Measuring Response to a Cancer Information Telephone Facility: Can-Dial GREGG S. WILKINSON, PHD, EDWIN A. MIRAND, PHD, DSC AND SAXON GRAHAM, PHD
Abstract: In an attempt to meet the need for increasing public knowledge about cancer, a system providing free information by telephone has been developed. The system is comprised of 36 pre-recorded taped lectures containing information about various aspects of cancer. Interested individuals call a toll-free number, indicate a topic of interest, and listen to the pre-recorded lecture over the phone. An operator handles incoming calls and obtains information from callers used in evaluating the program. During the first year of operation, over 30,000 calls were processed. Topics most frequently requested included those con-
cerning smoking, breast and cervical cancer, and general information. Female response exceeded male response in all age categories. Older people responded less frequently than younger. Urban utilization greatly exceeded suburban and rural utilization. Considerable fluctuation in response related to promotional activities was found. Printed advertisements elicited far greater response than radio and television. Promotional efforts in an experimental group of low-utilizing townships greatly increased utilization while no change was observed in a control group. (Am. J. Public Health 66:367-371, 1976)
Several types of cancer can be controlled either by means of improved preventive behavior or by early diagnosis and therapy. For instance, lung cancer, the leading cause of cancer-related deaths among men' could be greatly reduced if individuals would limit or cease their smoking.2 Mortality from breast cancer, the leading cause of female cancer deaths, might be reduced through earlier diagnosis. The same also applies to cervical cancer via increased use of routine Papanicolaou smears, and colon and rectal cancer if diagnostic methods such as proctosigmoidoscopy were more frequently employed.2 High mortality for these diseases results largely from disuse of rather than unavailability of tech-
Can-Dial
niques for control. One approach in improving health behavior on the part of individuals is to increase public awareness, interest, and knowledge about cancer etiology, prevention, and diagnosis. In an attempt to meet this challenge, Can-Dial, a telephone education program which offers information about cancer to the public has been developed at Roswell Park Memorial Institute. Address reprint requests to Dr. Gregg S. Wilkinson, Cancer Control Program, Roswell Park Memorial Institute, 666 Elm Street, Buffalo, NY 14263. Dr. Wilkinson is Senior Research Scientist, Roswell Park Memorial Institute; Dr. Mirand is Associate Director, Roswell Park Memorial Institute; Dr. Graham is Professor, State University of New York at Buffalo, and Principal Scientist, Roswell Park Memorial Institute. This project was supported in part by NCI Contract N01-CN-45073. Submitted to the Journal July 2, 1975, this paper was revised and accepted for publication on November 12, 1975.
AJPH, April, 1976, Vol. 66, No. 4
The Can-Dial program consists of a library of 36 brief, prerecorded lectures in English about cancer; 28 of these are also available in Spanish. The original library of 28 tapes was expanded to its present size as a result of public interest. The length of various lectures varies from just under one minute to approximately seven minutes. Four telephone lines connected to a recording and playback console managed by a telephone operator are maintained. The program is in operation 16 hours a day, seven days a week. Members of the community may call toll-free to request the topic desired from an operator, who then selects the proper cassette and activates the playback mechanism.3 Although dial access programs have been tried before4-6 this is a first attempt to offer cancer-specific information on such a large scale to the general public. First year costs totaled $47,581, including salaries for two full-time and two part-time telephone operators, equipment rental and maintenance, supplies and indirect costs. This figure does not contain expenses incurred in conducting a large scale evaluation of the project or the voluntary support of cooperating physicians. A major rationale for this program is to increase public knowledge and awareness of cancer in upstate New York. Another goal is to develop and evaluate approaches which can be applied to cancer education efforts in any community. Consequently, a systematic assessment is being conducted to determine patterns of use, characteristics of users, and user motivation, as well as program impact. The focus of this paper is to evaluate findings to date. 367
WILKINSON ET AL.
