1. What We Have Learned: Pharmaceutical Wrap-Around Programs Victor J. Strecher, PhD, MPH Professor and Director Center for Health Communications Research School of Public Health University of Michigan Founder and Chairman HealthMedia, Inc.

2. * OTC use=85%; prescription use=15% of medication use Percent of quitters who use each cessation therapy and long-term quit rates among those who use the therapy. Hughes JR. Motivating and helping smokers to stop smoking. Journal of General Internal Medicine 2003; 18:1053-1057

3. crossing the chasm

4. Adoption Reach Efficacy Maintenance Implementation

5. crossing the chasm Data Production Measures Prototypes Analysis Validity Operations Tech support Design Regulatory

6. R each E fficacy A doption I mplementation M aintenance (ROI?)(turn-key?)(scalable?) Estimated status of behavioral wrap-arounds to pharmacological smoking cessation products (RE-AIM criteria).

7. R each E fficacy A doption I mplementation M aintenance Group counseling  (ROI?)(turn-key?)(scalable?) Estimated status of behavioral wrap-arounds to pharmacological smoking cessation products (RE-AIM criteria).

8. R each E fficacy A doption I mplementation M aintenance Untailored print  Group counseling  (turn-key?)(scalable?) Estimated status of behavioral wrap-arounds to pharmacological smoking cessation products (RE-AIM criteria). (ROI?) 

9. R each E fficacy A doption I mplementation M aintenance Untailored print  Group counseling  Clinician counseling (turn-key?)(scalable?)  Estimated status of behavioral wrap-arounds to pharmacological smoking cessation products (RE-AIM criteria). (ROI?) 

10. R each E fficacy A doption I mplementation M aintenance Untailored print  Group counseling  Clinician counseling Proactive telephonic  (turn-key?)(scalable?)  Estimated status of behavioral wrap-arounds to pharmacological smoking cessation products (RE-AIM criteria). (ROI?) 

11. R each E fficacy A doption I mplementation M aintenance Untailored print  Group counseling  Clinician counseling Reactive telephonic  Proactive telephonic  (turn-key?)(scalable?)  Estimated status of behavioral wrap-arounds to pharmacological smoking cessation products (RE-AIM criteria). (ROI?)  

12. R each E fficacy A doption I mplementation M aintenance Untailored print  Group counseling  Tailored print   Clinician counseling Reactive telephonic  Proactive telephonic  (turn-key?)(scalable?)  Estimated status of behavioral wrap-arounds to pharmacological smoking cessation products (RE-AIM criteria). (ROI?)  

13. R each E fficacy A doption I mplementation M aintenance Untailored print  IVR  Group counseling  Tailored print   Clinician counseling Reactive telephonic  Proactive telephonic  (turn-key?)(scalable?)  Estimated status of behavioral wrap-arounds to pharmacological smoking cessation products (RE-AIM criteria). (ROI?)   

14. R each E fficacy A doption I mplementation M aintenance Untailored print  IVR  Public web  Group counseling  Tailored print   Clinician counseling Reactive telephonic  Proactive telephonic   (turn-key?)(scalable?)  Estimated status of behavioral wrap-arounds to pharmacological smoking cessation products (RE-AIM criteria). (ROI?)   

15. R each E fficacy A doption I mplementation M aintenance Untailored print  IVR  Public web  Branded web   Group counseling  Tailored print   Clinician counseling Reactive telephonic  Proactive telephonic   (ROI?)(turn-key?)(scalable?)  Estimated status of behavioral wrap-arounds to pharmacological smoking cessation products (RE-AIM criteria).   

16. 0.60.81.01.21.41.61.82.02.22.42.62.8 0.4 NRT+Tailored web (n=3501; Strecher et al, 2005) 3 mo (10wk ca): 23% vs 18% NRT+Tailored print (n=3683; Shiffman et al, 2001) 3 mo (10wk ca): 18% vs 11% NRT+Tailored print (n=2424; Shiffman et al, 2000) 3 mo (10wk ca): 28% vs 18% NRT+Telecounseling (n=330; Solomon et al, 2005) 6 mo (7 day pp): 38% vs 30% NRT+Telecounseling (n=214; Solomon et al, 2000) 6 mo (7 day pp): 23% vs 19% NRT+Telecounseling (n=380; Ockene et al, 1991) 6 mo (7 day pp): 18% vs 15% NRT+Telecounseling (n=336; Lando et al, 1997) 6 mo (7 day pp): 25% vs 23% NRT+Untailored print (n=522; Fortmann & Killen, 1995) 6 mo (7 day pp): 28% vs 26% NRT+Untailored print (n=303; Lando et al, 1988) 6 mo NRT+Video (n=424; Killen et al, 1997) 6 mo 7 day pp): 16% vs 25% Comparison of behavior adjuncts to nicotine replacement therapy (odds ratios): 2.04 [1.49-2.81] 1.78 [1.28-2.48] 1.14 [0.69-1.87] 1.01 [0.66-1.54] 0.82 [0.47-1.44] 0.60 [0.36-0.99] 1.23 [0.68-2.22] 1.29 [0.66-2.50] 1.42 [0.90-2.24] Behavioral adjunct 1.34 [1.13-1.58]

17. Outcome expectations Efficacy expectations BEHAVIORPERSONOUTCOME

18. Perceived competence It is difficult for me to find effective solutions to the problems that come my way. (reversed) Typically, my plans don't work out well. (reversed) I succeed in the projects I undertake. I am able to do things as well as most other people.

19. Abstinence at 6 month follow-up by shallow versus deeply tailored self-efficacy messages, stratified by perceived competence. Test of shallow tailoring sub-group: OR=1.66 (95% CI=1.07-2.60) p<.05. Test of interaction: OR=1.70 (95% CI=0.92-3.15) p<.10. PRELIMINARY DATA Efficacy Expectation Messages 6-month abstinence

20. Abstinence at 6 month follow-up by shallow versus deeply tailored outcome messages, stratified by perceived competence. Test of shallow tailoring sub-group: OR=1.87 (95% CI=1.19-2.97) p<.01. Test of interaction: OR=2.05 (95% CI=1.11-3.84) p<.05. PRELIMINARY DATA Outcome Expectation Messages 6-month abstinence

21. “The best way to predict the future is to invent it.” Alan Kay Promote reach via media (e.g., inclusion in product advertising; periodically offering the program for free). Promote reach by creating stand-alone program that smokers pay for. Enhances perceived value. Increases ROI Improve the value of the program to the consumer through program enhancements. Conclusions

22. Thank you Victor J. Strecher, PhD, MPH Professor and Director Center for Health Communications Research School of Public Health University of Michigan Founder and Chairman HealthMedia, Inc.