MDS Implementation Guide: Annotated Tables (2009) …c.ymcdn.com/sites/ fileMDS Implementation Guide: Annotated Tables (2009) ... and considered “in compliance” with th e MDS

MDS Implementation Guide: Annotated Tables (2009)

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MDS Intake and Follow-up Questions – Annotated Table of Questions General notes RESPONSE CATEGORIES:

• The response categories “don’t know” “refused” and “not asked” have been added to nearly all MDS items. This is to provide consistency across items, and to remind quitlines that it is important to consider using these response categories. There are instances where some quitlines will not be able to include these response categories (e.g., a question is required to assess eligibility for services). Because of this or other reasons, quitlines should not feel obligated to include don’t know, refused, or not asked for every item.

• “Refused” should be selected if a caller prefers not to provide a response to a question. • “Not Asked” should be selected if a call is interrupted. Quitlines should be able to distinguish between questions that are not asked of a particular individual (as indicated

by the selection of a “not asked” response category), and questions that are not asked at all by the quitline. PROBES: Quitlines are encouraged to probe callers who initially are unable to answer certain questions, and only to select “don’t know” if the caller truly cannot provide an answer, despite probes. Sample probes have been included in the survey itself. Assessing questions through conversation: Some quitlines do not have scripted questions for some of the information collected in the MDS, such as zip or postal code, age, etc. While the ideal solution is to have all quitlines explicitly ask each question exactly the way it is written in the MDS, it has been noted throughout the annotated table where assessing questions without directly asking them is acceptable, and considered “in compliance” with the MDS. In most cases, however, a confirmation question is suggested.


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Intake Questions - Annotated MDS Intake question and response categories

Who should be asked this question

General notes Notes for those asking the question Notes for programmers/ reporting

NAQC MDS Intake Question 1: How can I help you? DO NOT READ � Want help / information about quitting

Optional Probe if selected: So, you are still using tobacco right now?

� Want help / information about staying quit � Want to refer someone for help � Want general information or materials about quitline service � Other: (specify) ______________________ � Refused � Don’t know � Not asked 2a. Just to confirm, are you calling for yourself, or calling on behalf of or to help someone else? : � Calling for yourself (SKIP

TO Q3)

All callers The purpose of questions 1 and 2 is to indicate the types of people calling quitlines (in order to better assist quitlines in providing appropriate services to those who are calling), and to determine eligibility for services (especially for quitlines that do not provide services to proxy callers). The most important categories of callers are those who are calling for themselves, and those who are calling for others (proxy callers). Quitlines are encouraged to prioritize being able to report on callers in these two categories.

Definitions: “Calling for self” = current or former tobacco users who are calling the quitline to help with a new quit attempt, maintain a previous quit attempt, or to get more information about quitting for themselves.

“Proxy caller” = anyone who is calling for information or to refer a tobacco user for help with quitting. The proxy may or may not use tobacco him or herself.

The probe was included because many callers who have recently quit select this first option, and later in the call it becomes clear that they have quit fairly recently and are really calling to try to avoid slipping or relapsing. Clarifying their intention for calling up front can help streamline the call process. This may also have implications for eligibility for medications for some quitlines. For question 2a, a prefix was added “just to confirm” to avoid the perception that this information was already gathered in q1. The response options were added to the question stem to aid with consistent phrasing of the question across quitlines.

Questions 1 and 2 do not need to be asked in exactly the way written here. The priority for quitlines should be to be able to report on number of callers calling for themselves and number of proxy callers. Reason for calling should be used by the quitline to appropriately provide services for the caller. The value of keeping question 2a is that it directly ties to the annual survey request for number of callers calling for themselves – it allows quitlines to easily flag those who are NOT calling for themselves.


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� Calling on behalf of or to help someone else (CONTINUE TO Q2b)

DO NOT READ � Refused � Don’t know � Not asked

Optional: 2b. Are you: � A health professional � A friend or family member � A community organization,

worksite, insurance � Other:

____________________

All callers (for those quitlines that opt to ask this question)

Question 2b is intended to help quitlines better understand the types of people they are reaching.

Question 2b is now optional. The response categories should be tailored according to the various promotional strategies and outreach efforts for each quitline. The response categories listed here should be used as a starting point for discussion.


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MDS Intake question and response categories



NAQC MDS Intake Question 3: How did you hear about the quitline? (DO NOT READ; CHECK ALL RESPONSES) (Optional – specific types of promotion) � MEDIA

� Newspaper � Radio � Television � Internet/web

Other selections can be added by quitline � OTHER ADVERTISING

� Phone directory � Flyers, brochures Other selections can be added by quitline

� REFERRAL � Health professional (doctor, dentist,

etc.) � Family / friends � Workplace � Health insurance � Community organization � Other:

_________________________ Other selections can be added by quitline

� Don’t know � Refused � Not asked

All callers (for self and proxy) should be asked this question.

The purpose of MDS Intake Question #3 is to provide maximum flexibility for quitlines to be able to add promotional strategies as is appropriate for each individual quitline. Because each quitline will have unique promotional strategies, the recommended goal is to be able to report back in the three major categories: Media, Other Advertising, and Referral. These three categories were devised to be able to distinguish between mass media advertising and promotions (those that reach a general audience), Other advertising (designed to reach a targeted audience - geographic or otherwise), and Referrals (designed to capture promotional strategies that rely on networks outside of the quitline itself – other people, whether or not they are formally organized).

None of the response items should be read aloud. Definitions: Media = traditional advertising or communications formats, including both paid and earned media, designed to reach a broad, general (non-targeted) audience. If quitlines want to specify between paid and earned media, they should do so within the Media category. Internet (web pages or advertising) should be included in this category. To obtain more reliable information from this question with respect to specific paid media campaigns, the response options should change as frequently as new advertising is fielded. Other Advertising = Any targeted advertising that does not reach a general audience. Telephone directory, flyers, brochures, billboards, etc. should all be captured in this category. Targeting can be focused on a specific population, geographic area, etc. Referral = any case where the caller has heard about the quitline from someone else. Specific referral networks might be included here (e.g., pharmacists or dental hygienists), or it might be a general catch-all category. Note: fax-referral programs could be included here, but most callers would select “health professional” rather than “fax referral.”

For assistance with determining how open-ended responses should be mapped onto specific response categories, contact NAQC for the most recent version of the list of promotional strategies and how they are mapped back to these three categories ([email protected]). NAQC can also assist with determining how particular promotional strategies should map onto the three major categories. For further assistance, email [email protected]


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Who should be asked this question General notes Notes for those asking the question

Notes for programmers/ reporting

NAQC MDS Intake Question 4: Is this your first call to the quitline in the past year? DO NOT READ � Yes � No � Optional: How

many times did you call the quitline in the past year? ____ (# of times)


All tobacco users calling for themselves should be asked this question. For quitlines that ask this at the beginning of the call, all callers would be asked the question.

MDS Intake Question 4 is intended to help provide a rough mechanism for identifying repeat callers. Quitlines without another method of de-duplicating callers over a 12 month period should use the response to this question to determine which callers are counted in the number of unique individuals calling the quitline for the Annual Survey, as well as to calculate reach and quit rates. Only callers calling for themselves should be included in those calculations, and therefore only callers calling for themselves are required to be asked this question. Other callers can be asked the question, especially for the purposes of locating a previous call record, but the goal should be to ask at least all callers calling for themselves. Note: for quitlines with the capacity to look up a former caller and link multiple registrations or enrolments to a unique individual, this question may need to be asked first, or close to the beginning of the call.

None of the response categories should be read aloud.


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General notes Notes for those asking the question


MDS INTAKE QUESTION 5: What types of tobacco do you use now or in the past 30 days? Cigarettes? (record response) Cigars? (record response) A pipe? (record response) Chewing tobacco, snuff, or dip? (record response) Any other type of tobacco? (record response)

DO NOT READ Cigarettes

� Yes

� No

� Don’t know

� Refused

� Not asked Cigars

� Yes

� No

� Don’t know

� Refused

� Not asked Pipe

� Yes

� No

� Don’t know

� Refused

� Not asked

Chewing tobacco, snuff, or dip

� Yes

� No

� Don’t know

� Refused

� Not asked Other (optional)

� Yes � Optional (specify): _____________

� No

� Don’t know

� Refused

� Not asked

� None (note: no to all above equals none)

All tobacco users calling for themselves should be asked this question.

