Who uses the Smoker's Quitline in Massachusetts?
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Adult↗
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The uninsured and Medicaid Oregon tobacco user experience in a real world, phone based cessation programme.
OBJECTIVE: To describe the experience of uninsured and Medicaid Oregon tobacco users who registered in Free & Clear (F&C), a telephone based cessation programme including five scheduled outbound calls. DESIGN AND SETTING: Using a retrospective cohort design, 1334 (423 uninsured, 806 Medicaid, and 105 commercially insured) Oregon tobacco users who registered in F&C between 18 November 1998 and 28 February 2000 were identified and followed for 12 months post-registration; 648 (48.6%) were successfully contacted at 12 months. Information was collected from the F&C database. Unconditional logistic regression, adjusted for race and education, was used. RESULTS: The seven day quit rate at 12 months, assuming non-respondents were smokers, was 14.8% (95% confidence interval (CI) 13.0 to 16.9). This rate was significantly higher among commercially insured participants (v Medicaid but not uninsured) and among participants who completed > or = 5 calls (v < 5 calls). The quit rate for those contacted at 12 months was 30.6% (95% CI 27.0% to 34.3%) and varied, however not significantly, by insurance and number of calls. After adjustment, respondents who completed > or = 5 calls were 60% more likely to quit tobacco (odds ratio (OR) 1.6, 95% CI 0.9 to 3.1), and uninsured respondents who completed > or = 5 calls were 70% more likely to quit tobacco (OR 1.7, 95% CI 0.9 to 3.5), relative to those who completed < 5 calls, but the difference was not significant. CONCLUSIONS: The quit rates are similar to those reported in efficacy trials. The observed variation in quitting tobacco for respondents by number of calls completed and by insurance merits further investigation concentrating on increasing compliance with the call schedule, particularly for the uninsured.
Adult↗
Generating Quitline calls during Australia's National Tobacco Campaign: effects of television advertisement execution and programme placement.
OBJECTIVE: The study sought to measure the relative efficiency of different television advertisements and types of television programmes in which advertisements were placed, in generating calls to Australia's national Quitline. DESIGN: The study entailed an analysis of the number of calls generated to the Quitline relative to the weight of advertising exposure (in target audience rating points (TARPs) for particular television advertisements and for placement of these advertisements in particular types of television programmes. A total of 238 television advertisement placements and 1769 calls to the Quitline were analysed in Sydney and Melbourne. RESULTS: The more graphic "eye" advertisement conveying new information about the association between smoking and macular degeneration leading to blindness was more efficient in generating quitline calls than the "tar" advertisement, which reinforced the message of tar in a smoker's lungs. Combining the health effects advertisements with a quitline modelling advertisement tended to increase the efficiency of generating Quitline calls. Placing advertisements in lower involvement programmes appears to provide greater efficiency in generating Quitline calls than in higher involvement programmes. CONCLUSIONS: Tobacco control campaign planners can increase the number of calls to telephone quitlines by assessing the efficiency of particular advertisements to generate such calls. Pairing of health effect and quitline modelling advertisements can increase efficiency in generating calls. Placement of advertisements in lower involvement programme types may increase efficiency in generating Quitline calls.
Adolescent↗
Uptake and effectiveness of the Australian telephone Quitline service in the context of a mass media campaign.
OBJECTIVES: Since June 1997, Australia has run its first nationally coordinated mass media anti-smoking campaign, with all States collaborating to offer a standard Quitline service. An overview of the Australian national Quitline service is presented as well as two studies describing (a) the relationship between television advertising and call volume and type, and (b) the quit rates of callers over time. DESIGN: Data on extent of advertising, as measured by weekly television target audience rating points (TARPs), is compared with weekly call volume and disposition. A randomly selected sample of callers was followed up at 3 weeks, 6 months and 12 months to assess caller appraisal and quit rates. SETTING: The Australian Quitline service, in the context of a nationally coordinated, major anti tobacco campaign. RESULTS: In a one year period from June 1997, 3.6% of adult Australian smokers called the Quitline. Weekly call volume was strongly related to TARPs and increased further when an advertisement specifically promoting the Quitline was broadcast. Calls involving requests for counselling, as opposed to brief calls to request quit materials, were more likely with lower TARPs. Of the cohort who were smoking at baseline, 28% reported they had quit smoking at a one year follow up and 5% had been quit for an entire year. CONCLUSIONS: In the context of a national mass media campaign, this study illustrates that it is possible to bring together differing State based services to provide an accessible, acceptable, and effective quit smoking service.
