Giving a way free stuff to motivate smokers to call a Quitline

North American Quitline Consortium MeetingMay 2, 2005

Advertising works, but costs lots of $$$$$$$

NYC Media Campaign Launched Feb, 2001

Data

Summary of Call Volume to NYS Smoker's Quitline Since 01/01/00

Counselor AssistedVoice MailTotal Calls

January-00466981253

February-0026233590

March-0010177253

April-007376175

May-005167220

June-0010664302

July-0010746254

August-0012657282

September-0010139256

October-0013571375

November-00167219730

December-004384671800

January-0156611433326

February-0173816195737

March-011656338811510

April-0195715935550

May-0194527767114

June-0180812754626

July-016678343415

August-016048863145

September-013777492637

October-0178814684967

November-01120113936440

December-0196512685996

January-02131914956337

February-02117313624914

Call Chart

1800

3326

5737

11510

5550

7114

4626

3415

3145

2637

4967

6440

5996

NYC "Quit Yet?" Campaign

Call Volume and Quit Yet Camapign 2001

Sheet2

Sheet3

Population ImpactReach x Efficacy = Effect

Combine strategies that increase reach and enhance efficacy

+=

in population quit ratio

Why dont more smokers use NRT to quit?HERE ARE SOME REASONSLow accessMisperceptions about nicotine and how NRT worksLousy Marketing (public health vs. tobacco)Negative attributes of current NRT meds (taste, design, nicotine delivery)

Price and convenience matter

NRT Give Away Programs in NYS

InterventionCounties/BoroughPromotion done to inform smokers of free NRTNumber enrolled programVoucher 2-wk Erie, NiagaraPress release; posters in Eckerd drugs stores; Quit & Win contest1,099Mail 1-wk Albany, Fulton, Montgomery, Rensselaer, Saratoga, Schenectady, Washington, WarrenPress release and kick-off press conference; paid radio advertising1,334Mail 2-wk Chemung, Delaware, Genesee, Livingston, Monroe, Ontario, Orleans, Otsego, Schoharie, Schuyler, Seneca, Steuben, Wayne, Wyoming YatesPress release two print ads in the newspaper2,323Mail 6-wk Bronx, Brooklyn, Manhattan, Queens, Staten IslandPress release and kick-off press conference35,334

Follow-up Surveys

Program Reach

Call volume to the Quit Line in response to New York City Free patch Give Away Program (>425,000 calls in 1st 3-days!!!)

Average weekly call volume to the Quitline Before, During, and After the Offer for Free NRT

Self-reported use of nicotine medication

Quit attempts and smoking status ~4-months after enrollment

Relative risk of quitting measured at ~4-months among Quitline callers who got free NRT and those that did not get NRT Relative risk for quitting comparing each NRT program group to the control group of subjects who called the Quitline before free NRT was available while adjusting for demographic characteristics (age, gender, race), type of health insurance, cigarettes smoked per day at baseline, use of other quit methods (i.e., any additional medications, attending a stop smoking class).

Intervention N% QuitRR*95% CI(Lower-Upper)No NRT42212%1.0ReferentVoucher-2 wk 46427%2.91.9-4.4Mail 1-wk 46921%2.01.3-3.1Mail 2-wk 47224%2.41.6-3.7Mail 6-wk 57833%3.82.6-5.7

Cost and effectiveness of interventions

Long-term effects: smoking status of NYC program participants measured at ~4 and 12 months

NRT Voucher + Better Quit

+

25-fold increase in calls

Erie-Niagara Graph (2)

