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Innovations in Healthcare Delivery

Improving public health with advertising

A young man calls Alaska’s Tobacco Quit Line, increasing his likelihood to quit for good.

A young man calls Alaska’s Tobacco Quit Line, increasing his likelihood to quit for good.

Photo courtesy of Northwest Strategies

When it comes to public health, changing people’s opinions—and behaviors—isn’t always easy to do. How do you convince someone to quit smoking or to never start? How do you provide them with the knowledge and the means to live a healthier life?

The State of Alaska Tobacco Prevention and Control Program has found a way. Over the past 10 years, cigarette sales have declined by more than 50 percent; adult smoking prevalence has decreased by 25 percent and high school students’ smoking prevalence has dropped by more than 60 percent over the same time period. As a result, Alaska has saved almost $400 million in health care costs and prevented 8,900 premature deaths.

But the battle is not yet over. Working in conjunction with Anchorage-based advertising agency Northwest Strategies, the TPC is continuing to reach out to high-risk groups while countering the effects of pro-tobacco advertising.

 

The Problem

Tobacco use costs Alaska $579 million annually in direct medical costs and lost productivity due to tobacco-related deaths. Each year, 31 million packs of cigarettes are sold in the state; for every $9 pack of cigarettes purchased, it costs Alaskans an additional $19 per pack in costs associated with smoking.

“The Tobacco Prevention and Control Program has done a lot of incredible work over the last 10 years in combating smoking prevalence in Alaska adults, but we are still working to move the needle in other groups,” explains Tiffany Tutiakoff, president, Northwest Strategies. “There are several disparate populations that we’re addressing that range across a variety of tobacco use. This includes rural and Alaska Natives who have a high prevalence of chewing tobacco use and youth ages 18 to 25, who have flat-lined in prevalence. There is concern that those numbers are not going down.”

The TPC’s comprehensive tobacco prevention and control program, which is based on best practices and strategies identified by the Centers for Disease Control, is based on four goals: to prevent youth from starting tobacco use; to promote cessation of tobacco use among youth and adults; to protect the public from exposure to secondhand smoke; and to identify and eliminate tobacco-related disparities and achieve health equity. One of the ways in which the TPC does this is by creating marketing campaigns to educate the public and to counter the epic amounts of money being spent by the tobacco industry pushing its products.

“Tobacco companies spend more than $1 million an hour marketing their products in the U.S., which is a crazy amount of money,” explains Alexandria Hicks, program manager, State of Alaska Tobacco Prevention and Control Program. “We have to counter this investment. A health communications/intervention campaign is one of the most important components of our program in terms of sustainability because it has been shown that messages of longer duration and higher intensity are associated with greater declines in smoking rates.”

 

Delivering the Message

Fortunately for Alaskans, the state has chosen to fund the TPC at the level recommended by the CDC. While there has been a trend in recent years to cut funding from state tobacco programs nationwide, the TPC spends approximately $800,000 on paid media annually with approximately 35 percent of that money going toward specific cessation or stop-smoking health communications.

“We’ve been working with the TPC for three-and-a-half years, and for the first two years, our message focused on cessation and stimulating quit attempts,” says Tutiakoff. “Our goal was to make an emotional connection with tobacco users, and then provide resources, which is why TV spots were tagged with Alaska’s Tobacco Quit Line. In 2012, the CDC began funding a campaign called, ‘Tips from a Former Smoker,’ which provided the state with an additional layer of communication.”

“Up until recently we did not focus cessation media communications efforts on the quit line; however, we aggressively promoted its existence and availability to Alaskans, statewide. Our quit line is considered the platinum standard of state quit lines,” adds Hicks. “Currently we’re investing in promotion of quit line services—showing how it works for the caller and the incredible host of benefits that it offers.”

Through a statewide multimedia campaign, which includes print, radio, TV and online components, Northwest Strategies and the TPC are informing tobacco users about the nicotine replacement therapy and counseling support provided by the quit line. “We’ve created four unique spots that will run this year: one features a woman dealing with relapse, which is quite common—it takes an average of 11 attempts before a person successfully quits,” says Tutiakoff. “The second spot highlights real ‘quit coaches’ as a way to establish trust, and to encourage smokers to pick up the phone and call.”

