Reach Lit Review Highlights

Jessie Saul, PhD

March 4 and 6, 2009

Increasing Reach of Tobacco Cessation Quitlines:

A review of the literature

Process and Timeline

• Member examples requested and received – December 2008

• Review of published literature conducted – January and Feb 2009

• Highlights presented – March 2009

• Final resource document release –April 2009

Purpose

• Gather information – “what do we know?”

• Create a user-friendly document to share this information with the quitline community

• Quitlines can use this information to make decisions about promoting services

HIGHLIGHTS

General findings

• Quitlines work, promotions work

• Balance between promotions and services needed

• Promotions must vary, and be varied

MEMBER EXAMPLES

• California showed a 5-fold call volume increase due to fluctuations in media budget

• Several states experienced a flood of calls after successful media campaigns, but were unable to handle the call volume

Television advertising

• Daytime ad placements more effective, and cost-effective, than evening placements

• Testimonials of affected family members, new health risks, more effective than graphic images

• “Why quit” and “How to quit” combinations more effective

MEMBER EXAMPLES

• Utah found one television ad “Make Life Easier” to generate more calls from men than other ads

• Nevada partners with their Health District which funds mass media tagged with quitline info

• New Mexico tracks ad campaigns, call volume, cost per call

Direct media (not TV)

• TV most effective at generating calls, also most expensive

• Radio more cost effective than TV

• Classified ads can reach smokers at all stages of change

• Internet advertising shows great promise, increased flexibility, low $$

• Direct mail is cost effective

Member examples

• Vermont has had success with radio advertising and direct mail (TV: 14.5%; Direct mail: 13.0%; Radio: 5.2%)

• Minnesota saw large call increases after airing the “Loon on my back” radio ads

• Alabama used a “post-it” newspaper ad

Community connections and referral networks

• Implement a system of identifying tobacco users at every visit

• Fax referral (“fax to quit”) programs

–Also in combination with 2As and refer, or 3As and refer

• All require partnerships between quitlines and health system organizations

MEMBER EXAMPLES

• Wisconsin – regional outreach model “detailing” for health care providers. Fax referral program sees 56% enrollment rate due to training around selection of referrals (those interested in quitting)

• Ohio – worked with dentists, ERs, sent postcards to targeted areas to try to reach rural smokers. Found it is more expensive to reach rural smokers, but they may need the most help.

• Nevada promotes the quitline at health fairs –bump in 200 calls per quarter after fairs.

• California partners with grantees of the tobacco control program – non-media referrals have increased over time.

0

200

400

600

800

1000

1200

1400

1600

1800

Calls p

er m

on

th

1992 1994 1996 1998 2000

Average monthly callers reporting non-

media referral source

From The California Smokers’ Helpline: A Case Study, 2000

NRT

• Provision of NRT has doubled call volume in nearly all cases

– Early response often overwhelms available lines

• Resource intensive

• Less NRT may be as effective for reach

• More restrictive eligibility criteria

• Call volume dips over time; repeat of the offer may raise it again

MEMBER EXAMPLES

• New York: online NRT application (40% of NRT is from online applicants)

• Minnesota’s initial offering of NRT was not advertised at all, earned media generated huge spike in calls

Priority Populations

• Promotional campaigns targeted at specific populations can be effective, but can be costly

• Depending on the population of interest and the type of campaign, targeted campaigns may not be more effective at increasing reach than general campaigns

• Many underserved tobacco users may not be aware of the benefits available to them (e.g., Medicaid users)

MEMBER EXAMPLES

• California only sees large numbers of calls from ethnic minority smokers when ad campaigns targeting those populations are aired

• California has found messages need to be tailored, not just translated (e.g., “help” line, not “counseling”)

• Proactive telemarketing showed promise at reaching men, low education, and certain racial/ethnic groups in South Carolina

• Working with community networks (e.g. lay health workers or churches) can be effective ways of reaching more African American and Hispanic tobacco users

Policies and Laws

• Cigarette warning labels with the quitline number increase calls

– More callers uncertain about quitting

– Increased call volume sustained over time (Netherlands)

• Smoke-free laws

– Policies and laws themselves can increase call volumes

– Media campaigns promoting quitline services can be very effective during policy change

MEMBER EXAMPLES

• Wisconsin combined a tax increase with 2-week starter kit of NRT and successful earned media campaign –record number of calls

• Policy playbook provides additional examples of ways to use policy change to promote cessation services (available at http://naquitline.org/playbook/)

Measuring Reach Resources

• NAQC Issue Paper on Measuring Reach (available at

• Implementation plan for the reach standard measurement

• Member resources (e.g., NM spreadsheets)

NEW MEXICO TOBACCO USE PREVENTION AND CONTROL PROGRAM

Comparison of Adult Smoking Prevalence to % of Registered Callers

to 1-800 QUIT NOW in FY2008

% adult

smokers

that

called

QL

% of

adult

smokersGroup

Smoking

Prevalence

# adult

smokers

# called

QL

% of total

QL callers

Hispanic 21.8% 132,114 2,765 2.1% 42.9% 38.5%

American

Indian 21.4% 26,513 287 1.1% 8.6% 4.0%

TOTAL 21.3% 307,927 7,186 2.3%

spreadsheet prepared by Nancy Jane Heilman, NM TUPAC Quitline Specialist

1-800 QUIT NOW data from "2008 Annual Summary Report"

population estimates from James Padilla, TUPAC epidemiologist

calls to QL

'08

County

2006 adult

population

(estimated)

smoking

prevalence

#

smokers

% of

total NM

smokers

# %

Bernalillo 461,684 20.0% 92,337 30% 3295 45%

Catron* 2,863 20.2% 578 0% 5 0%

Chaves 45,647 23.5% 10,727 4% 272 4%

Cibola* 20,004 21.6% 4,321 1% 79 1%

Colfax* 10,438 19.4% 2,025 1% 48 1%

Curry 31,529 24.9% 7,851 3% 129 2%

De Baca* 1,601 24.6% 394 0% 10 0%

Dona Ana 138,887 17.3% 24,027 8% 196 3%

Prepared by the New Mexico Tobacco Prevention and Control Program

NEXT STEPS

• Complete the resource document

• Link to existing resources–Media warehouses/free or low-cost ads

–NAQC Policy playbook

–Member contacts

• NAQC standard measurement of reach – implementation plan

• NAQC proposed goal of increasing reach of quitlines