美CDC戒烟活动促使近2百万人尝试戒烟

《柳叶刀》(Lancet)9月9日在线发表的一项分析显示，在2012年美国疾病预防控制中心(CDC)推出既往吸烟者戒烟秘诀活动后，近2百万美国人尝试戒烟，并且其中至少10万人已永久戒烟(doi: 10.1016/S0140-6736(13)61686-4)。

该分析估计，自2012年3月启动该活动后，已有160万美国人尝试戒烟，并且至2012年6月(该活动结束时)，其中至少10万人可被定义为永久戒烟。

该活动获平价医疗法案的公共卫生与预防资金提供的5400万美元资助。该活动采取多种广告形式进行推广。平面广告展示的是既往吸烟者的开放性心脏手术吻合口或瘢痕图片。广播广告和CDC网站上的视频广告是让既往吸烟者描述烟草对其健康的不良影响。电视广告引导观众拨打1-800-QUIT-NOW戒烟热线或访问国立癌症研究所的戒烟援助网站www.smokefree.gov。


整个CDC网站上访问次数最多的页面是既往吸烟者Terrie Hall女士的证词，目前点击量为250万次。Hall女士告诉吸烟者：“在你还能够记录你的声音的时候，把它录下来留给你所爱的人吧。”Hall女士被诊断为喉癌，其喉部已被切除，目前需人工发声器才能说话。

总体而言，每5名吸烟者中有4名观看过该戒烟活动的广告。为了评估该活动的效果，CDC通过全国性的在线调查对当前吸烟者(一生中曾吸烟至少100支且目前每天或每隔几天吸烟的人)和非吸烟者(所有其他人)进行了比较。在戒烟活动开始前进行1次基线调查，戒烟活动结束后又进行1次调查。

在基线调查中，吸烟者和非吸烟者的回应率分别为70% (4,108)和58% (3,000)。在戒烟活动结束后的调查中，吸烟者和非吸烟者的回应率分别为74% (3,058)和74% (2,220)。约75%的吸烟者和非吸烟者表示曾看过至少1次戒烟广告。

过去3个月内尝试戒烟的吸烟者比例从戒烟活动前的31%增至活动后的35%。在为期12周的戒烟活动结束时，13%尝试戒烟的吸烟者未再吸烟。

CDC研究者对该活动的总体回应结果进行分层后发现，年轻吸烟者、轻度吸烟者、美国黑人吸烟者和教育程度较低的吸烟者尝试戒烟的次数更多。

在为期12周的戒烟活动期间，1-800-QUIT-NOW戒烟热线电话增加了132%，比过去1年同期增加了200,000个电话。此外，有500,000人访问www.smokefree.gov网站。

分析显示，该戒烟活动促使大量非吸烟者与其朋友或家庭成员谈论吸烟的危害和戒烟的益处。研究者表示，将结果应用于美国人群的话，约有5百万非吸烟者向其朋友或家庭成员推荐戒烟服务，并且有6百万人讨论吸烟的危害。

Lisha Hancock是从其家庭成员那听到戒烟建议的吸烟者之一，但她也表示Terrie Hall的故事对她影响很大。Hancock女士从21岁开始吸烟，已吸烟17年。家庭和同行压力并未促使她戒烟，但其5岁儿子观看Hall女士的广告后提出的问题和回应及其从Hall女士现身说法中得到的观感促使其决定在饮食和运动上做出一些改变，并使用尼古丁含片帮助戒烟，目前已戒烟6个月。

CDC研究者发现，由于戒烟人数的增加，该戒烟活动可能为美国人群增加了500,000个质量调整生命年，表明每拯救1个生命年的成本少于200美元，这使该戒烟活动成为最具有成本效益的预防干预。

同时，联邦政府花在该戒烟活动上的5400万美元少于烟草行业3天营销所花的费用。研究者表示，烟草行业的年支出为80亿美元，远超出联邦政府的应对能力，但对联邦政府在这场实力悬殊的较量中取得胜利表示乐观。

CDC今年3月至6月又进行了新一轮的既往吸烟者戒烟秘诀活动，劝告吸烟者与其医生讨论戒烟的事宜。未来CDC将继续探索提醒公众注意吸烟危害的途径。

研究者声明无经济利益冲突。

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By: ALICIA AULT, Internal Medicine News Digital Network

Almost 2 million Americans tried to quit smoking in the wake of a 2012 government educational campaign, and at least 100,000 of them have quit permanently.

