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Lei Zhang, Katrina Vickerman, Ann Malarcher, Kelly Carpenter, Changes in Quitline Caller Characteristics During a National Tobacco Education Campaign, Nicotine & Tobacco Research, Volume 17, Issue 9, September 2015, Pages 1161–1166, https://doi.org/10.1093/ntr/ntu271
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Abstract
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.
Using quitline data from 20U.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.
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.
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.
Introduction
During March 19–June 10, 2012, the Centers for Disease Control and Prevention (CDC) aired Tips From Former Smokers (Tips) campaign, the first federally funded national tobacco education campaign in the United States.1–3 The Tips campaign featured former smokers talking about their experiences and their families’ experiences living with diseases caused by smoking and secondhand smoke exposure.2,4 While television was the primary media channel for the campaign, additional advertising via radio, digital video, online banners, and print was also used.
The campaign was intended to encourage smokers aged 18–54 years to quit and to inform them that free help was available from quitline’s national portal 1-800-QUIT-NOW, which connects callers to their states quitlines. Approximately one-third of the campaign’s television ads were tagged with the quitline number. Quitlines increase cessation and are recommended as part of comprehensive state tobacco control programs.2,5 Analyses on the number of calls to 1-800-QUIT-NOW and on intermediate cessation outcomes among quitline callers during the Tips campaign suggest that the campaign increased quitline use, quit attempts, and 7+ day quit outcomes.1,6
Although the positive effect of antismoking mass media campaigns on quitline calls has been well established,1,7–11 the extent to which these campaigns influence the types of smokers who call quitlines is uncertain. A recent study on media campaigns found that antismoking ads decreases the proportion of quitline callers who are ready to quit and the proportion with high confidence in quitting.12 In another study, precontemplators (smokers not ready to quit) were more responsive to ads depicting the negative health consequences of smoking, whereas contemplators (smokers getting ready to quit) and those in the preparation stage (smokers ready to quit) were more responsive to ads emphasizing the benefits of quitting.13 Another study observed greater increases in quitlines calls from low socioeconomic groups when more emotionally intense ads were on air.14 Knowing whether antismoking mass media campaigns change caller characteristics helps quitlines prepare for how to best assist callers during campaigns and better understand their program outcomes. Such information is also needed by media strategists to assess whether campaigns have reached their target population. To our knowledge, this study is the first to assess changes in demographics and smoking-related behaviors during a national tobacco education campaign, and also examine these characteristics by self-reported campaign awareness.
Methods
We examined caller characteristic data for 121,643 tobacco users who enrolled in phone-based cessation services through 20 state and the District of Columbia quitlines operated by Alere Wellbeing, Inc. Demographics and tobacco use history (tobacco type, amount used, dependence, Stage of Change—a measure of readiness to quit15) were obtained from callers during program registration. Motivation, confidence in quitting and number of previous quit attempts were reported at their first counseling session. All analyses focused on tobacco users aged 18+ years who enrolled in a phone cessation program offered through the quitline.
The first set of analyses examined characteristics of callers during Tips (March 19, 2012 to June 10, 2012) compared to callers from a similar time period in 2011 (March 21, 2011 to June 12, 2011). The second set of analyses focused on awareness of the Tips campaign among quitline callers in 13 states. Awareness was assessed by the question: “In the past three months, did you hear about 1-800-QUIT-NOW from any advertisements with smokers telling personal stories and tips about living with health problems?” Group differences were assessed using SAS 9.3, adjusting for clustering by state.
Results
Table 1 shows demographics for Tips callers and callers from a similar time period in 2011 as well as callers who reported campaign awareness versus those who were unaware of Tips. Overall, the number of callers during the Tips campaign increased by 72% from the same time in 2011 (76,933 vs. 44,710). No statistically significant differences were found in gender, age, race/ethnicity, preferred language, or education when comparing callers during the Tips campaign versus 2011. Small differences existed by campaign awareness. Callers who reported awareness of the campaign were more likely to be female (60.7% vs. 58.3%; p = .0002), younger (78.1% vs. 75.0% aged 18–54 years; p < .0001), non-Hispanic Black (20.2% vs. 16.6%; p < .0001), have some college or trade school education (29.9% vs. 28.2%, p < .001), and were less likely to be Spanish-speaking (3.3% vs. 5.1%; p < .0001) when compared to callers unaware of the Tips campaign. A higher proportion of callers reported chronic obstructive pulmonary disease (COPD) or emphysema (2012: 17.6%; 2011: 15.8%, p < .0001) during Tips campaign than 2011, although a lower percentage reported having this condition by campaign awareness (those who were aware of Tips: 17.9% vs. unaware of Tips: 18.9%, p = .0217). Additionally, callers who reported awareness of the campaign were more likely to have diabetes (11.8% vs. 11.3%; p = .0074) when compared to callers unaware of the Tips campaign (Table 1). A larger proportion of uninsured (43.1% vs. 39.0%; p = .04) and lower proportion of commercially insured callers (21.2% vs. 25.8%; p = .04) contacted the quitline during Tips compared to 2011. We observed similar results when we examined insurance status by campaign awareness.
