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Tobacco in Australia Facts & IssuesA comprehensive online resource
Tobacco in Australia: Facts and Issues. Fourth Edition
A comprehensive review of the major issues in smoking and health in Australia, compiled by Cancer Council Victoria.
First edition published by ASH (Australia) Limited, Surry Hills, NSW, 1989 Second edition published by the Victorian Smoking and Health Program, Carlton South, Victoria (Quit Victoria), 1995 Third edition published by Cancer Council Victoria 2008 in electronic format only.
ISBN number: 978-0-947283-76-6
Suggested citation: Scollo, MM and Winstanley, MH. Tobacco in Australia: Facts and issues. 4th edn. Melbourne: Cancer Council Victoria; 2012. Available from www.TobaccoInAustralia.org.au OR <Author(s) of relevant chapter section>, <Name of chapter section> in Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. 4th edn. Melbourne: Cancer Council Victoria; 2012. <Last updated on (date of latest update of relevant chapter section)> Available from < url of relevant chapter or section>
Tobacco in Australia: Facts and Issues; 4th Edition updates earlier editions of the book published in 1995, 1989 and 2008. This edition is greatly expanded, comprising chapters written and reviewed by authors with expertise in each subject area. Tobacco in Australia: Facts and Issues is available online, free of charge. A hard copy version of this publication has not been produced.
This work has been produced with the objective of bringing about a reduction in death and disease caused by tobacco use. Much of it has been derived from other published sources and these should be quoted where appropriate. The text may be freely reproduced and figures and graphs (except where reproduced from other sources) may be used, giving appropriate acknowledgement to Cancer Council Victoria.
Editors and authors of this work have tried to ensure that the text is free from errors or inconsistencies. However in a resource of this size it is probable that some irregularities remain. Please notify Cancer Council Victoria if you become aware of matters in the text that require correction.
Editorial views expressed in Tobacco in Australia: Facts and Issues. Fourth Edition are those of the authors.
The update of this publication was funded by the Australian Government Department of Health and Ageing.
Cancer Council Victoria 1 Rathdowne Street Carlton VIC 3053
Project manager: Michelle Scollo Senior Policy Adviser, with assistance from Merryn Pearce, Policy and Projects Officer, Quit Victoria. Editorial advice and editing: Rosemary Moore Website design: Creative Services, Cancer Council Victoria Design and production: Jean Anselmi Communications Proofreading: Caz Garvey
Book excerpt List of chapters available at tobaccoinaustralia.org.auIntroduction
Chapter 1 Trends in the prevalence of smoking
Chapter 2 Trends in tobacco consumption
Chapter 3 The health effects of active smoking
Chapter 4 The health effects of secondhand smoke
Chapter 5 Factors influencing the uptake and prevention of smoking
Chapter 6 Addiction
Chapter 7 Smoking cessation
Chapter 8 Tobacco use among Aboriginal peoples and Torres Strait Islanders
Chapter 9 Smoking and social disadvantage
Chapter 10 The tobacco industry in Australian society
Chapter 11 Tobacco advertising and promotion
Chapter 12 The construction and labelling of Australian cigarettes
Chapter 13 The pricing and taxation of tobacco products in Australia
Chapter 14 Social marketing and public education campaigns
Chapter 15 Smokefree environments
Chapter 16 Tobacco litigation in Australia
Chapter 17 The economics of tobacco control
Chapter 18 The WHO Framework Convention on Tobacco Control
Appendix 1 Useful weblinks to tobacco resources
Tobacco in Australia Facts & Issues A comprehensive online resource tobaccoinaustralia.org.au
Chapter 14Social marketing and public education campaigns
iChapter 14: Social marketing and public education campaigns
Date of last update: 19 Jan 2012
Chapter 14
Social marketing and public education campaigns
Tom Carroll PhDUpdated by Trish Cotter 2011
Table of contents14.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
14.1 Mass media public education campaigns: an overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
14.2 The role of mass media campaigns within a comprehensive smoking control program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 514.2.1 The Framework Convention on Tobacco Control . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
14.2.2 The National Tobacco Strategy 2004–09 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
14.3 Tobacco-control campaigns in Australia: experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 914.3.1 Programs initiated by the Australian Government . . . . . . . . . . . . . . . . . . . . . . . . . . 9
14.3.1.1 The National Campaign Against Drug Abuse . . . . . . . . . . . . . . . . . . . 9
14.3.1.2 The National Tobacco Campaign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
14.3.1.3 Australian Competition and Consumer Commission campaign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
14.3.1.4 Introduction of graphic health warnings . . . . . . . . . . . . . . . . . . . . . . . 11
14.3.1.5 The National Tobacco Youth Campaign . . . . . . . . . . . . . . . . . . . . . . . . 12
14.3.2 State and territory campaigns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
14.3.2.1 State-based Quit campaigns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
14.3.2.2 Health promotion foundations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14.3.2.3 State-based graphic health warnings campaign collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14.3.3 International use of Australian tobacco campaign materials . . . . . . . . . . . 14
14.4 Examining the effectiveness of public education campaigns . . . . . . . . . . . . . . . . . . . . . . . . 1914.4.1 Population-level effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
14.4.1.1 Population-level effectiveness: adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
14.4.1.2 Population-level effectiveness: youth . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
14.4.2 Campaign content and theme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
14.4.2.1 Campaign content and theme: adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
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Date of last update: 19 Jan 2012
14.4.2.2 Campaign content and theme: youth . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
14.4.3 Campaign exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
14.4.3.1 Campaign exposure: adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
14.4.3.2 Campaign exposure: youth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
14.4.4 Targeting and demographic sub-groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
14.4.5 Reaching Australians from culturally and linguistically diverse backgrounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
14.4.6 Reaching Indigenous smokers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
14.4.7 Media channels (including new media) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
14.4.7.1 Television . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
14.4.7.2 Radio and cinema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
14.4.7.3 Social media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
14.4.8 Cigarette smoking in movies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
14.4.9 Pharmaceutical advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
14.5 News media coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
iiiChapter 14: Social marketing and public education campaigns
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Tables and figuresTable 14.3.1 TV commercials produced in Australia since 2005
Figure 14.4.1 Model of media in the digital age
1Chapter 14: Social marketing and public education campaigns
Section: 14.0 Date of last update: 19 Jan 2012
14.0
IntroductionAnti-smoking mass media campaigns have been a feature of Australia’s tobacco-control landscape since the early 1970s, when the then Director of the Cancer Council Victoria, Dr Nigel Gray, produced a series of low-budget advertisements highlighting the health consequences of smoking. In the late 1970s, one of the world’s first evaluated anti-smoking mass media campaigns was trialled in Australia on the New South Wales Central Coast. In 1983, when the ‘Sponge’ commercial first used in the Central Coast campaign was aired in New South Wales as part of the ‘Quit. For Life’ Campaign1 it proved to be highly successful and was associated with a 1% decrease in smoking prevalence in Sydney, a significant change when compared with Melbourne (which did not introduce a Quit campaign until the following year), where the prevalence did not decline.2
State-based campaigns, particularly in Western Australia, Victoria and New South Wales, continued the practice of using formative research to guide the development of media campaigns and surveys to evaluate their impact. Research-based campaigns in Australia quickly became a key component of tobacco-control efforts.
