Effects of different intervention strategies in the implementation of a nationwide tobacco Quit and Win contest in Sweden

Objective — To compare the effects of two different strategies to recruit participants in a community based "Quit and Win" (Q&W) tobacco cessation contest in the years 1988 and 1989. Design — The first strategy was based on nationwide mass media activities encouraging people to participate. The second strategy also included local mobilisation of collaborators at the county level in order to recruit as many participants as possible. A lagged design was used to evaluate the effectiveness of the two strategies. The mass media strategy was carried out nationwide both years. The second strategy was implemented in Stockholm County in 1988, and in Dalarna County in 1989. Data were collected before and after implementation, and included formative and outcome evaluations. Random samples of participants in the programme were followed up with a questionnaire distributed six months after the programme in order to collect data on tobacco use and sources of information about the Q&W contest. Setting — All people in Sweden aged 16 years or over who reported using tobacco (including oral snuff) daily for at least one year were potential participants. From a baseline survey in 1988 it was estimated that the target population was 2.0 million tobacco users. Main outcome measures — Data were collected from the participants' entry forms and six month follow up questionnaires sent to a randomised sample of participants in the 1988 (n = 946) and 1989 contests in Stockholm County (n = 879), Dalarna County (n = 890), and other Swedish counties (n = 845). Participants in the 1988 contest were also followed up after one year (n = 882), and four years (n = 724). Results — In all, 12840 daily tobacco users participated in the 1988 Q&W contest and 17774 participated in the 1989 contest. In 1988, the participant rate was 19.3 per 1000 daily tobacco users in Stockholm County, 2.6 in Dalarna County, and 3.2 in other Swedish counties. The figures for 1989 were 12.7, 24.9, and 7.0, respectively. After six months 24% of all the participants in 1988 reported to be tobacco-free, and in 1989 this figure was 27%. There was no significant difference in the outcome between the two intervention strategies; after four years almost 20% were still tobacco-free. The total cost per participant, including intervention and evaluation, was estimated to be US$56 for the mass media strategy and US$45 for the combined mass media and local organisational strategy. The corresponding cost per tobacco-free quitte