The Impact of the Tips from Former Smokers® Campaign on Reducing Cigarette Smoking Relapse.

Evidence-based mass-reach health communication campaigns can increase tobacco cessation, use of cessation resources such as quitlines, and change tobacco-related social norms. These interventions have been associated with a lower likelihood of cigarette smoking relapse in studies conducted internationally; however, no studies have assessed this outcome for a national campaign in the United States. This study examined the relationship between Tips from Former Smokers® (Tips®) campaign exposure and the odds of cigarette smoking relapse among adults who formerly smoked. Using data from the 2014 to 2019 Tips longitudinal campaign surveys, we estimated first episode of relapse (versus remaining a former smoker) as a function of Tips gross rating points (GRPs, a measure of media exposure). Higher levels of Tips GRPs were associated with lower odds of relapse (aOR = 0.63, 95% CI: 0.50-0.78). These results suggest that the Tips campaign may reduce smoking relapse, in addition to the established effect of increasing smoking cessation. Former smokers can be considered a secondary target audience for smoking cessation mass media campaigns, and mass media campaigns could be considered a component of smoking relapse prevention efforts.

Differences in Quitline Registrants' Characteristics During National Radio Versus Television Antismoking Campaigns.

INTRODUCTION: The Centers for Disease Control and Prevention's Tips From Former Smokers® campaign encourages smokers to get help with quitting smoking by promoting 1-800-QUIT-NOW. Campaign advertisements featuring an offer of help with obtaining free cessation medication aired nationally on radio for 2 weeks in 2016. Similar advertisements aired nationally on TV for 3 weeks in 2017. The comparison period of 2016 radio campaign and 2017 TV campaign was used to examine the characteristics of quitline registrants by a media referral source (TV or radio). METHODS: Data on the number and demographics of quitline registrants in 2016 and 2017 were obtained from the Centers for Disease Control and Prevention's National Quitline Data Warehouse. The investigators conducted t-tests to assess the demographic differences between registrants who heard about the quitline through the radio advertisements and those who heard about it through the TV advertisements during the comparison period. This analysis was conducted in 2019. RESULTS: The registrants who heard about the quitline from radio advertisements were more likely to be male, younger, and have more years of education. However, the registrants who heard about the quitline from TV advertisements were more likely to be Black, non-Hispanic, and have fewer years of education. CONCLUSIONS: The findings suggest that the demographic profiles of quitline registrants vary significantly based on how registrants hear about the quitline (via radio or TV). These differences in the characteristics of registrants can help inform the tobacco control mass media purchasing strategies and may enable media efforts to target the specific subgroups of smokers in a better way.

Cost Effectiveness of the Tips From Former Smokers® Campaign-U.S., 2012-2018.

INTRODUCTION: Since 2012, the Centers for Disease Control and Prevention has conducted the national Tips From Former Smokers® public education campaign, which motivates smokers to quit by featuring people living with the real-life health consequences of smoking. Cost effectiveness, from the healthcare sector perspective, of the Tips From Former Smokers® campaign was compared over 2012-2018 with that of no campaign. METHODS: A combination of survey data from a nationally representative sample of U.S. adults that includes cigarette smokers and literature-based lifetime relapse rates were used to calculate the cumulative number of Tips From Former Smokers® campaign‒associated lifetime quits during 2012-2018. Then, lifetime health benefits (premature deaths averted, life years saved, and quality-adjusted life years gained) and healthcare sector cost savings associated with these quits were assessed. All the costs were adjusted for inflation in 2018 U.S. dollars. The Tips From Former Smokers® campaign was conducted and the survey data were collected during 2012-2018. Analyses were conducted in 2019. RESULTS: During 2012-2018, the Tips From Former Smokers® campaign was associated with an estimated 129,100 premature deaths avoided, 803,800 life years gained, 1.38 million quality-adjusted life years gained, and $7.3 billion in healthcare sector cost savings on the basis of an estimated 642,200 campaign-associated lifetime quits. The Tips From Former Smokers® campaign was associated with cost savings per lifetime quit of $11,400, per life year gained of $9,100, per premature deaths avoided of $56,800, and per quality-adjusted life year gained of $5,300. CONCLUSIONS: Mass-reach health education campaigns, such as Tips From Former Smokers®, can help smokers quit, improve health outcomes, and potentially reduce healthcare sector costs.

Exposure to Secondhand Smoke in Homes and Vehicles Among US Youths, United States, 2011-2019.

In this study, we report the prevalence of self-reported secondhand smoke (SHS) exposure in homes and vehicles among US middle and high school students in 2019 and changes in SHS exposure over time. Data were from 7 years of the National Youth Tobacco Survey (NYTS; 2011, 2013, and 2015-2019). In 2019, 25.3% (an estimated 6.7 million) of students reported home SHS exposure and 23.3% (6.1 million) reported vehicle SHS exposure. Home and vehicle SHS exposure significantly declined during 2011 through 2018, except for home exposure among non-Hispanic black students. Implementation of smoke-free policies in public and private settings can reduce SHS exposure.