There are now two options for the sequence of questions assessing for types of tobacco use, amount of tobacco used, and date of last tobacco use. Option 1 assess for all types of tobacco (cigarettes and other) as a single sequence, and was intended to streamline the assessment process. Option 2 is more similar to the original MDS, as it assesses for cigarette use first, and other types of tobacco use afterwards (for Option 2, see Appendix A). Either sequence is considered to be “compliant” with the MDS. Both options are provided to ensure the necessary flexibility for quitlines, and to minimize the burden of implementing the updated version of the MDS. For both versions, the questions are the same (and their question numbers match across options). Both options require the ability to refer back to Intake Question 5 or 6a to determine which later items will be asked. [Note: the Option 1 sequence does not have a question 6a.]

The phrase “now or in the past 30 days” was added for greater clarity. Some quitlines have reported that many people say “no” to the question about “current” use but have quit only very recently, requiring quitline staff to return to this question later and change the response. Because skip patterns for later questions rely on the response to this question, it is important to get an accurate response as early as possible. “Now or in the past 30 days” gets callers thinking about the appropriate period of time for the questions below that ask about the date of last tobacco use, which should be used to identify those callers who should be included in the denominator for the NAQC quit rate calculation.

A small number of callers may have quit more than 30 days ago. Those quitlines that provide different services for extended quitters may want to consider choosing a longer time frame than 30 days in the stem of question 5.


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General notes

Notes for those asking the question Notes for programmers/ reporting

NAQC MDS Intake Question 5a: Read 5a if caller responded “yes” to cigarettes above. 5a. Do you currently smoke cigarettes every day, some days, or not at all? [CANADA ONLY: Do you currently smoke cigarettes daily, occasionally, or not at all?] [NOTE: “currently” refers to right now, today.] (CHECK ONE) DO NOT READ � Everyday [CANADA ONLY: Daily] � Some days [CANADA ONLY:

Occasionally] (if less than 7 days per week) � Optional if respond “Some Days/Occasionally”: How many days did you smoke in the last 30 days? ____

� Not at all (skip to 5a(2)) � Don’t know � Refused � Not asked

All tobacco users responding “yes” to cigarettes in MDS Intake question 5 should be asked this question.

“Currently” refers to right now, today. MDS Intake Question 5a, b, c, d, and e are intended to assess for current tobacco use status. These items should be asked exactly as written, whether they are asked as a group, or whether the cigarette questions are separated out. Response categories of “Every day/Daily” “some days/Occasionally” and “not at all” should not be read aloud, since they are part of the question stem.


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NAQC MDS Intake Question 5a(1) If this item is assessed through conversation with the caller, the number should be confirmed. Example: “You said that you smoke 10 cigarettes per day on the days that you smoke. Is that correct?” 5a(1). How many cigarettes do you smoke per day on the days that you smoke (cigarettes per day)? ____ (If caller says over 100, confirm. 100 cpd = 5 packs per day)

If caller cannot identify a specific number, probe: “Give me your best guess – it is OK if it is not perfect.”

DO NOT READ � Don’t know � Refused � Not asked

EVERY DAY/DAILY CIGARETTE SMOKERS SKIP TO 5b, c, d, or e as indicated by the type of tobacco use question above.

All callers reporting smoking cigarettes “every day” or “some days” to question 5a should be asked this question.

MDS question 5(a)(1) is intended to measure the amount of cigarette use.

This question should be read exactly as written. See instructions for verifying a response assessed through conversation with the caller. Probe included to encourage specific responses to this question. “Don’t know” should be selected as a last resort. If respondent reports smoking less than one cigarette per day, confirm that this is on the days that they smoke, and not a daily average over several days.

Responses to this question can be used to calculate a Heaviness of Smoking Index. Responses should be recorded as discrete numbers, not as ranges. If the data collection system allows for partial (fractional) numbers to be recorded, it is OK to record less than one cigarette per day. If the system requires whole numbers to be entered, it is suggested that quitlines round up to the next whole number. E.g., 0.3 cigarettes (or 1/3 of a cigarette) would be recorded as 1 cigarette per day for data collection systems that require whole numbers to be entered. Given that smokers are smoking less, quitlines may want to consider modifying data collection systems to allow for fractions of numbers if they don’t already.


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NAQC MDS Intake Question 5a(2) 5a(2) When was the last time you smoked a cigarette, even a puff (dd/mm/yyyy)?

If caller cannot identify a specific date, use one or more of the following probes: “Can you be more specific? Is there a date that stands out, in particular, such as a holiday or special occasion? Do you remember what month or season? Was it closer to the beginning, middle, or end of the month? Do you remember if it was during the week or on a weekend? Do you remember if it was closer to the beginning, middle, or end of the week?”


All callers reporting “some days” or “not at all” to question 5a.

This follow-up question is a critical component of assessing a caller’s current tobacco use status. It is important to read this question exactly as written, including the “even a puff” phrase. Probe to get the caller to identify as close a date as possible to the date of last cigarette/other tobacco product. Only as a last resort code this as “don’t know.”

In case a caller is unable to remember a specific date for date of last cigarette/other tobacco product use, do not use a real date to code for “don’t know.” This is a change from the original MDS items. Date of last tobacco use questions are now labeled as questions 5(a-e)2 (previously they were not labeled. The questions asking about date of last other tobacco product use (non-cigarette) are new questions, designed to provide more complete information, and to assist quitlines in identifying exactly who should be included in the denominator for the quit rate calculation (all those reporting any tobacco use, even a puff or pinch, in the last 30 days should be included in the denominator of the quit rate calculation) Callers reporting “everyday/daily” cigarette use can skip this question, and can be assumed to have smoked on the day the intake questions were asked.


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MDS Intake question and response categories Who should be

asked this question General notes

Notes for those asking the question


NAQC MDS Intake Question 5b: Read 5b if caller responded “yes” to cigars above. 5b. Do you currently smoke CIGARS every day, some days, or not at all? [CANADA ONLY: Do you currently smoke CIGARS daily, occasionally, or not at all?] [NOTE: “currently” refers to right now, today.] (CHECK ONE) DO NOT READ � Everyday [CANADA ONLY: Daily] � Some days [CANADA ONLY: Occasionally] (if less than 7 days

per week) � Optional if respond “Some Days/Occasionally”: How many days did you smoke in the last 30 days? ____

� Not at all (skip to 5b(2)) � Don’t know � Refused � Not asked

All callers responding “yes” to cigars in question 5.



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NAQC MDS Intake Question 5b(1) If this item is assessed through conversation with the caller, counsellors or other quitline staff should confirm the number. For example, “You said that you smoke 10 cigars per week during the weeks that you smoke. Is that correct?” 5b(1). How many CIGARS do you smoke per week during the weeks that you smoke? (cigars per week) ____



EVERY DAY/DAILY CIGAR SMOKERS SKIP TO 5c, d, or e as indicated by the type of tobacco use question above.

All callers responding “every day” or “some days” to question 5b.

If respondent reports smoking less than one cigar per week, confirm that this is on the weeks that they smoke, and not a weekly average over several weeks.

If the data collection system allows for partial (fractional) numbers to be recorded, it is OK to record less than one cigar per week. If the system requires whole numbers to be entered, it is suggested that quitlines round up to the next whole number. E.g., 0.3 cigars (or 1/3 of a cigar) would be recorded as 1 cigar per week for data collection systems that require whole numbers to be entered. Given that smokers are smoking less, quitlines may want to consider modifying data collection systems to allow for fractions of numbers if they don’t already.


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NAQC MDS Intake Question 5b(2) 5b(2) When was the last time you smoked a cigar, even a puff (dd/mm/yyyy)?



All callers reporting “some days” or “not at all” to question 5b.


In case a caller is unable to remember a specific date for date of last cigarette/other tobacco product use, do not use a real date to code for “don’t know.” This is a change from the original MDS items. Date of last tobacco use questions are now labeled as questions 5(a-e)2 (previously they were not labeled. The questions asking about date of last other tobacco product use (non-cigarette) are new questions, designed to provide more complete information, and to assist quitlines in identifying exactly who should be included in the denominator for the quit rate calculation (all those reporting any tobacco use, even a puff or pinch, in the last 30 days should be included in the denominator of the quit rate calculation)


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NAQC MDS Intake Question 5c Read 5c if caller responded “yes” to a pipe above. 5c. Do you currently smoke A PIPE every day, some days, or not at all? [CANADA ONLY: Do you currently smoke A PIPE daily, occasionally, or not at all?] [NOTE: “currently” refers to right now, today.] (CHECK ONE) DO NOT READ � Everyday [CANADA ONLY: Daily] � Some days [CANADA ONLY: Occasionally] (if less than 7

days per week) � Optional if respond “Some Days/Occasionally”: How many days did you smoke in the last 30 days? ____

� Not at all (skip to 5c(2)) � Don’t know � Refused � Not asked

All callers responding “yes” to a pipe in question 5.



