CareerSource SRNT Presentation 3-16-16

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!