Smoker Segmentation A Rationale for Segmenting The Older Smoker (50 plus)

December 12, 2003December 12, 2003 Conference on Tobacco or Health, BostConference on Tobacco or Health, Bostonon

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Smoker SegmentationSmoker Segmentation A Rationale for Segmenting A Rationale for Segmenting The Older Smoker (50 plus)The Older Smoker (50 plus)

Richard K. DelanoRichard K. DelanoPresidentPresidentSocial Marketing Services, LLCSocial Marketing Services, [email protected]@optonline.net

Krista V. SchaafsmaKrista V. SchaafsmaSenior AssociateSenior AssociateSocial Marketing Services, LLCSocial Marketing Services, [email protected]@preventionpointe.com

22December 12, 2003December 12, 2003 Conference on Tobacco or Health, BostConference on Tobacco or Health, Bostonon

Overview to PresentationOverview to Presentation

Discussing benefits and costs of Discussing benefits and costs of segmentationsegmentation

Understanding the older smoker segmentUnderstanding the older smoker segment

Determining the ROI for this segmentDetermining the ROI for this segment

Mass media campaign opportunitiesMass media campaign opportunities

Grassroots opportunities – “Quitting after Grassroots opportunities – “Quitting after 50” Smoker Referral Network50” Smoker Referral Network

Making the case for the older smoker (OS)Making the case for the older smoker (OS)


Segmentation ConsiderationsSegmentation ConsiderationsWeighing the Benefits/CostsWeighing the Benefits/Costs

Benefits of segmenting older smokers:Benefits of segmenting older smokers:

Propensity of segment to attempt & succeed in quittingPropensity of segment to attempt & succeed in quitting

Near term ROI value for health cost savings Near term ROI value for health cost savings

Media and message relevancy Media and message relevancy

Unique promotional/media channels, lower costs Unique promotional/media channels, lower costs

New set of prospective referral partnersNew set of prospective referral partners

Costs of segmenting older smokers:Costs of segmenting older smokers:

Creative costsCreative costs

Promotional costsPromotional costs

Management time and costsManagement time and costs


The Older Smoker (>50 yrs.)The Older Smoker (>50 yrs.)National PerspectiveNational Perspective

13 million nationally 13 million nationally 27% of smoker 27% of smoker populationpopulation58% smoke high 58% smoke high nicotine brandsnicotine brandsSmokers between 45 Smokers between 45 and 64 are 3X more and 64 are 3X more likely to die of likely to die of smoking related smoking related disease than NSdisease than NS

Mortality rates from Mortality rates from COPD 4 X older NS COPD 4 X older NS (>65)(>65)

Smokers 2 X as likely Smokers 2 X as likely as non-smokers to as non-smokers to develop Alzheimer’s develop Alzheimer’s (ALA web site)(ALA web site)

Cessation adds years Cessation adds years of independent life as of independent life as well as years of life. well as years of life.


The Older SmokerThe Older SmokerDemographicsDemographics

Size of population in US, 13M or 22% of the 50 Size of population in US, 13M or 22% of the 50 -65 pop. and 11% of the >65 pop.-65 pop. and 11% of the >65 pop.

Several sub-segments exist based on Several sub-segments exist based on generation, income, education, race, and agegeneration, income, education, race, and age

As boomer generation ages, number of older As boomer generation ages, number of older smokers likely to increase numericallysmokers likely to increase numerically

Density of OS population varies by state. Density of OS population varies by state. Nevada leads with 32% of young old and 23% Nevada leads with 32% of young old and 23% of old old.of old old.


The Older SmokerThe Older SmokerAttitudes Toward QuittingAttitudes Toward Quitting

Most began to smoke before SG report (1964) Most began to smoke before SG report (1964) Lower belief that smoking & illness are related *Lower belief that smoking & illness are related *More likely to be skeptical about benefits of More likely to be skeptical about benefits of quitting; 50% said that continuing to smoke would quitting; 50% said that continuing to smoke would not make their health worse **not make their health worse **More view smoking for stress, way to control More view smoking for stress, way to control weight *weight *Attitude likely to change w/ onset of adverse Attitude likely to change w/ onset of adverse health consequences when attributed to smokinghealth consequences when attributed to smokingHigh correlation between doctor’s advice & High correlation between doctor’s advice & increase in belief of health risk *increase in belief of health risk *

*AUTS data set analyzed by and Orleans, Jepson, Resch, & Rimer 1994 *AUTS data set analyzed by and Orleans, Jepson, Resch, & Rimer 1994 * * Orleans study of AARP member smokers 1994* * Orleans study of AARP member smokers 1994


