Sage Journals: Discover world-class research

Abstract

Introduction

Tobacco quitlines play a crucial role in cessation efforts; however, the proportion of quitline use among those who smoke remains low with less than 1% of U.S. adults utilizing quitline services in 2022. In 2020, the Illinois Department of Public Health and Illinois’ Tobacco Quitline (ITQL) provider, the American Lung Association, developed a mass media campaign to drive call volume to the state’s quitline (ITQL). Based on available data on quitline use and formative research learnings, campaign messages promoting urgency were tailored to the lived experiences of Illinois adults who smoke, with a focus on priority populations (i.e., males, individuals of lower socio-economic position, those with a history of a mental health diagnosis).

Methods

This study assessed whether self-reported ITQL media campaign awareness and online engagement are associated with commitment to quitting, intention to quit in the next 12 months, and intention to use ITQL. Three cross-sectional online surveys (n = 1122) were conducted during campaign media implementation with current Illinois residents aged 18-65 who self-reported smoking in the past 30 days and/or had at least one quit attempt in the past 12 months. A series of logistic and linear regression models were used to evaluate the relationships between campaign awareness/engagement and outcomes.

Results

The overall rate of campaign awareness and online engagement (55%) exceeded those reported by similar campaigns. In adjusted regression analyses, campaign awareness/engagement had a significant, positive influence on commitment to quitting (ß = 0.27), intentions to quit (OR = 1.51; 95% CI: 1.064,2.134), and intentions to use ITQL (ß = 0.99) among adults in Illinois who smoke, including priority audiences.

Conclusion

While more research is needed on tailored mass media campaigns that promote the use of quitlines, this study provides evidence that tailored mass media campaigns are effective in changing quitting behavior and can be utilized in reaching priority populations.

Keywords

smoking smoking cessation predictors evaluation mental health health disparities

Introduction

State of Cessation in the U.S

In 2021, approximately 46 million adults in the United States (U.S.) (18.7%) reported current tobacco product use, with cigarettes being the most used product (11.5%).¹ Although cigarette smoking has declined over time, its use continues to be the leading cause of preventable disease and death among adults in the U.S.¹ Quitlines play a crucial role in cessation efforts, demonstrating effectiveness across diverse populations. According to the recent North American Quitline Consortium (NAQC) Annual Survey, 32.8% of individuals utilizing quitline services achieved a minimum of 30 days of abstinence from smoking at 7-month follow-up.² However, the proportion of quitline use among those who smoke remains low with less than 1% (0.74%) of U.S. adults utilizing quitline services in 2022.² There was also a notable decline in cessation activity during the COVID-19 pandemic,^2-4 further highlighting the need to reengage those who smoke in cessation resource utilization (i.e., quitlines), especially among those at increased risk for compounding health disparities.

While many adults in the U.S. who smoke make quit attempts, most quit attempts are made without the use of cessation aids/treatments.⁵ Mass media campaigns like CDC Tips From Former Smokers campaign⁶ and The Tobacco Free Florida campaign⁷ are often leveraged to promote quitline services and increase utilization and have demonstrated effectiveness in increasing population-level quit attempts.^8-14 However, there is a need to better understand and document tailored mass media messages for various populations at increased risk of tobacco use and/or tobacco-related health outcomes (e.g., African American/Black; LGBTQ individuals; individuals of lower socio-economic position (SEP); individuals with a history of a mental health diagnosis).^15-17 Existing research shows promise that culturally tailored messages can successfully increase reach, motivation to quit, and smoking abstinence among these priority populations.^18-22

Illinois Tobacco Quitline (ITQL) Public Education Campaign

In 2020, the American Lung Association and Illinois Department of Public Health contracted Rescue Agency, a behavior change marketing agency, to develop a mass media campaign to drive call volume to the state’s quitline number. The primary audience was adults (18+ years) who smoke cigarettes. Within this overarching audience, it was also important to reach populations at increased risk for tobacco use and, specifically, those who were less likely to use ITQL according to program data. This led to a specific focus on tailored content for males, individuals of lower SEP, and individuals with a mental health diagnosis, to increase program reach. Qualitative message testing conducted in 2021 and 2022 (n = 50) among individuals of lower SEP and/or a history of a mental health diagnosis with representation across gender and race/ethnicity found that current smokers reported motivation to quit when shown messages that: (1) connect being tobacco-free with their top quit motivators (e.g., family, cost) and (2) spotlight ITQL service features (e.g., nicotine replacement therapy, counseling with a coach, customizable quit plans).

These research insights helped to inform a strategic framework that includes diversified messages designed to: (1) meet the audience where they are in their current readiness to quit based on Stages of Change Theory, as research posits that movement to subsequent stages of quitting may require different messaging approaches,²³ (2) promote urgency and intentions to quit by demonstrating how being tobacco-free can benefit the audience in meaningful ways, (3) promote intentions to use ITQL by showing how quitline support can make future quit attempts more successful, and (4) feature diverse talent who reflect the lived experiences of priority audiences as identified through research. Each set of creative assets was live between January 2021 and February 2023, beginning with Quitting Time, which was live from January 2021 through February 2021. Real Ripoff ran from October 2021 through February 2022. Experienced Help ran from October 2022 through December 2022. Don’t Miss Out ran from December 2022 through February 2023. Creative assets were strategically rolled out to coincide with periods when the CDC Tips From Former Smokers campaign ads were inactive in the state (see Table 1 for ad examples).

