Advertisements influence Spanish-speakers to quit smoking

From television and radio commercials to newspaper, magazine and Internet advertisements, Americans are inundated with marketing campaigns endorsing the latest products and services. Yet, viewers often forget these advertisements present lifesaving public health messages.

Through a targeted media campaign, Colorado’s Spanish-speaking smokers are now utilizing the State’s QuitLine to stop smoking.  In 2007, Colorado School of Public Health Professors, Dr. Emily Burns and Dr. Arnold Levinson collaborated with the Colorado Department of Public Health and Environment to study the impact of a Spanish-language advertising campaign on Colorado’s QuitLine usage. 

The Colorado QuitLine is a free telephone coaching service that connects people who want to quit smoking or using other tobacco products to an experienced Quit Coach and a free supply of nicotine patches. Prior to the media campaign, Drs. Burns and Levinson had been collecting QuitLine data and recognized there were a disproportionate number of Latino callers compared to other populations.

“We knew from looking at the QuitLine data that Latinos weren’t calling,” said Dr. Burns. “But what we didn’t know was how we could get this population to utilize the QuitLine.”

Under a contract with the Colorado State Tobacco Education and Prevention Partnership, a commercial media firm designed a Spanish QuitLine media campaign that aired predominantly on Spanish-language television and radio channels and in Latino-attended movie theaters. The ads delivered positive and encouraging messages about quitting through actors portraying key family members.

Surprisingly, Drs. Burns and Levinson’s recently published study of the media campaign showed positive results. “Initially, we just wanted to see that the Spanish-speaking Latino population did as well as other QuitLine participants,” said Dr. Burns.  “But what our study actually showed was that Latino enrollment and cessation rates were better than other populations and that the media campaign actually helped them quit.”

Smoking rates higher for Colorado Latinos

In Colorado more than 20 percent of the population or 685,000 adults smoke, according to the Centers for Disease Control and Prevention (CDC). Of those who smoke, 22.8 percent are Latino, which is 1.5 times the rate for White, non-Latinos at 15.6 percent. Additionally, Latino smokers speak mainly Spanish at home and historically have been underrepresented in the Colorado QuitLine.  Compared to the percent of Latino smokers nationally (16.2 percent), Colorado has a higher percentage.

“The percent of Latino smokers in Colorado is high and the rate hasn’t dropped since 2001,” explains Dr. Levinson. “This population is harder to reach and often does not use any cessation resources even though the State has worked to make culturally-appropriate and bilingual QuitLine services available.”

One of the largest population segments with high smoking rates is people with low socioeconomic status (SES). Two out of three smokers fall into this segment.  Colorado’s Latino smokers are no different.  Dr. Levinson says factors such as low SES and poor access to health care are reasons Latinos smoke. Likewise, Latinos are less likely to use the nicotine patch and telephone counseling. Lung cancer is also the leading cause of cancer deaths among Latinos

With more than 4,300 Coloradans dying every year from tobacco-related illnesses, the State is looking for ways to eliminate tobacco-related health disparities and increase QuitLine utilization. Nationally, only two to three percent of the smoking population uses the QuitLine as a cessation method.

Increasing Latino QuitLine Use

Latinos are one of ten priority populations states are focusing their cessation efforts on. In the past, only 16.6 percent of Colorado QuitLine enrollees have been Latino. Drs. Burns and Levinson have changed that.

During campaign, QuitLine calls increased among Latinos by 57.6 percent. The study also showed that Latino respondents were younger, more often Spanish speaking, uninsured and less educated compared to pre-campaign Latino callers.

“Our study has received a lot of attention because every state has a QuitLine and every state is looking for ways to make it very available, accessible, and easier for people to quit regardless of their socioeconomic status,” said Dr. Levinson.

Dr. Burns states, “Prior to our study, there was a Spanish-speaking QuitLine but there were no ways to attract this disadvantaged and hard to reach population to use it.”

When the respondents called the QuitLine, they worked with a Quit Coach to set-up a personal quit plan. The coaches also helped the respondents overcome common barriers, such as dealing with stress, fighting cravings and coping with irritability. Along with the plan, the callers were placed on a free nicotine replacement therapy. 

Drs. Burns and Levinson’s study results showed quit rates during the media campaign improved.  Seven-day abstinence improved from 29.6 percent to 41 percent and six-month abstinence increased from 9.6 percent to 18.8 percent.

“We didn’t expect to see as large of an increase in callers or as large a number of callers sticking to the program,” said Dr. Burns. “This population was completely different from the Latino population the QuitLine attracted prior to the media campaign.”

Continuing with their tobacco research Drs. Burns and Levinson are looking at the QuitLine content since it is more than 30 years old.  They want to learn more about what makes people want to smoke, what makes them want to quit, and what gets people to stay enrolled in the program.

“Smokers who start on nicotine replacement therapy don’t use them long enough,” Dr. Levinson said.  The person who uses the patch or gum will on average use it for 10 days, when they should be using it for eight weeks,” explains Dr. Levinson. 

Another study is looking at ways to keep people connected to their cessation plans.  This program is placing patient navigators in Head Start programs throughout Denver, since predominantly low socioeconomic populations use these services. The professors hope to understand the barriers to calling the QuitLine and sticking with the program.

“Despite reducing the epidemic in half, the current smoking epidemic is still the leading cause of preventable death in our state,” says Dr. Levinson. “We still need to focus on the tobacco epidemic.”

Read the recently published, “Reaching Spanish-Speaking Smokers: State-Level Evidence of Untapped Potential for QuitLine Utilization,” by Emily K. Burns, MD, MSPH and Arnold H. Levinson, PhD in the American Journal of Public Health.

To learn more about Colorado’s QuitLine, please visit the program’s Web site at www.coquitline.org.