Promoting calls to a quitline: quantifying the influence of message theme, strong negative emotions and graphic images in television advertisements

Hope and sadness: Balancing emotions in tobacco control mass media campaigns aimed at smokers

ISSUE ADDRESSED

Australia has smoking prevalence of less than 15% among adults, but there are concerns that the rates of decline have stabilised. Sustained mass media campaigns are central to decreasing prevalence, and the emotions evoked by campaigns contribute to their impact. This study investigates the association between potential exposure to campaigns that evoke different emotions on quitting salience (thinking about quitting), quitting intentions and quitting attempts.

METHODS

Data on quitting outcomes were obtained from weekly cross-sectional telephone surveys with adult smokers and recent quitters between 2013 and 2018. Campaign activity data were collated, and population-level potential campaign exposure was measured by time and dose.

RESULTS

Using multivariate analyses, a positive association between potential exposure to 'hope' campaigns and thinking about quitting and intending to quit was noted, but no association was seen with quit attempts. Potential exposure to 'sadness' evoking campaigns was positively associated with quitting salience and negatively associated with quit attempts, whereas those potentially exposed to campaigns evoking multiple negative emotions (fear, guilt and sadness) were approximately 30% more likely to make a quit attempt.

CONCLUSIONS

This study suggests a relationship between the emotional content of campaigns, quitting behaviours. Campaign planners should consider campaigns that evoke negative emotions for population-wide efforts to bring about quitting activity alongside hopeful campaigns that promote quitting salience and quitting intentions. The emotional content of campaigns provides an additional consideration for campaigns targeting smokers and influencing quitting activity. SO WHAT?: This study demonstrates the importance of balancing the emotional content of campaigns to ensure that campaign advertising is given the greatest chance to achieve its objectives. Utilising campaigns that evoke negative emotions appear to be needed to encourage quitting attempts but maintaining hopeful campaigns to promote thinking about quitting and intending to quit is also an important component of the mix of tobacco control campaigns.

Messaging to prevent and reduce young adults' waterpipe tobacco smoking: A randomized trial

INTRODUCTION

More than 10% of U.S. young adults have smoked waterpipe tobacco in the past month and >25% of those who have never smoked are susceptible. We tested messages designed to prevent and reduce waterpipe tobacco smoking (WTS).

METHODS

In 2020, we recruited 830 U.S. young adults (18-30 years) who had never smoked waterpipe tobacco and were susceptible or currently smoked waterpipe tobacco for an online study. We randomized participants to intervention messages about the risks of WTS or control messages unrelated to tobacco. Participants had up to four message exposures over 12 weeks and completed two-, four-, and six-month follow-ups. Outcomes were WTS initiation and curiosity (susceptible never smokers), WTS frequency, cessation, motivation to quit (those who currently smoked), and WTS risk perceptions.

RESULTS

Intervention messages increased perceived addictiveness of WTS at two months (β = 0.27; 95% CI: 0.11, 0.43) in susceptible never smokers. There were no significant intervention effects in those who currently smoked. Exploratory analyses among intervention participants showed that higher dose of message exposure decreased WTS initiation at six months in susceptible never smokers (RR = 0.68; 95% CI: 0.48, 0.96) and decreased WTS frequency (IRR = 0.84; 95% CI: 0.73, 0.97) and increased cessation (RR = 1.31; 95% CI: 1.07, 1.59) at six months in those who smoked.

CONCLUSIONS

Although the WTS intervention messages had few significant effects on outcomes overall, a higher dose of message exposure affected behavioral outcomes in the intervention arm. Findings highlight the need to identify effective message content and optimal message dose, especially for digital media campaigns.

The Association between Quitline Characteristics and Smoking Cessation by Educational Attainment, Income, Race/Ethnicity, and Sex

Little research examines how tobacco quitlines affect disparities in smoking cessation in the United States. Our study utilized data from the Tobacco Use Supplement to the Current Population Survey (2010, 2011, 2012, 2015, 2018) (TUS-CPS) and state-level quitline data from the North American Quitline Consortium and National Quitline Data Warehouse. We ran multilevel logistic regression models assessing a state-run quitline's budget, reach, number of counseling sessions offered per caller, and hours of operation on 90-day smoking cessation. Multiplicative interactions between all exposures and sex, race/ethnicity, income, and education were tested to understand potential effect modification. We found no evidence that budget, reach, number of counseling sessions, or hours available for counseling were associated with cessation in the main effects analyses. However, when looking at effect modification by sex, we found that higher budgets were associated with greater cessation in males relative to females. Further, higher budgets and offering more sessions had a stronger association with cessation among individuals with lower education, while available counseling hours were more strongly associated with cessation among those with higher education. No quitline characteristics examined were associated with smoking cessation. We found evidence for effect modification by sex and education. Despite proven efficacy at the individual-level, current resource allocation to quitlines may not be sufficient to improve rates of cessation.

The Effectiveness of Online Messages for Promoting Smoking Cessation Resources: Predicting Nationwide Campaign Effects From Neural Responses in the EX Campaign

What are the key ingredients that make some persuasive messages resonate with audiences and elicit action, while others fail? Billions of dollars per year are put towards changing human behavior, but it is difficult to know which messages will be the most persuasive in the field. By combining novel neuroimaging techniques and large-scale online data, we examine the role of key health communication variables relevant to motivating action at scale. We exposed a sample of smokers to anti-smoking web-banner messages from a real-world campaign while measuring message-evoked brain response patterns via fMRI, and we also obtained subjective evaluations of each banner. Neural indices were derived based on: (i) message-evoked activity in specific brain regions; and (ii) spatially distributed response patterns, both selected based on prior research and theoretical considerations. Next, we connected the neural and subjective data with an independent, objective outcome of message success, which is the per-banner click-through rate in the real-world campaign. Results show that messages evoking brain responses more similar to signatures of negative emotion and vividness had lower online click-through-rates. This strategy helps to connect and integrate the rapidly growing body of knowledge about brain function with formative research and outcome evaluation of health campaigns, and could ultimately further disease prevention efforts.

