During March 4–June 23, 2013, CDC conducted its second annual national paid-media
tobacco education campaign encouraging adult smokers to quit. These campaigns, called
Tips from Former Smokers (Tips), feature true stories of former smokers living with
serious smoking-related diseases. To assess the immediate impact of the 2013 Tips
campaign, CDC analyzed the weekly numbers of calls to the national telephone quitline
portal (1-800-QUIT-NOW) and the weekly numbers of unique visitors to the Tips website
( http://www.cdc.gov/tips )* during the 16-week campaign and during the 4 weeks before
and after the campaign. During the campaign, the average weekly numbers of calls and
website visitors increased by 75% and almost 38-fold, respectively, compared with
the 4 weeks before the campaign, and quickly decreased almost to pre-campaign levels
once the campaign ended. This suggests that the campaign led to 151,536 additional
quitline calls and nearly 2.8 million additional unique Tips website visitors above
pre-campaign levels. During the first 12 weeks of the campaign,† when the national
television ads were on and off air on alternate weeks, average weekly call volume
fell by 38% during the 6 weeks when the national television ads were off air compared
with the 6 weeks when these ads were running. These results suggest that emotionally
evocative tobacco education media campaigns featuring graphic images of the health
effects of smoking can increase quitline calls and website visits and that these campaigns’
effects decrease rapidly once they are discontinued.
The 2013 campaign included advertising on television, online (Internet and mobile),
radio, print, billboards, buses and bus stop shelters, and social media. The campaign’s
television component included national ads in all 210 U.S. designated market areas
(DMAs) and additional local ads in 67 of these DMAs, which were selected randomly.§
To extend the campaign’s length, the national television ads were placed using a “pulsing”
strategy, which involved airing them on a 1-week-on, 1-week-off basis through the
first 12 weeks of the campaign, while the local television ads ran continuously throughout
the campaign. The campaign’s online component consisted of national ads only and ran
continuously throughout the campaign.
The campaign’s television ads included one of three calls to action: an invitation
to call 1-800-QUIT-NOW (66%), an invitation to visit the Tips website (28%), and the
message “Talk with your doctor (6%).”¶ During the campaign’s first 12 weeks, all online
ads included the Tips website; during its last 4 weeks, these ads included a mix of
the Tips website, 1-800-QUIT-NOW, and “Talk with your doctor.” In addition to featuring
Tips ads, which provide motivation to quit smoking, the Tips website syndicated extensive
information on how to quit from the National Cancer Institute’s (NCI’s) cessation
website (http://www.smokefree.gov).
This analysis used 1-800-QUIT-NOW call volume data collected by NCI from the national
portal and data on unique visitors to the Tips campaign website collected by CDC using
Adobe SiteCatalyst and Google Analytics. For the purposes of this report, unique visitors
are defined as persons who visited the Tips website one or more times in a given week.
A total of 352,848 calls to 1-800-QUIT-NOW occurred during the 2013 campaign, for
a weekly average of 22,053 calls (Figure 1).** This represents 151,536 additional
calls (a 75% increase) above what would have been expected had call volume continued
at the level observed during the 4 weeks before the campaign (February 4–March 3),
when the weekly average was 12,582 calls. The average weekly call volume of 13,044
calls during the 4 weeks after the campaign (June 24–July 21) was 41% lower than the
weekly average observed during the campaign.†† Both the increase in call volume from
the pre-campaign weeks to the campaign weeks and the decrease in call volume from
the campaign weeks to the post-campaign weeks were statistically significant (p<0.05),
whereas no significant difference in call volume was found between the pre-campaign
and post-campaign weeks (p=0.60).§§
During the campaign’s first 12 weeks, average weekly call volume was 38% lower during
the 6 weeks when the national television ads were off-air compared with the 6 weeks
when these ads were running (16,500 versus 26,571). A separate analysis found that
during off-air weeks, call volume in DMAs without local ads fell nearly to the level
of the 4 pre-campaign weeks.
Nearly 2.9 million (2,868,059) unique visitors accessed the Tips campaign website
during the 2013 Tips campaign, for a weekly average of 179,254 unique visitors (Figure
2). This represents almost 2.8 million (2,792,475) additional unique visitors (a nearly
38-fold increase) above what would have been expected had website traffic continued
at the level observed during the 4 weeks before the campaign, when the weekly average
was 4,724 visitors. The weekly average of 7,575 website visitors during the 4 post-campaign
weeks was 96% lower than the weekly average observed during the campaign. The cessation
sections of the English and Spanish Tips websites received almost half a million page
views during the campaign, suggesting that many visitors to the Tips website were
actively seeking information on how to quit smoking. Although the weekly number of
website visitors varied during the course of the campaign, this variation did not
clearly follow the pattern of the national television ad pulsing.
Editorial Note
Emotionally evocative tobacco education media campaigns featuring graphic images of
smoking-related diseases are effective in motivating smokers to quit (1–5). Telephone
quitlines increase quit rates (6). The 1-800-QUIT-NOW portal, operated by NCI, seamlessly
routes callers to their state quitlines based on area code. CDC funds state quitlines
as part of its support for comprehensive state tobacco control programs. Web-based
cessation interventions are promising (6), but the available evidence is insufficient
to fully assess their effectiveness (7).
