RWJF and its partners are finding ways to redesign tobacco-cessation treatments and delivery systems and to promote them to make them more appealing to smokers, especially to reach underserved low-income smokers.
What Is Known About Building Demand for Treatment Services and Products
Creating demand for tobacco treatment services and products faces obstacles, such as awareness, cost, coverage and people's belief they can quit on their own. One approach to these barriers is unlikely to work. A coordinated approach is needed.
- Knowledge of coverage. In a 2006 article in the American Journal of Preventive Medicine (31:5) McMenamin et. al., wrote that "knowledge of Medicaid coverage and the perceived effectiveness of TDTs [tobacco-dependence treatments] are associated with increased use of TDTs in the Medicaid population."
- Cost of TDTs. In a 1996 article in Addictive Behavior (July–August), Hines wrote that young adult smokers rated their probability of using a stop-smoking program or a nicotine patch on cost, convenience and increased likelihood of success. "They were extremely sensitive to cost of the methods…. Young smokers would be likely to choose assisted methods when attempting to stop if they appreciated the increased likelihood of success with these methods and if the cost was not high."
- Appeal of quitting solo. At the same time, Hines' study and one by Hammond et. al. in Addiction (August 2004, 99(8) found that smokers thought they were just as likely to quit on their own as with assistance.
- Need for a multifaceted, coordinated approach to build demand. RWJF's Addressing Tobacco in Managed Care's 2005 conference report stated that behaviors around tobacco use are not rational. "Financial incentives will not… be enough to get people to quit or demand and seek effective treatment." The report went onto say that "incentives that derive from lower overall health care costs will not motivate younger tobacco users who do not identify themselves as high-risk and also are healthy and therefore not currently incurring high costs." Instead the report recommends coordinated policy and environmental changes to not only prevent smoking initiation but promote cessation and the use of proven quitting treatments, product and services. These will "motivate and support quitters' efforts." (See Conference Report.)
Key RWJF-Sponsored Initiatives: Research
- Substance Abuse Policy Research Program (SAPRP) (1994–10) and its predecessor, the Tobacco Policy Research and Evaluation Program (TPREP) (1992–1996) have supported policy-relevant, peer-reviewed research that increases understanding of policies for reducing the harm of tobacco use. These programs provided seminal findings showing the beneficial quitting effects from reducing smoker's out-of-pocket costs for tobacco-dependence treatments, promoting and funding state tobacco quitline and implementing cessation policies, in concert with comprehensive smoke-free airs laws and tobacco tax increases, which have been found to generate consumer damnd for cessation services. Results are summarized in SAPRP knowledge assets and reports, including"Increasing the Use of Smoking Cessation Treatments" and "A Research Agenda to Achieve a Smoke-Free Society." (See Program Results on SAPRP, Program Results on TPREP and SAPRP Knowledge Assets.)
Other research projects include these findings:
- Smokers are more likely to quit if treatments are easily accessible. Findings from a study of smokers covered by Medicaid suggest that "state Medicaid programs need to develop better communication with their enrollees who smoke to inform them about coverage for TDTs [tobacco-dependence treatments] and the effectiveness of TDTs." (See publication.)
- Exposure to smoking cessation therapy advertising makes people more likely to attempt to quit, more likely to have success in quitting and more likely to purchase smoking-cessation products. But it also improves the chances of quitting with and without the use of products. See NBER working paper.
- Medicaid coverage of smoking-cessation therapies does not have a statistically significant effect on consumer demand for this treatment. (Program ID# 053957)
- Those who are insured are more likely to respond to advertising of smoking-cessation therapy by quitting or attempting to quit than those without insurance. (Program ID# 053957)
- Changing the classification of nicotine gum and patch from prescription only to over-the-counter increased their use. The U.S. Food and Drug Administration reclassified nicotine gum and the nicotine patch from prescription only to over-the-counter availability in 1996. A 2002–05 RWJF-supported study by the Roswell Park Cancer Institute in Buffalo found overall nicotine-replacement therapy usage increased. This was true despite an increase in the cost of the gum and patch. (See Program Results.)