Methods Two types of evaluation are being conducted: (1) to examine trends in response and traits of users as compared to the general population, and (2) to assess improvements in cancer control behavior evinced by users as compared to non-users. All callers are asked to give their names, occupations, ages, addresses, and source of information about CanDial. The date, time of each call, and topic requested are also recorded. Socioeconomic status and type of residence is determined from census tract of address. This enables us to test hypotheses suggested by previous research.7 Since young people have been shown to adopt new behavior patterns more readily, we hypothesized greater response from this age-group.8 9 Because females often are oriented more than males to family health matters, we anticipated greater female response.8 Earlier research has noted the value of mass media in increasing awareness of an innovation, and we wish to examine the relationship between Can-Dial response and promotion by radio and television. Furthermore, we hypothesized that printed brochures providing the Can-Dial telephone number and subjects offered would increase response since individuals would thus have continued access to the phone number, repeated exposures to information contained in the printed message, and could respond at their convenience. Some studies have shown greater use of public health facilities by upper socioeconomic classes, supposedly because of superior health training and more diversified exposure to communications media. On the other hand, some studies show no difference or difference in the opposite direction, perhaps because there are no longer great differences in health training and media exposure by social class.9-1' Urbanites traditionally are considered more accepting of innovations than rural dwellers, perhaps because of more contact with media. For these reasons, we wanted to examine the relation between response, residence, and socioeconomic background.
Findings Time Trends
Monitoring of all calls has been conducted continuously since April 15, 1974. During its first year, the Can-Dial program received 30,135 calls. In response, a total of 27,504 tapes were played. The discrepancy between calls received and tapes played is due to calls requesting untaped information, wrong numbers, or crank calls. Eight per cent of total calls have been from individuals who dialed the wrong number or who requested information not available on tape. Another 11 per cent hung up before making a request. Of the remaining calls, 27 per cent were from persons who had called upon an earlier occasion. It should be kept in mind that analyses discussed subsequently deal with numbers of calls, not callers. We plan later to examine individuals making multiple calls as compared to those making only one. Monthly response increased gradually from the beginning of operations to a peak of over 3,000 calls for the 368
months of August through January (with the exception of December), and a decline in response during February and March. These monthly fluctuations may be related to a number of influences including timing of promotional efforts, increased public knowledge about the service, as well as holidays and vacation periods. During the first four months, public knowledge of Can-Dial was minimal. An increase in response during August coincides with the beginning of free, community-wide distribution of a classified telephone directory which contained a large advertisement about Can-Dial. Furthermore, by August, promotional efforts may have increased public knowledge about the program. A drop in response during December is perhaps related to the holiday season. Finally, the decline during February and March may be due to a decrease in promotional activities as part of an experiment designed to assess their impact. This will be discussed later. Daily and Hourly Fluctuations Consistent fluctuations by day and hour have been experienced. We have found response to be low on Mondays, to increase to a peak on Wednesdays, and gradually to decrease to the lowest level on Sundays. It is interesting that response was highest during the middle of the work week, lower during the beginning and end of the work week, and lowest during the weekend. A distinct tendency exists for hourly response to start low during the beginning of a day's operation, gradually increase to the middle of the day, and taper off during the later hours. Slight decreases occur around meal times. Hourly and daily response patterns provide clues for planning staff-ing needs, improving the cost-benefit ratio in scheduling operators, and determining times for conducting telephone in-
terviews. Topics Requested The most popular topic concerns quitting smoking. It was requested almost twice as often as the second most popular tape. In fact, four of the ten subjects chosen most frequently concern smoking. The second most frequently selected topic concerns breast cancer. It is interesting that tapes dealing with common female sites of cancer all are frequently requested subjects. However, for males, only two of the five sites responsible for the greatest cancer mortality are frequently chosen: lung cancer and large bowel cancer. The other leading male cancers: prostate, pancreas, and stomach were among the 14 least requested topics. Source of Information
Understanding the caller's source of information about Can-Dial prior to his call allows us to compare the effectiveness of different modes of promotion and tells us something about communication within the community. The greatest number of callers reported learning of Can-Dial from brochures which describe the program and list topics offered as well as the phone number. Brochures were given to supermarkets, stores, banks, churches, hospitals, libraries, and drug stores for public distribution. The White Directory, a classified telephone directory, was the second most freAJPH, April, 1976, Vol. 66, No. 4
CAN-DIAL TABLE 1-Topics According To Popularity 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28.
