2 State Quitline

National Network of Tobacco Censation Quitlines Evaluation

Attachment 2a state TCM instrument

National Network of Tobacco Cessation Quitlines Evaluation

OMB: 0925-0576

The application indicates that you proposed to use promotion funding for [INSERT ITEM]. During 2005, did you actually use funds this activity?

IF YES:

Please provide a brief description of the major promotions, such as media or methods used and the specific populations targeted.

IF NO:

Can you tell me why you didn’t use the Initiative funds for [INSERT ITEM]?

Document [doc]

Download: doc | pdf

OMB Number: 0925-XXXX

Expiration Date: __________

attachment 2a

State Tobacco Control Manager Data Collection Instrument

TOBACCO CONTROL MANAGER PERSONAL INFORMATION

[Filled in beforehand; confirm.]

Name: __________________________________________

Title: ___________________________________________

State: __________________________________________

Phone number: ___________________________________

Email: __________________________________________

Appointment information:

____________________________________________________

Interviewer:

Interview Date:

Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*). Do not return the completed form to this address.

Intro Script

Hello, my name is ______________________. I am a researcher from Westat, a national health research organization.

The National Cancer Institute and the Centers for Disease Control and Prevention have contracted with Westat to conduct an evaluation of the National Network of Tobacco Cessation Quitlines Initiative. The knowledge and perspective of each state’s tobacco control manager is a vital component of this evaluation.

I would like to obtain your views on a number of questions and topics related to the Quitline Network Initiative, which I will refer to as the Initiative. Our interview should last about an hour. Is this a convenient time for you? [IF NO: please tell me when you would like me to call back.]

Thank you for agreeing to be interviewed about the Initiative. There are several topics I would like to cover with you today. They include your impressions, experiences, plans and activities surrounding the Initiative.

If you agree, I’d like to record our conversation so that I can pay close attention to what you are telling me without having to stop and write extensive notes. The recording will only be used to review our discussion for a more detailed analysis. Do you agree to have this interview recorded?

[Check here if respondent agrees to recording: ________ ]

Your participation in this interview is voluntary and there are no penalties if you decide not to respond to the information collection as a whole or any particular question. You can refuse to answer any question and “I don’t know” is an acceptable response. The information you provide will be kept confidential and will not be disclosed in identifiable form to anyone. Responses to this interview will be reported in summary form only or will be presented in a way that their source cannot be identified. Do you have any questions before we begin?

In this interview I will be asking you to provide your opinion about some items or events as well as some factual pieces of information. In some instances I will ask you to think about the Initiative as a whole, which includes the process of applying for and receiving funds, the launch of the national 1-800-QUIT-NOW number, and other activities your state has engaged in with the various federal agencies involved with the Initiative. At other times, I will ask you to specifically think about the time since the launch of 1-800-QUIT-NOW number.

OMB NUMBER: ##########

EXPIRES: mm/dd/yyyy

1.	In general, how did you regard the announcement of the Initiative when you first heard of it?

______________________________________________________________________

2.	In general, how do you regard it now?

______________________________________________________________________

3.	What about the Initiative did you think was handled well? What could have been handled better?

______________________________________________________________________

Our records indicate your state quitline began operation in [MONTH YEAR].

In general, please describe your state’s quitline before the launch of 1-800-QUIT-NOW in November 2004 and then again as of the end of December 2005.

[IF NEEDED: We realize your quitline was not (fully) operational during {this time/these times} but anticipate your state having engaged in developmental activities. Please discuss those.]

[PROBE: We are interested in knowing more about your quitline during the first year the 1-800-QUIT-NOW number was live. How far along, or developed, was your quitline by the end of 2005, compared to a year earlier? ]

_________________________________________________________________

[ASK ONLY IF STATE HAD QUITLINE PRIOR TO NOVEMBER 2004]

Now I’d like to know how the Initiative affected your state quitline activities. As I read each activity, please tell me if the Initiative was responsible for an increase, decrease or had no effect on the activity in 2005.

How did the Initiative affect…

[IF AN EXPLANATION IS OFFERED RECORD IN THE MARGIN.]