Attitudes drive fewer attempts, Attitudes drive fewer attempts, but more success.but more success. David Burns, MD (CPS data)David Burns, MD (CPS data)

AgeAge Daily Daily Smokers Smokers No Quit No Quit AttemptsAttempts

Daily Daily Smokers Smokers w/Quit w/Quit AttemptsAttempts

Occasional Occasional SmokersSmokers

Former Former SmokersSmokers

< 3 < 3 MonthsMonths

Former Former SmokersSmokers

> 3 > 3 MonthsMonths

Sample Sample SizeSize

25 – 4425 – 44 61.4761.47%%

27.6%27.6% 3.57%3.57% 2.84%2.84% 4.25%4.25% 15,40615,406

45 – 6445 – 64 65.4465.44%%

23.5323.53%%

3.13%3.13% 2.72%2.72% 5.19%5.19% 10,74610,746

65+65+ 67.1367.13%%

19.1519.15%%

3.29%3.29% 3.22%3.22% 7.21%7.21%%%

2,9332,933


2001 focus groups among older 2001 focus groups among older smokers and former smokers smokers and former smokers

The Center for Social Gerontology 2001The Center for Social Gerontology 2001

Key motivator:Key motivator:- Regain healthRegain health- Death of friendDeath of friend- Strong will powerStrong will power- Willingness to change Willingness to change

behaviorbehavior- There’s help availableThere’s help available- Family issuesFamily issues

Barrier:Barrier:- Feeling physically wellFeeling physically well- (No barrier)(No barrier)- Lack of will powerLack of will power- Environmental factors Environmental factors

and fear of failureand fear of failure- Lack of awarenessLack of awareness- (No barrier) (No barrier)


The Older SmokerThe Older SmokerSpecial Cessation ConsiderationsSpecial Cessation Considerations

Higher levels of nicotine dependency may Higher levels of nicotine dependency may suggest NRT at higher dose & longer duration. suggest NRT at higher dose & longer duration. 58% of OS smoke high-nicotine brands (>1.0 mg )58% of OS smoke high-nicotine brands (>1.0 mg )““CNS” Concerned Non Smokers (GSK) are CNS” Concerned Non Smokers (GSK) are potentially more valuable if coached to be a potentially more valuable if coached to be a positive support networkpositive support networkOS tend to believe many smoking-related OS tend to believe many smoking-related symptoms are simply the result of agingsymptoms are simply the result of agingPhysicians and pharmacists can play a Physicians and pharmacists can play a particularly significant roleparticularly significant role


The Older SmokerThe Older SmokerUnderstanding ResiliencyUnderstanding Resiliency

20 minutes -20 minutes - Blood pressure decreases. Pulse rate drops. Body Blood pressure decreases. Pulse rate drops. Body temperature of hands and feet increasestemperature of hands and feet increases8 hours -8 hours - Carbon monoxide down . Oxygen level in blood normal Carbon monoxide down . Oxygen level in blood normal24 hours -24 hours - Chance of heart attack decreases Chance of heart attack decreases48 hours -48 hours - Ability to smell and taste is enhanced Ability to smell and taste is enhanced2 wks-3 mo. -2 wks-3 mo. - Circulation improves, Walking easier, Lung function Circulation improves, Walking easier, Lung function increasesincreases1 - 9 mo. -1 - 9 mo. - Coughing, sinus congestion, fatigue, shortness of breath Coughing, sinus congestion, fatigue, shortness of breath downdown1 yr -1 yr - Excess risk of coronary heart disease is decreased to half that Excess risk of coronary heart disease is decreased to half that of a smokerof a smoker5 yrs -5 yrs - Stroke risk is reduced to that of a nonsmoker 5 – 15 years Stroke risk is reduced to that of a nonsmoker 5 – 15 years after quittingafter quitting10 yrs -10 yrs - Risk of lung cancer drops to as little as one-half that of Risk of lung cancer drops to as little as one-half that of continuing smokers Risk of cancer to the mouth, throat, esophagus, continuing smokers Risk of cancer to the mouth, throat, esophagus, bladder, kidney, and pancreas decreases. Risk of ulcer decreasesbladder, kidney, and pancreas decreases. Risk of ulcer decreases


Reducing risk of heart attack & stroke: Reducing risk of heart attack & stroke: The New Living HeartThe New Living Heart, ,

