Arizona Adult Tobacco Survey Response to Health Professional Query Behavior

1
Arizona Adult Tobacco Survey Response to Health
Professional Query Behavior

• Richard S. Porter, MS
• Bob Leischow, MPH
• Arizona Department of Health Services

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Background

• 1994, the Tobacco Tax and Health Care Act voter
  approved
• increased the sales tax on tobacco products
• allocated a portion of the revenues for tobacco
  control activities
• 1995, Arizona Department of Health Services
  established the Tobacco Education and Prevention
  Program (TEPP)

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Surveillance

• 1996, TEPP conducted the Arizona Adult Tobacco
  Survey to establish prevalence of tobacco use
  among 6,000 adults 18 years and older.
• 1999, a follow-up adult survey was conducted
  among 4,898 adults.
• CASRO Rate 1996- 83.4 1999- 74.6

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Methodology

• Samples randomly drawn from residential telephone
  numbers and administered using a Computer
  Assisted Telephone Interview (CATI) system
• Administered in both English and Spanish
• Information collected on tobacco use, quitting
  behavior, impact of cost on use, ETS, health
  professional counseling practices, tobacco
  knowledge, media, and demographics
• Data analysis completed using weighted data

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Demographic Profile of Survey Sample
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Limitations

• Statewide surveillance data does not establish a
  direct causal relationship between the TEPP
  efforts and adult prevalence rates. However,
  there is only one (1) statewide tobacco control
  program in Arizona.
• The ACTEV project is analyzing cessation data at
  the local and state levels.
• The Arizona Smokers Helpline is determining quit
  rates among those clients who have entered their
  cessation counseling services.
• The media campaign continues to evaluate their
  effectiveness at the local and state levels.
• Survey excluded those households without a
  telephone. However, the sample size was large
  enough to draw general conclusions.

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Statistically Significant
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Questions asked of Adult Respondents
1. In the last 12 months did a medical
practitioner such as a doctor, a nurse
practitioner, or a physicians assistant discuss
smoking with you at all? 2. In the last 12
months did a medical practitioner such as a
doctor, a nurse practitioner, or a physicians
assistant advise you to stop smoking? 3. Did
you try to quit when a medical practitioner
advised you to stop smoking? 4. In the last 12
months did a dental professional such as a
dentist or dental hygienist discuss smoking with
you at all? 5. In the last 12 months did a
dental professional such as a dentist or dental
hygienist advise you to stop smoking? 6. Did you
try to quit when a dental professional advised
you to stop smoking?
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Responses of Adults to the Medical Practitioner
Questions
1996 1999
(n1,670) (n1,249) Question
(95 CI) (95 CI)
p value
In last year did MD, Nurse practitioner
30.9 2.8 43.7 3.7 lt.001
or PA ask you about
smoking? If yes, did they advise
you to stop smoking? 81.3 4.0
83.9 4.0 .379 Tried to quit
when 30.0 5.4 31.0 5.7
.747 advised
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Responses of Adults to the Dental Practitioner
Questions
1996 1999
(n1,670) (n1,249) Question
(95 CI) (95 CI)
p value
In last year did a Dentist ask you
13.7 2.2 31.6 5.4
lt.001 about smoking? If yes, did
they advise you to stop smoking?
72.1 7.8 78.9 6.8
.022 Tried to quit when 24.6 8.3
22.6 9.5 .625 advised
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Conclusions

• Among adult smokers in Arizona there was a
  significant increase in the proportion of Medical
  practitioners who asked about smoking in 1999
  compared to 1996.
• Dentists asked their smoking patients more often
  about smoking in 1999 compared to 1996.
• Patients who were asked about smoking were
  advised 70-80 of the time to quit.
• The Arizona Health Care Partnership sponsored by
  TEPP appears to be having some positive effect on
  Medical Professionals behavior.

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TEPP Structure

• Community-based local projects
• Media campaign
• Statewide projects
• Arizona Tobacco Information Network (ATIN)
• Arizona Cessation Training and Evaluation (ACTEV)
• Pilot Projects
• Women, Infant and Children cessation project
• CHAMPS Peer-led prevention project

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Local projects
Integrated efforts
Pilot Projects CHAMPS WIC
Statewide Projects -Az Tobacco Information
Network -Az Cessation Training and Evaluation
Media campaign
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Local Projects

• Coalition building and maintenance
• Prevention
• School-based, community-based, youth access
• Cessation
• Youth, adults, health care providers,
  preg/postpartum women and partners
• Creating Tobacco Free Environments
• Homes, schools, workplaces, public places

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Arizona Health Care Partnership

• Sponsored and administered by the AzTEPP
• Goal Integrate comprehensive, innovative, and
  evidence-based tobacco prevention and cessation
  into Arizona healthcare systems.
• Member representation (partial list)
• Managed care organizations
• Pharmacies
• Medical associations
• VA
• Arizona Health Care Cost Containment System
  (state Medicaid agency)
• Foundation for Cardiovascular Health
• Universities
• Arizona Department of Health Services

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Health Care Systems - Training

• Based on the Public Health Services Guideline for
  Treating Tobacco Use and Dependence
• Designed to educate and assist health care
  clinicians, administrators, and purchasers of
  health care in the development and implementation
  of tobacco cessation policies and procedures into
  systems.

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Speakers Bureau Training

• Goal To train Arizona healthcare professionals
  in the application of best practices in tobacco
  control within healthcare and clinic settings.
• CME/CEU approved by a number of professional
  associations.
• Member representation (partial list)
• American Cancer Society
• Arizona Health Care Cost Containment System
• Arizona Latin-American Medical Association
• Community-based organizations
• Managed care organizations
• Hospitals
• Maricopa County Office of Oral Health
• VA
• Arizona Department of Health Services