If You Want To Give Up Cigarettes Cancer of the Breast-and How to Detect It The Effect of Cigarette Smoking on the Non-Smoker Cancer's Warning Signals What is Cancer? Lung Cancer Cancer of the Uterus Cancer of the Colon and Rectum Hodgkin's Disease Cigarette Smoking and the Pregnant Woman What is the Pap Test-How Can It Help You? Leukemia Cancer of the Skin Cancer of the Brain Cancer of the Stomach Cancer of the Bone Cancer of the Mouth Chemotherapy: Drugs vs Cancer Cancer of the Larynx Cancer of the Bladder Cigarette Smoking and Dental Problems Cancer of the Prostate Cancer of the Liver What is the Roswell Park Memorial Institute? Words From a Hospital Chaplain Radiation Therapy in Cancer Treatment Cancer of the Pancreas Service and Rehabilitation Information for Cancer Patients and Their Families
quently mentioned source, followed by television and radio, information distributed in schools, friends and relatives, with printed sources such as newspapers being cited least often. A possible explanation for these patterns may lie in the time required for a potential caller to become aware of the program, digest the information offered, find it to be of interest, and then contact the service. Brochures and the White Directory provide a record of the Can-Dial phone number and enable one to call when it is convenient, whereas television and radio messages require almost instantaneous action on the listener's part. Examination of response in relation to timing of electronic media advertisements provides support for this explanation. We have been unable to account for all response peaks during a typical day, because of the inability of some television and most radio stations to document when Can-Dial advertisements were broadcast. But we have been able to document the hourly effect of those television ads whose time we can verify. Usually, a television advertisement results in an immediate flurry of calls which taper off within an hour. Age and Sex of Caller The greatest number of calls came from young females; young males accounted for the second highest number. Among females, those age 20 to 39 called most frequently, followed respectively by those under 20, 40 to 59, and 60 years and over. For males, the greatest number of calls came from those under 20 years and decreased steadily with age. The high response by males under age 20 probably reflects their interest in smoking as well as the influence of schools in AJPH, April, 1976, Vol. 66, No. 4
motivating individuals to call. Use was less frequent among the elderly, with both males and females over age 60 calling the least. It is clear that efforts should be expanded in the direction of informing older individuals, those at highest cancer risk, about Can-Dial. Socioeconomic Status Although enough information is not collected at the time of a call to devise a precise measure of socioeconomic status, we are able to derive an estimate from the caller's address. This is accomplished by locating a respondent's residence within a census tract, examining median family income in these census tracts, and assigning each to a socioeconomic status category. By arranging census tracts from high to low median income, grouping them in sextiles for the Buffalo-Lackawanna urban area and quartiles for both the first ring suburbs and for outer ring exurbs, we can assign a rough approximation of a respondent's status from his census tract of residence. It was hypothesized that response would vary among social strata. The hypothesis is confirmed, but differences are small. The largest difference in the Buffalo area exists between sextile 2 with a rate of 60.99 calls per 10,000 population and sextile 6 with a rate of 53.24. Similar small socioeconomic differences occurred in the city, suburbs, and exurbs. The decreasing response as one proceeds out of the central metropolitan area to the suburbs and rural areas is much more striking and much greater than that between upper and lower socioeconomic categories. Somewhat surprising is the high response among quartiles 3 in the first and outer ring areas, and sextile 5 in the Buffalo-Lackawanna region. This indicates that lower middle classes are responding well to this program, perhaps even better than upper middle or, in some cases, upper status groups. It may be of more significance for planning an information-dispensing program that upper class suburban areas have responded less well than even the lower class urban areas. Although no tolls are charged for calls from any of these areas, those at greater distances from the central cities responded less well. Township of Residence Considerable variation among Niagara frontier townships was discovered. The Erie County suburb of Orchard Park demonstrated the greatest response, with a rate of 154 TABLE 2-Response per 10,000 by Social Status within Buffalo, Suburbs, and Exurbs, May through October, 1974
Buffalo-Lackawanna
First Ring Suburbs
(Sextile)
(Quartile)
N =2809
N =2022
1 11 III IV V VI Total
60.90 60.99 55.65 56.71 59.23 53.24 57.71
1 11 III IV
Outer Ring Exurbs (Quartile) N =474 1 28.98 11 30.28 III 34.79
46.74 44.57 49.37 37.42
IV 18.93
44.64
28.03
369
WILKINSON ET AL.