This analysis shows that the number of weekly calls to 1-800-QUIT-NOW increased as
soon as the Tips campaign began, decreased when the national television ads were off-air,
increased each time these ads returned to the air, and decreased when the campaign
ended. Each of these increases and decreases was rapid and substantial. These findings
reinforce previous evidence that media campaigns can motivate smokers to try to quit
and to seek information on quitting (1–5), while also offering additional evidence
that these campaigns’ effects fade quickly once they end (2,3,8). These findings underscore
the public health importance of sustaining campaigns over time, and suggest that the
Tips campaign might have generated even more quitline calls if the national television
ads had run continuously and had appeared over a longer period. If the national television
ads had been aired continuously without pulsing over the entire 16 weeks of the campaign,
assuming the average weekly call volume observed during the first 6 “on” weeks was
sustained, about 425,000 calls would have occurred during the campaign (i.e., about
72,000 more calls than actually occurred).
As with 1-800-QUIT-NOW calls, the weekly number of unique visitors to the Tips campaign
website increased sharply immediately after the campaign began and decreased sharply
once it ended. However, although the number of weekly website visitors varied during
the campaign, the pulsing pattern was far less evident than it was for quitline calls.
This suggests that the national online ads, which ran continuously throughout the
campaign, were a greater driver of website traffic than the pulsed national television
ads. This is plausible, because online ads have a built-in advantage in directing
traffic to a website; online ad viewers need only click on an ad to visit the website.
In addition, only about 28% of the television ads included the website. During the
weeks of April 22–28 and June 17–23, the amount of online advertising increased sharply,
corresponding with substantial increases in unique website visitors, indicating that
website traffic is responsive to changes in the online ad exposure dose. The fact
that there were almost 3 million visitors to the Tips website during the 2013 campaign
suggests that online ads hold promise for motivating smokers to engage in cessation
information-seeking activity.
Although substantial increases occurred in the numbers of 1-800-QUIT-NOW calls and
Tips website visitors during the 2013 Tips campaign, total numbers of calls and website
visitors during the 2013 campaign are somewhat smaller than during the 2012 Tips campaign
(9).¶¶ This likely reflects at least two factors. First, the national television and
online ad purchases were lower in 2013 than in 2012. Second, national television ads
including 1-800-QUIT-NOW ran for only 9 weeks in 2013, compared with 12 weeks in 2012.
What is already known on this topic?
The number of weekly calls to a national quitline portal and the number of weekly
unique visitors to a cessation website increased substantially during the 2012 Tips
from Former Smokers national tobacco education media campaign (Tips campaign) compared
with the same period in 2011.
What is added by this report?
The number of weekly calls to the national quitline portal and the number of weekly
unique visitors to the Tips campaign website increased substantially during the 2013
Tips campaign, compared with the 4 weeks preceding the campaign. These numbers decreased
rapidly once the campaign ended. Calls also decreased sharply during campaign weeks
when the national television ads were off the air. Increases in quitline call volume
appeared to be driven primarily by television ads, whereas increases in traffic to
the Tips website appeared to be driven primarily by online ads.
What are the implications for public health practice?
Tobacco education media campaigns featuring true personal stories from former smokers
with serious smoking-related diseases and graphic images can substantially increase
calls to quitlines and visitors to campaign websites, which would be expected to result
in increases in quit attempts and successful quit attempts. Quitline calls and website
visitors fall sharply when campaigns are discontinued. Media campaigns such as the
Tips campaign might have an even greater impact if they were sustained at a high intensity
for a longer time.
The findings in this report are subject to at least five limitations. First, this
analysis was a natural time series analysis and did not control for other factors
that could have contributed to the increases in weekly call volume and website visitors
observed during the 2013 Tips campaign. However, the observed impact of the campaign’s
pulsing strategy on call volume, as well as the sharp increase and decrease in calls
and website visitors observed immediately after the campaign began and ended, point
to a causal relationship. Secondly, NCI data on calls to 1-800-QUIT-NOW reflect the
number of call attempts, not the number of unique callers, completed calls, or callers
receiving services. The NCI data also do not capture calls to other state quitline
numbers besides 1-800-QUIT-NOW. Third, adding the weekly numbers of Tips website unique
visitors to calculate total unique visitors during the campaign likely somewhat overestimates
this total because the same person could be counted several times if they visited
the Tips website repeatedly over several different weeks. Fourth, the number of Tips
website visitors included both web and mobile visitors, so some persons who visited
the website through both these channels could have been counted twice, resulting in
an overestimate. Finally, 1-800-QUIT-NOW calls and visitors to the Tips website are
preliminary indicators of quit attempts and successful cessation, outcomes which future
evaluations of the 2013 Tips campaign will examine. However, the 2012 Tips campaign
was associated with increases in call volume, website visitors, quit attempts, and
successful cessation, suggesting that the first two indicators predict the latter
two outcomes (9,10).
Calls to quitlines and traffic to the campaign website increased sharply when the
Tips campaign was on the air, suggesting that this campaign likely motivated many
smokers to try to quit. Quitline call volume appeared to be driven primarily by television
ads, whereas traffic to the Tips website appeared to be driven primarily by online
ads. Both quitline calls and website traffic fell rapidly when the campaign was discontinued.
These findings speak to the effectiveness of emotionally evocative media campaigns
featuring graphic images in increasing interest in quitting smoking, and highlight
the even greater impact these campaigns might have if they were sustained at a high
intensity for a longer time. If the national television ads that aired during “on”
weeks of the 2013 Tips campaign were run throughout the year at this level and produced
the same response, this would translate into almost 1.4 million calls to 1-800-QUIT-NOW
in 2013, which is 500,000 more calls than the portal received in 2012 and by far the
most calls that it has received in any year since its inception.