H. Sample Table Shells

The National Quitline Data Warehouse Sample State Report: STATE System (Updated Quarterly)

State Name

Quitline Services

Hours of Operation: xxam - xxpm

(when live pick-up/counseling is available)

Available Languages: English, Spanish, etc.

Counseling No. of Sessions

Group 1 (i.e., All Adults) x

Group 2 (i.e., Persons who receive Medicaid) x

Medications No. of weeks Eligibility

Nicotine Replacement Therapy

• Patch

• Gum

• Lozenge

• Inhaler

• Nasal Spray

Prescription Medications

• Buproprion

• Chantix
  
  

Total Call Volume and Services Received

Total Number of Calls (N)

Caller Type

Calling for help/information for themselves (N, Percent)

Calling to assist someone else (N, Percent)

Other (N, Percent)

Services Tobacco Users Received

Any Service (counseling, medication, or both) (N)

Counseling (N, Percent)

Medication (N, Percent)

Referral Source

Learned of Quitline Through:

Media (TV, Radio, etc.) (N, Percent)

Other Advertising (N, Percent)

Health Professional Referral (N, Percent)

Other (N, Percent)

Mode of Entry to Quitline

Called the quitline (N, Percent)

Fax referral (N, Percent)

Website (N, Percent)

Other (N, Percent)

Characteristics of Callers Who Received Counseling

Gender:

Men (N, Percent)

Women (N, Percent)

Race/Ethnicity:

African American, Non-Hispanic (N, Percent)

American Indian/Alaska Native, Non-Hispanic (N, Percent)

Asian/Pacific Islander, Non-Hispanic (N, Percent)

Other, Non-Hispanic (N, Percent)

Hispanic (N, Percent)

White, Non-Hispanic (N, Percent)

Years of Education:

< 12 Years (N, Percent)

12 Years (N, Percent)

> 12 Years (N, Percent)

Age:

18-24 Years (N, Percent)

25-44 Years (N, Percent)

45-64 Years (N, Percent)

65+ Years (N, Percent)

Type of Tobacco:

Cigarettes (N, Percent)

Cigars (N, Percent)

Pipes (N, Percent)

Chewing Tobacco or Snuff (N, Percent)

Other Tobacco Products (N, Percent)

Number of Quitters (quit for 30-days at 7-months post enrollment)

Number of persons who received a service who quit (N, Percent)