That’s according to an analysis of the Centers for Disease Control and Prevention’s (CDC’s) Tips From Former Smokers campaign that was published online in the Lancet on Sept. 9 (doi: 10.1016/S0140-6736(13)61686-4). The analysis by CDC officials estimates that 1.6 million Americans tried to quit after the campaign’s launch in March 2012. By June 2012, when it ended, at least 100,000 of them could be defined as having permanently quit.

"These are really minimal estimates," said Dr. Thomas Frieden, director of the CDC, in a briefing with reporters. "We think the actual impact may have been even larger than this."

Terri Hall, a former smoker, offered this tip to smokers as part of the CDC\'s campaign: "Record your voice for loved ones while you still can." Ms. Hall was diagnosed with throat cancer, had her larynx removed, and now speaks with the aid of an artificial voice box.
 
The Tips From Former Smokers campaign was made possible by a $54 million grant from the Affordable Care Act’s Public Health and Prevention Fund. Print ads featured graphic photos of former smokers with stomas, or scars from open heart surgery. Former smokers also described tobacco’s toll on their health in broadcast and radio ads and videos posted to the CDC website. The TV ads directed viewers to the 1-800-QUIT-NOW quit line or to the National Cancer Institute’s quit assistance website, www.smokefree.gov.

A testimonial from former smoker Terrie Hall has been the most-visited page on the entire CDC site, receiving 2.5 million hits so far, Dr. Frieden said. In it, Ms. Hall tells smokers: "Record your voice for loved ones while you still can." Ms. Hall was diagnosed with throat cancer, had her larynx removed, and now speaks with the aid of an artificial voice box.

Overall, the tips campaign was seen by four out of five smokers, the Lancet report estimated.

To assess how well the campaign worked, the CDC used a nationally representative online survey. Current smokers – those who had smoked at least 100 cigarettes in their lifetime and now smoked every day or some days – and nonsmokers (all others) were compared. There was a baseline survey before the campaign started and another immediately after the campaign ended.

Of the invited smokers, 70% (4,108) responded, and 58% (3,000) of the invited nonsmokers responded to the baseline survey. After the campaign ended, 74% (3,058) of the smokers and 74% (2,220) of the nonsmokers responded. About 75% of the smokers and nonsmokers said they recalled seeing at least one tips ad.

The prevalence of smokers who tried to quit in the past 3 months increased from 31% before the tips campaign to 35% after the campaign. At the end of the 12-week campaign, 13% of smokers who tried to quit said they had not smoked again.

After stratifying the results of the overall response to the campaign, the CDC researchers found that there were more quit attempts among younger smokers, lighter smokers, African American smokers, and smokers with less education.

Calls to the 1-800-QUIT-NOW line increased 132% during the 12-week campaign, 200,000 more calls than during the same period the previous year. There were also 500,000 unique visitors to the www.smokefree.gov website.

The analysis showed that the campaign spurred a large number of nonsmokers to talk to their friends or family about the dangers of smoking and quitting. Applying the findings to the U.S. population, the researchers reported that almost 5 million nonsmokers recommended a smoking cessation service to a friend or family member, and 6 million discussed the dangers of smoking.

Lisha Hancock was one of those smokers who heard from a family member about quitting, but she also said that she was influenced greatly by Terrie Hall’s story. Ms. Hancock told reporters that she smoked for 17 years, starting at age 21. Family and peer pressure did not motivate her to quit. But her 5-year-old son’s questions and response to Ms. Hall’s ads, along with her own impressions from Ms. Hall’s testimonial, moved her. "You can see the regret and sadness in her eyes," said Ms. Hancock, in a conference call.

After seeing the ads and online testimonials, Ms. Hancock decided to make a plan, made some diet and exercise changes, and used nicotine lozenges to help her quit. She has gone about 6 months without smoking, she said.

The CDC report found that thanks to more people quitting, the campaign may have added 500,000 quality-adjusted life-years to the U.S. population, which suggests a cost per life-year saved of less than $200. That ranks the campaign "among the most cost-effective preventive interventions," said the CDC authors.

Dr. Tom Frieden
 
Meanwhile, the $54 million spent on the campaign is less than what the tobacco industry spends for 3 days of marketing, according to the report. The industry’s $8 billion in annual spending far outweighs the federal government’s capabilities, but Dr. Frieden said he was optimistic. "We’re going to win that David and Goliath battle," he told reporters.

Dr. Frieden said that the study results validated a large, national educational antismoking campaign. The CDC will continue to find ways to alert the public to the dangers of smoking, he said. The agency ran additional Tips From Former Smokers ads between March and June this year. That campaign included exhortations for smokers to talk to their physicians about quitting.

The authors reported having no financial disclosures.