2

7

7

3

7

4

3

3

12

8

6

9

1

1

2

7

7

6

370

386

85

51

258

171

190

126

317

210

59

339

267

206

329

232

99

57

245

155

139

141

98

54

30

123

91

76

42

55

15

17

42

56

47

22

17

6

4

24

29

29

22

8

15

6

20

14

24

28

16

10

5

6

6

8

9

7

3

0

8

11

5

8

5

6

4

10

13

9

6

13

3

2

9

7

Erie-Niagara GiveawayBEGAN July 10th, 2003 PRESS CONFERENCE

Erie-Niagara GiveawayENDED August 6th, 2003

Erie-Niagara Call Volume

Month/Day

Erie-Niagara Graph

2

7

7

3

7

4

3

3

12

8

6

9

1

1

2

7

7

6

370

386

85

51

258

171

190

126

317

210

59

339

267

206

329

232

99

57

245

155

139

141

98

54

30

123

91

76

42

55

15

17

42

56

47

22

17

6

4

24

29

29

22

8

15

6

20

14

24

28

16

10

5

6

6

8

9

7

3

0

8

11

5

8

5

6

4

10

13

9

6

13

3

2

9

7

Erie-Niagara GiveawayBEGAN July 10th, 2003

Erie-Niagara GiveawayENDED August 6th, 2003

Erie-Niagara Call Volume

Month/Day

2003 Erie-Niagara NRT Voucher Giveaway Program: July 10th - August 6th

Sheet1

2003 Erie-Niagara Voucher Giveaway (July 10th - August 6th)

Month/DayErie-Niagara Call Volume

22-Jun2

23-Jun7

24-Jun7

25-Jun3

26-Jun7

27-Jun4

28-Jun3

29-Jun3

30-Jun12

1-Jul8

2-Jul6

3-Jul9

4-Jul1

5-Jul1

6-Jul2

7-Jul7

8-Jul7

9-Jul6

10-Jul370

11-Jul386

12-Jul85

13-Jul51

14-Jul258

15-Jul171

16-Jul190

17-Jul126

18-Jul317

19-Jul210

20-Jul59

21-Jul339

22-Jul267

23-Jul206

24-Jul329

25-Jul232

26-Jul99

27-Jul57

28-Jul245

29-Jul155

30-Jul139

31-Jul141

1-Aug98

2-Aug54

3-Aug30

4-Aug123

5-Aug91

6-Aug76

7-Aug42

8-Aug55

9-Aug15

10-Aug17

11-Aug42

12-Aug56

13-Aug47

14-Aug22

15-Aug17

16-Aug6

17-Aug4

18-Aug24

19-Aug29

20-Aug29

21-Aug22

22-Aug8

23-Aug15

24-Aug6

25-Aug20

26-Aug14

27-Aug24

28-Aug28

29-Aug16

30-Aug10

31-Aug5

1-Sep6

2-Sep6

3-Sep8

4-Sep9

5-Sep7

6-Sep3

7-Sep0

8-Sep8

9-Sep11

10-Sep5

11-Sep8

12-Sep5

13-Sep6

14-Sep4

15-Sep10

16-Sep13

17-Sep9

18-Sep6

19-Sep13

20-Sep3

21-Sep2

22-Sep9

23-Sep7

Standard (Control) Ad and Better Quit (Experimental) Ad Standard Quitline AdMay 3, 2004 Better Quit AdMay 24, 2004

2-fold increase in calls

Erie-Niagara Graph

1

17

7

4

7

8

4

0

12

16

6

8

7

2

2

12

8

13

9

6

1

1

9

6

3

7

4

2

1

31

24

12

5

8

1

0

0

7

3

7

3

3

1

CONTROL AD (1x time)Appeared Monday, May 3, 2004

EXPERIMENTAL AD (1x time)Appeared Monday, May 24, 2004

Erie-Niagara Total Call Volumes

Month/Day

Sheet1

2004 Erie-Niagara Standard Ad + Free Better Quit Offer vs. Standard Ad (April 25th - June 6th)

Month/DayErie-Niagara Call Volume

25-Apr1

26-Apr17

27-Apr7

28-Apr4

29-Apr7

30-Apr8

1-May4

2-May0

3-May12

4-May16

5-May6

6-May8

7-May7

8-May2

9-May2

10-May12

11-May8

12-May13

13-May9

14-May6

15-May1

16-May1

17-May9

18-May6

19-May3

20-May7

21-May4

22-May2

23-May1

24-May31

25-May24

26-May12

27-May5

28-May8

29-May1

30-May0

31-May0

1-Jun7

2-Jun3

3-Jun7

4-Jun3

5-Jun3

6-Jun1

Cost Effectiveness Ratios for Quitline Program - Voucher for 2-Week Supply of NRT

-22% quit rate for July Voucher program -12% quit rate for annual survey evaluation-No NRT-$194= whole cost of program divided quit rate of-22%-$424 =whole cost of program divided quit rate of 10% -10% computed by taking out 12% quit rate (22%-12%=10%)-filter out the number of people who would have quit without the NRT

Take home messagesThe offer of free NRT induced many smokers to call the Quitline Quit rates measured at 4 months were higher among those who got NRT compared to those who did not (21%-35% vs. 12%)Quit rates were higher in those who got more NRT to useCost-effectiveness needs to consider both reach and efficacy

The End

-higher ratio means more of a difference from the program period (during) -13.4 shows that because calls were so high during the program that the calls after were significantly less as compared to during

61% Used all NRT-22% used or more and 17% used less than Shows that all 61% were motivated to go and redeem voucher23% shows that 77% did not use all their patches and may have been better off sending less, i.e. 2 weeks-Relative Risk- means relative chance of quitting-No NRT, comparison groupCI-Confidence Intervalused to determine if something is significant or not, It is determined significant if above 1 -Referent)-The more NRT, more chance of quitting (just quit attempts not quit behavior?)-3.8 compared to 2.6-5.7 is a 2.9 increase-Cost calculated just using the cost of the NRTNYC callers between Jan-July, 10 + cig/day followed up in 12 months 33.2% are not the same people who reported 7 day prevalence at 4 months 23.1% are the people who reported abstinence at 4 months and 12 months 27.9% were the people at 12 months who reported abstinences at least 6 months the gold standard9% were the Jan-July NYC QL callers (no NRT) who reported 6 month abstinences -22% quit rate for July Voucher program -12% quit rate for annual survey evaluation-No NRT-$194= whole cost of program divided quit rate of-22%$424 =whole cost of program divided quit rate of 10% 10% computed by taking out 12% (22%-12%=10%)-filter out the number of people who would have quit without the NRT