	INCREASE	DECREASE	HAD NO EFFECT	REF	DK
The types of services provided?	1	2	3	7	8
The days and times when live services were provided?	1	2	3	7	8
The number or variety of formal or informal partnership relationships?	1	2	3	7	8
Eligibility criteria for individuals receiving services?	1	2	3	7	8
Payment requirements for individuals to receive services?	1	2	3	7	8
Specific populations targeted?	1	2	3	7	8
Specific populations actually served?	1	2	3	7	8

6.	How would you summarize the impact of the Initiative on your capacity to deliver quitline programs and services in 2005?

_________________________________________________________________

7.	In general, how do you think the Initiative impacted the amount, sources and allocation of state funding for the quitline in 2005?

_________________________________________________________________

8.	The RFA issued in June 2004 outlined specific ways in which Initiative funds could be used. As I read each of the following activities please tell me whether you used Initiative funds for that activity. Did you use Initiative funds to…

ACTIVITY	YES	NO	REF	DK
Begin providing proactive counseling?	1	2	7	8
Expand your proactive counseling services?	1	2	7	8
Promote your quitline?	1	2	7	8
Expand your outreach to special populations?	1	2	7	8
Develop special language services and materials?	1	2	7	8
Outreach to healthcare systems and providers for referrals?	1	2	7	8

9.	In 2005, did the Initiative impact the amount of funding for the quitline and related activities from…

			IF YES & STATE HAD QUITLINE BEFORE DECEMBER 2005: Did it cause an increase or decrease to this funding?
	YES	NO	REF	DK	INCREASE	DECREASE
The State Health Department budget?	1	2	7	8	3	4
The State Tobacco Control budget?	1	2	7	8	3	4
MSA funds?	1	2	7	8	3	4
Earmarked taxes or other dedicated funding sources?	1	2	7	8	3	4
The Federal government?	1	2	7	8	3	4
Other Public or Private sources?	1	2	7	8	3	4

10.	After November 2004, did you seek ways to increase non-federal funding for your quitline?

YES	1
NO	2
REF	7
DK	8

11.	After November 2004, did you receive more non-federal funds for your quitline?

YES	1
NO	2
REF	7
DK	8

12.	Were funds from other sources reduced because you received Initiative funding?

YES	1
NO	2
NO OTHER FEDERAL FUNDING	3
REF	7
DK	8

13.	Thinking about the initial round of funding, please describe the application process you went through within your state when seeking Initiative funds, including who was involved, how you approached the selection of program areas. How did you choose the program areas to which you applied?

_________________________________________________________________

14.

[Thinking about the initial round of funding, please describe the application process you went through within your state when seeking Initiative funds, including who was involved, how you approached the selection of program areas.]

Did you establish workgroups comprised of various community leaders and health care providers? Please describe these groups.

_________________________________________________________________

15.	Now I’d like to turn to the topic of promotions. In your original application for supplemental CDC funds you outlined how your state proposed to use Initiative funds earmarked for promotions related to the quitline.

16.	IF NOT INCLUDED IN THE LIST IN ITEM 15 ABOVE: In addition to the things we just discussed, did you use the Initiative funds for…

	YES	NO	REF	DK	IF YES: Please provide a brief description of the major [PROMOTION TYPE], such as the media or methods used and the specific populations targeted.
Paid advertising?	1	2	7	8
Earned media?	1	2	7	8
Outreach to health care providers or systems?	1	2	7	8
Generally increasing the number or types of channels used to promote your quitline?	1	2	7	8
Anything else?	1	2	7	8

17.

My next questions address your assessment of your overall quitline promotion activities between November 2004 and the end of December 2005.

On a scale of 1 to 5 (where 1 is not at all successful and 5 is highly successful), overall, how successful do you think your quitline promotions were at reaching specific populations targeted in 2005?

1	2	3	4	5
NOT AT ALL SUCCESSFUL				HIGHLY SUCCESSFUL

REF	7
DK	8

18.	[ASK ONLY IF STATE HAD QUITLINE PRIOR TO DECEMBER 2005] Overall, how successful do you think your quitline promotions were at prompting those targeted populations to call your quitline?

1	2	3	4	5
NOT AT ALL SUCCESSFUL				HIGHLY SUCCESSFUL

REF	7
DK	8

19.	[ASK ONLY IF STATE HAD QUITLINE PRIOR TO DECEMBER 2005] Do you think that your 2005 promotional activities contributed to a significant increase in calls to your quitline, a moderate increase or had no direct effect on the number of calls to your quitline?