Table 1.

Campaign Ad Examples.

Ad Name & Image	Description	Strategic approach
Quitting time	A young man discussing his realization that it was time to quit when he felt cigarettes were taking control of his life. The ad emphasizes that using resources like a quitline significantly increases the likelihood of successfully quitting smoking, providing additional encouragement to those considering making the call.	Priority Audience(s): Male, lower SEP Strategic messaging components: 1. Readiness to quit: Pre-contemplation or contemplating quitting. 2. Urgency: Cigarette addiction takes control of your life and your time. 3. ITQL services: Free patches and gum to help with nicotine cravings. 4. Lived experiences: Young man who works a shift job, trying to make ends meet.
Real ripoff	A middle-aged man reflecting on his financial struggles, juggling two jobs and bills but still finding money tight. He highlights the real ripoff, smoking, which can cost hundreds of dollars each month. The ad emphasizes that calling ITQL is a free resource, offering access to gum or patches to help quit smoking. The man shares that by quitting, he’s been able to reclaim his hard-earned money, demonstrating the financial benefits of quitting alongside the health advantages.	Priority Audience(s): Male, lower SEP Strategic messaging components: 1. Readiness to quit: Contemplating quitting. 2. Urgency: The cost of cigarettes contributes to financial struggle. 3. ITQL services: Free services, gum, and patches. 4. Lived experiences: Older man, who works multiple jobs to make ends meet; has past quit attempts.
Experienced help	An experienced quit counselor discussing the anxiety and stress that often come with the idea of quitting smoking. She explains that by calling ITQL, individuals can connect with certified tobacco counselors who provide free counseling and support. The ad also highlights the long-term mental health benefits of quitting smoking, including reduced feelings of anxiety and depression, reinforcing the idea that seeking help through ITQL can make the quitting process less overwhelming and more effective.	Priority Audience(s): Individuals with a history of a mental health diagnosis Strategic messaging components: 1. Readiness to quit: Contemplating or preparing to quit. 2. Urgency: Relieving stress. 3. ITQL services: Empathetic support and free resources. 4. Lived experiences: Experiencing mental health challenges as well as increased stress from nicotine withdrawals; has past quit attempts.
Don’t Miss out	A young man contemplating his future and what he could miss out on if he doesn’t quit smoking. The ad underscores the fact that, on average, those who smoke die 10 years earlier than those that don’t smoke. It also promotes ITQL as a free resource, offering access to certified counselors who can provide support and guidance in quitting smoking, emphasizing the importance of taking action for a longer, healthier life.	Priority Audience(s): Males Strategic messaging components: 1. Readiness to quit: Contemplating or preparing to quit. 2. Urgency: Missing out on memories with family. 3. ITQL services: Counselors and free customized quit plan. 4. Lived experiences: Young father with children, concerned about their future.

The primary goal of the media campaign was to drive traffic to enrollment opportunities on the quitline website (quityes.org) and hotline (1-866-QUIT-YES). In service of the goal, the media plan included a 50% budget allocation to digital media channels, such as YouTube ads, paid search on Google, paid ads on social media, and promoted posts on ITQL’s owned social media pages. Social media ads promoting these services included a mix of videos, GIFs, and static images. The remainder of the media plan (50%) included traditional media channels, such as television and out-of-home placements at point-of-sale locations to remind the audience to enroll. This media mix reflects the wide age-range of the audience, which varies in its consumption of traditional and digital media. A secondary focus of the campaign media was driving campaign awareness to help keep ITQL top-of-mind for the audience. Aligned with this approach, total impressions, a measure of audience exposure, were consistent across three scheduled media runs (number of impressions for: Quitting Time = 43.6 million; Real Ripoff = 48.3 million; Experienced Help & Don’t Miss Out = 47.2 million). When creative assets were live in-market, quitline callers were asked how they learned about the Quitline, and 44%–71% of total callers identified “ITQL Media” as the source. Additionally, 46%-77% of ITQL website clicks showing intent to enroll came from the campaign’s online paid media ads.

Current Study

In the current study, we assessed (1) whether campaign awareness and online engagement is associated with commitment to quitting, intention to quit in the next 12 months, and intention to use ITQL and (2) demographic factors associated with these outcomes.

Methods

Procedure and Participants

Three cross-sectional online surveys (n = 1122) were conducted during campaign media implementation from 2021 to 2023. Wave 1 was conducted from July to August 2021 (32.6%), Wave 2 from April to May 2022 (33.3%), and Wave 3 in February 2023 (34.0%). Recruitment was conducted by a market research panel, which distributed an online screener survey. Eligibility criteria included current residence in Illinois, age 18-65, and smoking in the past 30 days and/or at least one quit attempt in the past 12 months. Eligible individuals were invited to continue with the evaluation survey, which included additional demographics, smoking behaviors and attitudes, and awareness and intent to use the ITQL campaign. All eligible participants provided electronic consent, and the study protocol was approved by Advarra, Inc. (Protocol no. PRO 17907). As is standard among research panels, participants received an incentive in the form of credits equivalent to up to $5.

