Sample Quarterly State Report

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

Hours of Operation:
(when live pick-up/counseling is available)

xxam - xxpm

Available Languages: English, Spanish, etc.
No. of Sessions
x
x

Counseling
Group 1 (i.e., All Adults)
Group 2 (i.e., Persons who receive Medicaid)
Medications
Nicotine Replacement Therapy
o Patch
o Gum
o Lozenge
o Inhaler
o Nasal Spray
Prescription Medications
o Buproprion
o Chantix

No. of weeks

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)

Eligibility

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)