After some years of experimentation with different styles and messages, Australia’s first truly national campaign, the National Tobacco Campaign, was launched in 1997 and heralded the return of ‘scare tactics’ to communication about the harms of smoking. The National Tobacco Campaign has set the tone for research, development and evaluation of public health campaigns at the national and state/territory level since that time. Australia has become well recognised internationally for its mass media campaigns. The World Lung Foundation reviewed hundreds of advertisements highlighting the health consequences of smoking for its mass media resource (http://67.199.72.89/mmr/english/ads_pc.html) to identify those proven to be most effective. Of the 21 selected, 13 were Australian.
This chapter describes Australia’s history and progress in running mass media campaigns to discourage smoking and some of what has been learnt along the way. It also presents the latest evidence for running mass media campaigns: Australian and international, the context of such campaigns within comprehensive tobacco-control programs, optimal funding, and opportunities and challenges ahead.
2 Tobacco in Australia:Facts and Issues
Section: 14.0 Date of last update: 19 Jan 2012
References1. Pierce J, Dwyer T, Frape G, Chapman S, Chamberlain A and Burke N. Evaluation of the Sydney ‘Quit For Life’ anti-smoking campaign. Part 1. Achievement of intermediate goals. Medical
Journal of Australia 1986;144(7):341–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3959949
2. Dwyer T, Pierce J, Hannam C and Burke N. Evaluation of the Sydney ‘Quit for Life’ anti-smoking campaign. Part 2. Changes in smoking prevalence. Medical Journal of Australia 1986;144(7):344–7. Available from: http://lib.bioinfo.pl/pmid:3959949
3Chapter 14: Social marketing and public education campaigns
Section: 14.1Date of last update: 19 Jan 2012
14.1
Mass media public education campaigns: an overviewContributor: Trish Cotter, September 2011
Mass media campaigns for tobacco control generally use commercial marketing techniques to influence the knowledge, attitudes and ultimately the behaviours of individuals, groups, organisations and society as a whole.1 This marketing approach is often referred to as ‘social marketing’. Unlike commercial marketing approaches, where the beneficiary is the originator or shareholder, social marketing campaigns are designed to benefit the recipient of the message.
Mass media campaigns work directly to change behaviour. Large proportions of populations are exposed to messages designed to affect individuals’ decision-making.2 Mass media campaigns can also operate indirectly, by setting an agenda for interpersonal and public discussion that can lead to changes in social norms or public policy.2
Mass media campaigns have been used since the 1970s and are now viewed within comprehensive tobacco-control programs as essential for promoting prevention as well as motivating and encouraging smokers to quit. These campaigns also increase community understanding and recognition of the harms associated with tobacco smoking and facilitate policy initiatives to reduce this harm.
Media campaigns are expensive to produce and broadcast, and effective campaigns need medical, behavioural and marketing expertise to ensure that their content is scientifically accurate and their presentation effective.2 Formative research identifies and defines campaign goals and objectives and informs the development of creative executions for pre-testing, production and implementation. The choice of media channel and frequency of airing are equally important, to ensure the target population sees the material often enough for it to be remembered and acted upon.
Evidence from controlled field experiments and population studies conducted by investigators in many countries shows that anti-tobacco mass media campaigns can reduce tobacco use.3–5
4 Tobacco in Australia:Facts and Issues
Section: 14.1Date of last update: 19 Jan 2012
References1. Donovan R and Henley N. Social marketing. Principles and practice. Melbourne, Australia: IP Communications, 2003.