shows what we have already observed: a decrease from urban to suburban to rural areas. An Experiment in Promotion and Response
The variation in utilization rates among towns and municipalities suggested the need for inquiry into the consistently poor response in certain of them. As a result we designed an experiment to increase and measure response in certain areas. One suburban and two rural townships of relatively low response (Clarence, Evans, and Brant) were selected to be the experimental area of a promotional campaign. Another suburban and two other rural townships (Cheektowaga, Alden, and Marilla) having a similar low response were selected as controls in which no promotional efforts were conducted. Television and radio announcements continued as usual. During the month of January, 1975, those towns comprising the experimental group were subjected to a high saturation promotional effort. All grocery stores, pharmacies, banks, etc., were asked to display Can-Dial brochures. Brochures were also given to schools and students asked to distribute them to their parents. Ads describing Can-Dial were run in all local newspapers. These activities ceased at the end of January. Utilization rates for the experimental towns were then compared with those of the control group for the month preceding the campaign, the month of the campaign, and the month following the campaign. As demonstrated by Figure 2, calls from the three experimental towns increased dramatically during the month of the campaign and remained higher after the campaign than before. In contrast, response in the control group did not change significantly. This simple experiment suggests that response is closely
FIGURE 1-Source of Information about Can-Dial as Reported by Respondents: May through October, 1974.
per 10,000 population. Lowest response came from the Cattaraugus Indian Reservation and the town of Collins in Southern Erie County. The high response from Orchard Park residents may be partly derived from the interest Orchard Park Schools demonstrated toward the Can-Dial Program. In general, response among political subdivisions MONTH BEFORE CAMPAIGN
MONTH OF CAM PAIGN
MONTH AFTER CAMPAIGN
DECEMBER
JANUARY
FEBRUARY
240 220 o 200
Abstract: In an attempt to meet the need for increasing public knowledge about cancer, a system providing free information by telephone has been developed. The system is comprised of 36 pre-recorded taped lectures containing information about various aspects of cancer. Interested individuals call a toll-free number, indicate a topic of interest, and listen to the pre-recorded lecture over the phone. An operator handles incoming calls and obtains information from callers used in evaluating the program. During the first year of operation, over 30,000 calls were processed. Topics most frequently requested included those con-
cerning smoking, breast and cervical cancer, and general information. Female response exceeded male response in all age categories. Older people responded less frequently than younger. Urban utilization greatly exceeded suburban and rural utilization. Considerable fluctuation in response related to promotional activities was found. Printed advertisements elicited far greater response than radio and television. Promotional efforts in an experimental group of low-utilizing townships greatly increased utilization while no change was observed in a control group. (Am. J. Public Health 66:367-371, 1976)
Several types of cancer can be controlled either by means of improved preventive behavior or by early diagnosis and therapy. For instance, lung cancer, the leading cause of cancer-related deaths among men' could be greatly reduced if individuals would limit or cease their smoking.2 Mortality from breast cancer, the leading cause of female cancer deaths, might be reduced through earlier diagnosis. The same also applies to cervical cancer via increased use of routine Papanicolaou smears, and colon and rectal cancer if diagnostic methods such as proctosigmoidoscopy were more frequently employed.2 High mortality for these diseases results largely from disuse of rather than unavailability of tech-
Can-Dial
niques for control. One approach in improving health behavior on the part of individuals is to increase public awareness, interest, and knowledge about cancer etiology, prevention, and diagnosis. In an attempt to meet this challenge, Can-Dial, a telephone education program which offers information about cancer to the public has been developed at Roswell Park Memorial Institute. Address reprint requests to Dr. Gregg S. Wilkinson, Cancer Control Program, Roswell Park Memorial Institute, 666 Elm Street, Buffalo, NY 14263. Dr. Wilkinson is Senior Research Scientist, Roswell Park Memorial Institute; Dr. Mirand is Associate Director, Roswell Park Memorial Institute; Dr. Graham is Professor, State University of New York at Buffalo, and Principal Scientist, Roswell Park Memorial Institute. This project was supported in part by NCI Contract N01-CN-45073. Submitted to the Journal July 2, 1975, this paper was revised and accepted for publication on November 12, 1975.
