This proposal focuses on testing a new idea to increase smoking cessation on the population level. We propose to conduct population surveys and intervention studies to demonstrate that nonsmokers hold the key to increasing population cessation. This large project is grouped by three overlapping phases: Phase 1: Surveys: We will conduct surveys of nationally representative samples to test the hypothesis that the attitudinal gaps between nonsmokers and smokers on tobacco control measures are significantly larger among those living in states with a high tobacco control index than among those in low index states, and that the attitudinal gap (grouped by state) predicts the smoking cessation rate. The survey of 3,500 smokers and 3,500 nonsmokers will be conducted with Knowledge Networks Inc. Phase 2. A Randomized Trial: We will recruit 2,960 smoking households (with an adult non-smoker) from the general community (half from California and half from Oklahoma) and randomly assign them into a 2 x 2 factorial design: one factor is whether the intervention targets smokers or nonsmokers and the other is the intensity of the intervention. They will be followed up for 12 months. Two primary hypotheses to test are: Messages targeting nonsmokers produce significantly higher quit rates among smokers in the household than messages targeting smokers and that higher intervention intensity produce a higher quit rate. Phase 3. A Comparative Media Study and Dissemination: We will create a new cessation media spot and compare it with the existing media campaign in California and Oklahoma. The health departments of these two states (who are co-investigators) have committed to coordinate their ongoing media campaign with this study. In a selected in market in each state, we will use an ABAB design (A= targeting smokers and B=targeting nonsmokers) to test the effects of the new media spots. Using the number of calls to each state quitline as a proxy measure, we will test the that hypothesis that media spots targeting nonsmokers produce significantly higher rates of quitline calls than media spots targeting smokers. We in cooperate dissemination into the project through collaboration with multiple state health departments
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