Anti-smoking advertising: lessons learned

Melanie Wakefield
Director, Centre for Behavioural Research in Cancer, The Cancer Council Victoria

Anti-tobacco advertising

Melanie Wakefield explained that the prevalence of smoking in Australia began to plateau in the 1960s after the Royal College of Physicians and United States' Surgeon General's reports linked smoking with cancer.

In 1967 the Anti-Cancer Council of Victoria did an audit of what was on television in Melbourne, and found that:

One cigarette commercial was screened every 12 minutes on Melbourne evening television.
The themes of these advertisements included the different qualities of the products; for example, filters, mild, smooth, quality tobacco, taste flavour, king size, smoke all the time (day-time or night-time ... It's always the right time).

In 1971 the Anti-Cancer Council used television advertising to get a broadcast ban on tobacco advertising on the public and political agenda. One of the first anti-tobacco advertisements was created. This was the first time that Australians had seen an anti-tobacco ad, but the target was the policy makers as much as the public.

Broadcast cigarette advertising in Australia began to be phased out in 1973 and completed by 1976. In the United States they weren't able to get a broadcast ban but one anti-tobacco ad was required to be broadcast for every three tobacco ads from 1976. Over a period of a couple of years tobacco use declined so quickly that cigarette companies voluntarily withdrew their tobacco advertising.

Lessons

Anti-tobacco advertising can influence the tobacco policy agenda.
Anti-tobacco advertising competes favorably with tobacco advertising in reducing consumption.

The National Tobacco Campaign

During the 1980s various Australian states developed anti-smoking campaigns. The first campaign was run in Sydney in 1983 and Melbourne was used as a control. There were some favourable effects in Sydney so the campaign was moved to Melbourne. Subsequently, other states started their own campaigns.

The success of these campaigns led to further calls for a national campaign in Australia , and in 1997 the National Tobacco Campaign (NTC) was launched. This campaign was aimed at:

smokers aged 18–39 years
blue-collar workers.

Part of the development of the campaign was based on comments from smokers who were interviewed for previous Quit campaign research. These comments included:

I want to quit sometime. Most smokers regretted having started in the first place.
Tell me something new!
Shock me!

The communication brief included:

Put quitting onto today's agenda not sometime down the track.
Translate intention into action.
Actions (like quitting) that occur over time need resources and reinforcements .

The campaign was not just an advertising campaign but had a number of resources to help people with their quit attempt. One of the most important resources was the establishment of the national Quitline.

Anti-smoking advertisements need to stimulate a particular response from the smoker. Advertisements should include:

an empathy device—a smoker moment, a slightly self-deprecating moment that leads to the response, "That's me, I do that.", "The people behind this ad understand me."

a conditioning device—linking the act of smoking with some kind of damage
new news—information that smokers didn't know before, "This affects me and I did not know it"
certain effects rather than possible effects, "These are immediate and certain effects of smoking, not just a chance I take".

A fear-based campaign was linked with the help to quit. The various advertisements ran from May 1997 to December 1998 and there was a direct connection between the advertisements and calls to the Quitline. There was an immediate response to the advertisements with calls.

Population surveys occurred throughout the campaign:

baseline—May 1997 (artery, lung, tumour ads)
6-month follow-up—November 1997 (brain, call for help ads)
18-month follow-up—November 1998 (eye, tar ads)
3.5-year follow-up—November 2000.

Main findings after 6 months

Campaign was seen and recalled by a majority of smokers in the target group.
Campaign advertising was highly salient —especially the "artery" ad.
There were increases in ad-specific learning —54–83% agreed smoking blocks up arteries with fatty deposits.
There was a slight increase in the percentage who disagreed that health effects are exaggerated— 59–64%.
More people were thinking about quitting—thought about quitting at least daily (up 18% from baseline).
More people were trying to quit—tried to quit in last 2 weeks (3–6%).
More people had quit—quit in past year (8.3–11.4%).
Fewer people were smoking—smoking prevalence (23.5–22.1%).

Main findings after 18 months

Continued high recognition of ads by 87% of smokers and re cent quitters.
Reported new learning about health effects of smoking maintained.
Increases in getting help to quit in past 6 months:
– Quitline (2–5%)
– NRT (7–15%)
– reading how-to-quit literature (16–24%).
No further increases in intention to quit.
Maintained decrease in smoking prevalence, no further decline.

Main findings after 3.5 years

Continued high recognition of campaign advertising (88%).
Evidence of new learning related to new ad (especially "eye").
Continued increase in percentage disagreeing that the health effects of smoking are exaggerated.
Since 18 month follow-up , maintained percentage of smokers who say they will not be smoking a year from now.
Continued decline in smoking prevalence.

Confounding influences on prevalence?

There was no price discounting during the first and second phases of the campaign.

Major cigarette tax changes were introduced during 1999 and 2000 involving:

per-weight to per-stick method of excise
start of Goods and Services Tax (GST)
extra increases in cigarette tax.

During the first 6-month and 18-month periods, most change was probably due to the campaign (1997–1998); during the last two years (1999–2000), most change was probably due to tax changes.

Adolescents

Although the target group was adults it was very interesting to see the effect on adolescents. Among 400 Australian teens in 1998:

84% of teen smokers thought NTC ads relevant to them
33% said NTC discouraged some friends from smoking
85% said NTC made smoking seem less "cool" and desirable.

Among 3714 Victorian teens in 1999:

8% of experimenters said NTC ads helped them quit.

There has been a decline in the prevalence of smoking among adolescents. The smoking rates among Australian young people aged 12–15 years and 16–17 years are the lowest they have ever been.

Lessons

Anti-tobacco advertising has rapid behavioural effects that decay quickly (prompted recall lasts longer).
Anti-tobacco advertising is one component of effective tobacco control measures (cigarette price etc is important also).
Anti-tobacco advertising designed for adults can also influence young people (at least in this campaign).

Teen-directed media campaigns in the United States —a natural experiment

The United States provides a natural experiment on the effectiveness of anti-tobacco advertising because of the variation in the timing and amount of anti-tobacco advertising carried out in different states. In the United States , the tobacco industry is back on television and they are running "youth smoking prevention" campaigns. One campaign was directed at young people and the other was directed at parents. It was possible to examine the relationship between the amount and type of anti-smoking advertising and youth smoking prevention advertising for different state campaigns.

The arguments for teen-directed media campaigns include:

it is "easier not to start than to quit"
it is important to avoid early exposure to carcinogens
public approval.

The arguments against teen-directed media campaigns include:

they are hard to do well
they invite rebellion if they seem authoritarian
the tobacco industry wants them (!)
young people are suspicious of advertisements aimed at them; for example: "Why pick on kids when so many adults smoke?", "Your attempt to do a 'cool' campaign to persuade us not to smoke is pathetic".

In contrast it has been found that:

Campaigns that influence parents to quit will reduce an important source of influence on youth smoking—parental role modelling.
Campaigns that make adult smoking seem undesirable reduce motivation to use tobacco as badge of adulthood—change broader community norms.

As adult smoking prevalence declines, so does youth smoking because:

Most adolescents aspire to be treated as adults.
Adolescents at risk for smoking are at a developmental stage where their powers of cognition are those of adults.

Philip Morris' youth prevention campaign

The results of a youth prevention campaign run by tobacco company Philip Morris and directed at children aged between 14 and 18 years had no effect on smoking attitudes, weakened intentions not to smoke in the future and reduced disapproval of adult smoking.

Lessons

Cessation campaigns aimed at adults seem able to influence young people—"a two-for-one effect".
Youth campaigns are hard to do well and risk "boomerang effects".

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Last updated: September 2005