Quit & Win Campaign: the experience in Germany

This case study presents the development and implementation in Germany of a smoking cessation campaign for adults known as “Quit & Win”, based on an innovative international smoking cessation competition organized every other year to reduce population tobacco use.

The Quit & Win competition was introduced in 1985 during the North Karelia Project in Finland as a new regionally-based antismoking campaign.¹³ In 1994, the success of the Finnish

experience led to the development of an international campaign in 13 countries, coordinated by the National Public Health Institute of Finland and supported by WHO as part of its Countrywide Integrated Noncommunicable Diseases Intervention (CINDI) programme.¹⁴ Since 1994, the competition has been held biennially, growing rapidly from 60 000 participants in 13 countries in 1994 to 700 000 participants in 73 countries in 2004 (Table 1).

Table 1. Number of countries and individuals participating in Quit & Win competitions, 1994–2006

Year Countries Smokers

1994 13 60 000

1996 25 70 000

1998 48 200 000

2002 69 426 000

2002 76 670 000

2004 71 700 000

2006 84 700 000

In 2004, a total of 359 019 smokers gave up smoking in the participating countries. The largest number of smokers participating in the competition were in Germany, where 90 184 people attempted to stop smoking.

Situation prior to the campaign

International experience has shown that the Quit & Win campaign could be carried out in different populations and cultures. It offers benefits both to individual smokers, who are given incentives and support to give up smoking, and to the organizers of the campaign, who get the opportunity to build coalitions with fellow organizers and activists, gain recognition for their activities, generate publicity for smoking-related issues and obtain assistance for smokers to quit.

In Germany, as in some other countries, the campaign was adopted countrywide and in 2000 the first nationwide smoking cessation campaign was implemented. Until then smoking cessation had not been a priority in the fight against tobacco and had not received much attention from health professionals and other relevant actors in the country. Consequently efforts were sporadic, fragmented and too weak to have an impact at national level, especially given the powerful tobacco industry in Germany which influenced policies against tobacco control measures to achieve one of the lowest tobacco prices in Europe.

Launch, development and implementation

Germany has participated in the Quit & Win campaign since 2000 with an initial turnout of 25 000 smokers, increasing to over 90 000 (about 0.5% of German smokers) in 2004. The

13 The North Karelia Project began in 1972 as a project to prevent cardiovascular disease among residents of this province of Eastern Finland. The Finnish Heart Association coordinated the initial discussions with community representatives, national experts and representatives of WHO. Later, the programme expanded to include other noncommunicable diseases.

14 The CINDI network comprises 29 participating countries (28 Member States of the WHO European Region and Canada) and three candidate countries.

German campaign, appropriately named “Rauchfrei” (smoke-free), is the biggest national quit-smoking campaign worldwide.

The launch of the campaign in Germany was designed and organized by the German Cancer Research Centre and has been largely supported by the Public Health Institute of Finland and the German Federal Centre for Health Education. Leading health nongovernmental organizations, such as the German Coalition against Smoking, have given strong support and cooperation and financial assistance has come from the Federal Government, which regarded the Campaign as a useful platform for conveying to the public messages on smoking cessation, passive smoking, tobacco taxation, tobacco advertising and under-age smoking.

The content of the campaign was adapted during the design phase to reflect the German context and strengthened with local innovations such as the introduction of the helper contest where participating smokers could nominate a helper – typically a nonsmoker – who helped to motivate the participants during the Campaign and who were also eligible to win the financial prizes offered to the participating smokers, provided the smoker they supported stopped smoking. This innovation gave additional support to participating smokers and broadened the audience to include nonsmokers.

A further innovation was the incorporation of media advocacy, involving media partners as well as partners from medical and educational fields, who provided support from own resources.

Various channels were used to promote the campaign. For example, in 2000, 2002 and 2004, 145 000 “action packets”, each containing 50 entry forms, posters and stickers, were sent to pharmacies, physicians, clinics, companies and educational facilities, which distributed them to a wide audience.

Advocacy in newspapers and magazines and on television and radio raised public awareness.

The 2002 and 2004 campaigns were covered by around 1100 print articles with over 200 million copies of the printed material distributed. These campaigns also reached around 78.6 million viewers through 170 television reports. Further dissemination was achieved through 150 radio reports, 8 press conferences, 17 press releases and 27 press agency reports. In total, the Quit &

Win Campaign was covered in 159 television and 101 radio programmes.

The internet was the most commonly used means for signing up participants. In 2004, 48 979 of the 90 184 participants signed up via the internet. The campaign web site was visited by over 1 million people the during the five-month campaign period. Internet service providers such as Yahoo™ and Google™ supported the initiative by installing banners and links to the campaign web site and by reporting it in weekly columns.

Impact of the campaign

Of the smokers who quit during the 2000, 2002 and 2004 campaigns, 30%, 22% and 32%, respectively, had managed to remain smoke-free one year after stopping, while 70% managed to abstain for one month: rates similar to those observed in campaigns in other countries. Overall, as a result of these three campaigns, an estimated 59 000 new former smokers had not relapsed one year after the campaign.

In addition to the measurable effects on public awareness of smoking, “Rauchfrei”, through its effective media advocacy which led to sustained and high-volume media coverage, contributed to creating the perception that smoking was not the norm and was socially unacceptable.

The German Quit & Win team succeeded in creating a large health communication network with several thousand organizations actively contributing to smoking cessation campaigns.

Lessons and conclusions

The Quit & Win campaign has been successfully implemented in Germany with high participation rates among smokers combined with high abstinence rates after the end of the competition, which has led to a substantial public impact. The campaign has also brought the importance of tobacco control higher up the public agenda.

The campaign was widely accepted by the public as it was perceived to have a positive stance towards smokers who wanted to stop rather than being a campaign against smokers. This positive approach also encouraged the engagement of journalists and helped to promote the campaign, which was critically important for media advocacy as there was no budget for advertising.

The campaign has proved to be a practical, cost-effective evidence-based method of smoking cessation for population-wide public health use, which can reach out to a large number of smokers at low cost. By inviting smokers to take the opportunity of trying to stop smoking for a limited period and nonsmokers to give them active support, it has brought both groups together in the fight against tobacco.

Critical success factors which have helped in the roll-out of the initiative in Germany have included the introduction of “helpers”, the engagement of journalists and the wide support of the media.

The campaign has raised public attention about tobacco control issues and provided much-needed recognition for the anti-tobacco movement by generating positive publicity and media interest in smoking-related issues. It has created opportunities for coalition-building and helped in the development of partnerships and collaboration between government departments,

nongovernmental organizations and commercial organizations active against tobacco.

The International Quit & Win office reported that 700 000 smokers in 84 countries participated in 2006.