AJPH, April, 1976, Vol. 66, No. 4
The Can-Dial program consists of a library of 36 brief, prerecorded lectures in English about cancer; 28 of these are also available in Spanish. The original library of 28 tapes was expanded to its present size as a result of public interest. The length of various lectures varies from just under one minute to approximately seven minutes. Four telephone lines connected to a recording and playback console managed by a telephone operator are maintained. The program is in operation 16 hours a day, seven days a week. Members of the community may call toll-free to request the topic desired from an operator, who then selects the proper cassette and activates the playback mechanism.3 Although dial access programs have been tried before4-6 this is a first attempt to offer cancer-specific information on such a large scale to the general public. First year costs totaled $47,581, including salaries for two full-time and two part-time telephone operators, equipment rental and maintenance, supplies and indirect costs. This figure does not contain expenses incurred in conducting a large scale evaluation of the project or the voluntary support of cooperating physicians. A major rationale for this program is to increase public knowledge and awareness of cancer in upstate New York. Another goal is to develop and evaluate approaches which can be applied to cancer education efforts in any community. Consequently, a systematic assessment is being conducted to determine patterns of use, characteristics of users, and user motivation, as well as program impact. The focus of this paper is to evaluate findings to date. 367
WILKINSON ET AL.
Methods Two types of evaluation are being conducted: (1) to examine trends in response and traits of users as compared to the general population, and (2) to assess improvements in cancer control behavior evinced by users as compared to non-users. All callers are asked to give their names, occupations, ages, addresses, and source of information about CanDial. The date, time of each call, and topic requested are also recorded. Socioeconomic status and type of residence is determined from census tract of address. This enables us to test hypotheses suggested by previous research.7 Since young people have been shown to adopt new behavior patterns more readily, we hypothesized greater response from this age-group.8 9 Because females often are oriented more than males to family health matters, we anticipated greater female response.8 Earlier research has noted the value of mass media in increasing awareness of an innovation, and we wish to examine the relationship between Can-Dial response and promotion by radio and television. Furthermore, we hypothesized that printed brochures providing the Can-Dial telephone number and subjects offered would increase response since individuals would thus have continued access to the phone number, repeated exposures to information contained in the printed message, and could respond at their convenience. Some studies have shown greater use of public health facilities by upper socioeconomic classes, supposedly because of superior health training and more diversified exposure to communications media. On the other hand, some studies show no difference or difference in the opposite direction, perhaps because there are no longer great differences in health training and media exposure by social class.9-1' Urbanites traditionally are considered more accepting of innovations than rural dwellers, perhaps because of more contact with media. For these reasons, we wanted to examine the relation between response, residence, and socioeconomic background.
