Enhancing the dissemination of population-based smoking cessation programs, a study of selected communication variables

Abstract

Attempts to reduce the prevalence of smoking through quit smoking program have, to date, been largely unsuccessful. A major reason for this may be that quit smoking programs designed for broad population have not attracted large numbers of smokers to participate in them.

A systematic review of the literature was conducted to identify potential communication variables that might enhance recruitment for population based quit smoking programs. Thirty-three publications reporting the results of 40 recruitment campaigns were located. The median recruitment rate across all campaigns was 2.0 per cent of smokers. Logistic regression was used to examine the effect of six variables on recruitment rate: the type of program sponsor, the type of program offered, the cost of the program, presence or absence of an incentive, whether messages were segmented by stage of change, and the type of channel used to send messages. The only significant predictor of recruitment rate was channel type. Studies that used pro-active recruitment strategies (telephone and interpersonal communication) were 66.5 times more effective than those using passive recruitment strategies (mass media, direct mail). An attempt to examine whether segmenting messages by stage of change enhanced recruitment was inconclusive.

In a follow-up study, 14,369 smokers and ex-smokers aged 18 and over from Windsor, Canada were randomly assigned to one of seven recruitment conditions to test the effects of using different channel types (mass media, direct mail, telephone) and messages (segmented by stage or change or not) on recruitment rate (% of target population who enrolled in the quit smoking program offered), recruitment efficiency (% of target population who received the messages and enrolled), and cost efficiency (mean cost per enrollee).

Messages segmented by stage of change and delivered by telemarketing produced the highest recruitment rate (8.8% of smokers; 7.2% of smokers plus ex-smokers). Messages segmented by stage of change improved the odds of recruitment relative to generic messages for smokers (OR = 1.40; 95% CI: 1.02 - 1.92) and smokers plus ex-smokers (OR = 1.53; 95% CI: 1.16-2.01). Using two channels to deliver messages to smokers (OR = 1.30; 95% CI: 0.99 - 1.72) or smokers plus ex-smokers (OR = 1.15; 95% CI:.90 - 1.46) did not improve recruitment relative to the use of a single channel. The effect of channel was highly significant. For smokers, staged messages delivered by telephone were more successful than those using mass media (OR = 4.72; 95% CI: 2.90 - 7.67) or mail (OR = 4.49; 95% CI: 2.83-7.11). A similar pattern of results emerged with smokers plus ex-smokers. The greatest increase in recruitment rates and recruitment efficiency occurred among smokers in precontemplation and former smokers in the action and maintenance stages. Staged messages by telephone also produced the highest recruitment efficiency rate (26.9%), and were also the most cost efficient recruitment strategy ($32.57 CDN per enrollee).

The present results suggest that researchers and practitioners interested in population wide tobacco control should pay more attention to recruitment. Relative to the most common recruitment strategies (i.e. mass media or direct mail), using telemarketing to send messages specifically designed to appeal to smokers across the continuum of change has the potential to increase participation in population based quit smoking programs by more than 400 per cent. Future studies are required to replicate and extend these findings.