Rendez-vous 124
Thursday January 3 2002
Todd is Program Director Tobacco Use Cessation and Prevention Program
Lexington-Fayette County Health Department
Lexington, Kentucky, USA
Thank you Todd for accepting our rendez-vous. May I ask you to introduce yourself ?
Todd Warnick: In 1993, I first got involved in tobacco control. In 1993, the Kentucky Department for Public Health (KDPH) with funding from the Centers for Disease Control and Prevention (CDC) Office on Smoking and Health (OSH) advertised a tobacco control manager job position.
This was the very first public health tobacco control position in the state. Interestingly, the job position was contracted through a local health department in Lexington, Kentucky and "assigned" full-time to the state health department in Frankfort (state capitol).
Prior to accepting the position, I was employed as a state certified substance abuse counselor who had just finished a graduate program in health administration with an emphasis on public administration. The state position seemed like a perfect fit. In 2000, I have good reason to believe the tobacco industry, along with health allies aligning themselves with tobacco farming interests, targeted me because of my resistance to "youth only" tobacco control programs. In 2000, the state was deciding Master Settlement Agreement (MSA) allocations and many state/national health organizations wanted MSA funding, and (in my opinion) knowingly conspired with the tobacco industry to acquire funding by advocating for ineffective "youth only" tobacco control MSA funding allocations. In 2000, the contractual arrangement between the state health department and local health department was "terminated." The state health department subsequently replaced the entire tobacco control staff with people lacking tobacco control experience.
My priorities are to decrease tobacco use by promoting comprehensive tobacco cessation and clean indoor air policies. I also enjoy advocating for the civil rights of people with disabilities caused or worsened by exposure to secondhand tobacco smoke. Federal and state anti-discrimination laws can be employed to protect the civil rights of people sensitive to secondhand tobacco smoke exposure.
Q1. How did you come up with the idea of the quit and win contest? Can you explain how you organized it? Is it expensive?
Todd Warnick: Each year over 8,000 Kentuckians die from cigarette smoking alone. Most behavioral approaches to smoking cessation have traditionally focused on individuals and small groups of smokers, and they have had little impact on smoking rates. The idea of the Bluegrass Quit and Win (BQW) 2001 contest, the first statewide contest of its kind, came from the World Health Organization (WHO) and a quit and win contest in Ontario, Canada, organized by Robin Holmes. The WHO annually conducts an international quit and win contest and I read materials about it. I also read a newspaper article describing the impressive quit and win program in Ontario, Canada. I was interested in the quit and win concept because of Kentucky's high smoking rate (#1 in nation) and lack of population-based cessation programs. I read the scientific literature, consulted directly with Ms. Holmes and other quit and win staff in Ontario, Canada, and decided the quit and win approach was a promising population-based cessation approach. Other staff and I at the health department decided to pilot the quit and win approach in Kentucky, a major tobacco-producing state.
Upon making the decision to pilot the quit and win approach, we (staff and I) contacted Dr. Ellen Hahn, a faculty member at the University of Kentucky College of Nursing, with a track record of tobacco control policy research. A research design that employed a treatment and control group was developed to: 1. Test the effect of a multi-component statewide cessation contest on cigarettes smoked per day, quit attempts, quit rates, social support, and perceived harmfulness of tobacco and secondhand smoke; 2. Examine the relationship between age, gender, cigarettes smoked per day, perceived harmfulness of tobacco, stage of change, nicotine dependence, and social support and quit rates among all study participants in both treatment and control group; and 3. Explore the utilization of contest components, extent of media exposure, and buddy characteristics reported by contest participants.
The quit and win contest started on September 10, 2001 and ended on October 9, 2001 (30 days). Only regular tobacco users (age 18 or older) who have smoked cigarettes and/or used some other form of tobacco in the past 30 days at the time of entry were eligible for the contest. Contest participants also had to seek the support of a non-tobacco using buddy. Successful participants, who had quit for 30-days were eligible for a $2,500 grand prize or five $500 runner-up prizes.
Another unique aspect of the contest was the array of help, assistance and motivational messages available to people wanting to quit and win. The Bluegrass Quit and Win 2001 Contest used a multi-component campaign that included:
Q2. How many people registered for the contest? it seems there were more women than men. Are there other specificities about the participants?
Todd Warnick: Approximately 879 people, mostly heavy smokers in central Kentucky participated in the BQW 2001. This represents almost as many people quitting in Kentucky through local health department cessation programs in the past year...combined. More women than men participated in the contest. Over half of the participants registered for the contest on-line. Kentucky utilization of the telephone quit line provided by the National Cancer Institute smoking cessation centers increased by 1100 percent. Contest participants expressed appreciation of the BQW 2001, and especially enjoyed the weekly postcards that were mailed to them.
