TOBACCO RELATED MEDIA EXPOSURE AND INDICATORS OF SMOKING CESSATION Andrew Hyland, PhD Cheryl Higbee...

TOBACCO RELATED MEDIA EXPOSURE TOBACCO RELATED MEDIA EXPOSURE AND INDICATORS OF SMOKING AND INDICATORS OF SMOKING

CESSATION CESSATION

Andrew Hyland, PhD Cheryl Higbee

Melanie Wakefield, PhD Glen Szczypka, PhD Joseph Bauer, PhD

Gary A. Giovino, PhDK. Michael Cummings, PhD, MPH

Presented at

2003 National Conference on Tobacco or Health

Boston, Massachusetts

December 11, 2003

Acknowledgement

• NCI State and Community Tobacco Control Intervention Grants Program.

• Bob Vollinger and other NCI TCP staff

Objective

To assess the relationship between exposure to tobacco control and pharmaceutical company advertising on cessation and use of stop smoking medications.

Background

• Adults exposed to more anti-tobacco media promoted by state-sponsored programs may be more likely to stop smoking.

• Greater exposure to pharmaceutical ads for NRT or Zyban may increase utilization of these products.

• The COMMIT population provides individual smoking rates in geographically diverse areas.

Narrator: Secondhand smoke kills.(c) California Department of Health Services

MethodsData Sources

1) Community Intervention Trial for Smoking Cessation (COMMIT).

2) Gross Rating Points (GRP’s) from Nielsen Media Research.

Data Sources - COMMIT

• Community Intervention Trial for Smoking Cessation (COMMIT)

• Funded by NCI, conducted between 1988 and 1993• A match-pair, randomized trial of 22 small to medium

communities in 9 US states and 1 Canadian province• ~1,000 smokers from each community identified

surveyed in 1988 and followed until 1993• Smokers in intervention communities hypothesized to

have higher quit rates

• In 1988, over 10,000 heavy smokers (25+ cpd) and more than 10,000 light to moderate smokers (<25 cpd) completed a 20 minute tobacco use telephone survey.

• In 1993, over 13,000 members of this cohort were re-interviewed to assess the quit rate in each community

• Smokers in intervention communities hypothesized to have higher quit rates.

COMMIT

COMMIT CommunitiesNEW YORK

Binghamton/ Johnson City,New Rochelle, Utica, Yonkers

WASHINGTONBellingham, Longview/ Kelso

NEW MEXICOLas Cruces, Sante Fe

NEW JERSEYTrenton, Paterson

OREGONAlbany/

Corvallis, Medford/ Ashland

NORTH CAROLINAGreensboro, Raleigh

IOWACedar Rapids,

Davenport

MASSACHUSETTSLowell, Fitchburg/

LeominsterONTARIOBrantford, Peterboro

CALIFORNIAHayward, Vallejo

• Goal of COMMIT : test the hypothesis that an intervention, delivered through multiple community channels over a 4-year period, would result in higher quit rates, particularly among heavy smokers.

• Budgets - ~$220K per community per year.• COMMIT did help establish tobacco control

infrastructure in communities; however it stopped in 1993.

COMMIT Intervention

• The COMMIT intervention focused on (1) media and community-wide events, (2) health care providers, (3) work-sites and other community organizations, and (4) cessation resources.

• COMMIT intervention had 58 activities implemented through four primary channels: public education through the (1) media and community-wide events, (2) health care providers, (3) work-sites and other community organizations, and (4) cessation resources.

COMMIT Intervention

• Significantly higher quit rates in light to moderate smokers (<25 CPD) in intervention communities (30.6% vs. 27.5%)

• No effect in heavier smokers (25+ CPD) – 18.0% vs. 18.7%

COMMIT Results

• With NCI funding, we tried to re-interview all the U.S. participants from 20 communities who completed a 1993 survey in the summer of 2001 (n=13,544).

• 7,329 subjects were tracked and completed the telephone interview.

– Annual attrition rate was actually slightly less than during the original COMMIT study

– Younger, Hispanic, less educated, lower income people, and residents in CA, NM, NJ, and 1 MA town more likely to be lost to follow-up in 2001

COMMIT 2001 Follow-up Survey

•Media data was obtained for the top 75 media markets in the US for 1999 and 2000.

