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An anti-smoking telephone helpline accelerates smoking cessation
Evidence-based public health
© HarcourtBraceandCompanyLtd 1998
An anti-smoking telephone helpline accelerates smoking cessation
Platt S, Tannahill A, Watson J, Fraser E. Effectiveness ofantismokhzg telephone helpline: follow up survery. BMJ 1997; 314:1371-1375
Objective To evaluate the effectiveness of a telephone helpline (Smokeline) in Scotland.
up 3 weeks, 6 months and 1 year after their call.
2. Smoking cessation rates 3. Smoking prevalence. Results 5.9% of adult smokers called Smokeline during the year. One year after the initial call, 23.6% (95% confidence intervals [CIs] 20.2% to 27.0%) of the cohort studied reported that they had stopped smoking. Changes in smoking prevalence in the general population revealed that there was a decline in smoking prevalence of 4% (95% [CIs] 0.75% to 7.3%) over the time of the 1993-1994 compaign in which the telephone line was complemented by mass media advertising and a number of other interventions.
Literature review Method Survey with additional cohort study of adult callers to Smokeline; 10% of the callers (8547) were included in the survey. A cohort of the smokers (848) was followed
:OMMENTAR~
In the English-speaking developed countries, a large proportion of those w h o have ever smoked have already given up the habit. In Australia, for example, ex-smokers n o w exceed continuing smokers) The great majority of these individuals gave up smoking without formal assistance of any kind. At the same time, whether for reasons of their own health, the price of tobacco products, changing attitudes towards smoking, or a desire not to set a bad example for their own or other people's children, stopping smoking has found its way on to the 'personal agenda' of most people w h o continue to smoke. That the adoption of smoke-free policies in workplaces is followed by a significant proportion of smokers giving up the habit 2 suggests that many continuing smokers can quit relatively easily. Some, however, feel that they need additional help. Telephone Quit-lines have been used widely as an adjunct to mass media campaigns encouraging adult smokers to q u i t ) A small number have been subjected to evaluation. In their simplest form, Quit-lines provide access to pre-recorded messages. Currently, the most sophisticated versions involve structured interview of the caller and preparation and subsequent dispatch to him or her of printed materials that are 'tailored" to his or her psychological state of preparedness to quit. 4 Platt et al have evaluated an intermediate version in which callers discussed quitting with
MARCH 1998
No explicit strategy; 28 references. Outcome measures 1. Number of adult smokers calling Smokeline
a trained 'counsellor' and were sent a generic pamphlet if this was requested. The results from the Scottish Smokeline are remarkable and important with regard to both its coverage of the target population and its impact on their smoking habits. Platt et al estimate that more than 1 in 20 of all adult smokers in Scotland contacted the service in its first year of operation and provide data to show that it increased the downwards trend in the prevalence of smoking by around 25%. That trend accelerated sharply during the period of their prospective cohort study of adult callers to Smokeline in any case. The price of cigarettes increased by 6.5% in March 1993 and a widely accepted estimate of the price elasticity of demand among adult smokers suggests that this would have itself produced a decrease in smoking of 2.6%. 3 However, Platt's figures indicate that the availability and use of the Smokeline counselling service played an important role in boosting this figure further, to a net change of 4% over the 2 years (I 992-I 994.) Platt and his colleagues freely acknowledge that their study was potentially open to certain biases, being non-randomized, dependent on self-reports of cessation, open to selection bias in those w h o could be followed-up and confounded by the changes in price. Nevertheless, their results suggest that the combination of strong quit messages in the mass media with very active promotion of a telephone counselling service for would-
Authors' conclusions The authors conclude that a mass media campaign, combined with a telephone support line, 'made a significant contribution' to the acceleration in the reduction of smoking prevalence in Scotland.
be ex-smokers enhances the impact of the mass communication strategy. Unfortunately, they provide no details of what the augmented strategy cost - calls to Smokeline were f r e e - and experience elsewhere suggests that continuing investment of resources, creativity, market research and evaluation are necessary if the momentum and impact of sophisticated population-wide health promotion activities are to be sustained.
Professor Konrad Jamrozik Chairman Australian Council on Smoking and Health University of Western Australia Perth, Australia References 1. National Heart Foundation of Australia and Australian Institute of Health and Welfare.
Risk Factor Prevalence Study- Survey no. 3, 1989. Canberra, NHF, 1991 2. Borland R, Owen N, Hocking B. Changes in smoking behaviour after a total workplace smoking ban. Aust J Public Health 1991; 15:130-134 3. US Department of Health and Human Services. Reducing the health consequences of smoking: 25 years of progress. A report of the Surgeon General. DHHS Publication no. (CDC) 89-8411, 1989; 410-413 4. Strecher V J, Kreuter M, Den Boer D J, Kobrin
S, Hospiers H J, Skinner C S. The effects of computer-tailored smoking cessation messages in family practice. J Farn Pract 1994; 39:262-270
EVIDENCE-BASED HEALTH POLICY AND MANAGEMENT
15
© HarcourtBraceandCompanyLtd 1998
An anti-smoking telephone helpline accelerates smoking cessation
Platt S, Tannahill A, Watson J, Fraser E. Effectiveness ofantismokhzg telephone helpline: follow up survery. BMJ 1997; 314:1371-1375
Objective To evaluate the effectiveness of a telephone helpline (Smokeline) in Scotland.
up 3 weeks, 6 months and 1 year after their call.
