Smoker Segmentation A Rationale for Segmenting The Older Smoker (50 plus)

1. Smoker SegmentationA Rationale for Segmenting The Older Smoker (50 plus) Krista V. Schaafsma Senior Associate Social Marketing Services, LLC 616-975-9620 krista@preventionpointe.com Richard K. Delano President Social Marketing Services, LLC 631-537-4990 Delanork@optonline.net Conference on Tobacco or Health, Boston

2. Overview to Presentation • Discussing benefits and costs of segmentation • Understanding the older smoker segment • Determining the ROI for this segment • Mass media campaign opportunities • Grassroots opportunities – “Quitting after 50” Smoker Referral Network • Making the case for the older smoker (OS) Conference on Tobacco or Health, Boston

3. Segmentation ConsiderationsWeighing the Benefits/Costs Benefits of segmenting older smokers: • Propensity of segment to attempt & succeed in quitting • Near term ROI value for health cost savings • Media and message relevancy • Unique promotional/media channels, lower costs • New set of prospective referral partners Costs of segmenting older smokers: • Creative costs • Promotional costs • Management time and costs Conference on Tobacco or Health, Boston

4. 13 million nationally 27% of smoker population 58% smoke high nicotine brands Smokers between 45 and 64 are 3X more likely to die of smoking related disease than NS Mortality rates from COPD 4 X older NS (>65) Smokers 2 X as likely as non-smokers to develop Alzheimer’s (ALA web site) Cessation adds years of independent life as well as years of life. The Older Smoker (>50 yrs.)National Perspective Conference on Tobacco or Health, Boston

5. The Older SmokerDemographics • Size of population in US, 13M or 22% of the 50 -65 pop. and 11% of the >65 pop. • Several sub-segments exist based on generation, income, education, race, and age • As boomer generation ages, number of older smokers likely to increase numerically • Density of OS population varies by state. Nevada leads with 32% of young old and 23% of old old. Conference on Tobacco or Health, Boston

6. The Older SmokerAttitudes Toward Quitting • Most began to smoke before SG report (1964) • Lower belief that smoking & illness are related * • More likely to be skeptical about benefits of quitting; 50% said that continuing to smoke would not make their health worse ** • More view smoking for stress, way to control weight * • Attitude likely to change w/ onset of adverse health consequences when attributed to smoking • High correlation between doctor’s advice & increase in belief of health risk * *AUTS data set analyzed by and Orleans, Jepson, Resch, & Rimer 1994 * * Orleans study of AARP member smokers 1994 Conference on Tobacco or Health, Boston

7. Attitudes drive fewer attempts, but more success.David Burns, MD (CPS data) Conference on Tobacco or Health, Boston

8. Key motivator: Regain health Death of friend Strong will power Willingness to change behavior There’s help available Family issues Barrier: Feeling physically well (No barrier) Lack of will power Environmental factors and fear of failure Lack of awareness (No barrier) 2001 focus groups among older smokers and former smokers The Center for Social Gerontology 2001 Conference on Tobacco or Health, Boston

9. The Older SmokerSpecial Cessation Considerations • Higher levels of nicotine dependency may suggest NRT at higher dose & longer duration. 58% of OS smoke high-nicotine brands (>1.0 mg ) • “CNS” Concerned Non Smokers (GSK) are potentially more valuable if coached to be a positive support network • OS tend to believe many smoking-related symptoms are simply the result of aging • Physicians and pharmacists can play a particularly significant role Conference on Tobacco or Health, Boston

10. The Older SmokerUnderstanding Resiliency • 20 minutes - Blood pressure decreases. Pulse rate drops. Body temperature of hands and feet increases • 8 hours - Carbon monoxide down . Oxygen level in blood normal • 24 hours - Chance of heart attack decreases • 48 hours - Ability to smell and taste is enhanced • 2 wks-3 mo. - Circulation improves, Walking easier, Lung function increases • 1 - 9 mo. - Coughing, sinus congestion, fatigue, shortness of breath down • 1 yr - Excess risk of coronary heart disease is decreased to half that of a smoker • 5 yrs - Stroke risk is reduced to that of a nonsmoker 5 – 15 years after quitting • 10 yrs - Risk of lung cancer drops to as little as one-half that of continuing smokers Risk of cancer to the mouth, throat, esophagus, bladder, kidney, and pancreas decreases. Risk of ulcer decreases Conference on Tobacco or Health, Boston

11. Reducing risk of heart attack & stroke: The New Living Heart, DeBakey and Gotto • Older smokers should know that “your increased risk of heart disease and stroke disappears within two or three years after quitting…regardless of how long you smoked or how many cigarettes you smoked daily” Conference on Tobacco or Health, Boston