Adolescent↗
Australia's National Tobacco Campaign.
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Advertising↗
Telephone assistance for smoking cessation: one year cost effectiveness estimations.
A randomised trial evaluated the American Cancer Society's telephone counselling service to assist smoking cessation. Counselling nearly doubles a smokers' odds of quitting and maintaining cessation for one year. The estimated cost for each case of maintained smoking cessation attributable to counselling availability is approximately 1300 dollars.
American Cancer Society↗
Which smokers use the smoking cessation Quitline in Hong Kong, and how effective is the Quitline?
OBJECTIVE: To describe the characteristics of the Chinese subjects who utilised the first telephone smoking cessation service in Hong Kong, and to evaluate its effectiveness. METHODS: The Quitline provided Hong Kong residents with free telephone smoking cessation services which was publicised through a press conference, media reports, pamphlets, and posters at public and private hospitals and clinics. Callers who completed an initial interview from 13 December 2000 to 31 May 2002 were included. Smokers were interviewed using a structured record sheet and provided with stage matched counselling. A follow up interview was carried out after six months. Analysis was conducted by intention-to-treat. RESULTS: Of the 1120 callers who completed initial assessments, 1047 were current smokers and 872 consented to follow ups. Compared to the general smoking population, the Quitline attracted more of those who were female, younger, single, unemployed, higher educated, smoking more than 20 cigarettes per day, and those with quitting experience. At six months, 12% (95% confidence interval 10% to 15%) of the participants reported that they had not smoked a cigarette for the past seven days. A stepwise logistic regression model showed that the use of nicotine replacement therapy at the present attempt to quit, having made one or more serious attempts to quit in the past, perceiving less difficulties in quitting, and smoking the first cigarette at age 15 years or above were significant predictors of quitting. CONCLUSION: This first Quitline in Asia appears to be acceptable to Chinese smokers, with quit rate comparable to those of better funded Quitlines in the West. A low cost Quitline is a promising model for smoking cessation services in the East.
Adolescent↗
The effectiveness of television advertising campaigns on generating calls to a national Quitline by Māori.
OBJECTIVE: To examine the effectiveness of four mass media campaigns on calls to a national Quitline by Māori (the indigenous people of New Zealand). METHODS: Monthly Quitline call data and calls within one hour of a television commercial (TVC) being shown were analysed for the 2002-2003 period. Data on target audience rating points (TARPs) and expenditure on TVCs were also used (n = 2319 TVC placements). RESULTS: Māori were found to register with the Quitline at higher rates during the most intense six campaign months (15% more registrations compared to less intense months). The most effective campaign generated 115 calls per 100 TARPs by Māori callers within one hour of TVC airing (the "Every cigarette" campaign). A more Māori orientated campaign with both health and cultural themes generated 91 calls per 100 TARPs from Māori callers. For these two campaigns combined, the advertising cost per new registration with the Quitline by a Māori caller was NZD 30-48. Two second hand smoke campaigns that did not show the Quitline number were much less effective at 25 and 45 calls per 100 TARPs. CONCLUSIONS: These television advertising campaigns were effective and cost effective in generating calls to a national Quitline by Māori. Health authorities should continue to explore the use of both "threat appeal" style media campaigns and culturally appropriate campaigns to support Quitline use by indigenous peoples.
Adult↗
22 years on: the impact and relevance of the UK No Smoking Day.
OBJECTIVES: To evaluate the impact and relevance of the national awareness day "No Smoking Day" 22 years after it was launched. DESIGN: Triangulation of data from a variety of sources. Retrospective surveys conducted one week and three months after No Smoking Day, media coverage, website activity, and volume of calls to national smokers' helplines. MAIN OUTCOME MEASURES: Self reports of awareness and smoking behaviour changes one week and three months after No Smoking Day. Volume of media coverage, visits to No Smoking Day website, and volumes of calls to smokers' helplines. RESULTS: Follow up at one week indicates awareness of No Smoking Day is lower in 2004 than in 1986 but still high at 70% for all smokers. The decline in participation from 18% of aware smokers in 1994 to 7% in 2001 has been reversed and in 2005 19% quit or reduced their smoking on No Smoking Day. Three months after No Smoking Day awareness was 78% in 2004, lower than in previous studies but still high and equivalent to 9,965,000 smokers when applied to the population estimate of UK smokers. Likewise participation has decreased but at 14% in 2004 is equivalent to an estimated 1,840,000 (1 in 7 of UK smokers) claiming to quit or reduce their consumption on the Day. Among those who participated, 11% were still not smoking more than three months after the Day, equivalent to an estimated 85,000 smokers (0.7% of UK smokers). Media volume has increased even though campaign spend has remained relatively constant and calls to national smokers' helplines on No Smoking Day are typically four times those received on an average day. CONCLUSIONS: These data suggest that after 22 years No Smoking Day continues to be successful in reaching smokers. With a budget insufficient to pay for advertising, this public awareness campaign supported by local activities appears to be effective in helping smokers to stop.
