Nicotine & Tobacco Research, 2015, 617–621 doi:10.1093/ntr/ntu198 Brief report Advance Access publication September 25, 2014
Brief report
A Profile of Callers to the New South Wales Quitline, Australia, 2008–2011 Anne C. Grunseit PhD1, Ding Ding PhD1, Caroline Anderson MPH2, Debra Crosbie3, Sally Dunlop PhD2,4, Adrian Bauman PhD1 Prevention Research Collaboration, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia; 2Screening and Prevention, Cancer Institute NSW, Eveleigh, New South Wales, Australia; 3Systems and Operations, ADIS NSW and NSW Quitline, Alcohol and Drug Service, Darlinghurst, New South Wales, Australia; 4School of Public Health, University of Sydney, New South Wales, Australia 1
Corresponding Author: Anne C. Grunseit, PhD, Prevention Research Collaboration, School of Public Health, Level 6, The Hub, Charles Perkins Centre, University of Sydney, Camperdown, New South Wales 2006, Australia. Telephone: 61-2-86271834; Fax: 61-2-9036-3184; E-mail: [email protected]
Abstract Introduction: One population-level solution to smoking cessation are quitlines, telephone-based services to aid quitting. Monitoring the profile of quitline callers in a changing tobacco policy environment is important for informing future policy strategies and identifying target groups to improve the reach and impact of quitline services. Methods: De-identified data from 43,618 new callers to the New South Wales Quitline, Australia between January 2008 and October 2011 (inclusive) were extracted from the Quitline database. Regression analyses explored the effect of year of first call on the distribution of demographic and smoking-related variables. Results: Men calling the Quitline increased proportionately (prevalence ratio [PR] = 1.05, 95% CI = 1.03–1.08), but callers from non-major city areas fell (PR = 0.90, 95% CI = 0.87–0.93) in 2011 versus 2008. The proportion of callers not working demonstrated a significant increasing linear trend (PR = 1.08, p < .001), although area-level socioeconomic status did not change. The proportions of new Quitline callers who had stopped smoking (relative to still smoking) (relative risk ratio [RRR] = 1.29, 95% CI = 1.14–1.46) and who were classified as low nicotine dependent (vs. high nicotine dependent, RRR = 1.60, 95% CI = 1.39–1.83) were higher in 2011 versus 2008. Proportionately, more callers nominated “money” as a motivation to quit in 2010 (PR = 1.58, 95% CI = 1.49–1.66) and 2011 (PR = 1.70, 95% CI = 1.62–1.79) compared with 2008. Conclusions: Quitline callers showed decreasing tobacco consumption and dependence 2008 to 2011, but remained more addicted than the average NSW smoker. Clear effects of tobacco policy were shown, as money as a motivator increased dramatically in conjunction with increased tobacco taxation, highlighting the importance of promoting cessation services concurrent with policy change to capitalize on increased motivation to quit.
Introduction Tobacco smoking is the leading lifestyle risk factor for disease burden in Australia.1 Although the prevalence of smoking has steadily declined in the past decade2 and is currently approximately 16%,3
encouraging and supporting smokers to quit remains a public health priority. One population-level solution to smoking cessation are quitlines, telephone-based services to aid quitting. Call-in services for quitting
© The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: [email protected].
