A comparison of two methods for assessing awareness of antitobacco television advertisements.

BACKGROUND: This study uses an online survey panel to compare two approaches for assessing ad awareness. The first uses a screenshot of a television ad and the second shows participants a full-length video of the ad. METHODS: We randomly assigned 1034 Minnesota respondents to view a screenshot or a streaming video from two antitobacco ads. The study used one ad from ClearWay Minnesota's ITALIC! We All Pay the Price campaign, and one from the Centers for Disease Control ITALIC! Tips campaign. The key measure used to assess ad awareness was aided ad recall. Multivariate analyses of recall with cessation behaviour and attitudinal beliefs assessed the validity of these approaches. RESULTS: The respondents who saw the video reported significantly higher recall than those who saw the screenshot. Associations of recall with cessation behaviour and attitudinal beliefs were stronger and in the anticipated direction using the screenshot method. Over 20% of the respondents assigned to the video group could not see the ad. People who were under 45 years old, had incomes greater than $35,000 and women were reportedly less able to access the video. CONCLUSIONS: The methodology used to assess recall matters. Campaigns may exaggerate the successes or failures of their media campaigns, depending on the approach they employ and how they compare it to other media campaign evaluations. When incorporating streaming video, researchers should consider accessibility and report possible response bias. Researchers should fully define the measures they use, specify any viewing accessibility issues, and make ad comparisons only when using comparable methods.

Tobacco User Characteristics and Outcomes Related to Intensity of Quitline Program Use: Results From Minnesota and Pennsylvania.

CONTEXT: Tobacco users in all 50 states have access to quitline telephone counseling and cessation medications. While studies show multiple calls relate to quit success, most participants do not complete a full call series. To date, quitline program use studies have analyzed single factors-such as number of calls or counseling minutes. OBJECTIVE: This study combines multiple factors of quitline program use across 2 states to describe how participants use a 5-call program; assess whether intensity of program use is associated with participant subgroups; and assess whether key outcomes (quitting, satisfaction) are associated with intensity. DESIGN, SETTING, AND PARTICIPANTS: This observational study examines data for quitline participants in Minnesota (n = 2844) and Pennsylvania (n = 14 359) in 2011 and 2012. A subset of participants was surveyed 7 months after registration to assess key outcomes (response rates: Minnesota 65%; Pennsylvania 60%). MAIN OUTCOME MEASURES: Quitline utilization data were used to identify program use variables: nicotine replacement therapy provision, number of counseling calls, number of counseling minutes, days from first to last counseling call, and days from registration to first counseling call. Ten program use groups were created using all 5 program use variables, from lowest (1) to highest (10) intensity. RESULTS: Results were similar for both states. Only 11% of Minnesota and 8% of Pennsylvania participants completed all 5 calls. Intensity of quitline program use was associated with several participant characteristics including health conditions and age. Both quit status and program satisfaction were associated with program use intensity. Quit rates peaked in group 9, participants who received the full 5-call program. CONCLUSIONS: Quitlines should focus on engaging participants in multiple calls to improve quit outcomes. In addition, it is important to leverage multiple program use factors for a fuller understanding of how quitline participants use a program.

Seizing an opportunity: increasing use of cessation services following a tobacco tax increase.

BACKGROUND: Tobacco tax increases are associated with increases in quitline calls and reductions in smoking prevalence. In 2013, ClearWay Minnesota(SM) conducted a six-week media campaign promoting QUITPLAN® Services (QUITPLAN Helpline and quitplan.com) to leverage the state's tax increase. The purpose of this study was to ascertain the association of the tax increase and media campaign on call volumes, web visits, and enrollments in QUITPLAN Services. METHODS: In this observational study, call volume, web visits, enrollments, and participant characteristics were analyzed for the periods June-August 2012 and June-August 2013. Enrollment data and information about media campaigns were analyzed using multivariate regression analysis to determine the association of the tax increase on QUITPLAN Services while controlling for media. RESULTS: There was a 160% increase in total combined calls and web visits, and an 81% increase in enrollments in QUITPLAN Services. Helpline call volumes and enrollments declined back to prior year levels approximately six weeks after the tax increase. Visits to and enrollments in quitplan.com also declined, but increased again in mid-August. The tax increase and media explained over 70% of variation in enrollments in the QUITPLAN Helpline, with media explaining 34% of the variance and the tax increase explaining an additional 36.1% of this variance. However, media explained 64% of the variance in quitplan.com enrollments, and the tax increase explained an additional 7.6% of this variance. CONCLUSIONS: Since tax increases occur infrequently, these policy changes must be fully leveraged as quickly as possible to help reduce prevalence.

