摘要：Objectives. We used longitudinal data to examine the relationship between confirmed awareness of a national, branded, mass media smoking cessation campaign and cessation outcomes. Methods. We surveyed adult smokers (n = 4067) in 8 designated market areas (“media markets”) at baseline and again approximately 6 months later. We used multivariable models to examine campaign effects on cognitions about quitting, quit attempts, and 30-day abstinence. Results. Respondents who demonstrated confirmed awareness of the EX campaign were significantly more likely to increase their level of agreement on a cessation-related cognitions index from baseline to follow-up (odds ratio [OR] = 1.6; P = .046). Individuals with confirmed campaign awareness had a 24% greater chance than did those who were not aware of the campaign of making a quit attempt between baseline and follow-up (OR = 1.24; P = .048). Conclusions. A national, branded, mass media smoking cessation campaign can change smokers' cognitions about quitting and increase quit attempts. We strongly recommend that federal and state governments provide funding for media campaigns to increase smoking cessation, particularly for campaigns that have been shown to impact quit attempts and abstinence. Mass media campaigns can be used to change smoking-related cognitions and to prompt quitting behavior, particularly when combined with other tobacco control efforts. 1 , 2 Media campaigns at the national, community, and city level have been effectively used to increase smoking cessation among adults. 3 – 8 The EX campaign (National Alliance for Tobacco Cessation, Washington, DC) was designed as a branded, mass media campaign aimed to encourage adult smokers to quit. 9 , 10 This campaign was pilot tested in 4 US cities in 2006 and 2007. 10 In a longitudinal pilot study, confirmed campaign awareness was associated with statistically significant change in campaign-related cognitions over approximately 6 months. 10 Given these findings, in the spring of 2008 the National Alliance for Tobacco Cessation (NATC)—a partnership of states, national public health organizations, foundations, and corporations—launched EX as a national campaign. The EX campaign is grounded in behavior change theory 11 – 13 and the evidence regarding effective mass media campaigns. 1 , 14 – 18 Given the evidence that branding can enhance the impact of a public health campaign, all messages are branded “EX.” 19 , 20 The target audience was defined as “smokers who are open to quitting but may not know how to successfully quit.” The campaign message strategy was based on qualitative data from smokers at various stages in the quitting process, derived from more than 40 focus groups (more than 300 participants), 48 in-depth interviews, and a national survey of more than 1000 smokers. Messages are characterized by an empathetic, smoker-to-smoker voice that encourages smokers to relearn their life without cigarettes. Emphasis is placed on disassociating smoking from common daily activities that would otherwise function as smoking cues, such as driving or drinking coffee. During the 6-month national campaign period, March 31 through September 28, 2008, EX advertisements aired on cable television at 549 average quarterly targeted rating points (TRPs). TRPs are the standard unit of measurement for media delivery and reflect both the reach and the frequency of an advertisement. Reach describes the total percentage of the targeted population that is exposed to the advertisement; frequency describes the number of times individuals in the targeted population saw the advertisement, on average. TRPs are identical to gross rating points (GRPs), except that they are delivered to, and measured within, a specific and defined audience. 2 EX advertising was not evenly distributed across the campaign period; 68% of the EX TRPs aired in the first 3 months of the campaign. Pfizer's My Time to Quit campaign aired nationally at 382 average quarterly TRPs during the same period as the national EX campaign. The Phillip Morris campaign, Quit Assist, did not air during the study period; however, because it aired nationally in 2007 awareness of the campaign was measured and was included as a covariate in the present study to control for any residual campaign effects. No local or state-level tobacco control media was airing in 6 of the 8 designated market areas (DMAs) from which the study sample was drawn. In one DMA, occasional public service announcements aired; in another, no information was available as to whether public service announcements would air. Public service announcements generally air at a low TRP level. According to the Centers for Disease Control and Prevention, campaigns that deliver 1200 or more average quarterly TRPs during the introductory year of a campaign can expect to reach 75% to 85% of the target audience, in which case evaluators may expect to detect campaign awareness at 6 months, attitude change at 12 to 18 months, and behavior change at 18 to 24 months. 2 Given funding constraints, the total media delivery of the EX campaign was approximately 47% of the level recommended by the Centers for Disease Control and Prevention. 2 Nevertheless, on the basis of the findings noted in the evaluation of the EX pilot campaign we hypothesized that EX awareness would be associated with significant change in campaign-related cognitions and behaviors despite the lower media delivery level. To test this hypothesis, we examined a longitudinal cohort of adult smokers drawn from 8 DMAs, with control for baseline and contextual variables.
