RFP DOH Production and Media Buying Services for Promotion of the Florida Quitline and Tobacco Cessation Services

Transcription

1 RFP DOH Production and Media Buying Services for Promotion of the Florida Quitline and Tobacco Cessation Services 1. Q: Can each market use the combination of Television and Radio to achieve the TRPs totals or must they achieve point totals independently? A: TRPs for Broadcast television and radio can be combined. 2. Q: Can the respondent use cable networks instead of standard networks or a combination of both? A: The Department is not opposed to cable networks or a combination of both cable and standard networks. The vendor should identify the most appropriate medium based on the outlined target audiences. 3. Q: Can "value added" be other forms of media besides :30's and 60's? A: Yes 4. Q: Is the 75-85% of the target in each DMA or Statewide? A: Statewide 5. Q: Are the 10 listed markets DMA's or Metros? A: DMA s 6. Q: Will all of the media buying agencies, including minority be bidding against the incumbent advertising agency, Zimmerman? A: There is no incumbent agency for the contract that will result from this RFP. 7. Q: Regarding Hispanic and African American targets, are their TRP's part of the total or does the respondent have to have 1200 and 800 TRP's respectively per quarter for each target? A: The Hispanic and African American target audiences are included in the overall total. 8. Q: In reference to Page 10, Section B, iii: Regarding the section that reads "Ads should reach 75% to 85% of the target audience each quarter of the year during the media campaign, with an average of 1,200 TRPs per quarter during the introduction of the campaign and 800 TRPs per quarter thereafter. What time period is defined as "the introduction of the campaign"? A: The introduction of the campaign is defined as the first six months. 9. Q: Regarding the same aforementioned section, is the Department requesting 800 TRPs, statewide, on average, for every quarter between now and January 30, 2012? A: Yes, besides the introduction period. 10. Q: Are three letters of recommendation required along with the references contact information? Or is the filling out of Attachment III sufficient? A: Three letters of recommendation and Attachment III are required. 11. Q: May we place outdoor and/or transit spots as well as television and radio spots? Or are television and radio the only media vehicles permitted? A: Based on best practices, broadcast television and radio are the preferred media vehicles. 1

2 12. Q: Is a full resume from each key personnel responsible for the implementation of the contract required or is a brief synopsis of each person sufficient? A: Refer to Section 4.25 in the RFP document. 13. Q: What does securing a lifetime buyout of all products entail (as addressed on page 10)? A: Securing lifetime usage rights for the selected television and radio spots. 14. Q: Regarding the markets listed in the Television and Radio Media Plan/Mix, are all listed markets to be reached during this campaign or can markets be left out according to our research findings? A: All markets must be included in this statewide promotion. 15. Q: Please confirm the flight is for 19 months utilizing the $530K budget, scheduled to run through January A: The contract period will end January 30, Media flights will begin upon execution of the contract and approval of the media plan and conclude prior to the end of the contract. 16. Q: Is there any seasonality/celebrations that we need to be aware of for emphasis? A: The Department emphasizes cessation promotions during New Year s and traditional tobacco observances (Through With Chew Week, World No Tobacco Day, and Great American Smokeout). 17. Q: The RFP states the campaign is statewide. Are there particular markets you would like to target? A: All markets should be included in this statewide promotion. 18. Q: One of the priority populations includes rural populations; is this the sole target for this RFP? A: Refer to Section 4.4 of the RFP document. 19. Q: Is there a media campaign already running currently as part of this same Tobacco Free campaign? If so, which markets and what type of media? A: Yes, the Tobacco Free Florida campaign is currently running statewide. The overall campaign includes many media components for both youth prevention and cessation messages. Visit for more information. 20. Q: Are both TV and radio required in each market we purchase? A: Yes, unless it is determined that the media vehicle is not appropriate for the target audience in a given market. 21. Q: How much time has been allotted at the end of the TV and radio spots for the tags? A: Tobacco Free Florida spots already have Quitline tags. The time allotted for spots that will be selected from the CDC Resource Center and other state tobacco programs cannot be determined at this time (since selection of the spots has not been finalized). 22. Q: 4.3 Major Program Goals this states that the campaign will be evaluated by an external independent evaluator. Are we to include costs and recommendations for an evaluator or has the DOH already contracted for this? A: The Department contracts for this service separately. 23. Q: 4.5, B. Task, b. Activities, iii What is the timing of this campaign start, length, end date? Are the TRP goals estimated for radio and television combined or separate? Are all markets in the State of Florida to be included every DMA and 2

3 every radio Metro? If the budget does not allow for all markets to be purchased, would you please provide research or data to assist in selecting markets with best opportunity for results? A: The campaign will begin once the contract is executed and the media plan is approved by the Department. The contract ends January 30, TRPs for Broadcast television and radio can be combined. This is a statewide promotion; all media markets in the state will be included. Evaluation results can be provided. 24. Q: 4.5, C. Task, b. Activities, i. Meet with BTPP staff as determined by BTPP will these meetings required to be in person or can they be conducted via telephone and/or video-conferencing? If in person, would you please provide an estimate of number of meetings? A: Meetings are typically conducted via telephone conference. 25. Q: 4.5 Proposal Requirements under C. you are requesting a proposed overall marketing plan and timeline yet the scope of services is limited to production and media buying services. Would you please elaborate further what you are requesting? A: The overall marketing plan will include all tasks requested in the RFP. 26. Q: Along the same lines, can you please clarify the difference between question B under Proposal Requirements which reads: Provide a proposed overall marketing plan and timeline and F, which reads: Provide proposed statewide broadcast media plan, timeline, budget and added-value opportunities. A: The overall marketing plan and timeline would incorporate the statewide broadcast media plan, timeline, budget and added-value opportunities. 27. Q: Is the agency responsible for creating online banners or any materials needed for added value? A: Unless online banners or other materials have already been created by the Department, the contracted vendor will be responsible for creating any online banners or any materials needed for added value. 28. Q: How will this contract work with or leverage the findings from or results of DOH_ "Evaluation of the Area Health Education Centers Tobacco Cessation Interventions"? When will the results of the evaluation be available as a resource for contracts such as DOH_09-092? A: All evaluation reports will be made available as a resource. 29. Q: Who is the awardee for DOH_09-011? How will the DOH_ contractor work with them? A: Professional Data Analysts, Inc. was awarded the contract for the Evaluation of the Area Health Education Centers Tobacco Cessation Interventions solicitation. Since this media RFP does not include promoting Area Health Education Centers (AHEC), the vendor awarded the contract from this solicitation will not need to coordinate efforts with the AHEC evaluation efforts. 30. Q: Who is the awardee for DOH_ "Social Marketing Campaign for Tobacco Health Communication Interventions"? How will the DOH_ contractor work with them? A: Refer to the Vendor Bid System for the current status of this solicitation. 31. Q: Can we see the creative products that this contract will leverage or have as a resource? (e.g., logo/branding standards, existing TV/radio spots from CDC Resource Center and other state program [ref 4.1]) 3

4 A: Selection of spots from the CDC Resource Center and other state programs have not been finalized yet. Tobacco Free Florida media: Q: Is there an incumbent agency for this program? Who are they and are they bidding as well? A: There is no incumbent agency for the contract that will result from this RFP. 33. Q: What is the timeline of this campaign? Start/end dates for media buying to take place? [ref 4.5 Proposal Req "c" and 4.14 Campaign Performance Measures "1"] A: The campaign will begin once the contract is executed and the media plan is approved by the Department. The contract ends January 30, Q: Who are the evaluator/research firms contracted by DOH that we are required to work with? [ref 4.5.C.b.ii] A: Research Triangle Institute, Inc. is the Bureau s annual independent evaluation contractor. Professional Data Analysts, Inc. is the Bureau s Florida Quitline cessation media evaluation contractor. The vendor selected as a result of this RFP will need to: report media campaign efforts, media campaign timing, buy details, impressions, total TRPs, etc. Ongoing communication with evaluators is expected. 35. Q: Is this solely a radio/tv campaign? Does this include cable TV? YouTube? Other broadcast? A: The Department is not opposed to cable networks or a combination of both cable and standard networks. The vendor should identify the most appropriate medium based on the outlined target audiences. 36. Q: Are we able to do promotions and other "value-added" opportunities as part of the radio campaign (e.g., celebrity spokespersons, promotion packages)? A: Other value-added opportunities are welcomed and will be reviewed by the Department for approval. 37. Q: What did you find successful (and not) in prior campaigns? What are the best practices you want to continue? A: Refer to the attached Evaluation Report documents. 38. Q: What is the budget breakout for media buying to reach specific target markets (e.g., young adults, males, hispanics, etc.)? [ref 4.4 and 4.5.B.b.iii] What is the detailed breakout divided for TV, radio, other media for these target markets? A: The vendor should identify the appropriate budget breakdown. The breakdown can be further developed with the Department once a contract is in place. 39. Q: Can we leverage or optimize the efforts of the DOH_ campaign? A: Quitline materials produced from the Tobacco Free Florida campaign can be utilized. 40. Q: Is there a list of all the agencies participating in this bid? A: No 41. Q: Who are the members of the evaluation team? A: The Department has assembled an evaluation team consisting of marketing and tobacco experts. 42. Q: What is the current breakdown of media spending by DMA? A: Since a contract for this specific initiative does not exist, there is no current breakdown of media spending by DMA. 4

5 43. Q: What is the current breakdown of media spending by ethnicity specifically white, Hispanic, African-American? What is the current breakdown of media spending by types of media per ethnicity? (TV, radio, cable, other) A: Since a contract for this specific initiative does not exist, there is no current breakdown of media spending by ethnicity. 44. Q: Please clarify your definition of "past performance" versus individual or corporate capabilities to qualify for the required work. We have individual staff experience in areas that our company at large has not performed, for example. A: Refer to Section 4.25 in the RFP document. 45. Q: We are teaming with another small business to bid for the tasks collectively. Would the media buying vendor need to be the prime contractor? A: Refer to Section 5.6 and 3.1 of the RFP document. 46. Q: Who would the contractors report to or work under? What is your reporting structure? A: The contract resulting from this RFP will be managed b a contract manager within the Bureau of Tobacco Prevention Program. Refer to Section 4.12 of the RFP document. 47. Q: Is there a required workplace or can the work be conducted from multiple locations? A: There is no required workplace. Refer to Sections 4.10 and 4.11 of the RFP document. 48. Q: Do you have multi-lingual staff members that the contractors would work with for translating materials and information? A: It is preferred that a translating company be used for translating materials and information. 49. Q: Is there an oral presentation requirement as part of this bid? A: There will be no oral presentation. 50. Q: Can you provide a complete list of all existing Web sites that are attached to the Tobacco Free Florida campaign? Who will the contractor coordinate with at each Web site to sync with the media campaign? A: Current sites: Main sites: Micro sites: The awarded vendor will not be required to coordinate with each website to sync with the media campaign. 51. Q: Should the media budgets be divided by quarters? Which quarters? (e.g., 2010 Q4, 2011 Q1, etc.) A: It is up to each vendor to decide how the media budget should be divided. 52. Q: Could you provide a sample cost structure breakdown? A: The vendor should identify the appropriate budget breakdown. 5

6 53. Q: Are the evaluation proposal meetings open to vendor or the public? A: There are no proposal meetings planned. 54. Q: What ODC's are part of this bid? A: Since a definition of ODC was not provided, this question cannot be answered. 55. Q: How many FTEs are expected as minimum/maximum to fulfill this bid? A: There are no expected minimum/maximum FTE guidelines. 56. Q: How will compensation be paid out to the prime and sub contractors? A: Refer to Section 4.19 of the RFP document. 57. Q: What is the current breakout of the target audience (18-55)? Please provide detail breakdown in smaller age increments (e.g., under 18, 18-25, 25-40, etc.) A: and Q: Can you provide any more detail on the breakout of the target audience (18-55)? For example, under 25, High School grads? Over 40 unemployed? etc? A: and Q: Is there a designated budget for production and also for media? A: There is no designated budget. Since production is minimal media buying should be the majority of the contract budget. 60. Q: Must the RFP strictly adhere to the forms of media indicated being radio and broadcast or if other forms of media such as social media, blogs, etc may be considered to compliment the campaign? A: Broadcast radio and television are the preferred forms of media. Social media, blogs, etc will not be needed. 61. Q: Is your department seeking an annual relationship or a project with a designated period? A: The initial term of the contract resulting from this RFP shall be from the date of execution of the contract through January 30, Q: The RFP states that the primary target audience includes adults age with several priority populations listed, including Hispanics. Does the proposed media plan need to include a buy specifically for the Hispanic population throughout Florida? A: The Hispanic target audience should be included in the media buy as part of this contract. 63. Q: The RFP requests a media plan that covers Florida without specifying which markets. Should the proposed media plan cover each market in Florida (Ft. Myers, Gainesville, Jacksonville, Miami, Orlando, Panama City, Pensacola, Tallahassee, Tampa and West Palm Beach)? A: All media markets in Florida should be covered. 6

7 Florida Quit-For-Life Line Final Annual Media Report: July 2007 June 2008 October 15, 2008 Prepared for: Lauren Porter, MPH, Ph.D. Florida Department of Health Division of Health Access and Tobacco 4052 Bald Cypress Way, Bin C-23 Tallahassee, Florida Prepared by: Anne Betzner, M.A. Michael Luxenberg, Ph.D. Julie Rainey Matt Christenson Professional Data Analysts, Inc. 219 Main Street SE, Suite 302 Minneapolis, MN 55414

8 Retrospective Media Report October 15, 2008 Table of Contents Executive Summary... ii Overall Impact of the Media Campaign on Target Audiences... iii The Impact of the Media Campaign on Call Volume for Select Priority Populations...v The Impact of Quitline and NRT Tagging on Call Volume... vii Introduction... 1 The Quitline... 1 This Evaluation... 1 About this Report... 2 Report Content and Organization...2 Methodology... 3 Limitations...3 Description of the Media Campaign... 4 Media Calendar, Type, Content and Audience... 4 Frequency and Duration of Advertising by Market... 4 The Impact of Media on Call Volume... 5 Quitline Reach... 7 Reach for 25 to 54 Year Olds...7 Reach 18 to 24 Year Olds...10 Reach for those 55 Years or Older...12 Summary...13 Type of Quitline Callers Call Volume by Target Group Hispanic Smokers...17 African American Smokers...18 Women...19 Summary...19 The Impact of Quitline and NRT Tagging: A Multi-variate Approach Appendix 1: Reach for Tobacco Users Years Old Appendix 2: Reach for Tobacco Users Years Old Appendix 3: Reach for Tobacco Users 55 Years of Age or Older Produced by Professional Data Analysts, Inc. For the Florida Department of Health, Division of Health Access and Tobacco Page i of viii

9 Retrospective Media Report October 15, 2008 Executive Summary The Florida Quit-For-Life Line (Quitline) is one component of the Florida Tobacco Prevention and Control Program housed in the Florida Department of Health (DOH). The Quitline provides toll-free telephone-based tobacco use cessation service to any person living in Florida who wants to try to quit smoking. Since its inception in 2001, the Quitline services have been administered by the American Cancer Society (ACS), which provides counseling sessions and self-help materials in English and Spanish, translation service for other languages, pharmacotherapy assistance, and TDD service for the hearing impaired. In April 2007, the Florida Department of Health contracted with Professional Data Analysts, Inc. (PDA) to conduct an external, independent process and outcome evaluation of the Florida Quit-For-Life Line and the media campaign that promotes it. This report examines the impact of the media campaign run from July 2007 to June 2008 in motivating smokers to the Quitline. The primary audience for this report is the Department of Health, Division of Health Access and Tobacco, so that staff responsible for current Quitline and media administration can reflect upon the previous campaign and apply lessons learned to upcoming media efforts. The study may also provide early indications that resources expended on Quitline-related media are justified or not. Findings may be helpful in responding to Legislative and public inquiries about the current use of funds to support Quitline media. This study is based on call volume and caller-provided information gathered by ACS, as well as information on media activities provided by the media vendor, The zimmerman Agency. A key limitation of the study is that it is observational in nature, and not a controlled, randomized experiment. Therefore, it is impossible to conclude from this study that media caused call volume to rise or fall. Instead, this report describes the relationship of call volume to media campaign intensity, which may be influenced by many other factors. This report examines five media campaigns which ran from July 2007 to June The timing, target audience, market, type of media and the presence of Quitline tagging are shown in Table A below. Taken together the media campaigns ran a total of 32,006 spots. The number of spots per month by media type can be seen in Table B below. Table 1. Media Calendar, Type, Content and Audience Time Target Market Media Quitline Tagged 1/28/08 3/16/08 Adults State 1 TV No 2/18/08 3/30/08 Adults State 1 Radio No 4/14/08 6/8/08 Adults State 1 Radio Yes 5/5/08 6/15/08 2 Adults State 1 TV Yes 5/19/08 6/29/08 3 Adults State 1 Cable Yes 1 Includes the following DMAs: Tampa, Miami, Orlando, West Palm Beach, Jacksonville, Fort Myers, Tallahassee, Panama Ciy, Gainesville, Pensacola 2 Tampa and Miami ran from 5/5/08 6/29/08 3 Pensacola ran from 5/19/08 6/22/08 Produced by Professional Data Analysts, Inc. For the Florida Department of Health, Division of Health Access and Tobacco Page ii of viii

10 Retrospective Media Report October 15, 2008 Table B. Media spots per month by media type # of Spots Month TV Radio Cable Total April 0 6, ,663 May 3,022 8,133 4,758 15,923 June 2, ,422 9,420 Total 5,998 14,828 4,758 32,006 Overall Impact of the Media Campaign on Target Audiences The target audience of the campaigns described above is adult tobacco users aged 25 to 54 who are seeking to quit. Therefore, reach is provided for callers seeking to quit for that targeted age, as well as for those and those 55 and older. Reach is calculated by summing the number of people who called the Quitline to quit, divided by the number of smokers in Florida, as calculated by BRFSS 2007 population estimates. The media campaign is successful in reaching members of the target audience. The actual reach for the target audience of the media campaign (25-54 year olds seeking to quit) is 1.9. This is higher than the average reach of Quitlines, which was about 1%, as reported in and greater than reach for the younger and older age groups (0.9% and 0.6%, respectively). The Quitline s success is even more dramatic considering that media was run for only about five months of the year. If the campaign had run for a full 12 months, the rate of reach would be even higher. This finding also suggests that if reaching younger (18-24 years) or older (55 or more years) populations is important to the DOH, specialized media campaigns may need to be developed to reach them. Figure 1. Actual reach of the media campaign by target audience age 2.0% 1.8% 1.6% 1.4% 1.2% 1.0% 0.8% 0.6% 0.4% 0.2% 0.0% 1.9% 0.9% Actual Reach FY % Years Years 55+ Years 1 Cummins, S. E., Bailey, L., Campbell, S., Koon-Kirby, C. & Zhu, Shu-Hong. (2005). Tobacco cessation quitlines in North American: a descriptive study. Tobacco Contol, 16, i9 il5. Produced by Professional Data Analysts, Inc. For the Florida Department of Health, Division of Health Access and Tobacco Page iii of viii

