Introduction There is substantial evidence that mass media campaigns increase calls to quitlines as well as smoking cessation. In 2012, the Centers for Disease Control and Prevention launched the first federally funded national tobacco education campaign, Tips From Former Smokers (R) (ie, Tips). From 2012 through 2023, Tips aired advertisements on television. To date, no studies have examined the long-term effect of a national smoking cessation campaign on quitline calls. This study examined the long-term impact of Tips television ads on calls to 1-800-QUIT-NOW from 2012 through 2023. Methods Exposure to the Tips campaign was measured using weekly gross rating points (GRPs) for television ads in each U.S. designated market area. We obtained data on calls to 1-800-QUIT-NOW from the National Cancer Institute and used linear regression to model calls to 1-800-QUIT-NOW, from 2012 through 2023, as a function of weekly media market-level GRPs for Tips television ads. Using the regression model results, we calculated predicted values of calls to 1-800-QUIT-NOW across observed GRP values to determine the total calls to 1-800-QUIT-NOW that were attributable to the Tips campaign during 2012-2023. Results Tips GRPs were positively and significantly associated with calls to 1-800-QUIT-NOW across all years (b = 39.94, p < .001). Based on this association, we estimate the Tips campaign generated nearly 2.1 million additional calls to 1-800-QUIT-NOW during 2012-2023. Conclusions Exposure to the Tips campaign has consistently and significantly increased calls to tobacco quitlines. Implications Quitlines provide evidence-based support to help people quit smoking. They have been shown to increase the likelihood of successfully quitting. Mass media campaigns have promoted quitlines, and quitline calls have increased significantly with media promotion. The long-term effect of campaigns-like the Centers for Disease Control and Prevention's Tips From Former Smokers (R) (ie, Tips)-on quitline calls has not been determined. From 2012 through 2023, exposure to the Tips campaign is estimated to have generated nearly 2.1 million additional calls to 1-800-QUIT-NOW. This study supports the continued use of mass media to promote quitlines.

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.

BackgroundHigh-intensity antitobacco media campaigns are a proven strategy to reduce the harms of cigarette smoking. While buy-in from multiple stakeholders is needed to launch meaningful health policy, the budgetary impact of sustained media campaigns from multiple payer perspectives is unknown.MethodsWe estimated the budgetary impact and time to breakeven from societal, all-payer, Medicare, Medicaid and private insurer perspectives of national antitobacco media campaigns in the USA. Campaigns of 1, 5 and 10 years of durations were assessed in a microsimulation model to estimate the 10 and 20-year health and budgetary impact. Simulation model inputs were obtained from literature and both pubic use and proprietary data sets.ResultsThe microsimulation predicts that a 10-year national smoking cessation campaign would produce net savings of $10.4, $5.1, $1.4, $3.6 and $0.2 billion from the societal, all-payer, Medicare, Medicaid and private insurer perspectives, respectively. National antitobacco media campaigns of 1, 5 and 10-year durations could produce net savings for Medicaid and Medicare within 2 years, and for private insurers within 6–9 years. A 10-year campaign would reduce adult cigarette smoking prevalence by 1.2 percentage points, prevent 23 500 smoking-attributable deaths over the first 10 years. In sensitivity analysis, media campaign costs would be offset by reductions in medical care spending of smoking among all payers combined within 6 years in all tested scenarios.Conclusions1, 5 and 10-year antitobacco media campaigns all yield net savings within 10 years from all perspectives. Multiyear campaigns yield substantially higher savings than a 1-year campaign.

IntroductionThe 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).MethodsData 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.ResultsThe 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.ConclusionsThe 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.

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.

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.