The Potential Impact of the New York State Smokers' Quitline on Population-Level Smoking Rates in New York

Receiving smoking cessation services from telephone quitlines significantly increases quit success compared with no intervention or other quitting methods. To affect population-level smoking, quitlines must provide a sufficient proportion of smokers with effective interventions. Nationally, quitlines reach around 1% of adult smokers annually. From 2011 through 2016, the average annual reach of the New York State Smokers' Quitline (NYSSQL) was 2.9%. We used data on the reach and cessation outcomes of NYSSQL to estimate its current impact on population-level smoking prevalence and to estimate how much reach would have to increase to achieve population-level smoking prevalence reductions. We estimate NYSSQL is associated with a 0.02 to 0.04 percentage point reduction in smoking prevalence in New York annually. If NYSSQL achieved the recommended annual reach of 8% (CDC Best Practices) and 16% (NAQC), state-level prevalence would decrease by an estimated 0.07-0.12 and 0.13-0.24 percentage points per year, respectively. To achieve those recommended levels of reach, NYSSQL would need to provide services to approximately 3.5 to 6.9 times more smokers annually. Given their reach, quitlines are limited in their ability to affect population-level smoking. Increasing quitline reach may not be feasible and would likely be cost-prohibitive. It may be necessary to re-think the role of quitlines in tobacco control efforts. In New York, the quitline is being integrated into larger efforts to promote cessation through health systems change.

Fear, Sadness and Hope: Which Emotions Maximize Impact of Anti-Tobacco Mass Media Advertisements among Lower and Higher SES Groups?

Emotive anti-tobacco advertisements can increase quitting. Discrete emotion theories suggest evoking fear may be more effective than sadness; less research has focused on hope. A weekly cross-sectional survey of smokers and recent quitters (N = 7683) measured past-month quit attempts. The main predictor was level of exposure to four different types of anti-tobacco advertisements broadcast in the two months prior to quit attempts: advertisements predominantly evoking fear, sadness, hope, or evoking multiple negative emotions (i.e., fear, guilt, and/or sadness). Greater exposure to fear-evoking advertisements (OR = 2.16, p < .01) increased odds of making a quit attempt and showed similar effectiveness among those in lower and higher SES areas. Greater exposure to advertisements evoking multiple negative emotions increased quit attempts (OR = 1.70, p < .01), but interactions indicated this was driven by those in lower SES, but not higher SES areas. Greater exposure to hope-evoking advertisements enhanced effects of fear-evoking advertisements among those in higher SES, but not lower SES areas. Findings suggest to be maximally effective across the whole population avoid messages evoking sadness and use messages eliciting fear. If the aim is to specifically motivate those living in lower SES areas where smoking rates are higher, multiple negative emotion messages, but not hope-evoking messages, may also be effective.

The Impact of a National Tobacco Education Campaign on State-Specific Quitline Calls

PURPOSE

The ads from the first federally funded national tobacco education campaign, Tips From Former Smokers (Tips), considerably increased quitline calls nationwide. This study evaluates the effect of Tips on state-specific quitline calls.

DESIGN

Precampaign, during-campaign, and postcampaign comparison; regression modeling.

SETTING

All fifty states as well as the District of Columbia.

SUBJECTS

Calls to state quitlines.

INTERVENTION

Tips.

MEASURES

Tips campaign exposure was measured by gross rating points (GRPs). Calls to quitline's 1-800-QUIT-NOW were assigned to markets in each state based on their area codes.

ANALYSIS

Multivariate regression was used to assess the relationship between calls to state quitlines and media market-level Tips GRPs, while controlling for market and area code characteristics.

RESULTS

Nationally, every 100 Tips GRPs per week at the market level was associated with an average of 45 additional quitline calls in each area code (β = 44.65, p < .001). Tips GRPs were associated with significant increases in quitline calls in 46 states and the District of Columbia, of which 11 experienced effects significantly larger than the national average and 5 experienced significantly smaller effects. We were unable to detect statistically significant effects of GRPs on call volumes for four states. Graphically, call volumes in those states followed Tips GRPs.

CONCLUSION

The Tips campaign significantly increased calls to quitlines for almost all the states. These findings underscore the effectiveness of national tobacco media campaigns for reaching state audiences.

Mass media interventions for smoking cessation in adults

BACKGROUND

Mass media tobacco control campaigns can reach large numbers of people. Much of the literature is focused on the effects of tobacco control advertising on young people, but there are also a number of evaluations of campaigns targeting adult smokers, which show mixed results. Campaigns may be local, regional or national, and may be combined with other components of a comprehensive tobacco control policy.

OBJECTIVES

To assess the effectiveness of mass media interventions in reducing smoking among adults.

SEARCH METHODS

The Cochrane Tobacco Addiction Group search strategy was combined with additional searches for any studies that referred to tobacco/smoking cessation, mass media and adults. We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) and a number of electronic databases. The last search was carried out in November 2016.

SELECTION CRITERIA

Controlled trials allocating communities, regions or states to intervention or control conditions; interrupted time series.Adults, 25 years or older, who regularly smoke cigarettes. Studies which cover all adults as defined in studies were included.Mass media are defined here as channels of communication such as television, radio, newspapers, billboards, posters, leaflets or booklets intended to reach large numbers of people, and which are not dependent on person-to-person contact. The purpose of the mass media campaign must be primarily to encourage smokers to quit. They could be carried out alone or in conjunction with tobacco control programmes.The primary outcome was change in smoking behaviour. This could be reported as changes in prevalence, changes in cigarette consumption, quit rates, or odds of being a smoker.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed all studies for inclusion criteria and for study quality (MB, LS, RTM). One author (MB) extracted data, and a second author (LS) checked them.Results were not pooled due to heterogeneity of the included studies and are presented narratively and in table form.

MAIN RESULTS

Eleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow-up, methods of evaluation and also in definitions and measures of smoking behaviour used. Among seven campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large-scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. Among the eight studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex-smokers combined.

AUTHORS' CONCLUSIONS

There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality. One state-wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign. Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme. Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney). The intensity and duration of mass media campaigns may influence effectiveness, but length of follow-up and concurrent secular trends and events can make this difficult to quantify. No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender.

Earned print media in advancing tobacco control in Himachal Pradesh, India: a descriptive study

BACKGROUND

The Union-Bloomberg Initiative tobacco control projects were implemented in Himachal Pradesh (a hilly state in North India) from 2007 to 2014. The project focused on the establishment of an administrative framework; increasing the capacity of stakeholders; enforcement of legislation; coalition and networking with multiple stakeholders; awareness generation with focus on earned media and monitoring and evaluation with policy-focussed research. This study aimed to systematically analyse all earned print news items related to the projects.

METHODS

In this cross-sectional descriptive study, quantitative content analysis of earned print news items was carried out using predetermined codes related to areas of tobacco control policies. We also carried out a cost description of the hypothetical value of this earned media. The area of the news item in cm² was multiplied by the average rate of space for the paid news item in that particular newspaper.