A SIGNIFICANT INCREASE	1
A MODERATE INCREASE	2
NO DIRECT EFFECT	3
REF	7
DK	8

20.	Thinking about the various types of promotion activities during 2005, how prominent was the 1-800-QUIT-NOW number itself in these promotions? Would you describe 1-800-QUIT-NOW as…

A focal point,	1
A major element but not a focal point,	2
A secondary piece of information,	3
A minor aspect of the promotional effort, or	4
Not a part of the promotions at all?	5
REF	7
DK	8

21.	Now I’d like to talk about different populations that you may have targeted with your promotions. In 2005, did your state use Initiative funds to target…


	YES	NO	REF	DK
Pregnant women?	1	2	7	8
Blacks or African Americans?	1	2	7	8
Hispanics?	1	2	7	8
Asians?	1	2	7	8
Native Americans?	1	2	7	8
Youth?	1	2	7	8
Low SES populations?	1	2	7	8
Any other priority population? SPECIFY: __________________	1	2	7	8

22.	Now I’d like to talk about any special focus on priority populations. First, think about services provided to different priority populations. In 2005, as a result of the Initiative did your state provide enhanced, specialized or appropriate services to…

	YES	NO	REF	DK
Pregnant women?	1	2	7	8
Blacks or African Americans?	1	2	7	8
Hispanics?	1	2	7	8
Asians?	1	2	7	8
Native Americans?	1	2	7	8
Youth?	1	2	7	8
Low SES populations?	1	2	7	8
Any other priority population? SPECIFY: __________________	1	2	7	8

23.	[ASK ONLY IF STATE HAD QUITLINE PRIOR TO DECEMBER 2005] On a scale of 1 to 5 where 1 means none and 5 means all, how much of the expansion of service levels for priority populations in 2005 would you attribute to the Initiative?

NONE		SOME		ALL
1	2	3	4	5

24.	Now I’d like you to think about the media coverage of the 1-800-QUIT-NOW number. What is your general assessment of the media coverage of 1-800-QUIT-NOW in your state during 2005?

_________________________________________________________________

25.	Think about the various types of media coverage 1-800-QUIT-NOW received in your state during 2005. Overall, would you rate the variety as…

Excellent,	1
Good,	2
Fair, or	3
Poor?	4
REF	7
DK	8

26.	Thinking about the amount of media coverage 1-800-QUIT-NOW received in your state during 2005. Overall, would you rate the amount as…

Excellent,	1
Good,	2
Fair, or	3
Poor?	4
REF	7
DK	8

27.

I’m going to read a list of organizations that might promote 1-800-QUIT-NOW to their members or constituents, or as part of their own broader promotional campaigns. As I read each one, please tell me if that type of organization promoted the number in your state during 2005.

Was 1-800-QUIT-NOW promoted in your state by any…

	YES	NO	REF	DK	IF YES: Please briefly describe the promotion.
Public health agencies or clinics?	1	2	7	8
Other health care delivery organizations or systems, such as a hospital or HMO?	1	2	7	8
Health insurers?	1	2	7	8
Volunteer service organizations or other public or non-profit social service agencies?	1	2	7	8
Special interest or advocacy organizations?	1	2	7	8
Volunteer health organizations, such as the American Lung Association?	1	2	7	8
Anti-tobacco coalitions or advocacy groups?	1	2	7	8
School, church, community-based coalitions or related organizations?	1	2	7	8
Pharmaceutical companies?	1	2	7	8
Public or private employers?	1	2	7	8
Labor union or workers groups?	1	2	7	8
Media, advertising, or PR organizations?	1	2	7	8
Health care professionals?	1	2	7	8

28.

Think about your interactions with representatives of the CDC, NCI, or other federal agencies during 2004 and 2005. What types of communication occurred between your state and the federal government in relation to the Initiative? What occasioned these communications? What were the main issues addressed?

[IF NEEDED: Examples include group meetings, in-person visits, phone and email exchanges, and so forth.]