INTRODUCTION People living with mental health conditions (MH+) are more likely to smoke cigarettes than people without mental health conditions (MH-) and to experience tobacco-related disparities. The Tips From Former Smokers® (Tips®) campaign is a proven population-level strategy for motivating smokers to quit. In 2016, Tips included ads featuring Rebecca, a former smoker with depression. We evaluated self-reported frequency of exposure to the Rebecca and other Tips ads in association with quit intentions and quit attempts among MH+ and MH- smokers. METHODS Intentions to quit and past 6-month quit attempts lasting at least 24 hours were reported from a two-wave longitudinal online survey conducted before and after the 2016 Tips campaign with a nationally representative sample of US adult cigarette smokers with (MH+, N = 777) and without (MH-, N = 1806) lifetime mental health conditions. RESULTS In 2016, among MH+ respondents, greater exposure to the Rebecca ads was significantly associated with increased odds of intending to quit in the next 30 days (adjusted odds ratio [AOR] = 1.40, p < .05) and with reporting a quit attempt in the past 6 months (AOR = 1.25, p < .05). Among MH- respondents, greater exposure to the other Tips ads was associated with increased odds of making a quit attempt (AOR = 1.19, p < .05). CONCLUSIONS Exposure to the Rebecca ads was associated with a greater likelihood of intentions to quit and quit attempts among MH+ smokers; whereas, exposure to the other (non-mental-health-related) Tips ads was associated with a greater likelihood of quit attempts among MH- smokers. IMPLICATIONS National media campaigns are an important population-level strategy for reaching specific population groups who are experiencing tobacco-related disparities. The findings support the inclusion of ads featuring people living with mental health conditions in national tobacco education media campaigns, such as Tips.

Introduction: Cigarette smoking is a major preventable cause of disease and death among U.S. Hispanics. Tobacco-cessation quitlines have been shown to increase quitting among Hispanics. However, the use of quitlines by this population remains low, especially among Spanish-speaking Hispanics. This study evaluates the promotion of 1-855-DEJELO-YA (a quitline portal that routes callers to state-specific Spanish-language services) implemented as cart of the Centers for Disease Control and Prevention's national Tips From Former Smokers (R) (Tips (R)) campaign. Additionally, this study examines how media content impacted calls to 1-855-DEJELO-YA. Methods: Using National Cancer Institute data on calls to 1-855-DEJELO-YA from February 2013 to December 2014, multivariate linear regressions were conducted of weekly area code-level call volume as a function of media market-level Gross Rating Points for Tips Spanish-language TV ads tagged with 1-855-DEJELO-YA. The models were adjusted for covariates, including market-level population characteristics and state fixed effects. The data were analyzed from October 2017 through April 2018. Results: Greater exposure to Tips Spanish-language ads was associated with increased calls to 1-855-DEJELO-YA (p<0.001). On average, each additional 100 Tips Gross Rating Points per media market increased calls by 0.56 (95% CI=0.45, 0.67) calls/week/area code, representing congruent to 974 additional calls beyond the baseline. Media messages highlighting health consequences of smoking had a greater effect size than messages highlighting health effects of secondhand smoke. Conclusions: A national Spanish-language quitline number could be a useful cessation resource for Spanish-speaking cigarette smokers. Opportunities exist to increase use of this number through a national Spanish-language media campaign, particularly by focusing campaign messages on the health consequences of smoking. (C) 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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.

BACKGROUND:In 2012, the US Centers for Disease Control and Prevention (CDC) launched Tips From Former Smokers (Tips), the first federally funded national tobacco education campaign. In 2013, a follow-up Tips campaign aired on national cable television networks, radio, and other channels, with supporting digital advertising to drive traffic to the Tips campaign website.OBJECTIVE:The objective of this study was to use geographic and temporal variability in 2013 Tips campaign television media doses and ad tagging to evaluate changes in traffic to the campaign website in response to specific doses of campaign media.METHODS:Linear regression models were used to estimate the dose-response relationship between weekly market-level television gross rating points (GRPs) and weekly Web traffic to the Tips campaign website. This relationship was measured using unique visitors, total visits, and page views as outcomes. Ad GRP effects were estimated separately for ads tagged with the Tips campaign website URL and 1-800-QUIT-NOW.RESULTS:In the average media market, an increase of 100 television GRPs per week for ads tagged with the Tips campaign website URL was associated with an increase of 650 unique visitors (P<.001), 769 total visits (P<.001), and 1255 total page views (P<.001) per week. The associations between GRPs for ads tagged with 1-800-QUIT-NOW and each Web traffic measure were also statistically significant (P<.001), but smaller in magnitude.CONCLUSIONS:Based on these findings, we estimate that the 16-week 2013 Tips television campaign generated approximately 660,000 unique visitors, 900,000 total visits, and 1,390,000 page views for the Tips campaign website. These findings can help campaign planners forecast the likely impact of targeted advertising efforts on consumers' use of campaign-specific websites.