RESULTS

There were 6348 news items: the numbers steadily increased with time. Focus on Monitoring tobacco use, Protecting people from tobacco smoke, Offering help to quit, Warning about dangers of tobacco, Enforcing a ban on tobacco advertising and promotion, Raising tax on tobacco products was seen in 24, 17, 9, 23, 22 and 3% of news items, respectively. Press releases were highest at 44% and report by correspondents at 24%. Further, 55, 23 and 21% news items focused on smoking, smokeless and both forms of tobacco use, respectively. Sixty-six per cent and 34% news items, respectively, were focused on youth and women. The news items had a hypothetical value of US$1503 628.3, which was three times more than the funds spent on all project activities.

CONCLUSIONS

In the absence of funding for paid media, the project strategically used earned media to promote tobacco control policies in the state.

Does Digital Video Advertising Increase Population-Level Reach of Multimedia Campaigns? Evidence From the 2013 Tips From Former Smokers Campaign

Background

Federal and state public health agencies in the United States are increasingly using digital advertising and social media to promote messages from broader multimedia campaigns. However, little evidence exists on population-level campaign awareness and relative cost efficiencies of digital advertising in the context of a comprehensive public health education campaign.

Objective

Our objective was to compare the impact of increased doses of digital video and television advertising from the 2013 Tips From Former Smokers (Tips) campaign on overall campaign awareness at the population level. We also compared the relative cost efficiencies across these media platforms.

Methods

We used data from a large national online survey of approximately 15,000 US smokers conducted in 2013 immediately after the conclusion of the 2013 Tips campaign. These data were used to compare the effects of variation in media dose of digital video and television advertising on population-level awareness of the Tips campaign. We implemented higher doses of digital video among selected media markets and randomly selected other markets to receive similar higher doses of television ads. Multivariate logistic regressions estimated the odds of overall campaign awareness via digital or television format as a function of higher-dose media in each market area. All statistical tests used the .05 threshold for statistical significance and the .10 level for marginal nonsignificance. We used adjusted advertising costs for the additional doses of digital and television advertising to compare the cost efficiencies of digital and television advertising on the basis of costs per percentage point of population awareness generated.

Results

Higher-dose digital video advertising was associated with 94% increased odds of awareness of any ad online relative to standard-dose markets (P<.001). Higher-dose digital advertising was associated with a marginally nonsignificant increase (46%) in overall campaign awareness regardless of media format (P=.09). Higher-dose television advertising was associated with 81% increased odds of overall ad awareness regardless of media format (P<.001). Increased doses of television advertising were also associated with significantly higher odds of awareness of any ad on television (P<.001) and online (P=.04). The adjusted cost of each additional percentage point of population-level reach generated by higher doses of advertising was approximately US $440,000 for digital advertising and US $1 million for television advertising.

Conclusions

Television advertising generated relatively higher levels of overall campaign awareness. However, digital video was relatively more cost efficient for generating awareness. These results suggest that digital video may be used as a cost-efficient complement to traditional advertising modes (eg, television), but digital video should not replace television given the relatively smaller audience size of digital video viewers.

Association Between Media Dose, Ad Tagging, and Changes in Web Traffic for a National Tobacco Education Campaign: A Market-Level Longitudinal Study

BACKGROUND

In 2012, the US Centers for Disease Control and Prevention (CDC) launched Tips From Former Smokers (Tips), the first federally funded national tobacco education campaign. In 2013, a follow-up Tips campaign aired on national cable television networks, radio, and other channels, with supporting digital advertising to drive traffic to the Tips campaign website.

OBJECTIVE

The objective of this study was to use geographic and temporal variability in 2013 Tips campaign television media doses and ad tagging to evaluate changes in traffic to the campaign website in response to specific doses of campaign media.

METHODS

Linear regression models were used to estimate the dose-response relationship between weekly market-level television gross rating points (GRPs) and weekly Web traffic to the Tips campaign website. This relationship was measured using unique visitors, total visits, and page views as outcomes. Ad GRP effects were estimated separately for ads tagged with the Tips campaign website URL and 1-800-QUIT-NOW.

RESULTS

In the average media market, an increase of 100 television GRPs per week for ads tagged with the Tips campaign website URL was associated with an increase of 650 unique visitors (P<.001), 769 total visits (P<.001), and 1255 total page views (P<.001) per week. The associations between GRPs for ads tagged with 1-800-QUIT-NOW and each Web traffic measure were also statistically significant (P<.001), but smaller in magnitude.

CONCLUSIONS

Based on these findings, we estimate that the 16-week 2013 Tips television campaign generated approximately 660,000 unique visitors, 900,000 total visits, and 1,390,000 page views for the Tips campaign website. These findings can help campaign planners forecast the likely impact of targeted advertising efforts on consumers' use of campaign-specific websites.

Impact of Canadian tobacco packaging policy on use of a toll-free quit-smoking line: an interrupted time-series analysis

BACKGROUND

A policy for new pictorial health warning labels on tobacco packaging was introduced by Health Canada in 2012. The labels included, for the first time, a prominently displayed toll-free number for a quit-smoking line. We used data from the Ontario provincial quitline to investigate the call volume and number of new callers receiving treatment in the months before and after the new policy was introduced.

METHODS

We used an interrupted time-series analysis to examine trends in the overall call volume and number of new callers receiving treatment (≥ 1 telephone counselling session) through Ontario's quitline (Smokers' Helpline) between January 2010 and December 2013. We analyzed data using Box-Jenkins autoregressive integrated moving-average models; we adjusted the models for a major campaign promoting the quitline, a seasonality (January) effect and tobacco pricing.

RESULTS

We found a relative increase of 160% in the average monthly call volume during the 7 months after the introduction of the new labels (870 calls per month at baseline and 1391 additional calls per month on average after the policy change; standard error [SE] 108.94, p < 0.001), and a sustained increase of 43% in subsequent months. We observed a relative increase of 174% in the number of new callers receiving treatment (153 new callers per month at baseline and 267 additional new callers per month after the policy change; SE 40.03, p < 0.001) and a sustained increase of 80% in subsequent months. The effect was significant even after controlling for a major promotion campaign and the January effect.

INTERPRETATION

We found a significant increase in the monthly overall call volume and number of new callers receiving treatment per month after the introduction of the new tobacco health warning labels, with a sustained increase in overall calls and new callers beyond the first 7 months. Our findings add to the body of evidence on the benefit of including a toll-free quitline number on tobacco packaging.

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.