2. Jamrozik K. Population strategies to prevent smoking. British Medical Journal 2004;328(7442):759−62. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15044295
3. National Cancer Institute. Part 4−Tobacco control and media interventions. Monograph 19: the role of the media in promoting and reducing tobacco use. Bethesda, Maryland: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2008;429−546. Available from: http://cancercontrol.cancer.gov/tcrb/monographs/19/index.html
4. Wakefield M, Durkin S, Spittal M, Siahpush M, Scollo M, Simpson J, et al. Impact of tobacco control policies and mass media campaigns on monthly adult smoking prevalence: time series analysis. American Journal of Public Health 2008;98:1443−50. Available from: http://www.ajph.org/cgi/content/abstract/98/8/1443
5. Durkin S, Brennan E and Wakefield M. Mass media campaigns to promote smoking cessation among adults: an integrative review.Tobacco Control 2012;21(2) 127–38. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/21/2/127?etoc
5Chapter 14: Social marketing and public education campaigns
Section: 14.2.1Date of last update: 19 Jan 2012
14.2
The role of mass media campaigns within a comprehensive smoking control programContributors: Tom Carroll PhD, August 2007, updated by Trish Cotter, September 2011
The strength of evidence for mass media campaigns within the context of a comprehensive tobacco-control program continues to grow. The role of the media has been recognised almost as long as our knowledge of tobacco as the cause of lung cancer. Almost 50 years ago (1962) the Royal College of Physicians of London, in its report on smoking and health,1 called on governments to:
< provide more education to the public and especially children concerning the hazards of smoking < more effectively restrict the sale of tobacco to children < restrict tobacco advertising < more widely restrict smoking in public places < increase tax on cigarettes, perhaps by adjusting the tax on pipe and cigar tobaccos < inform purchasers of the tar and nicotine content of the smoke of cigarettes < investigate the value of anti-smoking clinics to help those who find difficulty in giving up smoking.
Three decades ago the World Health Organization and the International Union Against Cancer (UICC) advocated that a reduction in tobacco consumption could be achieved through a number of interrelated measures.2 They gave the objectives of a comprehensive smoking control program as:
< achieving lower smoking rates in all age groups by applying all practical downward pressures on smoking rates, including health warnings on tobacco packets, increased taxation, restrictions on smoking opportunities, support for the rights of non-smokers, and information and education programs
< encouraging non-smokers to remain non-smokers < ceasing all forms of tobacco advertising and promotion < encouraging those who had not yet stopped smoking, and therefore remained at high risk, to reduce, as far as possible, their exposure to the harmful components of tobacco smoke
< liaising with other health organisations and authorities to ensure maximum effectiveness and to avoid conflict of activities.
This recommended tobacco-control program recognised that synergies are created when all components of a program are implemented, rather than simply individual strategies. As more evidence has emerged from tobacco-control programs internationally, the importance of social marketing and public education campaigns within a comprehensive program of strategies and activities has continued to be emphasised.3
14.2.1
The Framework Convention on Tobacco ControlThe World Health Organization Framework Convention on Tobacco Control (WHO FCTC) was adopted at the Fifty-sixth World Health Assembly in 2003 and entered into force on 27 February 2005.4 The Australian Government formally ratified the WHO FCTC on 27 October 2004.5 See Chapter 18 for a detailed description. Article 12 of the Convention (Education, communication, training and public awareness) calls for the use of all available communication tools to promote and strengthen public awareness of tobacco-control issues. Guidance on education, communication and training measures concerning tobacco dependence and cessation is outlined in Article 14 (Demand reduction measures concerning tobacco dependence and cessation).
6 Tobacco in Australia:Facts and Issues
Section: 14.2.2Date of last update: 19 Jan 2012
Since the ratification of the treaty, parties to the WHO FCTC have developed, refined and adopted guidelinesi to assist signatories to draft legislation and administer programs that will embody its provisions. These guidelines recognise that awareness of tobacco-control issues is essential for public acceptance of policy changes. This includes bans on advertising and promoting tobacco products.ii Public awareness can help to bring about change in the behavioural norms around tobacco consumption and exposure to tobacco smoke.iii It is recognised that health warnings will be more effective when part of a broader public education campaign.iv
In the recommended actions for demand reduction approaches concerning dependence and promotion, mass communication and education programs are seen as essential both for encouraging tobacco cessation (Section 44) and encouraging tobacco users to draw on this support (Section 60).v These programs can include unpaid and paid media placements. The guidelines for population approaches also recommend brief advice by healthcare workers, establishing quitlines and monitoring and evaluating programs to measure progress and impact. Guidelines for Article 12vi spell out how countries might go about developing, implementing and evaluating effective tobacco-control education campaigns. Australians with expertise in tobacco-control policy have had considerable input into these and other WHO FCTC Guidelines.
14.2.2
The National Tobacco Strategy 2004–09The key role played by tobacco-control campaigns has been recognised in Australia’s National Drug Strategic Framework. As part of this framework, the National Tobacco Strategy 2004–09 had the goal of significantly improving health and reducing the social costs caused by, and the inequity exacerbated by, tobacco in all its forms.6
The objectives of the strategy among all social groups are: < to prevent uptake of smoking < to encourage and assist as many smokers as possible to quit as soon as possible < to eliminate harmful exposure to tobacco smoke among non-smokers < where feasible, to reduce harm associated with continuing use of, and dependence on, tobacco and nicotine.
Quit and Smokefree messages were central to the National Tobacco Strategy 2004–09. The strategy noted that ‘[discouraging] initiation to smoking and [promoting] quitting, as well as not smoking around children, requires sustained and commercially realistic funding for campaigns’. This is necessary:
< to keep quitting on people’s agendas and to reach people as they cycle in and out of ‘readiness to quit’ at many times each year
< to reach people at times in their life when they are vulnerable to messages about smoking, and times when they are more likely than usual to be responsive to encouragement to change.