PURPOSE:The ads from the first federally funded national tobacco education campaign, Tips From Former Smokers (Tips), considerably increased quitline calls nationwide. This study evaluates the effect of Tips on state-specific quitline calls.DESIGN:Precampaign, during-campaign, and postcampaign comparison; regression modeling.SETTING:All fifty states as well as the District of Columbia.SUBJECTS:Calls to state quitlines.INTERVENTION:Tips.MEASURES:Tips campaign exposure was measured by gross rating points (GRPs). Calls to quitline's 1-800-QUIT-NOW were assigned to markets in each state based on their area codes.ANALYSIS:Multivariate regression was used to assess the relationship between calls to state quitlines and media market-level Tips GRPs, while controlling for market and area code characteristics.RESULTS:Nationally, every 100 Tips GRPs per week at the market level was associated with an average of 45 additional quitline calls in each area code (β = 44.65, p < .001). Tips GRPs were associated with significant increases in quitline calls in 46 states and the District of Columbia, of which 11 experienced effects significantly larger than the national average and 5 experienced significantly smaller effects. We were unable to detect statistically significant effects of GRPs on call volumes for four states. Graphically, call volumes in those states followed Tips GRPs.CONCLUSION:The Tips campaign significantly increased calls to quitlines for almost all the states. These findings underscore the effectiveness of national tobacco media campaigns for reaching state audiences.

INTRODUCTION:Previous research has shown that the first federally funded national tobacco education campaign (Tips) increased calls to the national quitline portal (1-800-QUIT-NOW). Quitlines in 13 states have alternate state-specific telephone numbers. This study examined quitline calls to 1-800-QUIT-NOW in states with and without alternate numbers during the Tips campaign. METHODS:We used data on calls to 1-800-QUIT-NOW from all US states and the District of Columbia from 2 weeks before to 2 weeks after the 2012 Tips campaign. Similar data were obtained for California's alternate number, 1-800-NO-BUTTS. Multivariate linear models examined whether an interaction existed between Tips exposure, as measured by gross rating points, and presence of an alternate quitline number as well as the effect of Tips on calls to California's 1-800-NO-BUTTS. RESULTS:Having an alternate quitline number did not affect the rate of increase in calls to 1-800-QUIT-NOW, but it was associated with lower absolute numbers of calls to 1-800-QUIT-NOW. On average, states with alternate numbers had 98 fewer calls to 1-800-QUIT-NOW per week in a given area code than those without an alternate number (P < .001). In California, Tips gross rating points were positively correlated with calls to 1-800-QUIT-NOW (b = 38.5, P < .001) and to 1-800-NO-BUTTS (b = 14.1, P < .05). CONCLUSIONS:The Tips campaign had the same effect in increasing calls to 1-800-QUIT-NOW in states with and without alternate quitline numbers and had a modest spillover effect on calls to California's alternate number. States may consider the advantages and disadvantages of having alternate quitline numbers given continued national promotions of 1-800-QUIT-NOW. IMPLICATIONS:This is the first study that assesses whether the impact of a national tobacco education campaign promoting the national quitline portal number was influenced by the presence of state-specific quitline numbers and whether there was any spillover effect on calls to states' alternate quitline numbers. This study provides important information for states to consider the advantages and disadvantages of maintaining state-specific quitline numbers.

BACKGROUND:Federal and state public health agencies in the United States are increasingly using digital advertising and social media to promote messages from broader multimedia campaigns. However, little evidence exists on population-level campaign awareness and relative cost efficiencies of digital advertising in the context of a comprehensive public health education campaign.OBJECTIVE:Our objective was to compare the impact of increased doses of digital video and television advertising from the 2013 Tips From Former Smokers (Tips) campaign on overall campaign awareness at the population level. We also compared the relative cost efficiencies across these media platforms.METHODS:We used data from a large national online survey of approximately 15,000 US smokers conducted in 2013 immediately after the conclusion of the 2013 Tips campaign. These data were used to compare the effects of variation in media dose of digital video and television advertising on population-level awareness of the Tips campaign. We implemented higher doses of digital video among selected media markets and randomly selected other markets to receive similar higher doses of television ads. Multivariate logistic regressions estimated the odds of overall campaign awareness via digital or television format as a function of higher-dose media in each market area. All statistical tests used the .05 threshold for statistical significance and the .10 level for marginal nonsignificance. We used adjusted advertising costs for the additional doses of digital and television advertising to compare the cost efficiencies of digital and television advertising on the basis of costs per percentage point of population awareness generated.RESULTS:Higher-dose digital video advertising was associated with 94% increased odds of awareness of any ad online relative to standard-dose markets (P<.001). Higher-dose digital advertising was associated with a marginally nonsignificant increase (46%) in overall campaign awareness regardless of media format (P=.09). Higher-dose television advertising was associated with 81% increased odds of overall ad awareness regardless of media format (P<.001). Increased doses of television advertising were also associated with significantly higher odds of awareness of any ad on television (P<.001) and online (P=.04). The adjusted cost of each additional percentage point of population-level reach generated by higher doses of advertising was approximately US $440,000 for digital advertising and US $1 million for television advertising.CONCLUSIONS:Television advertising generated relatively higher levels of overall campaign awareness. However, digital video was relatively more cost efficient for generating awareness. These results suggest that digital video may be used as a cost-efficient complement to traditional advertising modes (eg, television), but digital video should not replace television given the relatively smaller audience size of digital video viewers.