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NAQC MDS Intake Question 5c(1) If this item is assessed through conversation with the caller, counsellors or other quitline staff should confirm the number. For example, “You said that you smoke 10 pipes per week during the weeks that you smoke. Is that correct?” 5c(1). How many PIPES do you smoke per week during the weeks that you smoke? (Pipes per week) ____



EVERY DAY/DAILY PIPE SMOKERS SKIP TO 5d, or e as indicated by the type of tobacco use question above.

All callers responding “every day” or “some days” to question 5c.

If respondent reports smoking less than one pipe per week, confirm that this is on the weeks that they smoke, and not a weekly average over several weeks.

If the data collection system allows for partial (fractional) numbers to be recorded, it is OK to record less than one pipe per week. If the system requires whole numbers to be entered, it is suggested that quitlines round up to the next whole number. E.g., 0.5 A pipe (or 1/2 of a pipe) would be recorded as 1 pipe per week for data collection systems that require whole numbers to be entered. Given that smokers are smoking less, quitlines may want to consider modifying data collection systems to allow for fractions of numbers if they don’t already.


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NAQC MDS Intake Question 5c(2) 5c(2) When was the last time you smoked a pipe, even a puff (dd/mm/yyyy)?



All callers responding “some days” or “not at all” to question 5c.




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asked this question

General notes


NAQC MDS Intake Question 5d Read 5d if caller responded “yes” to chewing tobacco or snuff above. 5d. Do you currently use CHEWING TOBACCO, SNUFF, OR DIP every day, some days, or not at all? [CANADA ONLY: Do you currently smoke CHEWING TOBACCO, SNUFF, OR DIP daily, occasionally, or not at all?] [NOTE: “currently” refers to right now, today.] (CHECK ONE) DO NOT READ � Everyday [CANADA ONLY: Daily] � Some days [CANADA ONLY: Occasionally] (if

less than 7 days per week) � Optional if respond “Some Days/Occasionally”: How many days did you chew in the last 30 days? ____

� Not at all (skip to 5d(2)) � Don’t know � Refused � Not asked

All tobacco users responding “yes” to chewing tobacco, snuff, or dip in MDS Intake question 5 should be asked this question.



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asked this question

General notes


NAQC MDS Intake Question 5d(1) If this item is assessed through conversation with the caller, counsellors or other quitline staff should confirm the number. For example, “You said that you use 2 tins per week during the weeks that you chew. Is that correct?” 5d(1). How many POUCHES OR TINS do you use per week during the weeks that you use tobacco? (pouches/tins per week) ____

If caller cannot identify a specific number, probe: “Give me your best guess – it is OK if it is not perfect.” DO NOT READ � Don’t know � Refused � Not asked

EVERY DAY/DAILY CHEW/SNUFF USERS SKIP TO 5e if indicated by the type of tobacco use question above.

All callers responding “every day” or “some days” to question 5d.

If respondent reports using less than one pouch or tin per week, confirm that this is on the weeks that they use tobacco, and not a weekly average over several weeks.

If the data collection system allows for partial (fractional) numbers to be recorded, it is OK to record less than one pouch or tin per week. If the system requires whole numbers to be entered, it is suggested that quitlines round up to the next whole number. E.g., half a pinch would be recorded as 1 pinch per week for data collection systems that require whole numbers to be entered. Quitlines may want to consider modifying data collection systems to allow for fractions of numbers if they don’t already.


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asked this question

General notes


NAQC MDS Intake Question 5d(2) All callers responding “some days” or “not at all” to question 5d. 5d(2) When was the last time you used chewing tobacco, snuff, or dip, even a pinch (dd/mm/yyyy)?



All callers responding “some days” or “not at all” to question 5d.

This follow-up question is a critical component of assessing a caller’s current tobacco use status. It is important to read this question exactly as written, including the “even a pinch” phrase. Probe to get the caller to identify as close a date as possible to the date of last cigarette/other tobacco product. Only as a last resort code this as “don’t know.”



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asked this question

General notes


NAQC MDS Intake question 5e Read 5e if caller responded “yes” to other types of tobacco above. 5e. Do you currently use OTHER TYPES OF TOBACCO every day, some days, or not at all? [CANADA ONLY: Do you currently use OTHER TYPES OF TOBACCO daily, occasionally, or not at all?] [NOTE: “currently” refers to right now, today.] (CHECK ONE) DO NOT READ � Everyday [CANADA ONLY: Daily] � Some days [CANADA ONLY: Occasionally] (if less

than 7 days per week) � Optional if respond “Some Days/Occasionally”: How many days did you use other types of tobacco in the last 30 days? ____

� Not at all (skip to 5e(2)) � Don’t know � Refused � Not asked

All tobacco users responding “yes” to other types of tobacco in MDS Intake question 5 should be asked this question.

“Currently” refers to right now, today. MDS Intake Question 5a, b, c, d, and e are intended to assess for current tobacco use status. These items should be asked exactly as written, whether they are asked as a group, or whether the cigarette questions are separated out. Response categories of “Every day/Daily” “some days/Occasionally” and “not at all” should not be read aloud, since they are part of the question stem. Quitlines may want to consider specifying which product(s) they are referring to in the question stem, depending on how respondents answered question 5.

If a caller is using multiple other tobacco products (e.g., bidis and hookahs), quitlines may want to either provide another field to collect data here, or create a decision rule to determine which product will be asked about (e.g., most recent use, product used most often, product the caller is wanting help to quit, etc.)


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asked this question

General notes


NAQC MDS Intake Question 5e(1) If this item is assessed through conversation with the caller, counsellors or other quitline staff should confirm the number. For example, “You said that you smoke 10 bidis per week during the weeks that you smoke. Is that correct?” 5e(1). How much OTHER TOBACCO do you use per week during the weeks that you smoke? (other tobacco per week) ____



EVERY DAY/DAILY OTHER TOBACCO PRODUCT USERS SKIP TO MDS INTAKE Q6

All callers responding “every day” or “some days” to question 5c.

If respondent reports using less than one other type of tobacco per week, confirm that this is on the weeks that they use tobacco, and not a weekly average over several weeks.

If the data collection system allows for partial (fractional) numbers to be recorded, it is OK to record less than one per week. If the system requires whole numbers to be entered, it is suggested that quitlines round up to the next whole number. E.g., half a bidi would be recorded as 1 bidi per week for data collection systems that require whole numbers to be entered. Quitlines may want to consider modifying data collection systems to allow for fractions of numbers if they don’t already.


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asked this question

General notes


NAQC MDS Intake Question 5e(2) 5e(2) When was the last time you used other types of tobacco, even a puff or pinch (dd/mm/yyyy)?



All callers responding “some days” or “not at all” to question 5e.

This follow-up question is a critical component of assessing a caller’s current tobacco use status. It is important to read this question exactly as written, including the “even a puff or pinch” phrase. Probe to get the caller to identify as close a date as possible to the date of last cigarette/other tobacco product. Only as a last resort code this as “don’t know.”



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NAQC MDS Intake Question 6 Cigarette smokers only: How soon after you wake up do you smoke your first cigarette? (DO NOT READ) � Within five minutes � 6 to 30 minutes � 31 to 60 minutes � More than 60 minutes � Don’t know � Refused � Not asked

All callers reporting “yes” to cigarettes in question 5.

MDS Intake question 6 is intended to assess the Fagerstrom measure of nicotine dependence. It should be asked exactly as written. No response categories should be read aloud.

NAQC MDS Optional Question 7: How soon after you wake up do you use tobacco (other than cigarettes)? (DO NOT READ) � Within five minutes � 6 to 30 minutes � 31 to 60 minutes � More than 60 minutes � Don’t know � Refused � Not asked

Anyone who reported “everyday/daily” or “someday/occasional” use of cigars, pipe, chew/snuff, or other tobacco products, should be asked this question (for quitlines choosing to use this question).

This is a new question, designed to provide parallel information about nicotine addiction for other tobacco product users. This is a validated measure of nicotine dependence for smokeless tobacco users, but not for other types of tobacco users, and results should thus be interpreted with caution. For more information on the validated scale for smokeless tobacco, see Ebbert, Patten, and Schroeder 2006. The Fagerström Test for Nicotine Dependence-Smokeless Tobacco. Addict Behav. 31(9):1716-21.


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asked this question



NAQC MDS Intake Question 8: Do you intend to quit within the next 30 days? (DO NOT READ) � Yes � No � Don’t know � Refused � Not asked

All those who reported using any form of tobacco “everyday/daily” or “somedays/occasionally”(MDS Intake Questions 5a-e) should be asked this question. Anyone reporting “not at all” to all forms of tobacco should not be asked this question.

MDS Intake question 9 is intended to assess readiness to quit. Note: the technical definition of “stage of change” involves several other questions, including readiness to quit in the next six months, and having made at least one quit attempt in the past year.