11 Retrospective Media Report October 15, 2008 Does the intensity of the media campaign matter? To answer this question, an estimated, annualized reach was calculated for each of three time periods: (1) the zero intensity campaign, before the campaign started (7/1/2007 1/27/2008), (2) the moderate intensity campaign, while ads ran but were not tagged with the Quitline (1/28/08 4/13/2008), and (2) the high intensity campaign, while ads tagged with the Quitline ran (4/14/2008 6/30/2008). Because each of the three time periods is less than a year, an estimated annualized rate of reach was calculated. This rate is an estimate because it takes the number of callers from the specified time period and extrapolates it to a full year, assuming that the rate of reach for the observed period would be constant for the whole year, which is likely an optimistic assumption. Higher intensity campaigns are more successful. Figure 2 below illustrates that for all age groups, campaign reach was strongest during the high intensity campaign. Among the target audience, 25 to 54 year olds seeking to quit, the estimated annualized reach was 7.40%. This exceeds the CDC s recommendation that Quitlines are capable of reaching 6% of smokers. Figure 2. Estimated annualized reach by target audience age and campaign intensity 8% 7% 7.40% 6% 5% 4% 3.62% 3% 2% 1% 0% 2.37% 0.85% 0.15% 0.12% 0.43% 0.07% 0.24% Years Years 55+ Years No campaign Untagged campaign Tagged campaign Produced by Professional Data Analysts, Inc. For the Florida Department of Health, Division of Health Access and Tobacco Page iv of viii

12 Retrospective Media Report October 15, 2008 The Impact of the Media Campaign on Call Volume for Select Priority Populations The actual advertising content of the media campaign was not specifically designed to target Hispanic or African American smokers, although Spanish language advertising was placed in targeted DMAs and the English-language version was placed on stations with large African American audiences. Because the quitline seeks to serve all smokers, it is important to the DOH that Hispanic and African American smokers are well-served by the media campaign. Figure 4 below illustrates the absolute number ofcallers to the Quitline by campaign intensity for these two key racial/ethnic groups. More intense media campaigns are successful in driving Hispanic and African American smokers to the quitline. The greater the intensity of the campaign, the higher the call volume. The number of Hispanic callers to the Quitline was only 292 during the zero intensity campaign. In the moderate campaign, the number of Hispanic callers jumped to 396. The high intensity campaign tagged with the Quitline resulted in an exponential jump of 2,861 callers to the Quitline. The number of African Americans calling the Quitline increased similarly, from 243 to 354 to 2,752. Figure 4. Absolute number of those calling to quit personally by campaign intensity and race Hispanic 2752 African American No campaign Untagged campaign Tagged campaign Produced by Professional Data Analysts, Inc. For the Florida Department of Health, Division of Health Access and Tobacco Page v of viii

13 Retrospective Media Report October 15, 2008 Media campaigns were effective among Hispanic and African American smokers, but less so than for smokers statewide. Figure 5 below shows the proportion of callers who were Hispanic and African American by campaign intensity. Surprisingly, as campaign intensity increases, the proportion of callers who are Hispanic or African American decreases. The proportion of Hispanic callers to the Quitline was highest during the period with no campaign (15.8%) and dropped to 11.1% during the untagged campaign, to 9.1% in the tagged campaign. The proportion of Florida smokers who are Hispanic is 15.7% (2007 BRFSS), so the proportion of Hispanic smokers in both the moderate intensity untagged campaign and high intensity tagged campaign fall below this level. The proportion of African American smokers mirror the pattern described above. The highest proportion of African American smokers called during the period with no campaign (13.2%), and dropped to 9.9% during the moderate campaign, and dropped again to 8.8% in the high intensity campaign. The proportion of Florida smokers who are African American is 11.5% (2007 BRFSS), so the proportion of Hispanic smokers in both the moderate intensity untagged campaign and high intensity tagged campaign fall below this level. Media campaigns in 2005, 2006 and 2007 were shown to increase reach among Hispanic and African Americans 2. It is likely that media campaigns that target these groups in terms of ad content and placement would increase reach to be more proportionate to the percentage of smokers who are Hispanic and African American. Figure 5. Proportion of all those calling to personally quit by campaign intensity and race 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 15.8% 11.1% Hispanic 13.2% 9.9% 9.1% 8.8% African American No campaign Untagged campaign Tagged campaign 2 Betzner, A.; Luxenberg, M. G., Rainey, J., Christenson, M. (July ). Florida Quit-For-Life Line Retrospective Media Report: July 2003 June Tallahassee, FL: Florida Department of Health, Division of Health Access and Tobacco. Produced by Professional Data Analysts, Inc. For the Florida Department of Health, Division of Health Access and Tobacco Page vi of viii

14 Retrospective Media Report October 15, 2008 Figure 6 below shows the actual rate of reach for all smokers, Hispanic smokers, African American smokers and women smokers for fiscal year The rate of reach for all smokers in FY was 1.27%. The rate of reach among women was strong at 1.40%. However, the rate of reach was only 0.61% among Hispanic smokers and 0.77% among African American smokers. These results suggest that the media campaign was relatively less effective for Hispanic and African American smokers. While the media campaigns did not specifically target African Americans and Hispanics, it is critical that these groups are well-served. Specialized media campaigns targeting each group could be an effective means to increase their call volume to state averages. Figure 6. Actual reach by race for fiscal year % 1.4% 1.2% 1.27% 1.40% 1.0% 0.8% 0.6% 0.61% 0.77% 0.4% 0.2% 0.0% All Smokers Hispanic Sm okers African Am erican Sm okers Wom en Sm okers The Impact of Quitline and NRT Tagging on Call Volume To investigate the impact of the media campaign on Quitline call volume, a linear regression was conducted. The dependent variable was the natural log of the number of weekly calls to the Quitline for adults who were calling to quit. Three dependent variables were included: (1) the moderate intensity campaign period (yes/no), (2) the high intensity campaign period (yes/no), and (3) the period during which NRT was tagged (4/14/525). We hypothesized that being in the moderate intensity campaign period, the high intensity campaign period, and the period during which NRT was tagged would positively impact call volumes. This hypothesis was proven correct. Overall, the logistic regression found that ads tagging both the Quitline and NRT were most effective in driving callers to the Quitline, followed by ads that tagged the Quitline only. The model estimates that a campaign that tags both the Quitline and NRT would result in a weekly call volume of 4,494 adults seeking to quit. This is about 4.5 times greater than a campaign that tags just the Quitline. Produced by Professional Data Analysts, Inc. For the Florida Department of Health, Division of Health Access and Tobacco Page vii of viii

15 Retrospective Media Report October 15, 2008 The model estimates that a campaign that uses a Quitline tag (but no NRT tag) would result in a weekly call volume of 1,005 adults seeking to quit. This is 8.3 times more callers than ads with no tags at all. The model estimates that the initial zero intensity campaign has a baseline weekly call volume by 62 adults who call to quit. It is important to note that having five days a year with exceptionally high call volume, for example, does not provide all Floridians seeking to quit in a year with an equal opportunity to learn about and call the Quitline. Achieving a moderate level of call volume that is consistent throughout the year provides for a fairer distribution of services for all Floridians. The estimated number of callers per year based on the regression model estimates below is as follows: No advertising: Approximately 3,245 adults calling to quit Advertising with no tags: Approximately 6,261 adults calling to quit Advertising with NRT only tag: Approximately 28,174 adults calling to quit Advertising with Quitline only tag: Approximately 52,239 adults calling to quit Advertsing with NRT and Quitline tags: Approximately 233,688 adults calling to quit Produced by Professional Data Analysts, Inc. For the Florida Department of Health, Division of Health Access and Tobacco Page viii of viii

16 Retrospective Media Report October 15, 2008 Introduction The Quitline Housed in the Florida Department of Health (DOH), the Florida Tobacco Prevention and Control Program is a comprehensive tobacco control effort required by the Florida Legislature and funded with tobacco settlement dollars. The Florida Quit-For-Life Line (Quitline) is one component of this comprehensive program. The Quitline provides tollfree telephone-based tobacco use cessation service. Any person living in Florida who wants to try to quit smoking can use the Quitline. Since its inception in 2001, the Quitline services have been administered by the American Cancer Society (ACS), which provides counseling sessions and self-help materials in English and Spanish, translation service for other languages, pharmacotherapy assistance, and TDD service for the hearing impaired. Since 2003, the Quitline has been supported by media campaigns designed to motivate targeted callers to the Quitline. These media efforts followed the successful Florida truth campaign designed to prevent tobacco use among youth. Additionally, the DOH has funded the following tobacco related efforts: Area Health Education Centers, county health departments, medical schools, and other organizations to deliver cessation and health professional training services. The Florida Tobacco Prevention and Control Program is currently guided by a 23-person Tobacco Advisory Council. This Evaluation In April 2007, the Florida Department of Health contracted with Professional Data Analysts, Inc. (PDA) to conduct an external, independent process and outcome evaluation the Florida Quit-For-Life Line and the media campaign that promotes it. The evaluation is designed to assess Quitline functioning and outcomes, and the extent to which the Quitline media campaign is motivating smokers to call the Quitline. Areas for improvement and successes will be reported. The evaluations will be used to make midcourse and yearly corrections, and to identify and recognize areas of success. Findings will be presented to the Advisory Council for their consideration and presented at regional and national conferences. The evaluation of the Quitline includes the following components: A study of call volume and the characteristics of Quitline callers based on intake data provided by ACS. A seven-month follow-up study of Quitline callers tobacco use, based on ACS data, and superseded by an independent follow-up evaluation conducted by PDA. Data will be reported retrospectively ( ), annually and monthly. Call volume, caller characteristics and caller outcomes will be updated monthly and made publically available via an Online Query and Reporting System. Produced by Professional Data Analysts, Inc. Page 1 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

17 Retrospective Media Report October 15, 2008 The evaluation of the media campaign includes the following components: A study of call volume based on data provided by ACS, to determine the extent to which the media motivates smokers to call the Quitline. A retrospective report that assesses trends from 2003 to 2007 will be produced. Annual reports will also assess trends. Two special media studies are designed to assess the effectiveness of media. PDA will conduct these investigations to gather information about smokers exposure to media campaigns, their feedback on them, and their quitting behaviors (including calls to the Quitline). A random digit dial telephone survey will be conducted in fiscal years and , and the findings will be reported in annual reports for those fiscal years. Focus groups that examine the impact of the media campaign on important sub-populations that are under-represented in the studies described above. An examination of earned media and its impact on motivating smokers to call the Quitline. The Online Query and Reporting System is available for the public to query call volume and caller characteristics by year and geographic location (county, designated market area / DMA or region). These queries may assist counties in understanding the relationship between their local media campaigns and call volume. About this Report This report examines the impact of the July 2007 to June 2008 media campaign in motivating smokers to the Quitline. The primary audience for this report is the Department of Health, Division of Health Access and Tobacco, so that staff responsible for current Quitline and media administration can reflect upon the previous campaign and apply lessons learned to upcoming media efforts. The study may also provide early indications that resources expended on Quitline-related media are justified or not. Findings may be helpful in responding to Legislative and public inquiries about the current use of funds to support Quitline media. This report supercedes a preliminary report on the relationship of call volume to the media campaign that was submitted July 15, This final report includes data through June 30, 2008 while the preliminary report only included data through May 31, Report Content and Organization First, the nature and intensity of media campaigns from June 2007 to June 2008 is described. A calendar of media buys by market is presented, and the type, content and audience for media is described. Where information was available the frequency and duration of the media by market was presented. Second, the impact of media on call volume is examined as follows: The effect of the media campaign on call volume is described pictorially. An annualized rate of reach is estimated overall and within DMAs, for three periods of media intensity (no campaign, campaign without Quitline tags and Produced by Professional Data Analysts, Inc. Page 2 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

18 Retrospective Media Report October 15, 2008 campaign with Quitline tags). This comparison allows for an examination of the impact of the media on reach. Annualized reach is also computed for targeted and non-targeted age groups and subpopulations of interest (Hispanics, African Americans and women) to examine the impact of campaign intensity on reach within these groups. Bivariate comparisons of call volume by targeted and non-targeted groups is conducted to statistically test trends identified in the reach analysis. A regression analysis is conducted to predict call volume based on media intensity and the number of media spots per week. Finally, conclusion and recommendations are discussed in the last section of the report. Methodology This study is observational in nature and is based on call volume and caller-provided information gathered by ACS. Additionally, information on media campaigns was provided by the zimmerman agency, the vendor that created the creative materials for the campaigns and bought the spots. Monica Corbett and the zimmerman agency were very helpful in providing the information necessary for this report. Analyses were conducted using the statistical software package SPSS. Regression modeling was employed and crosstabulations were conducted. Reach was calculated based on call volume divided by population estimates provided by BRFSS. Limitations This study is limited by several methodological factors. First, because this study is observational and not a controlled, randomized experiment, it is impossible to conclude from this study that media caused call volume to rise or fall. Instead, this report describes the relationship of call volume to media campaign intensity, a relationship which may be influenced by many other factors, such as national trends in smoking or quitting prevalence; the availability of other quit programs; personal household factors such as an aunt who died of lung cancer; stress brought on by the state of the economy; etc. A second limitation is that the campaigns were relatively brief, only five months long, from February to June. A longer campaign provides more variability and more robust results. We anticipate that the annual media report will contain data from the full twelve months of the year. A third limitation may be described as an embarrassment of riches. The 2008 campaign was designed to appeal to all Floridians in all areas of the state, so may be considered universal. Statewide media saturation is likely excellent for Florida residents, but makes statistical analysis somewhat challenging. Statistical analysis is based on identifying variation in data. Because the target audiences and locations for the state were universal, there was little variation to be analyzed. Produced by Professional Data Analysts, Inc. Page 3 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

19 Retrospective Media Report October 15, 2008 A final limitation is incomplete knowledge of all of the media campaign activities. the zimmerman agency produced a wide range of media activities that were not explicitly designed to motivate smokers to call the Quitline, but that may have had that influence. These activities were not accounted for in our analysis, which may bias findings. Examining PDA s media evaluation findings in conjunction with those produced by the media evaluation contractor (University of Miami) will help to assess the comprehensive media campaigns in Florida. Description of the Media Campaign Media Calendar, Type, Content and Audience Five media campaigns were run from July 2007 to June The timing, target audience, market and type of media are shown in Table 1 below. Table 1 also indicates if the Quitline was tagged during the campaign. Table 1. Media Calendar, Type, Content and Audience Time Target Market Media Quitline Tagged 2/18/08 3/30/08 Adults State 1 Radio No 4/14/08 6/8/08 Adults State 1 Radio Yes 1/28/08 3/16/08 Adults State 1 TV No 5/5/08 6/15/08 2 Adults State 1 TV Yes 5/19/08 6/29/08 3 Adults State 1 Cable Yes Includes the following DMAs: Tampa, Miami, Orlando, West Palm Beach, Jacksonville, Fort Myers, Tallahassee, Panama Ciy, Gainesville, Pensacola 2 Tampa and Miami ran from 5/5/08 6/29/08 3 Pensacola ran from 5/19/08 6/22/08 Frequency and Duration of Advertising by Market TV advertisements were 30 seconds in length and radio ads were 60. The number of spots per month by media type can be see in Table 2 below. Table 2. Media spots per month by media type # of Spots Month TV Radio Cable Total April 0 6, ,663 May 3,022 8,133 4,758 15,923 June 2, ,422 9,420 Total 5,998 14,828 4,758 32,006 Produced by Professional Data Analysts, Inc. Page 4 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

20 Retrospective Media Report October 15, 2008 The Impact of Media on Call Volume Figure 1, below, pictorially represents the impact of media campaign on call volume. During the period when no media campaigns were running (7/1/07 to 1/27/08), call volume was quite low. Call volume experienced a small spike during the period when the media campaign ran without Quitline tags (1/28/08 4/13/08). A substantial and dramatic spike occurred during the last period of the year, from 4/14/08 to 5/30/08, when the Quitline media campaign ran with the Quitline tag. This visual representation of call volume by media campaign period strongly suggests that the campaign had a substantial impact on increasing call volume. The remainder of this report investigates this question statistically. Produced by Professional Data Analysts, Inc. Page 5 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

21 Retrospective Media Report October 15, 2008 Fiscal Year 2008 Call Volume (7/1/2007 through 6/30/2008) Call Volume* # of TV Spots # of Radio Spots # of Cable Spots Weekly Call Volume / Number of Media Spots Broadcast media campaign using ads not tagged with quitline (1/28/08-4/13/08) Broadcast media campaign using ads tagged with the quitline (4/14/08 6/30/08) 7/2/2007 9/2/ /2/2007 1/2/ /2/2008 5/2/2008 * Call volume is all callers aged 18 and over who are calling about Produced by Professional Data Analysts, Inc. Page 6 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

22 Retrospective Media Report October 15, 2008 Quitline Reach For the purposes of this analysis, reach is defined as the number of the media campaign s target population calling the Quitline divided by the number in the targeted population. This rate is calculated for three distinct periods: before the campaign started (7/1/07 1/27/08), while the campaign that ran without Quitline tags (1/28/08 4/14/08), and during the media campaign that included Quitline tags (4/14/08 5/31/08). Actual rates of reach are calculated, as well as estimated annualized rates of reach. Rates are annualized by estimating the rate for a twelve month period, assuming that the rate stays constant. Please note that estimated annualized rates of reach are estimates only and do not reflect the real rate of reach. Actual reach and annualized rates of reach are computed for those calling to quit in the targeted age group (25 54 years), and for two non-targeted age groups: years and 55 or more years. Within each age group, reach is calculated overall and within each DMA. Finally, within each age group, reach is calculated for sub-populations of interest: Hispanics, African Americans and women. For these groups, reach is calculated overall and for each DMA. Reach for 25 to 54 Year Olds The target population for the media campaign is tobacco users 25 to 54 year olds seeking to quit. Table 1 summarizes the actual and estimated annualized reach for all 25 to 54 year olds seeking to quit statewide, and for Hispanics, African Americans and females in this age group. A 2007 study published in the Journal of Tobacco Control provides some context for interpreting the estimated Quitline reach percentages presented here. For fiscal year 2005, the study found the average quitline reach in the United States to be about 1%, although individual state quitline reach ranged from 0.01% to 4.3%. 3 The Center for Disease Control and Prevention provides additional guidance for quitlines with regard to reach. The 2007 Best Practices for Comprehensive Tobacco Control Programs suggest that with sufficient promotion and clinician referral, and with NRT made more easily available, a state quitline could serve 8% of tobacco users aged 18 years and older and that approximately 75% of callers (6% of a state s tobacco users) would seek counseling services. 3 Sharon E Cummins, Linda Bailey, Sharon Campbell, Carrie Koon-Kirby, and Shu-Hong Zhu. Tobacco cessation quitlines in North America: a descriptive study. Tob. Control, Dec 2007; 16: i9 - i15. Produced by Professional Data Analysts, Inc. Page 7 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

