1. Arizona Department of Health Services - Tobacco Education and Prevention Program Promoting Quitlines: Toolkit Media Recommendations Pamela Powers, MPH Network for Information and Counseling - Arizona Smokers’ Helpline Mel & Enid Zuckerman Arizona College of Public Health National Conference on Tobacco or Health, San Francisco, California, Nov. 20, 2002

2. Arizona Department of Health Services - Tobacco Education and Prevention Program The Public Health Price of Tobacco Use  Thousands of teens initiate tobacco use daily  Tobacco use costs the U.S. $150 billion annually in medical expenses (CDC)  Tobacco use causes 440,000 deaths each year in the U.S. (CDC)  Secondhand smoke causes lung cancer and heart disease in nonsmokers.  For every smoker who quits, nine will try and fail. Tobacco use is addicting.

3. Arizona Department of Health Services - Tobacco Education and Prevention Program Communication Strategies  We know the messages…  Now, what is the most effective way to communicate these messages? –Television –Public Relations –Outreach BUT… before you think strategy…think planning…

4. Arizona Department of Health Services - Tobacco Education and Prevention Program Marketing Basics: 4P’s Weinreich, NK, Hands-On Social Marketing, 1999  Product  Does your product (the quitline) appeal to the primary target audience? (service, hours, languages, etc.)  Price  What is the client’s cost to use the service? (monetary cost, psychological cost of quitting, time commitment)  Place  Distribution channels: do clients know how to access?  Promotion  What are the best ways to reach your audience?

5. Arizona Department of Health Services - Tobacco Education and Prevention Program Social Marketing Basics: 4P’s Weinreich, NK, Hands-On Social Marketing, 1999  Publics  Do you need buy-in from others to ensure the success of your campaign? (advocates, providers, legislators)  Partnership  What collaborators can help you sell your service? (worksites, providers, voluntary organizations)  Policy  What role can policy change play in your marketing?  Purse strings  What steps are necessary to secure funding?

6. Arizona Department of Health Services - Tobacco Education and Prevention Program Communication Planning  Every service has multiple audiences  Communication planning can help you identify your audiences and the messages and strategies to reach them –Invite staff, stakeholders, funding agencies, and other colleagues to provide input into your plan –Your communication plan should be synchronized with your organization’s overall strategic plan  What audiences does your quitline have?

7. Arizona Department of Health Services - Tobacco Education and Prevention Program AudiencesMessagesCommunication ToolsDistribution Channels Adult Tobacco Users  Try to quit  Quitting takes practice  Free services are available  Quitline can help you  Medications can help  Social support can help  Secondhand smoke harms others  Health effects of using and quitting  Commercials  Media relations (news and feature stories)  Testimonials (from quitters who used services or from collaborating physicians)  Personal advice  Health education materials (posters, brochures)  TV  Radio  Newspaper  Magazines  Direct mail  Web  Friends/family  Co-workers  Physicians  Events  Physicians’ Offices  Web  Libraries  Worksites  Schools  Hospitals Audience: Adult Tobacco Users Behavior Change Goals: Make a quit attempt Quit using tobacco altogether Call quitline Adopt smoke-free home policy, etc.

8. Arizona Department of Health Services - Tobacco Education and Prevention Program AudiencesMessagesCommunication Tools Distribution Channels Healthcare Providers  Help your patients quit  Your advice to quit is a powerful motivator  Effective treatments are available  Free services are available  Quitlines can help your patients  Medications can help your patients  Cessation training is available for you and your staff  Collateral materials are available for your office  AHRQ guidelines  Media relations (news and feature stories)  Testimonials (from quitters who used services or from collaborating physicians)  Presentations  Health education materials (posters, brochures)  Journal articles  TV  Radio  Newspaper  Magazines  Direct mail  Web  Trade publications  Conferences  Workshops  Local professional meetings  Outreach events  Web  Medical journals  Academic publications  Web Audience: Healthcare Providers Behavior Change Goals: Intervene with tobacco using patients Refer tobacco using patients to services Prescribe cessation medications, etc.