This question should be asked exactly as written. Note: “Intend to quit” is not the same as “willing to quit.”


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NAQC MDS Intake Optional Question 9: Optional 9a: At what age did you start smoking cigarettes regularly? _________ (age in years) Optional 9b: At what age did you start smoking cigars regularly? _________ (age in years) Optional 9c: At what age did you start smoking a pipe regularly? _________ (age in years) Optional 9d: At what age did you start using chewing tobacco, snuff, or dip regularly? _________ (age in years) Optional 9e: At what age did you start using other tobacco products regularly? _________ (age in years)

Callers reporting “yes” to the various forms of tobacco use in question 5 (or 5 and 6a for Option 2) should be asked the corresponding optional questions 9a-9e.

MDS Intake questions 9a-e are intended to identify the length of time callers have been using specific forms of tobacco. Questions 9b-e have been added to allow for length of use to be specified for each type of tobacco, and especially to identify those who are switching from cigarettes to chewing tobacco/snuff (or just adding chewing tobacco/snuff) due to increased restrictions on smoking activity and tobacco industry marketing of smokeless tobacco products to help smokers cope with these restrictions. While asking about “regular” use does not capture information on callers who quit for a significant period of time after they first started using tobacco regularly, it is the question used most frequently by other national surveys. The MDS questions were designed to capture information relevant to a caller’s current quit attempt. For that reason, complete tobacco use history is not captured here. For example, if a caller used chewing tobacco, but quit 10 years ago, that information will not be captured explicitly through the MDS questions. If quitlines want to capture a “complete” tobacco use history, they will want to add a question that asks about “ever” use of tobacco products, and use the responses of that question as criteria to ask the relevant MDS questions, such as 9a-e.

This question was selected over age of initiation (or first use) because counseling staff reported that regular use was a much more helpful piece of information for the counseling process. For question 9e, quitlines may want to consider specifying which other tobacco product(s) they are referring to in the question stem, depending on how respondents answered question 5.

Quitlines that are interested are encouraged to ask about both age of regular use AND number of years used each type of tobacco in order to compare responses, and to help determine which question is better to include in future iterations of the MDS. For question 9e, if a caller is using multiple other tobacco products (e.g., bidis and hookahs), quitlines may want to either provide another field to collect data here, or create a decision rule to determine which product will be asked about (e.g., most recent use, product used most often, product the caller is wanting help to quit, etc.)


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CALLER CHARACTERISTICS MDS Intake question and response categories Who should be

asked this question General notes Notes for those asking the

question Notes for programmers/ reporting

Optional Scripting: Before we finish, I'd like to ask you some additional questions about yourself. Several communities have been targeted by the tobacco industry or have higher smoking rates. We have some special materials for people in these communities, and your answers can help us understand whether we are serving all tobacco users well. Please remember that participation is voluntary and your answers will remain confidential. This should only take a few minutes. May I ask you these additional questions?

All callers eligible for service by the quitline (including proxy callers, if the quitline serves proxy callers).

This introductory text can help explain why quitlines ask questions that may seem less relevant to a caller’s tobacco use or quit attempt.

This scripting can be modified by quitlines as needed.

NAQC MDS Intake Question 10: First I need to verify are you male or female? � Male � Female � Refused


Note: Several quitlines currently include “transgender” as a response option for MDS question 10. If quitlines want to include an option for “transgender” it is strongly encouraged that they adopt the MDS optional question on sexual orientation (see question #18)

MDS Intake question 10 may be assessed through conversation with the caller rather than asked outright. However, if there is any doubt regarding the caller’s gender, it should be addressed explicitly.


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MDS Intake question and response categories Who should be asked this

question General notes


NAQC MDS Intake Question 11: What year were you born? _ _ _ _ It is acceptable to assess this information through conversation with the caller, although the specific year of birth should be confirmed. (E.g., “you just said you are 52 years old. Does that mean you were born in 1957?”) � Don’t know � Refused � Not asked


MDS Intake question 11 is intended to allow quitlines to capture a caller’s age without collecting the exact date of birth which is more easily linked to a person’s identity. It is acceptable to assess this information through conversation with the caller, although the specific year of birth should be confirmed. (E.g., “you just said you are 52 years old. Does that mean you were born in 1957?”)

Optional 11a: What is your date of birth? _ _ / _ _ _ _ (mm/yyyy)


Quitlines are encouraged to consider NOT collecting full date of birth, due to identity theft concerns.





NAQC MDS Intake Question 12: What is your zip code? (Canada: What is your postal code?) � Don’t know � Refused � Not asked


MDS Intake question 12 is intended to allow for geographic mapping of call volume in smaller areas than states or provinces. It can also be used to assess eligibility for services.

It is acceptable to assess this information through conversation with the caller, although the specific zip or postal code should be confirmed for accuracy.

US: if 9-digit zip code is collected, recommend collecting 5 digits in a separate field from last four digits. This will facilitate combining data with other quitlines regardless of the number of digits they collect. Canada: Postal code field should be able to contain both letters and numbers; six characters long.


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MDS Intake question and response categories Who should be asked

this question General notes Notes for

those asking the question


NAQC MDS Intake Optional Question 13 Optional (USA only): Do you have any health insurance, including pre-paid or government programs? � Yes – GO TO OPTIONAL QUESTION 14 � No – SKIP TO QUESTION 15 � Don’t know � Refused � Not asked


MDS Intake question 13 is intended to be used for U.S. quitlines only. Canadian quitlines may use this question if they find it useful. The purpose of the question is to be able to identify what proportion of callers have no health insurance (this can also be used as a proxy measure for low SES). If a quitline wishes to assess the specific health plan of a caller, it should be assessed as separate question (see optional question 14).


asked this question



NAQC MDS Intake Optional Question 14 Optional (USA only): What type of health insurance do you have? Suggested prompt: Please take out your health insurance card and read off the name of the health plan on the card.

Quitlines are to provide response categories that meet the needs of the individual state, province, or territory, but responses should be able to be rolled up to: Private Insurance, Government-sponsored insurance (including Medicaid, Medicare, military insurance, etc.), or no insurance. � Don’t know � Refused � Not asked

Callers reporting “yes” to optional intake question 13.

This question is asked on the NAQC annual survey, with response categories of “no insurance,” “government-sponsored insurance,” and “private insurance.”

See suggested prompt.

Quitlines are to provide response categories that meet the needs of the individual state, province, or territory, but responses should be able to be rolled up to: Private Insurance, Government-sponsored insurance (including Medicaid, Medicare, military insurance, etc.), or no insurance.


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question General notes Notes for those asking

the question Notes for programmers/ reporting

NAQC MDS Intake Question 15: What is the highest level of education you have completed? (DO NOT READ) USA: � Less than grade 9 � Grade 9 to 11, no degree � GED � High school degree � Some college or university � College or university degree � Refused � Don’t know � Not asked CANADA: � Less than high school � High school diploma � Some college, Technical or trade school (includes any post-

high school education, including technical or trade school, but not a degree.)

� College or university degree (includes AA, BA, Masters, Ph.D.)

� Refused � Don’t know � Not asked


MDS Intake question 15 is intended to provide additional demographic information on callers. Education level can also serve as a proxy variable for SES.

The question should be asked exactly as written, with an emphasis on the completion of the various levels of education, not just the initiation or attempted completion of a level.

If a quitline wishes to add additional response categories to those listed here, the goal of reporting in the categories listed below should be a priority. NAQC can provide assistance to determine whether and how additional response categories should be added.


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question General notes Notes for



NAQC MDS Intake Question 16: USA only: Are you of Hispanic, Latino, or Spanish origin? � No (Not of Hispanic, Latino, or Spanish origin) � Yes (of Hispanic, Latino, or Spanish origin) � Refused � Don’t know � Not asked


The US Census question includes several response options for “yes” including specific countries of origin. Quitlines should feel free to expand the response categories for the race and ethnicity questions as is most useful to them. The highest priority is to be able to report back in MDS response categories. For additional assistance in determining how best to expand or condense response categories, contact NAQC at [email protected].

This question should be asked exactly as written.

Some quitlines find it much more useful to combine question 16 with question 17. Regardless of whether the questions are asked separately or together, the critical element is to be able to report back in the response categories as listed in the MDS.


