Objective: The population reach of tobacco quitlines is an important measure of treatment seeking and penetration of services. Maine offers an opportunity to examine temporal changes in quitline reach and referral sources in the context of a comprehensive tobacco treatment programme. The impact of a $1.00 cigarette tax increase is also examined. Methods: This is a descriptive analysis of Maine Tobacco Helpline call volume September 2001 to December 2006. Annual reach was estimated using a cross sectional state surveillance survey. Weekly call volume was examined during 2005, a year of marked changes in tobacco taxes and quitline resources. Referral patterns were analysed yearly. Results: Maine's Tobacco Helpline observed more than a threefold increase in population reach during a four year interval, from 1.9% to over 6% per year. Calls increased substantially in 2005, concurrent with added hours of operation and a rise in the cigarette tax. Over time, callers increasingly reported hearing about the quitline from health professionals, from 10% in 2001 to 38% in 2006. Conclusions: Tobacco treatment programmes offering free nicotine therapy and professional medical education can drive quitline utilisation over time. Call volume can also be affected by quitline operational and policy changes that promote the reduction of tobacco use.T elephonic counselling, or quitlines, have demonstrated both efficacy and real world effectiveness. 1 2 Based on these findings, the Guideline to Community Preventive Services: Tobacco Use Prevention and Control recommends quitline services be included as a component of a comprehensive state tobacco control programme. 3 To achieve the best outcomes, quitlines must demonstrate both effectiveness and reach, or population based utilisation by smokers in the region served.Zhu and colleagues showed increasing use of the California Helpline over seven years, with callers learning about the quitline from media as well as non-media sources. 4 The overall quitline use among adult smokers, however, was less than 1% per year. Paid media and/or free nicotine replacement therapy (NRT) drives quitline demand. An et al found that offering NRT through the Minnesota Quitline led to a substantial increase in call volume. 5 In that study, quitline reach was less than 2% in a year. The New York Quitline was able to reach 2.9% of the state's smokers (smoking 10+ cigarettes daily) by promoting a NRT ''starter kit,'' with a concomitant rise in quit outcomes observed. 6 While no US state quitlines appear to have a population reach over 3% per year, higher smoker penetration has been seen outside the United States. In Australia and the United Kingdom, media campaigns resulted in quitline use of 3.6% and 4.2% of adult smokers, respectively, during one year. 7 8 Recently, methods less dependent on media and NRT have been developed, such as integrating tobacco treatment into clinical care using a quitline fax referral. 9 Finally, policies such as smoking bans have been shown to boost smoker interest in quitting an...

Non-U.S. birthplace, family history of diabetes, and non-Puerto Rican ethnicity were associated with quitting smoking at pregnancy onset in Hispanic women. Prepregnancy marijuana use and smoking, parity, and stress were associated with continued smoking.

Background In the United States, the mortality rate from traffic injury is higher in rural and in southern regions, for reasons that are not well understood. Methods For 1754 (56%) of the 3142 US counties, we obtained data allowing for separation of the deaths/population (D/P) rate into deaths/injury (D/I), injuries/crash (I/C), crashes/exposure (C/E), and exposure/population (E/P), with exposure measured as vehicle miles traveled. A “decomposition method” proposed by Li and Baker was extended to study how the contributions of these components were affected by three measures of rural location, as well as southern location. Results The method of Li and Baker extended without difficulty to include non-binary effects and multiple exposures. D/I was by far the most important determinant in the county-to-county variation in D/P, and accounted for the greatest portion of the rural/urban disparity. After controlling for the rural effect, I/C accounted for most of the southern/northern disparity. Conclusions The increased mortality rate from traffic injury in rural areas can be attributed to the increased probability of death given that a person has been injured, possibly due to challenges faced by emergency medical response systems. In southern areas, there is an increased probability of injury given that a person has crashed, possibly due to differences in vehicle, road, or driving conditions.

Background-Mortality from traffic crashes is often higher in rural regions, and this may be attributable to decreased survival probability after severe injury.