In this paper, results are presented on the response to an antismoking media campaign designed to encourage women cigarette smokers with young children to call for information on quitting. The intervention campaign used a mix of professionally produced broadcast and print materials that encouraged smokers to call the National Cancer Institute's Cancer Information Service (CIS) for information on quitting. The campaign was implemented in seven media markets in New York state, Pennsylvania, and Delaware; each of these markets was paired with a control market in one of the three states. Response to the campaign was gauged by monitoring calls to the New York and Pennsylvania area CIS offices from smokers residing in intervention and control media markets. Results from the 46-week campaign show that the number of calls for smoking-cessation information was five times greater from intervention markets than from control markets. The campaign also was successful in reaching the target audience of mothers of young children. Twenty-nine percent of calls received from intervention markets were from the target audience compared with 10% from the control markets. Forty-four percent of all calls received from intervention markets came during a 5-week period when time was purchased to air television spots.

This study provides estimates of deaths attributable to smoking, years of potential life lost (YPLL), and economic costs for each of New York's 57 counties and New York City for the period 1987 to 1989. Results show that in New York State, cigarette smoking was responsible for an average of 30,359 deaths, 409,129 YPLL, and nearly $4 billion in economic costs annually. Overall, smoking-attributable deaths comprised 17.7% of all deaths, or more than the combined total from accidents, AIDS, homicide, and suicide. Findings demonstrate the enormous health and economic burden caused by tobacco use and reinforce the need for policies that discourage smoking, such as increased cigarette taxes, limited smoking in public places, enforcement of youth tobacco access laws, and funding for tobacco education programs.

It has been suggested that tailoring self-help materials for specific target populations will increase their effectiveness. This study tested the value of a self-help guide tailored specifically for women with young children. These women were recruited through a media campaign that encouraged smokers to call the Cancer Information Service (CIS) for assistance in stopping smoking. Women smokers with young children (under the age of 6) who called the CIS were given telephone counseling on quitting and were mailed one of three stop smoking guides. One third of callers received Quitting Times, a guide written specifically for women with young children; one third received the American Lung Association guide, Freedom from Smoking for You and Your FamilyR; and one third received Clearing the Air, a guide developed by the National Cancer Institute. Six months after calling the CIS, these women were contacted by telephone to assess changes in smoking behavior. Overall, 12.5% of the women reported not smoking for at least 1 week at the time of the 6-month follow-up interview. There were no significant differences between subjects in the three groups in use of the self-help guides, methods used to attempt quitting, and quitting behavior. Findings from this study do not support the hypothesis that using a tailored stop smoking guide increases the targeted audience's cessation rate or affects quitting-related behavior. However, it should be noted that the smokers who called were predominantly in the contemplation or action stages.

Recent studies have described tobacco advertising in the print media, on billboards, and through sponsorship of cultural and sporting events. However, little attention has been given to another common and unavoidable source of tobacco advertising, that which is encountered in retail stores. In July 1987, we conducted a survey of 61 packaged goods retail stores in Buffalo, NY, to assess the prevalence and type of point-of-sale tobacco advertising. In addition, store owners or managers were surveyed to determine their store's policy regarding tobacco advertising, receipt of monetary incentives from distributors for displaying tobacco ads, and willingness to display antitobacco ads. Six types of stores were involved in the study: 10 supermarkets, 10 privately owned grocery stores, 9 chain convenience food stores that do not sell gasoline, 11 chain convenience food stores that sell gasoline, 11 chain pharmacies, and 10 private pharmacies. Two-thirds of the stores displayed tobacco posters, and 87 percent had promotional items advertising tobacco products, primarily cigarettes. Larger stores, and those that were privately owned, tended to display more posters and promotional items. Eighty percent of tobacco product displays were for cigarettes, 16 percent for smokeless tobacco products, and 4 percent for cigars and pipe tobacco. Convenience stores selling gasoline had the most separate tobacco product displays. Of tobacco product displays, 24 percent were located adjacent to candy and snack displays. Twenty-nine of the 61 store owners or managers indicated that their store had a policy regulating the display of tobacco ads and tobacco product displays. Policies dealt primarily with the location of tobacco posters (for example, no ads in the window) and number of product displays. Only 14 shop owners or managers indicated that they had previously displayed antitobacco information; more than half (31 of 61) said that they would be willing to display antitobaccoads.In many stores space availability is a barrier to displaying antitobacco information. Materials should be designed that have some utility for the store, such as posters that list store hours or directional information (that is, in and out signs).Antitobacco messages could also be displayed on check out dividers, check out mats, shopping carts,shopping bags, and milk cartons. In chain stores,decisions regarding the display of antitobacco information are likely to be made at the corporate level. Standards encouraging retailers to adopt more responsible policies related to advertising and sale of tobacco products should be established.

