Increases in Quitline Calls and Smoking Cessation Website Visitors During a National Tobacco Education Campaign — March 19–June 10, 2012

Mass media campaigns and telephone quitlines are effective in increasing cessation rates among cigarette smokers (1–5). During March 19–June 10, 2012, CDC aired Tips from Former Smokers (TIPS), the first federally funded, nationwide, paid-media tobacco education campaign in the United States. The TIPS campaign featured former smokers talking about their experiences living with diseases caused by smoking. The campaign was primarily intended to encourage adult smokers aged 18–54 years to quit by making them aware of the health damage caused by smoking and letting them know that they could call the telephone quitline portal 1-800-QUIT-NOW or visit the National Cancer Institute (NCI) smoking cessation website (http://www.smokefree.gov) if they needed free help to quit. The campaign included advertising on national and local cable television, local radio, online media, and billboards, and in movie theaters, transit venues, and print media. To determine the effects of the TIPS campaign on weekly quitline call volume and weekly unique visitors to the cessation website, CDC analyzed call and visitor data immediately before, during, and immediately after the campaign period and compared them with data from the corresponding weeks in 2011. This report summarizes the results of that analysis, which found that the number of weekly calls to the quitline from the 50 states, the District of Columbia, Guam, and Puerto Rico increased 132% (207,519 additional calls) during the TIPS campaign, and the number of unique visitors to the cessation website increased 428% (510,571 additional unique visitors). These results indicate that many smokers are interested in quitting and learning more about cessation assistance, and will respond to motivational messages that include an offer of help.

The distribution of the TIPS campaign advertising purchases included 80% for national advertising and 20% for additional advertising in media markets with higher-than-average adult smoking prevalence. The advertising was intended to reach approximately 87% of U.S. adults aged 18–54 years an average of 18 times each.* All television and radio advertisements included either the quitline portal number or the smoking cessation website address, each of which appeared on television for approximately 3 seconds while being read aloud.† CDC compared weekly quitline call volume and number of unique website visitors during the TIPS campaign period (March 19–June 10, 2012) with the corresponding weeks (March 21–June 12, 2011) in the previous year. Data on calls and unique website visitors were obtained from NCI. Call volume represented total attempted calls, not unique callers. Some persons might have both called the portal number and visited the NCI website. Data for the 2-week period May 30–June 12, 2011, (corresponding to approximately 15% of the 12-week baseline comparison period) were missing because of a database error, and therefore were imputed from the average weekly call volume during March 21–May 29, 2011. The number of unique visitors to the cessation website was obtained by NCI from Google Analytics.

Total call volume during the TIPS campaign was 365,194 calls, compared with 157,675 calls during the corresponding 12 weeks in 2011, for a total of 207,519 additional calls or a 132% increase (Figure 1). Compared with the corresponding weeks in 2011, weekly increases in calls during the campaign ranged from 86% to 160%. The website received 629,898 unique visitors during the TIPS campaign, compared with 119,327 during the same period in 2011, for a total of 510,571 additional unique visitors or a 428% increase (Figure 2). Weekly increases in visitors compared with the corresponding weeks in 2011 ranged from 355% to 484%. Altogether, compared with 2011 data, 718,090 additional calls and unique website visitors were received during the TIPS campaign.

Reported by

Erik Augustson, PhD, Mary Anne Bright, MN, National Cancer Institute, Bethesda, Maryland. Stephen Babb, MPH, Ann Malarcher PhD, Robert Rodes, MS, Diane Beistle, Timothy McAfee, MD, Paul Mowery, MA, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Corresponding contributor: Stephen Babb, sbabb@cdc.gov, 770-488-1172.

Editorial Note

Well-designed tobacco education media campaigns with adequate reach increase cessation and reduce tobacco use (1–3). Evidence reviews of tobacco education media campaigns have found that emotionally evocative advertisements that employ graphic images and personal testimonials showing the negative health consequences of smoking are especially effective in motivating smokers to quit (2,3). The findings from the analysis described in this report generally were consistent with results reported from campaigns conducted in U.S. states and other countries (2,3).