• The media data consists of Gross Rating Points (GRP’s) from Nielsen Media Research.

The sum of all rating points achieved by a schedule of advertisements for a particular time period.

•Every 100 GRP’s represent 1 exposure per person per year for a particular piece of media

Data Sources - Media Data

Data Sources - Media Data•The GRP’s for each month were summed over 1 year for 1999 and 2000.

•The categories of GRP’s were:

State Health Department Ads

Nicotine Replacement Therapy and Zyban

American Legacy Foundation Ads

Tobacco company Ads

Other – includes small, non-governmental organizations which purchased anti-smoking ads

COMMIT Sample Sizes

Completes in 1988 22,046

Completes in 2001 7,329

Included in top 75 media markets 5,214

Live in same community in

1988 and 2001 3,620

Smokers in 2000 2,807

Smokers in 1999 2,949

Gross Rating Points (GRP’s) for State-sponsored Advertisements by

Community, 2000

Gross Rating Points (GRP’s) for NRT and Zyban Advertisements by

Community, 2000

Gross Rating Points (GRP’s) for Tobacco Company Advertisements

by Community, 2000

Analysis – Outcomes1) Quitting

• Smoking status in 2001 determined from follow-up survey.

• Former smokers were asked the year that they quit. Those who quit during or after the year 2000 were considered

smokers in 2000.

Those who quit during or after 1999 were considered smokers in 1999.

2) Use of stop-smoking medications. Report of use of nicotine patch, nicotine gum, inhaler or nasal

spray or Zyban in 1999 or 2000.

Analysis – Predictors1) State GRP’s

• State sponsored anti-tobacco advertisements.

2) NRT GRP’s

• Advertisements for nicotine replacement therapies and Zyban.

Media Data was looked at in two different ways:

• Annual number of GRP’s for a particular type of advertisement (State or NRT).

• High or Low level of GRP’s for a particular type of advertisement based on the median GRP.

Analysis – Control Variables• Analyses control for:

– Age at baseline– Race– Gender– Education– Amount smoked in 1993– Quit attempts in 1993

• Analyses are stratified by responses to the question:– How much increase has there been in the amount of

information in the media on the dangers of smoking? (No increase or a decrease, increased a little, increased moderately, increased a lot).

Analysis – Control Variables

Results - CessationPercent Quit Smoking in 2000 by

Community

0%2%4%6%8%

10%12%

Haywar

d, CA

New R

oche

lle, N

Y

Lowell

, MA

Belling

ham

, WA

Fitchb

urg,

MA

Longv

iew, W

A

Utica,

NY

Trento

n, NJ

Raleig

h, NC

Green

sbor

o, NC

Santa

Fe, NM

Vallejo

, CA

Yonke

rs, N

Y

Alban

y, O

R

Paterso

n, NJ

% Q

uit

“High” Level of State GRP in 2000 (2000 GRP’s or more)

Note: Odds ratio = 1.09, 95% CI = (0.95 – 1.26) from a logistic regression model controlling for gender, age, race, amount smoked in 1993, education, and quit attempts in 1993.



Percent Quit Smoking in 1999 by Community

0%2%4%6%8%

10%12%

Paterso

n, NJ

Yonke

rs, N

Y

Utica,

NY

Raleig

h, NC

Vallejo

, CA

New R

oche

lle, N

Y

Green

sbor

o, NC

Alban

y/Cor

vali.

.