The National Tobacco Strategy encouraged the promotion of hard-hitting, well-researched campaigns to: < encourage smokers to personalise the health risks of smoking < keep quitting on smokers’ ‘agenda’ < increase understanding of the quitting process < promote treatments and services.7
i For copies of the WHO FCTC guidelines that have been adopted to date, go to: http://www.who.int/fctc/protocol/guidelines/adopted/en/ii Refer to Sections 3f, 69 and 70 of the WHO FCTC guidelines for Article 13: Guidelines on tobacco advertising, promotion and sponsorship. Available from: http://www.who.int/fctc/
protocol/guidelines/adopted/article_13/en/index.htmliii Refer to sections 29 and 30 of the WHO FCTC guidelines for Article 8: Protection from exposure to tobacco smoke. Available from: http://www.who.int/fctc/protocol/guidelines/adopted/
article_8/en/index.htmliv Refer to Section 42 of the WHO FCTC guidelines for Article 11: Packaging and labelling of tobacco products. Available from: http://www.who.int/fctc/protocol/guidelines/adopted/
article_11/en/index.htmlv Refer to Sections 10, 44 and 60 of the WHO FCTC guidelines for Article 14: Demand reduction measures concerning tobacco dependence and cessation. Available from: http://www.who.
int/fctc/protocol/guidelines/adopted/article_14/en/index.htmlvi Refer to WHO FCTC guidelines for Article 12: Guidelines on education, communication, training and public awareness. Available from: http://www.who.int/fctc/protocol/guidelines/
adopted/article_12/en/index.html
7Chapter 14: Social marketing and public education campaigns
Section: 14.2.2Date of last update: 19 Jan 2012
The National Tobacco Strategy also encouraged promoting the advantages of not starting and of stopping before quitting becomes more difficult, as well as the advantages of parents quitting while their children are still young.
Increasing the promotion of Quit and Smokefree messages nationally supported other components of the National Tobacco Strategy, such as:
< generating greater support for further regulation < promoting greater use of services and treatment for smokers < providing support for parents, carers and educators helping children develop a healthy lifestyle < supporting policies that reduce smoking as a means of addressing disadvantage < targeting communication messages and services to ensure access by disadvantaged groups < fostering collaboration in program policy and development.
8 Tobacco in Australia:Facts and Issues
Section: 14.2.2Date of last update: 19 Jan 2012
References1. Royal College of Physicians. Smoking and health: report of the Royal College of Physicians on smoking in relation to cancer of the lung and other diseases. London: Pitman Medical
Publishing Co Ltd., 1962.
2. Gray N and Daube M. Guidelines for smoking control. UICC technical report series no. 52. Geneva: International Union Against Cancer, 1980.
3. Centers for Disease Control and Prevention. Ch. 1 Overview of counter-marketing programs. Designing and Implementing an Effective Tobacco Counter-marketing Campaign. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2003;Available from: http://www.cdc.gov/tobacco/stateandcommunity/counter_marketing/manual/index.htm
4. WHO Framework Convention on Tobacco Control. Geneva: World Health Organization, 2003. Available from: http://www.who.int/tobacco/framework/WHO_FCTC_english.pdf
5. Australian Government Department of Health and Ageing. Framework Convention on Tobacco Control. Canberra: Government of Australia, 2004 [viewed 14 October 2011]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/tobacco-conv
6. Ministerial Council on Drug Strategy. Australian National Tobacco Strategy 2004-2009. Canberra: Department of Health and Ageing, 2005. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/tobacco-strat
7. Ministerial Council on Drug Strategy. Meeting the challenges of the next five years-2: Ideas and resources for increasing promotion of Quit and Smokefree messages. National Tobacco Strategy, supporting documents. Canberra: Department of Health and Ageing, 2005. Available from: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/phd-pub-tobacco-tobccstrat2-cnt.htm/
9Chapter 14: Social marketing and public education campaigns
Section: 14.3.1.1Date of last update: 19 Jan 2012
14.3
Tobacco-control campaigns in Australia: experienceContributors: Tom Carroll, PhD August 2007, updated by Trish Cotter September 2011 with assistance from Kate Purcell, August 2011
As early as 1971, Dr Nigel Gray, then Director of the Anti-Cancer Council of Victoria, encouraged production of anti-smoking television advertisements. A series of about 26 low-budget black and white advertisements were created, mostly humorous and featuring English actors Warren Mitchell, Fred Parslowe and Miriam Karlin. Also during these early years of tobacco control, Sir MacFarlane Burnett appeared in two television advertisements about lung cancer and teenage smoking.1
Following the initial ‘Quit. For Life’ campaign community trial in the late 1970s as part of the New South Wales North Coast Healthy Lifestyle Program,2 statewide tobacco-control campaigns were developed in Australia by some states in the early 1980s. These commenced in New South Wales, Victoria, Western Australia and South Australia, and were funded by government and non-government organisations. In Queensland, Tasmania, the Australian Capital Territory and the Northern Territory, tobacco-control activities were initiated by a range of organisations.3 Since then, campaigns have been developed and implemented nationally (see Section 14.3.1) and across states and territories (see Section 14.3.2) as part of increasingly comprehensive tobacco-control programs.
14.3.1
Programs initiated by the Australian GovernmentThe first national campaign on smoking was the National Warning Against Smoking campaign conducted between 1972 and 1975 at a cost of $500,000 per annum.4 The campaign used posters and slogans with anti-smoking messages. As part of the campaign, the Commonwealth Department of Health printed cardboard signs requesting smokers not to smoke nearby; these were made freely available to the public. Because the campaign was not formally evaluated no information is available about its impact.
14.3.1.1
The National Campaign Against Drug AbuseThe Ministerial Council on Drug Strategy (MCDS) was formed in 1985, comprising all Australian state and territory Health Ministers, Commonwealth Ministers for Health and Customs, and the Attorney-General.5 An early initiative of the MCDS was the launch of the National Campaign Against Drug Abuse, which aimed to reduce drug use in the community through education, rehabilitation and law enforcement. This program was later renamed the National Drug Strategy. Importantly, the National Campaign Against Drug Abuse acknowledged tobacco smoking as the major contributor to drug-related deaths in Australia.5 This ensured that tobacco issues maintained a high profile among health professionals and the media.