The effect of exposure to media campaign messages on adult cessation

INTRODUCTION

Numerous studies have examined the relationship between antitobacco mass-media campaigns and quit attempts. However, less is known about the effect of these campaigns on relapse. This paper evaluates the effect of media exposure on smokers' quit attempts and relapse.

METHODS

We used data from the Florida Adult Cohort Survey, a telephone follow-up survey of adult smokers and recent quitters, who completed the Florida Adult Tobacco Survey. For this study, 1823 unique smokers and recent quitters from baseline first observed between July 2008 and October 2012 were surveyed through up to seven follow-up interviews between October 2009 and October 2013. Media exposure during this period primarily represents exposure to Florida's Tobacco Free Florida (TFF) campaign, although it also includes exposure to the Centers for Disease Control and Prevention's Tips From Former Smokers media campaign in 2012-2013. A multiple-spell discrete-time survival model was estimated using logistic regression. Each spell represents a quit attempt or relapse event.

RESULTS

The odds of the first observed quit attempt are higher at higher levels of target rating points (TRPs) (aOR=1.02, p=0.023). The odds ratio for relapse and second quit and second relapse was not statistically significant.

CONCLUSIONS

The results suggest that exposure to media campaign messages in Florida has led to increases in quit attempts. Although the estimates were not statistically significant for relapse or the second spell of quit attempts or relapse, the results suggest that media messages might also influence subsequent quit attempts or relapses after an initial quit attempt.

Changes in Quitline Caller Characteristics During a National Tobacco Education Campaign

INTRODUCTION

The Centers for Disease Control and Prevention launched the first federally-funded national tobacco education campaign, "Tips From Former Smokers" (Tips), in 2012. This study examined changes in quitline caller characteristics, including demographics and smoking-related behaviors before and during the Tips campaign.

METHODS

Using quitline data from 20 U.S. states and the District of Columbia, we examined characteristics of 76,933 callers during the Tips campaign (March 19, 2012 to June 10, 2012) compared to 44,710 callers from a similar time period in 2011 (March 21, 2011 to June 12, 2011). We also examined whether characteristics differed by self-reported awareness of Tips during the campaign in 13 quitlines that added a Tips awareness question. Group differences were assessed using chi-square and t tests, adjusted for clustering by state.

RESULTS

Overall, few meaningful differences in caller characteristic existed, indicating broad reach of the Tips campaign across demographic groups. Compared with 2011, the number of callers during Tips increased by 72% and callers were twice as likely to hear about the quitline through television media. The proportion of uninsured callers was slightly higher during the Tips campaign than in 2011. Persons aware of the campaign were slightly more likely to be non-Hispanic Blacks, younger than age 55 years, and uninsured than those unaware of the campaign.

CONCLUSIONS

The Tips campaign increased the reach of quitline services to the general population of smokers, with increases across all demographic and tobacco use groups, but particularly among those who were uninsured. Such campaigns have the potential to increase access to cessation services for the uninsured.

Finding the keys to successful adult-targeted advertisements on obesity prevention: an experimental audience testing study

Background

Mass media communications are an important component of comprehensive interventions to address population levels of overweight and obesity, yet we have little understanding of the effective characteristics of specific advertisements (ads) on this topic. This study aimed to quantitatively test audience reactions to existing adult-focused public health television ads addressing overweight and obesity to determine which ads have the highest levels of message acceptance, argument strength, personalised perceived effectiveness and negative emotional impact.

Methods

1116 Australian adults aged 21-55 years recruited from a national online panel participated in this web-based study. Quotas were applied to achieve even numbers of males and females, those aged 21-29 years and 30-55 years, and those with a healthy weight (BMI = 18.5-24.9) and overweight/obesity (BMI = 25+). Participants were randomly assigned to view and rate four of eight ads that varied in terms of message content (health consequences, supportive/encouraging or social norms/acceptability) and execution style (graphic, simulation/animation, positive or negative testimonial, or depicted scene).

Results

Toxic fat (a graphic, health consequences ad) was the top performing ad on all four outcome measures and was significantly more likely than the other ads tested to promote strong responses in terms of message acceptance, argument strength and negative emotional impact. Measure up (a negative testimonial, health consequences ad) performed comparably on personalised perceived effectiveness. Most ads produced stronger perceptions of personalised perceived effectiveness among participants with overweight/obesity compared to participants with healthy weight. Some ads were more likely to promote strong negative emotions among participants with overweight/obesity.

Conclusions

Findings provide preliminary evidence of the most promising content and executional styles of ads that could be pursued as part of obesity prevention campaigns. Ads emphasising the negative health consequences of excess weight appear to elicit stronger cognitive and emotional responses from adults with overweight/obesity. However, careful pre-testing of these types of ads is needed prior to their inclusion in actual campaigns to ensure they do not have unintended negative impacts such as increased stigmatisation of vulnerable individuals and increased levels of body dissatisfaction and/or eating-disordered behaviour among at-risk population sub-groups.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2159-6) contains supplementary material, which is available to authorized users.

Recall of anti-tobacco advertisements and effects on quitting behavior: results from the California smokers cohort

OBJECTIVES

We assessed whether an anti-tobacco television advertisement called "Stages," which depicted a woman giving a brief emotional narrative of her experiences with tobacco use, would be recalled more often and have a greater effect on smoking cessation than 3 other advertisements with different intended themes.

METHODS

Our data were derived from a sample of 2596 California adult smokers. We used multivariable log-binomial and modified Poisson regression models to calculate respondents' probability of quitting as a result of advertisement recall.

RESULTS

More respondents recalled the "Stages" ad (58.5%) than the 3 other ads (23.1%, 23.4%, and 25.6%; P<.001). Respondents who recalled "Stages" at baseline had a higher probability than those who did not recall the ad of making a quit attempt between baseline and follow-up (adjusted risk ratio [RR]=1.18; 95% confidence interval [CI]=1.03, 1.34) and a higher probability of being in a period of smoking abstinence for at least a month at follow-up (adjusted RR=1.55; 95% CI=1.02, 2.37).

CONCLUSIONS

Anti-tobacco television advertisements that depict visceral and personal messages may be recalled by a larger percentage of smokers and may have a greater impact on smoking cessation than other types of advertisements.