Measures

Demographics

Participants reported age (free-response), gender identity, race and ethnicity, and sexual orientation. Questions were adapted from the 2021 Behavior Risk Factor Surveillance System survey (BRFSS).²⁴ In the current analysis, educational attainment was utilized as a proxy for SEP with the question, “What is the highest level of education that you have finished or gotten credit for?” with responses ranging from “Less than high school” to “Graduate Courses or Degree (Master’s Degree, PhD, MD).” Education is a commonly used indicator of SEP in the health literature, as it is strongly related to key factors that determine SEP, such as social opportunities for career advancement, cultural capital, and parental educational choices.^25,26 A dichotomous variable was created reflecting higher SEP (completed more than high school) or lower SEP (finished high school, earned a GED, or less).²⁷

History of Mental Health Diagnosis

Participants were asked, “Has a doctor, nurse, or other health professional EVER told you that you had a condition such as depression, anxiety, ADHD (attention deficit hyperactivity disorder), bipolar disorder, PTSD (post-traumatic stress disorder), social anxiety disorder, or schizophrenia?” (Yes/No).²⁴

Smoking Status

To assess smoking status, participants were asked to provide a numeric response from 0-30 for the question, “During the past 30 days, on how many days did you smoke cigarettes (ones that have to be lit and burned), even one or two puffs?”²⁸ Quit status was determined by the question, “During the past 12 months, have you stopped smoking cigarettes for one day or longer because you were trying to quit smoking?” (Yes/No).²⁴

Commitment to Quitting

To assess the extent to which campaign messaging was motivating to the audience, participants completed the 8-item commitment to quitting smoking scale ranging from 1-strongly disagree to 5-strongly agree.²⁹ Responses were averaged for a commitment to quitting score (Cronbach α = .89). Example items include “I’m willing to put up with whatever discomfort I have to in order to quit smoking” and “I’m not going to let anything get in the way of my quitting smoking.”

Intention to Quit

To assess the extent to which participants intended to quit smoking, they were asked: “Which of the following best describes your thinking about quitting smoking?” Response options included, “I already quit smoking cigarettes,” “I am thinking of quitting within the next month,” “I am thinking of quitting within the next 12 months,” “I am thinking of quitting someday, but not in the next 12 months,” and “Not interested in quitting.”^30,31 For analysis, a dichotomous variable was created indicating whether participants had any intention to quit in the future (“I am thinking of quitting within the next month,” “I am thinking of quitting within the next 12 months,” “I am thinking of quitting someday, but not in the next 12 months”) or no intentions (“Not interested in quitting”). Those who had already quit (n = 149) were excluded from analysis.

Intention to Use ITQL

To assess the likelihood of using ITQL, participants reported: “How likely is it that you will call the Illinois Tobacco Quitline to help you quit smoking?” and “How likely is it that you will enroll online with the Illinois Tobacco Quitline to help you quit smoking?” on a scale from 1-“I definitely will not” to 7-“I definitely will” (r = .84).

Awareness and Engagement

Following self-reported smoking behaviors, beliefs, and intentions, participants answered a series of questions to assess aided campaign awareness. First, participants were presented with a 30-second video advertisement (1-2 ads, depending on the wave) and social media ads (0-4, depending on the wave) and indicated if they had previously encountered each. To assess online engagement, participants were asked to indicate if they had previously interacted with or shared any ITQL social media posts, videos, or advertisements. A dichotomous (yes/no) variable was created indicating whether participants reported aided awareness and/or past engagement with ITQL online content.

Data Analysis

Sample size was determined by an a priori power analysis using an online calculator; assuming statistical power of .90, a small effect size (.15), and up to 8 predictors in the model resulted in a suggested sample size of 982.³² Analyses were conducted using IBM SPSS Statistics Version 29.0.2.0(20). Descriptive statistics were used to summarize sample characteristics and campaign awareness and engagement. To evaluate the relationships between campaign awareness and engagement and key outcomes (commitment to quitting, intention to quit, intention to use ITQL), we ran a series of linear and logistic regression models with robust standard errors. Gender, education, and history of a mental health diagnosis were included in the models to account for priority audiences. Missing values were deleted listwise. No outliers were identified. All models adjusted for race, sexual orientation, age, and survey wave as control variables.

Results

Sample Characteristics

The sample was consistent with the demographic profile of Illinois. The majority of survey participants were non-Hispanic white (68.1%) and identified as heterosexual (85.4%). Nearly half were ages 35-54 (48.0%), with a roughly even split between males (49.6%) and females (48.4%). Most smoked in the past 30 days (90.1%), and nearly half (41.3%) also reported a past year quit attempt. There were no significant differences in demographics between survey waves. See Table 2 for sample characteristics.

Table 2.