DeBakey and GottoDeBakey and Gotto

Older smokers should Older smokers should know that “your know that “your increased risk of heart increased risk of heart disease and stroke disease and stroke disappears within two disappears within two or three years after or three years after quitting…regardless of quitting…regardless of how long you smoked how long you smoked or how many or how many cigarettes you cigarettes you smoked dailysmoked daily””


Potential Factors for ROI AnalysisPotential Factors for ROI Analysis

Annual health cost/productivity loss of OS Annual health cost/productivity loss of OS versus that of a versus that of a younger smokeryounger smokerAnnual health cost/productivity loss of OS Annual health cost/productivity loss of OS versus that of a versus that of a former smokerformer smokerExtent to which Extent to which near termnear term tobacco-related tobacco-related treatment costs (ie. CVD ), can be eliminated or treatment costs (ie. CVD ), can be eliminated or reduced by quitting after 50reduced by quitting after 50Extent to which certain Extent to which certain near termnear term tobacco- tobacco-related treatment costs (ie.COPD) can be related treatment costs (ie.COPD) can be deferred and the financial value of that deferral deferred and the financial value of that deferral (Canadian data)(Canadian data)

Human QOL implications must have valueHuman QOL implications must have value


Lung Cancer Mortality Rates for SmokersLung Cancer Mortality Rates for Smokersof 40+ CPD, Never Smokers and Smokers of 40+ CPD, Never Smokers and Smokers

who Quit at Age 50who Quit at Age 50

0

100

200

300

400

500

600

700

800

40-44 45-49 50-54 55-59 60-64 65-69 70-74Age Group

Dea

th R

ate

per 1

00,0

00

CPS I Data

Residual risk

Risk avoidedby cessationCessation at

age 50

Risk of acontinuing smoker


Years of Life Saved by Cessation at Different Years of Life Saved by Cessation at Different Ages and Amounts SmokedAges and Amounts Smoked D Burns, MDD Burns, MD

30 40 50 60 70

CPD

40+ CPD 7.84 6.62 4.88 2.86 1.13

21-39 CPD 6.97 5.93 4.44 2.66 1.08

20 CPD 6.1 5.23 3.97 2.42 1.02

10-19 CPD 5.02 4.34 3.34 2.09 0.91

1-9 CPD 3.2 2.81 2.21 1.44 0.67

Age at Cessation


The Older SmokerThe Older SmokerLearning from Arizona Case StudyLearning from Arizona Case StudyArizona baseline in 1996 Arizona baseline in 1996 with follow-up in 1999with follow-up in 1999

ChuckChuck ran 6/98 – 10/00 ran 6/98 – 10/00

MMWR noted: reduction MMWR noted: reduction of smoker pop. - 20.2% of smoker pop. - 20.2%

Decline in older smokers Decline in older smokers over 45 was 28.6%over 45 was 28.6%

Decline in 18 to 44 Decline in 18 to 44 smoker pop. 16.2%smoker pop. 16.2%


The Older SmokerThe Older SmokerThe Arizona Case StudyThe Arizona Case Study

Meaningful improvement was made in Meaningful improvement was made in increasing the participation of the medical increasing the participation of the medical community as reported by smokerscommunity as reported by smokersDid a health care provider ask you about Did a health care provider ask you about smoking?smoking? from 30.9% to 43.7% from 30.9% to 43.7%Were you asked about smoking and Were you asked about smoking and advised to stop smoking by a health advised to stop smoking by a health provider?provider? from 25.1% to 36.7% from 25.1% to 36.7%Did a dentist ask you about smoking? Did a dentist ask you about smoking? from 13.7% to 31.7%from 13.7% to 31.7%


The Older SmokerThe Older SmokerCampaign ObjectivesCampaign Objectives

Utilize tailored advertising to increase % of OS Utilize tailored advertising to increase % of OS who believe quitting will improve health who believe quitting will improve health Develop a Develop a Quitting after 50Quitting after 50 Smoker Referral Smoker Referral Network among professions & organizations Network among professions & organizations Take advantage of media, promotional, and PR Take advantage of media, promotional, and PR opportunities that are uniquely available for this opportunities that are uniquely available for this segment to achieve the objectives noted above segment to achieve the objectives noted above (i.e. state edition of AARP magazine, state and (i.e. state edition of AARP magazine, state and local fairs, low cpm TV)local fairs, low cpm TV)Increase number of OS utilizing state & local Increase number of OS utilizing state & local cessation servicescessation services