Traditional and innovative promotional strategies of tobacco cessation services: a review of the literature

An estimated 43.5 million American adults currently smoke cigarettes. Well-designed tobacco education campaigns with adequate reach increase cessation and reduce tobacco use. Smokers report great interest in quitting but few use effective treatments including quitlines (QLs). This review examined traditional (TV, radio, print ads) versus innovative tobacco cessation (internet, social media) promotions for QL services. Between November 2011 and January 2012, searches were conducted on EBSCO, PubMed, Wilson, OCLC, CQ Press, Google Scholar, Gale, LexisNexis, and JSTOR. Existing literature shows that the amount of radio and print advertising, and promotion of free cessation medications increases QL call volume. Television advertising volume seems to be the best predictor of QL service awareness. Much of the literature on Internet advertising compares the characteristics of participants recruited for studies through various channels. The majority of the papers indicated that Internet-recruited participants were younger; this was the only demographic characteristic with high agreement across studies. Traditional media was only studied within mass media campaigns with TV ads having a consistent impact on increasing calls to QLs, therefore, it is hard to distinguish the impact of traditional media as an independent QL promotion intervention. With innovative media, while many QL services have a presence on social media sites, there is no literature on evaluating the effectiveness of these channels for quitline promotion.

The impact of a state-sponsored mass media campaign on use of telephone quitline and web-based cessation services

INTRODUCTION

Most US smokers do not use evidence-based interventions as part of their quit attempts. Quitlines and Web-based treatments may contribute to reductions in population-level tobacco use if successfully promoted. Currently, few states implement sustained media campaigns to promote services and increase adult smoking cessation. This study examines the effects of Florida's tobacco cessation media campaign and a nationally funded media campaign on telephone quitline and Web-based registrations for cessation services from November 2010 through September 2013.

METHODS

We conducted multivariable analyses of weekly media-market-level target rating points (TRPs) and weekly registrations for cessation services through the Florida Quitline (1-877-U-CAN-NOW) or its Web-based cessation service, Web Coach (www.quitnow.net/florida).

RESULTS

During 35 months, 141,221 tobacco users registered for cessation services through the Florida Quitline, and 53,513 registered through Web Coach. An increase in 100 weekly TRPs was associated with an increase of 7 weekly Florida Quitline registrants (β = 6.8, P < .001) and 2 Web Coach registrants (β = 1.7, P = .003) in an average media market. An increase in TRPs affected registrants from multiple demographic subgroups similarly. When state and national media campaigns aired simultaneously, approximately one-fifth of Florida's Quitline registrants came from the nationally advertised portal (1-800-QUIT-NOW).

CONCLUSION

Sustained, state-sponsored media can increase the number of registrants to telephone quitlines and Web-based cessation services. Federally funded media campaigns can further increase the reach of state-sponsored cessation services.

How does the emotive content of televised anti-smoking mass media campaigns influence monthly calls to the NHS Stop Smoking helpline in England?

OBJECTIVE

To investigate the effects of different types of televised mass media campaign content on calls to the English NHS Stop Smoking helpline.

METHOD

We used UK government-funded televised tobacco control campaigns from April 2005 to April 2010, categorised as either "positive" (eliciting happiness, satisfaction or hope) or "negative" (eliciting fear, guilt or disgust). We built negative binomial generalised additive models (GAMs) with linear and smooth terms for monthly per capita exposure to each campaign type (expressed as Gross Ratings Points, or GRPs) to determine their effect on calls in the same month. We adjusted for seasonal trends, inflation-adjusted weighted average cigarette prices and other tobacco control policies.

RESULTS

We found non-linear associations between exposure to positive and negative emotive campaigns and quitline calls. The rate of calls increased more than 50% as exposure to positive campaigns increased from 0 to 400 GRPs (rate ratio: 1.58, 95% CI: 1.25-2.01). An increase in calls in response to negative emotive campaigns was only apparent after monthly exposure exceeded 400 GRPs.

CONCLUSION

While positive campaigns were most effective at increasing quitline calls, those with negative emotive content were also found to impact on call rates but only at higher levels of exposure.

A comparison of on-pack Quitline information formats

BACKGROUND

Although tobacco packages have evolved to feature health warnings and, in Australia, dissuasive colours, the format of on-pack cessation information has not changed. We compared how alternative Quitline information formats affected smokers' perceptions and choice behaviours, and their likelihood of seeking cessation support.

METHODS

We conducted an online study comprising a choice experiment using a two (number of panels) by three (panel position: above, middle, below) plus control (current format) design, and a between-subjects comparison of a two-panel format and the control. The sample comprised 608 New Zealand smokers.

RESULTS

Relative to the current format, respondents regarded each test format as more effective in communicating cessation information (p<0.0001), particularly the two-panel formats. Respondents found the two-panel format tested via paired comparisons significantly easier to read, more visually salient and more likely than the control to encourage them and other smokers to consider quitting (all p<0.0001). Heat map comparisons showed that the Quitline number and affirming message were significantly more salient in the test format than in the current format (p<0.0001), although the headline and warning explanation were more salient in the control.

CONCLUSIONS

Reformatting Quitline information could improve its visual salience and readability and capitalise on the dissonance that pictorial warning labels and plain packaging create. Enhancing stimuli that may prompt smokers to try and quit, affirming their decision to do so and prompting the use of cessation support could increase the number and success of quit attempts.

Effectiveness of tobacco control television advertisements with different types of emotional content on tobacco use in England, 2004-2010

AIM

To examine the effects of tobacco control television advertisements with positive and negative emotional content on adult smoking prevalence and cigarette consumption.

DESIGN

Analysis of monthly cross-sectional surveys using generalised additive models.

SETTING

England.

PARTICIPANTS

60 000 adults aged 18 years or over living in England and interviewed in the Opinions and Lifestyle Survey from 2004 to 2010.

MEASUREMENTS

Current smoking status, daily cigarette consumption, tobacco control gross rating points (GRPs-a measure of per capita advertising exposure), cigarette costliness, concurrent tobacco control policies, sociodemographic variables.

RESULTS

After adjusting for cigarette costliness, other tobacco control policies and individual characteristics, we found that a 400-point increase in positive emotive GRPs was associated with 7% lower odds of smoking (odds ratio (OR) 0.93, 95% CI 0.87 to 0.98) 1 month later and a similar increase in negative emotive GRPs was significantly associated with 4% lower odds of smoking (OR 0.96, 95% CI 0.92 to 0.999) 2 months later. An increase in negative emotive GRPs from 0 to 400 was also associated with a significant 3.3% (95% CI 1.1 to 5.6) decrease in average cigarette consumption. There was no evidence that the association between positive emotive GRPs and the outcomes differed depending on the intensity of negative emotive GRPs (and vice versa).

CONCLUSIONS

This is the first study to explore the effects of campaigns with different types of emotive content on adult smoking prevalence and consumption. It suggests that both types of campaign (positive and negative) are effective in reducing smoking prevalence, whereas consumption among smokers was only affected by campaigns evoking negative emotions.