Despite overwhelming evidence documenting the hazards of cigarette smoking, the tobacco industry denies that smoking has been proven to cause disease. The industry professes a desire to clear up the smoking and health "question" and often points to its support of the Council for Tobacco Research (CTR) as evidence of its interest in investigating the health dangers of smoking. This paper presents results of a survey of CTR-funded scientists regarding their beliefs about the health dangers posed by smoking cigarettes. The vast majority of scientists funded by the CTR believe that cigarette smoking is an addiction that causes a wide range of serious, often fatal, diseases. This result suggests that the tobacco industry is unwilling to accept even the opinions of scientists it has deemed worthy of funding. Scientists should consider the ethical implications of accepting funds from the CTR and other tobacco industry-supported institutions.

This study reports the results of an intervention to stop the illegal sale of cigarettes to minors. Sixty-two of 120 stores in Erie County, New York, were randomly selected to receive in the mail an informational packet requesting their help in stopping the illegal sale of tobacco to minors. The packet included a letter to the store manager citing the law prohibiting the sale of tobacco products to minors and requesting their assistance in observing the law; a supply of warning signs; and a tip sheet designed to assist store managers in educating their employees about the law. Two weeks after the mailing, stores in the study were visited by study teenagers aged 14 to 16 who attempted to purchase cigarettes. The intervention resulted in an increased number of stores posting warning signs, but had no effect on deterring the sale of cigarettes to minors. Minors purchased cigarettes in 77% of stores that received the special mailing and in 86% of nonintervention stores. Warning signs were visible in 40% of stores that received the special mailing and in none of the nonintervention stores. The findings from this study suggest that a merchant education program to increase awareness of the law and posting of warning signs is not sufficient to discourage the sale of tobacco products to minors.

This paper presents the results oj a jollow-up evaluation conducted to assess the impact oj a community-wide stop smoking contest conducted in Buffalo, lVew York in January 1988. The contest challenged smokers to make a pledge to quit jar 30 days to have a chance to win $1,000 cash, a vacation trip, or other prizes. Finalists were randomly selected and chemically tested to verify abstinence. Telephone jollow-up interviews were conducted on a sample oj 411 contestants six weeks and eight months ajter the quit date. A total oj 2,565 smokers enrolled in the contest. Compared to smokers in the general population, contestants were more likely to be jemale, white, under age 40, and smoke 25 or more cigarettes daily. Over 90 percent oj contestants attempted to stop smoking, 51 percent quit jar the 3D-day contest period, and 32 percent were not smoking ajter eight months.

Of the 17 million smokers in North America who attempt to quit smoking each year, fewer than one in ten succeed [1, 2]. How can communities improve smokers' chances of quitting? The National Cancer Institute addresses this question through COMMIT, the Community Intervention Trial for Smoking Cessation. COMMIT is the largest smoking intervention trial in the world, involving over 2 million people in twenty-two North American communities. The study protocol requires that the implementation of mandated interventions in each community be managed by a Community Board and at least four task forces (Health Care, Worksites and Organizations, Cessation Resources, and Public Education, including Media and Youth). Three required and three optional interventions in the COMMIT protocol relate to the availability of cessation resources and services. The Cessation Resources Task Force, composed of community volunteers, supervises implementation of these interventions at each site. The activities of each task force are integrated with the others in a community action plan. How COMMIT activities enhance the utilization of cessation resources and services and how these services fit into a community intervention is the subject of this article. Descriptions of the study design and evaluation plan, and of the community mobilization process are presented elsewhere [3, 4].