2. Smoking cessation rates 3. Smoking prevalence. Results 5.9% of adult smokers called Smokeline during the year. One year after the initial call, 23.6% (95% confidence intervals [CIs] 20.2% to 27.0%) of the cohort studied reported that they had stopped smoking. Changes in smoking prevalence in the general population revealed that there was a decline in smoking prevalence of 4% (95% [CIs] 0.75% to 7.3%) over the time of the 1993-1994 compaign in which the telephone line was complemented by mass media advertising and a number of other interventions.
Literature review Method Survey with additional cohort study of adult callers to Smokeline; 10% of the callers (8547) were included in the survey. A cohort of the smokers (848) was followed
:OMMENTAR~
In the English-speaking developed countries, a large proportion of those w h o have ever smoked have already given up the habit. In Australia, for example, ex-smokers n o w exceed continuing smokers) The great majority of these individuals gave up smoking without formal assistance of any kind. At the same time, whether for reasons of their own health, the price of tobacco products, changing attitudes towards smoking, or a desire not to set a bad example for their own or other people's children, stopping smoking has found its way on to the 'personal agenda' of most people w h o continue to smoke. That the adoption of smoke-free policies in workplaces is followed by a significant proportion of smokers giving up the habit 2 suggests that many continuing smokers can quit relatively easily. Some, however, feel that they need additional help. Telephone Quit-lines have been used widely as an adjunct to mass media campaigns encouraging adult smokers to q u i t ) A small number have been subjected to evaluation. In their simplest form, Quit-lines provide access to pre-recorded messages. Currently, the most sophisticated versions involve structured interview of the caller and preparation and subsequent dispatch to him or her of printed materials that are 'tailored" to his or her psychological state of preparedness to quit. 4 Platt et al have evaluated an intermediate version in which callers discussed quitting with
MARCH 1998
No explicit strategy; 28 references. Outcome measures 1. Number of adult smokers calling Smokeline
a trained 'counsellor' and were sent a generic pamphlet if this was requested. The results from the Scottish Smokeline are remarkable and important with regard to both its coverage of the target population and its impact on their smoking habits. Platt et al estimate that more than 1 in 20 of all adult smokers in Scotland contacted the service in its first year of operation and provide data to show that it increased the downwards trend in the prevalence of smoking by around 25%. That trend accelerated sharply during the period of their prospective cohort study of adult callers to Smokeline in any case. The price of cigarettes increased by 6.5% in March 1993 and a widely accepted estimate of the price elasticity of demand among adult smokers suggests that this would have itself produced a decrease in smoking of 2.6%. 3 However, Platt's figures indicate that the availability and use of the Smokeline counselling service played an important role in boosting this figure further, to a net change of 4% over the 2 years (I 992-I 994.) Platt and his colleagues freely acknowledge that their study was potentially open to certain biases, being non-randomized, dependent on self-reports of cessation, open to selection bias in those w h o could be followed-up and confounded by the changes in price. Nevertheless, their results suggest that the combination of strong quit messages in the mass media with very active promotion of a telephone counselling service for would-
Authors' conclusions The authors conclude that a mass media campaign, combined with a telephone support line, 'made a significant contribution' to the acceleration in the reduction of smoking prevalence in Scotland.
be ex-smokers enhances the impact of the mass communication strategy. Unfortunately, they provide no details of what the augmented strategy cost - calls to Smokeline were f r e e - and experience elsewhere suggests that continuing investment of resources, creativity, market research and evaluation are necessary if the momentum and impact of sophisticated population-wide health promotion activities are to be sustained.
Professor Konrad Jamrozik Chairman Australian Council on Smoking and Health University of Western Australia Perth, Australia References 1. National Heart Foundation of Australia and Australian Institute of Health and Welfare.
Risk Factor Prevalence Study- Survey no. 3, 1989. Canberra, NHF, 1991 2. Borland R, Owen N, Hocking B. Changes in smoking behaviour after a total workplace smoking ban. Aust J Public Health 1991; 15:130-134 3. US Department of Health and Human Services. Reducing the health consequences of smoking: 25 years of progress. A report of the Surgeon General. DHHS Publication no. (CDC) 89-8411, 1989; 410-413 4. Strecher V J, Kreuter M, Den Boer D J, Kobrin
S, Hospiers H J, Skinner C S. The effects of computer-tailored smoking cessation messages in family practice. J Farn Pract 1994; 39:262-270
EVIDENCE-BASED HEALTH POLICY AND MANAGEMENT
15