___________________________________________________________________________

29.	In the original supplemental funding RFA issued in June 2004, the CDC identified different areas of technical assistance or training that they would provide. As I read each item, please tell me if they provided it to you. Did the CDC provide you with…

					IF YES: How useful did you find this assistance? Would you say very effective, somewhat effective, or not at all effective?
	YES	NO	REF	DK	VERY	SOMEWHAT	NOT AT ALL
A list of best practices or guidelines for quitline operations and services?	1	2	7	8	3	4	5
Assistance in contracting for quitline services?	1	2	7	8	3	4	5
Quitline monitoring and surveillance?	1	2	7	8	3	4	5
Anything else? [SPECIFY: ___________________________]	1	2	7	8	3	4	5

30.	Next I’m going to read a list of channels the CDC may have used to deliver technical assistance or training. As I read each one, please tell me if the CDC used this method. Did they use…

					IF YES: How useful did you find this method of technical assistance? Would you say very effective, somewhat effective, or not at all effective?
	YES	NO	REF	DK	VERY	SOMEWHAT	NOT AT ALL
Workshops?	1	2	7	8	3	4	5
Conferences?	1	2	7	8	3	4	5
Training sessions?	1	2	7	8	3	4	5
Individualized in-person assistance?	1	2	7	8	3	4	5
Email communication?	1	2	7	8	3	4	5
Verbal communication?	1	2	7	8	3	4	5
The electronic center for State information sharing?	1	2	7	8	3	4	5
The State Forum?	1	2	7	8	3	4	5

31.

One of the key objectives of the Initiative has been to foster partnerships between the state quitlines and public and private entities who share a common interest with them.

My next questions are related to the creation or enhancement of relationships with agencies or quitlines in other states.

As a specific result of the Initiative, did your state engage in any in any new partnership activities during 2005 with agencies or state quitlines in other states?

YES	1
NO	2
REF	7
DK	8

32.	As a specific result of the Initiative, did your state expand any existing partnerships during 2005 with agencies or state quitlines in other states?

YES	1
NO	2
REF	7
DK	8

IF 31 OR 32 ARE ANSWERED YES CONTINUE, ELSE SKIP TO 35

33.	What goals did you have in mind when deciding to establish or expand these partnerships with other states?

_________________________________________________________________

34.	Next I am going to read a list of possible activities your quitline might participate in with other states. For each, please tell me if, during 2005, your quitline was in a partnership that engaged in the activity. Was the quitline in a partnership that…

	YES	NO	REF	DK
Engaged in joint promotion activities?	1	2	7	8
Held in meetings or conferences?	1	2	7	8
Shared information, provided technical assistance or advice regarding general quitline issues?	1	2	7	8
[Shared information, provided technical assistance or advice] regarding quitline treatment, service or vendor related issues?	1	2	7	8
[Shared information, provided technical assistance or advice] regarding telephone and information technology issues?	1	2	7	8
[Shared information, provided technical assistance or advice] regarding serving special populations?	1	2	7	8
[Shared information, provides technical assistance and advice] regarding training?	1	2	7	8

35.

My next questions are about your quitline’s partnerships with organizations or agencies within your state. Please think about the relationships or coalitions your quitline was engaged in during 2005. As I read each type, tell me if your quitline was involved in any type of working relationship with this type of organization during 2005.

During 2005, was your quitline in a partnership with any…

			IF YES: Was this partnership newly created, expanded, or unchanged as a result of the Initiative?
	YES	NO	REF	DK	NEW	EXPANDED	UNCHANGED
Public health agencies or clinics?	1	2	7	8	3	4	5
Other health care delivery organizations or systems, such as a hospitals or HMOs?	1	2	7	8	3	4	5
Health insurers?	1	2	7	8	3	4	5
Volunteer service organizations or other public or non-profit social service agencies?	1	2	7	8	3	4	5
Special interest or advocacy organizations?	1	2	7	8	3	4	5
Volunteer health organizations, such as the American Lung Association?	1	2	7	8	3	4	5
Anti-tobacco coalitions or advocacy groups?	1	2	7	8	3	4	5
Schools, churches, community-based coalitions or related organizations?	1	2	7	8	3	4	5
Pharmaceutical companies?	1	2	7	8	3	4	5

			IF YES: Was this partnership newly created, expanded, or unchanged as a result of the Initiative?
	YES	NO	REF	DK	NEW	EXPANDED	UNCHANGED
Public or private employers?	1	2	7	8	3	4	5
Labor unions or workers groups?	1	2	7	8	3	4	5
Media, advertising, or PR organizations?	1	2	7	8	3	4	5