Findings Time Trends
Monitoring of all calls has been conducted continuously since April 15, 1974. During its first year, the Can-Dial program received 30,135 calls. In response, a total of 27,504 tapes were played. The discrepancy between calls received and tapes played is due to calls requesting untaped information, wrong numbers, or crank calls. Eight per cent of total calls have been from individuals who dialed the wrong number or who requested information not available on tape. Another 11 per cent hung up before making a request. Of the remaining calls, 27 per cent were from persons who had called upon an earlier occasion. It should be kept in mind that analyses discussed subsequently deal with numbers of calls, not callers. We plan later to examine individuals making multiple calls as compared to those making only one. Monthly response increased gradually from the beginning of operations to a peak of over 3,000 calls for the 368
months of August through January (with the exception of December), and a decline in response during February and March. These monthly fluctuations may be related to a number of influences including timing of promotional efforts, increased public knowledge about the service, as well as holidays and vacation periods. During the first four months, public knowledge of Can-Dial was minimal. An increase in response during August coincides with the beginning of free, community-wide distribution of a classified telephone directory which contained a large advertisement about Can-Dial. Furthermore, by August, promotional efforts may have increased public knowledge about the program. A drop in response during December is perhaps related to the holiday season. Finally, the decline during February and March may be due to a decrease in promotional activities as part of an experiment designed to assess their impact. This will be discussed later. Daily and Hourly Fluctuations Consistent fluctuations by day and hour have been experienced. We have found response to be low on Mondays, to increase to a peak on Wednesdays, and gradually to decrease to the lowest level on Sundays. It is interesting that response was highest during the middle of the work week, lower during the beginning and end of the work week, and lowest during the weekend. A distinct tendency exists for hourly response to start low during the beginning of a day's operation, gradually increase to the middle of the day, and taper off during the later hours. Slight decreases occur around meal times. Hourly and daily response patterns provide clues for planning staff-ing needs, improving the cost-benefit ratio in scheduling operators, and determining times for conducting telephone in-
terviews. Topics Requested The most popular topic concerns quitting smoking. It was requested almost twice as often as the second most popular tape. In fact, four of the ten subjects chosen most frequently concern smoking. The second most frequently selected topic concerns breast cancer. It is interesting that tapes dealing with common female sites of cancer all are frequently requested subjects. However, for males, only two of the five sites responsible for the greatest cancer mortality are frequently chosen: lung cancer and large bowel cancer. The other leading male cancers: prostate, pancreas, and stomach were among the 14 least requested topics. Source of Information
Understanding the caller's source of information about Can-Dial prior to his call allows us to compare the effectiveness of different modes of promotion and tells us something about communication within the community. The greatest number of callers reported learning of Can-Dial from brochures which describe the program and list topics offered as well as the phone number. Brochures were given to supermarkets, stores, banks, churches, hospitals, libraries, and drug stores for public distribution. The White Directory, a classified telephone directory, was the second most freAJPH, April, 1976, Vol. 66, No. 4
CAN-DIAL TABLE 1-Topics According To Popularity 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28.
If You Want To Give Up Cigarettes Cancer of the Breast-and How to Detect It The Effect of Cigarette Smoking on the Non-Smoker Cancer's Warning Signals What is Cancer? Lung Cancer Cancer of the Uterus Cancer of the Colon and Rectum Hodgkin's Disease Cigarette Smoking and the Pregnant Woman What is the Pap Test-How Can It Help You? Leukemia Cancer of the Skin Cancer of the Brain Cancer of the Stomach Cancer of the Bone Cancer of the Mouth Chemotherapy: Drugs vs Cancer Cancer of the Larynx Cancer of the Bladder Cigarette Smoking and Dental Problems Cancer of the Prostate Cancer of the Liver What is the Roswell Park Memorial Institute? Words From a Hospital Chaplain Radiation Therapy in Cancer Treatment Cancer of the Pancreas Service and Rehabilitation Information for Cancer Patients and Their Families
quently mentioned source, followed by television and radio, information distributed in schools, friends and relatives, with printed sources such as newspapers being cited least often. A possible explanation for these patterns may lie in the time required for a potential caller to become aware of the program, digest the information offered, find it to be of interest, and then contact the service. Brochures and the White Directory provide a record of the Can-Dial phone number and enable one to call when it is convenient, whereas television and radio messages require almost instantaneous action on the listener's part. Examination of response in relation to timing of electronic media advertisements provides support for this explanation. We have been unable to account for all response peaks during a typical day, because of the inability of some television and most radio stations to document when Can-Dial advertisements were broadcast. But we have been able to document the hourly effect of those television ads whose time we can verify. Usually, a television advertisement results in an immediate flurry of calls which taper off within an hour. Age and Sex of Caller The greatest number of calls came from young females; young males accounted for the second highest number. Among females, those age 20 to 39 called most frequently, followed respectively by those under 20, 40 to 59, and 60 years and over. For males, the greatest number of calls came from those under 20 years and decreased steadily with age. The high response by males under age 20 probably reflects their interest in smoking as well as the influence of schools in AJPH, April, 1976, Vol. 66, No. 4
