Giving a way free stuff to motivate smokers to call a Quitline North American Quitline Consortium Meeting May 2, 2005

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

NYC Media Campaign Launched Feb, 2001

Population Impact Reach x Efficacy = Effect

Combine strategies that increase reach and enhance efficacy

+ = in population quit ratio

Why don’t more smokers use NRT to quit? HERE ARE SOME REASONS… –Low access –Misperceptions about nicotine and how NRT works –Lousy 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/Borough Promotion done to inform smokers of free NRT Number enrolled program Voucher 2-wk Erie, Niagara Press release; posters in Eckerd drugs stores; Quit & Win contest 1,099 Mail 1-wk Albany, Fulton, Montgomery, Rensselaer, Saratoga, Schenectady, Washington, Warren Press release and kick-off press conference; paid radio advertising 1,334 Mail 2-wk Chemung, Delaware, Genesee, Livingston, Monroe, Ontario, Orleans, Otsego, Schoharie, Schuyler, Seneca, Steuben, Wayne, Wyoming Yates Press release two print ads in the newspaper 2,323 Mail 6-wk Bronx, Brooklyn, Manhattan, Queens, Staten Island Press release and kick-off press conference 35,334

Follow-up Surveys Follow-up Survey Voucher 2-wk Mail 1-wk Mail 2-wk Mail 6-wk # selected to be interviewed ,0331,386 # interviews completed Response rate67%69%48%64% Average duration of follow-up (months) 3.4 months 2.9 months 3.1 months 5.6 months

Program Reach Program enrollment and reach Voucher 2-wk Mail 1-wk Mail 2-wk Mail 6-wk # enrolled1,0991,3342,32335,334 # smokers in region 199,999172,660279,775735,224 % of smokers enrolled 0.5%0.8% 4.8%

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

Average weekly call volume to the Quitline Before, During, and After the Offer for Free NRT Intervention Voucher 2-wk Mail 1-wk Mail 2-wk Mail 6-wk Ratio of calls to the Quitline during the free NRT program and 4-weeks before the offer Ratio of calls to the Quitline during the free NRT program and 4-weeks after the offer

Self-reported use of nicotine medication Intervention Voucher 2-wk Mail 1-wk Mail 2-wk Mail 6-wk % who received their NRT 83%97%99% Overall % who used the free NRT 70%75%80%88% Average number of days of NRT use* All-61% >1/2-22% <1/2-17% 5921 % who used all of the NRT 61%56%49%23% % who purchased additional NRT 12%22%19%3%

Quit attempts and smoking status ~4-months after enrollment

Intervention N% QuitRR* 95% CI (Lower- Upper) No NRT 42212%1.0Referent Voucher-2 wk 46427% Mail 1-wk 46921% Mail 2-wk 47224% Mail 6-wk 57833% 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).

Cost and effectiveness of interventions Intervention Voucher 2-wk Mail 1-wk Mail 2-wk Mail 6-wk Cost of Intervention $46,365$38,441$96,826$2.7 million Cost per Smoker enrolled $42$29$42$76 Cost per quit attributable to the NRT mail out $274$306$347

Long-term effects: smoking status of NYC program participants measured at ~4 and 12 months Characteristics NYC Patch program Participants at 4 Months (N=884) NYC Patch Program Participants at 12 Months (N=578) NYC Smokers’ Quitline Callers Jan.-Jul (N=206) % Who Made a Quit Attempt 89.6%93.4%85.6% 7 Day Non- Smoking Prevalence 34.0%33.2%22.3% % Continuous Abstainers N/A23.1%N/A % 6-Month Continuous Abstainers N/A27.9%9.2%

NRT Voucher + Better Quit® +

25-fold increase in calls

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

2-fold increase in calls

Cost Effectiveness Ratios for Quitline Program - Voucher for 2-Week Supply of NRT InterventionCost Per Call to the Quitline Cost Per Smoker Enrolled in Program Cost Per Quit Cost Per Extra Quit Attributable to the NRT Give-Away Voucher for 2-Week Supply of NRT 7/10/03 – 8/6/03 $21$42$192$ % 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 messages The 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 use Cost-effectiveness needs to consider both reach and efficacy

The End