9. Arizona Department of Health Services - Tobacco Education and Prevention Program AudiencesMessagesCommunication Tools Distribution Channels Journalists  Tobacco taxes are beneficial (give reasons)  Clean indoor air is important (give reasons)  Secondhand smoke harms others  Quitting takes practice  Free services are available  Quitlines can help people quit  Medications can help people quit  Social support can help people quit  Health effects of using and quitting  We will work with you to help you build interesting stories  Press releases  Press packets  Pre-written stories  Health education materials (posters, brochures)  Verbal background information  Presentations  Health education materials (posters, brochures)  Journal articles  Fax  E-mail  Web  Direct mail  Press conferences  Events  Phone calls  Personal meetings  Media events  Conferences  Local professional meetings  Web  Medical journals  Academic publications  Web Audience: Journalists Behavior Change Goals:  Write newspaper stories about tobacco taxes, quitline services, clean indoor air, health effects of tobacco use, etc.  Produce television stories about tobacco taxes, quitline services, clean indoor air, health effects of tobacco use, etc.  Attend media events  Use Web-based background information about quitline

10. Arizona Department of Health Services - Tobacco Education and Prevention Program What Motivates People to Seek Cessation Services?  Advertising (Paid) –Television –Radio –Newspaper  Referrals (Unpaid) –Friends, family, former clients –Community-based tobacco projects, worksites –Healthcare providers –Community Events Interruption Marketing Permission Marketing – Billboards – Telephone book

11. Arizona Department of Health Services - Tobacco Education and Prevention Program Who Uses Arizona’s Helpline?

12. Arizona Department of Health Services - Tobacco Education and Prevention Program Helpline Recruitment Sources

13. Arizona Department of Health Services - Tobacco Education and Prevention Program Impact of TV on Access to Services  Well-placed, effective TV commercials motivate people to access services –Message  Different messages motivate different people  Test messages! –Audience targeting (youth, adult, diverse communities)  Placement (i.e., prime time, soaps, Simpsons, etc.)  Message testing is particularly important when targeting –Gross Ratings Points (GRPs)  Don’t overwhelm service provider by buying too much advertising; split markets, stagger buys

14. Arizona Department of Health Services - Tobacco Education and Prevention Program Chuck Campaign: an Innovative Approach to Recruitment PreparationAction Humorous, non-threatening testimonials motivated tobacco users to call Arizona Smokers’ Helpline

15. Arizona Department of Health Services - Tobacco Education and Prevention Program Chuck Findings  Callers chose counseling services more often as Chuck progressed to action  Counseling calls increased significantly  Questions only calls decreased significantly  Chuck appealed equally to men and women  A greater percentage of African-Americans called during Chuck ads (compared to no advertising or health effects advertising)

16. Arizona Department of Health Services - Tobacco Education and Prevention Program General Market TV

17. Arizona Department of Health Services - Tobacco Education and Prevention Program Targeting Selected Audiences  Marketing to Hispanics –Spanish language television and radio  Marketing to pregnant women –Guilt ads vs. empowerment ads

18. Arizona Department of Health Services - Tobacco Education and Prevention Program Spanish TV Strategies  Different strategies of Spanish television were tested –Carlos –Humorous commercials –Telemundo Telethon featuring Helpline counselors –Univision Helpline walk-through featuring health reporter

19. Arizona Department of Health Services - Tobacco Education and Prevention Program Spanish TV Commercials Carlos Health Reporter Telethon

20. Arizona Department of Health Services - Tobacco Education and Prevention Program Impact of Spanish TV Advertising  Hispanic callers preferred Chuck over Carlos (Spanish Chuck)  Telethon and Health Reporter ads generated more Spanish calls than previous ads  Highly produced ads generated significantly fewer calls than low-budget ads featuring local talent (trusted source)  Spanish speakers use pre-recorded voice tips more than English speakers