Background. Measures of perceived effectiveness (PE) of ads have been validated to predict changes in cognitive precursors of quit attempts, but a relationship between PE and actual quit attempts has not been shown in population-based studies. We analyzed smokers' PE ratings of ads from the national Tips From Former Smokers (Tips) campaign to (1)establish the validity of PE in predicting quit attempts in a large, nationally representative sample of smokers; (2)identify behavioral and demographic correlates of PE among respondents; and (3)examine whether PE is influenced by matching the race/ethnicity of ad participants with that of the ad viewer.Methods. We used survey data from two waves (baseline and follow-up) of a longitudinal online cohort of adult U.S. cigarette smokers. Respondents were shown one or more of 14 Tips campaign ads and were asked to assess each ad in terms of PE. We used multivariate models to estimate the association between baseline PE and prospective quit attempts; cross-sectional associations between PE and various respondent characteristics, including race/ethnicity, desire to quit, and health conditions; and the association between race/ethnicity of respondents and Tips ad participants.Results. Higher PE at baseline was associated with increased odds of a quit attempt at follow-up. Higher PE scores were associated with non-Hispanic black race, Hispanic ethnicity, higher desire to quit, presence of a chronic health condition, and presence of a mental health condition. There was no relationship between PE scores and matched race/ethnicity of the respondent and Tips ad participants.Conclusions. This is the first study to demonstrate an association between PE scores for antismoking ads and prospective quit attempts in a large, nationally representative sample of smokers. Our findings also provide strong evidence that racial/ethnic minority subpopulations, including non-Hispanic blacks and Hispanics, react more favorably to Tips campaign ads irrespective of race/ethnicity of the ad participant. This suggests that message characteristics (e.g., graphic visuals and emotional content) may play a more important role in PE than race/ethnicity of ad participants.

In 2012, the Centers for Disease Control and Prevention launched a national tobacco education campaign, Tips From Former Smokers, that consisted of graphic, emotionally evocative, testimonial-style advertisements. This longitudinal study examines changes in beliefs, tobacco-related cognitions and intentions to quit smoking among U.S. adult smokers after a 12-week airing of the campaign (n = 4040 adult smokers pre- and post-campaign). Exposure to the campaign was associated with greater odds of intending to quit within the next 30 days [odds ratio (OR) = 1.28, P < 0.01] and within the next 6 months (OR = 1.12, P < 0.05), and quit intentions were stronger among respondents with greater campaign exposure (OR = 1.12, P < 0.01). Campaign exposure was also associated with significant changes in beliefs about smoking-related risks (ORs = 1.15-2.40) and increased worries about health (b = 0.30, P < 0.001). Based on study change rates applied to U.S. census data, an estimated 566 000 additional U.S. smokers reported their intention to quit smoking within the next 6 months as a result of viewing campaign advertisements. Campaign effects were consistent with the theory of reasoned action and an expanding body of research demonstrating that graphic, emotional advertisements are highly effective for prompting positive cessation-related cognitions and behavioral intentions.