Another spot features a young Alaska Native male going through the quit line process, and the last profiles a couple who quit smoking together. “We used real people who actually called the quit line; they’re not actors,” adds Tutiakoff.

And the message is getting through: The campaign started on New Year’s Day and January 2013 reports show a 55 percent increase in call volume over the same time frame last year, with enrollees citing the TV commercial as the No. 1 reason why they called.

 

Stretching Ad Dollars

By coordinating the campaign with the spots being run by the CDC, the state is making its money go further. “The CDC sets up their plans and we work around those plans,” explains Tutiakoff. “We stretch our dollars by piggybacking on what they’re doing. Our quit line campaign is primarily a cable-dominant buy, but in places where there is no TV coverage or radio stations, we fill in the holes with other components.”

Northwest Strategies and the TPC review campaigns on a weekly, monthly and quarterly basis and also invest in both qualitative and quantitative research and testing, such as focus groups and surveys, at the beginning and end of each campaign. “We also perform a recall survey to ensure campaigns are working and that we are getting a good return on our investment,” says Hicks.

Because what works with different audiences can change over time, Northwest Strategies and the TPC continually revisit messaging strategies. “People were not responding to scare tactics before, but now we’re starting to see these tactics working in the CDC’s ‘Tips from a Former Smoker’ campaign that shows a man with his legs amputated and a woman with a tracheotomy,” says Tutiakoff.

“We found that our ‘Dear Me’ campaign, in which smokers shared a letter to themselves about smoking, really resonated with Alaskans,” she adds. “Smokers identified with those featured because they are facing the same battle with addiction; in fact, they often used the tag line when calling the quit line, which was ‘No one can make me quit but me.’ It was a highly effective campaign.”

Northwest Strategies also came up with the “Great for Business” campaign as a way to protect the public from exposure to secondhand smoke. TV spots, which ran for 18 months, featured testimonials from business owners about how their businesses had gotten better since they went smoke-free.

“Typically, when smoke-free policies come to pass, the hospitality industry is the sticking point,” says Tutiakoff. “But bars and restaurants are workplaces, too, where patrons and servers are breathing second-hand smoke.” To this end, TV spots featured well-known business owners, such as Mike Gordon of Chilkoot Charlie’s and Cheryl Brendell of The Food Factory, talking about the benefits of running a smoke-free business, including decreased insurance costs, less cleaning and maintenance costs and happier employees.

Northwest Strategies’ current smokefree workplace policy media campaign is called “The Real Cost,” geared to urban residents ages 25 to 54 who typically do not smoke and who are not affected by secondhand smoke. While their health may not be compromised, the multimedia campaign points out that their wallets are—to the tune of $579 million every year in direct medical expenditures and lost productivity due to tobacco-related deaths.

 

Next Up

While Alaska is not yet 100 percent tobacco-free, huge strides have been made in communicating the health benefits of quitting, or never starting, smoking. Northwest Strategies has used its experiences in social marketing to create other campaigns focused on behavior change for clients as diverse as the Alaska Network on Domestic Violence and Sexual Assault; the American Lung Association Alaska; the Municipality of Anchorage’s Air Quality Public Awareness Program, and the State of Alaska’s Department of Environmental Conservation Air Quality Program.

The agency is currently using this success as a springboard to help the State of Alaska Obesity Prevention and Control Program with formative research and direction to support their launch of a new public health campaign addressing childhood obesity. “We’re presently working on a research and communications plan that involves message testing and analysis of similar campaigns in an effort to identify what is working, so it is still in the early stages,” says Tutiakoff. “But soon I expect that we’ll see a national trend of different obesity initiatives looking at what tobacco programs have done in the area of public health messaging and modeling their strategies after that success.”

Vanessa Orr is the former editor of the Capital City Weekly in Juneau.

This originally appeared in the May 2013 print edition of Alaska Business Monthly magazine.

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