PoPulationand Public HealtH etHics

practice
or equitably reaching your population. These decisions reflect, in part, the
value placed on different ethical principles.
Case
One health department questioned if the “Quit and Win” program was the
best use of resources. Staff followed an evidence-informed approach to defining
the question, seeking out and appraising studies and considering the
studies’ applicability to their region. A high-quality, systematic review by Cahill
and Perera 4 on “Quit and Win” contests for smoking cessation informed
the practice question.
The review showed the overall effects of contests on community prevalence
of smoking were small, with 1 in 556 smokers expected to quit for 12 months
as a result of the contest. In the case region, 1,572 of 170,500 smokers had
signed up in the past year. Study participants were predominately middle
class Caucasian females, while the region’s smokers were ethnically diverse
and mostly male.
Costs to the health department were about $40,000 per year for the campaign,
including promotion of the contest via newspaper advertising. Money
for the prizes (car, trips, and credit card gift cards) was donated by privatesector
sponsors.
Based on the research evidence and the low participation rates, the team decided
to forego the “Quit and Win” program and consider alternate uses of
the resources. This decision was communicated to the tobacco control community.
The health department is currently exploring the evidence for other
smoking cessation interventions, including building capacity with family
practitioners.
This case raises certain ethical issues:
1 Accountability, quality: Research supporting quit-and-win contests
exists, but is either of poor quality or has little applicability to the local
setting. This case raises a dilemma: the province encouraged the
program but the research suggested it would be ineffective. Is it the
responsibility of every local jurisdiction to critically assess evidence
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