motivating individuals to call. Use was less frequent among the elderly, with both males and females over age 60 calling the least. It is clear that efforts should be expanded in the direction of informing older individuals, those at highest cancer risk, about Can-Dial. Socioeconomic Status Although enough information is not collected at the time of a call to devise a precise measure of socioeconomic status, we are able to derive an estimate from the caller's address. This is accomplished by locating a respondent's residence within a census tract, examining median family income in these census tracts, and assigning each to a socioeconomic status category. By arranging census tracts from high to low median income, grouping them in sextiles for the Buffalo-Lackawanna urban area and quartiles for both the first ring suburbs and for outer ring exurbs, we can assign a rough approximation of a respondent's status from his census tract of residence. It was hypothesized that response would vary among social strata. The hypothesis is confirmed, but differences are small. The largest difference in the Buffalo area exists between sextile 2 with a rate of 60.99 calls per 10,000 population and sextile 6 with a rate of 53.24. Similar small socioeconomic differences occurred in the city, suburbs, and exurbs. The decreasing response as one proceeds out of the central metropolitan area to the suburbs and rural areas is much more striking and much greater than that between upper and lower socioeconomic categories. Somewhat surprising is the high response among quartiles 3 in the first and outer ring areas, and sextile 5 in the Buffalo-Lackawanna region. This indicates that lower middle classes are responding well to this program, perhaps even better than upper middle or, in some cases, upper status groups. It may be of more significance for planning an information-dispensing program that upper class suburban areas have responded less well than even the lower class urban areas. Although no tolls are charged for calls from any of these areas, those at greater distances from the central cities responded less well. Township of Residence Considerable variation among Niagara frontier townships was discovered. The Erie County suburb of Orchard Park demonstrated the greatest response, with a rate of 154 TABLE 2-Response per 10,000 by Social Status within Buffalo, Suburbs, and Exurbs, May through October, 1974
Buffalo-Lackawanna
First Ring Suburbs
(Sextile)
(Quartile)
N =2809
N =2022
1 11 III IV V VI Total
60.90 60.99 55.65 56.71 59.23 53.24 57.71
1 11 III IV
Outer Ring Exurbs (Quartile) N =474 1 28.98 11 30.28 III 34.79
46.74 44.57 49.37 37.42
IV 18.93
44.64
28.03
369
WILKINSON ET AL.
shows what we have already observed: a decrease from urban to suburban to rural areas. An Experiment in Promotion and Response
The variation in utilization rates among towns and municipalities suggested the need for inquiry into the consistently poor response in certain of them. As a result we designed an experiment to increase and measure response in certain areas. One suburban and two rural townships of relatively low response (Clarence, Evans, and Brant) were selected to be the experimental area of a promotional campaign. Another suburban and two other rural townships (Cheektowaga, Alden, and Marilla) having a similar low response were selected as controls in which no promotional efforts were conducted. Television and radio announcements continued as usual. During the month of January, 1975, those towns comprising the experimental group were subjected to a high saturation promotional effort. All grocery stores, pharmacies, banks, etc., were asked to display Can-Dial brochures. Brochures were also given to schools and students asked to distribute them to their parents. Ads describing Can-Dial were run in all local newspapers. These activities ceased at the end of January. Utilization rates for the experimental towns were then compared with those of the control group for the month preceding the campaign, the month of the campaign, and the month following the campaign. As demonstrated by Figure 2, calls from the three experimental towns increased dramatically during the month of the campaign and remained higher after the campaign than before. In contrast, response in the control group did not change significantly. This simple experiment suggests that response is closely
FIGURE 1-Source of Information about Can-Dial as Reported by Respondents: May through October, 1974.
per 10,000 population. Lowest response came from the Cattaraugus Indian Reservation and the town of Collins in Southern Erie County. The high response from Orchard Park residents may be partly derived from the interest Orchard Park Schools demonstrated toward the Can-Dial Program. In general, response among political subdivisions MONTH BEFORE CAMPAIGN
MONTH OF CAM PAIGN
MONTH AFTER CAMPAIGN
DECEMBER
JANUARY
FEBRUARY
240 220 o 200