As part of the social marketing arm of the National Campaign Against Drug Abuse, a $2 million national television, cinema and print advertising campaign asking ‘Smoking – who needs it?’ was launched in 1990 and continued through 1991. It targeted teenage girls and young adult women6 and was designed to complement existing state-based programs. Campaign evaluation surveys showed significant increases in negative perceptions of smoking among the target audience, and an elevation in the percentage of young girls intending to reduce their rate of smoking.7 A low-key cinema campaign aimed at teenage smoking was conducted in 1995.
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Section: 14.3.1.2Date of last update: 19 Jan 2012
14.3.1.2
The National Tobacco CampaignThrough the 1990s Quit organisations working across Australia cooperated extensively with materials being shared or adapted where possible. However it was not until 1997 that a truly national campaign, galvanising the collective expertise and resources of all Australian Quit campaigns and the Commonwealth, was launched.
The National Tobacco Campaign was developed as steady reductions in smoking prevalence observed through the 1980s and early 1990s were stalling.8 In 1995, the Australian Government allocated research funds towards regaining the tobacco control momentum. In 1996, a commitment was made to pool the extensive tobacco control expertise and resources in Australia to develop a collaborative national anti-smoking campaign.9 Managed by the Commonwealth Department of Health and Aged Care with advice from a Ministerial Tobacco Advisory Group chaired by Professor David Hill, the National Tobacco Campaign was launched in June 1997 with funding of more than $7 million across two years. The added support from state-based organisations meant the total investment in the first six-month phase of the National Tobacco Campaign was approximately $9 million.10 With the advent of the National Tobacco Campaign, funding for tobacco-control programs in Australia increased from 26 cents per adult in 1996 to 55 cents per adult in 1998 and continued at 49 cents per adult in 2001.11
The Australian Government contributed 75% of the $4.5 million spent on advertising in the initial phase of campaign activity (June–October 1997). In subsequent phases of the campaign, states and territories contributed more: by 2000 the Australian Government contribution was estimated at $2.18 million compared with $3.29 million from state and territory Quit organisations.12
The National Tobacco Campaign targeted smokers aged 18–40 years. It is Australia’s most intense and enduring mass media tobacco-control campaign. One of its great strengths was the collaboration in its development and operation between the national, state and territory governments and non-government organisations.
The primary objective was to elevate quitting on smokers’ personal agendas. The campaign recognised that to potentiate the intention to quit smoking, an individual needed to gain fresh insights. Smokers needed to see material as personally relevant and gain confidence in their own ability to quit smoking (self-efficacy) as well as see they would gain more than they lost by giving up smoking. The task of the creative strategy was to instil the message and remind smokers of it often so that it remained on their personal agenda.13
The creative development process called for close collaboration between the advertising agency’s creative team and medical experts in the cardiovascular, neurology and respiratory fields. Between 1997 and 2000, six health effects advertisements were produced (known as ‘Artery’, ‘Lung’, ‘Tumour’, ‘Brain’, ‘Eye’ and ‘Tar’) and one ‘Call for help’ advertisement showing a caller to the Quitline.
A lower socio-economic bias was adopted in media placement, which reflected the social class gradient of smoking in Australia.14 In support of the primary campaign advertising medium of television, secondary media included print advertising, radio, outdoor (billboards, bus and tram sides) and a campaign website: www.quitnow.info.au.
For more on the National Tobacco Campaign development and implementation see: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/national-tobacco-campaign-lp.
Evaluating the National Tobacco CampaignThree evaluation volumes15,17 and a dedicated supplement to the Tobacco Control journal18 have published extensive research and evaluation on the campaign.
There was a significant reduction in smoking prevalence among Australian adults observed over the period of the National Tobacco Campaign.19 Campaign surveys indicated a decline from 23.5% in May 1997 to 20.4% in November 2000.12 It is difficult to know how much of this decline can be attributed to the National Tobacco Campaign,11 as opposed to other tobacco-control policy initiatives such as increased taxes on cigarettes20 or other trends. Nevertheless, campaign survey findings regarding advertising recall, recognition, appraisal, new learning and changes in health beliefs and attitudes are consistent with predicting these changes in smoking prevalence.21
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Section: 14.3.1.4Date of last update: 19 Jan 2012
Overall, the results of campaign surveys indicated that the campaign advertising was seen and recalled by the majority of the target audience, with levels of prompted recognition of campaign advertising at approximately 90%. Approximately half of the smokers who recognised the campaign advertising reported that this had made them more likely to quit.
In addition to the annual cross-sectional surveys conducted each November from 1997 to 2000, a continuous tracking study explored the relationship between campaign advertising and measures such as awareness and response to the advertising and indicators of interest in quitting. It assessed ‘cut-through’ of campaign advertising, response to this advertising and considered levels of response generated at different levels of campaign advertising weight.22 Unprompted recall and recognition (prompted recall) were related to advertising weight (measured in Target Audience Rating Points (TARPs). The greater the advertising weight for a particular advertisement, the greater the levels of recall and recognition.23 However, it was also found that cut-through for a particular advertisement was clearly mediated by its message and creative execution. ‘Artery’, ‘Brain’ and ‘Tar’ achieved the highest cut-through per TARP of the health effects advertisements.
Further studies have since been undertaken that provide valuable information on program placement, relationship between advertising and call generation, and optimal TARP weights to inform campaign media planning—see Section 14.4.3.