Facilitators of health systems change for tobacco dependence treatment: a qualitative study of stakeholders' perceptions.

BACKGROUND: Health systems play key roles in identifying tobacco users and providing evidence-based care to help them quit. Health systems change - changes to health care processes, policies and financing - has potential to build capacity within these systems to address tobacco use. In 2010, ClearWay MinnesotaSM piloted a health systems change funding initiative, providing resources and technical assistance to four health care systems. This paper presents findings from a process evaluation, describing key stakeholders' views on whether changes to how health systems treat tobacco use resulted from this initiative and what may have facilitated those changes. METHODS: A process evaluation was conducted by an independent evaluation firm. A qualitative case study approach provided understanding of systems change efforts. Interviews were conducted with key informants representing the health systems, funder and technical assistance providers. Core documents were reviewed and compared to thematic analysis from the interviews. Results were triangulated with existing literature to check for convergence or divergence. A cross-case analysis of the findings was conducted in which themes were compared and contrasted. RESULTS: All systems created and implemented well-defined written tobacco use screening, documentation and treatment referral protocols for every patient at every visit. Three implemented systematic follow-up procedures for patients referred to treatment, and three also implemented changes to electronic health records systems to facilitate screening, referral and reporting. Fax referral to quitline services was implemented or enhanced by two systems. Elements that facilitated successful systems changes included capitalizing on environmental changes, ensuring participation and support at all organizational levels, using technology, establishing ongoing training and continuous quality improvement mechanisms and leveraging external funding and technical assistance. CONCLUSIONS: This evaluation demonstrates that health systems can implement substantial changes to facilitate routine treatment of tobacco dependence in a relatively short timeframe. Implementing best practices like these, including increased emphasis on the implementation and use of electronic health record systems and healthcare quality measures, is increasingly important given the changing health care environment. Lessons learned from this project can be resources for states and health systems likely to implement similar systems changes.

The relation between media promotions and service volume for a statewide tobacco quitline and a web-based cessation program.

BACKGROUND: This observational study assessed the relation between mass media campaigns and service volume for a statewide tobacco cessation quitline and stand-alone web-based cessation program. METHODS: Multivariate regression analysis was used to identify how weekly calls to a cessation quitline and weekly registrations to a web-based cessation program are related to levels of broadcast media, media campaigns, and media types, controlling for the impact of external and earned media events. RESULTS: There was a positive relation between weekly broadcast targeted rating points and the number of weekly calls to a cessation quitline and the number of weekly registrations to a web-based cessation program. Additionally, print secondhand smoke ads and online cessation ads were positively related to weekly quitline calls. Television and radio cessation ads and radio smoke-free law ads were positively related to web program registration levels. There was a positive relation between the number of web registrations and the number of calls to the cessation quitline, with increases in registrations to the web in 1 week corresponding to increases in calls to the quitline in the subsequent week. Web program registration levels were more highly influenced by earned media and other external events than were quitline call volumes. CONCLUSION: Overall, broadcast advertising had a greater impact on registrations for the web program than calls to the quitline. Furthermore, registrations for the web program influenced calls to the quitline. These two findings suggest the evolving roles of web-based cessation programs and Internet-use practices should be considered when creating cessation programs and media campaigns to promote them. Additionally, because different types of media and campaigns were positively associated with calls to the quitline and web registrations, developing mass media campaigns that offer a variety of messages and communicate through different types of media to motivate tobacco users to seek services appears important to reach tobacco users. Further research is needed to better understand the complexities and opportunities involved in simultaneous promotion of quitline and web-based cessation services.