23 Retrospective Media Report October 15, 2008 The findings on Quitline reach suggest the following interpretations and conclusions: The actual rate of reach for those year olds seeking to quit is 1.85%. This is above the average reach for quitlines, which is about 1.0%. Recall that for 7 months of the year, no campaign ads were running, which biases the rate downwards. Estimated annualized Quitline reach for all callers 25 to 54 years old is the highest during the period when the campaign was tagged with the Quitline. Reach is 7.40% for this period. This reach is an estimate based on two and one-half months of call volumes during the time when the Quitline ads were run (4/14/08 to 6/29/08) and extrapolated to 12 months time, assuming the rate stays constant. The estimated 7.40% reach is excellent. It is higher than the reach of quitlines on average and higher than the rate that CDC suggests that rates can be. The rate is exponentially higher than the rate for the untagged media campaign (0.85%) and with no media campaign (0.15%). The annualized estimated rate of reach increases with the intensity of the media campaign, suggesting that stronger media campaigns are related to higher call volume. The estimated annualied rate of reach among Hispanics, African Americans and women aged who are seeking to quit increases as the intensity of the media increases, also. Therefore, the media campaign is shown to increase reach among these groups. However, consider the estimated, annualized rate of reach during the strong, tagged campaign period. The rate among Hispanics (3.01%) and African Americans (3.80%) is much lower than that of all year olds (7.40%). Media campaigns in 2005, 2006 and 2007 were shown to increase reach among Hispanic and African Americans 4. It s likely that media campaigns that target these audiences would increase reach to the levels seen for all 25 to 54 year olds. Please note the small number of observations for some cells, which can make estimated reach unstable. The media campaign tagged with the Quitline has favorable estimated annualized reach among women (8.44%). Table 3 below presents the actual and estimated annualized reach for all Florida callers, and for Hispanic, African American and female callers. See Appendix 1 for a table of actual and estimated annualized reach for year olds by DMA. Reach for Hispanic, African American and women callers by DMA is also provided in Appendix 1. 4 Betzner, A.; Luxenberg, M. G., Rainey, J., Christenson, M. (July ). Florida Quit-For-Life Line Retrospective Media Report: July 2003 June Tallahassee, FL: Florida Department of Health, Division of Health Access and Tobacco. Produced by Professional Data Analysts, Inc. Page 8 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

24 Retrospective Media Report October 15, 2008 Table 3. Summary of actual and estimated annualized reach for year olds Actual Reach Annualized Reach Ages Number Served All Callers Fiscal Year (7/1/07-6/30/08; 366 days) No campaign (7/1/07-1/27/08; 211 days) No quitline tag on ads (1/28/08-4/13/08; 77 days) Ads tagged with quitline (4/14/2008 6/30/2008; 78 days) No campaign (7/1/07-1/27/08; 211 days) No quitline tag on ads (1/28/08-4/13/08; 77 days) Ads tagged with quitline (4/14/2008 6/30/2008; 78 days) 2008 Florida Population Estimates 1 FL State Totals 1.85% 0.15% 0.85% 7.40% 1,249 2,610 22,975 7,528,261 Hispanics FL State Totals 0.79% 0.10% 0.43% 3.01% ,179 1,752,479 African Americans FL State Totals 0.98% 0.12% 0.49% 3.80% ,053 1,309,766 Females FL State Totals 2.10% 0.17% 0.95% 8.44% 713 1,451 13,100 3,763,376 1 Estimates from 2007 BRFSS Table 4 below statistically tests the relationship between Quitline callers age (among those calling to quit) and campaign intensity. During the period with no campaign, only about 67% of callers were aged 25 to 54. After the campaign started (but had no Quitline tag), this proportion jumped to about 75% and maintained that proportion during the campaign with the Quitline tags. The relationship between the two variables is significant (p <.001). This finding confirms that the media campaign was successful in motivating the 24 to 55 year olds to call the Quitline to quit using tobacco. Produced by Professional Data Analysts, Inc. Page 9 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

25 Retrospective Media Report October 15, 2008 Table 4. Call volume of age by Quitline intensity People aged 18 and above who are calling regarding themselves agegroup Count % Count % Count % No campaign (7/1/2007-1/27/2008; 211 days) Phase3 Fiscal year 2008 media campaign No quitline tag on ads (1/28/2008-4/13/2008; 77 days) Ads tagged with quitline (4/14/2008-5/31/2008; 48 days) Total % 8.6% 8.2% 8.5% % 75.3% 74.3% 74.0% % 16.1% 17.5% 17.6% Total Count % % 100.0% 100.0% 100.0% χ 2 = , p <.001 Reach 18 to 24 Year Olds Actual and annualized estimated reach is calculated as described for tobacco users 18 to 24 year olds who are seeking to quit. Although this group is not targeted by the media, it is none-the-less of interest to the DOH because rates of smoking among young people have been rising. The summary table below shows trends similar to those outlined in the section above. The actual rate of reach is lower for those years old than for the target audience of the campaign, those years old (0.93% and 1.85%, respectively). Recall that for 7 months of the year, no campaign ads were running. The annualized estimated rate of reach increases with the intensity of the campaign (0.12% for the period with no campaign, 0.43% for the period with the untagged campaign, and 3.62% for the period with the tagged campaign). This indicates that the stronger media campaigns are associated with higher call volumes. Considering the stronger, tagged campaign period, annualized estimated rates of reach for year olds (3.62%) are lower overall than those for 25 to 54 year olds (7.40%). This suggests that the DOH is successful in targeting 25 to 54 year olds, and if the DOH would like to target younger groups equally well, specially targeted media efforts may have to be made. The annualized estimated rates of reach among Hispanics, African Americans and women who are 18 to 24 increases as the intensity of the media increases. However, the rate of reach during the stronger, tagged campaign among Produced by Professional Data Analysts, Inc. Page 10 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

26 Retrospective Media Report October 15, 2008 Hispanics (1.93%) and African Americans (1.12%) tobacco users is much lower than that of all year olds (3.62%). Considering the stronger, tagged campaign period, the annualized estimated rate of reach for women year olds (3.82%) is similar to the annualized estimated rate of reach for all year olds (3.62%). Table 5 below presents the actual and estimated annualized reach for all Florida callers, and for Hispanic, African American and female callers. See Appendix 2 for a table of actual and estimated annualized reach for year olds by DMA. Reach for Hispanic, African American and women callers by DMA is also provided in Appendix 2. Table 5. Summary of actual and estimated annualized reach for 18 to 24 year olds Actual Reach Annualized Reach Ages Number Served All Callers Fiscal Year (7/1/07-6/30/08; 366 days) No campaign 7/1/2007-1/27/2008; 211 days) No quitline tag on ads 1/28/2008-4/13/2008; 77 days) Ads tagged with quitline (4/14/2008 6/30/2008; 78 days) No campaign 7/1/2007-1/27/2008; 211 days) No quitline tag on ads 1/28/2008-4/13/2008; 77 days) Ads tagged with quitline (4/14/2008 6/30/2008; 78 days) 2008 Florida Population Estimates 1 FL State Totals 0.93% 0.12% 0.43% 3.62% ,541 1,702,820 Hispanics FL State Totals 0.53% 0.11% 0.25% 1.93% ,541 African Americans FL State Totals 0.29% 0.04% 0.10% 1.12% ,709 Females FL State Totals 0.98% 0.12% 0.46% 3.82% , ,242 1 Estimates from 2007 BRFSS Produced by Professional Data Analysts, Inc. Page 11 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

27 Retrospective Media Report October 15, 2008 Reach for those 55 Years or Older Actual and annualized estimated reach is calculated as described above for tobacco users 55 years or older who are seeking to quit. Although this group is not targeted by the media, it is none-the-less of interest to the DOH. The summary table below shows the similar trends outlined in the section above. The actual rate of reach is lower for those 55 years or older than for the target audience of the campaign, those years old (0.60% and 1.85%, respectively). Recall that for 7 months of the year, no campaign ads were running, which biases the rate of reach downwards. The annualized estimated rate of reach increases with the intensity of the campaign (0.07% for the period with no campaign, 0.24% for the period with the untagged campaign, and 2.37% for the period with the tagged campaign). This indicates that the stronger media campaigns are associated with higher call volumes. Considering the stronger, tagged campaign period, annualized estimated rates of reach for those 55 years or older (2.37%) is lower overall than those for 25 to 54 year olds (7.40%). This suggests that the DOH is successful in targeting 25 to 54 year olds, and if the DOH would like to target older groups equally well, specially targeted media efforts may have to be made. The annualized estimated rates of reach among Hispanics, African Americans and women who are 55 years or older increases as the intensity of the media increases. The rate of reach during the stronger, tagged campaign is about equal for African Americans (2.17%) and all Floridians (2.37%) aged 55 years or older. However, the rate of reach during the stronger, tagged campaign among Hispanics (0.81%) tobacco users 55 years or older is much lower than that of all year olds (7.40%). This suggests that if the DOH is interested in reaching this group, a specialized media campaign may be warranted. Considering the stronger, tagged campaign period, the annualized rate of reach for women 55 years or older (2.53%) is similar to the annualized rate of reach for all 55 years or older (2.37%). Table 6 below presents the actual and estimated annualized reach for all Florida callers aged 55 years or older, and for Hispanic, African American and female callers. See Appendix 2 for a table of actual and estimated annualized reach for those 55 years of age or older by DMA. Reach for Hispanic, African American and women callers is also provided in Appendix 3 by DMA. Produced by Professional Data Analysts, Inc. Page 12 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

28 Retrospective Media Report October 15, 2008 Table 6. Summary of actual and estimated annualized reach for those 55 and older Actual Reach 55+ Annualized Reach Ages 55 and above Number Served All Callers Fiscal Year (7/1/07-6/30/08; 366 days) No campaign (7/1/2007-1/27/2008; 211 days) No quitline tag on ads (1/28/2008-4/13/2008; 77 days) Ads tagged with quitline (4/14/2008 6/30/2008; 78 days) No campaign (7/1/2007-1/27/2008; 211 days) No quitline tag on ads (1/28/2008-4/13/2008; 77 days) Ads tagged with quitline (4/14/2008 6/30/2008; 78 days) 2008 Florida Population Estimates 1 FL State Totals 0.60% 0.07% 0.24% 2.37% ,379 5,505,879 Hispanics FL State Totals 0.22% 0.04% 0.10% 0.81% ,738 African Americans FL State Totals 0.57% 0.08% 0.32% 2.17% ,792 Females FL State Totals 0.64% 0.08% 0.26% 2.53% ,146 3,014,357 1 Estimates from 2007 BRFSS Summary The media campaign is successful in reaching members of the target audience (those years old who call to quit). The actual reach for this target audience is 1.9. This is higher than the average reach of quitlines, which was about 1%, as reported in The Quitline s success is magnified when we recall that media was run for only about five months of the year. If the campaign had run for a full 12 months, the rate of reach would be even higher. This finding also suggests that if reaching younger (18-24 years) or older (55 or more years) target populations is important to the DOH, specialized media campaigns may need to be developed to reach them. 5 Cummins, S. E., Bailey, L., Campbell, S., Koon-Kirby, C. & Zhu, Shu-Hong. (2005). Tobacco cessation quitlines in North American: a descriptive study. Tobacco Contol, 16, i9 il5. Produced by Professional Data Analysts, Inc. Page 13 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

29 Retrospective Media Report October 15, 2008 Figure 7. Actual reach of the media campaign by target audience age 2.0% 1.8% 1.6% 1.4% 1.2% 1.0% 0.8% 0.6% 0.4% 0.2% 0.0% 1.9% 0.9% Actual Reach FY % Years Years 55+ Years Produced by Professional Data Analysts, Inc. Page 14 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

30 Retrospective Media Report October 15, 2008 Type of Quitline Callers The section above suggests that the media campaign was very effective in driving callers to the Quitline. This section begins a series of statistical tests that probe that question. First, the relationship between intensity of the media campaign and types of callers to the Quitline is examined. We would expect to see higher proportions of callers personally quitting, as this was the message targeted by advertising. Table 7 below shows that the proportion of callers personally quitting increased from 71.1% during the period with no media campaign, to 88.6% with a campaign with no Quitline tag, and finally to 94.3% with the media including the Quitline tag. The relationship between type of caller and intensity of media campaign is significant. This provides further evidence that media campaign was successful in motivating smokers to call the Quitline. Table 8 below provides detailed information about the proportion of people quitting personally by DMA, and Table 9 provides detailed information on the proportion of friends and family who called by DMA. Table 7. Type of caller by intensity of campaign Type of Caller Other (examples: Drs. office, Teachers, Community Orgs) Family Members (including spouses)/friend of Current Smoker Count % Count % No campaign (7/1/2007-1/27/2008; 211 days) Fiscal year 2008 media campaign No quitline tag on ads (1/28/2008-4/13/2008; 77 days) Ads tagged with quitline (4/14/2008-5/31/2008; 48 days) Total % 5.7% 1.5% 3.2% % 2.9% 2.4% 2.7% Personally Quitting Count % 71.1% 88.6% 94.3% 92.2% Already Quit Count % 3.9% 2.8% 1.8% 2.0% Total Count % 100.0% 100.0% 100.0% 100.0% χ 2 = , p <.001 Produced by Professional Data Analysts, Inc. Page 15 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

31 Retrospective Media Report October 15, 2008 Table 8. N and % of people calling the Quitline that are ready to quit within 30 days by DMA No campaign (7/1/2007-1/27/2008; 211 days) No quitline tag on ads (1/28/2008-4/13/2008; 77 days) Ads tagged with quitline (4/14/2008 5/31/2008; 48 days) Miami - Ft. Lauderdale, FL DMA % % % Tallahassee - Thomasville, FL - GA % % % DMA Orlando - Daytona Beach - Melbourne, FL % % % DMA Tampa - St. Petersburg - Sarasota, FL DMA % % % West Palm Beach - Ft. Pierce, FL DMA % % % Jacksonville, FL - Brunswick, GA DMA % % % Ft. Myers - Naples, FL % % % DMA Gainesville, FL DMA % % % Panama City, FL DMA % % % Mobile, AL - Pensacola, FL - MS DMA % % % Table 9. N and % of people calling the Quitline that are family or friends of someone else by DMA No campaign (7/1/2007-1/27/2008; 211 days) No quitline tag on ads (1/28/2008-4/13/2008; 77 days) Ads tagged with quitline (4/14/2008 5/31/2008; 48 days) Miami - Ft. Lauderdale, FL DMA % % % Tallahassee - Thomasville, FL - GA 0 0% 4 2.5% % DMA Orlando - Daytona Beach - Melbourne, FL % % % DMA Tampa - St. Petersburg - Sarasota, FL DMA % % % West Palm Beach - Ft. Pierce, FL DMA % % % Jacksonville, FL - Brunswick, GA DMA % % % Ft. Myers - Naples, FL % 5 1.7% % DMA Gainesville, FL DMA 3 5.1% 2 1.9% % Panama City, FL DMA 1 1.3% 0 0% % Mobile, AL - Pensacola, FL - MS DMA 5 2.9% 6 3.6% % Produced by Professional Data Analysts, Inc. Page 16 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

32 Retrospective Media Report October 15, 2008 Call Volume by Target Group Call volume among several key demographic groups is crosstabulated by intensity of the campaign in this section. Hispanic Smokers The media campaign does not specifically target Hispanic callers, but it does produce and distribute Spanish-language advertising in targeted DMAs. Because the Quitline seeks to serve all smokers, it is important to the DOH that Hispanics are wellserved by the media campaign. Table 10 below shows an absolute increase in the number of Hispanic smokers that called the Quitline to quit as the intensity of the media campaign increased (from 292 with no campaign to 396 to 2,861 with the Quitline tagged media campaign). However, the proportion of callers who are Hispanic has dropped since the campaign started, from 15.8% with no campaign to 11.1% and finally 9.1% with the Quitline tagged campaign). Hispanic ethnicity is significantly related to campaign intensity. This finding suggests that while the campaign is reaching Hispanic smokers, it is even more successful in driving non-hispanic smokers to the Quitline. It is possible that a Hispanic-targeted ad campaign could increase call volume to be proportionally closer to the statewide proportion of Hispanic smokers. Table 10. Call volume of Hispanic ethnicity by Quitline intensity People aged 18 and above who are calling regarding themselves Phase3 Fiscal year 2008 media campaign Total ETHNICITY_ HISPANIC ] Are you Hispanic or Latino? 1.00 Yes Count % 1.00 No campaign (7/1/2007-1/27/2008; 211 days) 2.00 No quitline tag on ads (1/28/2008-4/13/2008; 77 days) 3.00 Ads tagged with quitline (4/14/2008-5/31/2008; 48 days) % 11.1% 9.1% 9.5% 2.00 No Count % % 88.9% 90.9% 88.7% Total Count % % 100.0% 100.0% 100.0% χ 2 = , p <.001 Produced by Professional Data Analysts, Inc. Page 17 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

33 Retrospective Media Report October 15, 2008 African American Smokers As with Hispanic smokers, the media campaign does not specifically target African Americans, but the DOH has a strong interest in assuring that this group is well served. Table 11 below shows the proportion of African Americans who call to quit in each of the three periods of media intensity. The findings are similar to those reported for Hispanic smokers above. The absolute number of African American callers increases dramatically as the intensity of the media campaign increased, from 243 with no campaign to 354 and 2,752 with the Quitline-tagged campaign. So the campaign is successful in driving African American callers to the Quitline. However, the proportion of callers in each time period decreased as the intensity of the campaign increased. With no campaign, 12.2% of callers were African American. During the campaign not tagged by the Quitline, 9.8% of callers were African American, which dropped to 8.8% during the Quitline-tagged campaign. Race is significantly related to call volume and the intensity of the campaign. This finding suggests that while the campaign is reaching African-American smokers, it is even more successful in driving non-african-american smokers to the Quitline. It is possible that a African-American-targeted ad campaign could increase call volume to be proportionally closer to the statewide proportion of African American tobacco users. Table 11. Call volume of Race by Quitline intensity Race White Count % 2.00 Black Count % 3.00 Others Count % Phase3 Fiscal year 2008 media campaign 2.00 No quitline tag on ads (1/28/2008-4/13/2008; 77 days) 1.00 No campaign (7/1/2007-1/27/2008; 211 days) 3.00 Ads tagged with quitline (4/14/2008-5/31/2008; 48 days) Total % 75.4% 78.4% 77.4% % 9.9% 8.8% 9.1% % 14.6% 13.0% 13.4% Total Count % % 100.0% 100.0% 100.0% χ 2 = , p <.001 Produced by Professional Data Analysts, Inc. Page 18 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

34 Retrospective Media Report October 15, 2008 Women Women are not a group specifically targeted by the media campaign, but the DOH has an interest in ensuring the women are well served by it. Table 12 below shows the proportion of women who called the Quitline to quit during the three periods of the campaign (56% to 58%) is somewhat higher than the proportion of women in the population. The chi-square test indicates that the proportion of women calling the Quitline did not significantly shift as the campaign grew stronger. The intensity of the campaign does not appear to influence women to call the Quitline, either positively or negatively. Given that more women call the Quitline than men, it is a positive finding that the campaign does not disproportionately influence even more women (and less men) to call the Quitline. Media campaigns that target men to call may be useful in increasing the number of men who call the Quitline. Table 12. Call volume of Sex by Quitline intensity People aged 18 and above who are calling regarding themselves ngender ] Gender 1.00 Male Count % 2.00 Female Count % 1.00 No campaign (7/1/2007-1/27/2008; 211 days) Phase3 Fiscal year 2008 media campaign 2.00 No quitline tag on ads (1/28/2008-4/13/2008; 77 days) 3.00 Ads tagged with quitline (4/14/2008-5/31/2008; 48 days) Total % 44.2% 43.1% 43.2% % 55.8% 56.9% 56.8% Total Count % % 100.0% 100.0% 100.0% NS, p =.250 Summary Figure 8 below shows the actual rate of reach for all smokers, Hispanic smokers, African American smokers and women smokers for fiscal year The rate of reach for all smokers in FY was 1.27%. The rate of reach among women was strong at 1.40%. However, the rate of reach was only 0.61% among Hispanic smokers and 0.77% among African American smokers. These results suggest that the media campaign was less effective for Hispanic and African American smokers. Media campaigns in 2005, 2006 and 2007 were shown to increase reach among Hispanic and African American smokers. While the media campaigns did not specifically targeted African Americans and Hispanics, it is critical that these groups are well-served. Specialized media campaigns targeting each group could be an effective means to increase their call volume to state averages. Produced by Professional Data Analysts, Inc. Page 19 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