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618 have been documented for three decades, initially in Australia and then in the United States.4,5 Over recent years, quitlines have proliferated throughout the Americas, Europe, and Asia.6 In Australia, every state and territory has a quitline service. Compared with other smoking cessation programs, quitlines have several major advantages; they are convenient, anonymous, follow structured protocols, and have a high likelihood of followup.7 A recent meta-analysis concluded that telephone quitlines are effective in assisting smoking cessation among diverse populations in a real world setting.8 Despite the effectiveness of telephone-based counseling, only a minority of smokers utilize this service. Estimates of smokers using quitlines have varied between 1% to 6% in the United States and 11% in New Zealand.9–11 Quitlines should reach disadvantaged and marginalized smokers who may be unable to access or afford other quit supports.12 Monitoring characteristics of quitline callers is therefore important for identifying trends in caller profile. Only one quitline (New Zealand) has examined caller characteristics over time, and reported an increase in callers who were younger, had smoked for less than 10 years, started smoking at 15 years or older, used roll-up cigarettes, were less nicotine dependent, or were pregnant smokers between 2001 and 2005.11,13,14 Despite the long history of quitline services, no study has examined characteristics of callers to an Australian quitline. We analyzed the characteristics of new callers to the New South Wales (NSW) Quitline over the period 2008–2011 to examine whether the demographic profile, level of addiction, living circumstances (with/without smokers), motivations, and quitting status at first call show change over time. Between 2008 and 2011, important changes in tobacco control policy occurred, namely significant price increases; more smoke-free public places; and changes in the regulations for tobacco point of sale and packaging.15 Focusing on these years affords an analysis of smokers accessing the NSW Quitline in a changing policy environment to inform future policy strategies and identify target groups to improve the reach and impact of quitline services.
Methods Data Sources and Population The NSW Quitline in Australia is a confidential telephone service to assist smoking cessation and has been a stand-alone service since 2002. Callers may obtain information, referrals, advice and/or ongoing free counseling from trained advisors. Contact, demographic, and smoking information are routinely collected from callers to support cessation efforts. For the current study, de-identified data from new callers (i.e., first call within the study period) to the Quitline between January 2008 and October 2011 (inclusive) were extracted from the quitline caller database. Those who called on behalf of others, for information only, who were health professionals, students calling for research purposes or hoax callers were excluded.
Measures Age collected in 10-year age spans was dichotomized at 30 years as smoking prevalence peaks at this age.15 Region was indicated using a standard measure of remoteness,16 dichotomized for the current analysis into “major city” versus “non-major city.” Area-level socioeconomic status (SES) was measured at the postcode level in quintiles using socioeconomic indices for areas (SEIFA).17 Living situation was coded as living with/without smokers. Age started
smoking was dichotomized into
Brief report
A Profile of Callers to the New South Wales Quitline, Australia, 2008–2011 Anne C. Grunseit PhD1, Ding Ding PhD1, Caroline Anderson MPH2, Debra Crosbie3, Sally Dunlop PhD2,4, Adrian Bauman PhD1 Prevention Research Collaboration, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia; 2Screening and Prevention, Cancer Institute NSW, Eveleigh, New South Wales, Australia; 3Systems and Operations, ADIS NSW and NSW Quitline, Alcohol and Drug Service, Darlinghurst, New South Wales, Australia; 4School of Public Health, University of Sydney, New South Wales, Australia 1
Corresponding Author: Anne C. Grunseit, PhD, Prevention Research Collaboration, School of Public Health, Level 6, The Hub, Charles Perkins Centre, University of Sydney, Camperdown, New South Wales 2006, Australia. Telephone: 61-2-86271834; Fax: 61-2-9036-3184; E-mail: [email protected]
Abstract Introduction: One population-level solution to smoking cessation are quitlines, telephone-based services to aid quitting. Monitoring the profile of quitline callers in a changing tobacco policy environment is important for informing future policy strategies and identifying target groups to improve the reach and impact of quitline services. Methods: De-identified data from 43,618 new callers to the New South Wales Quitline, Australia between January 2008 and October 2011 (inclusive) were extracted from the Quitline database. Regression analyses explored the effect of year of first call on the distribution of demographic and smoking-related variables. Results: Men calling the Quitline increased proportionately (prevalence ratio [PR] = 1.05, 95% CI = 1.03–1.08), but callers from non-major city areas fell (PR = 0.90, 95% CI = 0.87–0.93) in 2011 versus 2008. The proportion of callers not working demonstrated a significant increasing linear trend (PR = 1.08, p < .001), although area-level socioeconomic status did not change. The proportions of new Quitline callers who had stopped smoking (relative to still smoking) (relative risk ratio [RRR] = 1.29, 95% CI = 1.14–1.46) and who were classified as low nicotine dependent (vs. high nicotine dependent, RRR = 1.60, 95% CI = 1.39–1.83) were higher in 2011 versus 2008. Proportionately, more callers nominated “money” as a motivation to quit in 2010 (PR = 1.58, 95% CI = 1.49–1.66) and 2011 (PR = 1.70, 95% CI = 1.62–1.79) compared with 2008. Conclusions: Quitline callers showed decreasing tobacco consumption and dependence 2008 to 2011, but remained more addicted than the average NSW smoker. Clear effects of tobacco policy were shown, as money as a motivator increased dramatically in conjunction with increased tobacco taxation, highlighting the importance of promoting cessation services concurrent with policy change to capitalize on increased motivation to quit.