Adolescent↗
New smoke-free environments legislation stimulates calls to a national Quitline.
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Adolescent↗
Non-smokers seeking help for smokers: a preliminary study.
OBJECTIVES: To examine the phenomenon of non-smokers spontaneously taking action to seek help for smokers; to provide profiles of non-smoking helpers by language and ethnic groups. SETTING: A large, statewide tobacco quitline (California Smokers' Helpline) in operation since 1992 in California, providing free cessation services in English, Spanish, Mandarin, Cantonese, Korean, and Vietnamese. SUBJECTS: Callers between August 1992 and September 2005 who identified themselves as either white, black, Hispanic, American Indian, or Asian (n = 349,110). A subset of these were "proxies": callers seeking help for someone else. For more detailed analysis, n = 2143 non-smoking proxies calling from October 2004 through September 2005. MAIN OUTCOME MEASURES: Proportions of proxies among all callers in each of seven language/ethnic groups; demographics of proxies; and proxies' relationships to smokers on whose behalf they called. RESULTS: Over 22 000 non-smoking proxies called. Proportions differed dramatically across language/ethnic groups, from mean (+/-95% confidence interval) 2.7 (0.3)% among English-speaking American Indians through 9.3 (0.3)% among English-speaking Hispanics to 35.3 (0.7)% among Asian-speaking Asians. Beyond the differences in proportion, however, remarkable similarities emerged across all groups. Proxies were primarily women (79.2 (1.7)%), living in the same household as the smokers (65.0 (2.1)%), and having either explicit or implicit understandings with the smokers that calling on their behalf was acceptable (90.0 (1.3)%). CONCLUSIONS: The willingness of non-smokers to seek help for smokers holds promise for tobacco cessation and may help address ethnic and language disparities. Non-smoking women in smokers' households may be the first group to target.
Adolescent↗
Seasonal variations in stage of change among Quitline clients.
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Hotlines↗
Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy.
BACKGROUND: Tobacco users receiving behavioural and pharmacological assistance are more likely to quit. Although telephone quitlines provide population access to counselling, few offer pharmacotherapy. OBJECTIVE: To assess change in cessation rates and programme impact after the addition of free nicotine replacement therapy (NRT) to statewide quitline services. DESIGN, SETTING, PARTICIPANTS: An observational study of cohorts of callers to the Minnesota QUITPLAN(SM) Helpline before (n = 380) and after (n = 373) the addition of access to free NRT. INTERVENTION: Mailing of NRT (patch or gum) to callers enrolling in multi-session counselling. MAIN OUTCOME MEASURE: Thirty-day abstinence six months after programme registration. RESULTS: The number of callers increased from 155 (SD 75) to 679 (180) per month pre-NRT to post-NRT (difference 524, 95% confidence interval (CI) 323 to 725). Post-NRT, the proportion of callers enrolling in multi-session counselling (23.4% v 90.1%, difference 66.6%, 95% CI 60.8% to 71.6%) and using pharmacotherapy (46.8% v 86.8%, difference 40.0%, 95% CI 31.3% to 47.9%) increased. Thirty-day abstinence at six months increased from 10.0% pre-NRT to 18.2% post-NRT (difference 8.2%, 95% CI 3.1% to 13.4%). Post-NRT the average number of new ex-smokers per month among registrants increased from 15.5 to 123.6 (difference 108.1, 95% CI 61.1 to 155.0). The cost per quit pre-NRT was 1362 dollars (SD 207 dollars). The cost per quit post-NRT was 1934 dollars (215 dollars) suggesting a possible increase in cost per quit (difference 572 dollars, 95% CI -12 dollars to 1157 dollars). CONCLUSION: The addition of free NRT to a state quitline is followed by increases in participation and abstinence rates resulting in an eightfold increase in programme impact. These findings support the addition of access to pharmacological therapy as part of state quitline services.