Caller characteristics . | % During Tips 2012 (19 March to June 10) . | % Before Tips 2011 (21 March to June 12) . | p value . | % During Tips 2012: aware of Tips . | % During Tips 2012: unaware of Tips . | p value . |
---|---|---|---|---|---|---|
Total N | 76,933 | 44,710 | 34,080 | 17,863 | ||
Gender—Female | 59.5 | 59.5 | .97 | 60.7 | 58.3 | .0002 |
Age | ||||||
18–24 years | 9.4 | 10.0 | .12 | 9.6 | 8.7 | <.0001 |
25–54 years | 67.6 | 68.3 | 68.5 | 66.3 | ||
55+ years | 23.1 | 21.7 | 21.9 | 25.0 | ||
Race/ethnicity | ||||||
White, NH | 64.2 | 67.0 | .13 | 65.4 | 67.5 | <.0001 |
Black or African American, NH | 20.9 | 17.7 | 20.2 | 16.6 | ||
Hispanic | 8.6 | 8.0 | 8.9 | 10.3 | ||
Other, NH | 6.3 | 7.3 | 5.5 | 5.5 | ||
Language | ||||||
English | 96.7 | 97.1 | .45 | 96.7 | 94.8 | <.0001 |
Spanish | 3.3 | 2.8 | 3.3 | 5.1 | ||
Other | 0.0 | 0.1 | 0.0 | 0.0 | ||
Education | ||||||
Less than high school | 21.0 | 19.5 | .17 | 21.0 | 21.7 | <.0001 |
High school degree/GED | 36.3 | 35.6 | 36.5 | 37.1 | ||
Some college/trade school | 29.9 | 30.9 | 29.9 | 28.2 | ||
College/trade school degree | 12.8 | 14.0 | 12.7 | 13.0 | ||
Chronic conditionc | ||||||
Asthma | 18.0 | 17.7 | .65 | 17.3 | 17.2 | .7086 |
COPD/emphysema | 17.6 | 15.8 | <.0001 | 17.9 | 18.9 | .0217 |
Diabetes | 11.3 | 10.9 | .24 | 10.8 | 11.3 | .0074 |
Coronary artery disease (CAD) | 8.4 | 8.3 | .44 | 8.5 | 8.9 | .1426 |
Health insurance | ||||||
Medicare | 11.8 | 11.0 | .04 | 11.5 | 12.5 | .0114 |
Private/commercial | 21.2 | 25.8 | 19.8 | 20.4 | ||
Medicaid | 23.9 | 24.2 | 23.6 | 24.4 | ||
Uninsured | 43.1 | 39.0 | 45.1 | 42.8 |
Caller characteristics . | % During Tips 2012 (19 March to June 10) . | % Before Tips 2011 (21 March to June 12) . | p value . | % During Tips 2012: aware of Tips . | % During Tips 2012: unaware of Tips . | p value . |
---|---|---|---|---|---|---|
Total N | 76,933 | 44,710 | 34,080 | 17,863 | ||
Gender—Female | 59.5 | 59.5 | .97 | 60.7 | 58.3 | .0002 |
Age | ||||||
18–24 years | 9.4 | 10.0 | .12 | 9.6 | 8.7 | <.0001 |
25–54 years | 67.6 | 68.3 | 68.5 | 66.3 | ||
55+ years | 23.1 | 21.7 | 21.9 | 25.0 | ||
Race/ethnicity | ||||||
White, NH | 64.2 | 67.0 | .13 | 65.4 | 67.5 | <.0001 |
Black or African American, NH | 20.9 | 17.7 | 20.2 | 16.6 | ||
Hispanic | 8.6 | 8.0 | 8.9 | 10.3 | ||
Other, NH | 6.3 | 7.3 | 5.5 | 5.5 | ||
Language | ||||||
English | 96.7 | 97.1 | .45 | 96.7 | 94.8 | <.0001 |
Spanish | 3.3 | 2.8 | 3.3 | 5.1 | ||
Other | 0.0 | 0.1 | 0.0 | 0.0 | ||
Education | ||||||
Less than high school | 21.0 | 19.5 | .17 | 21.0 | 21.7 | <.0001 |
High school degree/GED | 36.3 | 35.6 | 36.5 | 37.1 | ||
Some college/trade school | 29.9 | 30.9 | 29.9 | 28.2 | ||
College/trade school degree | 12.8 | 14.0 | 12.7 | 13.0 | ||
Chronic conditionc | ||||||
Asthma | 18.0 | 17.7 | .65 | 17.3 | 17.2 | .7086 |
COPD/emphysema | 17.6 | 15.8 | <.0001 | 17.9 | 18.9 | .0217 |
Diabetes | 11.3 | 10.9 | .24 | 10.8 | 11.3 | .0074 |
Coronary artery disease (CAD) | 8.4 | 8.3 | .44 | 8.5 | 8.9 | .1426 |
Health insurance | ||||||
Medicare | 11.8 | 11.0 | .04 | 11.5 | 12.5 | .0114 |
Private/commercial | 21.2 | 25.8 | 19.8 | 20.4 | ||
Medicaid | 23.9 | 24.2 | 23.6 | 24.4 | ||
Uninsured | 43.1 | 39.0 | 45.1 | 42.8 |
COPD = Chronic Obstructive Pulmonary Disease; GED = General Education Development; N = number of callers; NH = non-Hispanic. Responses of “refused” and “don’t know” excluded from analyses.
aParticipating state quitlines included Alaska, Arkansas, Connecticut, Delaware, Florida, Georgia, Hawaii, Indiana, Kansas, Louisiana, Maryland, Missouri, Nebraska, New Jersey, North Carolina, Oklahoma, Oregon, Texas, Vermont, and Wisconsin, as well as the District of Columbia quitline.
bCampaign awareness was assessed among callers from 13 state quitlines who called during the Tips campaign: Arkansas, Delaware, Florida, Georgia, Indiana, Kansas, Maryland, Missouri, Nebraska, Oklahoma, Iowa, Texas, and Vermont.
cThree of the 22 states asked about Chronic Bronchitis (instead of COPD) and Heart Disease and Heart Attack (instead of CAD). For these 3 states, if a participant endorsed Chronic Bronchitis, Heart Disease, or Heart Attack, their response was included as an endorsement for COPD or CAD, as appropriate.
