Impact of Canadian tobacco packaging policy on use of a toll-free quit-smoking line: an interrupted time-series analysis

Abstract

Background:A policy for new pictorial health warning labels on tobacco packaging was introduced by Health Canada in 2012. The labels included, for the first time, a prominently displayed toll-free number for a quit-smoking line. We used data from the Ontario provincial quitline to investigate the call volume and number of new callers receiving treatment in the months before and after the new policy was introduced. Methods:We used an interrupted time-series analysis to examine trends in the overall call volume and number of new callers receiving treatment (≥ 1 telephone counselling session) through Ontario's quitline (Smokers' Helpline) between January 2010 and December 2013. We analyzed data using Box-Jenkins autoregressive integrated moving-average models; we adjusted the models for a major campaign promoting the quitline, a seasonality (January) effect and tobacco pricing. Results:We found a relative increase of 160% in the average monthly call volume during the 7 months after the introduction of the new labels (870 calls per month at baseline and 1391 additional calls per month on average after the policy change; standard error [SE] 108.94, p < 0.001), and a sustained increase of 43% in subsequent months. We observed a relative increase of 174% in the number of new callers receiving treatment (153 new callers per month at baseline and 267 additional new callers per month after the policy change; SE 40.03, p < 0.001) and a sustained increase of 80% in subsequent months. The effect was significant even after controlling for a major promotion campaign and the January effect. Interpretation:We found a significant increase in the monthly overall call volume and number of new callers receiving treatment per month after the introduction of the new tobacco health warning labels, with a sustained increase in overall calls and new callers beyond the first 7 months. Our findings add to the body of evidence on the benefit of including a toll-free quitline number on tobacco packaging. Abstract Research CMAJ OPEN E60CMAJ OPEN, 4(1)Quitlines are an effective public health intervention that can be used by smokers who are motivated to seek support to quit using tobacco.11 Their use is supported in a US Department of Health Human Services clinical practice guideline on treating tobacco use and dependence. 12 Quitlines can be easily accessed free of charge, have no eligibility restrictions and provide evidence-based information, advice and motivational counselling to callers. 13 The volume of calls has frequently been used as an indicator of interest in quitting in response to population-based smoking cessation policies, such as health warning labels with a toll-free quitline number. 10,14,15 We used data from the Ontario provincial quitline to investigate whether there were changes in call volumes, the number of new callers receiving treatment and the characteristics of new callers in the months leading up to, and after, the introduction of Health Canada's new policy of having health warning labels include the toll-free quit...

Geographic Representativeness of a Web-Based Smoking Cessation Intervention: Reach Equity Analysis

“…Results indicate that the reach of BecomeAnEX was relatively similar across the rural-urban continuum. We observed some differences, although the magnitude of difference was relatively small when compared with other published ReRas [ 21 , 22 ]. The reach to rural areas was of particular interest, because smokers in those areas often have higher smoking rates and reduced access to other forms of cessation treatment.…”

“…A ReRa of 1.0 indicates that a group is perfectly represented, greater than 1.0 indicates overrepresentation, and less than 1.0 indicates underrepresentation. For example, Baskerville et al [ 22 ] used ReRas to examine the equity of quitline treatment reach across 3 specific vulnerable populations (young males; those with less than high school education; and rural dwellers) following implementation of tobacco warning labels with the toll-free quitline number. They found substantial variability in the reach equity of quitlines for rural populations across Canadian provinces, ranging from approximately 0.1 for rural smokers in Manitoba to approximately 1.4 for rural smokers in New Brunswick.…”

Tobacco package health warnings: a global success story

“…[77][78][79][80][81] Many countries have warnings that include toll-free quitline numbers, which can lead to a substantial increase in calls. [82][83][84][85][86][87][88][89] Many warnings also include a website address. Costa Rica requires a large QR code on the package back (figure 3).…”

Influence of new tobacco control policies and campaigns on Quitline call volume in Korea

“…These countries have succeeded in promoting Quitlines through mass media campaigns, education, and the inclusion of the Quitline number on cigarette packs. Furthermore, the impact of tobacco control policies and campaigns on cessation attempts could be measured by monitoring the call volumes to the Quitline in these countries 2,4,14-18 . However, in Asian countries, data to evaluate the extent to which increases in use of Quitline reflect the effects of policies and campaigns are lacking.…”