FigureDuring March 4 to June 23, 2013, the Centers for Disease Control and Prevention conducted its second annual national paid-media tobacco-education campaign encouraging adult smokers to quit. These campaigns, called Tips from Former Smokers (Tips), feature true stories of former smokers living with serious smoking-related diseases. To assess the immediate impact of the 2013 Tips campaign, CDC analyzed the weekly numbers of calls to the national telephone quitline portal (1–800-QUIT-NOW) and the weekly numbers of unique visitors to the Tips website (www.cdc.gov/tips) during the 16-week campaign and during the four weeks before and after the campaign. (In addition to unique visitors to that cite [in English], the numbers reported include unique visitors to the associated resources www.cdc.gov/consejos [Spanish], m.cdc.gov/tips [English, mobile platform], and m.cdc.gov/consejos [Spanish, mobile platform]). The average weekly numbers of calls and website visitors increased by 75 percent and almost 38-fold, respectively, compared with the four weeks before the campaign and quickly decreased almost to pre-campaign levels once the campaign ended. This suggests that the campaign led to 151,536 additional quitline calls and nearly 2.8 million additional unique Tips website visitors above pre-campaign levels. During the first 12 weeks of the campaign, when the national television ads were on and off air on alternate weeks, the average weekly call volume fell by 38 percent during the six weeks when the national television ads were off air compared with the six weeks when these ads were running. This part of the analysis focuses on the first 12 weeks of the campaign because the calls to action featured on the TV and online ads and the pulsing schedule changed substantially during the last four weeks of the campaign. The results suggest that emotionally evocative tobacco education media campaigns featuring graphic images of the health effects of smoking can increase quitline calls and website visits and that these campaigns' effects decrease rapidly once they are discontinued. The 2013 campaign included advertising on television, online (Internet and mobile), radio, print, billboards, buses and bus stop shelters, and social media. The campaign's television component included national ads in all 210 U.S. designated market areas and additional local ads in 67 of these market areas, which were selected randomly. Because of resource constraints, the 20 largest designated market areas in the United States were excluded from the randomization process and received the national television ads only. To extend the campaign's length, the national television ads were placed using a “pulsing” strategy, which involved airing them on a one-week-on, one-week-off basis through the first 12 weeks of the campaign, while the local television ads ran continuously throughout the campaign. The campaign's online component consisted of national ads only and ran continuously throughout the campaign. The campaign's television ads included one of three calls to action: an invitation to call 1-800-QUIT-NOW (66%), an invitation to visit the Tips website (28%), and the message “Talk with your doctor” (6%). (During the ninth week of the campaign [May 27-June 2], most television ads included this message. The full message was “You can quit—talk with your doctor for help.”) During the campaign's first 12 weeks, all online ads included the Tips website; during its last four weeks, these ads included a mix of the Tips website, 1-800-QUIT-NOW, and “Talk with your doctor.” In addition to featuring Tips ads, which provide motivation to quit smoking, the Tips website syndicated extensive information on how to quit from the NCI's cessation website (www.smokefree.gov). This analysis used 1-800-QUIT-NOW call-volume data collected by NCI from the national portal and data on unique visitors to the Tips campaign website collected by CDC using Adobe SiteCatalyst and Google Analytics. For the purposes of this report, unique visitors were defined as persons who visited the Tips website one or more times in a given week. A total of 352,848 calls to 1-800-QUIT-NOW occurred during the 2013 campaign, for a weekly average of 22,053 calls. This represents 151,536 additional calls (75% increase) above what would have been expected had call volume continued at the level observed during the four weeks before the campaign (February 4 to March 3), when the weekly average was 12,582 calls. The campaign call totals reported in this analysis do not include almost 150,000 calls that were generated by mobile “click-to-call” promotions beginning April 1. These calls were excluded from the analysis because reports from several state quitlines suggested that few, if any, of these callers remained on the line to receive services. The average weekly call volume of 13,044 calls during the four weeks after the campaign (June 24 to July 21) was 41 percent lower than the weekly average observed during the campaign. (Some television stations continued to run ads for a short period after the campaign ended.) Both the increase in call volume from the pre-campaign weeks to the campaign weeks and the decrease in call volume from the campaign weeks to the post-campaign weeks were statistically significant (p<0.05), whereas no significant difference in call volume was found between the pre-campaign and post-campaign weeks (p=0.60). During the campaign's first 12 weeks, the average weekly call volume was 38 percent lower during the six weeks when the national television ads were off-air compared with the six weeks when these ads were running (16,500 vs. 26,571). A separate analysis found that during off-air weeks, the call volume in the designated market areas without local ads fell nearly to the level of the four pre-campaign weeks. Nearly 2.9 million (2,868,059) unique visitors accessed the Tips campaign website during the 2013 Tips campaign, for a weekly average of 179,254 unique visitors. This represents almost 2.8 million (2,792,475) additional unique visitors (a nearly 38-fold increase) above what would have been expected had website traffic continued at the level observed during the four weeks before the campaign, when the weekly average was 4,724 visitors. The weekly average of 7,575 website visitors during the four post-campaign weeks was 96 percent lower than the weekly average observed during the campaign. The cessation sections of the English and Spanish Tips websites received almost half a million page views during the campaign, suggesting that many visitors to the Tips website were actively seeking information on how to quit smoking. Although the weekly number of website visitors varied during the course of the campaign, this variation did not clearly follow the pattern of the national television ad pulsing. Emotionally Evocative Emotionally evocative tobacco education media campaigns featuring graphic images of smoking-related diseases are effective in motivating smokers to quit.1–5 Telephone quitlines increase quit rates.6 The 1–800-QUIT-NOW portal, operated by NCI, seamlessly routes callers to their state quitlines based on area code. CDC funds state quitlines as part of its support for comprehensive state tobacco-control programs. Web-based cessation interventions are promising,6 but the available evidence is insufficient to fully assess their effectiveness.7 This analysis shows that the number of weekly calls to 1-800-QUIT-NOW increased as soon as the Tips campaign began, decreased when the national television ads were off-air, increased each time these ads returned to the air, and decreased when the campaign ended. Each of these increases and decreases was rapid and substantial. These findings reinforce previous evidence that media campaigns can motivate smokers to try to quit and to seek information on quitting,1–5 while also offering additional evidence that these campaigns' effects fade quickly once they end.2,3,8 These findings underscore the public health importance of sustaining campaigns over time, and suggest that the Tips campaign might have generated even more quitline calls if the national television ads had run continuously and had appeared over a longer period. If the national television ads had been aired continuously without pulsing over the entire 16 weeks of the campaign, assuming the average weekly call volume observed during the first six “on” weeks was sustained, about 425,000 calls would have occurred during the campaign (i.e., about 72,000 more calls than actually occurred). As with 1-800-QUIT-NOW calls, the weekly number of unique visitors to the Tips campaign website increased sharply immediately after the campaign began and decreased sharply once it ended. However, although the number of weekly website visitors varied during the campaign, the pulsing pattern was far less evident than it was for quitline calls. Suggestion that National Online Ads Were More Effective than the National TV Ads This suggests that the national online ads, which ran continuously throughout the campaign, were a greater driver of website traffic than the pulsed national television ads. This is plausible, because online ads have a built-in advantage in directing traffic to a website—online ad viewers need only click on an ad to visit the website. In addition, only about 28 percent of the television ads included the website. During the weeks of April 22-28 and June 17-23, the amount of online advertising increased sharply, corresponding with substantial increases in unique website visitors, indicating that website traffic is responsive to changes in the online ad exposure dose. The fact that there were almost three million visitors to the Tips website during the 2013 campaign suggests that online ads hold promise for motivating smokers to engage in cessation information-seeking activity. Although substantial increases occurred in the numbers of 1-800-QUIT-NOW calls and Tips website visitors during the campaign, the total numbers of calls and website visitors during the 2013 campaign are somewhat smaller than during the 2012 Tips campaign.9 This comparison of website traffic in the 2012 and 2013 Tips campaigns takes into account that the 2012 ads featured one of two websites, whereas the 2013 ads included a single website. Accordingly, 2,868,059 visitors to the Tips website during the 2013 campaign are being compared with the combination of 629,898 unique visitors to the smokefree.gov website and the most comparable available indicator of 2,750,420 visits to the Tips website during the 2012 campaign. This likely reflects at least two factors: First, the national television and online ad purchases were lower in 2013 than in 2012. Second, national television ads including 1-800-QUIT-NOW ran for only nine weeks in 2013, compared with 12 weeks in 2012. Limitations The findings in this report are subject to at least five limitations: First, this analysis was a natural time series analysis and did not control for other factors that could have contributed to the increases in weekly call volume and website visitors observed during the 2013 Tips campaign. However, the observed impact of the campaign's pulsing strategy on call volume, as well as the sharp increase and decrease in calls and website visitors observed immediately after the campaign began and ended, point to a causal relationship. Secondly, NCI data on calls to 1-800-QUIT-NOW reflect the number of call attempts, not the number of unique callers, completed calls, or callers receiving services. The NCI data also do not capture calls to other state quitline numbers besides 1-800-QUIT-NOW. Third, adding the weekly numbers of Tips website unique visitors to calculate total unique visitors during the campaign likely somewhat overestimates this total because the same person could be counted several times if they visited the Tips website repeatedly over several different weeks. Fourth, the number of Tips website visitors included both web and mobile visitors, so some persons who visited the website through both these channels could have been counted twice, resulting in an overestimate. Finally, 1-800-QUIT-NOW calls and visitors to the Tips website are preliminary indicators of quit attempts and successful cessation, outcomes that future evaluations of the 2013 Tips campaign will examine. However, the 2012 Tips campaign was associated with increases in call volume, website visitors, quit attempts, and successful cessation, suggesting that the first two indicators predict the latter two outcomes.9,10 Conclusion Calls to quitlines and traffic to the campaign website increased sharply when the Tips campaign was on the air, suggesting that this campaign likely motivated many smokers to try to quit. Quitline call volume appeared to be driven primarily by television ads, whereas traffic to the Tips website appeared to be driven primarily by online ads. Both quitline calls and website traffic fell rapidly when the campaign was discontinued. The findings speak to the effectiveness of emotionally evocative media campaigns featuring graphic images in increasing interest in quitting smoking, and highlight the even greater impact these campaigns might have if they were sustained at a high intensity for a longer time. If the national television ads that aired during “on” weeks of the 2013 Tips campaign were run throughout the year at this level and produced the same response, this would translate into almost 1.4 million calls to 1-800-QUIT-NOW in 2013, which is 500,000 more calls than the portal received in 2012 and by far the most calls that it has received in any year since its inception.