35 Retrospective Media Report October 15, 2008 Figure 8. Actual reach by race for fiscal year % 1.4% 1.2% 1.27% 1.40% 1.0% 0.8% 0.6% 0.61% 0.77% 0.4% 0.2% 0.0% All Smokers Hispanic Sm okers African Am erican Sm okers Wom en Sm okers The Impact of Quitline and NRT Tagging: A Multi-variate Approach To investigate the impact of the media campaign on Quitline call volume, a linear regression was conducted. The dependent variable was the natural log of the number of weekly calls to the Quitline for adults who were calling to quit. Analysis was first conducted using a host of independent variables 6 to predict call volume. After extensive analysis it was determined that the most meaningful and parsimonious model includes three independent variables that represent media tagging. These variables include: Phase 2 of the campaign (moderate intensity with ads that do not tag the Quitline running from 1/28/08-4/13/08) as compared to the zero intensity campaign Phase 1 (7/1/08-1/27/08) Phase 3 of the campaign (high intensity with ads that tag the Quitline running from 4/14/08-6/30/08) as compared to the zero intensity campaign Phase 1 (7/1/08-1/27/08) The phase of the campaign where NRT was tagged ( while supplies last ), running from 3/17/08-5/19/08. In some ways, this model was a surprise to us. We expected the number of spots or media Gross Rating Points (GRPs) to predict call volume, but our initial analyses suggested that these variables did not do so. However, we do not conclude that these 6 Indpendent variables included: Phase of campaign (zero, moderate or high intensity), NRT tagging, weekly number of television spots and grps, weekly number of radio spots and grps, weekly number of cable spots and grps, weekly number of in-kind or one-for-one no charge ads, daypart code for ads (spots and grps by daypart), DMA where ads were run, weekly number of spots and grps for ads targeting special populations for radio (Hispanics, African Americans, Haitian) and TV (Hispanics), reach and frequency of ads, daily number of unique page views of the quitline webpage on the TobaccoFreeFlorida.com web site, the number of times per week web ads were clicked on, and average weekly price of regular gasoline (as an indicator of stress). Produced by Professional Data Analysts, Inc. Page 20 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

36 Retrospective Media Report October 15, 2008 variables are unrelated to call volume. Instead we suspect that their predictive power was masked because they are confounded in time with the very powerful predictors of Quitline and NRT tagging. In short, we believe the way the media campaign was implemented influenced results, and those results best reflect the strong influence that Quitline and NRT tagging have on call volume. The findings for model 1 are summarized here and found in Tables 13, 14 and 15 below. The model presented here is successful in predicting call volume. Model 1 accounts for 95.1% of variance in call volume (r 2 =.951, see Table 15). This is an exceptionally high r 2 value and indicates that the model includes the most influential predictor variables. Even a zero intensity campaign garners a small call volume. The model estimates that the initial zero intensity campaign impacts weekly call volume by 62.4 adults who call to quit (see Table 17). A completely untagged media campaign doubles call volume. The estimated weekly number of adults who are predicted to call to quit during a moderate campaign (ads with no Quitline or NRT tags) is 120.4, double the zero intensity campaign. NRT only tagging is 4.5 times more effective than no tagging. Interestingly, during a short period of time, ads were tagged with NRT ( while supplies last ), but not the Quitline. The estimated number of weekly callers during this condition is 541.8, or 4.5 times greater than an completely untagged campaign and 10 times greater than the zero intensity campaign. It is likely that callers reached the Quitline through the internet, even though it was not tagged. Quitline only tagging is 8.3 times more effective than no tagging. The model estimates that a campaign that uses a Quitline tag (but no NRT tag) would result in a weekly call volume of 1,004.6 adults seeking to quit. This is 8.3 times more callers than ads with no tags at all, and 1.9 times more than just an NRT tag. Quitline and NRT tagging is times more effective than no tagging. The model estimates that a campaign that tags both the Quitline and NRT would result in a weekly call volume of 4,494.0 adults seeking to quit. This is about 4.5 times greater than a campaign that tags just the Quitline and about 8.3 times greater than a campaign that tags just NRT. Taken together, this evidence suggests that tagging ads with NRT ( while supplies last ) is the most effective strategy to increase call volume. However, it is important to note that having five days a year with exceptionally high call volume, for example, does not provide all Floridians seeking to quit in a year with an equal opportunity to learn about and call the Quitline. Achieving a moderate level of call volume that is consistent throughout the year provides for a fairer distribution of services for all Floridians. The estimated number of callers per year based on the estimates below is as follows: No advertising: Approximately 3,245 adults calling to quit Advertising with no tags: Approximately 6,261 adults calling to quit Advertising with NRT only tag: Approximately 28,174 adults calling to quit Produced by Professional Data Analysts, Inc. Page 21 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

37 Retrospective Media Report October 15, 2008 Advertising with Quitline only tag: Approximately 52,239 adults calling to quit Advertsing with NRT and Quitline tags: Approximately 233,688 adults calling to quit Table 15. Linear regression 1 model summary Adjusted R Std. Error of the Model R R Square Square Estimate 1.977(a) a Predictors: (Constant), NRTtag NRT tagged ads: weeks of 3/17/2008 through 5/19/2008, Phase2 Non-tagged ad campaign 1/28/08-4/13/08, Phase3 Tagged ad campaign beginning 4/14/08 F= ; df=3,48; p<.001 Table 16. Linear regression 1 table of coefficients Model Unstandardized Coefficients Standardized Coefficients t Sig. 95% Confidence Interval for B 1 (Constant) B Std. Error Beta Lower Bound Upper Bound Phase3 Tagged ad campaign beginning 4/14/ Phase2 Non-tagged ad campaign 1/28/08-4/13/ NRTtag NRT tagged ads: weeks of 3/17/2008 through 5/19/ a Dependent Variable: lncallsages18plus Table 17. Linear regression 1 predicted weekly call volumes by campaign intensity Campaign phase Predicted average weekly call volume ages calling regarding themselves Initial, no campaign (7/1/2007 1/27/2008) 62.4 Non-Quitline tagged ads, no NRT tag (1/28/2008-3/16/2008) Non-Quitline tagged ads with NRT tag (3/17/2008 4/13/2008) Quitline tag with no NRT tag (5/26/2008 6/30/2008) 1,004.6 Quitline tag and NRT tag (4/14/2008 5/25/2008) 4,494.0 Produced by Professional Data Analysts, Inc. Page 22 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

38 Retrospective Media Report October 15, 2008 Appendix 1: Reach for Tobacco Users Years Old Table 15. Actual and estimated annualized reach for 25 to 54 year olds by subpopulation and DMA Current smokers ages calling regarding themselves BRFSS 2007 smoking prevalence est.= 19.3% Actual Reach Ages Annualized Reach Ages Number Served No quitline tag on No No quitline Ads tagged No ads campaign tag on ads with quitline campaign (1/28/07 (7/1/07 - (1/28/07 - (4/14/08 (7/1/ /27/08; 4/13/08; 77 6/30/08; 78 1/27/08; 4/13/08; 211 days) days) days) 211 days) 77 days) Fiscal Year (7/1/07-6/30/08; 366 days) Ads tagged with quitline (4/14/08 6/30/08; 78 days) 2008 Florida Population Estimates All Callers Florida State Totals 1.85% 0.15% 0.85% 7.40% 1,249 2,610 22,975 7,528,261 Miami - Ft. Lauderdale 1.14% 0.10% 0.51% 4.57% ,503 1,858,961 Tallahassee - Thomasville GA 2.00% 0.10% 1.44% 7.68% ,191 Orlando - Daytona Beach - Melbourne 2.33% 0.13% 0.92% 9.66% ,966 1,498,126 Tampa - St. Petersburg - Sarasota 1.85% 0.20% 1.02% 7.10% ,816 1,645,527 West Palm Beach - Ft. Pierce 2.15% 0.10% 0.91% 8.90% , ,715 Jacksonville - Brunswick, GA 2.29% 0.16% 0.65% 9.64% , ,109 Ft. Myers - Naples 2.02% 0.17% 1.11% 7.90% , ,473 Gainesville 2.40% 0.18% 1.47% 9.31% ,759 Panama City 1.98% 0.24% 0.00% 7.71% ,874 Mobile, AL - Pensacola, 1.42% 0.34% 0.97% 4.79% ,526 Hispanics Florida State Totals 0.79% 0.10% 0.43% 3.01% ,179 1,752,479 Miami - Ft. Lauderdale 0.64% 0.08% 0.33% 2.46% ,745 Tallahassee - Thomasville GA 0.63% 0.00% 0.80% 2.17% ,303 Orlando - Daytona Beach - Melbourne 1.09% 0.12% 0.53% 4.28% ,205 Tampa - St. Petersburg - Sarasota 0.76% 0.13% 0.47% 2.76% ,831 West Palm Beach - Ft. Pierce 1.04% 0.11% 0.57% 3.99% ,546 Produced by Professional Data Analysts, Inc. Page 23 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

39 Retrospective Media Report October 15, 2008 Jacksonville - Brunswick, GA 1.12% 0.20% 0.50% 4.22% ,225 Ft. Myers - Naples 0.90% 0.13% 0.60% 3.25% ,020 Gainesville 1.15% 0.09% 1.03% 4.09% ,496 Panama City 0.99% 0.11% 0.63% 3.72% ,815 Mobile, AL - Pensacola, 0.65% 0.06% 0.17% 2.71% ,293 African Americans Florida State Totals 0.98% 0.12% 0.49% 3.80% ,053 1,309,766 Miami - Ft. Lauderdale 0.85% 0.08% 0.48% 3.25% ,521 Tallahassee - Thomasville GA 1.71% 0.09% 0.78% 7.02% ,124 Orlando - Daytona Beach - Melbourne 1.37% 0.14% 0.61% 5.42% ,039 Tampa - St. Petersburg - Sarasota 0.72% 0.16% 0.41% 2.53% ,361 West Palm Beach - Ft. Pierce 0.78% 0.04% 0.31% 3.24% ,928 Jacksonville - Brunswick, GA 1.19% 0.15% 0.39% 4.80% ,427 Ft. Myers - Naples 0.66% 0.12% 0.47% 2.27% ,237 Gainesville 0.77% 0.08% 0.75% 2.65% ,860 Panama City 0.50% 0.14% 0.30% 1.65% ,939 Mobile, AL - Pensacola, 1.14% 0.36% 0.85% 3.55% ,330 Females Florida State Totals 2.10% 0.17% 0.95% 8.44% 713 1,451 13,100 3,763,376 Miami - Ft. Lauderdale 1.15% 0.09% 0.52% 4.61% , ,706 Tallahassee - Thomasville GA 2.55% 0.15% 2.11% 9.44% ,160 Orlando - Daytona Beach - Melbourne 2.72% 0.14% 1.00% 11.34% , ,795 Tampa - St. Petersburg - Sarasota 2.04% 0.23% 1.07% 7.87% , ,452 West Palm Beach - Ft. Pierce 2.44% 0.13% 1.01% 10.07% , ,476 Jacksonville - Brunswick, GA 2.76% 0.18% 0.85% 11.58% , ,636 Ft. Myers - Naples 2.37% 0.18% 1.28% 9.36% ,705 Gainesville 2.73% 0.25% 1.40% 10.71% ,576 Panama City 2.89% 0.39% 1.31% 11.19% ,084 Mobile, AL - Pensacola, 1.86% 0.44% 1.25% 6.26% ,786 Produced by Professional Data Analysts, Inc. Page 24 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

40 Retrospective Media Report October 15, 2008 Appendix 2: Reach for Tobacco Users Years Old Table 16. Actual and estimated annualized reach for 18 to 24 years by subpopulations and DMAs Current smokers ages calling regarding themselves BRFSS 2007 smoking prevalence est. = 19.3% All Callers Actual Reach Ages Annualized Reach Ages Number Served No Ads quitline tagged No tag on No No quitline with campaign ads campaign tag on ads quitline (7/1/07 - (1/28/08 (7/1/07 - (1/28/08 - (4/14/08 1/27/08; - 1/27/08; 4/13/08; 6/30/08; 211 4/13/08; 211 days) 77 days) 78 days) days) 77 days) Fiscal Year (7/1/07-6/30/08; 366 days) Ads tagged with quitline (4/14/08 6/30/08; 78 days) 2008 Florida Population Estimates Florida State Totals 0.93% 0.12% 0.43% 3.62% ,541 1,702,820 Miami - Ft. Lauderdale 0.58% 0.08% 0.20% 2.31% ,026 Tallahassee - Thomasville GA 0.85% 0.08% 0.44% 3.35% ,346 Orlando - Daytona Beach - Melbourne 1.28% 0.09% 0.54% 5.21% ,607 Tampa - St. Petersburg - Sarasota 0.97% 0.21% 0.67% 3.29% ,479 West Palm Beach - Ft. Pierce 1.14% 0.09% 0.27% 4.83% ,520 Jacksonville - Brunswick GA 1.04% 0.14% 0.34% 4.16% ,113 Ft. Myers - Naples 0.90% 0.13% 0.39% 3.44% ,285 Gainesville 0.70% 0.07% 0.56% 2.54% ,889 Panama City 1.35% 0.08% 0.01% 5.65% ,039 Mobile AL - Pensacola 0.54% 0.16% 0.44% 1.67% ,516 Hispanics Florida State Totals 0.53% 0.11% 0.25% 1.93% ,541 Miami - Ft. Lauderdale 0.49% 0.09% 0.16% 1.90% ,983 Tallahassee - Thomasville GA 0.56% 0.00% 0.44% 2.17% ,577 Produced by Professional Data Analysts, Inc. Page 25 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

41 Retrospective Media Report October 15, 2008 Orlando - Daytona Beach - Melbourne 0.71% 0.16% 0.34% 2.55% ,364 Tampa - St. Petersburg - Sarasota 0.40% 0.20% 0.29% 1.03% ,059 West Palm Beach - Ft. Pierce 0.68% 0.12% 0.32% 2.55% ,377 Jacksonville, FL - Brunswick GA 0.85% 0.00% 0.21% 3.78% ,555 Ft. Myers - Naples 0.43% 0.00% 0.37% 1.64% ,632 Gainesville 0.30% 0.00% 0.35% 1.05% ,927 Panama City 0.57% 0.00% 0.00% 2.67% ,814 Mobile AL - Pensacola 0.00% 0.00% 0.00% 0.00% ,253 African Americans Florida State Totals 0.29% 0.04% 0.10% 1.12% ,709 Miami - Ft. Lauderdale 0.30% 0.05% 0.07% 1.21% ,886 Tallahassee - Thomasville GA 0.25% 0.00% 0.08% 1.11% ,704 Orlando - Daytona Beach - Melbourne 0.46% 0.03% 0.08% 1.98% ,378 Tampa - St. Petersburg - Sarasota 0.20% 0.13% 0.09% 0.52% ,840 West Palm Beach - Ft. Pierce 0.27% 0.03% 0.00% 1.18% ,000 Jacksonville, FL - Brunswick GA 0.26% 0.02% 0.29% 0.87% ,980 Ft. Myers - Naples 0.14% 0.00% 0.23% 0.45% ,738 Gainesville 0.08% 0.00% 0.19% 0.19% ,995 Panama City 0.25% 0.14% 0.00% 0.78% ,210 Mobile AL - Pensacola 0.32% 0.00% 0.19% 1.31% ,978 Females Florida State Totals 0.98% 0.12% 0.46% 3.82% , ,242 Miami - Ft. Lauderdale 0.51% 0.07% 0.23% 1.98% ,883 Tallahassee - Thomasville GA 0.85% 0.06% 0.40% 3.43% ,097 Orlando - Daytona Beach - Melbourne 1.33% 0.11% 0.49% 5.43% ,652 Tampa - St. Petersburg - Sarasota 1.03% 0.23% 0.77% 3.47% ,235 West Palm Beach - Ft. 1.34% 0.08% 0.31% 5.76% ,279 Produced by Professional Data Analysts, Inc. Page 26 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

42 Retrospective Media Report October 15, 2008 Pierce Jacksonville, FL - Brunswick GA 1.12% 0.15% 0.27% 4.58% ,069 Ft. Myers - Naples 1.13% 0.17% 0.48% 4.35% ,260 Gainesville 0.63% 0.05% 0.66% 2.17% ,474 Panama City 1.76% 0.18% 0.84% 6.93% ,705 Mobile AL - Pensacola 0.67% 0.08% 0.50% 2.45% ,588 Produced by Professional Data Analysts, Inc. Page 27 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

43 Retrospective Media Report October 15, 2008 Appendix 3: Reach for Tobacco Users 55 Years of Age or Older Table 17. Actual and estimated annualized reach for those 55 and older by subpopulation and DMA Current smokers ages 55 and above calling regarding themselves BRFSS 2007 smoking prevalence est. = 19.3% Actual Reach Ages 55 and above Fiscal Year (7/1/07-6/30/08; 366 days) Annualized Reach Ages 55 and above No campaign (7/1/07-1/27/08; 211 days) No quitline tag on ads (1/28/08-4/13/08; 77 days) Ads tagged with quitline (4/14/08 6/30/08; 78 days) No campaign (7/1/07-1/27/08; 211 days) Number Served No quitline tag on ads (1/28/08-4/13/08; 77 days) Ads tagged with quitline (4/14/08 6/30/08; 78 days) 2008 Florida Population Estimates All Callers Florida State Totals 0.60% 0.07% 0.24% 2.37% ,379 5,505,879 Miami - Ft. Lauderdale 0.44% 0.06% 0.20% 1.70% ,075,482 Tallahassee - Thomasville GA 0.81% 0.09% 0.43% 3.12% ,742 Orlando - Daytona Beach - Melbourne 0.78% 0.05% 0.17% 3.32% ,439 1,049,399 Tampa - St. Petersburg - Sarasota 0.56% 0.08% 0.33% 2.07% ,221 1,427,231 West Palm Beach - Ft. Pierce, 0.58% 0.05% 0.20% 2.36% ,436 Jacksonville - Brunswick GA 0.91% 0.05% 0.15% 3.97% ,933 Ft. Myers - Naples 0.44% 0.05% 0.28% 1.63% ,234 Gainesville 0.90% 0.09% 0.28% 3.70% ,445 Panama City 0.52% 0.12% 0.00% 1.88% ,793 Mobile AL - Pensacola 0.40% 0.15% 0.37% 1.07% ,184 Hispanics Florida State Totals 0.22% 0.04% 0.10% 0.81% ,738 Miami - Ft. Lauderdale 0.14% 0.03% 0.09% 0.48% ,293 Tallahassee - Thomasville GA 0.00% 0.00% 0.00% 0.00% ,129 Orlando - Daytona Beach - Melbourne 0.42% 0.04% 0.07% 1.79% ,017 Produced by Professional Data Analysts, Inc. Page 28 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