12. Potential Factors for ROI Analysis • Annual health cost/productivity loss of OS versus that of a younger smoker • Annual health cost/productivity loss of OS versus that of a former smoker • Extent to which near term tobacco-related treatment costs (ie. CVD ), can be eliminated or reduced by quitting after 50 • Extent to which certain near term tobacco-related treatment costs (ie.COPD) can be deferred and the financial value of that deferral (Canadian data) • Human QOL implications must have value Conference on Tobacco or Health, Boston

13. Lung Cancer Mortality Rates for Smokersof 40+ CPD, Never Smokers and Smokers who Quit at Age 50 Conference on Tobacco or Health, Boston

14. Years of Life Saved by Cessation at Different Ages and Amounts SmokedD Burns, MD Conference on Tobacco or Health, Boston

15. The Older SmokerLearning from Arizona Case Study • Arizona baseline in 1996 with follow-up in 1999 • Chuck ran 6/98 – 10/00 • MMWR noted: reduction of smoker pop. - 20.2% • Decline in older smokers over 45 was 28.6% • Decline in 18 to 44 smoker pop. 16.2% Conference on Tobacco or Health, Boston

16. The Older SmokerThe Arizona Case Study • Meaningful improvement was made in increasing the participation of the medical community as reported by smokers • Did a health care provider ask you about smoking? from 30.9% to 43.7% • Were you asked about smoking and advised to stop smoking by a health provider? from 25.1% to 36.7% • Did a dentist ask you about smoking? from 13.7% to 31.7% Conference on Tobacco or Health, Boston

17. The Older SmokerCampaign Objectives • Utilize tailored advertising to increase % of OS who believe quitting will improve health • Develop a Quitting after 50 Smoker Referral Network among professions & organizations • Take advantage of media, promotional, and PR opportunities that are uniquely available for this segment to achieve the objectives noted above (i.e. state edition of AARP magazine, state and local fairs, low cpm TV) • Increase number of OS utilizing state & local cessation services Conference on Tobacco or Health, Boston

18. The Older SmokerMessage Strategies • 4 general areas for creative opportunities: • “Your breathing (and other) problems aren’t just a sign of growing old.” • “Your family wants to support you, be with you, now and later.” (CNS) • “Being tobacco-free is social norm.” • “Quitting smoking takes practice.” (CA) Conference on Tobacco or Health, Boston

19. The Older SmokerCreative Concept • Creative concept: “This Old Smoker” • Sympathetic and empathic spokesperson • Take off on “This Old House” • Effective way to highlight research-derived messages Conference on Tobacco or Health, Boston

20. The Older SmokerCreative Concept • Creative concept: “This Old Smoker” • Tailored for >50 yr. audience • Supports promotional extensions • Builds public support for OS quit attempts • Allows for inclusion of Prochaska’s “Stages of Change” Conference on Tobacco or Health, Boston

21. The Older SmokerUse of PR • Public relations—Setting the stage for the over 50 campaign–Internal & external audiences • Deliver persuasive messages to decision makers on the efficacy and efficiency of the campaign • Saturate the media with information about the health effects of quitting after 50 • Secure speaking engagements among influential seniors groups • Develop partnerships with senior advocacy groups (Example: AARP) Conference on Tobacco or Health, Boston

22. The Older SmokerUtilizing Clinicians and Pharms • Segment & support clinicians who regularly treat older pop. w/ materials tailored to help older smokers, focus on their needs, their benefits i.e. cessation improves drug performance, surgical success • Utilize in-store (pharmacy and grocery) media but extend campaign messages to these outlets; add take-one referral cards • Develop OS promotions that utilize pharmacy tie-ins • Seek out clinician spokespeople for media outreach through outlets that reach the older demo Conference on Tobacco or Health, Boston

23. Quitting After 50 Smoker Referral Network • Determine size and distribution of local older smoker population • Identify organizations that reach older smokers, educate on availability of cessation services, provide collateral • Request state support for incentives to stimulate incremental and low-cost “ready-to-quit” referrals • Identify unique settings like hospitals that offer teachable moments for older smokers seeking emergency medical care Conference on Tobacco or Health, Boston

24. The Older Smoker: Making the Case • Do we have adequate info about older smokers to determine potential success of the campaign? • Can we make a persuasive ROI case for focusing on this segment? • Aside from economic considerations, is there a compelling QOL statement that can be made by delaying early onset of disability due to smoking & compressing its duration? • Are there compelling media, promotional, and message opportunities to leverage through advertising & PR? • Is there potential for building a referral network to increase grassroots demand for support for this segment? Conference on Tobacco or Health, Boston