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NAQC MDS Intake question 17 USA: What is your race? Which one or more of these groups would you say best describes you? (select one or more) � White � Black, African Am., or Negro � American Indian or Alaska Native → Optional: Specify name of enrolled or principal tribe_______________________ � Asian

� Optional if respond “Asian”: Which specific ethnicity or race do you identify with the most? (Do not read responses; code answer)

� Asian Indian � Chinese � Filipino � Japanese � Korean � Vietnamese � Other Asian (e.g., Hmong, Lao,

Thai, Pakistani, Cambodian, etc.) → Optional: Specify

_______________________ � Native Hawaiian or other Pacific Islander

� Optional if respond “Native Hawaiian or other pacific islander”: Which specific


This question has been modified slightly from the original MDS question to more closely match the current US Census question. Census response categories have been collapsed slightly to facilitate asking the question. Quitlines should expand response categories as is most useful to them. The highest priority is to be able to report back in MDS response categories. For additional assistance in determining how best to expand or condense response categories, contact NAQC at [email protected].

The original MDS was not clear about whether this question should have a single-response or multi-response option. For maximum comparability with the US Census and other national surveys, a multi-response option is recommended. A multi-response option will also make it easier to report back in MDS categories for quitlines that are asking the race/ethnicity questions as a single item.


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ethnicity or race do you identify with the most? (Do not read responses; code answer)

� Guamanian or Chamorro � Samoan � Other Pacific Islander (e.g.,

Fijian, Tongan, etc.) → Optional: Specify _______________________

� Some other race → Optional: Specify _______________________ � Don’t know � Refused � Not Asked


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asked this question



MDS Intake Question 17a-c: CANADA: 17a: People living in Canada come from many different cultural and racial backgrounds. Are you (select all that apply): (Note: This information is collected to support programs that promote equal opportunity for everyone to share in the social, cultural, and economic life of Canada.) � White � Asian

� Optional if respond “Asian”: Which specific ethnicity or race do you identify with the most? (Do not read responses; code answer)

� Chinese � Filipino � Korean � Japanese � South Asian (e.g., East Indian, Pakistani,

Sri Lankan, etc.) � Southeast Asian (e.g., Vietnamese,

Cambodian, Malaysian, Laotian, etc.) � West Asian (e.g., Iranian, Afghan, etc.)

� Black � Latin American � Arab


Questions 17a and 17b are new for Canadian quitlines, and are taken from the Canadian census. They are also asked on the Canadian Community Health Survey, so have expanded comparability. Question 17a is most similar to the US ethnicity question, and so provides additional comparability to US quitlines.

Response categories for 17a have been collapsed slightly from the Census question. Quitlines should expand response categories as is most useful to them. The highest priority should be placed on being able to report back in MDS response categories. For additional assistance in determining how best to expand or condense response categories, contact NAQC at [email protected].


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� Aboriginal ( North American Indian, Métis, or Inuit (Eskimo))

� Other → Specify ____________________________

17b: Optional: Are you a member of an Indian Band/First Nation? � No � Yes, member of an Indian Band/First Nation →

Specify Indian Band/First Nation (for example, Musqueam) _______________________

17c: Optional: To which of the following ethnic or cultural groups did your ancestors belong? (ancestor = great grandparents or further back) (READ; CAN CHECK MORE THAN ONE) � Canadian (English or French Canadian) � Aboriginal (Native Indian, Métis, Inuit) � British (English, Irish, Scottish, Welsh) � European (specify country): __________________ � Asian (specify country): __________________ � Other (specify): __________________ (DON’T

READ) � None of the above (DON’T READ) � Don’t know (DON’T READ) � Refused (DON’T READ)


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question General notes



NAQC MDS Intake Optional Question 18: Recommended question and scripting: Do you consider yourself to be one or more of the following: [say the letter and the response option so that they can respond by either one] a) Straight b) Gay or Lesbian c) Bisexual d) Transgender [IF pause or refusal/none of above, also say: You can name a different category if that fits you better: _____________________] e) Other i. queer ii. genderqueer

iii. dyke iv. other

All callers eligible for service by the quitline (including proxy callers, if the quitline serves proxy callers) for quitlines opting to use this question.

MDS Optional Question 18 is intended to help quitlines identify the populations they are serving. This version of the question has been cognitively tested in partnership by the national GLBT network and Blue Cross and Blue Shield of Minnesota. If used, all introductory scripting and prompts are strongly recommended; the refusal rate for this question was much higher without the additional scripting during the testing phase for this item.

These are not read aloud, but are pre-coded as they were the most frequently chosen in the testing phase.


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MDS Intake question and response categories Who

should be asked

General notes

NAQC MDS INTAKE ADMINISTRATIVE DATA

All callers NAQC Intake Administrative data is a list of items all quitlines are recommended to collect on each caller. Rationale for each item is included below.

Counselor ID (Optional) Caller ID

In the event that quitlines decide to combine intake data for research or other purposes, it will be important to be able to identify which information belongs to which caller, necessitating a “Caller ID” or some other identifier for each unique individual.

Date of first contact with quitline (dd/mm/yyyy): Date of first contact can be used to calculate when follow-up should take place. Services provided to caller (or that the caller registered for) (Check all that apply): � Basic information (no materials sent) � Literature and/or self-help materials � Reactive counseling (one counseling session) � Proactive counseling (more than one counseling

session) � Medications (FDA approved) (Optional: type of

medication.) � Referral to another service (for tobacco cessation

or other services) � Other

Quitlines are encouraged to capture which services were provided to which callers. The original intent of this item was to capture “result of registration” or something similar. Because callers can receive multiple types of information or “service” on each call, the status of this item will change over time for a given caller. What really matters is being able to report on all materials/services provided over the entire course of treatment. It is not critical to know which services were provided on each call. It will be critical to be able to identify which callers received “some evidence-based treatment” – at this point at least one counselling call and/or receipt of NRT or other medications. Because this is a critical definition for both the NAQC reach and quit rate calculations, the ability to easily identify this population of callers will be very important for quitlines. Because the definition of “evidence-based treatment” will evolve over time as the state of the science also evolves, it will be strategic for quitlines to be able to identify recipients of each new service that is provided (e.g., web-based counselling, text messaging, automated emails, etc.) Capturing type of medication provided could be useful in assessing the relative impact of various types of medications. It could also be used as a comparison to follow-up questions that ask about types and amounts of medications used.

Mode of entry to the quitline (e.g., direct call to the number, fax referral, internet advertising, email solicitation/click-through, etc.)

Quitlines are encouraged to be able to identify mode of entry to the quitline to identify successful referral networks and systems. NAQC asks about number of callers referred from various sources on the Annual Survey. It is important for quitlines to be able to track the success of each type of recruitment and promotional strategy to better make determinations about which methods to continue and which to change or stop. Quitlines should discuss whether it is technically feasible to be able to track mode of entry to the quitline, and/or whether it is important to be able to do so according to the quitline’s goals. NAQC is not recommending a particular method for tracking mode of entry to the quitline at this time.


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Follow-up Questions - Annotated Selecting a population for follow-up surveys: Specific guidance on selecting a population for follow-up surveys can be found in the NAQC issue paper on measuring quit rates (See http://www.naquitline.org/pdfs/NAQC_IssuePaper_MeasuringQuitRates_Final.pdf). Any population can be followed up, but only certain callers should be included in the NAQC standard quit rate calculation. See the issue paper for more details, or contact NAQC for assistance in determining who should be followed up and who should be included in the NAQC standard quit rate calculation. MDS Follow-up question and response categories




NAQC MDS Follow-Up Question 1: Overall, how satisfied were you with the service you received from the quitline? (READ ALL, CHECK ONE ONLY) � Very satisfied � Mostly satisfied � Somewhat satisfied � Not at all satisfied DO NOT READ THESE OPTIONS � Don’t know � Refused � Not asked

All callers selected for follow-up survey

A great deal of discussion took place on this item about whether to change the response options to make them more balanced with even numbers of positive and negative response options. Data were reviewed showing how the same respondents answered both types of questions; the correlation was high (0.83). Several quitlines find the original version of this question very useful, and were concerned about limiting the number of positive responses to two. Adding three positive and three negative responses would make the question challenging for respondents to answer by telephone. Virtually 100% of quitlines currently ask this question exactly as originally recommended. Weighing all the issues together, it is recommended to continue asking this question as originally proposed with no changes other than adding a “Not asked” response option. Additional potential satisfaction questions are included in Appendix B.


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MDS Follow-up question and response categories Who should

be asked this question



MDS FOLLOW -UP QUESTION 2: What types of tobacco do you use now or in the past 30 days? Cigarettes? (record response) Cigars? (record response) A pipe? (record response) Chewing tobacco, snuff, or dip? (record response) Any other type of tobacco? (record response)

DO NOT READ Cigarettes

� Yes

� No

� Don’t know

� Refused

� Not asked Cigars

� Yes

� No

� Don’t know

� Refused

� Not asked Pipe

� Yes

� No

� Don’t know

� Refused

� Not asked

Chewing tobacco, snuff, or dip

� Yes

� No

� Don’t know

� Refused

� Not asked Other (optional)

� Yes � Optional (specify): _________________

� No

� Don’t know

� Refused

� Not asked

� None (note: no to all above equals none)

All callers selected for follow-up survey

The phrase “now or in the past 30 days” was added for greater clarity. Because skip patterns for later questions rely on the response to this question, it is important to get an accurate response as early as possible. “Now or in the past 30 days” gets callers thinking about the appropriate period of time for later questions about quitting, which should be used to identify those callers who should be included in the numerator for the NAQC quit rate calculation.