44 Retrospective Media Report October 15, 2008 Tampa - St. Petersburg - Sarasota 0.27% 0.10% 0.17% 0.80% ,639 West Palm Beach - Ft. Pierce, 0.32% 0.00% 0.06% 1.43% ,748 Jacksonville - Brunswick GA 0.33% 0.00% 0.00% 1.53% ,679 Ft. Myers - Naples 0.42% 0.04% 0.40% 1.47% ,733 Gainesville 0.99% 0.00% 0.00% 4.63% ,618 Panama City 0.49% 0.42% 0.00% 1.14% ,131 Mobile AL - Pensacola 0.14% 0.00% 0.65% 0.00% ,751 African Americans Florida State Totals 0.57% 0.08% 0.32% 2.17% ,792 Miami - Ft. Lauderdale, FL DMA 0.43% 0.05% 0.26% 1.59% ,385 Tallahassee - Thomasville, FL - GA DMA 1.28% 0.16% 1.01% 4.53% ,923 Orlando - Daytona Beach - Melbourne, FL DMA 0.75% 0.05% 0.17% 3.22% ,218 Tampa - St. Petersburg - Sarasota, FL DMA 0.35% 0.05% 0.18% 1.33% ,249 West Palm Beach - Ft. Pierce, FL DMA 0.37% 0.06% 0.26% 1.34% ,024 Jacksonville, FL - Brunswick, GA DMA 0.92% 0.07% 0.18% 3.95% ,599 Ft. Myers - Naples, FL DMA 0.56% 0.05% 1.33% 1.17% ,609 Gainesville, FL DMA 0.48% 0.21% 0.29% 1.41% ,574 Panama City, FL DMA 0.34% 0.10% 0.80% 0.53% ,176 Mobile, AL - Pensacola, FL - MS DMA 0.91% 0.42% 0.87% 2.28% ,035 Females Florida State Totals 0.64% 0.08% 0.26% 2.53% ,146 3,014,357 Miami - Ft. Lauderdale, FL DMA 0.42% 0.06% 0.19% 1.60% ,223 Tallahassee - Thomasville, FL - GA DMA 0.99% 0.14% 0.62% 3.65% ,774 Orlando - Daytona Beach - Melbourne, FL DMA 0.86% 0.08% 0.24% 3.60% ,405 Tampa - St. Petersburg - Sarasota, FL DMA 0.58% 0.09% 0.34% 2.13% ,400 Produced by Professional Data Analysts, Inc. Page 29 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

45 Retrospective Media Report October 15, 2008 West Palm Beach - Ft. Pierce, FL DMA 0.62% 0.06% 0.19% 2.52% ,862 Jacksonville, FL - Brunswick, GA DMA 1.06% 0.07% 0.13% 4.64% ,743 Ft. Myers - Naples, FL DMA 0.50% 0.07% 0.34% 1.82% ,316 Gainesville, FL DMA 1.07% 0.14% 0.32% 4.34% ,567 Panama City, FL DMA 0.65% 0.10% 0.35% 2.45% ,420 Mobile, AL - Pensacola, FL - MS DMA 0.44% 0.14% 0.38% 1.30% ,647 Produced by Professional Data Analysts, Inc. Page 30 of 30 For the Florida Department of Health, Division of Health Access and Tobacco

46 Florida Department of Health Progress Report Principal Investigator: Noella A. Dietz, Ph.D. Institution: University of Miami Project Title: 2008 Tobacco Control Media Evaluation Project/2008 Media Evaluation of Statewide Marketing and Public Relations Anti-tobacco Contract Grant Number: UM 66488N, DOH Period Covered By This Report: 07/01/09 to 09/30/09 INTRODUCTION Briefly, the primary objective of the Tobacco Control Media Evaluation is to monitor and track the reach and penetration of the paid media campaign of the Florida Tobacco Control Program. In order to accomplish this broad objective, it is necessary to consider all the media components which include television, radio, print, billboard advertisements, promotional events and distributed paraphernalia, and the associated website. We evaluate these individual media components using the CDC recommended procedures and measures. For each media component, we present data depicting the level of self-reported awareness and four measures of confirmed awareness: event confirmed awareness, theme confirmed awareness, event or theme confirmed awareness, and event and theme confirmed awareness. In addition to the media component data, we also report data on total self-reported and confirmed awareness of the total paid media campaign employing two alternative measures of campaign awareness. The Florida Tobacco Control Program targets three demographically distinct sub-populations using distinct messaging. First, it targets youth (12 17 year olds) with an emphasis on tobacco uptake and prevention messages. Second, it targets young adults (18 24 year olds) with a combination of primarily prevention, secondhand smoke, and cessation messages. Third, it targets the adult population (ages 25 and over) with a combination of cessation and second-hand smoke messages. A previous report evaluated the reach and penetration of the youth targeted media program. This report focuses exclusively on the adult population, however, we do include young adults in this report because our adult sample ranged from 18 to 65 and older. We will provide a report focusing exclusively on the young adult population. The

47 basic theoretical underpinnings and logic model outlining the process and outcome evaluation of paid media programs were discussed in detail in the first report, focused on youths. Rather than repeating the theoretical model and logic model here, we refer the reader to pages 1 4 of the youth report (Progress Report 4). Similarly, the instrument employed in the adult survey and the design of the items used to measure self-reported and confirmed awareness of the paid media program parallel those discussed in detail in the youth report (Progress Report 4). Other than to emphasize that we do not include self-reported awareness as a valid and reliable measure of actually having seen an advertisement, and to highlight the fact that there are important differences between the four measures of awareness employed, we refer the reader, again, to the youth report for a detailed discussion of each of the measures (pages 5 8 and 17 21, Progress Report 4). Briefly, event confirmation captures a respondent s ability to describe what occurs in an advertisement after being cued to that advertisement. Theme confirmation tests the individual s ability to describe any of the messages, themes, or brand of the advertisement. The remaining two measures are based on combinations of these two measures of confirmation; they are event or theme confirmation and event and theme confirmation. To note, the event or theme combination is the broadest and most inclusive of the confirmation measures. The event and theme measure is by far the metric providing us with the most proof that an advertisement was actually seen because it requires a person to provide acceptable responses to both the question on event and the question on theme. SURVEY DESIGN AND METHODOLOGY A copy of the adult survey is provided to FDOH in Appendix A. The survey instrument and protocol were reviewed and approved by the Human Subjects Committees of both the University of Miami Miller School of Medicine and the University of Florida. Persons 18 and over who agreed to participate in the survey were told that they would receive a check for $12.50 for their participation. They also were informed that in order to receive their check we would have to ask for their name and address at the end of the survey. Persons agreeing to participate were assured that this information along with their answers to all the questions contained in the survey would be held in strict confidence, and would only be used independent of their name. The sampling universe was a list of telephone numbers provided by Gensys, Inc. Gensys is the most respected provider of listed samples in the country; they provide services to

48 many private researchers as well as to a host of researchers in the health arena. Listed samples afford the advantage of increasing the likelihood that each number dialed will be to a household containing a targeted person. Other sampling methods such as random digit dialing (RDD) do not afford this characteristic. Listed samples do because they are selectively created to maximize the likelihood that a number dialed will be to a household that contains a specifically targeted type of person. Telephone numbers on the list can be called randomly from the generated lists. While listed sampling frames, such as the one used in this work, contain the positive attributes of efficiency and randomness, they are not without shortcomings. A major one of these is that they are restricted to land based lines. Thus, like most RDD samples, they do not contain cell phone numbers and they still contain some disconnected numbers, as well as some business and fax numbers. With these issues in mind, a sample of 2,200 adults ages 18 and over were interviewed by the survey vendor, the University of Florida Survey and Research Center. We have employed this vendor to conduct nearly 20 tobacco related and media evaluation surveys for us. We worked with the supervisory staff of the Survey and Research Center to develop the needed training programs for their telephone interviewers, who are generally college students. The facilities of the Survey and Research Center include 75 interviewer stations, equipped with computers, and each of which has a programmed interview schedule that allows each interviewer to input responses as the questionnaire is administered. Each interview station can be monitored by senior staff to enhance quality assurance, and we can access each interview for additional monitoring. Interviews can be directly downloaded to a master data file for additional checking and editing when necessary. Interviews were conducted seven days a week and calls were initiated from 3:00 pm through 9:00 pm, with calls on Saturday made from 11:00 am through 9:00 pm and Sunday from 1:00 pm to 9:00 pm. All surveys are pretested and edited for quality prior to the launch of the formal survey. It is particularly difficult to determine whether a sample is representative of the target population at the end of a decade; we are nearly ten years away from the last census which provides the most accurate count of basic demographic parameters. Basic population estimates are available through the American Community Survey Census data suggest that at the turn of the last decade about 57% of the population 18 and over was female, and our sample contained about 61% adult women. This is a substantial gap, however, the gap between females and males in the adult population has been widening with each successive decade as

49 the population ages. Additionally, there is clear evidence to suggest that as the economy of the State has declined, there has been a relatively large emigration of primarily males employed in the construction and agricultural sectors. In short, there is probably no doubt that the 61/39% split by gender in our sample over estimates the number of women in the adult population; however, the weight of evidence clearly suggests that the over representation of females in the adult years may not be as great as one would think. A similar situation exists when we examine the age distribution of the adult population of the sample. It is important in looking at these data, as is the case for all of the sample comparisons made here, that our reference is the adult population of the State and not the State s total population. With this caveat in mind, the sample age distribution is as follows: (6%), (19%), (48%), and 70 and older (27%). The 2000 Census data show that the two middle age groups should contain about 69% of the population and the sample approaches this with 67% in these ages. The discrepancies that occur are at the oldest and the youngest age categories of the adult age distribution Census data showed that there was about 22% of the adult population in the 70 and over age group and nearly 10% in the young adult ages. These figures imply that the oldest population is over represented by about 5% and the youngest population is under represented by about 3%. Yet, all available evidence also suggests that demographic trends in the State, since the 2000 Census, will show an increase in the percent of the population over 70 and a decrease in the percent of adults in the young adult ages by the time of the 2010 Census. Thus, it is likely that the differences noted will be minimized and that the sample is not off as much as implied. The ethnic distribution of the adult population can be estimated from data available from the Bureau of Economic and Business Research at the University of Florida. These data imply that in 2007 the adult population of the State contained 15.9% African Americans, 21.3% Hispanics, 57.9% Whites, and a residual category of persons of Other ethnic origins totaling 6.9%. The sample appears to have captured the ethnic dimension rather well; it contains 16.5% of African Americans, 22.5% Hispanics, 54.9% Whites, and 6.1% percent of the Other group. Again, the small differences that do appear are probably consistent with demographic trends. Finally, we also collected data on a range of socioeconomic factors including household structure, size and presence of children, and income as well as individual level data on respondent tobacco use, education, and employment status. All of these factors, save tobacco

50 use, are more difficult to get reliable and valid adult population estimates for than the more strictly demographic factors discussed above. The sample distributions for all of these factors are, plus or minus, within a few percentage points of the 2000 population data suggesting that the sample captures the representativeness of the Florida adult population. The distributions for gender, age, ethnicity, and income are reported in the extreme left hand column of Table 2.1. CHAPTER 2 SELF REPORTED AND CONFIRMED AWARENESS OF MAJOR PAID MEDIA AND PROMOTIONAL ITEMS INTRODUCTION In this Chapter, we focus on the reach and penetration of the paid media program and related promotional items and public relations activities targeting the adult population. First, we consider the four television advertisements that have been aired since the campaign s inception. Two of the television advertisements (Working Man and Pregnant Woman) were aired recently and two of the advertisements (Catch and Buckle Up) were aired with the launch of the media campaign in January of Following the analyses of the television advertisements, we will examine the reach and penetration of two radio advertisements (Noise and Pregnancy Myths). The examination of reach and penetration concludes with analyses of two items of paraphernalia (Beach Ball and Wrist Band), the billboard, and three websites (the program website, professional and college athletic websites). Table 2.1 shows the percent of all persons interviewed who reported either having seen or saying that they may have seen each of the four television advertisements included in the survey. There is little difference between the percent self-reporting having seen or thinking they may have seen three of the television advertisement (Working Man, 23%; Catch, 22%, and Buckle Up, 25%), but one advertisement (Pregnant Woman, 15%) was self-reported as having been or may have been seen by fewer than 15% of the adult population. Thus, although these data do not suggest that the reach of the television advertisements can be characterized as moderate or high, they do suggest two important considerations. The first is a relatively high level of consistency from one advertisement to the next, and second the corollary observation that the self-reported data suggest that the earlier run advertisements do just as well, if not better, than the advertisements run prior to the survey.

51 Table 2.1. Self Reported Awareness of Four Television Advertisements for the Adult Population and Age, Gender, Ethnic, and Household Income Groups Television Yes/Maybe No Advertisement N % N % Total Working Man All Adults , ,200 Gender Groups Females , ,351 Males Age Groups , Ethnic Groups White ,197 Hispanic African American Other HH Income Groups DK/Refused $10,999 or less $11,000-$25, $26,000-$75, $76,000 or more Pregnant Woman All Adults , ,200 Gender Groups Females , ,351 Males Age Groups , Ethnic Groups White , ,197 Hispanic African American Other HH Income Groups DK/Refused $10,999 or less $11,000-$25, $26,000-$75, $76,000 or more

52 Catch All Adults , ,200 Gender Groups Females , ,351 Males Age Groups , Ethnic Groups White ,197 Hispanic African American Other HH Income Groups DK/Refused $10,999 or less $11,000-$25, $26,000-$75, $76,000 or more Buckle Up All Adults , ,200 Gender Groups Females ,351 Males Age Groups , Ethnic Groups White ,197 Hispanic African American Other HH Income Groups DK/Refused $10,999 or less $11,000-$25, $26,000-$75, $76,000 or more With respect to penetration, the self-report data produced mixed results. For example, with respect to gender and age, there were only minor and insignificant differences between the

53 advertisements. The only advertisement producing a gender difference was Buckle Up; females (27%) were more likely to self-report awareness than males (21%) (X 2 = p =.001). The only advertisement where the difference between the high and low level of self-report for age was Working Man, where 16% of year olds self-report awareness versus over 26% of persons 70 and over (X 2 = 5.96; p =.025). The penetration for ethnic groups and household income groups on self-report are far less favorable, but interesting. For example, there are significant ethnic differences in the penetration of each of the advertisements, but the groups producing the largest differences tended to vary from one television advertisement to the next. African Americans self-reported the highest level of awareness (29%) for Working Man, while Whites had the lowest level (19%) (X 2 = 15.07, p =.001). Although Whites (11%) also had the lowest level of self-report for Pregnant Woman, Hispanics had the highest level at 24% (X 2 = 49.80, p =.001). The pattern observed for Working Man is reversed for Catch; for this advertisement Whites claimed the highest self report (26%), while African Americans (14%) demonstrated the lowest (X 2 = 20.09, p =.001). For Buckle Up, the largest ethnic differential was between Hispanics (30%) and African Americans (22%) (X 2 = 6.13, p =.025). In short, regarding self-report, there are relatively large ethnic differences for each of the television advertisements, but there is no consistent ethnic differential. For household income groups, on the other hand, there is a far more consistent pattern. For three of the advertisements (Working Man, Pregnant Woman, and Buckle Up) the lowest level of self-report was among persons in the highest household income group ($76,000 or more) and the highest level of self-report was in the lowest level of household income (Less than $11,000). The chi squares for each of these differences are significant (X 2 = 13.92, p =.001; X 2 = 36.19, p =.001; X 2 = 7.10, p =.01, respectively). Catch was the only television advertisement that did not show significant household income penetration differences. The data in Table 2.2 show the levels of confirmed awareness of each advertisement employing four different measures of confirmation. For the total population of adults, these gage the level of reach for each advertisement and for each of the subpopulation groups they measure the penetration of advertisements along the dimension identified. In looking at these data, it is important to bear in mind not only that each of the four measures employed provide proof of who did and did not see the advertisements, but also that each of the four measures is based on a different set of criteria.

54 Table 2.2. Confirmed Awareness of Four Television Advertisements for the Adult Population and Age, Gender, Ethnic, and Household Income Groups Television Event Theme Event or Theme Event & Theme Advertisement Confirmed Confirmed Confirmed Confirmed % % % % Working Man All Adults Gender Groups Females Males Age Groups Ethnic Groups White Hispanic African American Other HH Income Groups DK/Refused $10,999 or less $11,000-$25, $26,000-$75, $76,000 or more Pregnant Woman All Adults Gender Groups Females Males Age Groups Ethnic Groups White Hispanic African American Other HH Income Groups DK/Refused $10,999 or less $11,000-$25, $26,000-$75, $76,000 or more

55 Catch All Adults Gender Groups Females Males Age Groups Ethnic Groups White Hispanic African American Other HH Income Groups DK/Refused $10,999 or less $11,000-$25, $26,000-$75, $76,000 or more Buckle Up All Adults Gender Groups Females Males Age Groups Ethnic Groups White Hispanic African American Other HH Income Groups DK/Refused $10,999 or less $11,000-$25, $26,000-$75, $76,000 or more Overall, none of the measures of confirmation for any of the television advertisements suggest that the advertisements were seen by many people in the State. Between only 2% and 6% of the adult population could confirm awareness using the descriptive criteria on three of the

56 advertisements: Working Man, Pregnant Woman, and Catch. The best performing advertisement using event confirmation was Buckle Up (12%). The results employing the message or theme criteria, although slightly lower, were not markedly different. Over 9% of adults confirmed on theme for Buckle Up, but on each of the other three advertisements the level of theme confirmed awareness was only about 3%. Using the most liberal or inclusive criteria of having to confirm on either event or theme does increase the percent of adults demonstrating some proof of having seen advertisements, but these numbers are still troublingly low ranging from 4% to 7% for Working Man, Pregnant Woman, and Catch and then to 14% for Buckle Up. The highest standard of confirmation is obtained when an individual can confirm on both the event and theme criteria; and for these four advertisements people achieving this equaled only 7% for Buckle Up, while for the other three advertisements it was only about 1-2%. In short, the data for television reach strongly and consistently indicate that the reach was very weak at best. Within the context of these low levels of reach, it is noteworthy to observe that even though the levels of reach are low for three of the four advertisements (all save pregnant woman) theme confirmation is even lower than event confirmation suggesting that the major messages of the advertisements are not being effectively communicated. Table 2.2 also contains data for each of the measures of confirmation depicting differences in penetration for each of the advertisements. We must emphasize, however, that the extremely low levels of reach for each of the advertisements mitigates against assigning either practical or statistical significance to differences in penetration. That is, when so few people can confirm awareness of the advertisements splitting them among the categories of each of the penetration variables considered results in even smaller cell size numbers bringing about very unstable estimates of the differences. Similarly, the small numbers result in very small absolute differences being very large relative differences. For example, for Working Man, there is only an absolute difference of 2.7 percentage points between the percent of females confirming on event (3.6%) and the percent of males (5.3%), but because these figures are so low this results in a 75% difference. Even for the advertisement with the highest level of reach (Buckle Up) these problems persist, but to a somewhat lower degree. Table 2.3 shows the self-report data, as well as the confirmed awareness data, depicting the levels of reach and penetration of the two radio advertisements included in the adult survey.

