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Anne Betzner Marilyn LeedsJane Parker Katherine RehorstJulie Rainey Elisia NortonSRNT 2016
Using employment infrastructure to recruit for statewide cessation programs: Referrals, enrollments and outcomes
Source: http://blog.chron.com/careerrescue/2011/10/your-smoking-habit-may-affect-your-job-search/
Unemployed use tobacco at higher rates than other employment groups
28.0% 19.7% 15.1%
% Tobacco Users by Employment Status
Unemployment services well placed to reach and serve smokers
Why Target Unemployed Smokers?
Helping the unemployed quit has the potential to alleviate tobacco-related disparities
Prochaska JJ, Shi Y, Rodgers A. Tobacco use among the job seeking unemployed in California. Preventive Medicine. 2013; 56(5) 329-332.
Kendzor DE, et al. Individual- and area-level unemployment influence smoking cessation among African Americans participating in a randomized clinical trial. Social Science & Medicine. 2012; 74(9) 1394-1401.
CareerSource provides employment & other opportunitiesto 1 million low income & unemployed Floridians per year.
Referral Form
Study aim
Understand the performance of the CareerSource program vs. three comparison groups regarding:1. Number of referrals2. Conversion from referral to
enrollment3. Enrollee demographic & clinical
characteristics4. Program use5. Outcomes
Observational study with comparison groups
CareerSource
Clinic Fax
CMO
Self-referral
++
Recruitment dates
Jan Feb Mar Apr May Jun
2015
CareerSource, Clinic Fax, Self-referrals
CMO
Outcome study
• Sampling- Exhaustive (CareerSource,
Clinic Fax, CMO)- Random (self-referrals)
• 7-month follow-up telephone survey
• Quitline only
Number of Referrals & Reach
Number of Referrals
CMO CareerSource Clinic Fax
4,107
2,603
1,760
Number of referrals by program
Estimated Reach
% of unemployed tobacco users re-ferred to CareerSource
0%
1%
2%
3%
4%
1.5%
2013 BRFSS
1.8% of all tobacco users are reached from all referral sources
Estimated promotional reach
Conversion from Referral to Enrollment
Conversion from Referral to Enrollment Clinic Fax CareerSource CMO
0%
20%
40%
60%
80%
100%
30% 26% 20%
Quitline average
Conversion rate by referral source
p<.01
p=.04
Enrollee Characteristics
CareerSource Demographics
Female
Age 25 to 54
White/Caucasian
Non-Hispanic
54%
70%
64%
89%
Percent of CareerSource participants
CareerSource Tobacco Use
Cigarettes only
Every day use
<1 pack
91%
96%
52%
Percent of CareerSource participants
CareerSource vs. Medical Referral Enrollees
0% 25% 50% 75% 100%
Series1
60%
CareerSource CMO Clinic Fax
African American
Low education level(HS or Less)
p<.01
p<.05
CareerSource vs. Unemployed tobacco users statewide
0% 25% 50% 75% 100%
CareerSource Unemployed tobacco users statewide
CareerSource referred enrollee groups who are well-represented
African American
p<.01
Program Use
Quitline Evidence-based Service
CareerSource Clinic Fax CMO Self-referrals
57%67% 67%
88%
Proportion of enrollees who receive evidence-based services
p<.01
p<.01
p<.01
NRT Shipped
CareerSource Clinic Fax CMO Self-referrals
81% 77% 77% 81%
Proportion of Quitline and WebCoach active users who received NRT
NSNS NS
Text2Quit Enrollment
CareerSource Clinic Fax CMO Self-referrals
40%32% 30% 33%
Proportion enrolled in Text2Quit
p<.01
p<.01
p<.01
Use of Text2Quit Services
CareerSource Clinic Fax CMO Self-referrals
90% 85% 83% 83%
Proportion of Text2Quit enrollees who sent 1 or more messages
NS p<.01
p<.01
Outcomes
7 Month Follow-up Survey Response
Completed Surveys
Response Rate
CareerSource
210 53%
Clinic Fax 150 60%Self-referral
586 55%
QuitlineSatisfaction
CareerSource Clinic Fax Self-referrals
88% 86% 83%
NS NS
Quitline 24-hour quit attempt
Ca-reer-
Source
Clinic Fax Self-referral 0%
20%
40%
60%
80%
100%
70.8%78.0% 80.2%76.8%
84.2% 83.3%
64.1%70.3%
76.7%
NS p<.01
Quitline 30-day abstinence
Ca-reer-
Source
Clinic Fax Self-referral 0%
20%
40%
60%
80%
100%
26.1% 32.0% 36.3%32.7%40.2% 40.4%
20.3%24.7%
32.4%
NS p<.01
Conclusions
• Number of referrals • Conversion rate • More African American and low education enrollees• Shipped NRT• Similar satisfaction, quit attempts, quit rate
CareerSource competitive with medical referral programs
• Conversion from referral to enrollment
• Program use• Quit attempts, Quit rate
Self-referrals perform better than other referral programs
• Observational study, self-selection• Florida-specific sample• Insufficient N for CMO outcomes
Limitations
• Preliminary evidence that non-medical referral sources like CareerSource have the potential to contribute substantially to cessation goals
Overall conclusion
• Funding: State of Florida, Tobacco Settlement Trust Fund
• No industry funding • No off-label medication uses discussed
Disclosures
Thank you!
