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In 1996, the Office on Smoking and Health of the Centers for Disease Control and Prevention (CDC), asked The HMO Group to conduct anti-tobacco media campaigns aimed at young people in two or three communities that had member health maintenance organisations (HMOs). The HMO Group is a strategic national alliance of HMOs working to strengthen their quality and performance through collaborative efforts. Kaiser Permanente (KPC), in Denver, Colorado, and Group Health Northwest (GHNW) in Spokane, Washington, were fortunate to be recipients of CDC funds to conduct these campaigns. This paper is a summary of the activities of these two campaigns and the lessons learned.
Purpose of the campaigns
The purpose of the campaigns was to increase the airing and placement of existing messages which counter tobacco advertisements. The Office on Smoking and Health has a Media Campaign Resource Center that houses anti-tobacco media materials. The campaigns provided opportunities for these materials to be used in the battle against “big tobacco”. The ultimate goal was to help prevent our children from using tobacco or, in the event that they were already using it, to try to get them to quit.
The request for proposals from The HMO Group to conduct the campaigns was received by KPC and GHNW in late August 1996. The two organisations were notified at the end of November that their proposals had been accepted. The campaigns were scheduled to finish by the end of February to take advantage of a special offer from the Office on Smoking and Health. This offer waived usage and talent fees for a set of four advertisements that were included in a Youth Performance Package. These fees, especially the talent fees, can be exorbitant, and the savings substantially increased the amount of television and radio airtime that the two HMOs were able to buy.
Timeline and budget
The KPC campaign ran from 16 January to 2 February 1997. GHNW ran its campaign from 20 January to 28 February 1997. Following is a summary of how both organisations used the funding (table).
Choosing the advertisements
In addition to the four Youth Performance Package advertisements, GHNW had access to two television advertisements which had been produced by the local American Stop Smoking Intervention Study (ASSIST) coalition. GHNW also had chosen to use print advertisements. The campaign committee members found that the choice of advertisements was very difficult, and so they decided to seek help. They conducted focus groups in an elementary school, a junior high school, and a church youth group. The input from the focus group members proved to be very helpful.
Role of the advertising agency
The HMO Group notified KPC and GHNW that they had received the funds for the campaign in late November, and the campaigns needed to be complete by the end of February to take advantage of the fee waiver on the Youth Performance Package. With the relatively short timeline and the holiday season approaching, both organisations chose to use advertising agencies to assist with placement. They felt the agencies’ expertise would be very helpful, would expedite the campaign, and would help to leverage funds to buy the most airtime.
The advertising agencies were able to negotiate one-for-one matching advertisements. In other words, one advertisement would be purchased, and a second would be given free. It was agreed that the matching advertisements would run at comparable times, not at 3 am! The advertising agencies were also familiar with the different stations and programmes. Their expertise in placement ensured that they reached the correct audience and obtained the maximum reach.
In addition, both participating HMOs designed programmes to enhance the campaign. KPC kicked off its campaign with a press conference. Staff recruited a local celebrity, John Mobley of the Denver Broncos, to lead the press conference, which was very successful. Teenagers who attended were given teeshirts bearing the logo “smoking: it’s to die for”. On the back of the shirt, it said, “mobley kicks butts”. The press conference was aired on four major television evening news programmes.
KPC also used a programme called Talk Backon a local radio station. Teenagers were invited to call in and talk about a topic of interest while on the air. During the campaign, the topic was, of course, tobacco.
In addition, KPC had a toll-free (freephone) telephone line installed so that people who learned of the campaign from the news or saw the advertisements could call in and ask for a packet of materials. The materials were specially developed for the campaign and were customised for the caller. KPC also offered six quit-smoking classes for teenagers at various locations and times throughout metro Denver.
GHNW elected to extend the programme by placing print advertisements in addition to television and radio spots. They were placed in an elementary school magazine, in high school newspapers, in the local newspaper, and in Northwest Health, a magazine that goes out to 76 000 GHNW subscriber households.
GHNW also used teeshirts. A local rock-music radio station offered to run a “Tobacco Facts” programme. During the day, the station would read tobacco facts, and in the evening it would offer a call-in time. If the caller could recall one of the facts aired during the day, the caller would receive a teeshirt. The logo on the shirt was “break from the pack”.
Surveys were conducted by both participating HMOs, using professional research companies. KPC gave written questionnaires before and after the campaign to more than 300 students in schools. GHNW was unable to get permission to conduct a survey in schools in time for the campaign, so it elected to do a telephone survey before and after the campaign with 200 students. The questionnaire, which had been developed collaboratively by the HMOs, was modified for the telephone surveys.
Kaiser Permanente Colorado
Eighty-eight per cent of those surveyed recalled seeing a KPC anti-smoking advertisement. (Television advertisements were recalled most often.) When asked about the intent to quit smoking in the next 30 days, “yes” responses from participants of all ages increased from 37% to 56%. Participants aged 13 and under increased their “yes” responses from 18% to 50%.
Although there were dramatic increases in intent to quit smoking, there was little or no change in participants’ actual attempts to quit smoking.
Group Health Northwest
When asked if they had seen or read messages or advertisements against smoking in the past several weeks, 62% of participants said “yes” in the pre-campaign survey and 74% said “yes” after the campaign. When asked about their intent to quit smoking in the next 30 days, participants’ “yes” responses decreased from 46% to 41%. Nearly half of the respondents who stated that they used tobacco products did not buy the products themselves.
Other campaign results
KPC received 76 calls following the press conference. Seventy-three per cent were from smokers, and 60% of the callers were under 20 years of age.
The ready-to-use advertisements resulted in substantial savings in time and money. In addition, they were already market tested. It would have been very time consuming and expensive to produce advertisements locally.
Using advertising agencies was very beneficial. Although their services were expensive, it was agreed that using them resulted in better placement of the advertisements, tremendous savings in time, and more cooperation from the media.
All but one of the stop-smoking classes offered in Denver were cancelled, and the one that was held had only four attendees. Tobacco cessation programmes for teenagers continue to be a challenge!
GHNW was surprised to learn that not all high schools have newspapers. Those that do not, however, were very willing to put up posters.
According to the results of the surveys, the advertisements were seen by a significant number of young people. The actual impact is not measurable, but the assumption is that the campaigns did affect some of the viewers. The budgets were small in terms of advertising campaigns, but it was felt that the project was worthwhile.
Reducing the incidence of tobacco use is the premier health promotion goal of both KPC and GHNW. The campaign contributed to this goal within participating HMOs and in their communities. It helped both organisations to be recognised as leaders in the fight against tobacco use. In addition, the campaigns helped the two participating HMOs develop valuable relationships with advertising agencies, the media, the public, and research companies. Both organisations received positive feedback from members and the community.
The authors would like to acknowledge the help of Toni Robideaux, President, Robideaux! Advertising and Marketing, Spokane, Washington; Maureen Hanrahan, Director of Prevention, Kaiser Permanente Colorada; and GBSM Advertising Agency (Steve Sander President), Denver, Colorado
The HMO Group is now the Alliance of Community Health Plans.
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