Association Between the Tips From Former Smokers Campaign and Smoking Cessation Among Adults, United States, 2012-2018.

In 2012, the Centers for Disease Control and Prevention (CDC) launched the national Tips From Former Smokers (Tips) campaign to encourage people who smoke to quit by showing real-life heath consequences of tobacco use and promoting evidence-based resources for quitting. To assess the campaign's impact on quit attempts and sustained-quit estimates (ie, quits lasting ≥6 mos), CDC analyzed data from a nationally representative longitudinal survey of US adults who smoke cigarettes, aged 18 years or older in 2012-2018. The Tips campaign was associated with an estimated 16.4 million quit attempts and 1,005,419 sustained quits. Continued implementation of cessation campaigns, including the Tips campaign, could accelerate progress toward reducing rates of smoking-related diseases and death.

Evidence of the Impact of the Tips From Former Smokers Campaign: Results From the Behavioral Risk Factor Surveillance System.

The Tips From Former Smokers campaign (Tips) has demonstrated significant impact as a population-based intervention for smoking cessation in the United States. Since 2012, evaluations of Tips have relied on web-panel data to attribute the campaign to smoking cessation outcomes. We re-examined the relationship between market-level doses of the campaign and quit attempts by using Behavioral Risk Factor Surveillance System (BRFSS) data to triangulate prior findings. We found that Tips was associated with increased quit attempts among smokers, which validates prior evaluation research on the impact of Tips. These results suggest that continued investments in Tips may help sustain its impact on cessation-related outcomes.

Media Flight Schedules and Seasonality in Relation to Quitline Call Volume.

CONTEXT: Given the high profile, cost, and vulnerability to budget cuts of mass-reach health education campaigns, researchers have cited the need for media buying strategies. OBJECTIVE: The objective of the current study is to fill a gap in the literature by comparing the impact of media flight schedule types in relation to tobacco quitline call volume. DESIGN: The retrospective study was designed to determine whether type of media flight schedule (eg, flighting, continuous, pulsing) impacted number of calls to the Maine Tobacco Helpline, while accounting for number of gross rating points (GRPs), seasonality, holidays, and other factors. SETTING: Maine has 3 designated market areas (DMAs): Portland/Auburn, Bangor, and Presque Isle. MAIN OUTCOME MEASURES: Daily call volume was matched with weekly GRPs. METHODS: A negative binomial regression model was created to examine the relationship among media flight schedules, number of GRPs, and call volume. Gross rating points reflect national networks and local cable TV media buys. A second model examined the association between GRP dose levels and call volume. RESULTS: The number of GRPs was a significant predictor of call volume (P < .001). Weekly number of GRPs within a media flight schedule was the most important indicator for potential effectiveness. Weekly low-dose GRPs were not effective in increasing calls, indicating a minimum threshold. For every 250 GRPs, 29% (or 73) more calls per week were attributed to the media campaigns (P < .001). Weekly quitline call volume was 21% (or 53 calls) lower during the weeks of Christmas, US Thanksgiving, and US Independence Day. CONCLUSION: Type of media flight schedule should be considered in the context of purchasing sufficient weekly, as well as quarterly, rating points to increase tobacco quitline call volume. In addition, our study is the first to quantify and report on lower tobacco quitline call volume during several US holidays.

Impact of the Tips From Former Smokers Campaign on Population-Level Smoking Cessation, 2012-2015.

This study provides estimates of the long-term cumulative impact of the Centers for Disease Control and Prevention's national tobacco education campaign, Tips From Former Smokers (Tips), on population-level smoking cessation. We used recently published estimates of the association between increased Tips campaign media doses and quit attempts to calculate campaign-attributable population sustained (6-month) quits during 2012-2015. Tips led to approximately 522,000 sustained quits during 2012-2015. These findings indicate that the Tips campaign's comprehensive approach to combining evidence-based messages with the promotion of cessation resources was successful in achieving substantial long-term cigarette cessation at the population level over multiple years.

Prevalence of smoke-free car and home rules in Maine before and after passage of a smoke-free vehicle law, 2007-2010.