Two cost-effectiveness studies 10, 24 were conducted on the initial phase of the campaign. Using the baseline survey (May 1997) and the first evaluation survey (November 1997), estimates were made regarding the reduction in number of smokers that could be attributed to the National Tobacco Campaign. From this calculation it was estimated that in its first six months of operation the National Tobacco Campaign achieved a reduction of 1.4% in the smoking prevalence, avoided 32,000 cases of chronic obstructive pulmonary disease, 11,000 cases of acute myocardial infarction, 10,000 cases of lung cancer and 2500 cases of stroke. In addition, Hurly and Matthews estimate that the National Tobacco Campaign prevented about 55,000 deaths and achieved gains of 323,000 life-years and 407,000 Quality Adjusted Life Years (QALYs) with potential healthcare savings of $740.6 million.24 The National Tobacco Campaign was therefore both cost saving and effective.
14.3.1.3
Australian Competition and Consumer Commission campaignDuring 2006 tobacco campaign activity increased nationally and among the state Quit organisations. In December 2005, the Australian Competition and Consumer Commission (ACCC) launched a $9 million campaign to advise smokers that ‘light’ and ‘mild’ cigarettes are not a healthier option than smoking other cigarettes. The campaign was funded by Philip Morris, British American Tobacco Australia and Imperial Tobacco Australia as part of court-enforceable undertaking obtained by the ACCC after finding that these tobacco companies had represented that cigarettes marketed and packaged as ‘light’, ‘mild’ or similar descriptors had certain health benefits in comparison to those marketed as regular or higher yield cigarettes.25 This campaign featured prominent television and outdoor advertising over the early months of 2006.
14.3.1.4
Introduction of graphic health warningsIn mid-February 2006 the Australian Government launched the first stage of its new National Tobacco Campaign to address youth smoking rates, committing $25 million over four years.26 This initial stage focused public attention on the release of a new system of graphic health warnings on tobacco product packaging. From 1 March 2006 tobacco products manufactured or imported into Australia were required to be printed with the new health warnings images (see Chapter 12A.1).27 This campaign was staged from February to April 2006 including the national broadcast of a television advertisement featuring a mouth and throat cancer graphic health warning.
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14.3.1.5
The National Tobacco Youth CampaignThe second stage of the Australian Government’s new National Tobacco Campaign targeting smoking rates among young adults and teenagers was launched at the end of December 2006 and the initial phase continued until March 2007. The new campaign, featuring television, cinema, magazines, radio and outdoor advertising, graphically depicted the range of toxic chemicals in cigarette smoke, as well as linking to graphic health warnings.26 Campaign advertisements can be viewed at www.quitnow.info.au.
14.3.2
State and territory campaigns
14.3.2.1
State-based Quit campaignsEarly state- and territory-based smoking-control activity was often undertaken by the state Cancer Councils and the Heart Foundation (formerly the National Heart Foundation). The combined finances and expertise of these groups resulted in a high standard of education campaigns and tobacco policy development in Australia.
These campaigns typically focused on a ‘Quit week’ of activities, but varied their activities throughout the year. Information on smoking, advice on quitting and the opportunity to attend cessation courses encouraged smokers to quit. Young people were targeted through schools, where class resources were designed for specific age groups. The Quit organisations also provided support and resources for health professionals, including medical practitioners, to assist with counselling and to support community-based activities. In some states a ‘Quitline’ (telephone information service) was available, delivering a recorded message that advised on quitting and directed callers to trained staff for individual counselling and self-help resources.
Informed by campaign research and evaluation studies, specific population groups were identified and targeted, including children, young women, Aboriginal and Torres Strait Islander smokers, smokers from non-English speaking backgrounds, and older smokers. Quit groups developed and delivered programs for workplaces that required general information or guidance on becoming smokefree and programs aimed at restaurants and other public places.
Mass media campaigns and sports sponsorships were the most visible means used to promote messages about smoking and health. The Quit message was also promoted through community events such as no-smoking days or education campaigns run in schools, hospitals, worksites, health centres and other community-based venues and through press and media coverage generated by these events.
The significant investment by and cooperation between state and territory Quit organisations (which include both government and non-government agencies) has continued since the National Tobacco Campaign. Many new campaigns have been created, focusing on a range of themes and primarily targeting adults; campaign organisations have frequently shared these advertisements.
Details of campaigns, including links to campaign advertising materials, are available on the websites of Quit organisations and other government and non-government organisations listed in Appendix 1. Advertisements produced since 2005 are listed and described in Table 14.3.1.
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Section: 14.3.2.3Date of last update: 19 Jan 2012
14.3.2.2
Health promotion foundationsDuring the late 1980s and the 1990s health promotion foundations were established by legislation in Victoria, South Australia, the Australian Capital Territory and Western Australia. These foundations were financed by an increased levy on state or territory tobacco license fees, and shared the objectives of:• sponsoring activities related to the promotion of health or to the prevention and early detection of disease• increasing awareness of programs promoting good health through sponsorship of sports, the arts and
popular culture• funding research and developing activities in support of these aims.
In 1993, the Queensland Health Promotion Council was also established to fund health promotion (though promotion via funding of sports was excluded). The Tasmanian Health Promotion Council was established along similar lines in the same year.
These foundations gave rise to new opportunities, especially in their capacity to provide an alternative source of funding from tobacco companies for sponsorships of sport and the arts. They were also able to purchase advertising space (particularly on billboards and in cinemas) previously used by tobacco companies, thereby assisting the advertising industry during the transition period when tobacco advertising bans were being introduced.
Sponsorship agreements brought about major opportunities for health promotion.28 Target groups now included participants in and spectators of sports or cultural events, who may not have been reached by previous health promotion strategies. Not only were messages about smoking prevention and smoking cessation seen more often, but the messages could also be tailored for specific audiences and adjusted to maintain a fresh and contemporary image. Importantly, the relationships that developed as a result of sponsorship contracts could also be used to encourage the adoption of changes such as policies on smokefree areas at venues, the provision of low alcohol drinks, healthy food choices and sun protection.29
14.3.2.3
State-based graphic health warnings campaign collaborationIn 2005 the Cancer Institute NSW and Quit Victoria spearheaded a major collaborative effort between eight state and territory anti-tobacco organisations, to capitalise on the introduction graphic health warnings. The initiative aimed to extend the impact of pack warnings beyond their initial newsworthiness. The basic premise of the advertising campaign was that if graphic health warnings served to remind smokers of the health consequences of smoking every time they had a cigarette30 then exposure to the health warnings advertisements might serve to increase the salience of these consequences.