The influence of antismoking television advertisements on cessation by race/ethnicity, socioeconomic status, and mental health status

Disparities in tobacco use and smoking cessation by race/ethnicity, education, income, and mental health status remain despite recent successes in reducing tobacco use. It is unclear to what extent media campaigns promote cessation within these population groups. This study aims to (1) assess whether exposure to antitobacco advertising is associated with making a quit attempt within a number of population subgroups, and (2) determine whether advertisement type differentialy affects cessation behavior across subgroups. We used data from the New York Adult Tobacco Survey (NY-ATS), a cross-sectional, random-digit-dial telephone survey of adults aged 18 or older in New York State conducted quarterly from 2003 through 2011 (N = 53,706). The sample for this study consists of 9,408 current smokers from the total NY-ATS sample. Regression methods were used to examine the effect of New York State's antismoking advertising, overall and by advertisement type (graphic and/or emotional), on making a quit attempt in the past 12 months. Exposure to antismoking advertising was measured in two ways: gross rating points (a measure of potential exposure) and self-reported confirmed recall of advertisements. This study yields three important findings. First, antismoking advertising promotes quit attempts among racial/ethnic minority smokers and smokers of lower education and income. Second, advertising effectiveness is attributable in part to advertisements with strong graphic imagery or negative emotion. Third, smokers with poor mental health do not appear to benefit from exposure to antismoking advertising of any type. This study contributes to the evidence about how cessation media campaigns can be used most effectively to increase quit attempts within vulnerable subgroups. In particular, it suggests that a general campaign can promote cessation among a range of sociodemographic groups. More research is needed to understand what message strategies might work for those with poor mental health.

Intermediate cessation outcomes among quitline callers during a national tobacco education campaign

INTRODUCTION

From March 19 through June 10, 2012, the Centers for Disease Control and Prevention launched the first federally funded National Tobacco Education Campaign: Tips From Former Smokers (Tips). This study examined the campaign's impact on quitline callers' intermediate cessation outcomes.

METHODS

We used quitline data from 23 states to examine changes in enrollment, service utilization, quit attempts, and self-reported quitting for 7 days or longer during Tips versus a similar time period in 2011. We used multivariate models to examine the relationship between Tips exposure (measured as gross rating points [GRPs]) and cessation outcomes during the campaign in 2012. We also assessed whether the Tips campaign's impact differed by state tobacco control funding.

RESULTS

Compared with similar weeks in 2011, the number of quitline callers and callers who received counseling and/or nicotine replacement therapies increased by 88.6% (48,738 in 2011 vs. 91,911 during Tips) and 70.8% (40,546 in 2011 vs. 69,254 during Tips), respectively. Greater numbers of callers reported having made 24-hr quit attempts or quitting for 7 days or longer during the campaign. Higher Tips campaign GRPs were positively associated with quit attempts and with quitting for 7 days or longer among persons from states with higher tobacco control funding. In states with lower funding, the highest GRP group (2,000+ GRPs) had lower levels of cessation compared with the middle GRP group (1,200-1,999 GRPs).

CONCLUSIONS

An evidence-based national tobacco education campaign with adequate reach and frequency can lead to substantial increases in quitline use and, to a lesser degree, intermediate cessation outcomes.

Association between tobacco plain packaging and Quitline calls: a population-based, interrupted time-series analysis

OBJECTIVES

To investigate whether the introduction of tobacco plain packaging in Australia from 1 October 2012 was associated with a change in the number of calls to the smoking cessation helpline, Quitline, and to compare this with the impact of the introduction of graphic health warnings from 1 March 2006.

DESIGN AND SETTING

Whole-of-population interrupted time-series analysis in New South Wales and the Australian Capital Territory between 1 March 2005 and October 2006 for the comparator, graphic health warnings, and October 2011 and April 2013 for the intervention of interest, tobacco plain packaging.

MAIN OUTCOME MEASURE

Weekly number of calls to the Quitline, after adjusting for seasonal trends, anti-tobacco advertising, cigarette costliness and the number of smokers in the community.

RESULTS

There was a 78% increase in the number of calls to the Quitline associated with the introduction of plain packaging (baseline, 363/week; peak, 651/week [95% CI, 523-780/week; P < 0.001]). This peak occurred 4 weeks after the initial appearance of plain packaging and has been prolonged. The 2006 introduction of graphic health warnings had the same relative increase in calls (84%; baseline, 910/week; peak, 1673/week [95% CI, 1383-1963/week; P < 0.001]) but the impact of plain packaging has continued for longer.

CONCLUSIONS

There has been a sustained increase in calls to the Quitline after the introduction of tobacco plain packaging. This increase is not attributable to anti-tobacco advertising activity, cigarette price increases nor other identifiable causes. This is an important incremental step in comprehensive tobacco control.

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.

Telephone counselling for smoking cessation

BACKGROUND

Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines.

OBJECTIVES

To evaluate the effect of proactive and reactive telephone support via helplines and in other settings to help smokers quit.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group Specialised Register for studies of telephone counselling, using search terms including 'hotlines' or 'quitline' or 'helpline'. Date of the most recent search: May 2013.

SELECTION CRITERIA

randomized or quasi-randomised controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters.

DATA COLLECTION AND ANALYSIS

One author identified and data extracted trials, and a second author checked them. The main outcome measure was the risk ratio for abstinence from smoking after at least six months follow-up. We selected the strictest measure of abstinence, using biochemically validated rates where available. We considered participants lost to follow-up to be continuing smokers. Where trials had more than one arm with a less intensive intervention we used only the most similar intervention without the telephone component as the control group in the primary analysis. We assessed statistical heterogeneity amongst subgroups of clinically comparable studies using the I² statistic. We considered trials recruiting callers to quitlines separately from studies recruiting in other settings. Where appropriate, we pooled studies using a fixed-effect model. We used a meta-regression to investigate the effect of differences in planned number of calls, selection for motivation, and the nature of the control condition (self help only, minimal intervention, pharmacotherapy) in the group of studies recruiting in non-quitline settings.

