THE STANFORD 5-CITY PROJECT SMOKERS' CHALLENGE II

In February, 1983, the FCP launched a quit smoking contest after conducting a smoking cessation television series and a self-helpprint campaign. Smokers motivations to quit and their preferred methods of quitting were gathered from our community survey data. From these data, and with analyses of the demographic profiles of participants in group programs, we decided to reach smokers who were not highly motivated to quit, to try to get more men in to the program, and to use incentives in the program. Several objectives were formulated for this 6-week quit smoking contest. These included:

achieving broad awareness of the contest in the general population.

recruiting a large number of smokers to sign up for the contest.

encouraging over 50% of the participating smokers to use community resources to quit.

achieving a quit rate at the end of the contest that was greater than other minimal contact programs (more that 20%).

providing those quitters with the skills to remain non smokers for one year.

The audience needs analysis then led us to establish moderately motivated male smokers as the target audience for the program and to utilize incentives to recruit them to the program and to encourage compliance with quit smoking advice. Several phases of formative evaluation were carried out to refine the contest strategy and promotion. To decide upon a title for the contest and the types of appeal for the promotional materials, smokers at local bars and after work gatherings were shown titles and sample ads and interviewed aout the effectivness of these materials. the results of these informal interviews yielded a contest called "Smokers' Challenge"; an appeal to smokers only; and promotional materials focused on the title first, the prize second and the contest information third.

Smokers responding to a community random phone survey (n=97) were asked what type of incentive (if any) would motivate them to participate in the contest. They were presented with the option of a trip to a local urban area, a color television set, and a car. The rate of a positive response to each alternative corresponded to the size of the prize of the incentive (trip 25%, television set 47%, car 67%). All prizes were donated by community groups; however, we were unable to obtain a car as the grand prize. Instead we were able to get a trip to Hawaii for two. We reasoned that the price of this prize was somewhat between the price of a car and a television set in price and would suffice as an adequate incentive.

Based on past experience and community population data on media use patterns, we selected television, newspaper, libraries, worksites, schools, stores, and physicians offices as the primary channels for promoting the contest. In addition, the community organization strategy of co-sponsorship was used to encourage the TV station to expand the frequency and intensity of message dissemination beyond traditional PSA play. Messages produced by the TV station were played 82 times in one month.

Price in the overall marketing mix included program cost, energy costs to sign up, and psychological costs (coping with urges, relapse prevention etc). The overall goal of the price analysis was to not impose barriers to participate in the contest for smokers who were moderatelyinterested in quitting. Since large scale recruitment and participation was crucial to the success of the program, we decided to remove financial and access barriers in the recruitment (we could only recruit at a limited number of distribution sites if fess were charged for participating in the contest) and to advertise community quit smoking programs that either were free or that charged a fee in the participation phase of the contest.

As presented in a published report, only some of the outcome objectives were achieved; the results of a random phone population srvey indicated that approximately 60% of the community were aware of the program, 501 mokers signed up for the program, more women (55%) than men were recruited (though the proportion of men was higher than other FCP group and self-help programs in the community), only a few signed up for community programs (11 groups, 22% self-help materials), 45% quit for a short time, and 22% quit with a year maintenance rate of 15%.

From analysis of the quit data, process tracking of the contest, and additional focus group discussions, it was decided that the promotion of the contest had been effective. It was also found that the quitting materials may not have appealed to the smokers who participated, that these quitting materials may not have appealed to the smokers who participated, that these quitting materials were sometimes not available at the contest sign-up locations, and that participating smoker's needed more support to stay quit. Revisions were made based on our experiences with the Smokers' Challenge I contest:

New quitting materials were developed that were more directive, and gave smokers a day-by-day set of guidelines for quitting in 12 days. This revised self-help program was supported by a 122-day radio show that reinforced the principle in the booklet. Based on smoker's stated preference for "cold turkey" approaches to quitting, this new guide was titled "Cold Turkey."

These new materials were the only quitting approach advertised in the recruitment materials: they were mailed to all participants requesting them, thus improving access to quitting information.

The contest was expanded from six weeks to three months. Smokers could earn chances for both the final prize and for smaller prizes if they sent in monthly "quit cards."

A second Smoker's Challenge contest attracted 588 smokers. Forty-five percent of entrants were male, 40% had less than a high school education (similar to the first contest), over 70% of participants signed up for the "Cold Turkey" booklet, 30% sent in the quit cards at the end of the contest, and a survey follow-up at three months after the contest with an alveolar carbon monoxide assessment on 20 entrants revealed a 30% quit rate. We established that access to quitting information was important to use and quit rates, and that a longer contest - while much more difficult to manage - yielded improved short term and interim results. We also saw that the demographics of contest participants were strikingly stable across both challenges. The new marketing mix with a revised product illustrates that process tracking during events and outcome evaluation are crucial to strategy refinement and goal readjustment.

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