Caller characteristics . | % During Tips 2012 (19 March to June 10) . | % Before Tips 2011 (21 March to June 12) . | p value . | % During Tips 2012: aware of Tips . | % During Tips 2012: unaware of Tips . | p value . |
---|---|---|---|---|---|---|
Total N | 76,933 | 44,710 | 34,080 | 17,863 | ||
Gender—Female | 59.5 | 59.5 | .97 | 60.7 | 58.3 | .0002 |
Age | ||||||
18–24 years | 9.4 | 10.0 | .12 | 9.6 | 8.7 | <.0001 |
25–54 years | 67.6 | 68.3 | 68.5 | 66.3 | ||
55+ years | 23.1 | 21.7 | 21.9 | 25.0 | ||
Race/ethnicity | ||||||
White, NH | 64.2 | 67.0 | .13 | 65.4 | 67.5 | <.0001 |
Black or African American, NH | 20.9 | 17.7 | 20.2 | 16.6 | ||
Hispanic | 8.6 | 8.0 | 8.9 | 10.3 | ||
Other, NH | 6.3 | 7.3 | 5.5 | 5.5 | ||
Language | ||||||
English | 96.7 | 97.1 | .45 | 96.7 | 94.8 | <.0001 |
Spanish | 3.3 | 2.8 | 3.3 | 5.1 | ||
Other | 0.0 | 0.1 | 0.0 | 0.0 | ||
Education | ||||||
Less than high school | 21.0 | 19.5 | .17 | 21.0 | 21.7 | <.0001 |
High school degree/GED | 36.3 | 35.6 | 36.5 | 37.1 | ||
Some college/trade school | 29.9 | 30.9 | 29.9 | 28.2 | ||
College/trade school degree | 12.8 | 14.0 | 12.7 | 13.0 | ||
Chronic conditionc | ||||||
Asthma | 18.0 | 17.7 | .65 | 17.3 | 17.2 | .7086 |
COPD/emphysema | 17.6 | 15.8 | <.0001 | 17.9 | 18.9 | .0217 |
Diabetes | 11.3 | 10.9 | .24 | 10.8 | 11.3 | .0074 |
Coronary artery disease (CAD) | 8.4 | 8.3 | .44 | 8.5 | 8.9 | .1426 |
Health insurance | ||||||
Medicare | 11.8 | 11.0 | .04 | 11.5 | 12.5 | .0114 |
Private/commercial | 21.2 | 25.8 | 19.8 | 20.4 | ||
Medicaid | 23.9 | 24.2 | 23.6 | 24.4 | ||
Uninsured | 43.1 | 39.0 | 45.1 | 42.8 |
Caller characteristics . | % During Tips 2012 (19 March to June 10) . | % Before Tips 2011 (21 March to June 12) . | p value . | % During Tips 2012: aware of Tips . | % During Tips 2012: unaware of Tips . | p value . |
---|---|---|---|---|---|---|
Total N | 76,933 | 44,710 | 34,080 | 17,863 | ||
Gender—Female | 59.5 | 59.5 | .97 | 60.7 | 58.3 | .0002 |
Age | ||||||
18–24 years | 9.4 | 10.0 | .12 | 9.6 | 8.7 | <.0001 |
25–54 years | 67.6 | 68.3 | 68.5 | 66.3 | ||
55+ years | 23.1 | 21.7 | 21.9 | 25.0 | ||
Race/ethnicity | ||||||
White, NH | 64.2 | 67.0 | .13 | 65.4 | 67.5 | <.0001 |
Black or African American, NH | 20.9 | 17.7 | 20.2 | 16.6 | ||
Hispanic | 8.6 | 8.0 | 8.9 | 10.3 | ||
Other, NH | 6.3 | 7.3 | 5.5 | 5.5 | ||
Language | ||||||
English | 96.7 | 97.1 | .45 | 96.7 | 94.8 | <.0001 |
Spanish | 3.3 | 2.8 | 3.3 | 5.1 | ||
Other | 0.0 | 0.1 | 0.0 | 0.0 | ||
Education | ||||||
Less than high school | 21.0 | 19.5 | .17 | 21.0 | 21.7 | <.0001 |
High school degree/GED | 36.3 | 35.6 | 36.5 | 37.1 | ||
Some college/trade school | 29.9 | 30.9 | 29.9 | 28.2 | ||
College/trade school degree | 12.8 | 14.0 | 12.7 | 13.0 | ||
Chronic conditionc | ||||||
Asthma | 18.0 | 17.7 | .65 | 17.3 | 17.2 | .7086 |
COPD/emphysema | 17.6 | 15.8 | <.0001 | 17.9 | 18.9 | .0217 |
Diabetes | 11.3 | 10.9 | .24 | 10.8 | 11.3 | .0074 |
Coronary artery disease (CAD) | 8.4 | 8.3 | .44 | 8.5 | 8.9 | .1426 |
Health insurance | ||||||
Medicare | 11.8 | 11.0 | .04 | 11.5 | 12.5 | .0114 |
Private/commercial | 21.2 | 25.8 | 19.8 | 20.4 | ||
Medicaid | 23.9 | 24.2 | 23.6 | 24.4 | ||
Uninsured | 43.1 | 39.0 | 45.1 | 42.8 |
COPD = Chronic Obstructive Pulmonary Disease; GED = General Education Development; N = number of callers; NH = non-Hispanic. Responses of “refused” and “don’t know” excluded from analyses.
