Development and evaluation of a social marketing campaign to address methamphetamine use in Los Angeles County.

BACKGROUND: This study describes the development and impact of a social marketing campaign in early 2020 intended to prevent and reduce methamphetamine use in Los Angeles County (LAC). We used social marketing principles and the transtheoretical model to design the campaign, which was intended to avoid stigmatization of methamphetamine users and communicate compassion, empathy, and support. METHODS: To evaluate its impact, we collected cross-sectional online survey data post-campaign (n = 1,873) from LAC residents in population segments considered higher risk for methamphetamine use. We examine associations between campaign exposure and outcomes using bivariate analyses and binary logistic regression models, which control for the impact of the COVID-19 pandemic on methamphetamine use or likelihood of use. RESULTS: The analyses revealed that campaign exposure was associated with having more negative attitudes toward methamphetamine, calling LAC's substance abuse service helpline, using methamphetamine fewer days, and considering abstaining. Frequency of exposure to campaign advertisements was positively associated with calling the helpline, suggesting a campaign dose effect. COVID-19-related factors were associated with using methamphetamine in the past 30 days. CONCLUSIONS: Social marketing campaigns hold promise for impacting methamphetamine prevention and cessation behaviors. This study adds to the limited literature on mass marketing interventions to address this major health issue.

Provider Attitudes and Practices on Treating Tobacco Dependence in New York City After 10 years of Comprehensive Tobacco Control Efforts.

To design strategies for provider education and implementation of clinical guidelines, this study investigated how physicians (1) approach tobacco cessation, including barriers to screening and treatment, (2) prioritize tobacco cessation, and (3) perceive the role of public health. Semi-structured focus groups were conducted with 30 New York City physicians across specialties. Physicians reported that they: (1) understand risks of smoking, as well as basic counseling and medications for smoking cessation; (2) do not always follow clinical guidelines for treatment of smoking cessation; (3) prioritize treatment of patients based upon a number of criteria; and (4) see the role of public health and the city health department as separate from the clinical environment, despite population-level interventions to reduce smoking. Physicians understand the importance of treating tobacco dependence, but identified barriers to treatment, some of which are health system-related. Further, patients who do not yet present with smoking-related illness may receive less intense interventions.

Public opinions on tax and retail-based tobacco control strategies.

BACKGROUND: While tobacco taxes and smoke-free air regulations have significantly decreased tobacco use, tobacco-related illness accounts for hundreds of thousands of annual deaths. Experts are considering additional strategies to further reduce tobacco consumption. METHODS: We investigated smokers' (n=2118) and non-smokers' (n=2210) opinions on existing and theoretical strategies, including tax and retailer-based strategies in New York City, across three cross-sectional surveys. RESULTS: Compared with smokers, non-smokers were significantly more likely (p<0.05) to favour all tobacco control strategies. Overall, 25% of smokers surveyed favoured increasing taxes on cigarettes, climbing to 60% if taxes were used to fund healthcare programmes. Among non-smokers, 72% favoured raising taxes, increasing to 83% if taxes were used to fund healthcare programmes. 54% of non-smoking New Yorkers favoured limiting the number of tobacco retail licences, as did 30% of smokers. The most popular retail-based strategies were raising the minimum age to purchase cigarettes from 18 to 21, with 60% of smokers and 69% of non-smokers in favour, and prohibiting retailers near schools from selling tobacco, with 51% of smokers and 69% of non-smokers in favour. Keeping tobacco products out of customers' view, prohibiting tobacco companies from paying retailers to display or advertise tobacco products and prohibiting price promotions were favoured by more than half of non-smokers surveyed, and almost half of smokers. CONCLUSIONS: While the support level varied between smokers and non-smokers, price and retail-based tobacco control strategies were consistently supported by the public, providing useful information for jurisdictions examining emerging tobacco control strategies.

One cigarette is one too many: evaluating a light smoker-targeted media campaign.

BACKGROUND: Light smokers represent an increasing share of adult smokers in various parts of the world including New York City (NYC). Since 2007, the NYC Department of Health and Mental Hygiene has aired hard-hitting antitobacco media campaigns paired with time-limited nicotine replacement therapy (NRT) giveaways. We evaluated an original antitobacco media campaign, developed to increase awareness of smoking risks and encourage cessation service use among light smokers in NYC. METHODS: We compared cessation service request volume during the campaign to historical periods without ads targeting light smokers. We used a cross-sectional online panel survey to assess the ad's perceived effectiveness and its impact on learning something new, quit intentions and concern for smoking-related health risks among non-daily, light daily and heavy daily smokers. RESULTS: The proportion of light smokers among smokers requesting cessation services increased 50% (from 13% to 20%) relative to previous time-limited NRT giveaways. Compared to heavy daily smokers, non-daily (aOR: 1.95, p<0.05) and light daily (aOR: 2.27, p<0.05) smokers were more likely to express increased concern about smoking-related health risks after viewing the ad. Perceived effectiveness of the ad did not differ by smoker type. CONCLUSIONS: This study provides evidence that light smokers were receptive to a targeted antitobacco message encouraging use of cessation services. The campaign appears to have been particularly effective in increasing smoking-related health concerns in this group. The lack of difference in perceived ad effectiveness by smoker type suggests the potential to develop such ads without sacrificing broad impact.

