion, reach and, ultimately, even greater success than is currently realized.
• Return on investment. No preventive service – not hypertension treatment, mammography, cholesterol treatment – has a better payoff in health impact and cost effectiveness than tobacco cessation services.

The key to public-private partnerships is shared strengths and benefits. Quitlines will be well-served by increased funding, promotion, reach, and sustainability. But insurers, employers, health systems, and government agencies will also benefit through shared recognition for evidenced-based services delivered, healthier workforces, fewer hospital admissions, and a superior return on investment.”

Quitlines have a long history of serving as the bridge that brings partners together and increasing awareness of the importance of offering cessation assistance. It is a lengthy process to build cost-sharing partnerships with the private sector (and the public one, for that matter!) and one that can have many starts and stops along the way. However, if we are to truly focus on the issue of sustainability and be successful in doing so, we simply must take the first step. Have you?

It is impossible to envision the future of quitlines without thinking about emerging technologies. To lead us wisely into a couple of blog conversations focused on technology’s influence on the future of quitlines NAQC asked Jack Boomer, Director of QuitNow Services for the British Columbia Lung Association, to answer our 6^th question: What strategies can we use to engage Generation Y in quit coaching? Here is what Jack had to say…

When we speak of Generation Y or Millennials, we’re talking about those born somewhere between 1981 and 1999 (13 to 31 year olds).

Having come of age in the computer and Internet era, this generation grew up in a culture where the defining theme is "velocity," both in terms of the rate of change and the pace of information. They’re the best educated generation in history, have an incredible amount of tech resources at their disposal and are potentially your next biggest customer.

Today, Generation Y constitutes more than a quarter of Canada’s population. They’re bigger than the Baby Boomer generation (1943 to1961) and six times the size of Generation X (1962 to 1981). They’re also the generation amongst which we find the highest rate of smokers. According to Canadian surveys, more than one in four twenty-something smoke, and the stats are a bit higher in the USA according to the US Surgeon General’s recent report.

Interestingly, our Canadian surveys suggest Generation Y smokes fewer cigarettes than older smokers. And while they try to quit more often than others, they do so with less success. Sounds like Generation Y could use our help, but how do we get through to them?

First, hang out where they do
Social media is where they live. They communicate via Facebook, Twitter and many other social media sites and sleep next to their cell phones. They surf the Web for everything, watch more YouTube than TV, and are used to having a world of answers at their fingertips. If your quit service doesn’t offer multiple service delivery options, especially online, you can forget about having a big impact on reaching this generation.

Second, don’t market to them, engage with them in conversation
Generation Y loves a collaborative environment and thrives when working in groups. Before they buy into anything they do their research. They read online reviews, browse websites, ask questions, and find out the pros and cons of any service. They look first to peers for help and guidance (friends, family, online communities, social networks and chat rooms), not so-called experts. If you want them to choose you for advice and guidance, you better keep an eye on what the world is saying about you online.

Third, provide regular recognition and rewards
Sometimes referred to as the "everybody gets a trophy” generation, Generation Y grew up being rewarded as much for participating as winning. They like regular feedback and are motivated by rewards. In fact, market research confirms this generation rates organizations with loyalty reward programs as the top incentive looked for in exchange for personal information. It also confirms many are happy to promote your service in exchange for rewards. If you’re looking to invest in an awareness-building campaign, make it interactive and reward people for participating and helping spread the word.

Finally, offer multiple service options
To reach Generation Y, I believe the way we deliver our services must mirror the way that Generation Y seeks information and support. We need to expand our definition of quit coaching to include text messaging support, mobile applications, online video chat counselling (using Skype for example) and live chat (see the National Cancer Institute’s version https://livehelp.cancer.gov/app/chat/chat_launch).

We need to get out of our comfort zone and meet the tech savvy Generation Y where they live if we are going to make a difference and help them quit smoking.

The BC Lung Association is up to the challenge through the use of QuitNow Services (QuitNow.ca) – are you?

NAQC recently asked Dr. Tim McAfee, Director, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, what are the lessons-learned over the past 20 years that quitlines MUST carry forward into the next 20 years? Here are his thoughts…

"Effectiveness is important. Reach and impact are REALLY important.

The promotion of quitlines may play as important a role in contributing to cessation as the increase in quit rates among callers. This is because most smokers motivated by promotion to try to quit, still quit without formal assistance. Knowing that help is just a phone call away if they need it may encourage them to act on quitting messages they hear from media campaigns or their health care providers, and thus increase their chances of succeeding. Quitlines may also have this effect by helping normalize quitting. This important secondary benefit of quitlines was demonstrated in one of the very first quitline studies (by Debbie Ossip at University of Rochester in New York)!