The TIPS campaign was based on previous research and formative testing indicating that an approach featuring testimonials from former smokers living with smoking-related diseases was memorable and believable, resonated well with both smokers and nonsmokers, and would encourage both of these groups to take action. The campaign was designed to have sufficient reach and frequency to be effective in encouraging change in smoking behaviors, in keeping with CDC recommendations (5). The primary long-term goals of the TIPS campaign were to generate at least 500,000 quit attempts and 50,000 successful quits. A short-term goal was to generate additional calls to state quitlines and additional visitors to the NCI smoking cessation website. The $54 million spent on the TIPS campaign is the equivalent of what cigarette manufacturers spend on advertising and promotion in 2 days.§

Quitlines significantly increase rates of smoking cessation, compared with minimal interventions, self-help, or no counseling; a meta-analysis of nine studies estimated the odds of quitting as 1.6 to 1 (95% confidence interval = 1.4–1.8) (4). All 50 states and the District of Columbia have their own quitlines. Callers to the national 1-800-QUIT-NOW portal are transferred to their state quitlines. The quitline network is supported by NCI, which manages the national portal, and by CDC, which provides supplemental funding to state quitlines as part of its support for comprehensive state tobacco control programs, as well as providing funding to the North American Quitline Consortium. State quitlines provide a variety of services, including brief advice, counseling, medications, self-help materials, and referrals to other cessation resources (6,7). Services usually are provided by a contractor, which can be a public or private organization. The specific services provided vary by state and eligibility (6). State quitlines currently reach only 1%–2% of smokers, largely because most state tobacco control programs lack sufficient funding to provide and promote quitline services to more callers (6,7). CDC recommends that state quitlines reach 6%–8% of the state's smokers (5), a level that has been achieved in a few U.S. states where services and promotional activities have been funded consistently (8).

The NCI smoking cessation website is administered by NCI. The website provides practical advice and tools, such as a step-by-step quit guide, to assist smokers as they think about and prepare for quitting. Smokers interested in quitting also can access NCI's LiveHelp service to chat with a counselor or sign up for the SmokefreeTXT text-messaging cessation program.¶ Although the Community Preventive Services Task Force recently found mixed evidence of the effectiveness of Internet-based cessation programs, in part because of wide variation in the content provided, the Task Force concluded that text messaging is effective in increasing cessation (1).

Results of the analysis described in this report suggest that smokers have not been "saturated" by state media campaigns or other health information to the point that they no longer respond to tobacco education campaigns. These results also illustrate the significant untapped potential of state quitlines to reach more smokers, especially given that only about one fourth of the television advertisements included the quitline portal number.

The increase in calls to 1-800-QUIT-NOW suggests that the TIPS campaign likely will generate increases in smoking cessation over time. This effect would be expected to occur through two mechanisms. First, smokers who called quitlines and obtained free counseling and, in some cases, free cessation medications would increase their chances of quitting successfully. Second, because mass media campaigns that include information on cessation resources normalize quitting and make smokers aware that help with quitting is available should they need it, the campaigns increase the number of quit attempts and successful quits, even among smokers who never call the quitline (7,9,10). The fact that the TIPS campaign resulted in more than 700,000 additional calls to state quitlines and visits to a cessation website suggests that the campaign motivated many other smokers to try to quit without assistance or with other forms of assistance.

The findings in this report are subject to at least four limitations. First, this was a natural history time series analysis and did not control for other factors that could have contributed to the observed increases in call volume and unique website visitors from 2011 to 2012. However, the immediate sharp uptick in both calls and visits at the onset of the campaign and the rapid tailing-off in both calls and visits after the campaign ended are strongly suggestive of a causal relationship between the campaign and these increases. Second, the NCI data on calls reflect only the number of attempted calls that were received by NCI at the national portal. The disposition of the callers and the types of services received once the caller was transferred to state quitlines were not captured by this analysis. In addition, the data do not reflect calls that might have been received directly by some state quitlines through other telephone numbers. Third, the analysis did not correlate quitline calls or visits to the cessation website with exposure to TIPS campaign advertisements. Finally, some states scaled back or halted their own media efforts before the TIPS campaign to conserve funding and to avoid generating more calls than their quitlines could handle, which might have resulted in understating the campaign's effect.

This report indicates that an evidence-based national tobacco education media campaign with adequate reach and frequency can lead to substantial increases in calls to a national portal for state quitlines and unique visitors to a cessation website. The increase indicates that many smokers are interested in quitting and in finding out more about cessation assistance, and will respond to motivational messages that include an offer of help. This analysis provides additional evidence that, within the context of comprehensive tobacco control efforts, tobacco education media campaigns are an important intervention for increasing cessation.

Acknowledgments

Yvonne Hunt, Diane Ruesch, Shani Taylor, Deanne Weber, Bob Zablocki, National Cancer Institute, Bethesda, Maryland. Robert Alexander, Shauntrelle Andrews, Jami Fraze, Asha Hill, Michelle Johns, Jerelyn Jordan, Brendan Kenemer, Sharanya Krishnan, Joel London, Bill Marx, Jane Mitchko, Amy Rowland, Karena F. Sapsis, Robin Scala, Karla Sneegas, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Linda Bailey, Jessie Saul, Tamatha Thomas-Haase, Natalia Gromov, North American Quitline Consortium, Oakland, California. The 14 U.S. residents who shared their personal stories through their participation in the TIPS campaign.

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