Sample Characteristics (n = 1122).

	n	%
Age in years (mean = 38.7 [SD = 11.7])
18-34	430	38.3
35-54	539	48.0
55-65	153	13.6
Race/ethnicity
White, non-Hispanic	763	68.1
Black, non-Hispanic	197	17.6
Hispanic/Latino	107	9.5
Asian, non-Hispanic	30	2.7
Another identity, non-Hispanic	25	2.1
Gender identity
Female	553	49.6
Male	546	48.4
Another identity	23	2.0
Sexual orientation
Heterosexual or straight	948	84.5
Bisexual or pansexual	112	10.1
Gay or lesbian	37	3.3
Another orientation	13	1.2
Socio-economic position (Education)
Lower SEP (High school grad, GED, or less)	360	32.1
Higher SEP (More than high school)	762	67.9
Mental health status
History of a mental health diagnosis	535	47.7
No history of a mental health diagnosis	587	52.3
Smoking status (mean # of days smoked = 18.9 [SD = 12.5])
Past 30-day use	1011	90.1
No past 30-day use, but tried quitting in the past year	111	9.9
Survey wave
Wave 1	366	32.6
Wave 2	374	33.3
Wave 3	382	34.0

Campaign Awareness and Engagement

Among the total sample, 55% reported aided awareness and/or online engagement with the campaign (Wave 1 = 52.5%; Wave 2 = 51.1%; Wave 3 = 61.3%). Campaign awareness and engagement did not change significantly between Wave 1 and Wave 2; it increased significantly between Wave 1 v. Wave 3 and Wave 2 v. 3 (P < .05). Among priority audiences, 62.6% of males, 48.9% of those of lower SEP, and 60.0% of those with a history of a mental health diagnosis reported aided awareness and/or online engagement.

Campaign Awareness and Engagement Predicting Key Outcomes

In adjusted regression analyses, campaign awareness/engagement was a significant predictor of commitment to quitting (ß = .270 [.161,.379], P < .001), intentions to quit (OR = 1.507 [1.064,2.134], P = .021), and intentions to use ITQL (ß = .990 [.767,1.213], P < .001) (Table 3). In all three models, gender, SEP, and history of a mental health diagnosis were also assessed as predictors. Male identity was a significant predictor of positive change: holding covariates constant, identifying as male was associated with a 0.319 increase (ß = .319 [.214,.425]) on the commitment to quitting scale and a 0.365 increase (ß = .365 [.156,.574]) on the intentions to use ITQL scale compared to identifying as female. Lower SEP was a significant predictor of reduced intentions to quit, associated with 32% lower odds of having intentions to quit compared to those of higher SEP (OR = .681 [.483 960]). Lower SEP was also associated with a 0.300 decrease in intentions to use the ITQL (ß = −.300 [-.521,-.079]). Finally, having a history of a mental health diagnosis was significantly associated with 70% greater odds of having intentions to quit (OR = 1.709 [1.205,2.424]) and a 0.402 increase on the intentions to use ITQL scale (ß = .402 [.193,.610]).

Table 3.

Campaign Awareness/engagement and Priority Audience Characteristics as Predictors of Key Outcomes.

	Mean (SD)	Adjusted regression analyses (reference category = unaware)
Commitment to quitting (n = 1122)	3.359 (.879)	ß = .270 [.161,.379]	P < .001
Male (ref = Female)		ß = .319 [.214,.425]	P < .001
HS education or less (ref = Greater than HS education)		ß = −.017 [-.124,.091]	P = .758
History of mental health diagnosis (ref = No MH diagnosis)		ß = .059 [-.046,.163]	P = .270
Intentions to quit (n = 973)		OR = 1.507 [1.064,2.134]	P = .021
Male (ref = Female)		OR = 1.000 [.712,1.407]	P = .996
HS education or less (ref = Greater than HS education)		OR = .681 [.483 960]	P = .028
History of mental health diagnosis (ref = No MH diagnosis)		OR = 1.709 [1.205,2.424]	P = .003
Intentions to use ITQL (n = 1122)	4.583 (1.794)	ß = .990 [.767,1.213]	P < .001
Male (ref = Female)		ß = .365 [.156,.574]	P < .001
HS education or less (ref = Greater than HS education)		ß = −.300 [-.521,-.079]	P = .008
History of mental health diagnosis (ref = No MH diagnosis)		ß = .402 [.193,.610]	P < .001

Note: All regression models adjusted for race/ethnicity, sexual orientation, age, and survey wave.

Discussion

Summary of Key Findings

The overall rate of campaign awareness/engagement exceeded those reported by similar state-sponsored mass media campaigns promoting cessation resources, with more than half of the sample (55%) reporting aided awareness and/or online engagement with the campaign, with awareness and engagement increasing significantly at Wave 3.^33-35 Additionally, findings suggest that campaign awareness and engagement had a positive influence on commitment to quitting, intentions to quit, and intentions to use ITQL among adults in Illinois who smoke cigarettes. Specifically among the priority audiences of the campaign, including males, those of lower SEP, and those with a history of a mental health diagnosis, the relationship between awareness/engagement and intentions to use ITQL was stronger than that of their respective comparison groups.

While the primary audience for the ITQL mass media campaign was all Illinois adults (18+ years) who smoke cigarettes, it was important to reach populations at increased risk for tobacco use who were less likely to use ITQL. This led to a focus on males, individuals of lower SEP, and individuals with a history of a mental health diagnosis. We observed variation in commitment to quitting and intention to quit among these audiences. Increased commitment to quitting was positively associated with increased awareness/engagement among males, compared to females. Increased odds of intention to quit was positively associated with awareness/engagement among those with a history of a mental health diagnosis, compared to those without a history. This is an important finding as there are societal misconceptions that those with a history of mental illness are generally not ready to quit.³⁶ However, literature has shown this audience reports similar or greater intentions to quit, compared to those without a history, and even reports high levels of satisfaction with treatment.^37-39 The current study aligns with this literature and suggests that ITQL’s tailored messaging appealed to and/or motivated individuals with a history of a mental health diagnosis to report quitting readiness.