During March 4-June 23, 2013, CDC conducted its second annual national paid-media tobacco education campaign encouraging adult smokers to quit. These campaigns, called Tips from Former Smokers (Tips), feature true stories of former smokers living with serious smoking-related diseases. To assess the immediate impact of the 2013 Tips campaign, CDC analyzed the weekly numbers of calls to the national telephone quitline portal (1-800-QUIT-NOW) and the weekly numbers of unique visitors to the Tips website (http://www.cdc.gov/tips)* during the 16-week campaign and during the 4 weeks before and after the campaign. During the campaign, the average weekly numbers of calls and website visitors increased by 75% and almost 38-fold, respectively, compared with the 4 weeks before the campaign, and quickly decreased almost to pre-campaign levels once the campaign ended. This suggests that the campaign led to 151,536 additional quitline calls and nearly 2.8 million additional unique Tips website visitors above pre-campaign levels. During the first 12 weeks of the campaign,† when the national television ads were on and off air on alternate weeks, average weekly call volume fell by 38% during the 6 weeks when the national television ads were off air compared with the 6 weeks when these ads were running. These results suggest that emotionally evocative tobacco education media campaigns featuring graphic images of the health effects of smoking can increase quitline calls and website visits and that these campaigns' effects decrease rapidly once they are discontinued.