The Older SmokerThe Older Smoker Message StrategiesMessage Strategies

4 general areas for creative opportunities:4 general areas for creative opportunities: ““Your breathing (and other) problems Your breathing (and other) problems

aren’t just a sign of growing old.”aren’t just a sign of growing old.” ““Your family wants to support you, be Your family wants to support you, be

with you, now and later.” (CNS)with you, now and later.” (CNS) ““Being tobacco-free is social norm.”Being tobacco-free is social norm.” ““Quitting smoking takes practice.” (CA)Quitting smoking takes practice.” (CA)


The Older SmokerThe Older SmokerCreative ConceptCreative Concept

Creative concept: Creative concept: “This Old Smoker”“This Old Smoker” Sympathetic and Sympathetic and

empathic empathic spokespersonspokesperson

Take off on Take off on “This Old House”“This Old House”

Effective way to Effective way to highlight research-highlight research-derived messagesderived messages


The Older SmokerThe Older SmokerCreative ConceptCreative Concept

Creative concept: Creative concept: “This Old Smoker”“This Old Smoker” Tailored for >50 yr. Tailored for >50 yr.

audienceaudience Supports promotional Supports promotional

extensionsextensions Builds public support Builds public support

for OS quit attempts for OS quit attempts Allows for inclusion of Allows for inclusion of

Prochaska’s “Stages Prochaska’s “Stages of Change”of Change”


The Older SmokerThe Older SmokerUse of PRUse of PR

Public relations—Setting the stage for the over Public relations—Setting the stage for the over 50 campaign–Internal & external audiences50 campaign–Internal & external audiences Deliver persuasive messages to decision makers Deliver persuasive messages to decision makers

on the efficacy and efficiency of the campaignon the efficacy and efficiency of the campaign Saturate the media with information about the Saturate the media with information about the

health effects of quitting after 50health effects of quitting after 50 Secure speaking engagements among influential Secure speaking engagements among influential

seniors groupsseniors groups Develop partnerships with senior advocacy Develop partnerships with senior advocacy

groups (Example: AARP)groups (Example: AARP)


The Older SmokerThe Older SmokerUtilizing Clinicians and PharmsUtilizing Clinicians and Pharms

Segment & support clinicians who regularly treat Segment & support clinicians who regularly treat older pop. w/ materials tailored to help older older pop. w/ materials tailored to help older smokers, focus on their needs, their benefits i.e. smokers, focus on their needs, their benefits i.e. cessation improves drug performance, surgical cessation improves drug performance, surgical successsuccessUtilize in-store (pharmacy and grocery) media but Utilize in-store (pharmacy and grocery) media but extend campaign messages to these outlets; extend campaign messages to these outlets; add take-one referral cardsadd take-one referral cardsDevelop OS promotions that utilize pharmacy tie-insDevelop OS promotions that utilize pharmacy tie-insSeek out clinician spokespeople for media outreach Seek out clinician spokespeople for media outreach through outlets that reach the older demothrough outlets that reach the older demo


Quitting After 50 Quitting After 50 Smoker Referral NetworkSmoker Referral Network

Determine size and distribution of local older Determine size and distribution of local older smoker populationsmoker populationIdentify organizations that reach older smokers, Identify organizations that reach older smokers, educate on availability of cessation services, educate on availability of cessation services, provide collateral provide collateral Request state support for incentives to stimulate Request state support for incentives to stimulate incremental and low-cost “ready-to-quit” referralsincremental and low-cost “ready-to-quit” referralsIdentify unique settings like hospitals that offer Identify unique settings like hospitals that offer teachable moments for older smokers seeking teachable moments for older smokers seeking emergency medical careemergency medical care


The Older Smoker:The Older Smoker: Making the Case Making the CaseDo we have adequate info about older smokers to Do we have adequate info about older smokers to determine potential success of the campaign?determine potential success of the campaign?Can we make a persuasive ROI case for focusing on Can we make a persuasive ROI case for focusing on this segment? this segment? Aside from economic considerations, is there a Aside from economic considerations, is there a compelling QOL statement that can be made by compelling QOL statement that can be made by delaying early onset of disability due to smoking & delaying early onset of disability due to smoking & compressing its duration?compressing its duration?Are there compelling media, promotional, and message Are there compelling media, promotional, and message opportunities to leverage through advertising & PR?opportunities to leverage through advertising & PR?Is there potential for building a referral network to Is there potential for building a referral network to increase grassroots demand for support for this increase grassroots demand for support for this segment? segment?

Documents

Smoker Segmentation A Rationale for Segmenting The Older Smoker (50 plus)