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MDS Follow-up question and response categories Who should be asked this question



NAQC MDS Follow-Up Question 2a: Read 2a if caller responded “yes” to cigarettes above. 2a. Do you currently smoke cigarettes every day, some days, or not at all? [CANADA ONLY: Do you currently smoke cigarettes daily, occasionally, or not at all?] [NOTE: “currently” refers to right now, today.] (CHECK ONE) DO NOT READ � Everyday [CANADA ONLY: Daily] � Some days [CANADA ONLY: Occasionally] (if less than 7 days per week)

� Optional if respond “Some Days/Occasionally”: How many days did you smoke in the last 30 days? ____

� Not at all (SKIP TO 2b, c, d, e, or Follow-up question #3 as indicated by the type of tobacco use question above)


Callers who respond “yes” to cigarettes in question 2.

MDS Follow-up Questions 2a-e are intended to assess for current tobacco use status.

These items should be asked exactly as written. Because the key response categories are included in the question stem, the response categories should not be read aloud.

These items allow quitlines to differentiate between “everyday/daily” and “some day/occasional” tobacco users. It also allows for comparison between intake and follow-up to determine if tobacco users have reduced their level of use from everyday/daily to some day/occasional use.


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MDS Follow-up question and response categories Who should be

asked this question



NAQC MDS Follow-up Question 2a(1) If this item is assessed through conversation with the caller, counsellors or other quitline staff should confirm the number. For example, “You said that you smoke 10 cigarettes per day on the days that you smoke. Is that correct?” 2a(1). How many cigarettes do you smoke per day on the days that you smoke (cigarettes per day)? ____ (If caller says over 100, confirm. 100 cpd = 5 packs per day)



SKIP TO 2b, c, d, e, or Follow-up question 3 as indicated by the type of tobacco use question above.

Callers reporting smoking cigarettes “every day/daily” or “some day/occasionally” to question 2a should be asked this question.

MDS follow-up question 2(a)(1) is intended to measure the amount of tobacco use (can also be used to calculate a Heaviness of Smoking Index).

It should be read exactly as written. If the item is assessed through conversation with the caller, counsellors or other quitline staff should confirm the number. For example, “You said that you smoke 10 cigarettes per day on the days that you smoke. Is that correct?” If respondent reports smoking less than one cigarette per day, confirm that this is on the days that they smoke, and not a daily average over several days.

Responses should be recorded as discrete numbers, not as ranges. If the data collection system allows for partial (fractional) numbers to be recorded, it is OK to record less than one cigarette per day. If the system requires whole numbers to be entered, it is suggested that quitlines round up to the next whole number. E.g., half a cigarette would be recorded as 1 cigarette per day for data collection systems that require whole numbers to be entered. Quitlines may want to consider modifying data collection systems to allow for fractions of numbers if they don’t already.


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asked this question



NAQC MDS Follow-up Question 2b Read 2b if caller responded “yes” to cigars above. 2b. Do you currently smoke CIGARS every day, some days, or not at all? [CANADA ONLY: Do you currently smoke CIGARS daily, occasionally, or not at all?] [NOTE: “currently” refers to right now, today.] (CHECK ONE) DO NOT READ � Everyday [CANADA ONLY: Daily] � Some days [CANADA ONLY: Occasionally] (if less than 7

days per week) � Optional if respond “Some Days/Occasionally”: How many days did you smoke in the last 30 days? ____

� Not at all (SKIP TO 2c, d, e, or Follow-up question 3 as indicated by the type of tobacco use question above


Callers reporting “yes” to cigar use in question 2.





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MDS Follow-up question and response categories



NAQC MDS Follow-up Question 2b(1) If this item is assessed through conversation with the caller, counsellors or other quitline staff should confirm the number. For example, “You said that you smoke 10 cigars per week during the weeks that you smoke. Is that correct?”. 2b(1). How many CIGARS do you smoke per week during the weeks that you smoke? (cigars per week) ____



SKIP TO 2c, d, e, or Follow-up question 3 as indicated by the type of tobacco use question above.

Callers reporting smoking cigars “every day/daily” or “some days/occasionally” to question 2b should be asked this question.

MDS question 2(b)(1) is intended to measure the amount of tobacco use.

This item should be read exactly as written. If the item is assessed through conversation with the caller, counsellors or other quitline staff should confirm the number. For example, “You said that you smoke 10 cigars per week during the weeks that you smoke. Is that correct?” If respondent reports smoking less than one cigar per week, confirm that this is on the weeks that they smoke, and not a weekly average over several weeks.

Responses should be recorded as discrete numbers, not as ranges. If the data collection system allows for partial (fractional) numbers to be recorded, it is OK to record less than one cigar per week. If the system requires whole numbers to be entered, it is suggested that quitlines round up to the next whole number. E.g., half a cigar would be recorded as 1 cigar per week for data collection systems that require whole numbers to be entered. Quitlines may want to consider modifying data collection systems to allow for fractions of numbers if they don’t already.


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asked this question



NAQC MDS Follow-up Question 2c Read 2c if caller responded “yes” to Pipes above. 2c. Do you currently smoke A PIPE every day, some days, or not at all? [CANADA ONLY: Do you currently smoke A PIPE daily, occasionally, or not at all?] [NOTE: “currently” refers to right now, today.] (CHECK ONE) DO NOT READ � Everyday [CANADA ONLY: Daily] � Some days [CANADA ONLY: Occasionally] (if less than 7 days

per week) � Optional if respond “Some Days/Occasionally”: How many days did you smoke in the last 30 days? ____

� Not at all SKIP TO 2 d, e, or Follow-up question 3 as indicated by the type of tobacco use question above


Callers who report “yes” to pipe use in question 2.





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NAQC MDS Follow-up Question 2c(1) If this item is assessed through conversation with the caller, counsellors or other quitline staff should confirm the number. For example, “You said that you smoke 10 Pipes per week during the weeks that you smoke. Is that correct?” 2c(1). How many PIPES do you smoke per week during the weeks that you smoke? (Pipes per week) ____



SKIP TO 2d, e, or Follow-up question 3 as indicated by the type of tobacco use question above.

Callers reporting smoking a pipe “every day/daily” or “some days/occasionally” to question 2c should be asked this question.

MDS question 2(c)(1) is intended to measure the amount of tobacco use.

This item should be read exactly as written. If the item is assessed through conversation with the caller, counsellors or other quitline staff should confirm the number. For example, “You said that you smoke 10 pipes per week during the weeks that you smoke. Is that correct?” If respondent reports smoking less than one pipe per week, confirm that this is on the weeks that they smoke, and not a weekly average over several weeks.

Responses should be recorded as discrete numbers, not as ranges. If the data collection system allows for partial (fractional) numbers to be recorded, it is OK to record less than one pipe per week. If the system requires whole numbers to be entered, it is suggested that quitlines round up to the next whole number. E.g., half a pipe would be recorded as 1 pipe per week for data collection systems that require whole numbers to be entered. Quitlines may want to consider modifying data collection systems to allow for fractions of numbers if they don’t already.


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asked this question



NAQC MDS Follow-up Question 2d Read 2d if caller responded “yes” to chewing tobacco, snuff, or dip above. 2d. Do you currently use CHEWING TOBACCO, SNUFF, OR DIP every day, some days, or not at all? [CANADA ONLY: Do you currently smoke CHEWING TOBACCO, SNUFF, OR DIP daily, occasionally, or not at all?] [NOTE: “currently” refers to right now, today.] (CHECK ONE) DO NOT READ � Everyday [CANADA ONLY: Daily] � Some days [CANADA ONLY: Occasionally] (if less

than 7 days per week) � Optional if respond “Some Days/Occasionally”: How many days did you chew in the last 30 days? ____

� Not at all (skip to 2e, or Follow-up question 3 as indicated by the type of tobacco use question above)


Callers who report “yes” to chewing tobacco, snuff, or dip use in question 2.





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NAQC MDS Follow-up Question 2d(1) If this item is assessed through conversation with the caller, counsellors or other quitline staff should confirm the number. For example, “You said that you use 2 tins per week during the weeks that you chew. Is that correct?” 2d(1). How many POUCHES OR TINS do you use per week during the weeks that you use tobacco? (pouches/tins per week) ____



SKIP TO 2e, or Follow-up question 3 as indicated by the type of tobacco use question above.