Introduction Tobacco smoking is the leading lifestyle risk factor for disease burden in Australia.1 Although the prevalence of smoking has steadily declined in the past decade2 and is currently approximately 16%,3
encouraging and supporting smokers to quit remains a public health priority. One population-level solution to smoking cessation are quitlines, telephone-based services to aid quitting. Call-in services for quitting
© The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: [email protected].
617
Nicotine & Tobacco Research, 2015, Vol. 17, No. 5
618 have been documented for three decades, initially in Australia and then in the United States.4,5 Over recent years, quitlines have proliferated throughout the Americas, Europe, and Asia.6 In Australia, every state and territory has a quitline service. Compared with other smoking cessation programs, quitlines have several major advantages; they are convenient, anonymous, follow structured protocols, and have a high likelihood of followup.7 A recent meta-analysis concluded that telephone quitlines are effective in assisting smoking cessation among diverse populations in a real world setting.8 Despite the effectiveness of telephone-based counseling, only a minority of smokers utilize this service. Estimates of smokers using quitlines have varied between 1% to 6% in the United States and 11% in New Zealand.9–11 Quitlines should reach disadvantaged and marginalized smokers who may be unable to access or afford other quit supports.12 Monitoring characteristics of quitline callers is therefore important for identifying trends in caller profile. Only one quitline (New Zealand) has examined caller characteristics over time, and reported an increase in callers who were younger, had smoked for less than 10 years, started smoking at 15 years or older, used roll-up cigarettes, were less nicotine dependent, or were pregnant smokers between 2001 and 2005.11,13,14 Despite the long history of quitline services, no study has examined characteristics of callers to an Australian quitline. We analyzed the characteristics of new callers to the New South Wales (NSW) Quitline over the period 2008–2011 to examine whether the demographic profile, level of addiction, living circumstances (with/without smokers), motivations, and quitting status at first call show change over time. Between 2008 and 2011, important changes in tobacco control policy occurred, namely significant price increases; more smoke-free public places; and changes in the regulations for tobacco point of sale and packaging.15 Focusing on these years affords an analysis of smokers accessing the NSW Quitline in a changing policy environment to inform future policy strategies and identify target groups to improve the reach and impact of quitline services.
Methods Data Sources and Population The NSW Quitline in Australia is a confidential telephone service to assist smoking cessation and has been a stand-alone service since 2002. Callers may obtain information, referrals, advice and/or ongoing free counseling from trained advisors. Contact, demographic, and smoking information are routinely collected from callers to support cessation efforts. For the current study, de-identified data from new callers (i.e., first call within the study period) to the Quitline between January 2008 and October 2011 (inclusive) were extracted from the quitline caller database. Those who called on behalf of others, for information only, who were health professionals, students calling for research purposes or hoax callers were excluded.
Measures Age collected in 10-year age spans was dichotomized at 30 years as smoking prevalence peaks at this age.15 Region was indicated using a standard measure of remoteness,16 dichotomized for the current analysis into “major city” versus “non-major city.” Area-level socioeconomic status (SES) was measured at the postcode level in quintiles using socioeconomic indices for areas (SEIFA).17 Living situation was coded as living with/without smokers. Age started
smoking was dichotomized into