Interestingly, those of lower SEP who were aware of the campaign were less likely to report intentions to quit and equally likely to report commitment to quitting, compared to those with higher SEP, suggesting that quitting was less important or less urgent for those with lower educational attainment regardless of campaign awareness and engagement. This may be due in part to extensive and pervasive predatory marketing by the tobacco industry in neighborhoods of lower income/SEP, to exploit and profit from those communities.^40-42 Higher tobacco retailer density, lower tobacco prices, and more tobacco marketing are found in neighborhoods of lower income/SEP than in higher income/SEP neighborhoods.^39,40 Adults who smoke that live in lower income/SEP neighborhoods close to tobacco retailers may be less likely to quit smoking, have lower pro-cessation attitudes than those living in higher income/SEP areas, and experience higher levels of chronic stress - all of which make it more difficult to stop smoking.^42,43 An added layer is industry tactics, such as targeted price promotions and coupons, that keep prices low.^41,42 Overall, this study contributes to a body of evidence demonstrating how tailored quitline promotions can successfully reach priority audiences.^15,44 Continued tailored communications and research are needed, especially for individuals of lower SEP and those with a mental health diagnosis.^13,15,45

Campaign Learnings and Implications

While the current study design does not allow for comparison of specific campaign elements or messages, media metrics related to engagement and enrollment intent revealed trends that could help inform future quitline campaigns. Total engagement over the three media runs ranged 3.1 to 5.2 million (number of digital engagements for: Quitting Time = 5.2 million; Real Ripoff = 3.1 million; Experienced Help & Don’t Miss Out = 4.8 million). All four message packages exceeded engagement benchmarks. Social media posts that utilized Gifs demonstrated the highest levels of digital engagement across all ads. Comments on social media posts represented a variety of themes; most often they included personal testimonials of successful quitting, mentions of preferred quit methods, reasons for quitting, and user-to-user conversations. These findings are aligned with research on characteristics of engaging anti-tobacco campaign messages, such as: strategic use of multiple social media platforms, eye-catching, high-quality graphics, and a clear call-to-action.⁴⁶ See Table 4 for examples of ITQL’s high-performing ads.

Table 4.

Examples of High-Performing Ads.

	Quitting time	Real rip-off	Experienced help	Don’t Miss out
Digital ads with highest Engagement	(Gif)	(Gif)	(Gif)	(Gif)
Digital ads with highest conversion rates**Based on subsequent clicks to “Enroll online” or “call to Enroll” on the ITQL website
Digital ads with highest clicks-to-call^^Based on clicks to “call now”

We also observed characteristics of successful conversion and click-to-call ads. Conversion ads are evaluated based on resulting clicks to enroll on the website, and click-to-call ads are evaluated based on the number of clicks. For Quitting Time, ads that provided visual representation of time demonstrating the urgency of quitting, resulted in the most conversions and clicks-to-call. For Real Rip-Off, the highest performing conversion ad was a carousel-style ad showing different individuals and reasons quitting can save money; the top ads also used the word “free” to describe resources. For Experienced Help, the highest performing ads focused on the personal benefits of quitting or using ITQL. For Don’t Miss Out, the highest performing ads showed happy, multi-generational family images and presented facts about early mortality from smoking.

Taken together, the current study and media metrics provide evidence that ITQL’s multi-channel, multi-message approach was successful in reaching and promoting quitting to Illinois adults who smoke cigarettes. Previous research supports the use of similar diverse strategies and platforms to promote quitline use and engagement among diverse populations.^46-48 This includes offering both online and hotline enrollment through ads, traditional and digital media promotion, as well as an array of core messages, messengers, and platforms.

The first three years of the COVID-19 pandemic coincided with planning and implementation of the ITQL media campaign, providing potentially useful learnings. A number of studies and reviews describe this period of time as a “challenge” for tobacco cessation and quitlines, especially in the first year.^49,50 For example, the national Tips For Former Smokers campaign, which is known for hard-hitting, motivating messages that drive calls to the national quitline, had released new ads in March of 2020. However, national quitline calls were down 39% for April, May, and June 2020 compared to the same quarter in 2019 and research shows that some quitlines were not equipped to provide telehealth services at the start of the pandemic.^4,51 Quitline staffing challenges also led to decreased follow-up and subsequent number of quit dates set in 2020 compared to 2019.⁵⁰

Through the course of the pandemic, data revealed that many adults who smoke cigarettes perceived smoking as increasing COVID19‒related health risks, and increased risk or harm perceptions were associated with reported quit attempts.^52-54 For other cigarette users, the pandemic was a time of increased stress, which increased perceived use.^49,52,54 During this time period, there was a continued need for cessation resources and quitline promotion, especially services that are available digitally or remotely. ITQL’s approach was likely successful, in part, because it was responsive to these needs: promoting urgency of quitting and keeping quitting top of mind, while acknowledging stress, uncertainty, and financial burdens that many were facing. ITQL offered free help that was available quickly and easily.