Making it harder to smoke and easier to quit: the effect of 10 years of tobacco control in New York City.

In 2002, New York City implemented a comprehensive tobacco control plan that discouraged smoking through excise taxes and smoke-free air laws and facilitated quitting through population-wide cessation services and hard-hitting media campaigns. Following the implementation of these activities through a well-funded and politically supported program, the adult smoking rate declined by 28% from 2002 to 2012, and the youth smoking rate declined by 52% from 2001 to 2011. These improvements indicate that local jurisdictions can have a significant positive effect on tobacco control.

Lessons learned from the implementation of a time-limited, large-scale nicotine replacement therapy giveaway program in New York City.

Since 2006, the New York City (NYC) Department of Health and Mental Hygiene has conducted the Nicotine Patch and Gum Program (NPGP) in collaboration with 311, NYC's non-emergency information line. In two prior years, the program was conducted in collaboration with the New York State (NYS) Smokers' Quitline and with community-based organizations. The NPGP is an annual, brief, population-based nicotine replacement therapy (NRT) giveaway for NYC residents, complementing the NYS Quitline's year-round NRT distribution program. Since 2006, 168,000 smokers have enrolled, with the largest number of enrollees in 2010 (n = 40,000) and the smallest number in 2009 (n = 28,000). A 2003 program evaluation demonstrated that smokers who received NRT through the NPGP had higher quit rates than smokers who did not receive NRT; these results were replicated in 2006 and 2008. Lessons learned from implementing the NPGP include: 1) time-limited NRT interventions are important complements to year-round NRT distribution; 2) expanding NRT distribution to light smokers increases treatment reach; and 3) employing multiple enrollment mechanisms, including telephone and online options, extends program reach to diverse groups of smokers. The NPGP provides a model for other jurisdictions considering implementing time-limited, population-based NRT programs as a complementary strategy to enhance ongoing tobacco control efforts.

Awareness and impact of New York City's graphic point-of-sale tobacco health warning signs.

BACKGROUND: To increase knowledge of smoking-related health risks and provide smoking cessation information at the point of sale, in 2009, New York City required the posting of graphic point-of-sale tobacco health warnings in tobacco retailers. This study is the first to evaluate the impact of such a policy in the USA. METHODS: Cross-sectional street-intercept surveys conducted among adult current smokers and recent quitters before and after signage implementation assessed the awareness and impact of the signs. Approximately 10 street-intercept surveys were conducted at each of 50 tobacco retailers in New York City before and after policy implementation. A total of 1007 adults who were either current smokers or recent quitters were surveyed about the awareness and impact of tobacco health warning signs. Multivariate risk ratios (RR) were calculated to estimate awareness and impact of the signs. RESULTS: Most participants (86%) were current smokers, and the sample was 28% African-American, 32% Hispanic/Latino and 27% non-Hispanic white. Awareness of tobacco health warning signs more than doubled after the policy implementation (adjusted RR =2.01, 95% CI 1.74 to 2.33). Signage posting was associated with an 11% increase in the extent to which signs made respondents think about quitting smoking (adjusted RR =1.11, 95% CI 1.01 to 1.22). CONCLUSIONS: A policy requiring tobacco retailers to display graphic health warning signs increased awareness of health risks of smoking and stimulated thoughts about quitting smoking. Additional research aimed at evaluating the effect of tobacco control measures in the retail environment is necessary to provide further rationale for implementing these changes.

Changes in smoking prevalence and number of cigarettes smoked per day following the implementation of a comprehensive tobacco control plan in New York City.

The New York City (NYC) Health Department has implemented a comprehensive tobacco control plan since 2002, and there was a 27% decline in adult smoking prevalence in NYC from 2002 to 2008. There are conflicting reports in the literature on whether residual smoker populations have a larger or smaller share of "hardcore" smokers. Changes in daily consumption and daily and nondaily smoking prevalence, common components used to define hardcore smokers, were evaluated in the context of the smoking prevalence decline. Using the NYC Community Health Survey, an annual random digit dial, cross-sectional survey that samples approximately 10,000 adults, the prevalence of current heavy daily, light daily, and nondaily smokers among NYC adults was compared between 2002 and 2008. A five-level categorical cigarettes per day (CPD) variable was also used to compare the population of smokers between the 2 years. From 2002 to 2008, significant declines were seen in the prevalence of daily smoking, heavy daily smoking, and nondaily smoking. Among daily smokers, there is also evidence of population declines in all but the lowest smoking category (one to five CPD). The mean CPD among daily smokers declined significantly, from 14.6 to 12.5. After an overall decline in smoking since 2002, the remaining smokers may be less nicotine dependent, based on changes in daily consumption and daily and nondaily smoking prevalence. These findings suggest the need to increase media and cessation efforts targeted towards lighter smokers.