57 Table 2.3. Percent of Adults Self Reporting Having Heard Two Radio Advertisements and Percent of Adults Confirming Awareness of Radio Advertisements By Gender, Age, Ethnicity and Income Self Reported Confirmed Awareness Radio Yes/ Event Theme Event or Event and Advertisement Maybe Theme Theme Noise All Adults Gender Groups Females Males Age Groups > Ethnic Groups White Hispanic African Amer Other HH Income Groups Dk/NA <11, ,000 25, ,000 75, ,000 > Pregnancy Myths All Adults Gender Groups Females Males Age Groups > Ethnic Groups White Hispanic African Amer Other Income Groups Dk/NA <11, ,000 25,

58 26,000 75, ,000 > From the first column of data, we see the self-reported data for reach for each of the radio advertisements, with just 7% for Noise and 12% for Pregnancy Myths. Given this, it is not surprising to find that the confirmed awareness levels for reach are very low. For Noise, none of the confirmed awareness metrics even reach 1%, and although better for Pregnancy Myths, none reach 6%. This again, leads to the problem where the numbers for reach are too low to allow us to assess penetration, but it is interesting to note that Pregnancy Myths theme confirmation exceeds event confirmation not only for reach, but also for penetration. When we look at penetration employing the theme criteria we see that there are no gender differences, and that among age groups, the highest levels of penetration are in one of the categories where this advertisement could be more appropriate (25 44), but on the one hand, they also are lowest among the youngest adults (18 24) where their importance is obviously the greatest. Similarly, there are some relatively sharp ethnic differentials on theme confirmation with Hispanics and African Americans reaching higher levels than the other identified groups. We need to caution, however, that all of these differences are based on very small numbers, and the fact that theme confirmation exceeds event confirmation may suggest that people were better able to guess at acceptable answers. In short, there is little, if any evidence in these data to conclusively suggest that the radio advertisements tested were effective in reaching and communicating campaign messages to adults. In addition to employing television and radio as means to getting and communicating campaign messages to adults, a number of other communication modes have been used. These include the distribution of various pieces of paraphernalia at anti-tobacco events and activities, a billboard, an anti-tobacco website, and the websites of some university and professional athletic teams in the State. For advertising related to each of these communication modes, we collected data to assess the reach and penetration; these are presented in Table 2.4. This Table is structured like the preceding ones for television and radio showing the self-report data in the first column with succeeding columns showing the various measures of confirmation. The first row of data under each media mode shows the reach while successive rows under each mode show the penetration.

59 Table 2.4. Percent of Adults Self Reporting and Confirming Awareness of Three Media Modes For the Total Adult Population and By Gender and Age, Ethnicity and Household Income Self Report Confirmed Awareness Media Yes/ Event Theme Event or Event and Items Maybe Theme Theme Beach Ball All Adults Gender Groups Females Males Age Groups > Ethnic Groups White Hispanic African Amer Other Income Groups DK/NA <11, ,000 25, ,000 75, ,000> Wrist Band All Adults Gender Groups Females Males Age Groups > Ethnic Groups White Hispanic African Amer Other Income Groups DK/NA <11, ,000 25,

60 26,000 75, ,000> Billboard All Adults Gender Groups Females Males Age Groups > Ethnic Groups White Hispanic African Amer Other Income Groups DK/NA <11, ,000 25, ,000 75, ,000> Tobacco Website All Adults Gender Groups Females Males Age Groups > Ethnic Groups White Hispanic African Amer Other Income Groups DK/NA <11, ,000 25, ,000 75, ,000>

61 Ever Event College Athletic Website Visited Confirmed All Adults Gender Groups Females Male Age Groups > Ethnic Groups White Hispanic African Amer Other Income Groups DK/NA <11, ,000 25, ,000 75, ,000> Pro Athletic Website All Adults Gender Groups Females Males Age Groups > Ethnic Groups White Hispanic African American Other Income Groups DK/NA <11, ,000 25, ,000 75, ,000> Two items of paraphernalia (the beach ball and the wrist band) were included in the survey.

62 These items were selected because the data that we had available indicated they were the most widely distributed at the time of the survey. Of the two items the wrist band was self-reported as having been seen by about three times as many people as the beach ball (13% vs. 4%). While this difference is substantial and statistically significant (X 2 = , p =.001), when it comes to making use of the confirmation data, we are again confronted with the problem that the numbers confirming awareness of both of the items of paraphernalia are too small to prove useful. For beach ball, none of the confirmation measures assessing reach attain a level of one-half of 1%. For wrist band, the event and theme confirmation measure attains a level of only 1.5% and the other three measures of confirmation are below this. With these extremely low levels of reach, no definitive observations can be made about differences in the effectiveness of these means of communication in penetrating population subgroups. The next panel of data, in Table 2.4, shows the self-report and confirmation measures for the billboard on display during the campaign. On the positive side, over 45% of adults self-reported having recently seen an anti-tobacco billboard. While this number is encouraging, all of the confirmation measures suggest a markedly lower level of people could offer proof of having seen the campaign s billboard. Event confirmation reached a level of only 2% for the billboard, but theme confirmation was at nearly 6% and event or theme confirmation at nearly 7%. However, event and theme confirmation was at only one-tenth of 1%. While the reach of the billboard was low, it may be worth noting that they are comparable or better than those for the individual television and radio advertisements. For example, the billboard had a higher level of reach on all four measures of confirmation than either of the radio advertisements and for both theme and event. Theme confirmation also was greater than that achieved by each of the television advertisements, except for Buckle Up. All of these differences are statistically significant save that for event and theme confirmation comparing Catch and the billboard, but it is important to bear in mind that the levels of reach for all are low. When we consider the penetration of the billboard, it is obvious that even in light of the absolute low overall reach, there are some relatively substantial differences in the extent to which the billboard was effective across sub populations. Again, however, the problem is that the very low levels of reach produce such small numbers that the significance of these cannot be substantively accessed. As noted above, we also collected data to assess the use of three different websites for

63 disseminating anti-tobacco campaign messages. The data in the fourth panel of Table 2.4 are for the principal campaign website: Tobacco Free Florida.com. It is important to note that the name for this website has been an integral part of both the logo and tag line for the media campaign. In nearly all video, audio, and signage messaging the TobaccoFreeFlorida.com symbol has appeared, and in this sense, it may well be the single best measure of the extent to which the population has responded to the campaign s major message, Tobacco Free Florida. The self-report measure is based on the item that asked, Are you aware of any anti-tobacco or anti-smoking website specifically for Florida residents? Only 8% of the sample responded yes or maybe to this item, as reported in the table. It is noteworthy, however, that when asked in the immediate next question of those who did respond yes/maybe if they had ever visited the website, only 31 persons or 1% of the sample said yes. As one would expect from these data, the level of reach assessed by the more valid confirmation measures is extremely low only reaching one-half of 1% for the most liberal confirmation measure (event or theme). The two remaining websites considered here are university and professional athletic team sites. These websites had a campaign message imbedded within them. For each website, three questions were asked. The first asked if a responded had ever visited a college (or professional) team website, the second if they had ever seen an anti-tobacco or anti-smoking message on the website, and for confirmation purposes people who responded yes or maybe to the latter were asked to describe the message. Over 22% of respondents reported having visited or thought they might have visited a college athletic website, and over 21% said the same for a professional team athletic website. When persons responding in this manner were asked if they had seen any anti-tobacco or anti-smoking messages on the website, however, the numbers drop off dramatically, undoubtedly reflecting where the messages were placed within the websites. For college athletic websites only 3% of people reported having seen an anti-tobacco/anti-smoking message on the website and for professional teams this figure was only 4%. When evaluated using the confirmation criteria of describing the advertisement we saw the reach of these websites drop below one-half of 1%. Next, in Table 2.5 we present data on respondent receptivity of the television and radio advertisements. It is particularly important to emphasize that the numbers presented in this table are based on the respondents meeting the event or theme criteria of confirmation. That is, all respondents had to do to be included in the calculations for this table was to confirm on either event or theme, not both. As explained earlier, this is the most inclusive of the confirmed

64 awareness measures, it is not the measure giving us the greatest level of confidence that respondents actually did and can recall the advertisement inquired about. We were forced to use this measure in an effort to maximize the number of cases because the level of reach for individual advertisements was so low. The number of cases yielded for each advertisement using this measure is reported in the last row of the columns identifying individual advertisements. These varied from just 12 to 313, and these numbers are to low to provide us with valid and reliable estimates of the various dimensions of receptivity. Thus, the reader electing to study these data should do so with extreme caution. Table 2.5. Receptivity of Television and Radio Advertisements by Respondents Confirming Awareness of Advertisements. Television Advertisements Radio Advertisements Receptivity Working Pregnant Pregnancy Item Man Woman Catch Buckle up Myth Noise (N=93) (N=52) (N= 142) (N= 313) (N=124) (N=12) Want to see again Agree Disagree Hold attention Agree Disagree Appear as positive Positive Negative Importance of message Important Unimportant Learn something new Agree Disagree Think of in future Likely Unlikely Talk to Friends Yes No

65 Summary and Conclusion Several conclusions can be drawn. When we examine the self-reported items, the data suggest that the reach of the television advertisements can be characterized as low. However, we see a relatively high level of consistency from one advertisement to the next, and we also see that the earlier run advertisements did just as well, if not better, than the advertisements run prior to the survey. To note, according to the 2008 media flight schedule, the television advertisements, Catch and Buckle Up, were aired more often than the 2009 television advertisements (Working Man and Mirror); we believe this to be a contributing factor affecting advertising awareness. Additionally, none of the measures of confirmation for any of the television advertisements suggest that the advertisements were seen by many people in the State. The best performing advertisement using event confirmation was Buckle Up (12%). Over 9% of adults confirmed on theme for Buckle Up, but on each of the other three advertisements the level of theme confirmed awareness was only about 3%. In short, the data for television reach strongly and consistently indicate that the reach was very weak at best. Further, theme confirmation is even lower than event confirmation suggesting that the major messages of the advertisements are not being effectively communicated. While we see differences in penetration for each of the advertisements, because of the low levels of reach for each of the advertisements, we are unable to assign practical or statistical significance to differences in penetration. When we examined the self-report data for the radio advertisements, as well as the confirmed awareness data for the adult survey, we see the self-reported data for reach for each of the radio advertisements was low. Hence, it is not surprising to find that the confirmed awareness levels for reach are very low. For Noise, none of the confirmed awareness metrics even reach 1%, and although better for Pregnancy Myths, none reach 6%. This again, leads to the problem where the numbers for reach are too low to allow us to assess penetration. An examination of the two main promotional items for adults, the wristband and beach ball, show wristband was self-reported as having been seen by about three times as many people as the beach ball (13% vs. 4%). While the difference is substantial and statistically significant, when it comes to making use of the confirmation data, we are again confronted with the problem that the numbers confirming awareness of both of the items of paraphernalia are too small to prove useful. With the extremely low levels of reach, no definitive observations can be made about differences in the effectiveness of these means of communication in penetrating

66 population subgroups. When we examine billboard, over 45% of adults self-reported having recently seen an anti-tobacco billboard. While this number is encouraging, all of the confirmation measures suggest a markedly lower level of people could offer proof of having seen the campaign s billboard (event confirmation equaled 2% for billboard and theme was almost 6%). While the reach of the billboard was low, it may be worth noting that they are comparable or better than those for the individual television and radio advertisements. However, because of the small numbers, the significance of any differences in penetration of the billboard cannot be substantively accessed. As noted above, we also collected data to assess the use of three different websites for disseminating anti-tobacco campaign messages. The principal campaign website is TobaccoFreeFlorida.com. It is important to note that the name for this website has been an integral part of both the logo and tag line for the media campaign. It may be the single best measure of the extent to which the population has responded to the campaign s major message. However, only 8% of respondents self-reported knowing TobaccoFreeFlorida.com and only 1% visited the website. As one would expect from these data, the level of reach assessed by the more valid confirmation measures was extremely low. For the two remaining websites, while a number of respondents have visited the university and professional athletic team sites, only 3% of people reported having seen an anti-tobacco/anti-smoking message on the college athletic website and for professional teams this figure was only 4%. When evaluated using the confirmation criteria of describing the advertisement, we saw the reach of these websites drop below one-half of 1%. Finally, for respondent receptivity to the advertising campaign, the numbers are too low to provide us with valid and reliable estimates of the various dimensions of receptivity. Chapter 3 CAMPAIGN AWARENESS AND CONFIRMED AWARENESS While it is important and useful to have data that allows an assessment of the reach and penetration of the individual components of a media campaign, it is, in many respects, equally, if not more important, to have data that provide the basis for an assessment of the reach and penetration of the broader or more generalized media campaign. There are basically three approaches to obtaining data and developing measures of overall awareness of an antismoking/anti-tobacco campaign. One of these is merely to ask respondents if they are aware of

67 such a campaign. The principal advantage of this approach is its simplicity. However, its primary disadvantages are that it assumes individuals understand the meaning of campaign in a public health context, and it does not allow us to place confidence in a positive reply as being one referring to the specific campaign we are concerned with. There may, and are likely to be, multiple anti-tobacco/anti-smoking campaigns cluttering the airways, such as American Legacy advertisements and advertisements from pharmaceutical companies, as well as public health oriented campaigns targeting other risky behaviors such as alcohol, drug, and diet practices. A second approach is to collect corroborating data that allows individuals to confirm their positive reply to the general/self-reported awareness item. The corroborating data is to ask the respondent to describe the characteristics of the campaign (event confirmation) or identify a major message or theme (theme confirmation) of the campaign. We then can develop measures of confirmed awareness that parallel those employed for the individual advertisements analyzed in the previous Chapter. These measures also can provide greater validity as we move from event confirmation to theme confirmation and on to event or theme and event and theme confirmation. To account for competing public health campaigns, we ask respondents the set of questions (both self-reported and corroborating items) three times or until they indicate they are aware of no other anti-tobacco/anti-smoking campaigns. This procedure has also been employed in previous surveys and is employed here. A third approach measures campaign awareness indirectly. This approach uses the data collected in the previous chapter on advertisement confirmed awareness. It assumes that each person who had some confirmed contact with the campaign visa-via exposure to at least one of the media modes had campaign awareness. The measure is calculated by aggregating all persons who confirmed on at least one television advertisement, then from the remaining pool we take all persons who confirmed on at least one radio advertisement, then we take all persons who confirmed on any of the promotional items, and so forth. This process also is repeated for the billboard and websites. This procedure ensures that each person is only counted once, but it is worth noting that it is possible for some individuals to have confirmed on more than one mode. There are two central issues surrounding the use of this procedure. First, and perhaps most importantly, this measure does not capture the extent to which people realize that there is a broad, multi-pronged effort underway to affect tobacco use and its consequences. Rather, what

68 it actually measures is the exposure of the population to at least one component of the antitobacco/anti-smoking campaign. Thus, the measure derived from this procedure might be more accurately described as a generalized measure of campaign exposure than as a measure of campaign awareness. A second issue revolves around the question of what standard of confirmed awareness is employed. We have elected, in this instance, to use the event or theme criteria. The major reason for this is because the numbers are so small that we wanted to maximize the potential number of respondents. Using the more stringent measure of event and theme would give us fewer than 5% of the sample having demonstrated exposure to the campaign. As long as it is realized that we are using the most lenient of criteria, and that it is exposure we are measuring, we feel that this criteria is acceptable. The data in Table 3.1 are for the direct measure of campaign awareness. The first column of the Table shows the self-reported level of campaign awareness and the remaining columns show confirmed campaign awareness for each of the four measures of confirmation. Thus, the first row of data in the Table shows the campaign s reach as assessed by each measure. Nearly 41% of the total sample indicated they were aware of an anti-tobacco/anti-smoking campaign occurring at the time of the survey. However, responses to the event criteria indicated that only about 25% of respondents were aware of the State s anti-tobacco/antismoking campaign. Particularly, disturbing is that the percent declined to only just over 3% when the theme criteria was applied, and to only 2% when the event and theme criteria was adopted. By any standard these levels of reach for theme and event are extremely low if the focus is placed on the importance of the campaign s messages. The remaining panels in the Table show quite clearly that there are some significant differences in the sub-population penetration of the campaign when we consider gender, age, ethnicity, and income groups. The data for each of the confirmation measures consistently show that there is greater awareness of the campaign among males than females. For example, while over 27% of males confirmed event for the campaign, less than 23% of females did (X 2 = 5.58, p =.025). Although the percent theme confirmation declines substantially for both males and females, the number for males (5%) is more than double the number achieved by females (2%) (X 2 = 13.98, p =.001). When event and theme confirmation figures for males (3%) and females (0.7%) are compared, the relative difference is even larger and significant (X 2 = 19.12, p =.001).

69 Table 3.1. Percent of All Adults and Gender, Age, Ethnicity and Income Groups Self Reporting And Confirming Awareness on a Direct Question Asking About Awareness of an Antitobacco/Anti-smoking Campaign in Florida Self Report Confirmed Awareness Campaign Yes/ Event Theme Event or Event and Awareness Maybe Theme Theme Direct Question All Adults Gender Groups Females Males Age Groups > Ethnic Groups White Hispanic African Am Other Income Groups DK/NA <11, ,000 25, ,000 75, ,000> There are similarly substantial differences among age groups, but it is interesting to note how these vary by measure. For instance, when we look at event confirmation, persons have the highest level of confirmation (27%) and persons at the young adult ages and the oldest age group have the lowest (about 21%) (X 2 = 9.66, p =.005). Theme confirmation, on the other hand, shows a different pattern; it is highest for young adults (8%) and lowest for oldest ages (3%) (X 2 = 6.05, p =.025). While these differences are statistically significant, we would emphasize that practically they are markedly less important than the low rates of confirmed campaign awareness they are based on. Ethnic and income differences also exist in confirmed campaign awareness. Event confirmation of campaign awareness is highest among Whites (28%) and lowest among African

70 Americans (16%) (X 2 = 20.71, p =.001). Hispanics have an event confirmation rate for campaign awareness (23%) that is intermediate between that of Whites and African Americans, and this rate is significantly lower than the rate for Whites (X 2 = 5.81, p =..025) and significantly higher than that for African Americans (X 2 = 5.07, p =.025). The theme confirmation declines markedly for each ethnic group, but the pattern for the level of confirmation remains the same; highest for Whites (4%), intermediate among Hispanics (3%) and lowest for African Americans (1%). Although the small difference here between Whites and Hispanics are not significant, the rate for African Americans is significantly lower (X 2 = 4.77, p =.05) than that for both Whites and Hispanics. Again, while the ethnic differences are notable, it is important to bear in mind that the overall levels of confirmation are low. Income group differences are interesting. Basically, they show that event confirmation of the campaign is directly associated with income, as income increases the level of confirmation increases. However, for theme confirmation the association is U shaped with persons at the lowest and highest levels of income having the highest levels of confirmation and those at the intermediate levels of income having the lowest. Less than 19% of persons in households with less than $11,000 confirmed event for the campaign, compared to nearly 29% of persons in households earning $76,000 or more (X 2 = 12.46, p =.001), or 26% of persons in households earning between $26,000 and $75,999 a year (X 2 = 7.36, p =.005). For theme confirmation, persons at the lowest level of household income had a confirmation rate of 6% compared to 1% for persons in household with incomes between $11,000 and $25,999 (X 2 = 10.92, p =.001). At the other end of the household income distribution, individuals in households earning more than $76,000 a year had a 5% rate of confirmation compared to a 2% rate of confirmation for persons in households earning between $26,000 and $75,999 annually (X 2 = 10.53, p =.001). Again, while these differences are significant, they pale in comparison to the overall low rates of confirmation for all household income subpopulations when it comes to confirming on the theme of the campaign. Finally, the data in Table 3.5 show the reach and penetration of the campaign measure using the indirect methodology. As noted above, it is important that this measure is appropriately viewed as either a measure of campaign confirmed awareness or as a composite measure of exposure to the media campaign. This latter view is grounded in the fact that the measures reported in the table are derived from confirmation data on the individual components of the media campaign. It also is important to note that we have elected for practical reasons to use

71 the most liberal measure (event or theme) of confirmation for each of the components, and that the analysis of each component clearly shows that this measure is largely driven by respondents abilities to confirm on the basis of description, not message or theme. Finally, although we show data for the addition of each individual component of the media campaign, the summary measure depicting the level of confirmed campaign awareness (exposure) is the one in the extreme right hand column, which includes all of the components. In this sense, it is important to realize that the order in which components are entered has an influence on their implied contribution (the value added as each component is included). Thus, for example, the final column includes not just persons who confirmed television, but also persons who confirmed television and any other component. Because we want each individual to only be considered once, the value added by successive components represents the number of people uniquely added by the component at that step and not the total of all persons who might have confirmed on the component. However, because the numbers confirming on each component are so low the value added undoubtedly also reflects this rather well. With these caveats in mind, we can see from the last column of the Table that the estimated reach of the campaign using the indirect procedure (32%) is somewhat higher than the estimate obtained (26% for event or theme) using the direct procedure (X 2 = 18.64, p =.001). One likely interpretation of this is that some people did not have enough exposure or exposure to only one component and did not realize from the limited exposure that it was part of a broader and greater effort. It also is readily apparent that some components added remarkable little to the population s exposure to the campaign. For example, the difference between television and radio and television, radio and promotional items is only 0.7% (28% - 27%). Similarly, the difference between television, radio, promotional items, and billboard versus television, radio, promotional items, billboard, and websites is 0.2% (32% - 32%) implying that promotional items and the websites did little to add to campaign awareness. Radio and the billboard, on the other hand, each added nearly 4%. The latter is particularly impressive given that it was the fourth component entered.