Study Limitations

The study utilized a convenience sample; therefore, findings cannot be generalized to a broader population, and the ability to draw causal conclusions or make comparisons from year to year is limited. Although efforts were made to temporally isolate this campaign from others in the market in Illinois, it is possible that participants were exposed to tobacco cessation or quitline messaging unrelated to the campaign of interest. Questions related to campaign awareness, engagement, and intent to utilize the quitline were not pilot tested with the intended audience prior to study launch, though they were adapted from previous tobacco control campaign research. Finally, we did not have a measure of income to assess participant socio-economic position and, therefore, utilized educational attainment as a proxy. Although education is commonly correlated with these constructs, it may not accurately represent participant income or SEP and may have impacted findings related to commitment to quitting and intentions to quit.^25,26

Conclusion

Overall, the Illinois Tobacco Quitline media campaign was successful in reaching, promoting quitline use, and influencing intentions to use ITQL among all intended audiences. While more research is needed on culturally tailored mass media campaigns that promote the use of quitlines, the evaluation of ITQL provides evidence that practical information about quitline resources presented by diverse messengers can positively impact the self-reported quit journey of adults who smoke. Phone calls attributed to campaign media, ad clicks to ITQL’s website, and millions of online engagements demonstrate additional evidence of positive outcomes. This study adds to the body of literature demonstrating that tailored mass media campaigns are effective in changing quitting behavior and can be utilized in reaching priority populations.

Supplemental Material

Supplemental Material - 1-866-QUIT-YES: How the Illinois Tobacco Quitline Reached Priority Audiences Through Mass Media

Supplemental Material for 1-866-QUIT-YES: How the Illinois Tobacco Quitline Reached Priority Audiences Through Mass Media by Dawnyéa D. Jackson, Taylor Goldman, Dana E. Wagner, Erika Redke, Gail DeVito, and Lori Younker in Tobacco Use Insights

Footnotes

Acknowledgements

We are grateful to Laura Pfeiffer, Anthony Garcia, Michelle Bellon, Maria Garcia, Shiloh Beckerley, and Jeff Jordan for their support of this work. We also gratefully acknowledge our participants.

ORCID iD

Dawnyéa D. Jackson

Ethical Approval

This study was approved by Advarra’s Institutional Review Board (Protocol no. PRO 17907) on December 23, 2020. All participants provided electronic consent prior to participating.

Informed Consent

All eligible participants provided electronic consent, and the study protocol was approved by Advarra, Inc. (Protocol no. PRO 17907).

Author Contributions

ER was responsible for the conceptualization of the study, and DJ, TG, and DW were responsible for conceptualizing the analysis for this manuscript. ER was responsible for managing recruitment and data collection. TG was responsible for data analysis. DJ, TG, and DW contributed to the data interpretations. ER and DJ developed the outline for the manuscript, and DJ and TG drafted the manuscript with significant inputs, reviews, and editing support from DW. GD and LY contributed to review and editing, as well as funding acquisition.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Made possible by funding from the Illinois Department of Public Health.

Conflicting Interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DJ, TG, DW, and ER are employed by Rescue Agency, which received funding from the Illinois Department of Public Health (IDPH) for this study. GD is employed by IDPH, which funded this study. LY is employed by the American Lung Association, which received funding from IDPH for this study.

Supplemental Material

Supplemental material for this article is available online.

References

Cornelius

Loretan

Jamal

, et al. Tobacco product use among adults – United States, 2021. MMWR Morb Mortal Wkly Rep. 2023;72:475-483. doi:10.15585/mmwr.mm7218a1

North American Quitline Consortium . NAQC FY22 annual survey: a national progress update; 2023;Published online July 31, 2023. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://cdn.ymaws.com/www.naquitline.org/resource/resmgr/2022_webinars/Final_FY22_Results_Webinarre.pdf

Bandi

Asare

Majmundar

, et al. Changes in smoking cessation-related behaviors among US adults during the COVID-19 pandemic. JAMA Netw Open. 2022;5(8):e2225149. doi:10.1001/jamanetworkopen.2022.25149

Jaklevic

. COVID-19 and the “lost year” for smokers trying to quit. JAMA. 2021;325(19):1929-1930. doi:10.1001/jama.2021.5601

Babb

Malarcher

Schauer

Asman

Jamal

. Quitting smoking among adults - United States, 2000-2015. MMWR Morb Mortal Wkly Rep. 2017;65(52):1457-1464. doi:10.15585/mmwr.mm6552a1

Rigotti

Wakefield

. Real people, real stories: a new mass media campaign that could help smokers quit. Ann Intern Med. 2012;157(12):907-909. doi:10.7326/0003-4819-156-1-201201010-00541

Duke

Woodlea

Arnold

MacMonegle

Nonnemaker

Porter

. Effect of a statewide media campaign on smoking cessation among Florida adults. Prev Chronic Dis. 2020;17:E17. doi:10.5888/pcd17.190271

Farrelly

Duke

Davis

, et al. Promotion of smoking cessation with emotional and/or graphic antismoking advertising. Am J Prev Med. 2012;43(5):475-482. doi:10.1016/j.amepre.2012.07.023

Duke

Mann

Davis

MacMonegle

Allen

Porter

. The impact of a state-sponsored mass media campaign on use of telephone quitline and web-based cessation services. Prev Chronic Dis. 2014;11:E225. doi:10.5888/pcd11.140354

10.

Davis

Nonnemaker

Farrelly

Niederdeppe

. Exploring differences in smokers’ perceptions of the effectiveness of cessation media messages. Tob Control. 2011;20(1):26-33. doi:10.1136/tc.2009.035568

11.