Lowell

, MA

Trento

n, NJ

Longv

iew, W

A

Fitchb

urg,

MA

Haywar

d, CA

Santa

Fe, NM

Belling

ham

, WA

% Q

uit



Percent Quit Smoking in 1999 by Community - Among those who responded that the media coverage has increased 'a lot'

02468

101214

Paterso

n

Trento

n

Yonke

rs

Longv

iew

Santa

Fe

Fitchb

urg

Raleig

h

Belling

ham

Utica

Green

sbor

o

Alban

y

Haywar

d

Lowell

New R

oche

lle

Vallejo

% Q

uit



0 2500 5000 7500

State GRP's

4

6

8

10

12

% Q

uit

Percent Quit in 2000 by State GRP level, Among those who reported that the media coverage has increased ‘a lot’


R2 = .1157

Relative Risk of Quitting Smoking in 2000 as a Function of Smoker Characteristics, and Exposure to State-sponsored

Anti-smoking advertisements in 2000

1.09

1.24

1.15

1

1.05

1.1

1.15

1.21.25

1.3

Overall "a lot" Not "a lot"Perception of Level of Increase in Media Coverage in Recent

Years

RR

*

*95% CI = (0.96 – 1.60), from a logistic regression model controlling for gender, age, race, amount smoked in 1993, education, and quit attempts in 1993.

Relative Risk of Quitting Smoking in 2000 as a Function of Smoker Characteristics, and "High" Exposure to State-

sponsored Anti-smoking advertisements in 2000

1.74

5.08

2.05

0

1

2

3

45

6


Years

RR

*


Relative Risk of Quitting Smoking in 1999 as a Function of Smoker Characteristics, and Exposure to State-sponsored

Anti-smoking advertisements in 1999

0.931.03

00

0.2

0.4

0.6

0.81

1.2


Years

RR

*


Relative Risk of Quitting Smoking in 1999 as a Function of Smoker Characteristics, and "High" Exposure to State-

sponsored Anti-smoking advertisements in 1999

1.56

3.47

00

1

2

3

4


Years

RR


*

Results – NRT UseUsed NRT or Zyban in 2000 by

Community

02468

101214

Lowell

Belling

ham

Trento

n

Fitchb

urg/

Leomi..

.

Longv

iew/K

elso

New R

oche

lle

Alban

y/Cor

valli

s

Haywar

dUtic

a

Sante

Fe

Patters

on

Yonke

rs

Raleig

h

Green

sbor

o

Vallejo

% Q

uit


“High” Level of NRT GRP in 2000 (11,800 GRP’s or more)

02468

10121416

Belling

ham

Trento

n

Lowell

Alban

y/Cor

valli

s

Sante

Fe

New R

oche

lle

Raleig

h

Fitchb

urg/

Leomi..

.

Longv

iew/K

elso

Haywar

dUtic

a

Yonke

rs

Patters

on

Green

sbor

o

Vallejo

% U

sed

NR

T



Used NRT or Zyban in 2000 by Community - Among those who Responded that the Media Coverage has

Increased 'A lot'





Used NRT or Zyban in 1999 by Community - Among those who Responded that the Media Coverage has

Increased 'A lot'

Percent Used NRT in 2000 by NRT GRP level, Among those who reported that the media coverage has increased ‘a lot’


NRT GRP

1400012000100008000

% U

sed

NR

T

16

14

12

10

8

6

4

R2 = 0.0111

Relative Risk of Using NRT or Zyban in 2000 as a Function of Smoker Characteristics, and Exposure to NRT

advertisements in 2000

1.15 1.27

0.93

0

0.5

1

1.5

2


Years

RR


*

Relative Risk of Using NRT or Zyban in 2000 as a Function of Smoker Characteristics, and "High" Exposure

to NRT advertisements in 2000

0.870.58

0.85

0

0.5

1

1.5

2


Years

RR


*

Relative Risk of Using NRT or Zyban in 1999 as a Function of Smoker Characteristics, and Exposure to NRT

advertisements in 1999

0.790.63

0.94

0

0.5

1

1.5

2


Years

RR


*

Relative Risk of Using NRT or Zyban in 1999 as a Function of Smoker Characteristics, and "High" Exposure

to NRT advertisements in 1999

0.4 0.32 0.36

0

0.5

1

1.5

2


Years

RR


*

Conclusions

• More exposure to state-sponsored anti-smoking advertisements increases the probability of cessation, particularly among those who report ‘a lot’ of increase in the media on the dangers of smoking.

• In this group, every 1000 additional GRP’s is estimated to increase cessation by 24%.

Conclusions

• Exposure to NRT or Zyban advertisements did not increase the probability of utilization of these products.

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