Race/Ethnic Variations in Quitline Use Among US Adult Tobacco Users in 45 States, 2011-2013.

INTRODUCTION: State quitlines provide free telephone-based cessation services and are available in all states. However, quitlines presently reach 1% of US cigarette smokers. We assessed variations in quitline reach by race/ethnicity across 45 US states included in the National Quitline Data Warehouse, a repository on non-identifiable data reported by state quitlines. METHODS: During 2011 to 2013, we analyzed 1 220 171 records from the National Quitline Data Warehouse. Annual quitline reach was defined as the proportion of cigarette smokers and smokeless tobacco users who utilized quitline services during each year, and was calculated by dividing the number of state-specific quitline registrants in each year by the number of adult cigarette smokers and smokeless tobacco users in the state. RESULTS: Average annual reach ranged from: 0.08% (Tennessee) to 3.42% (Hawaii) among non-Hispanic whites; 0.17% (Tennessee) to 3.85% (Delaware) among non-Hispanic blacks; 0.27% (Nevada) to 9.98% (Delaware) among non-Hispanic American Indians/Alaska Native; 0.03% (Alabama) to 2.43% (Hawaii) among non-Hispanic Asian/Pacific Islanders; and from 0.08% (Tennessee) to 3.18% (Maine) among Hispanics. Average annual reach was highest among non-Hispanic American Indians/Alaska Native in 27 states, non-Hispanic blacks in 14 states, and non-Hispanic whites in four states. CONCLUSIONS: Quitlines appear to be reaching minority populations; however, overall reach remains low and variations in quitline reach exist by race/ethnicity. Opportunities exist to increase the utilization of quitlines and other effective cessation treatments among racial/ethnic minority populations. IMPLICATIONS: Some studies have assessed quitline reach across demographic groups in individual states; however, no studies have provided multistate data about quitline reach across race/ethnic groups. Ongoing monitoring of the use of state quitlines can help guide targeted outreach to particular race/ethnic groups with the goal of increasing the overall proportion and number of tobacco users that use quitlines. These efforts should be complemented by comprehensive tobacco control initiatives that increase cessation including mass media campaigns, smoke-free policies, increased tobacco prices, expansion of health insurance coverage, and health systems change.

The Dose-Response Relationship Between Tobacco Education Advertising and Calls to Quitlines in the United States, March-June, 2012.

INTRODUCTION: We estimated changes in call volume in the United States in response to increases in advertising doses of the Tips From Former Smokers (Tips) campaign, the first federal national tobacco education campaign, which aired for 12 weeks from March 19 to June 10, 2012. We also measured the effectiveness of ad taglines that promoted calls directly with a quitline number (1-800-QUIT-NOW) and indirectly with a cessation help website (Smokefree.gov). METHODS: Multivariate regressions estimated the weekly number of calls to 1-800-QUIT-NOW by area code as a function of weekly market-level gross rating points (GRPs) from CDC's Tips campaign in 2012. The number of quitline calls attributable solely to Tips was predicted. RESULTS: For quitline-tagged ads, an additional 100 television GRPs per week was associated with an increase of 89 calls per week in a typical area code in the United States (P < .001). The same unit increase in advertising GRPs for ads tagged with Smokefree.gov was associated with an increase of 29 calls per week in any given area code (P < .001). We estimated that the Tips campaign was responsible for more than 170,000 additional calls to 1-800-QUIT-NOW during the campaign and that it would have generated approximately 140,000 additional calls if all ads were tagged with 1-800-QUIT-NOW. CONCLUSION: For campaign planners, these results make it possible to estimate 1) the likely impact of tobacco prevention media buys and 2) the additional quitline capacity needed at the national level should future campaigns of similar scale use 1-800-QUIT-NOW taglines exclusively.

Impact of a U.S. antismoking national media campaign on beliefs, cognitions and quit intentions.

In 2012, the Centers for Disease Control and Prevention launched a national tobacco education campaign, Tips From Former Smokers, that consisted of graphic, emotionally evocative, testimonial-style advertisements. This longitudinal study examines changes in beliefs, tobacco-related cognitions and intentions to quit smoking among U.S. adult smokers after a 12-week airing of the campaign (n = 4040 adult smokers pre- and post-campaign). Exposure to the campaign was associated with greater odds of intending to quit within the next 30 days [odds ratio (OR) = 1.28, P < 0.01] and within the next 6 months (OR = 1.12, P < 0.05), and quit intentions were stronger among respondents with greater campaign exposure (OR = 1.12, P < 0.01). Campaign exposure was also associated with significant changes in beliefs about smoking-related risks (ORs = 1.15-2.40) and increased worries about health (b = 0.30, P < 0.001). Based on study change rates applied to U.S. census data, an estimated 566 000 additional U.S. smokers reported their intention to quit smoking within the next 6 months as a result of viewing campaign advertisements. Campaign effects were consistent with the theory of reasoned action and an expanding body of research demonstrating that graphic, emotional advertisements are highly effective for prompting positive cessation-related cognitions and behavioral intentions.