MAIN RESULTS

Seventy-seven trials met the inclusion criteria. Some trials were judged to be at risk of bias in some domains but overall we did not judge the results to be at high risk of bias. Among smokers who contacted helplines, quit rates were higher for groups randomized to receive multiple sessions of proactive counselling (nine studies, > 24,000 participants, risk ratio (RR) for cessation at longest follow-up 1.37, 95% confidence interval (CI) 1.26 to 1.50). There was mixed evidence about whether increasing the number of calls altered quit rates but most trials used more than two calls. Three studies comparing different counselling approaches during a single quitline contact did not detect significant differences. Of three studies that tested the provision of access to a hotline two detected a significant benefit and one did not.Telephone counselling not initiated by calls to helplines also increased quitting (51 studies, > 30,000 participants, RR 1.27; 95% CI 1.20 to 1.36). In a meta-regression controlling for other factors the effect was estimated to be slightly larger if more calls were offered, and in trials that specifically recruited smokers motivated to try to quit. The relative extra benefit of counselling was smaller when it was provided in addition to pharmacotherapy (usually nicotine replacement therapy) than when the control group only received self-help material or a brief intervention.A further eight studies were too diverse to contribute to meta-analyses and are discussed separately. Two compared different intensities of counselling, both of which detected a dose response; one of these detected a benefit of multiple counselling sessions over a single call for people prescribed bupropion. The others tested a variety of interventions largely involving offering telephone counselling as part of a referral or systems change and none detected evidence of effect.

AUTHORS' CONCLUSIONS

Proactive telephone counselling aids smokers who seek help from quitlines. Telephone quitlines provide an important route of access to support for smokers, and call-back counselling enhances their usefulness. There is limited evidence about the optimal number of calls. Proactive telephone counselling also helps people who receive it in other settings. There is some evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit. Three or more calls increase the chances of quitting compared to a minimal intervention such as providing standard self-help materials, or brief advice, or compared to pharmacotherapy alone.

The impact of cessation media messages on cessation-related outcomes: results from a national experiment of smokers

PURPOSE

Examine effects of exposure to two types of cessation advertisements on changes in cessation-related outcomes.

DESIGN

Experimental data from a nationally representative, longitudinal sample of smokers, collected in three waves over 4 weeks.

SETTING

National. Subjects. Three thousand and two adult U.S. smokers aged 18+ completed baseline and follow-up interviews at 2 and 4 weeks, from December 2010 to February 2011.

INTERVENTION

Six randomly assigned conditions consisting of repeated exposure to cessation advertisements: why-to-quit advertisements featuring emotional, personal testimonies (1: WTQ-T) or graphic images (2: WTQ-G); how-to-quit advertisements (3: HTQ), a combination of both (4: WTQ-T + HTQ; 5: WTQ-G + HTQ), and no-ad condition (6: control).

MEASURES

Cessation-related beliefs, attitudes, intentions, and quitting behavior.

ANALYSIS

Multivariable ordinary least squares and logistic regressions testing whether exposure to antitobacco television advertisements were associated with changes in tobacco-related outcomes.

RESULTS

Exposure to WTQ-T or WTQ-G advertisements, both alone and combined with HTQ advertisements, elicited positive change in beliefs, attitudes, and intentions as compared to controls. Smokers in three of four WTQ conditions were substantially more likely to have quit smoking at 4 weeks than controls (odds ratios range from 5.9 to 10.1, p < .05 or better). No effects were found for the HTQ-only condition.

CONCLUSION

Exposure to WTQ advertisements markedly increases the odds that a smoker will quit in the study period, suggesting positive movement toward successful, long-term cessation. HTQ advertisements did not enhance advertising effectiveness and may not be suitable as a primary message strategy.

Televised antismoking advertising: effects of level and duration of exposure

OBJECTIVES

We assessed the effects of levels and duration of exposure to televised antismoking advertising on cognitive and behavioral changes.

METHODS

We used data from a serial cross-sectional telephone survey with weekly interviews of adult smokers and recent quitters in New South Wales, Australia (n = 13,301), between April 2005 and December 2010. We merged survey data with commercial TV ratings data to estimate individuals' exposure to antismoking advertising.

RESULTS

Logistic regression analyses indicated that after adjustment for a wide range of potential confounders, exposure to antismoking advertising at levels between 100 and 200 gross rating points per week on average over 6 to 9 weeks was associated with an increased likelihood of having (1) salient quitting thoughts and (2) recent quit attempts. Associations between exposure for shorter periods and these outcomes were not significant.

CONCLUSIONS

Broadcasting schedules may affect the success of antismoking ads. Campaign planners should ensure advertising exposure at adequate frequency over relatively sustained periods to maximize impact.

Mass media interventions for smoking cessation in adults

BACKGROUND

Mass media tobacco control campaigns can reach large numbers of people. Much of the literature is focused on the effects of tobacco control advertising on young people, but there are also a number of evaluations of campaigns targeting adult smokers, which show mixed results. Campaigns may be local, regional or national, and may be combined with other components of a comprehensive tobacco control policy.

OBJECTIVES

To assess the effectiveness of mass media interventions in reducing smoking among adults.

SEARCH METHODS

The Cochrane Tobacco Addiction Group search strategy was combined with additional searches for any studies that referred to tobacco/smoking cessation, mass media and adults. We also searched the Cochrane Register of Controlled Trials (CENTRAL) and a number of electronic databases. The last search was carried out in February 2013.

SELECTION CRITERIA

Controlled trials allocating communities, regions or states to intervention or control conditions; interrupted time series. Adults, 25 years or older, who regularly smoke cigarettes. Studies which cover all adults as defined in studies were included. Mass media are defined here as channels of communication such as television, radio, newspapers, billboards, posters, leaflets or booklets intended to reach large numbers of people, and which are not dependent on person-to-person contact. The purpose of the mass media campaign must be primarily to encourage smokers to quit. They could be carried out alone or in conjunction with tobacco control programmes. The primary outcome was change in smoking behaviour. This could be reported as changes in prevalence, changes in cigarette consumption, quit rates, odds of being a smoker.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed all studies for inclusion criteria and for study quality. One author (MB) extracted data, and a second author (LS) checked them.Results were not pooled due to heterogeneity of the included studies and are presented narratively and in table form.

MAIN RESULTS

Eleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow-up, methods of evaluation and also in definitions and measures of smoking behaviour used. Among nine campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large-scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. Among the seven studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex-smokers combined.

AUTHORS' CONCLUSIONS

There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality. One state-wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign. Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme. Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney). The intensity and duration of mass media campaigns may influence effectiveness, but length of follow-up and concurrent secular trends and events can make this difficult to quantify. No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender.