aParticipating state quitlines included Alaska, Arkansas, Connecticut, Delaware, Florida, Georgia, Hawaii, Indiana, Kansas, Louisiana, Maryland, Missouri, Nebraska, New Jersey, North Carolina, Oklahoma, Oregon, Texas, Vermont, and Wisconsin, as well as the District of Columbia quitline.
bCampaign awareness was assessed among callers from 13 state quitlines who called during the Tips campaign: Arkansas, Delaware, Florida, Georgia, Indiana, Kansas, Maryland, Missouri, Nebraska, Oklahoma, Iowa, Texas, and Vermont.
cThree of the 22 states asked about Chronic Bronchitis (instead of COPD) and Heart Disease and Heart Attack (instead of CAD). For these 3 states, if a participant endorsed Chronic Bronchitis, Heart Disease, or Heart Attack, their response was included as an endorsement for COPD or CAD, as appropriate.
Table 2 presents differences in how callers heard about the quitline and their tobacco use characteristics. Proportionally more callers reported they heard about the quitline through TV media (45.6% vs. 18.5%; p < .0001) in 2012 versus 2011. Similar results were observed by campaign awareness. Fewer callers reported smokeless tobacco use during Tips (2012: 2.3% vs. 2011: 3.1%; p < .0001) or among those reporting awareness of Tips (2.2% vs. those who were unaware of Tips: 2.6%, p = .0036). Slightly larger proportions of callers reported using cigar, pipe or other tobacco products during Tips than 2011. Small differences existed in the proportion of cigarette smokers by Tips awareness (96.9% aware vs. 96.4% unaware; p < .0001). Among cigarette smokers, the proportion of callers who had already stopped smoking was lower during the Tips campaign than in 2011 (2.8% vs. 4.2%; p < .0001). Comparing Tips versus 2011, a slightly higher percentage of callers were ready to set a quit date in the next 30 days (i.e., Preparation Stage of Change; 92.3% vs. 90.2%, p < .0001), whereas a lower percentage had already quit for 24hr (but less than 6 months) at program registration (i.e., Action Stage of Change; 5.8% vs. 7.4%; p < .0001). Similar results were observed by campaign awareness. We did not find any differences in cigarettes smoked per day or nicotine dependence level by time periods or reported Tips awareness (Table 2). When comparing callers during Tips to callers in 2011, a lower proportion had previously called the quitline in the past year (4.4% vs. 6.5%; p < .0001). However, no significant differences were observed by campaign awareness (Table 2).
Caller characteristics . | % During Tips 2012 (19 March to June 10) . | % Before Tips 2011 (21 March to June 12) . | p value . | % During Tips 2012: aware of Tips . | % During Tips 2012: unaware of Tips . | p value . |
---|---|---|---|---|---|---|
Total N | 76,933 | 44,710 | 34,080 | 17,863 | ||
How heard aboutc | ||||||
Media—TV | 45.6 | 18.5 | <.0001 | 57.5 | 32.1 | <.0001 |
Referral | 34.1 | 55.5 | 26.2 | 42.7 | ||
Media—other media | 10.4 | 9.4 | 9.3 | 14.0 | ||
Other advertising | 4.9 | 7.7 | 3.2 | 5.1 | ||
Other | 5.1 | 8.8 | 3.8 | 6.2 | ||
Tobacco type reported at enrollment | ||||||
Cigarette | 96.7 | 96.4 | .44 | 96.9 | 96.4 | .0164 |
Cigar | 4.1 | 3.4 | <.0001 | 4.4 | 4.3 | .3208 |
Smokeless tobacco (SLT) | 2.3 | 3.1 | <.0001 | 2.2 | 2.6 | .0036 |
Pipe | 0.4 | 0.3 | .01 | 0.3 | 0.4 | .5614 |
Other | 0.4 | 0.3 | <.0001 | 0.4 | 0.4 | .6165 |
Current cigarette use frequency | ||||||
Every day | 94.8 | 93.2 | <.0001 | 95.5 | 94.5 | .0003 |
Some days | 2.4 | 2.6 | 2.2 | 2.2 | ||
Not at all | 2.8 | 4.2 | 2.3 | 3.2 | ||
Stage of changed | ||||||
Precontemplation | 0.1 | 0.2 | <.0001 | 0.1 | 0.1 | <.0001 |
Contemplation | 1.6 | 2.0 | 1.4 | 1.5 | ||
Preparation | 92.3 | 90.2 | 93.4 | 92.2 | ||
Action | 5.8 | 7.4 | 5.1 | 6.0 | ||
Maintenance | 0.1 | 0.1 | 0.1 | 0.2 | ||
Cigarettes per day—Mean ± (SD) | 19.1 ± (11.5) | 18.9 ± (11.6) | .49 | 19.6 ± (11.3) | 19.7 ± (12.0) | .29 |