21. Arizona Department of Health Services - Tobacco Education and Prevention Program Spanish Market TV

22. Arizona Department of Health Services - Tobacco Education and Prevention Program Pregnancy-Specific Ads  Pregnant Power commercial –Significant increase in the proportion of female callers of any age –Significant increase in pregnant callers Pregnant Power Todos los Dias

23. Arizona Department of Health Services - Tobacco Education and Prevention Program Pregnancy-Specific Ads

24. Arizona Department of Health Services - Tobacco Education and Prevention Program Public Relations & Outreach  Public Relations –News and feature story placement –Guest appearances on radio and TV talk shows –Speakers’ Bureaus –Newsletters and trade publications –Sponsorships –Listserv promotions  Outreach –Targeted initiatives with specific groups –Direct mail incentives to referring agencies

25. Arizona Department of Health Services - Tobacco Education and Prevention Program Advertisin g  Pros: –Very large audiences –Potentially powerful recruitment tool –High visibility –Name recognition  Cons: –Expensive –High visibility –Not sure-fire  Pros: –Builds relationships (viral marketing) –Less expensive (not free) –Name recognition –Visibility with select audiences –Tell your story  Cons (~): –One relationship at a time –Smaller audiences –Not sure-fire PR/Outreach

26. Arizona Department of Health Services - Tobacco Education and Prevention Program Proactive Referral Networks  Community projects –Pilot project: referrals from Mohave County make up 68% of the proactive community referrals (FY 01-02)  WIC clinics –Pilot project: recruitment from Mohave County WIC increased 340% in 3 quarters

27. Arizona Department of Health Services - Tobacco Education and Prevention Program Proactive Referral  Outside agency conducts brief intervention  Gains client consent for Helpline call  Faxes referral to Helpline  Helpline calls, recruits client into services, does intake form Proactive Referrals

28. Arizona Department of Health Services - Tobacco Education and Prevention Program Expansion of Proactive Cessation Referral Network  Helpline and four counties working together to build healthcare referrals  Selected managed care organizations also will participate

29. Arizona Department of Health Services - Tobacco Education and Prevention Program Healthcare Provider Outreach  Give healthcare providers the tools they need on an ongoing basis –Basic cessation intervention training (5As) –Collateral materials for waiting room –Strategies to change systems (chart stickers, referral forms, NRT benefits, free cessation services, training, incentives) –Outcome results per referral

30. Arizona Department of Health Services - Tobacco Education and Prevention Program Healthcare Provider Materials/Incentives  Distribute aggregate client data to MCOs  Mail tailored packets MCO clients  Mail thank-you letters, incentives, and publications to referring HCPs

31. Arizona Department of Health Services - Tobacco Education and Prevention Program Conclusions: Quitline Promotion  Recommendations from the Toolkit : –Hire a media professional or advertising agency to assist in developing your quitline media campaign –Use social marketing fundamentals to develop a comprehensive communication plan to identify multiple audiences, messages and media venues –Use a variety of media and media strategies –Develop, test and implement targeted messages in appropriate venues to reach diverse populations

32. Arizona Department of Health Services - Tobacco Education and Prevention Program Conclusions: Quitline Promotion  Recommendations from the Toolkit : –Coordinate all media with the quitline management to ensure quality customer service –Work to develop collaborative relationships –Develop a consistent, recognizable corporate image and collateral materials (print and electronic) –Develop media tracking and evaluation measures and be prepared to act on those results—positive or negative

33. Arizona Department of Health Services - Tobacco Education and Prevention Program Arizona Smokers’ Helpline 1-800-55-66-222 www.ASHLine.org Slides available at: www.TEPP.org/presentations/index.html Mel & Enid Zuckerman Arizona College of Public Health University of Arizona, Tucson, Arizona