Key RWJF-Sponsored Initiatives: Action to Put Research Into Practice
- Doctors, nurses and their patients who smoke need to be made aware of Medicaid coverage benefits. The Medicaid Covers It Campaign in Wisconsin (Program ID# 063261) provided information to providers and a simple saying, "You Can Afford to Quit" to Medicaid beneficiaries. See presentation.
- Consumer Demand Roundtable has identified innovations to increase consumer demand for tobacco-dependence treatments, especially among low-income and racial/ethnic minority populations, and to embed these innovations into ongoing national cessation practice, policy, research and treatment product research and development. (See Program Results, journal article, December 2005 meeting report and May 2007 meeting report.) Participants identified the following areas as having the most potential for increasing demand for evidence-based tobacco-cessation products and services:
- View smokers as consumers and take a fresh look at quitting from their perspectives.
- Design evidence-based products and services to meet consumers' needs and wants.
- Market cessation products and services in ways that will reach into smokers' lives, especially smokers who are members of underserved groups.
- Seize policy changes as opportunities for "breakthrough" increases in treatment use and quit rates.
- Systematically measure, track and report quitting efforts and treatment use—and their drivers and benefits—to identify successes and opportunities.
- Seniors can be enticed to enroll in smoking-cessation programs sponsored by Medicare. Seven states established an outreach network of senior services and tobacco-control advocates to expand recruitment activities for the Medicare Stop Smoking Program, a federally funded demonstration project to test tobacco-cessation interventions as a Medicare benefit. All told, 7,354 seniors enrolled. The RAND Corporation is evaluating the effectiveness of three different smoking-cessation interventions it piloted. (See Program Results.)
- Dentists can convince low-income patients in public clinics to quit smoking. A program called CRUISE teaches dentists and dental hygienists to routinely assess patients' tobacco use and advises them on ways to help their patients quit. Dentists and hygienists needed training in the intervention. Patients in the intervention group were three to four times more likely to report at three months and six months that they had quit using tobacco than patients receiving usual care. (See Program Results.)
The March 2010 Special Issue of the American Journal of Preventive Medicine focuses on increasing consumer demand for cessation services.
- With two grants from RWJF, AED and IDEO teamed up to create a toolkit, Designing for Innovation: A Toolkit for Creating Solutions to Build Consumer Demand for Tobacco Cessation Products and Services. It can assist tobacco-control organizations in applying consumer demand design principles to tobacco-cessation products and services. The process of thinking differently about smoking-cessation products and services has five main steps: observe, look for patterns, brainstorm, prototype and get feedback.
- IDEO also produced a booklet, Consumer Demand Design Principles: 8 Design Principles for Redesigning Tobacco Cessation Products and Services. The principles are:
- Allow them to kick the tires
- Lower the bar
- Make it look and feel good
- Facilitate transitions
- Make progress tangible
- Foster community
- Connect the dots
- Integrate with their lives
More Than a Decade of Helping Smokers Quit: The Robert Wood Johnson Foundation's Investment in Tobacco Cessation
- 1. Strategy 1 - Science Push
- 2. Strategy 1.1 - United States Public Health Service Guideline
- 3. Strategy 1.2 - Reducing Smoking Among Pregnant Smokers
- 4. Strategy 1.3 - Youth
- 5. Strategy 2 - Capacity Building
- 6. Strategy 3.1 - Increasing Policy Supports and Incentives for Smoking Cessation and Treatment Use
- 7. Strategy 3.2 - Improving the Accessibility, Reach and Use of Proven Cessation Services: Quitlines and Other Cessation Service Delivery Innovations
- 8. Strategy 3.3 - Making Treatment More Affordable - Expanding Coverage
- 9. Strategy 3.4 - Making Treatment More Appealing: Building Consumer Demand for Evidence-Based Tobacco Treatment
- 10. Appendix 1: Major Tobacco-Cessation Grants of the Robert Wood Johnson Foundation