CDC Supplemental Funding for Quitline Initiative – 10/8/07

Q: In FY05, CDC provided supplemental funding for any state to be applied to support their tobacco cessation quitline initiative.  A presenter for this year's national conference is seeking additional perspective, both positive and/or negative, from a state perspective on the usefulness of the supplemental funding and its contribution toward sustaining or expanding the capacity of state quitlines.

A:

1. California: The Tobacco Cessation and Diabetes Collaborative was established with the CDC supplemental funding.  The funding, which is a modest amount, was the impetus for the California Tobacco Control Program and California Smokers' Helpline to partner with the California Diabetes Program to establish a collaborative project.  This collaboration has resulted in outreach and training to many Healthcare Providers, who interface with persons with diabetes who use tobacco to increase the referrals to the California Smokers' Helpline through the "Ask, Advise, Refer" model. Other key components that contributed to the success of this collaboration include the commitment and leadership of designated staff to this project.  Additional perspective on funding, both positive and negative are listed below.

Positive:

• Funding allowed each state to propose its own way of enhancing its quitline, rather than imposing a uniform mandate.
• Enabled a concerted effort to reach out to an important patient population (persons with diabetes), in a way that an unfunded partnership could not have done.
• Reached many health care providers with a specific message about the availability of a quitline to help patients with diabetes quit smoking, and a general message about the importance of intervening with patients who smoke, which has not only been successful in getting large numbers of patients with diabetes to receive effective treatment for smoking cessation, but also appears to have had a spillover effect, as health care providers have become much more active referrers of patients in general during this period.
• Increase the quitline's capacity and skill in treating smokers with diabetes, which is sustainable.
• Created a model for collaboration that can inform future quitline efforts to partner with diabetes and other chronic disease programs.

Negative:

• Annual allocations have been uncertain and declining.
• Guidance has not always been clear or timely.
• The distribution of funding among states seemed arbitrary

2. Iowa: CDC supplemental grant funding provided badly needed funding to sustain operations of Quitline Iowa at a time when our state funding was insufficient. The grant requirement that we form an Advisory Committee also forced us (in a good way) to begin involving key stakeholders across the state in reviewing and discussing quitline services.
    
3. Mississippi: The supplemental funding has been extremely useful for Mississippi's quitline.  The funds were used to enhance existing services through November 2006, i.e., increase promotions/services targeting pregnant women, etc.  The lead organization that had provided funds for the quitline (since its inception in 1998) experienced funding constraints and was no longer able to provide funds after November 2006.  Since that time, the supplemental funds have been used as the sole source of funding for the quitline.
    
4. Missouri:

Positive:

• If it wasn't for the CDC funding, we wouldn't have a quitline.  We receive no funding from MSA, tobacco excise tax or general revenue for any tobacco control programs. The CDC funding provides 85% of our funding, a portion of a federal block grant to Maternal & Child Health provides the other 15%.
• Near the end of the fiscal year, with remaining unspent funds, we offered free NRT to Medicaid/uninsured while funding lasted.  The news release was issued by the Governor [which means he was aware of and supported the program].  The response was overwhelming.  Missouri has 2% of the US population.  Because our smoking prevalence is higher than the national rate, MO represents 2.3% of smokers in US.  Prior to the NRT offer, MO accounted for 0.6% of the 800-Quit-Now calls.  When the offer was announced, MO accounted for 19.8% of callers.
• The response was noticed by two foundations, which subsequently contacted us regarding their interest in providing additional funding to the quitline.
• Before the NRT offer we averaged 150 calls per month; after the NRT offer was closed we averaged 250 calls per month.

Negative:

• The CDC funding is not enough.  We cannot promote the quitline too much for fear of bankrupting the budget...yet, if we don't promote enough, we have money unspent.
• Going in to the free NRT offer, our vendor was instructed to shut off the offer after a certain dollar amount was expended so that the telephone coaching service would not be jeopardized.  The calls came so fast [supervisors assigned to answer phones, 50 people on hold, people on hold for up to 10 minutes] that our remaining entire budget was spent in two days and the phone service was suspended.  This presented a potential embarrassment to the Governor to announce the quitline was down only two days after announcing free NRT.  The Governor's office found $283,000 to put into the quitline to bring the service back up and to extend the NRT offer for another 15 days.
• The shutdown of the quitline occurred during a time when the House and Senate were in conference committee to come to agreement for the Health Dept's budget.  The House approved $1M plus up to an additional $5M from MSA; the Senate approved $200K for a special project.  The situation of the quitline response had no effect.  There was no compromise, the Senate budget won out.
• Four months after the NRT offer had closed, we still get calls from people asking if or when we can offer NRT again.

5. Maryland: This funding has been very useful to Maryland - initially the CDC funds were the only funds we had available for this effort and it allowed us to get a Quitline up and running.  In the past couple of years, we have had the addition of over $1M in state funds added to the Quitline, while state media/counter-marketing funds had been cut.  We have now reallocated the federal Quitline funds to assist in promotion efforts rather than Quitline services, which has also been valuable.
    
6. Massachusetts: The quitline enhancement funding has been critical to sustain and expand our quitline capacity to respond to demand and to increase services for cultural and linguistic minorities. It has also been important to promote the quitline in selected communities with exceptionally high smoking prevalence rates.  It has allowed us to engage in pilot projects that would not be otherwise possible.  It has raised the visibility of the quitline and resulted in increased state funding for these projects. The enhancement funding puts the CDC (and NCI) behind a population-wide approach to cessation. This provides leverage for state-level efforts to maintain quitline resources.
    
7. New York: New York is in the fortunate position of being fairly well funded for programmatic activities.  Where we have difficulty, as with many states, is hiring staff.  Our Quitline supplement came at the expense of our cooperative agreement funds.  We gave up CDC dollars we use for staff to get CDC dollars to provide to the Quitline.  We have enough money to provide to the Quitline (and pretty much can allocate more as we need to).  We don't have enough money for staff.  Overall this initiative hurt New York, in my view, for these reasons.  Additionally, it makes the cooperative agreement application and progress reports that much more time consuming.  We have to assemble additional data from the Quitline and report on specific additional outcomes - it's just one more step.  We did not want to apply for the supplemental funds, but were told we had to.
    
8. Nebraska: In response to the TCN question of CDC supplemental funding to our State in 2005:  Nebraska would not have a Quitline if it were not for the supplemental funding recreived from CDC.  Our State settlement dollars had been cut and this offered an opportunity to reestablish the Nebraska Quitline.
    
9. New Hampshire: New Hampshire could not have maintained access to toll free resource without the funding and without the tri-state initiative relationship between NH, MA, and RI.
    
10. South Carolina: CDC supplemental Quitline funding gave South Carolina the seed money to build capacity, plan and finally launch a state-based Quitline in August 2006.  Without it, the state would not have the SC Tobacco Quitline since we do not have tobacco settlement or tobacco tax funds to support a Quitline service at this time.
     
11. West Virginia: CDC Supplemental funding was utilized in West Virginia to enhance and expand existing quitline services. An increase in the monthly cap of those able to use the quitline was accomplished. Additional quitline media and public education was also enabled by this funding.
     
12. Wisconsin: With our CDC Quitline Supplemental funding we have provided mini-grants to our four ethnic networks and poverty network to conduct focus groups and provide recommendations around treatment programs and the promotions of treatment.  Those networks have then worked on implementing some of those recommendations this past year.

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