Callers reporting using chewing tobacco, snuff, or dip “every day/daily” or “some days/occasionally” to question 2d should be asked this question.

MDS question 2(d)(1) is intended to measure the amount of tobacco use. Definition: Pouch = a bag of loose chew. For the purpose of this question, a pouch is NOT an individual small portion of tobacco in a teabag-like wrapping that is placed between the cheek and gum.

This item should be read exactly as written. If the item is assessed through conversation with the caller, counsellors or other quitline staff should confirm the number. For example, “You said that you use 2 tins per week during the weeks that you chew. Is that correct?” If respondent reports using less than one (individual) pouch or pinch per week, confirm that this is on the weeks that they use tobacco, and not a weekly average over several weeks.

Responses should be recorded as discrete numbers, not as ranges. If the data collection system allows for partial (fractional) numbers to be recorded, it is OK to record less than one pouch or tin per week. If the system requires whole numbers to be entered, it is suggested that quitlines round up to the next whole number. E.g., half a pinch would be recorded as 1 pinch per week for data collection systems that require whole numbers to be entered. Quitlines may want to consider modifying data collection systems to allow for fractions of numbers if they don’t already.


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asked this question General notes Notes for those asking

the question Notes for programmers/ reporting

NAQC MDS Follow-up Question 2e Read 2e if caller responded “yes” to other types of tobacco above. 2e. Do you currently use OTHER TYPES OF TOBACCO every day, some days, or not at all? [CANADA ONLY: Do you currently use OTHER TYPES OF TOBACCO daily, occasionally, or not at all?] [NOTE: “currently” refers to right now, today.] (CHECK ONE) DO NOT READ � Everyday [CANADA ONLY: Daily] � Some days [CANADA ONLY: Occasionally] (if less than

7 days per week) � Optional if respond “Some Days/Occasionally”: How many days did you use other types of tobacco in the last 30 days? ____

� Not at all (skip to Follow-up question 3) � Don’t know � Refused � Not asked

Callers who report “yes” to other types of tobacco use in question 2.


These items should be asked exactly as written. Because the key response categories are included in the question stem, the response categories should not be read aloud. Quitlines may want to consider specifying which product(s) they are referring to in the question stem, depending on how respondents answered question 2.

These items allow quitlines to differentiate between “everyday/daily” and “some day/occasional” tobacco users. It also allows for comparison between intake and follow-up to determine if tobacco users have reduced their level of use from everyday/daily to some day/occasional use. If a caller is using multiple other tobacco products (e.g., bidis and hookahs), quitlines may want to either provide another field to collect data here, or create a decision rule to determine which product will be asked about (e.g., most recent use, product used most often, product the caller is wanting help to quit, etc.)


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asked this question

General notes



NAQC MDS Follow-up Question 2e(1) If this item is assessed through conversation with the caller, counsellors or other quitline staff should confirm the number. For example, “You said that you smoke 10 bidis per week during the weeks that you smoke. Is that correct?” 2e(1). How much OTHER TOBACCO do you use per week during the weeks that you smoke? (other tobacco per week) ____



Callers reporting using other tobacco products “every day/daily” or “some days/occasionally” to question 2e should be asked this question.

MDS question 2e(1) is intended to measure the amount of tobacco use.

This item should be read exactly as written. If the item is assessed through conversation with the caller, counsellors or other quitline staff should confirm the number. For example, “You said that you smoke 10 bidis per week during the weeks that you smoke. Is that correct?” If respondent reports using less than one of another type of tobacco per week, confirm that this is on the weeks that they use tobacco, and not a weekly average over several weeks.

Responses should be recorded as discrete numbers, not as ranges. If the data collection system allows for partial (fractional) numbers to be recorded, it is OK to record less than one per week. If the system requires whole numbers to be entered, it is suggested that quitlines round up to the next whole number. E.g., half a hookah would be recorded as 1 hookah per week for data collection systems that require whole numbers to be entered. Quitlines may want to consider modifying data collection systems to allow for fractions of numbers if they don’t already.


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General notes


NAQC MDS Follow-Up Question 3: Cigarette smokers only: How soon after you wake up do you smoke your first cigarette? (DO NOT READ) � Within five minutes � 6 to 30 minutes � 31 to 60 minutes � More than 60 minutes � Don’t know � Refused � Not asked

MDS Follow-up question 3 is intended to assess the Fagerstrom measure of nicotine dependence for cigarette users. It should be asked exactly as written. No response categories should be read aloud.





NAQC MDS FOLLOW -UP OPTIONAL QUESTION 4: Other tobacco product users only: How soon after you wake up do you use tobacco (other than cigarettes)? (DO NOT READ) � Within five minutes � 6 to 30 minutes � 31 to 60 minutes � More than 60 minutes � Don’t know � Refused � Not asked

All respondents who reported “everyday/daily” or “some day/occasional” use of any non-cigarette tobacco product in questions 5b-e above should be asked this question.

This is a new question, designed to provide parallel information about nicotine addiction for other tobacco product users. This is a validated measure of nicotine addiction for smokeless tobacco products, but not for any other type of tobacco use. Ebbert et al published a study in 2006 (The Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST), Addict Behav 2006 September;31(9):1716-1721. available at www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1618870) testing a modified version of the Fagerstrom test for nicotine dependence for smokeless tobacco users. The question they found that had the strongest association with serum cotinine levels was “how soon after you wake up do you place your first dip?”

Because results have not been validated for other forms of tobacco, results should be interpreted carefully.


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MDS Follow-up question and response categories Who should be asked this

question General notes Notes for those

asking the question


NAQC MDS Follow-Up Question 5: All current tobacco users (smokers and other tobacco users) Do you intend to quit within the next 30 days? (DO NOT READ) � Yes � No � Don’t know � Refused � Not asked

All respondents who answered “every day/daily” or “some days/occasionally” to any type of tobacco product in MDS follow-up questions 2a-e, should be asked MDS follow-up question 5.

MDS follow-up question 5 is intended to assess readiness to quit. Note: the technical definition of “stage of change” involves several other questions, including readiness to quit in the next six months, and having made at least one quit attempt in the past year.

This question should be asked exactly as written. Note: “Intend to quit” is not the same as “willing to quit.”





NAQC MDS Follow-Up Question 6: [ALL RESPONDENTS] Since you first called the quitline on (Date of first contact), seven months ago, did you quit using tobacco for 24 hours or longer because you were trying to quit? (DO NOT READ, CHECK ONE ONLY) � Yes

� Optional if responded “Yes”: How many times did you quit using tobacco for 24 hours or longer? _____ For example, if you quit for 2 days and then started smoking again, and then quit for a week and started smoking again, that counts as 2 quits. (Note: collect number of intentional quit attempts only)

� No � Don’t know � Refused � Not asked

All respondents, regardless of quit status

MDS Follow-up question 6 is intended to determine one quitting measure: ever make a quit attempt since calling the quitline. This question should be asked about all tobacco use, not just cigarettes. The question should be limited to intentional quit attempts.

If the respondent is currently quit, the current quit counts as one quit attempt.


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NAQC MDS Follow-Up Question 7: Have you smoked any cigarettes or used other tobacco, even a puff or pinch, in the last 30 days? (DO NOT READ) � Yes � No (see optional

questions below) � Don’t know � Refused � Not asked

All respondents should be asked this question.

MDS Follow-up question 7 has been recommended as the primary measure of cessation for quitlines (see the NAQC Issue Paper on measuring quit rates at http://www.naquitline.org/pdfs/NAQC_IssuePaper_MeasuringQuitRates_Final.pdf) This question was recommended as the standard measure for several reasons, its ease of explanation to a non-scientific audience over the 7-day point prevalence question. This does NOT mean quitlines should stop using the 7-day question if they find it useful.

This question should be asked exactly as written, including the phrases “or used other tobacco” and “even a puff.” Note that the phrase “or pinch” has been added to add clarity to the question for other tobacco product users. No response options should be read aloud.

All respondents who said they are “every day” or “daily” tobacco users in follow-up questions 2a-e can skip this question – the assumed answer to follow-up question 10 is “yes” and can be coded as such. Any respondent reporting “every day/daily” use of any type of tobacco in follow-up questions 2a-e, or any respondent reporting “yes” to MDS follow-up question 7, should be excluded from the numerator for the NAQC quit rate calculation – they should not be counted as being abstinent from tobacco. NOTE: Question 7 is the recommended way to assess quit status for all tobacco users. It is the most straightforward, and imposes the least amount of burden on respondents. However, some quitlines may want to assess switching from one form of tobacco to another. To be able to determine whether a cigarette smoker at intake has successfully quit smoking but has switched to another form of tobacco, for example, question 7 must be asked separately for each type of tobacco identified in questions 2a-e. The number of people who successfully quit for the new NAQC standard quit rate calculation would need to be determined by combining the responses to all 30-day point prevalence questions – a respondent would only be counted as having successfully quit if they answered “no” to ALL types of tobacco use in the past 30 days.