Administration, Cutaneous↗
Cost effectiveness of a mass media-led anti-smoking campaign in Scotland.
OBJECTIVE: To evaluate the costs and outcomes associated with the Health Education Board for Scotland's general public anti-smoking campaign during the developmental stage and its first year of operation. DESIGN: Cost information collected retrospectively was combined with prospectively collected effectiveness data. SUBJECTS: A panel of 970 adults were recruited from a 1-in-10 random sample of adult callers to the telephone helpline (Smokeline). Those who smoked were subsequently interviewed at three weeks, six months, and one year follow up. Information on smoking status at one year and time spent as a non-smoker was available for 587 members of the panel. MAIN OUTCOME MEASURES: Intermediate outcomes in the follow-up sample included a point prevalence and period prevalence measure of smoking cessation. Long-term outcomes were measured in terms of predicted reductions in mortality as a consequence of smoking cessation. RESULTS: At the 12-month point, 9.88% of individuals in the follow-up sample reported themselves as non-smokers and as having given up for at least six months in the previous year. Estimates of the cost per life-year saved as a result of the campaign range from 304 pounds sterling to 656 pounds sterling. CONCLUSIONS: Provided that the benefits of smoking cessation are broadly accurate, and the assumed level of quitting can be directly attributed to Smokeline, then this mass media-led anti-smoking campaign appears to have been cost effective.
Adult↗
Saved by the bell: the role of telephone helpline services in the context of mass-media anti-smoking campaigns.
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Advertising↗
Impact of a telephone helpline for smokers who called during a mass media campaign.
OBJECTIVE: To evaluate the impact of a telephone helpline (Quitline) with additional support (written information) on callers who use the service during a mass media campaign. DESIGN: Telephone recall surveys of callers to the helpline carried out two months and one year after their initial call. SETTING: Telephone helpline. SUBJECTS: Callers to the helpline. MAIN OUTCOME MEASURES: Smoking behaviour change among callers to the helpline at two months and one year. RESULTS: At one year 22% (95% confidence interval (CI) 18.4% to 25.6%) of smokers reported that they had stopped smoking. Assuming that those who refuse to take part in the one year follow up are continuing smokers and a further 20% of reported successes fail biochemical validation, this yields an adjusted quit rate of 15. 6% (95% CI 12.7% to 18.9%) at one year. Among ex-smokers, 41% (95% CI 34.3% to 47.7%) reported that they were still not smoking at one year. The adjusted figure for ex-smokers at one year is 29% (95% CI 23.3% to 34.8%). Of those who resumed smoking 28% were smoking less than they had been initially. Currently Quitline receives around half a million calls in the course of one year, 93% of whom are phoning for themselves. This represents 4.2% of the total population of adults smokers in England. CONCLUSION: The Health Education Authority's advertising campaign was extremely successful in generating calls to the helpline. Very large numbers of smokers from diverse backgrounds, including the key groups highlighted in the UK government's recent proposals on tobacco, called the Quitline, which appeared to be very successful in helping these callers to stop smoking. For a single intervention to reach 4.2% of the total population of adult smokers in England is a major achievement. This makes Quitline a very promising model for public health intervention programs.
Adolescent↗
A centralised telephone service for tobacco cessation: the California experience.
OBJECTIVE: To provide an overview of the California Smokers' Helpline, an increasingly popular telephone program for tobacco cessation in California since 1992. As many states, regions, and nations are contemplating various telephone programs as part of large scale anti-tobacco campaigns, this paper presents a practical model. DESIGN: The Helpline provides Californians with free cessation services that include counselling, self help quit kits, and cessation related information. Services are provided in six spoken languages plus a line for the hearing impaired. The program is promoted statewide by media campaigns, health care providers, local tobacco control programs, and the public school system. SETTING: The Helpline is centrally operated through the University of California, San Diego and provides services statewide via telephone. RESULTS: The Helpline has served over 100 000 tobacco users and has become the chief cessation resource for the Comprehensive Tobacco Control Program in California. Media was the most important referral source for Helpline callers (50%), followed by health care providers (20%). About one third of the callers were ethnic minorities and 17% were 24 years old or younger. Compared to California smokers in general, the callers were more dependent on nicotine and more likely to live with other smokers, but they were also more likely to have tried to quit recently and were more ready to try again. Two randomised trials have demonstrated the efficacy of the Helpline's counselling protocol. CONCLUSION: A centralised helpline operation can be an accessible and effective service for tobacco users and should be included in any large scale, comprehensive tobacco control program.
Adolescent↗