Q3. The promotion efforts were centered around Fayette County. Were people in other counties impacted anyway? What type of press coverage did you get?
Todd Warnick: The Bluegrass Quit and Win Contest 2001, was heavily advertised in Fayette County (Lexington) and other counties local in central Kentucky. A request for the state health department to assist other local health departments to promote the contest was denied. The state health department also expressed concern about the contest and failed to post the BQW 2001 domain name as a link on the state health department website.
A grant application was funded by the Legacy Foundation to evaluate the Bluegrass Quit and Win 2001 Contest. The University of Kentucky College of Nursing is conducting a 3-month, 6-month, and 1-year evaluation. Thus far, preliminary results indicate a 3-month quit rate of around 30 percent.
The BQW 2001 was covered by international, national, regional, state, and local media. International and national media coverage included the BBC World News Service, CNN Headline News, CBS radio, ABC radio, National Public Radio and the Associated Press. Local stories were featured on the television, radio, and newspapers. A common question was..."Did the September 11th terrorist attach effect people's ability to quit tobacco?" Preliminary indications are the September 11th attack did effect some people's ability to stay quit.
Q4. Are there things you would now do differently? What advice would you give to people willing to organize a quit and win contest? Have you been contacted to share info about your experience?
Todd Warnick: The cash prizes ($5,000 total) were donated by a coalition of health care centers in Fayette County. Paid media was our greatest expense. We spend around $50,000 on a mixture of media that included billboards, newspaper/magazine advertisements and radio advertisements. The newspaper/magazine and billboard advertisements were designed locally. Approximately 21 billboards were used. The number of daily billboard exposures was 225,300 (#100 G.R.P./day). The radio messages came from the CDC Media Resource Center. The radio campaign impacted 500,000 people each week for six weeks. The radio advertisements used a 60 second format that was divided into two 30 second spots that aired back-to-back. The first 30 second spot featured an "emotional message" designed to motivate people to quit tobacco. The first spot featured themes on the harm of secondhand smoke and "testimonials" of people who lost someone to tobacco.
The second radio spot was developed locally. It gave information about the Bluegrass Quit and Win Contest and the cash prizes. In the future, we'll continue to use this type of back-to-back format, but with some revisions. There is an emerging body of research showing tobacco control media campaigns that include anti-Light/Ultra Light advertisements motivate smokers to quit. We plan to incorporate these type of messages into our next quit and win contest.
Television spots were not purchased. Next time we plan to use television spots. Again, anti-Light/Ultra Light advertisements will be investigated. Over 16,000 registration brochures were inserted into the University of Kentucky student newspaper in an attempt to recruit young adult tobacco users. The effort produced little or no return. In the future, different methods will used to engage this population. Table top tents were mailed to restaurants and bars. Many of the establishments placed the table top tents near their cash register or ordered extra tents for whole eating sections. In the future, we will allow greater lead time for distributing the registration brochures to community businesses and health agencies.
People who want to organize a quit and win contest should give themselves a lot of lead time. Quit and win contests are a lot of work. It is important to implement a high-quality program and foster community buy-in. Dozens of community agencies partnered with us. The National Cancer Institute smoking cessation centers allowed their toll-free number to be advertised in conjunction with the quit and win contest. The smoking cessation centers distributed quit and win materials to Kentucky callers and provided cessation counseling. In the future, we plan to recruit corporate sponsorship and more actively engage large health care centers in order to weave tobacco cessation into the fabric of the community. It is important to "legitimize" tobacco cessation for health and non-health interests alike. Data management is a major issue. The University of Kentucky College of Nursing provided assistance. Teleform software was used to automate the data entry system and create an instant data base for ongoing evaluation.
And finally, the health department and University of Kentucky College of Nursing was asked to present a workshop and poster session regarding the quit and win contest at the 2001 National Tobacco Control Conference in New Orleans. Several in-state agencies have also consulted with the health department to implement quit and win programs. An evaluation of the Bluegrass Quit and Win Program is being conducted and the findings will be published in a peer-reviewed scientific journal.
Q5. What's next?
Todd Warnick: In 2002, the Lexington-Fayette County Health Department will sponsor another statewide quit and win contest. Local health department and corporate co-sponsorship will be vigorously recruited. The next contest will also feature the option of individual "pledges" that will be donated to a state entity serving the health interests of people adversely affected by tobacco use.
Thank you Todd for taking the time to be with us today.
Rendez-vous is supported by a contract from the Robert Wood Johnson Foundation
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