The Community Intervention Trial (COMMIT) is designed to reduce the rate of heavy smoking in eleven pairs of North American communities over an eight-year period. The intervention, consisting of a minimum of fifty-one activities, is being implemented through local community boards and task forces. This article describes the goals and activities for the public education task force with a specific focus on “media advocacy,” an innovative use of mass media that follows more closely political activist models than traditional public service models. Two brief case studies are presented to illustrate some applications of media advocacy. The reasons for relatively infrequent use of media advocacy are discussed.

The 1989-1990 New York State budget increased the tax on a package of cigarettes from 21 to 33 cents. In this paper we estimate the impact of this tax increase on smoking prevalence and smoking-induced deaths in New York State. Findings show that 115,967 New Yorkers will be encouraged to quit or not start smoking as a result of the increased cigarette tax. The reduced prevalence of smoking attributed to the tax will result in the avoidance of approximately 28,992 premature smoking-induced deaths over the next generation.

This article presents results from an experimental study designed to evaluate the effects of two features of self-help smoking cessation booklets, format (i.e., day-by- day plan for quitting versus a less structured menu format) and quitting instructions (i.e., "cold turkey" versus gradual reduction) on smoking cessation. Four separate self- help booklets were developed for comparison in this study. Each varied on a combina tion of the two study factors, but were similar in content, length, style, and readabil ity. The four booklets provided similar advice on how to quit smoking, emphasizing behavioral self-management principles. In addition to the experimental booklets, a fifth control booklet provided general information about smoking and its adverse effects, but no specific advice on quitting. Study subjects included 1,534 adult cigar ette smokers who called a stop smoking hotline in Buffalo, New York seeking informa tion on how to quit. Subjects were followed up by phone one month and six months after enrollment to assess changes in smoking behavior. Overall, 18% of subjects re ported being off cigarettes for at least one week at the time of the six month follow-up interview. The format of the booklet and quitting instructions had no effect on smoking cessation rates. In addition, the four booklets emphasizing behavioral self- management skills were no more effective than the control booklet (6 month non- smoking prevalence rate: 17% versus 19%). It is recommended that future self-help quit smoking booklets include information aimed at motivating cessation and focus less attention on teaching strategies for quitting.

This is a study of physicians' stop-smoking advice to patients in a university-affiliated family medicine outpatient center. The study population consisted of 311 cigarette-smoking patients of 28 family-practice residents. Patients were monitored for three months to assess changes in their smoking habits and to measure the effects of advice from their physicians. Reports of advice were correlated with both patient and physician characteristics. Forty-one percent of the patients said they had been told by their physician to stop smoking during the three-month follow-up period. Heavy smokers (more than 26 cigarettes a day) (p = .02) and those being treated for tobacco-related conditions (p = .06) were most likely to report that their physician had advised them to quit smoking. Patients seen by a physician who was a cigarette smoker were less likely to report stop-smoking advice than patients seen by a nonsmoking physician (26 percent versus 44 percent, p = .02). Selectivity in the types of patients advised to quit smoking appears to reflect the physicians' personal judgments about the patients' likelihood of following their advice.

We present the results of a survey conducted to evaluate the impact of a newspaper mediated smoking cessation program conducted in Buffalo, New York in January 1987. Over half of all smokers surveyed reported exposure to the newspaper series; 13 per cent reported that the series prompted them to try to quit smoking, and 4 per cent stopped smoking for at least one week. We estimate that over 9,600 smokers in Erie County, New York stopped smoking for at least one week as a result of the newspaper's smoking cessation program.

This study examined the anti-smoking counseling practices of a group of family practice physicians and related these to success in persuading patients to stop smoking. The study population included 283 cigarette smoking patients of 28 family practice residents. Patients were followed over a 3-month period to assess changes in smoking behavior. Two measures of success in counseling patients to stop smoking were evaluated in the study: (1) the percentage of a physician's patients who tried to quit smoking, and (2) the percentage of a physician's patients who succeeded in quitting. Findings showed wide variation among physicians in the percentage of patients who tried to quit (range: 20%–77%) and the percentage of patients who succeeded in quitting (range: 0%–25%). Two counseling practices, advising patients to set a target date for quitting and scheduling follow-up visits with patients to monitor progress, were related to the percentage of a physician's patients who quit smoking. These two counseling practices represent a way of structuring the patients quitting effort and committing the patient to follow through with a decision to stop smoking, both of which appear to be key ingredients to success in counseling patients to stop smoking.