They Came, But Will They Come Back? An Observational Study of Re-Enrollment Predictors for the Oklahoma Tobacco Helpline

Purpose: Although quitlines reach 1% to 2% of tobacco users annually, additional efforts are needed to increase their impact. We hypothesized that offering less intensive services would increase the rate of re-enrollment in any service, as well as re-enrollment in more intensive services. This study describes the enrollment patterns and identifies re-enrollment predictors for Oklahoma Tobacco Helpline (OTH) participants. Design: This study used a comparative observational design. Setting: The setting for this study was the OTH, a telephone-based cessation program funded by the Oklahoma Tobacco Settlement Endowment Trust. The OTH participants could select either a multicall telephone-based cessation program (MC) or one or more individual services (IS), including a 2-week nicotine replacement therapy (NRT) starter kit, e-mail or text-based support, and a printed quit guide. Participants: A total of 35 648 first-time adult OTH participants eligible for the multicall program from October 2015 through September 2018 were included. Measures: Demographic and tobacco use variables and initial quitline service selection were collected at intake. Additional service utilization was tracked for 6 months following initial registration. Analysis: Pearson chi-square and t tests were used to test for significant differences between groups. Multinomial logistic regression was used to examine predictors of re-enrollment. Results: Individual services were more frequently selected (n = 17 266) than MC (n = 14 326), despite all users being eligible for MC. A much higher proportion of IS registrants re-enrolled than MC registrants (16% vs 3%, P < .0001) Among the IS cohort, those who received an NRT follow-up call were 14.7 times more likely to re-enroll in IS, and 7.8 times more likely to re-enroll in MC, than those who were not reached by phone. Conclusions: Access to free NRT without a telephone-coaching requirement is a draw for tobacco users, especially those with lower income and the uninsured. The results suggest the value of increasing use of nonphone services in an effort to increase interest in quitting and reach.

Promoting Statewide Quality Improvement in Tobacco Use Prevention Through Longitudinal Health Promotion Training for Tennessee County Health Departments

Professional development in health promotion is fundamental to conduct effective multiyear community-based health promotion programs to address tobacco use. Provided with $15 million over 3 years in new resources from the United States’ Master Tobacco Settlement Agreement, the Tennessee Department of Health organized a longitudinal staff development effort for 95 county health departments using an experiential pedagogy. Through statewide WORKshops, standardized plans, electronic reporting, use of logic modeling, social and behavior theory, and public health terminology were introduced and emphasized. A summative county evaluation document, entitled the Community Health Improvement Plan Against Tobacco Use (CHIPATU), was part of the experiential approach. The report was completed by health department officials from these 95 counites. This report documented tobacco use problem statements, county investments of Tobacco Settlement funds, strategy and project descriptions, and local changes in statewide outcome measures in three focused areas: reducing pregnancy smoking, reducing secondhand smoke exposure for young children, and reducing youth tobacco use initiation. The CHIPATU became a capstone evaluation document that reinforced county-based responsibility for assessment, goal setting, intervention planning, implementation, application of continuous improvement tools, and results. A statewide summary of 3 years’ efforts and outcomes from the 95 county CHIPATUs was included in the state Health Commissioner’s annual budget presentation for the Governor and General Assembly. The results documented the efficacy of the Department’s primary prevention programs, supported by staff development in use of health promotion approaches, to address long-standing public health issues.