INTRODUCTION: This is the first study to examine the prevalence of self-reported smoke-free rules for private cars and homes before and after the passage of a smoke-free vehicle law. METHODS: Data were examined for 13,461 Maine adults aged 18 or older who participated in the Behavioral Risk Factor Surveillance System, a state-based telephone survey covering health topics. Self-reported smoke-free car and home rules, smoking behavior, and demographic variables of age, sex, education, income, and children in household were analyzed for prevalence before and after the state's smoke-free vehicle law was passed. RESULTS: Prevalence of smoke-free car and home rules was significantly higher after Maine's smoke-free vehicle law was passed in the state (P = .004 for car rules and P = .009 for home rules). Variations in smoking rules differed by smoking and demographic variables. People with household incomes of less than $20,000 saw an increase of 14.3% in smoke-free car rules; overall, those with annual incomes of less than $20,000 and those with less than a high school education reported a lower prevalence of smoke-free car rules both before and after the law was passed than did people with higher incomes and higher education levels. The prevalence of smoke-free home rules after the law was implemented was higher among those with 4 or more years of college education than among those with lower levels of education (P = .02). CONCLUSION: The prevalence of smoke-free car and home rules among Maine adults was significantly higher after the passage of a statewide smoke-free vehicle law. This apparent change in smoke-free rule prevalence may be indicative of changing social norms related to the unacceptability of secondhand smoke exposure.

The influence of tobacco countermarketing ads on college students' knowledge, attitudes, and beliefs.

OBJECTIVE: To determine which antitobacco messages were perceived effective in changing college students' knowledge, attitudes, and beliefs about tobacco use. PARTICIPANTS: College students (n = 1,020) were surveyed before and after viewing 4 30-second antitobacco advertisements in 1 of 3 theme categories-social norms, health consequences, or tobacco industry manipulation. METHODS: An independent samples t test was used to test for differences in the mean responses to the knowledge, attitude, and belief questions at posttest by smoking status and gender. RESULTS: Health consequences ads significantly increased overall knowledge and negative attitudes and beliefs. CONCLUSION: Findings from this study may help health educators who work in college settings and other young adult settings to include media messages as part of a comprehensive tobacco control program.

Perceived effectiveness of tobacco countermarketing advertisements among young adults.

OBJECTIVES: To measure relative effectiveness of tobacco countermarketing advertisements by category and emotive execution style among young adults. METHODS: Participants (n=1011) from 2 US 4-year colleges, one southern and one northern were surveyed before and after viewing advertisements in one of 3 categories: social norms, health consequences, or tobacco industry manipulation and with 4 emotive execution styles: drama, testimonial (negative emotive) and humor, sarcasm (positive). RESULTS: Health consequences and negative emotive advertisements were rated significantly most persuasive. CONCLUSIONS: This is the first study to support the effectiveness of tobacco countermarketing advertisements emphasizing the negative emotive health consequences of smoking among young adults.

A review of interventions to reduce tobacco use in colleges and universities.

BACKGROUND: Interventions have been designed to reduce the prevalence of smoking in college/university students. This review presents a summary and synthesis of the interventions published in English from 1980 to the present. METHODS: Seven databases were searched for relevant published articles, and reference lists were examined for additional published studies. The studies were categorized as (1) individual approaches, such as on-campus cessation programs, and (2) institutional approaches, such as smoke-free policies. The studies were categorized by type of institution and geographic location, study design, sample demographics, and outcomes. RESULTS: Fourteen studies were identified; only five received a "satisfactory" rating based on evaluation criteria. Most studies were based on convenience samples, and were conducted in 4-year institutions. Seven studies used comparison groups, and three were multi-institutional. Individual approaches included educational group sessions and/or individual counseling that were conducted on campus mostly by healthcare personnel. None used nicotine replacement or other medications for cessation. The quit rates for both smokeless tobacco and cigarette users varied, depending on definitions and duration of follow-up contact. Institutional interventions focused mainly on campus smoking restrictions, smoke-free policies, antitobacco messages, and cigarette pricing. Results indicated that interventions can have a positive influence on student behavior, specifically by reducing tobacco use (i.e., prevalence of cigarette smoking and use of smokeless products, amount smoked) among college students, and increasing acceptability of smoking policies and campus restrictions among both tobacco users and nonusers. CONCLUSIONS: While some promising results have been noted, rigorous evaluations of a wider range of programs are needed, along with studies that address cultural and ethnic diversity on campuses.

Perceptions about cigarette smoking and risks among college students.

The objective of the present study was to describe how college students perceive the risks of cigarette smoking and addiction to nicotine. Data came from a self-administered survey of 1,020 college students enrolled in two 4-year liberal arts colleges in the United States. The survey was conducted in the fall of 2001. Smokers and nonsmokers differed markedly in their perceptions about the health risks associated with short-term exposure to smoking. College students in this sample who smoked did not fully comprehend the risks associated with smoking. Smokers were half as likely as nonsmokers to believe that there are health risks from smoking only on weekends or a couple of days a week. Anti-tobacco messages for young adult smokers need to communicate more effectively the concept that each cigarette they smoke is doing them damage.