A cost-effectiveness analysis of the first federally funded antismoking campaign.

BACKGROUND: In 2012, CDC launched the first federally funded national mass media antismoking campaign. The Tips From Former Smokers (Tips) campaign resulted in a 12% relative increase in population-level quit attempts. PURPOSE: Cost-effectiveness analysis was conducted in 2013 to evaluate Tips from a funding agency's perspective. METHODS: Estimates of sustained cessations; premature deaths averted; undiscounted life years (LYs) saved; and quality-adjusted life years (QALYs) gained by Tips were estimated. RESULTS: Tips saved about 179,099 QALYs and prevented 17,109 premature deaths in the U.S. With the campaign cost of roughly $48 million, Tips spent approximately $480 per quitter, $2,819 per premature death averted, $393 per LY saved, and $268 per QALY gained. CONCLUSIONS: Tips was not only successful at reducing smoking-attributable morbidity and mortality but also was a highly cost-effective mass media intervention.

Tobacco control in a changing media landscape: how tobacco control programs use the internet.

BACKGROUND: More than 80% of U.S. adults use the Internet, 65% of online adults use social media, and more than 60% use the Internet to find and share health information. PURPOSE: State tobacco control campaigns could effectively harness the powerful, inexpensive online messaging opportunities. Characterizing current Internet presence of state-sponsored tobacco control programs is an important first step toward informing such campaigns. METHODS: A research specialist searched the Internet for state-sponsored tobacco control resources and social media presence for each state in 2010 and 2011, to develop a resource inventory and observe change over 6 months. Data were analyzed and websites coded for interactivity and content between July and October 2011. RESULTS: Although all states have tobacco control websites, content and interactivity of those sites remain limited. State tobacco control program use of social media appears to be increasing over time. CONCLUSIONS: Information presented on the Internet by state-sponsored tobacco control programs remains modest and limited in interactivity, customization, and search engine optimization. These programs could take advantage of an important opportunity to communicate with the public about the health effects of tobacco use and available community cessation and prevention resources.

Effect of the first federally funded US antismoking national media campaign.

BACKGROUND: Every year, smoking kills more than 5 million people globally, including 440,000 people in the USA, where the long-term decline in smoking prevalence has slowed. The US Centers for Disease Control and Prevention (CDC) delivered a national, 3-month antismoking campaign called Tips From Former Smokers (Tips) that started in March, 2012, in which hard-hitting, emotionally evocative television advertising was featured, depicting smoking-related suffering in real people. We aimed to assess the effects of the Tips campaign. METHODS: We undertook baseline and follow-up surveys of nationally representative cohorts of adult smokers and non-smokers. The national effect of the Tips campaign was estimated by applying rates of change in the cohort before and after the campaign to US census data. FINDINGS: 3051 smokers and 2220 non-smokers completed baseline and follow-up assessments. 2395 (78%) smokers and 1632 (74%) non-smokers recalled seeing at least one Tips advertisement on television during the 3-month campaign. Quit attempts among smokers rose from 31.1% (95% CI 30.3-31.9) at baseline to 34.8% (34.0-35.7) at follow-up, a 12% relative increase. The prevalence of abstinence at follow-up among smokers who made a quit attempt was 13.4% (95% CI 9.7-17.2). Nationally, an estimated 1.64 million additional smokers made a quit attempt, and 220,000 (95% CI 159,000-282,000) remained abstinent at follow-up. Recommendations by non-smokers to quit grew from 2.6% at baseline to 5.1% at follow-up, and the prevalence of people talking with friends and family about the dangers of smoking rose from 31.9% (95% CI 31.3-32.5) to 35.2% (34.6-35.9), resulting in an estimated 4.7 million additional non-smokers recommending cessation services and more than 6 million talking about the dangers of smoking. INTERPRETATION: The high-exposure Tips media campaign was effective at increasing population-level quit attempts. The growth in smokers who quit and became sustained quitters could have added from a third to almost half a million quality-adjusted life-years to the US population. Expanded implementation of similar campaigns globally could accelerate progress on the WHO Framework Convention on Tobacco Control and reduce smoking prevalence globally. FUNDING: CDC, US Department of Health and Human Services.