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OPTIONAL: NAQC MDS Follow-Up Question 8: Have you smoked any cigarettes or used other tobacco, even a puff or pinch, in the last 7 days? (DO NOT READ) � Yes � No � Don’t know � Refused � Not asked

All respondents who said “yes” to question 7 (used tobacco in the past 30 days) should also be asked this question (if it is used). Respondents who say they are “every day” or “daily” tobacco users in follow-up questions 2a-e can skip this question – the assumed answer to follow-up question 8 is “yes” and can be coded as such. Respondents who say “no” to question 7 can skip question 8 – the assumed answer to follow-up question 8 is “no” and can be coded as such.

MDS Follow-up question 8 (7-day point prevalence abstinence) is now an optional question, and now follows the 30-day point prevalence abstinence question. The NAQC issue paper on measuring quit rates (http://www.naquitline.org/pdfs/NAQC_IssuePaper_MeasuringQuitRates_Final.pdf) recommends using the 30-day point prevalence measure as the NAQC standard calculation of quit rates. This does NOT mean that quitlines should stop asking the 7-day point prevalence question if they find it useful, or if they want to be able to compare 7-day point prevalence data from the past with what they will be collecting in the future. The question is still included in the MDS as an optional question so quitlines have a standard way of asking the question should they choose to do so. NOTE: Some quitlines may want to assess switching from one form of tobacco to another. To be able to determine whether a cigarette smoker at intake has successfully quit smoking but has switched to another form of tobacco, for example, question 8 must be asked separately for each type of tobacco identified in questions 2a-e. The total 7-day point prevalence abstinence rate would need to be determined by combining the responses to all 7-day point prevalence questions – a respondent would only be counted as having successfully quit if they answered “no” to ALL types of tobacco use in the past 7 days.

The question should be asked exactly as it is written here, including the phrases “or used other tobacco” and “even a puff.” Note that the phrase “or pinch” has been added to provide clarity around the measure for respondents. No response categories should be read aloud.


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MDS Follow-up question and response categories Who should be asked this

question General notes Notes for



OPTIONAL QUESTIONS: EITHER: Optional question 9 When was the last time you used any type of tobacco, even a puff or pinch (dd/mm/yyyy)? If caller cannot identify a specific date, use one or more of the following probes: “Can you be more specific? Is there a date that stands out, in particular, such as a holiday or special occasion? Do you remember what month or season? Was it closer to the beginning, middle, or end of the month? Do you remember if it was during the week or on a weekend? Do you remember if it was closer to the beginning, middle, or end of the week?”

Don’t know Refused Not asked

OR: Optional question 10a When was the last time you smoked a cigarette, even a puff (dd/mm/yyyy)? If caller cannot identify a specific date, use one or more of the following probes: “Can you be more specific? Is there a date that stands out, in particular, such as a holiday or special occasion? Do you remember what month or season? Was it closer to the beginning, middle, or end of the month? Do you remember if it was during the week or on a weekend? Do you remember if it was closer to the beginning, middle, or end of the week?”

Don’t know

Depends on the purpose of the question. If used to validate responses to questions 7 and/or 8, all respondents who answer questions 7 and/or 8 should be asked this question. If used to measure prolonged abstinence, all respondents who respond “no” to question 7 (use of tobacco in the past 30 days) should be asked this question. Questions 10a-e should follow the selection criteria outlined above, but should only be asked of those using (or attempting to quit using) the specific types of tobacco named in each item.

Follow-up optional questions 9 and 10a-e are intended to do several things: 1) for those who report having been quit for at least 30 days (“no” to question 10), these questions should be used to assess prolonged abstinence. Quitlines can opt to skip these questions for callers responding they DID use tobacco in the last 7 or 30 days (in questions 7 and 8), or they can opt to use it to validate responses to questions 7 and/or 9. The original MDS included a question that combined date of last tobacco use for all tobacco types combined. The Update includes a similar version, as well as a series of questions to ask about each type of tobacco separately. They are all now listed as optional questions, due to the large number of quitlines that do not ask about date of last tobacco use at follow-up, and the lack of clarity about the questions’ purpose.


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Refused Not asked

Optional question 10b When was the last time you smoked a cigar, even a puff (dd/mm/yyyy)? If caller cannot identify a specific date, use one or more of the following probes: “Can you be more specific? Is there a date that stands out, in particular, such as a holiday or special occasion? Do you remember what month or season? Was it closer to the beginning, middle, or end of the month? Do you remember if it was during the week or on a weekend? Do you remember if it was closer to the beginning, middle, or end of the week?”


Optional question 10c When was the last time you smoked a pipe, even a puff (dd/mm/yyyy)? If caller cannot identify a specific date, use one or more of the following probes: “Can you be more specific? Is there a date that stands out, in particular, such as a holiday or special occasion? Do you remember what month or season? Was it closer to the beginning, middle, or end of the month? Do you remember if it was during the week or on a weekend? Do you remember if it was closer to the beginning, middle, or end of the week?”



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Optional question 10d When was the last time you used chewing tobacco, snuff, or dip, even a pinch (dd/mm/yyyy)? If caller cannot identify a specific date, use one or more of the following probes: “Can you be more specific? Is there a date that stands out, in particular, such as a holiday or special occasion? Do you remember what month or season? Was it closer to the beginning, middle, or end of the month? Do you remember if it was during the week or on a weekend? Do you remember if it was closer to the beginning, middle, or end of the week?”


Optional question 10e When was the last time you used other types of tobacco, even a puff or pinch? (dd/mm/yyyy) If caller cannot identify a specific date, use one or more of the following probes: “Can you be more specific? Is there a date that stands out, in particular, such as a holiday or special occasion? Do you remember what month or season? Was it closer to the beginning, middle, or end of the month? Do you remember if it was during the week or on a weekend? Do you remember if it was closer to the beginning, middle, or end of the week?”



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asked this question



NAQC MDS FOLLOW -UP QUESTION 11 Since you first called the quitline seven months ago, have you used any of the following products or medications to help you quit? � Nicotine patches � Nicotine gum � Nicotine lozenges � Zyban (also called Wellbutrin or bupropion) � Chantix (also called varenicline) [CANADA: Champix] � Other medications to help you quit? (if yes, please

specify):__________________ (DO NOT READ) � No products or medications � Don’t know � Refused � Not asked

All respondents The follow-up questions about use of additional sources of help have been reworded slightly due to many quitlines not asking these questions according to the original MDS items. The advantage of asking the questions this way is that there is less of a leading question (did you use help? Yes/no), and only evidence-based treatments are offered as options. The medications are also named individually, which is designed to assist with caller recall.


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NAQC MDS FOLLOW -UP QUESTION 12 Other than the quitline or medications, did you use any other kinds of assistance to help you quit over the past seven months, such as advice from a health professional, or other kinds of quitting assistance? (let interviewee free-respond and prompt with response categories if needed.) (Check all that apply) � Advice from a health professional

→ Optional: quitlines may choose to include specific types of health professionals if they have special relationships with those groups. E.g., physician, pharmacist, nurse, dentist/hygienist

� Website → Optional: If yes, which one?_________________________ � Telephone program → Optional: If yes, which one?_________________________ � Counseling program → Optional: If yes, which one?_________________________ � Self-help materials → Optional: If yes, which one?_________________________ (DO NOT READ OR USE AS PROMPTS) � Something else (Optional: specify:______________) � Don’t know � Refused � Not asked

All respondents

The optional specification questions for website, telephone, counseling, and self-help can be used as quality control measures, if desired. The question asks about assistance “other than the quitline” – if the respondent specifies that the “additional” program was the quitline, additional clarifications can be made to ensure that they are only reporting information about assistance other than the quitline.


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MDS Follow-up question and response categories Who should be asked this question General

notes Notes for those asking the question


7 MONTH FOLLOW -UP ADMINISTRATIVE DATA Evaluator ID Caller ID Date of first contact with quitline (dd/mm/yyyy): _ _/_ _/_ _ _ _ Date of Evaluation Interview: seven months after date of first contact with quitline (dd/mm/yyyy): _ _/_ _/_ _ _ _

Questions should not be asked, but data should be collected on all respondents to the follow-up survey.

Documents

MDS Implementation Guide: Annotated Tables (2009) …c.ymcdn.com/sites/ fileMDS Implementation Guide: Annotated Tables (2009) ... and considered “in compliance” with th e MDS