Dependence (time to first tobacco use after waking) | ||||||
Within 5 min | 50.6 | 50.1 | .75 | 9.9 | 9.6 | .4867 |
6–30 min | 30.1 | 29.7 | 30.1 | 30.1 | ||
31–60 min | 9.7 | 10.1 | 50.4 | 50.9 | ||
More than 60 min | 9.6 | 10.2 | 9.5 | 9.4 | ||
Called in previous 12 months | 4.4 | 6.5 | <.0001 | 4.2 | 4.3 | .7875 |
Variables assessed during intervention: limited to callers who completed a coaching call | ||||||
Total N | 63,940 | 39,196 | 28,704 | 14,954 | ||
Previous quit attempts | ||||||
0 attempts | 10.1 | 10.5 | .006 | 10.1 | 10.2 | .49 |
1 attempt | 21.5 | 22.1 | 21.9 | 22.5 | ||
2–5 attempts | 50.7 | 50.5 | 50.8 | 50.3 | ||
6+ attempts | 17.7 | 16.9 | 17.2 | 17.1 | ||
Motivation to quit—Mean ± (SD) | 8.8 ± (1.6) | 8.8 ± (1.6) | .40 | 8.9 ± (1.5) | 8.8 ± (1.6) | .0253 |
Low (1–5) | 5.2 | 5.4 | .62 | 4.6 | 5.1 | .005 |
Moderate (6–8) | 30.5 | 30.8 | 29.7 | 30.4 | ||
High (9–10) | 64.3 | 63.9 | 65.7 | 64.6 | ||
Confidence to quit—Mean ± (SD) | 7.8 ± (2.2) | 7.9 ± (2.1) | .33 | 7.9 ± (2.2) | 7.9 ± (2.2) | .4812 |
Low (1–5) | 18.3 | 17.2 | .11 | 17.7 | 18.3 | .35 |
Moderate (6–8) | 36.2 | 37.1 | 36.2 | 35.6 | ||
High (9–10) | 45.5 | 45.7 | 46.2 | 46.1 |
Caller characteristics . | % During Tips 2012 (19 March to June 10) . | % Before Tips 2011 (21 March to June 12) . | p value . | % During Tips 2012: aware of Tips . | % During Tips 2012: unaware of Tips . | p value . |
---|---|---|---|---|---|---|
Total N | 76,933 | 44,710 | 34,080 | 17,863 | ||
How heard aboutc | ||||||
Media—TV | 45.6 | 18.5 | <.0001 | 57.5 | 32.1 | <.0001 |
Referral | 34.1 | 55.5 | 26.2 | 42.7 | ||
Media—other media | 10.4 | 9.4 | 9.3 | 14.0 | ||
Other advertising | 4.9 | 7.7 | 3.2 | 5.1 | ||
Other | 5.1 | 8.8 | 3.8 | 6.2 | ||
Tobacco type reported at enrollment | ||||||
Cigarette | 96.7 | 96.4 | .44 | 96.9 | 96.4 | .0164 |
Cigar | 4.1 | 3.4 | <.0001 | 4.4 | 4.3 | .3208 |
Smokeless tobacco (SLT) | 2.3 | 3.1 | <.0001 | 2.2 | 2.6 | .0036 |
Pipe | 0.4 | 0.3 | .01 | 0.3 | 0.4 | .5614 |
Other | 0.4 | 0.3 | <.0001 | 0.4 | 0.4 | .6165 |
Current cigarette use frequency | ||||||
Every day | 94.8 | 93.2 | <.0001 | 95.5 | 94.5 | .0003 |
Some days | 2.4 | 2.6 | 2.2 | 2.2 | ||
Not at all | 2.8 | 4.2 | 2.3 | 3.2 | ||
Stage of changed | ||||||
Precontemplation | 0.1 | 0.2 | <.0001 | 0.1 | 0.1 | <.0001 |
Contemplation | 1.6 | 2.0 | 1.4 | 1.5 | ||
Preparation | 92.3 | 90.2 | 93.4 | 92.2 | ||
Action | 5.8 | 7.4 | 5.1 | 6.0 | ||
Maintenance | 0.1 | 0.1 | 0.1 | 0.2 | ||
Cigarettes per day—Mean ± (SD) | 19.1 ± (11.5) | 18.9 ± (11.6) | .49 | 19.6 ± (11.3) | 19.7 ± (12.0) | .29 |
Dependence (time to first tobacco use after waking) | ||||||
Within 5 min | 50.6 | 50.1 | .75 | 9.9 | 9.6 | .4867 |
6–30 min | 30.1 | 29.7 | 30.1 | 30.1 | ||
31–60 min | 9.7 | 10.1 | 50.4 | 50.9 | ||
More than 60 min | 9.6 | 10.2 | 9.5 | 9.4 | ||
Called in previous 12 months | 4.4 | 6.5 | <.0001 | 4.2 | 4.3 | .7875 |
Variables assessed during intervention: limited to callers who completed a coaching call | ||||||
Total N | 63,940 | 39,196 | 28,704 | 14,954 | ||
Previous quit attempts | ||||||
0 attempts | 10.1 | 10.5 | .006 | 10.1 | 10.2 | .49 |
1 attempt | 21.5 | 22.1 | 21.9 | 22.5 | ||
2–5 attempts | 50.7 | 50.5 | 50.8 | 50.3 | ||
6+ attempts | 17.7 | 16.9 | 17.2 | 17.1 | ||
Motivation to quit—Mean ± (SD) | 8.8 ± (1.6) | 8.8 ± (1.6) | .40 | 8.9 ± (1.5) | 8.8 ± (1.6) | .0253 |
Low (1–5) | 5.2 | 5.4 | .62 | 4.6 | 5.1 | .005 |
Moderate (6–8) | 30.5 | 30.8 | 29.7 | 30.4 | ||
High (9–10) | 64.3 | 63.9 | 65.7 | 64.6 | ||
Confidence to quit—Mean ± (SD) | 7.8 ± (2.2) | 7.9 ± (2.1) | .33 | 7.9 ± (2.2) | 7.9 ± (2.2) | .4812 |
Low (1–5) | 18.3 | 17.2 | .11 | 17.7 | 18.3 | .35 |
Moderate (6–8) | 36.2 | 37.1 | 36.2 | 35.6 | ||
High (9–10) | 45.5 | 45.7 | 46.2 | 46.1 |
Responses of “refused” and “don’t know” excluded from analyses; N = number of callers.