We should keep thinking about ways that we can leverage quitlines to increase quit attempts and quit success among the general population of smokers, as well as to help smokers who call quitlines successfully quit. We also need to keep working to ensure quitlines expand on their impressive track record of use by populations experiencing tobacco-related disparities.

The reach of quitlines is highly dependent on how heavily they are promoted. Since most quitlines are funded at modest levels, states often make the difficult choice of under-promoting their quitlines and quitline services in order to avoid generating more calls than they can serve. This may inadvertently lend plausibility to skeptics who argue that quitlines should not be funded at all because they "only” reach 1-2% of the population. The reality is that this limited reach is due more to limited funding and promotion than to a lack of interest or an intrinsic ceiling on reach.

Quitlines can come in many different shapes and sizes, including state-funded, federal-funded, and community-funded, as well as employer- and health care system-funded quitlines. There are also hybrid arrangements where one system triages callers to other systems.

To be effective, quitlines need to pay close attention to the caller experience from start to finish. Quitlines have been successful because the researchers who developed them did so thoughtfully based on science, and because practitioners have paid close attention to training, protocol fidelity, and continuous improvement.

Regardless of the level of funding available to promote quitlines and provide service to callers, it’s critical that quitlines constantly strive to improve efficiency in order to maximize their reach without sacrificing caller success.

When they emerged in the 1980s and 1990s, quitlines were a dramatic innovation. Today they are one medium among a burgeoning array of electronic communication technologies being used to extend access to many types of health care services. Within this rapidly changing environment, it is important that quitlines evolve and redefine themselves to maximize reach and success (while retaining their commitment to evidence and evaluation). This includes exploring potential linkages and synergies with other new communications media like text messaging and web-based counseling. It may also involve potential paradigm shifts such as the creation of registries for longer-term interaction with quitters, as along the lines of the databases of tobacco users being compiled by the tobacco industry.”

Any of your own lessons learned that you’ll be sure to carry forward? What else have we learned over time that is important not to forget?

Keeping with the theme of celebrating our past while asking important questions about the future of quitlines, NAQC asked David Willoughby, CEO of ClearWay MN and former Chair of NAQC’s Board of Directors to weigh in on the question below:

Knowing what we know now, if we built the quitline cessation service of tomorrow, capable of serving and attracting tobacco users acrossthe whole nation, what would it look like?

"I’m not sure it’s possible to speculate about an ideal "quitline cessation service of tomorrow,” since there are so many variables involved – changing technology, smoker demographics and ways to use tobacco. But here are a few points that are important for any successful quitline in the 21^st Century.

• Identifying the quitline’s purpose is important. Reaching the greatest population requires a different approach than maximizing individual cessation outcomes, and a shift in emphasis may be necessary as we look down the road. For instance, traditionally we have focused our efforts on those smokers who are ready to make a quit attempt in the next 30 days, because they are more likely to have individual success from treatment. But might we have a greater health impact if we focused just on increasing engagement with smokers and reaching as many as possible – regardless of whether they are ready to quit or not? Specific goals will dictate a specific approach and could lead to better results.
  
  
• Services must be designed with the needs and expectations of our customers – smokers – in mind. There is a growing body of literature in the area of consumer demand, both in tobacco control and other fields. This knowledge provides a window into the lives of smokers – the social and environmental context in which quit attempts occur – and we should apply it when looking to the future of quitline cessation services.
  
  
• Technology must be integrated into quitline cessation services. Technology continues to change, and how smokers use technology is also evolving. Furthermore, demographic differences are emerging with respect to ownership and use of technology – for example, African Americans and Chicano Latinos are now more likely to own a smartphone than Caucasians (see http://pewinternet.org/Reports/2011/Smartphones.aspx). We should be using customers’ preferred technology to engage them and to keep them involved.
  
  
• Building partnerships to ensure quitline sustainability will be essential. The economic downturn of the past few years underscores the urgent need to expand funding for quitlines.We must learn as a community of quitlines how to best build support from our health plans, employers and other key stakeholders who have a vested in interest in creating cessation access for all tobacco users. NAQC has recognized the importance of forming public-private partnerships, and successful quitlines of the future will be those who have taken on the important work of building them.

At the beginning of 2012, we see that times are changing, the population of smokers is changing and technology is changing. As we look to the future, we need to ask ourselves, are we keeping up, keeping services fresh and taking advantage of every opportunity the future has to offer?”

How are you "keeping up?” Are there recent changes to your promotion efforts or to your service offerings that are helping you to extend your reach or improve effectiveness? Tell us more!!!...and thanks so much, David, for this answer and your continued leadership!