Durkin

Brennan

Wakefield

. Mass media campaigns to promote smoking cessation among adults: an integrative review. Tob Control. 2012;21(2):127-138. doi:10.1136/tobaccocontrol-2011-050345

12.

Durkin

Biener

Wakefield

. Effects of different types of antismoking ads on reducing disparities in smoking cessation among socioeconomic subgroups. Am J Public Health. 2009;99(12):2217-2223. doi:10.2105/AJPH.2009.161638

13.

Fiore

Baker

. 10 million calls and counting: progress and promise of tobacco quitlines in the United States. Am J Prev Med. 2021;60(3 Suppl 2):S103-S106. doi:10.1016/j.amepre.2020.06.021

14.

Prochaska

Gates

Davis

Gutierrez

Prutzman

Rodes

. The 2016 Tips from former Smokers® campaign: associations with quit intentions and quit attempts among smokers with and without mental health conditions. Nicotine Tob Res. 2019;21(5):576-583. doi:10.1093/ntr/nty241

15.

Berg

. Quitline reach and effectiveness among populations disproportionately affected by tobacco use: future directions. J Health Care Poor Underserved. 2021;32(3):1188-1198.

16.

Fallin

Lee

Bennett

Goodin

. Smoking cessation awareness and utilization among Lesbian, Gay, Bisexual, and Transgender adults: an analysis of the 2009-2010 national adult tobacco survey. Nicotine Tob Res. 2016;18(4):496-500. doi:10.1093/ntr/ntv103

17.

Boland

Mattick

Siahpush

, et al. Factors associated with Quitline and pharmacotherapy utilisation among low-socioeconomic status smokers. Addict Behav. 2019;89:113-120. doi:10.1016/j.addbeh.2018.09.029

18.

Steinberg

Rosen

Ganz

Wackowski

Jeong

Delnevo

. Communicating the benefits of quitting smoking on mental health increases motivation to quit in people with anxiety and/or depression: a randomized trial of two health messages. Addict Behav. 2024;149:107903. doi:10.1101/2023.02.17.23286103

19.

Keller

Christiansen

Kim

, et al. Increasing consumer demand among Medicaid enrollees for tobacco dependence treatment: the Wisconsin “Medicaid covers it” campaign. Am J Health Promot. 2011;25(6):392-395. doi:10.4278/ajhp.090923-QUAN-311

20.

Matthews

Breen

Veluz-Wilkins

, et al. Adaptation of a proactive smoking cessation intervention to increase tobacco quitline use by LGBT smokers. Prog Community Health Partnersh. 2019;13(5):71-84. doi:10.1353/cpr.2019.0040

21.

Zhu

Gardiner

Cummins

, et al. Quitline utilization rates of African-American and white smokers: the California experience. Am J Health Promot. 2011;25(5 Suppl):S51-58. doi:10.4278/ajhp.100611-QUAN-185

22.

Webb

Carpenter

Salmon

Resnicow

. Enhancing tobacco quitline outcomes for African American adults: an RCT of a culturally specific intervention. Am J Prev Med. 2023;65(6):964-972. doi:10.1016/j.amepre.2023.06.005

23.

Prochaska

DiClemente

. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390-395. doi:10.1037//0022-006x.51.3.390

24.

CDC . Behavioral risk factor surveillance System - questionnaires. 2024. https://www.cdc.gov/brfss/questionnaires/index.htm. Accessed 7 November 2024.

25.

Khalatbari-Soltani

Maccora

Blyth

Joannès

Kelly-Irving

. Measuring education in the context of health inequalities. Int J Epidemiol. 2022;51(3):701-708. doi:10.1093/ije/dyac058

26.

Galobardes

Shaw

Lawlor

Lynch

Davey Smith

. Indicators of socioeconomic position (part 1). J Epidemiol Community Health. 2006;60(1):7-12. doi:10.1136/jech.2004.023531

27.

U.S. Census Bureau . American Community Survey. https://www2.census.gov/programs-surveys/acs/methodology/questionnaires/2024/quest24.pdf. Accessed 7 November 2024.

28.

National adult tobacco survey. https://bigblue.depaul.edu/jlee141/econdata/health_data/NATS/2013-2014-questionnaire-tag508.pdf. Published online April 10, 2015.

29.

Kahler

LaChance

Strong

Ramsey

Monti

Brown

. The commitment to quitting smoking scale: initial validation in a smoking cessation trial for heavy social drinkers. Addict Behav. 2007;32(10):2420-2424. doi:10.1016/j.addbeh.2007.04.002

30.

Global Adult Tobacco Survey Collaborative Group . Global adult tobacco survey (GATS): core questionnaire with optional questions. https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/global-adult-tobacco-survey/questionnaire. Published online 2020.

31.

Kar

Sivanantham

Rehman

Chinnakali

Thiagarajan

. Willingness to quit tobacco and its correlates among Indian tobacco users—findings from the Global Adult Tobacco Survey India, 2016–17. J Postgrad Med. 2020;66(3):141-148. doi:10.4103/jpgm.JPGM_408_19

32.

Statistics Kingdom . Regression and ANOVA - sample size calculator. https://www.statskingdom.com/sample_size_regression.html. Accessed 30 October 2023.

33.

Czarnecki

Vichinsky

Ellis

Perl

. Media campaign effectiveness in promoting a smoking-cessation program. Am J Prev Med. 2010;38(3 Suppl):S333-342. doi:10.1016/j.amepre.2009.11.019

34.