aParticipating state quitlines included Alaska, Arkansas, Connecticut, Delaware, Florida, Georgia, Hawaii, Indiana, Kansas, Louisiana, Maryland, Missouri, Nebraska, New Jersey, North Carolina, Oklahoma, Oregon, Texas, Vermont, and Wisconsin, as well as the District of Columbia quitline.
bCampaign awareness was assessed among callers from 13 state quitlines who called during the Tips campaign: Arkansas, Delaware, Florida, Georgia, Indiana, Kansas, Maryland, Missouri, Nebraska, Oklahoma, Iowa, Texas, and Vermont.
c“Media—other” includes newspaper, radio, and internet/web. “Other advertising” includes flyers and brochures. “Referral” includes referral from health professionals, family/friends, workplace, health insurance, or community organizations. Responses that could not be categorized were classified as “Other.”
dProchaska and DiClemente. 15 Precontemplators: not ready to set a quit date within the next 6 months; Contemplators: ready to set a quit date within the next 6 months, but not within the next 30 days; Preparation: ready to set a quit date within the next 30 days; Action: quit for 24hr or more (but less than 6 months); Maintenance: quit for 6 months or more.
Caller characteristics . | % During Tips 2012 (19 March to June 10) . | % Before Tips 2011 (21 March to June 12) . | p value . | % During Tips 2012: aware of Tips . | % During Tips 2012: unaware of Tips . | p value . |
---|---|---|---|---|---|---|
Total N | 76,933 | 44,710 | 34,080 | 17,863 | ||
How heard aboutc | ||||||
Media—TV | 45.6 | 18.5 | <.0001 | 57.5 | 32.1 | <.0001 |
Referral | 34.1 | 55.5 | 26.2 | 42.7 | ||
Media—other media | 10.4 | 9.4 | 9.3 | 14.0 | ||
Other advertising | 4.9 | 7.7 | 3.2 | 5.1 | ||
Other | 5.1 | 8.8 | 3.8 | 6.2 | ||
Tobacco type reported at enrollment | ||||||
Cigarette | 96.7 | 96.4 | .44 | 96.9 | 96.4 | .0164 |
Cigar | 4.1 | 3.4 | <.0001 | 4.4 | 4.3 | .3208 |
Smokeless tobacco (SLT) | 2.3 | 3.1 | <.0001 | 2.2 | 2.6 | .0036 |
Pipe | 0.4 | 0.3 | .01 | 0.3 | 0.4 | .5614 |
Other | 0.4 | 0.3 | <.0001 | 0.4 | 0.4 | .6165 |
Current cigarette use frequency | ||||||
Every day | 94.8 | 93.2 | <.0001 | 95.5 | 94.5 | .0003 |
Some days | 2.4 | 2.6 | 2.2 | 2.2 | ||
Not at all | 2.8 | 4.2 | 2.3 | 3.2 | ||
Stage of changed | ||||||
Precontemplation | 0.1 | 0.2 | <.0001 | 0.1 | 0.1 | <.0001 |
Contemplation | 1.6 | 2.0 | 1.4 | 1.5 | ||
Preparation | 92.3 | 90.2 | 93.4 | 92.2 | ||
Action | 5.8 | 7.4 | 5.1 | 6.0 | ||
Maintenance | 0.1 | 0.1 | 0.1 | 0.2 | ||
Cigarettes per day—Mean ± (SD) | 19.1 ± (11.5) | 18.9 ± (11.6) | .49 | 19.6 ± (11.3) | 19.7 ± (12.0) | .29 |
Dependence (time to first tobacco use after waking) | ||||||
Within 5 min | 50.6 | 50.1 | .75 | 9.9 | 9.6 | .4867 |
6–30 min | 30.1 | 29.7 | 30.1 | 30.1 | ||
31–60 min | 9.7 | 10.1 | 50.4 | 50.9 | ||
More than 60 min | 9.6 | 10.2 | 9.5 | 9.4 | ||
Called in previous 12 months | 4.4 | 6.5 | <.0001 | 4.2 | 4.3 | .7875 |
Variables assessed during intervention: limited to callers who completed a coaching call | ||||||
Total N | 63,940 | 39,196 | 28,704 | 14,954 | ||
Previous quit attempts | ||||||
0 attempts | 10.1 | 10.5 | .006 | 10.1 | 10.2 | .49 |
1 attempt | 21.5 | 22.1 | 21.9 | 22.5 | ||
2–5 attempts | 50.7 | 50.5 | 50.8 | 50.3 | ||
6+ attempts | 17.7 | 16.9 | 17.2 | 17.1 | ||
Motivation to quit—Mean ± (SD) | 8.8 ± (1.6) | 8.8 ± (1.6) | .40 | 8.9 ± (1.5) | 8.8 ± (1.6) | .0253 |
Low (1–5) | 5.2 | 5.4 | .62 | 4.6 | 5.1 | .005 |
Moderate (6–8) | 30.5 | 30.8 | 29.7 | 30.4 | ||
High (9–10) | 64.3 | 63.9 | 65.7 | 64.6 | ||
Confidence to quit—Mean ± (SD) | 7.8 ± (2.2) | 7.9 ± (2.1) | .33 | 7.9 ± (2.2) | 7.9 ± (2.2) | .4812 |
Low (1–5) | 18.3 | 17.2 | .11 | 17.7 | 18.3 | .35 |
Moderate (6–8) | 36.2 | 37.1 | 36.2 | 35.6 | ||
High (9–10) | 45.5 | 45.7 | 46.2 | 46.1 |