72 Table 3.2. Percent of All Adults and Adults by Gender, Age, Ethnic, and Income Groups Having Campaign Awareness Measured By Combinations of Confirmed Awareness for Alternative Media Modes Campaign Awareness Television Television, Radio, Television, Radio, Television, Radio, Measured by Combined Television and and Promotion Items Promotion Items Media Modes Radio Promotion Items and Billboard Billboard & Websites All Adults Gender Groups Females Males Age Group > Ethnic Groups White Hispanic African Am Other Income Groups DK/NA <11, ,000 25, ,000 75, ,000> Again, focusing on the last column of Table 3.2 we can see that there are some substantial subpopulation differences in the penetration of the campaign. Penetration is clearly inversely related to age. Young adults had nearly a 44% awareness of the campaign compared to persons in the oldest ages who had only a 24% awareness of the campaign (X 2 = 19.95, p =.001). Similarly, compared to persons at the oldest ages, persons had a 39% level of confirmed awareness (X 2 = 24.81, p =.001), and persons a 33% level of awareness (X 2 = 14.08, p =.001). The differences between persons and is also significant (X 2 = 4.45, p =.05). As a general rule, large subpopulation differences are viewed negatively because they indicate that segments of the population are not being reached. In this case, however, the differences noted suggest that the most crucial subpopulation (the youngest adults) are being reached at a differentially higher rate and this is a positive dimension. At the same time, particularly given the cessation emphasis of the adult campaign, the data show a need to improve penetration for the two middle age groups.

73 The campaign has clearly penetrated ethnic groups differentially, even though there is no significant difference in penetration when we compare Whites and Hispanics (32% and 35%, respectively). The African American population had only a 26% rate of campaign awareness employing the indirect procedure and this rate is significantly lower than that reached by either the White population (X 2 = 4.70, p =.05) or the Hispanic population (X 2 = 6.78, p =.01). Finally, it is important to note that there are no significant differences in the extent to which the campaign has penetrated income groups. CHAPTER 4 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS When we directly measured campaign awareness, a large number of adults reported they were aware of the anti-tobacco campaign in Florida (about 41%); however, when we examined confirmed awareness of the campaign, about 25% of respondents were aware of the State s anti-tobacco/anti-smoking campaign (event) and only just over 3% when the theme criteria was applied, and less when the event and theme criteria was applied. By any standard, these levels of reach for theme and event are extremely low if the focus is placed on the importance of the campaign s messages. Further, while there were differences among the sub-populations for gender, age, ethnicity, and income, it is important to keep in mind that the overall levels of confirmation were low. When we examined the reach and penetration of the campaign using the indirect methodology, which is a summary measure, we found that this measure is largely driven by respondents abilities to confirm on the basis of description, not message or theme. Because the numbers confirming each component of the campaign are so low, the value added measure also reflects this. The estimated reach of the campaign using the indirect procedure (32%) is somewhat higher than the estimate obtained using the direct method (26% for event or theme). One likely interpretation of this is that some people did not have enough exposure to the campaign or were exposed to only one component and did not realize from the limited exposure that it was part of a broader and greater effort. The overall reach and the penetration analysis for each of the media components for adults was low. To increase the reach and penetration, we believe that as a part of the process evaluation, there should be an examination of the advertisements. The process evaluation should focus on advertisement placement where the ads have been run, when they have been run, as well as

74 how often. A main point in the success of any media campaign is for people to be exposed to the various components of the campaign, in particular the television advertisements, in order to be influenced by the media.

75 Evaluation of the Florida Quitline and Cessation Media Efforts 219 Main Street SE, Suite 302 Tele: Minneapolis, MN Fax:

76 Today s Presentation Overview and Selected Findings Quitline Evaluation Media Evaluation Demonstrate Online Query & Report System 2

77 Evaluation Design Evaluation of Quitline Monthly & Yearly Reporting to DOH Evaluation of Quitline Media Caller Intake Data 7-mo follow-up RDD Media Study Focus Groups Earned media Describes Number of Callers Callers demographic & clinical characteristics Quit rates & what predicts them Online Query System Provides Quitline caller data Customizable tables and charts by demographic, geographic and clinical characteristics Media Buys & Call Volume Internet media Describes Intensity & reach Receptivity Impact of media on awareness, attitudes and use of the quitline Focus on ages

78 Quitline Evaluation 4

79 Quitline Evaluation Purpose: Monitor the implementation of the Quitline Identify strengths and weaknesses Assess the effectiveness of the Quitline in helping Floridians quit tobacco. The Quitline Evaluation includes two sub-studies: Study 1: Analysis of Quitline callers Study 2: 7-month follow-up of Quitline callers 5

80 Quitline Evaluation Data For Study 1: Quitline caller data: counts and characteristics Quitline launched December 2001 For Study 1:NRT data For Study 1: Utilization data (number, duration, type of calls) For Study 2: follow-up data NRT launched December

81 Study 1: Analysis of Quitline Callers Reports the number of Floridians who are calling the Quitline, and describes their characteristics Compares callers to the population of Florida tobacco users to identify and over- or under-represented groups Examines the ways in which callers make use of available Quitline services, including telephone counseling and nicotine replacement therapy (NRT) 7

82 Study 1: Quitline Callers Preliminary Results August 31, 2009 Final Results Submitted October 15,

83 How many callers have used the Quitline? over 81,000 50,000 40,000 30,000 20,000 10, ,168 2,033 3,656 4,874 4,103 FY 02 FY 03 FY 04 FY 05 FY 06 FY 07 40,504 FY 08 22,520 FY 09 Registered callers 9

84 Call volume fluctuates over the year Possible influences: media, availability of NRT, tax increase, seasonal effects New Registrants by Month: FY ,252 1,487 1,622 1,680 1,366 1,830 5,735 1, ,275 1,469 1,600 Jul 08 Aug 08 Sep 08 Oct 08 Nov 08 Dec 08 Jan 09 Feb 09 Mar 09 Apr 09 May 09 Jun 09 Registered Callers 10

85 High call volume may reduce quality of service more investigation needed Disposition of Incoming Call by Month 14,000 12,000 10,000 Answered calls Calls ro lle d to v o ice m ail Abandoned calls 8,000 6,000 NRT program suspended 4,000 2,000 0 Jul Aug Sep Oct Nov De c Jan Fe b Mar Apr May Jun

86 Call volume fluctuates over the year Possible influences: media, availability of NRT, tax increase, seasonal effects New Registrants by Month: FY ,252 1,487 1,622 1,680 1,366 1,830 Jul 08 Aug 08 Sep 08 Oct 08 Nov 08 Broadcast cessation media campaign Dec 08 5,735 Jan 09 1,375 Feb Mar 09 1,275 1,469 1,600 Apr 09 May 09 Jun 09 Registered Callers 12

87 Call volume fluctuates over the year Possible influences: media, availability of NRT, tax increase, seasonal effects New Registrants by Month: FY ,252 1,487 1,622 1,680 1,366 1,830 Jul 08 Aug 08 Sep 08 Oct 08 Nov 08 Dec 08 NRT program suspended 5,735 Jan 09 1,375 Feb Mar 09 1,275 1,469 1,600 Apr 09 May 09 Jun 09 Registered Callers 13

88 Call volume fluctuates over the year Possible influences: media, availability of NRT, tax increase, seasonal effects New Registrants by Month: FY ,252 1,487 1,622 1,680 1,366 1,830 Jul 08 Aug 08 Sep 08 Oct 08 Nov 08 NRT automated voice message Dec 08 5,735 Jan 09 1,375 Feb Mar 09 1,275 1,469 1,600 Apr 09 May 09 Jun 09 Registered Callers 14

89 Call volume fluctuates over the year Possible influences: media, availability of NRT, tax increase, seasonal effects New Registrants by Month: FY ,252 1,487 1,622 1,680 1,366 1,830 Jul 08 Aug 08 Sep 08 Oct 08 Nov 08 Dec 08 Federal tobacco tax increase 5,735 Jan 09 1,375 Feb Mar 09 1,275 1,469 1,600 Apr 09 May 09 Jun 09 Registered Callers 15

90 Who uses the Quitline? Study compares characteristics of Quitline callers to those of the population of adult tobacco users in Florida to identify and over- or under-represented groups Adult tobacco users calling Quitline FY09: 20,304 All adult tobacco users in Florida 2008: 3,059,733 Source: American Cancer Society (ACS) caller intake data Source: Behavioral Risk Factor Surveillance System (BRFSS) survey data 16

91 Age Tobacco users in younger age groups are well-represented among Quitline callers Tobacco users in older age groups are under-represented 100% 80% 60% 40% 20% 0% Age category: Quitline vs. All Tobacco Users Q u itlin e F Y0 9 All Tobacco Users 22% 26% 23% 21% 21% 21% 12% 11% 10% 16% 13% 5%

92 Gender Although males have a higher smoking prevalence than females, the Quitline serves fewer males than females 100% 80% 60% Gender: Quitline vs. All Tobacco Users Quitline FY09 All Tobacco Users 58.2% 58.8% 40% 41.8% 41.2% 20% 0% Male Female 18

93 Education A strength of the FL Quitline is its success in reaching tobacco users with less education Smoking prevalence is higher among adults who have lower education levels and lower among college graduates 100% 80% 60% 40% 20% 0% Education level: Quitline vs. All Tobacco Users 15% 14% Less than high school 33% 30% High school grad or GED 36% 34% Some college/trade school Quitline FY09 All Tobacco Users 22% 16% College graduate 19

94 Hispanic or Latino Ethnicity Hispanic and Latino tobacco users are slightly underrepresented among Quitline callers, although the gap has narrowed over the past two years. Percent 100% 80% 60% 40% 20% 0% Ethnicity: Quitline vs. All Tobacco Users Quitline FY09 All To ba c c o 12.5% 14.3% Hispanic / Latino Callers ethnicity varies considerably by month, with spikes occurring in the spring of % 80% 60% 40% 20% 0% % Callers who identify as Hispanic/Latino by month: FY09 11% 12% 11% 13% 11% 11% 11% 14% 24% 19% 15% 12% Jul 08 Hispanic/Latino Callers Aug 08 Sep 08 Oct 08 Nov 08 Dec 08 Jan 09 Feb 09 Mar 09 Apr 09 May 09 Jun 0920

95 Pregnancy The proportion of pregnant callers among women increased from FY08 to FY 09. % of female callers age who are currently pregnant Quitline FY % Quitline FY % * Comparison to BRFSS not available due to sampling issues All tobacco users NA * The proportion of women who are pregnant varies considerably by month; potential influences include NRT availability and media campaigns 20% 15% 10% 5% 0% % Female Callers age who are currently pregnant by month 3% 4% 4% 4% Jul 08 Aug 08 Pregnant Callers Sep 08 Oct 08 5% 6% 6% Nov 08 Dec 08 Jan 09 11% Feb 09 6% 7% Mar 09 Apr 09 5% May 09 2% Jun 09 21

96 Health Insurance The Quitline is successfully serving uninsured tobacco users. Uninsured Commercially insured Medicaid (alone or with Medicare) Medicare only Quitline FY % 44.4% 12.1% 7.9% 22

97 How do callers make use of available Quitline services? Nearly all callers are tobacco users Unknown/ not collected 4% Other 2% Fam ily / friend 2% Tobacco User 92% CDC Best Practices benchmark: When NRT is provided and made easily available to quitline callers, 75% of callers will accept telephone cessation counseling services The Quitline exceeds this target. Service requested (among tobacco users only): Counseling: 92% Self help: 6% Information: 1% Not collected 1% 23

98 How do callers make use of available Quitline services? Nearly all callers are tobacco users Unknown/ not collected 4% Other 2% Fam ily / friend 2% Tobacco User 92% CDC Best Practices benchmark: When NRT is provided and made easily available to quitline callers, 75% of callers will accept telephone cessation counseling services The Quitline exceeds this target. Service requested (among tobacco users only): Counseling: 92% Self help: 6% Information: 1% Not collected 1% 24

99 When NRT is not available, fewer callers enroll in counseling* Quitline Service Requested by Month 100% 80% 60% 40% 20% 0% Jul 08 Aug 08 Sep 08 Oct 08 Nov 08 Dec 08 Jan 09 Feb 09 Mar 09 Apr 09 May 09 Jun 09 Counseling Self-help Inform ation Not colle cted-intake incom plete * NRT program suspended Jan 28 - Apr 15, 2009 due to funding shortages 25

100 Nicotine Replacement Therapy In FY09, 11,544 callers received NRT Most NRT recipients (97%) use only 1 type of NRT Patch is the type most commonly selected Type N % Patch 8, Gum 1, Lozenge 1, Callers could receive more than one type; percents add to more than100. Most callers receive a 4-week supply of NRT (likely due to income guidelines and dropout) Amount N % < 4 weeks % 5-8 weeks % > 8 weeks 554 5% 26

101 Who does / does not obtain NRT from the Quitline? Potential barriers to using cessation medications: cost, accessibility, medical contraindications, cultural issues, side effects, and lack of knowledge about the benefits of such medications Analyses compare NRT access among demographic groups Important considerations: Analyses are based on new callers in FY09 who received NRT (N=7,609) Callers may obtain NRT or other medications (Chantix, Zyban) from other sources Due to data limitations we cannot determine which callers were ineligible for NRT (due to insurance or medical screen) 27

102 Differences by demographic groups Overall, 38% of new callers in FY09 obtained NRT from the Quitline Certain demographic groups have greater or lesser use of Quitline-provided NRT Gender: a greater percentage of males (41%) receive Quitline NRT than females (36%) Race and ethnicity: More white callers receive Quitline NRT (40%) than Hispanic callers (36%) or African American (33.5%) callers 28

103 Differences by age, education level A greater percentage of callers ages obtain NRT Fewer callers in younger and older age groups do so A greater percentage of callers with post-secondary education obtain NRT Fewer callers with less education do so Age Group % receiving NRT Education level % receiving NRT Less than high school H.S. graduate Some college/trade school College graduate

104 Differences by health insurance Medicaid referral mechanism is in force Callers with Medicaid referred to obtain NRT via Medicaid benefits. Medicaid callers can return to the Quitline to obtain NRT should they have difficulty using Medicaid benefits. The effect of this policy can be seen: Insurance Type Uninsured Commercially Insured Medicaid (or Medicaid + Medicare) Medicare only % receiving NRT 42% 41% 15% 28% 30

105 Study 2: 7-Month Follow-Up Methodology Subjects Eligible participants are tobacco-using adults who consent to participate in the evaluation during the study window and have requested counseling services. Design Observational, pre-post telephone survey at baseline & 7 months Rolling design, N=75 completes per month Participants randomly sampled from eligible callers Up to 15 attempts are made to reach each contact Prenotification letters are sent, half with a $2 incentive enclosed, half with a $10 incentive promised upon completion Follow-up collected by Kerr & Downs Research, Tallahassee Conducted according to the guidelines of the North American Quitline Consortium 31

106 Study 2: 7-Month Follow-Up Caller Outcomes Quit rates Callers use of stop-smoking medications Caller satisfaction with Quitline services. Caller outcomes are compared among demographic and clinical groups, and the study will explore what predicts cessation (caller characteristics, program use, medication use, etc.) 32

107 Study 2: 7-Month Follow-Up Preliminary Results August 31, 2009 Final Results Submitted October 15,

108 Study 2: 7-Month Follow-Up Methodology (cont.) Response rate Survey achieved a 42.8% response rate (449 completions out of 1,050 consenting enrollees) Previous vendor response rate = 18.7% (2,376/12,678) 100% 90% 80% 7-month Follow-up Survey Response Rates by Vendor Implications Higher response rate provides greater confidence in reported outcomes Limitations North American Quitline Consortium (NAQC) cautions that a response rate less than 50% can lead to biased estimates 70% 60% 50% 40% 30% 20% 10% 0% 18.7% ACS 42.8% PDA 34

109 Study 2: 7-Month Follow-Up Overview of Caller Outcomes Presented Today (August-November 2008 Enrollees only) 1. Quit rates 2. Callers use of stop-smoking medications 3. Caller outcomes by insurance type 4. Caller satisfaction with Quitline services. 35

110 24-hour Abstinence Rates Percent of Aug-Nov 2008 callers achieving 24-hour abstinence at 7 month follow-up: Responder rates with 95% confidence intervals 100% 80% 60% 80.2% 83.7% 76.1% 40% 20% 0% 24-hour Abstinence (n=449) Methods: PDA administered 7-month follow-up survey Consent rate = 87% Survey response rate = 42.8%* Sample: Aug-Nov 2008 enrollees (N=1,050) Responder sample size: n=449 *Please note that response rates lower than 50% should be interpreted with caution. Abstinence rates may be over-estimated. Definitions: This measures indicates the proportion of callers who abstained from tobacco use for 24 hours (24- hour abstinence) and for 30-days or longer. Callers are defined as tobacco users who consented to the evaluation. 36

111 30-day Abstinence Rate Percent of Aug-Nov 2008 callers achieving 30-day point prevalence abstinence at 7 month follow-up: Responder rate with 95% confidence interval 100% 80% 60% 40% 20% 0% 31.6% 36.2% 27.4% 30-day Abstinence Rate (n=449) Methods: PDA administered 7-month follow-up survey Consent rate = 87% Survey response rate = 42.8%* Sample: Aug-Nov 2008 enrollees (N=1,050) Responder sample size: n=449 *Please note that response rates lower than 50% should be interpreted with caution. Abstinence rates may be over-estimated. Definitions: 30-day abstinence indicates the proportion of callers who did not smoke for the 30 days prior to evaluation follow-up at 7 months. Callers are defined as tobacco users who consented to the evaluation. 37