Leas

Myers

Strong

Hofstetter

Al-Delaimy

. Recall of anti-tobacco advertisements and effects on quitting behavior: results from the California smokers cohort. Am J Public Health. 2015;105(2):e90-e97. doi:10.2105/AJPH.2014.302249

35.

Plant

Montoya

Tyree

, et al. The break up: evaluation of an anti-smoking educational campaign for lesbians, gays, and bisexuals in Los Angeles county. J Health Commun. 2017;22(1):29-36. doi:10.1080/10810730.2016.1247485

36.

Sheals

Tombor

McNeill

Shahab

. A mixed-method systematic review and meta-analysis of mental health professionals’ attitudes toward smoking and smoking cessation among people with mental illnesses. Addict Abingdon Engl. 2016;111(9):1536-1553. doi:10.1111/add.13387

37.

Kalkhoran

Thorndike

Rigotti

Fung

Baggett

. Cigarette smoking and quitting-related factors among US adult health center patients with serious mental illness. J Gen Intern Med. 2019;34(6):986-991. doi:10.1007/s11606-019-04857-3

38.

Annamalai

Singh

O’Malley

. Smoking use and cessation among people with serious mental illness. Yale J Biol Med. 2015;88(3):271-277.

39.

Prochaska

Das

Young-Wolff

. Smoking, mental illness, and public health. Annu Rev Public Health. 2017;38(2017):165-185. doi:10.1146/annurev-publhealth-031816-044618

40.

Lee

JGL

Henriksen

Rose

Moreland-Russell

Ribisl

. A systematic review of neighborhood disparities in point-of-sale tobacco marketing. Am J Public Health. 2015;105(9):e8-e18. doi:10.2105/AJPH.2015.302777

41.

Brown-Johnson

England

Glantz

Ling

. Tobacco industry marketing to low socioeconomic status women in the U.S.A. Tob Control. 2014;23(e2):e139-146. doi:10.1136/tobaccocontrol-2013-051224

42.

Cruz

Rose

Lienemann

, et al. Pro-tobacco marketing and anti-tobacco campaigns aimed at vulnerable populations: A review of the literature. Tob Induc Dis. 2019;17:68. doi:10.18332/tid/111397

43.

Health, Income, and Poverty. RWJF. https://www.rwjf.org/content/rwjf-web/us/en/insights/our-research/2018/10/health--income-and-poverty-where-we-are-and-what-could-help.html. Accessed March 4, 2025.

44.

Sheffer

. Tobacco quitlines: Opportunities for innovation to increase reach and effectiveness. Prev Med. 2022;165(Pt B):107319. doi:10.1016/j.ypmed.2022.107319

45.

Colston

Cruz

Simard

Fleischer

. A Systematic Review Evaluating Disparities in State-Run Quitline Utilization and Effectiveness in the U.S. AJPM Focus. 2023;2(1):100042. doi:10.1016/j.focus.2022.100042

46.

Reuter

Wilson

Moran

, et al. General Audience Engagement With Antismoking Public Health Messages Across Multiple Social Media Sites: Comparative Analysis. JMIR Public Health Surveill. 2021;7(2):e24429. doi:10.2196/24429

47.

Keller

Lachter

Lien

Klein

. Online Versus Telephone Registration: Differences in Quitline Participant Characteristics. Am J Prev Med. 2021;60(3 Suppl 2):S136-S141. doi:10.1016/j.amepre.2019.12.025

48.

Carlini

Miles

Doyle

Celestino

Koutsky

. Using Diverse Communication Strategies to Re-Engage Relapsed Tobacco Quitline Users in Treatment, New York State, 2014. Prev Chronic Dis. 2015;12:E179. doi:10.5888/pcd12.150191

49.

Nagi

Reddy

Rakesh

Vyas

. Tobacco cessation is a challenge during COVID-19 pandemic: Is it a good time to quit? A systematic review. J Indian Acad Oral Med Radiol. 2021;33(1):82-90. doi:10.4103/jiaomr.jiaomr_132_20

50.

Chethi Reddy

Musale

Kadam

, et al. Challenges faced by tobacco quitline services during the COVID-19 pandemic. J Subst Use. 2024;29(3):376-381. doi:10.1080/14659891.2023.2167744

51.

Alqahtani

Aldhahir

Oyelade

Alghamdi

Almamary

. Smoking cessation during COVID-19: the top to-do list. NPJ Prim Care Respir Med. 2021;31:22. doi:10.1038/s41533-021-00238-8

52.

Klemperer

West

Peasley-Miklus

Villanti

. Change in Tobacco and Electronic Cigarette Use and Motivation to Quit in Response to COVID-19. Nicotine Tob Res. 2020;22(9):1662-1663. doi:10.1093/ntr/ntaa072

53.

Chun

Cheon

Hwang

. Systematic review of changed smoking behaviour, smoking cessation and psychological states of smokers according to cigarette type during the COVID-19 pandemic. BMJ Open. 2022;12(6):e055179. doi:10.1136/bmjopen-2021-055179

54.

Kalkhoran

Levy

Rigotti

. Smoking and E-Cigarette Use Among U.S. Adults During the COVID-19 Pandemic. Am J Prev Med. 2022;62(3):341-349. doi:10.1016/j.amepre.2021.08.018

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.15 MB