Caller characteristics . | % During Tips 2012 (19 March to June 10) . | % Before Tips 2011 (21 March to June 12) . | p value . | % During Tips 2012: aware of Tips . | % During Tips 2012: unaware of Tips . | p value . |
---|---|---|---|---|---|---|
Total N | 76,933 | 44,710 | 34,080 | 17,863 | ||
How heard aboutc | ||||||
Media—TV | 45.6 | 18.5 | <.0001 | 57.5 | 32.1 | <.0001 |
Referral | 34.1 | 55.5 | 26.2 | 42.7 | ||
Media—other media | 10.4 | 9.4 | 9.3 | 14.0 | ||
Other advertising | 4.9 | 7.7 | 3.2 | 5.1 | ||
Other | 5.1 | 8.8 | 3.8 | 6.2 | ||
Tobacco type reported at enrollment | ||||||
Cigarette | 96.7 | 96.4 | .44 | 96.9 | 96.4 | .0164 |
Cigar | 4.1 | 3.4 | <.0001 | 4.4 | 4.3 | .3208 |
Smokeless tobacco (SLT) | 2.3 | 3.1 | <.0001 | 2.2 | 2.6 | .0036 |
Pipe | 0.4 | 0.3 | .01 | 0.3 | 0.4 | .5614 |
Other | 0.4 | 0.3 | <.0001 | 0.4 | 0.4 | .6165 |
Current cigarette use frequency | ||||||
Every day | 94.8 | 93.2 | <.0001 | 95.5 | 94.5 | .0003 |
Some days | 2.4 | 2.6 | 2.2 | 2.2 | ||
Not at all | 2.8 | 4.2 | 2.3 | 3.2 | ||
Stage of changed | ||||||
Precontemplation | 0.1 | 0.2 | <.0001 | 0.1 | 0.1 | <.0001 |
Contemplation | 1.6 | 2.0 | 1.4 | 1.5 | ||
Preparation | 92.3 | 90.2 | 93.4 | 92.2 | ||
Action | 5.8 | 7.4 | 5.1 | 6.0 | ||
Maintenance | 0.1 | 0.1 | 0.1 | 0.2 | ||
Cigarettes per day—Mean ± (SD) | 19.1 ± (11.5) | 18.9 ± (11.6) | .49 | 19.6 ± (11.3) | 19.7 ± (12.0) | .29 |
Dependence (time to first tobacco use after waking) | ||||||
Within 5 min | 50.6 | 50.1 | .75 | 9.9 | 9.6 | .4867 |
6–30 min | 30.1 | 29.7 | 30.1 | 30.1 | ||
31–60 min | 9.7 | 10.1 | 50.4 | 50.9 | ||
More than 60 min | 9.6 | 10.2 | 9.5 | 9.4 | ||
Called in previous 12 months | 4.4 | 6.5 | <.0001 | 4.2 | 4.3 | .7875 |
Variables assessed during intervention: limited to callers who completed a coaching call | ||||||
Total N | 63,940 | 39,196 | 28,704 | 14,954 | ||
Previous quit attempts | ||||||
0 attempts | 10.1 | 10.5 | .006 | 10.1 | 10.2 | .49 |
1 attempt | 21.5 | 22.1 | 21.9 | 22.5 | ||
2–5 attempts | 50.7 | 50.5 | 50.8 | 50.3 | ||
6+ attempts | 17.7 | 16.9 | 17.2 | 17.1 | ||
Motivation to quit—Mean ± (SD) | 8.8 ± (1.6) | 8.8 ± (1.6) | .40 | 8.9 ± (1.5) | 8.8 ± (1.6) | .0253 |
Low (1–5) | 5.2 | 5.4 | .62 | 4.6 | 5.1 | .005 |
Moderate (6–8) | 30.5 | 30.8 | 29.7 | 30.4 | ||
High (9–10) | 64.3 | 63.9 | 65.7 | 64.6 | ||
Confidence to quit—Mean ± (SD) | 7.8 ± (2.2) | 7.9 ± (2.1) | .33 | 7.9 ± (2.2) | 7.9 ± (2.2) | .4812 |
Low (1–5) | 18.3 | 17.2 | .11 | 17.7 | 18.3 | .35 |
Moderate (6–8) | 36.2 | 37.1 | 36.2 | 35.6 | ||
High (9–10) | 45.5 | 45.7 | 46.2 | 46.1 |
Responses of “refused” and “don’t know” excluded from analyses; N = number of callers.
aParticipating state quitlines included Alaska, Arkansas, Connecticut, Delaware, Florida, Georgia, Hawaii, Indiana, Kansas, Louisiana, Maryland, Missouri, Nebraska, New Jersey, North Carolina, Oklahoma, Oregon, Texas, Vermont, and Wisconsin, as well as the District of Columbia quitline.
bCampaign awareness was assessed among callers from 13 state quitlines who called during the Tips campaign: Arkansas, Delaware, Florida, Georgia, Indiana, Kansas, Maryland, Missouri, Nebraska, Oklahoma, Iowa, Texas, and Vermont.
c“Media—other” includes newspaper, radio, and internet/web. “Other advertising” includes flyers and brochures. “Referral” includes referral from health professionals, family/friends, workplace, health insurance, or community organizations. Responses that could not be categorized were classified as “Other.”
dProchaska and DiClemente. 15 Precontemplators: not ready to set a quit date within the next 6 months; Contemplators: ready to set a quit date within the next 6 months, but not within the next 30 days; Preparation: ready to set a quit date within the next 30 days; Action: quit for 24hr or more (but less than 6 months); Maintenance: quit for 6 months or more.
