Sample Table Shells

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

xxam - xxpm

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

Eligibility Criteria
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)

(such as age, location, insurance,
or readiness to quit)

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)
Highest Level of Education:
> Less than high school (N, Percent)
> High school diploma (N, Percent)
> GED (N, Percent)
> Some college/technical school (N, Percent)
> College Degree (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)