[USE WITH THE FOLLOWING CATEGORIES IF NEEDED: These include relationships involving these professionals directly as clinical practitioners or through their professional associations. During 2005, did you partner with…]

Physicians?	1	2	7	8	3	4	5
Nurses, nurse practitioners, or physicians assistants?	1	2	7	8	3	4	5
Dentists or other dental professionals?	1	2	7	8	3	4	5
Pharmacists?	1	2	7	8	3	4	5
Any other type of health professionals? SPECIFY: ______________________	1	2	7	8	3	4	5

36.	Now I’m going to ask if your quitline worked with partners in some specific areas. For each area the partnership addressed, I will ask if your quitline was involved only before November 2004, only after November, 2004, or both before and after. Have your quitline’s partnerships involved…

	Only before November 2004	Only after November 2004	Both before and after November 2004	NOT AT ALL	REF	DK
Partners referring patients or clients to the quitline?	1	2	3	4	7	8
Your quitline referring callers to the partners?	1	2	3	4	7	8
A formal arrangement in which your quitline contracts with a partner to provide tobacco cessation services to the partner’s patients or clients?	1	2	3	4	7	8
A formal arrangement in which your quitline contracts with a partner for them to provide in-person or other types of tobacco cessation services for your quitline’s callers?	1	2	3	4	7	8
The partner furnishing over-the-counter nicotine replacement products to the quitline or its callers?	1	2	3	4	7	8
The partner furnishing prescription nicotine replacement or pharmacotherapy products to your quitline’s callers?	1	2	3	4	7	8
The partners promoting the quitline to their members, constituents, or employees?	1	2	3	4	7	8
The partners promoting the quitline to the general public?	1	2	3	4	7	8
The partners promoting the quitline to health care providers?	1	2	3	4	7	8
The partners promoting other tobacco cessation to their members, constituents, or employees?	1	2	3	4	7	8
The partners promoting other tobacco cessation to the general public?	1	2	3	4	7	8
The partners promoting other tobacco cessation to health care providers?	1	2	3	4	7	8
Collaborating on general tobacco-related health outreach or education campaigns?	1	2	3	4	7	8
Collaborating on broad anti-tobacco coalitions or missions, such as smoke-free air tobacco taxation policies, or regulation of tobacco advertising?	1	2	3	4	7	8
Participating in conferences or workgroups related to quitline programs, activities, and services?	1	2	3	4	7	8

37.	In general, what were the major goals your quitline intended to achieve though these in-state partner relationships?

_________________________________________________________________

38.	On a scale of 1 to 5 where 1 means a strong negative effect and 5 means a strong positive effect, what effect did the Initiative have on your state’s development of partnerships during 2005?

STRONG NEGATIVE				STRONG POSITIVE
1	2	3	4	5

39.	How would you describe the Initiative’s overall effect on tobacco cessation in {STATE}?

______________________________________________________________________

40.	In your opinion, what would be the most significant difference if the Initiative had not occurred?

______________________________________________________________________

41.	We are interested in the specific organizations with which states have partnered as a result of the Initiative. Please tell me specifically which groups or organizations your state quitline partnered with during 2005.

10.

_________________________________________________________________

42.

We are interested in getting quitline partners’ perspective on the Initiative. We would like you to nominate two partners that your quitline worked with in 2005. Your choice might be because they played a significant role in your quitline efforts or they may be able to offer interesting insights into the way the Initiative has affected your quitline and the broader tobacco control landscape in your state.

[NOMINEES MAY REPRESENT NEW OR EXISTING RELATIONSHIPS AS of NOVEMBER, 2004, BUT SHOULD HAVE BEEN ACTIVE IN 2005.]

Name:	___________________________	Organization:	______________________
Title:	___________________________	Phone:	( ) -
Email:	___________________________
Comments:	________________________________________________________________

Name:	___________________________	Organization:	______________________
Title:	___________________________	Phone:	( ) -
Email:	___________________________
Comments:	________________________________________________________________

43.	Finally, is there anything else about the Initiative you would like to discuss?

______________________________________________________________________

A2a-1

File Type	application/msword
File Title	ATTACHMENT 2a
Author	Ann Cleveland
Last Modified By	Susan Swain
File Modified	2006-07-21
File Created	2006-06-26