Among callers who completed at least one counseling call, callers during the Tips campaign reported greater numbers of past quit attempts (2012: 17.7% vs. 2011: 16.9% had 6+ past quit attempts; p = .006) (Table 2). No significant differences were observed by campaign awareness. In addition, those who were aware of the campaign reported higher motivation to quit (65.7% of those aware vs. 64.6% unaware reported a high level of motivation; p = .005). This difference was not significant in the comparison of time periods. No differences were observed in callers’ confidence to quit in either analysis (Table 2).
Discussion
The number of quitline callers who enrolled in phone counseling during the 2012 Tips campaign in these 20 states and District of Columbia increased by 72% compared to a similar time period in 2011. Most statistically significant differences we observed in caller characteristics were small and were likely due to the large number of quitline callers in this analysis. This study confirmed that the markedly increased reach during the Tips campaign1,2,6 was evident across all subpopulations of callers.
Calls from uninsured persons increased during Tips compared to the same time in 2011. We found similar results by Tips campaign awareness among those who called the quitlines during the campaign. Persons without insurance typically lack access to health information and care.16 Tips may have provided them with critical information about the health effects of smoking and a free cessation resource that prompted them to make a quit attempt.
Sixty-six percent of quitline callers during the Tips campaign reported that they had heard about the ads from TV. This finding may be due to the campaign’s utilization of television to drive calls to quitlines since the tagging of ads with 1-800-QUIT NOW occurred primarily on TV. Studies have shown that both heavy TV viewing and smoking are common among groups with lower socioeconomic status.17 Despite alternative technologies, TV continues to be a powerful medium for reaching smokers who traditionally have had limited access to health information.2
Callers during the campaign were less likely to use smokeless tobacco and this may be because no Tips ads targeted smokeless tobacco use. It may be important for future targeted campaigns to include education on the benefits of counseling for smokeless tobacco users.18 No differences were observed in the number of cigarettes smoked, nicotine dependence level, or confidence to quit smoking, suggesting that Tips continued to drive moderate to heavy smokers who were moderately or highly confident in quitting to quitlines.
With respect to Stage of Change,15 we found that tobacco users who enrolled during the Tips campaign were slightly less likely to have already quit for at least 24hr (but less than 6 months), indicating that Tips prompted tobacco users to engage in quitline services who may have been ready to quit but had not already taken action. This is consistent with other studies that show smokers who are not as far along the readiness-to-quit continuum15 tend to be more responsive to antismoking media campaigns.12
Important limitations should be considered when interpreting these results. First, we did not control for factors other than Tips that may have influenced quitline caller characteristics during this period. To address this concern, we performed a LexisNexis search that provided no evidence of other large-scale media campaigns that were likely to produce a national impact during the Tips period. In addition, only four states (New Hampshire, Vermont, Connecticut, and Hawaii) changed their excise tax rates between the two comparison periods and no changes in smoke-free air laws occurred between the two time periods.19 Also, our analysis by awareness of the Tips campaign confirmed many of the results from the year-to-year comparisons. Second, because our analyses focused on two years of data, changes could reflect secular trends rather than the impact of Tips. For this reason, we emphasized similar findings present in both the time periods and the campaign awareness analyses. Additionally, we explored standard reports from 2010–2012 (data was not available for all participating quitlines prior to 2010) and confirmed that changes occurred primarily in 2012. The prevalence of COPD increased over the 3 years with a greater increase in 2012, and the rates of uninsured callers decreased in 2011 and increased again in 2012. Third, we used self-reported awareness which may have introduced recall bias; however, when self-reported awareness was compared to categorized Gross Rating Points (GRP) from the Tips campaign, which is a measure of campaign exposure in each caller’s media market (i.e., advertisement reach times frequency of exposure),2 we found that awareness increased as GRP levels increased. Self-reported awareness was 63.0%, 69.3%, and 74.4% for the <1200, 1200 to <2000, and 2000+ GRP groups, respectively, which indicates that self-reported awareness may be a reasonably valid measure of campaign exposure. Fourth, awareness was only assessed in 13 states, which may limit the generalizability of those analyses. Finally, data on motivation, confidence in quitting, and history of previous quit attempts was only available for persons who completed at least one counseling call, who may be more motivated to quit than quitline callers in general.
In conclusion, few meaningful changes were observed in the characteristics of quitline callers during the national Tips tobacco education campaign. The campaign increased the reach of quitline services to all subgroups of smokers, but particularly those who were uninsured. Such campaigns have the potential to increase access to cessation services for the uninsured.
Funding
This work was funded by the Centers for Disease Control and Prevention (Contract #200-2012-M-51442) .
Declaration of Interests
None declared.
Acknowledgments
The authors thank T. McAfee, MD and S. Zbikowski, PhD for their review and feedback on this manuscript and for input on the study design, T. Altman, PhD for input on the study design, and C. Nash, BA for assistance with obtaining and managing data. We also acknowledge the state quitlines that participated in the study. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
References
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