112 Use of Stop Smoking Medications Overall, 75% of callers used some stop-smoking medication in the 7 months since enrolling in the program. 60% of callers used NRT alone to assist them in their quit Use of stop smoking pills (Zyban and Chantix) was low 100% 90% 80% 70% 60% 60.1% 50% 40% 30% 20% 10% 0% 25.4% 9.4% 0.9% 4.2% No M eds NR T O nly Z yban O nly C hantix O nly C om bination 38

113 Medication Use by Insurance Type Fewer Medicaid recipients use stop-smoking medications than callers with other insurance. Almost all Medicare recipients reported using some medication in the 7-months since enrollment. M edication Use by Insurance Type 100% 93.8% 90% 80% 70% 62.5% 75.9% 72.3% 60% 50% 40% 30% 20% 10% 0% M edicaid (n=40) M edicare (n=32) Commerically Insured (n=187) Uninsured (n=166) 39

114 Medicare and Medicaid recipient callers Medicare and Medicaid recipients have somewhat lower quit rates than uninsured and commercially insured individuals Uninsured individuals had the highest quit rates among the three insurance types 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 30-day Abstinence Rates by Insurance Type 22.5% Medicaid (n = 40) 28.1% Medicare (n = 32) 32.6% Com m e rica lly Insured (n=187) 34.9% Uninsured (n=166) 40

115 Overall Satisfaction with Quitline Overall, 90% of callers were very satisfied or somewhat satisfied with the service they received from the Florida Quitline (n=444) 100% S atisfaction w ith Florida Q uitline 80% 72.2% 60% 40% 20% 16.7% 5.4% 4.1% 0.7% 0% Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very dissatisfied Don't Know 41

116 Satisfaction with Quitline Counselors 93% or greater of Quitline survey respondents agreed or strongly agreed with the statements: The Quitline counselors showed compassion for your situation (93.1%, n=444) The counselors treated you with respect (97.5%, n=444) The counselors had a positive and helpful attitude (95.0%, n=444) 42

117 Satisfaction with Quitline Information and Counselor Support Most callers felt amount of information and level of support from counselors was about right, although some felt it was not enough information and support 100% 80% Amount of Information (n=443) 85.6% 100% 80% Level of Counselor Support (n=442) 82.4% 60% 60% 40% 20% 0% 12.9% Too Little About Right 1.6% Too M uch 40% 20% 0% 14.9% Too Little About Right 1.1% Too Much 43

118 Recommend to a Friend Most callers would recommend the Quitline to a friend and 75% report having recommended it to someone already. Recommend to a Friend? (n=447) Have Recommended (n=449) 100% 80% 93.1% 100% 80% 75.3% 60% 60% 40% 20% 0% 2.0% 4.9% Yes Maybe No 40% 20% 0% Yes 24.7% No 44

119 Summary QL serving large numbers of tobacco users, call volume fluctuates NRT availability influences Quitline registration and counseling enrollment QL surpasses CDC benchmark for enrolling in counseling NRT program is being implemented as intended Use of the NRT program varies by demographic groups Quit rates are within an acceptable range Callers are using cessation medications, but insurance type may be a barrier Satisfaction with the Quitline is high 45

120 Quitline Evaluation Questions? 46

121 Cessation Media Evaluation 47

122 Cessation Media Evaluation Goal: To understand the relationship between the cessation media campaign and call volume Two major studies Call Volume Study In Depth Media Study Relationship to University of Miami Media Study PDA study focuses on smokers and recent quitters only Coordinated survey design and methodology 48

123 Study 1: Call Volume Preliminary Findings Do Not Cite Final Report October 15,

124 Study 1: Call Volume Evaluation Questions Goal: To examine the relationship between call volume and cessation media efforts, controlling for a variety of other media activity To what extent do cessation media buys drive call volume? Do the factors that drive call volume differ for different target groups? 50

125 Study 1: Call Volume Overview Describe 3 major media components Broadcast media: Radio, TV PR & Earned Media Internet presence: websites and online banner ads Combine all data sources into a statistical model to estimate the relationship between media and call volume All media data provided by The Zimmerman Agency All data on call volume and caller characteristics provided by the American Cancer Society 51

126 Part 1: Media Description Broadcast Media PR & Earned Media Internet Presence Final Report October 15,

127 FY09 Cessation Broadcast Media Television Cessation Working Man Radio Cessation STW Wasting $ Cessation Prenatal Advice Cessation Females Prenatal Mirror 53

128 Combined TV, Cable and Radio Spots Broadcast by Week 9,000 Youth Prevention Cessation for Adults, Prenatal, STW 6,000 3,000 0 Hispanic Cessation for Adults, Prenatal & Youth Prevention Hispanic Prevention 54 Spots Broadcast 7 /7 / /7 / /7 / /7 / /7 / /7 / /7 / /7 / /7 / /7 / /7 / /7 / Fiscal Year 2009

129 TV Reach by Campaign and DMA 100% 80% TV Cessation TV Prenatal TV Prevention Reach 60% 40% 20% 0% FMY GVL JAX MIA ORL PC PCOLA TAMPA TLH WPB DM A 55

130 Radio Reach by Campaign and DMA 100% 80% Radio Cessation Radio Prenatal Radio Prevention Reach 60% 40% 20% 0% FMY GVL JAX MIA ORL PC PCOLA TAMPA TLH WPB DM A 56

131 TV Strength of Buys By Campaign and DMA TV Cessation TV Prenatal TV Prevention TRPs 1,600 1,400 1,200 1, FMY GVL JAX MIA ORL PC PCOLA TAMPA TLH WPB DM A 57

132 Radio Strength of Buys By Campaign and DMA Radio Cessation Radio Prenatal Radio Prevention TRPs 1,600 1,400 1,200 1, FMY GVL JAX MIA ORL PC PCOLA TAMPA TLH WPB DM A 58

133 FY 09 Quitline Reach: Statewide and by DMA FY09 Quitline Reach: 0.73% Range of Reach by DMA: 0.56% to 1.09% DMA Reach among Smokers Number of Smokers Rank # of Smokers Tallahassee 1.09% 65,966 9 Orlando 0.86% 501,854 3 Gainesville 0.85% 42, West Palm Bch 0.79% 264,866 4 Jacksonville 0.76% 246,201 5 Panama City 0.73% 70,420 8 Tampa 0.72% 701,617 1 Ft. Myers 0.66% 178,231 6 Pensacola 0.63% 116,082 7 Miami 0.56% 540,

134 Reach by Target Groups State Overall Females M ales

135 Media Dollars Spent Per Smoker National Comparison In FY08, Florida spent $1.58 on media per smoker in the state. It ranks 25 th out of 36 quitlines (higher than 2/3 of the quitlines) Media Cost Per Smoker $0 $2 $4 $6 $8 $10 $12 $14 $16 $18 $20 Dollars Spent on Media Per Smoker Media cost per smoker was calculated using Fiscal Year 2008 quitline media budget from the 2008 NAQC Annual Quitline Survey. The number of smokers in the state was from 2008 BRFSS data. Media cost per smoker was available for 36 of the 53 United States quitlines. 61

136 Public Relations Activities Purposes: To describe the frequency, contacts, and reach of Tobacco Free Florida campaign public relations activities To examine the relationship between TFF PR activities and other tobacco-related news coverage on calls to the Florida Quitline 62

137 FY09 Public Relations Activities Type Number (events, segments, articles) Contacts (attendees, impressions) Contacts per 100 Adult Smokers in the State Public Relations Events , Audio and Video News Releases 237 6,552, TV Earned Media 90 1,913, Print/Online Earned Media ,483,786 1,410.5 Total ,195,988 1,

138 Public Relations Events and Earned Media Reach Total Contacts per Adult Smoker FY09 64

139 PR Successes and Opportunities Maximize reach to areas with high numbers of smokers Orlando, West Palm Beach, and Miami-Ft. Lauderdale all had the high number of contacts during FY09 Tampa area relatively low PR contacts during FY09 but greatest number of smokers among all DMAs and has higher than average smoking prevalence compared to state Maximize reach to high smoking prevalence areas Tallahassee area has several counties with high smoking rates and had high level of contacts in FY09 Several of the DMAs with highest smoking prevalence counties (Jacksonville, Gainesville, and Panama City) had the moderate to low levels of PR contacts 65

140 Tobacco-Related TV News Monitored four types of local TV news coverage: 1. TFF-related (106 segments; 1.9 million impressions) 2. Stop-smoking Messages (2,889 segments; 60 million impressions) 3. Tobacco Tax Increase (4,469 segments; 84 million impressions) 4. Other Tobacco News fires, litter, crime, etc. (4,475 segments; 129 million impressions) 66

141 Audience Impressions for Tobacco-Related News Figure X. TV audience impressions for TFF campaign, stop-smoking messages, tobacco tax increase, and other tobacco news over time (FY09) 18,000,000 16,000,000 Tobacco Free Florida campaign Stop-smoking messages Tobacco tax increase Other tobacco news 14,000,000 Monthly Audience Impressions 12,000,000 10,000,000 8,000,000 6,000,000 4,000,000 2,000,000 0 July 08 Aug 08 Sept 08 Oct 08 Nov 08 Dec 08 Jan 09 Feb 09 Mar 09 Apr 09 May 09 June 09 67

142 Tobacco Free Florida Internet Presence Websites: Online media placements: Banner ads Streaming video and audio clips Ads on social media sites 68

143 Entry to prevention site; 9 microsites (e.g. Smokifier, Be Free Stuff) Entry to cessation site; 10 microsites (e.g. Qwitter, Quit Journals) 69

144 FY09 Visits by Traffic Type for TFF.com 8,000 7,000 6,000 5,000 4,000 3,000 Spikes: Jan, March, May June ,000 1, # of visits 07/01/08 01/21/08 08/11/08 09/01/08 09/22/08 10/13/08 11/03/08 11/24/08 12/15/08 01/05/09 01/26/09 02/16/09 03/09/09 03/30/09 04/20/09 05/11/09 06/01/09 06/22/09 week

145 TobaccoFreeFlorida.com Website Reach Visits per 100 Adult Smokers FY09 71

146 Main emphasis to match site goal 72

147 FY09 Visits by Traffic Type for FQL.com 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Spikes: Jan, Mid- February, March, and mid-to-late May 73 # of visits 1/1/09 1/12/09 1/26/09 2/9/09 2/23/09 3/9/09 3/23/09 4/6/09 4/20/09 5/4/09 5/18/09 6/1/09 6/15/09 week

148 FloridaQuitline.com Website Reach Visits per 100 Adult Smokers Jan-June 2009 Only 74

149 Online Media Placement & Campaign Timing Proportion of total online media placements % of placements 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% English cessation Hispanic cessation Youth prevention Cessation Hispanic Prenatal Hispanic prevention Prevention December January February March April May June 44.8% 6.3% 6.0% 7.2% 4.9% 24.5% 5.4% 75

150 Performance of Online Media Placements 244 million web users potentially viewed placements 221,669 clicks on ads Overall click-through-rate (CTR) above industry standard Cost varied widely Numerous effective placements with high CTR and low cost to tap for next round of online placements 76

151 Part 2: Statistical Modeling The relationship between media and call volume Final Report October 15,

152 Call Volume and Combined TV, Cable and Radio Spots 9,000 Spots Calls 2,500 7,500 2,000 6,000 4,500 3,000 1, Spots Broadcast Call Volum e 1,500 1, /3 0/2008 7/14/2008 7/2 8/2008 8/11/ /25/2008 9/8/2008 9/2 2/ /6 / /20/ /3/ /1 7/ /1/ /15/ /2 9/2008 1/1 2/2009 1/2 6/2009 2/9/2009 2/23/2009 3/9/ /23/ / 6/2009 4/2 0/2009 5/4/ /18 /2009 6/1/2009 6/1 5/ /29/2009 FY09 W eek Beginning 0

153 Effectiveness of Media in Driving Call Volume: Methods Call volume among the following groups were analyzed: age 10-24, 25-54, 55+, Females 18-34, Males The following factors were used to predict call volume: Base variables: week, lag of previous week call volumes, and DMA Call volume and caller age and gender NRT status: NRT off, NRT off/message on, NRT on Earned media: Impressions (LN) of PR events, ANR/VNR, TV earned media, print/online earned media, TV news Stop smoking, TV news Tobacco tax, TV news other Internet media: Visits (LN) to TFF.com and floridaquitline.com Broadcast media: TRPs (LN) for TV, Radio, Cable 79

154 Overall success of the statistical models R 2 is a statistic that ranges from 0 to 1.0. It represents the proportion of variation in call volume that the model accounts for and is a measure of model success. Target Group Age and Gender Female Male Base variables Full Model Unexplained variance Total variance

155 Marginal Contribution of Variable Types Cumulative R 2 of the remaining unexplained variance after base variables have been entered Add earned media % Target Group Age and Gender % % Female 0.8% Male 1.9% Add web visits 1.1% 4.3% 2.8% 2.0% 2.8% Add NRT status 7.3% 21.0% 12.3% 13.5% 8.9% Add media campaign 28.9% 47.1% 29.2% 35.8% 35.7% 81

156 Conclusions The internet and PR activities contribute a small amount to call volume NRT status contributes between 6.1% and 16.7% of the variance remaining in call volume after base variables are included. Broadcast media accounts for the greatest proportion of the variance remaining in call volume 16.9% to 26.8% Among all target groups, the highest proportion of variance accounted for by media was for adults

157 Study 2 In Depth Media Study Preliminary Findings Do Not Cite Final Report October 15,

158 Study 2: In Depth Media Study Purpose Examine the impact of the 12/29/08 1/18/09 English language cessation campaign on smokers and recent quitters. Examine the differential impact of the 3/16/09 3/29/09 Spanish language cessation on Hispanic smokers and recent quitters For the purposes of today s presentation, I will address only the 12/29/08-1/18/09 English language cessation campaign 84

159 Cessation Media: Theory of Change Process Measure Exposure to Media Immediate Outcomes Awareness of Quitline and Website Attitudes toward the Quitline Attitudes towards smoking & quitting Discussion of smoking & quitting with family & friends Intermediate Outcomes Calls to the Quitline Visits to Websites Other Quitting Behaviors - Use stop-smoking meds, advice, counseling and other aids - Make quit attempt Long Term Outcomes Cessation 7 months post attempt Decreased prevalence 85

160 Study 2: Outcomes Measured by In Depth Media Study Process measure Awareness of the ad campaign and specific ads (confirmed recall) Intermediate and longer term outcomes Awareness of quitline and websites (confirmed recall) Attitudes about the quitline Attitudes about smoking and quitting (5 attitudes derived from a factor analysis) Quitting behaviors Calls to quitline, visits to website Use of stop-smoking medications, advice, counseling, other aids Quit attempts 86

161 Study 2: In Depth Media Study Evaluation Questions To what extent does awareness of ads impact key outcomes? To what extent does campaign launch/implementation impact key outcomes? Which ads, if any, impact key outcomes? What demographic and clinical characteristics impact outcomes? 87

162 Study 2: In Depth Media Study Design Telephone survey: RDD, cell-phone, and listed samples Cross-sectional design of smokers and recent quitters Baseline Data Collection 12/1/08 12/14/08 Time 2 Data Collection 1/12/09 12/14/08 Time 3 Data Collection 3/30/08 4/12/08 English Campaign 12/29/08 1/18/09 Hispanic Campaign 3/16/09 3/29/09 Dec 08 Jan 09 Feb Mar Apr May 09 Time 1 and 2 oversample of Hispanic smokers and recent quitters; Time 3 Hispanic sample only 88

163 In Depth Media Study Preliminary Results Final Report October 15,

164 Survey Sample (N=1200) Age % 9.0 Education Gender and over Race Total % Some college or less 48% HS or less 52% Male 53% Female 47% Hispanic 15.6 White non- Hispanic 73.4 Other race (non- Hispanic) 11.0 Smoking Status Planning to quit in the next 30 days? Income Total % Recent Quitter 6% Yes 13% <$25,000 $25,000 to <$50, Current Smoker 94% No 87% $50,000 or more 35.5 Total

165 Exposure to Media: Theme or Event Awareness of Campaigns and Ads 50.0% 40.0% 30.0% 20.0% 18.7% 28.5% 23.5% 14.2% 10.0% 2.5% 0.0% Campaign Awareness "Working Man" "M irror" "W asting Money" "Advice" 91

166 Exposure to Media: Differences by Age, Gender, and Race Working Man Respondents aged were more likely to recall the ad Mirror White respondents and respondents aged were more likely to recall the ad No differences were seen for the Wasting Money and Advice Radio ads 92

167 The Relationship of Media Awareness to Outcomes Number of Ads Those who recalled 1 ad were 3.7 times more likely to be aware of the QL and web than those who saw no ads. Those who saw 2 ads were 4.2 times more likely than those who saw no ads. Ad recall is positively associated with all attitudes. The more ads a subject saw, the more desirable attitudes they expressed. Awareness of ads was not related to thoughts about quitting, quitting behaviors, or discussing smoking/health with family or friends. 93

168 The Relationship of Media Awareness to Outcomes Media Cohort Those surveyed after the cessation ads were aired were 2.6 times more likely to be aware of the QL and web than those surveyed before. Media cohort is positively associated only with the prosmoker attitude. Those surveyed after the cessation ads were aired had lower pro-smoker attitudes than those surveyed before it. Media cohort was not related to all other attitudes, thoughts about quitting, discussing smoking/health with family and friends, and quitting behaviors. 94

169 Drilling Down to the Ad Level Those who recalled Mirror were 4 times more likely to be aware of the QL and web than those who were not aware. Awareness of no other cessation ads were related to awareness of the QL and web. Those who saw Working Man were 2.8 times more likely to be aware of the campaign. Those who saw Mirror were 2.9 times more likely to be aware. Neither radio ad was related to campaign awareness 95

170 Drilling Down to the Ad Level Those who recalled Mirror had more desirable Attitudes about quitting Attitudes that smokers should quit (preg) Pro-smoker attitudes Attitudes about the quitline Those who recalled Working Man had more desirable attitudes that smokers should quit (preg) Those who recalled Advice had more desirable attitudes about reasons not to smoke Recall of ads was not associated with smoking rules 96

171 A Focus on Quitting Behaviors The following groups are more likely to engage in quitting behaviors Recent quitters are 3 times more likely compared to current smokers Those planning to quit in the next 30 days are 3 times more likely than those who aren t Those who called the quitline in the past year are 4 times more likely than those who didn t Those who visited the website in the past year are 2 times more likely than those who didn t No differences in age, race/ethnicity, gender, education, income, or other quit history variables. 97

172 Conclusions Recall of the English language cessation ads ranges from 2.5% and 28.5% among smokers/recent quitters. If recalled, the ads appear successful in achieving the immediate outcomes of awareness of the campaign and awareness of the quitline and TFF websites among smokers/recent quitters. If recalled, the cessation ads also appear successful in promoting desired attitudes about the quitline and attitudes about smoking and quitting among smokers/recent quitters. Recall of the Mirror ad among smokers/recent quitters was associated with several desired attitudes and awareness of the QL and web The ads do not appear to impact longer term outcomes like quitting behaviors among smokers/recent quitters 98

173 Quitline Evaluation Questions? 99

174 Demonstration: Online Query and Report System 100