New York tobacco control program cessation assistance: costs, benefits, and effectiveness

Tobacco use and cigarette smoking have long been causally linked to a wide variety of poor health outcomes, resulting in a number of public health policy initiatives to reduce prevalence and consumption. Benefits of these initiatives, however, have not been well-established quantitatively. Using 2005–2008 New York Adult Tobacco Survey data, we developed a simulation model to estimate the effectiveness and net benefits of the New York Tobacco Control Program’s (NY TCP’s) adult smoking cessation assistance initiatives, specifically media campaigns, telephone quitline counseling, and nicotine replacement therapy. In 2008, we estimate that NY TCP generated an estimated 49,195 additional, non-relapsing adult quits (95% CI: 19,878; 87,561) for a net benefit of over $800 million (95% CI: $211 million; $1,575 million). Although the simulation results varied considerably, reflecting uncertainty in the estimates and data, and data sufficient to establish definite causality are lacking, the cessation initiatives examined appear to yield substantial societal benefits. These benefits are of sufficient magnitude to fully offset expenditures not only on these initiatives, but on NY TCP as a whole.

Do different styles of antismoking ads influence the types of smokers who call quitlines?

This study examined the relationship between television antismoking advertisements and the proportion of smokers who call a smokers' quitline who are ready to quit or have high confidence in quitting. The primary data of interest came from completed intake interviews of smokers. Using a generalized linear model, we modeled the proportion of Quitline callers who are ready to quit and/or have high confidence in quitting. The primary explanatory variable was monthly target audience rating points (TARPs) for antismoking advertisements, a measure of broadcast media exposure, obtained from the state's media buyer. The proportions of callers ready to quit and with high confidence in quitting were negatively associated with total TARPs. This result, over all ad types, was driven by why to quit-graphic ads. These results suggest that why to quit-graphic ads influence smokers who are less ready to quit or have lower confidence they can quit, likely new quitters, to call the Quitline.

The influence of television advertisements on promoting calls to telephone quitlines

The aim of the study was to assess the relative effectiveness of cessation, secondhand smoke and other tobacco control television advertisements in promoting quitlines in nine states from 2002 through 2005. Quarterly, the number of individuals who used quitlines per 10 000 adult smokers in a media market are measured. Negative binomial regression analysis was used to link caller rates to market-level exposure to tobacco control television advertisements overall and by message theme. The relationship between caller rates and advertising exposure was positive and statistically significant (P < 0.001). Advertisements that focus on promoting cessation (P < 0.001), highlighting the dangers of secondhand smoke (P = 0.037), and all other tobacco countermarketing advertisements (P = 0.027) were significantly associated with quitline caller rates. For every 10% increase in exposure to cessation, secondhand smoke and other tobacco countermarketing advertisements, caller rates increased by 1.1, 0.2 and 0.4%, respectively. Caller rates significantly increased in quarters when cigarette excise tax increased (P < 0.001) and when the percentage of the population covered by comprehensive smoke-free air laws increased (P = 0.022). Although advertisements promoting cessation are the most effective in driving quitline use, other topics, such as messages highlighting the dangers of secondhand smoke, also prompt their quitlines.

The natural history of antismoking advertising recall: the influence of broadcasting parameters, emotional intensity and executional features

BACKGROUND

The necessary first steps for televised media campaign effects are population exposure and recall. To maximise the impact of campaign funding, it is critical to identify modifiable factors that increase the efficiency of an advertisement reaching the target audience and of their recalling that advertisement.

METHODS

Data come from a serial cross-sectional telephone survey with weekly interviews of adult smokers and recent quitters from the state of New South Wales, Australia, collected between April 2005 and December 2010 (total n=13 301). Survey data were merged with commercial TV ratings data (Gross Rating Points (GRPs)) to estimate individuals' exposure to antismoking campaigns.

RESULTS

Multivariable logistic regression analyses indicated that GRPs and broadcasting recency were positively associated with advertisement recall, such that advertisements broadcast more at higher levels or in more recent weeks were more likely to be recalled. Advertisements were more likely to be recalled in their launch phase than in following periods. Controlling for broadcasting parameters, advertisements higher in emotional intensity were more likely to be recalled than those low in emotion; and emotionally intense advertisements required fewer GRPs to achieve high levels of recall than lower emotion advertisements. There was some evidence for a diminishing effect of increased GRPs on recall.

CONCLUSIONS

In order to achieve sufficient levels of population recall of antismoking campaigns, advertisements need to be broadcast at adequate levels in relatively frequent cycles. Advertisements with highly emotional content may offer the most efficient means by which to increase population recall.

Promotion of smoking cessation with emotional and/or graphic antismoking advertising

BACKGROUND

Antismoking campaigns can be effective in promoting cessation, but less is known about the dose of advertising related to behavioral change among adult smokers, which types of messages are most effective, and effects on populations disproportionately affected by tobacco use.

PURPOSE

To assess the impact of emotional and/or graphic antismoking TV advertisements on quit attempts in the past 12 months among adult smokers in New York State.

METHODS

Individual-level data come from the 2003 through 2010 New York Adult Tobacco Surveys. The influence of exposure to antismoking advertisements overall, emotional and/or graphic advertisements, and other types of advertisements on reported attempts to stop smoking was examined. Exposure was measured by self-reported confirmed recall and market-level gross rating points. Analyses conducted in Spring 2012 included 8780 smokers and were stratified by desire to quit, income, and education.

RESULTS

Both measures of exposure to antismoking advertisements are positively associated with an increased odds of making a quit attempt among all smokers, among smokers who want to quit, and among smokers in different household income brackets (<$30,000 and ≥$30,000) and education levels (high-school degree or less education and at least some college education). Exposure to emotional and/or graphic advertisements is positively associated with making quit attempts among smokers overall and by desire to quit, income, and education. Exposure to advertisements without strong negative emotions or graphic images had no effect.

CONCLUSIONS

Strongly emotional and graphic antismoking advertisements are effective in increasing population-level quit attempts among adult smokers.

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.

Self-reported exposure to policy and environmental influences on smoking cessation and relapse: a 2-year longitudinal population-based study

Although most smokers want to quit, the long-term success rate of quit attempts remains low; research is needed to understand the policy and environmental influences that can increase the success of cessation efforts. This paper uses regression methods to investigate self-reported exposure to policy and environmental influences on quit attempts, maintenance of a quit attempt for at least 6 months, and relapse in a longitudinal population-based sample, the New York Adult Cohort Survey, followed for 12 months (N = 3,261) and 24 months (N = 1,142). When policy or environmental influence variables were assessed independently of other policy or environmental influence variables, many were significant for at least some of the cessation outcomes. In the full models that included a full set of policy or environmental influence variables, many significant associations became nonsignificant. A number of policies may have an influence on multiple cessation outcomes. However, the effect varies by cessation outcome, and statistical significance is influenced by model specification.