Responding to consumer insights31, the most salient health effects depicted in the graphic health warnings were those that were visible outside the body. The first advertisement, ‘Amputation’, was launched in May 2006 and dramatised the graphic health warning ‘smoking causes peripheral vascular disease’. It featured a surgeon about to amputate a man’s gangrenous foot. This advertisement was followed by ‘Mouth cancer’ in July 2006. The advertisement dramatised ‘smoking causes mouth and throat cancer’ and depicted a woman with mouth cancer. Three further advertisements were launched in 2007 to capitalise on the introduction of the second set of graphic warnings and focused on a smoker’s choice of packets with different health warnings (‘Which disease?’), the graphic depiction of an operation to remove plaque from a woman’s carotid artery (‘Carotid’) and a chilling portrayal of a man’s thoughts about the consequences of his smoking after experiencing a stroke (‘Voice within’). These powerful advertisements have been broadcast by most states as components of their tobacco-control programs, with heaviest exposure being bought in the most populous states of New South Wales and Victoria. These advertisements can be viewed on smoking and health program websites listed in Appendix 1.
Evaluation studies showed high levels of awareness and engagement with these advertisements, and prompting of significant discussion and quitting attempts.32 Brennan and colleagues demonstrated a complementary effect of the
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Section: 14.3.3Date of last update: 19 Jan 2012
advertising campaign and the graphic warnings introduction. Importantly, this research provides some of the first evidence in support of a multi-faceted approach to the introduction of new tobacco-control policies with the use of media campaigns to facilitate and extend understanding and impact.33
14.3.3
International use of Australian tobacco campaign materialsAdapting or re-using mass media material from other countries is becoming an increasingly accepted practice in Australia and overseas. Many Australian states have used materials that originated in other countries such as the US and the UK. Examples include the ‘Echo’ campaign adapted and re-shot based on a successful Californian advertisement, the ‘What’s worse’ ad featuring a woman telling her children she has lung cancer, the ‘Anthony’ testimonial ad from the UK, the ‘Ronoldo’ ad from Massachusetts and the ‘Cigarettes are eating you alive’ ad from New York.
Adapting materials saves on production costs and time, enabling resources to be concentrated into broadcasting.34 Some advertisements are more suitable for adaption than others. Those with good potential are those that have performed well in their country of origin. Ads are also more suitable for adaption if they have no people in them (e.g. using graphics, simulation or body parts) or have people who do not speak directly to the camera (so that a voiceover can be recorded in any language).34
Adapting advertisements reduces reliance on medical knowledge and marketing expertise, which may be hard to find or ‘upskill’ in short timeframes. This approach has now been used in many low and middle income countries by the World Lung Foundation using funds from the Bloomberg Initiative (see www.worldlungfoundation.org/mmr).
Some examples of successful Australian campaign exports are listed below.
Perhaps on Australia’s greatest campaign export has been the National Tobacco Campaign and specifically the ‘Artery’ advertisement. National Tobacco Campaign advertisements have been used and adapted in numerous countries around the world including Cambodia, Canada, Iceland, Mongolia, New Zealand, Norway, Poland, Singapore, the US (various states) and Vietnam.
The ‘Sponge’ campaign (Cancer Institute NSW) has been aired in the world’s most populous nations—in India (two national campaigns, for World No Tobacco Day 2009 and 2010), Russia and China, as well as in Turkey, the Philippines and Mauritius.
The ‘Carotid’ advertisement (Quit Victoria), made in 2007 in support of the new graphic health warnings, has been used by New South Wales, the Northern Territory and the state of New York and New York City.
The ‘Bubblewrap’ campaign (Quit Victoria), produced in 2005 and aiming to educate smokers on emphysema, has been used by New South Wales, South Australia, Western Australia, Queensland and Tasmania as well as in Greece, New York City, Egypt, Poland, Russia, Turkey and China.
The ‘Separation’ campaign (Quit Victoria), produced in 2008, which aimed to educate smokers on the impact their smoking has on others, has been used by Tasmania and in New York City, New York State, Virginia and Rhode Island in the US.
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Section: 14.3.3Date of last update: 19 Jan 2012
Table 14.3.1 TV commercials produced in Australia since 2005*
Theme Campaign name First run by DescriptionSimulated negative health effects
Bubblewrap Quit Victoria 2005 Using bubblewrap to represent human lungs, it aims to increase awareness of the dangers of smoking on the respiratory system and the inevitability of emphysema.
Sponge Cancer Institute NSW 2007
A remake of the 1979 ‘Sponge’ advertisement produced by John Bevins for the NSW Department of Health. The ad uses ordinary sponges to demonstrate how lungs soak up cigarette smoking and collect tar.
Stairway to emphysema
Cancer Institute NSW 2008
Aims to encourage smokers to quit by focusing on a well-established health consequence of smoking: emphysema. It links the common smoker feeling of breathlessness after climbing up a flight of stairs with symptoms of emphysema. Smokers are prompted to think about the damage smoking has already caused to their lungs and the fact that it is irreversible.
Emphysema TV Cancer Institute NSW 2009
This 60-second television commercial, adapted from the Quit Victoria emphysema radio advertisement, emphasises the health consequences of smoking by showing a man delivering the script and breathing exercise to camera. He engages the viewer by showing what it is like to have emphysema. The apparent discomfort reinforces what breathing is like in the later stages of emphysema.