Background: Secondhand smoke (SHS) exposure causes premature death and disease. Eliminating smoking in indoor spaces is the only way to fully protect nonsmokers from SHS exposure, and also contributes to helping smokers quit smoking. Primary health care providers can play an important role in advising nonsmoking patients to avoid SHS exposure, cautioning current smokers against exposing others to SHS, and referring tobacco users to cessation programs.Methods: The purpose of this paper is to examine primary care provider (obstetricians/gynecologists, pediatricians, and general practitioners) advice regarding SHS exposure and referral to cessation programs. Using data from the 2008 DocStyles survey (n = 1,454), we calculated the prevalence and adjusted odds ratios for offering patients advice regarding SHS exposure and referring adults who smoked or used other tobacco products to a cessation program.Results: The current study found that among a convenience sample of primary care providers, 94.9% encouraged parents to take steps to protect children from SHS exposure, 86.1% encouraged smokers to make their homes and cars smoke-free, and 77.4% encouraged nonsmokers to avoid SHS exposure. Approximately 44.0% of primary care providers usually or always referred patients who smoked or used tobacco products to cessation programs such as a quitline, a group cessation class, or one-on-one counseling.Conclusion: Findings from a convenience sample of primary care providers who participated in a web-based survey, suggests that many primary care providers are advising parents to protect children from SHS exposure, encouraging patients who smoke to maintain smoke-free homes and cars, and advising smokers on ways to avoid exposing others to SHS. Healthcare providers are encouraged to advise patients to avoid SHS exposure and to refer patients who use tobacco products to cessation services.