Graphic Mouth cancer Quit Victoria 2006 Builds on the graphic health warning ‘smoking causes mouth and throat cancer’ and highlights the fact that smoking is a major cause of cancer of the mouth (oral cavity) and throat (pharynx).
Amputation Cancer Institute 2006 Builds on the graphic health warning ‘smoking causes peripheral vascular disease’ and highlights that smoking can cause peripheral vascular disease (gangrene). The television advertisement is a dramatisation of the warning about peripheral vascular disease.
Carotid Quit Victoria 2007 Shows a carotid endarterectomy (surgical procedure) to remove a fatty deposit found in the main artery to the brain. The advertisement explains the link between smoking and stroke and aims to encourage people to quit.
Bronchoscopy Cancer Institute NSW 2007
Encourages smokers to quit by revealing what smoking-caused lung cancer looks and sounds like. It also communicates how the damage starts early and poor survival from lung cancer.
Artery (health warnings)
Department of Health and Ageing 1997 revised by Cancer Institute NSW 2008
Highlights connection with graphic health warning.
Everybody knows Cancer Institute NSW 2008
Presents memorable scenes from existing campaigns set to the music of the Leonard Cohen song of the same name. It shows the range of health consequences caused by smoking, and reinforces that smoking can lead to many diseases.
Cigarettes are eating you alive
Cancer Institute NSW, adapted from New York City Department of Health and Hygiene 2009
Portrays the negative health effects of smoking by using strong graphic images of disease and damaged tissue, which illustrate the multiple negative health effects of smoking.
Cigarettes are eating our kids alive
Cancer Institute NSW, adapted from New York City Department of Health and Hygiene 2009
Portrays the negative health effects of smoking around children by using strong graphic imagery of diseases and children affected by smoking.
Cough Australian Government 2011
Depicts a smoker going about his everyday business while suffering from a nagging smoker’s cough. Finishes with the tagline ‘At any time your smoker’s cough ... can become smoker-with-lung-cancer’s-cough. Every cigarette brings cancer closer’.
Sugar sugar Cancer Council WA 2010 Features a range of scenes depicting various smoking-related diseases including laryngeal cancer, chronic bronchitis, emphysema and heart disease. The advertisement is set to the well-known song by The Archies ‘Sugar Sugar’ and finishes with the words ‘Additives such as sugar and honey can hide the bitter taste of tobacco. But the damage cigarettes do can’t be hidden’.
Reflective Which disease? Cancer Institute NSW 2007
Produced as part of the National Health Warnings campaign; builds on multiple graphic health warnings. It focuses on the reality that you can’t choose which smoking-caused disease you will actually get if you continue to smoke. It encourages smokers to reflect on their own smoking behaviour and challenges their beliefs regarding the likely health consequences of their smoking.
If smoking was a friend
Cancer Institute NSW 2007
Encourages smokers to quit by showcasing the lengths smokers go to in order to accommodate smoking in their lives. It also highlights a number of health consequences caused by smoking.
Narrative testimonial
Parents Quit Victoria 2000 Produced by Quit Victoria and Cancer Council South Australia in 2001, it aims to increase awareness among smokers, particularly parents, of the negative effects smoking has on their health, fitness and lifestyle.
Excuses/echo 1, 11 and 111
Cancer Institute 2005 A remake of a successful Californian television commercial. Tackles smokers’ self-exempting beliefs by balancing their excuses with the certain consequences of continued smoking.
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Theme Campaign name First run by DescriptionNarrative testimonial (continued)
Voice within Cancer Institute NSW 2007
Aims to build on the graphic health warning ‘smoking doubles your risk of stroke’ to reinforce the fact that smoking can cause stroke and to motivate and remind smokers to quit.
Zita Cancer Council WA Uses edited footage from a Channel Seven Today Tonight story. It tells the story of Zita Roberts, a 36-year-old Perth mother of three. She had terminal lung cancer caused by smoking,
Anthony Cancer Institute NSW, adapted from UK 2008
Based on the personal testimony of a man diagnosed with throat and lung cancer. It was developed in the UK to motivate smokers to quit smoking.
Separation Quit Victoria 2008 Set at a train station, it powerfully depicts the personal and emotional impact that smoking-caused illnesses have on the lives of smokers’ families, particularly their children. The tagline ‘If this is how your child feels after losing you for a minute, imagine if they lost you for life’ aims to convince smokers to quit now.
Best intentions Cancer Institute NSW 2008
Research with smokers revealed the specific milestones in their life when they had promised themselves they would quit smoking e.g. New Year. Many expressed a sense of regret at missing these key milestones. The advertisement was developed in consultation with cancer care experts and patient case studies.
What’s worse? Cancer Institute NSW, adapted from UK 2009
Developed by the Department of Health UK, it depicts the real-life health consequences of smoking. It evokes an emotional response by focusing on the difficult situation of a mother communicating the realities of her illness to her young children.
Who will you leave behind?
Cancer Council WA Focuses on the experiences, thoughts and emotions of family members left behind by those who die from smoking-related diseases. The advertisements feature Luke and Ben, as well as Luke’s son James, talking about their father, Neil, who died from a smoking-related illness. Family photos and footage of Neil set the scene in the background.
Ronoldo Quit Victoria 2009 Adapted from the Massachusetts Department of Public Health, this ad features Ronaldo Martinez, who at 39 years of age lost his voicebox due to smoking-induced cancer and now breathes through a permanent hole in his throat. Ronaldo talks about how his life will never be the same now he has a tracheotomy.
Adrian’s regret Cancer Council WA, adapted from New Zealand 2010
The story of New Zealand man Adrian Pilkington, who, at the time of filming, was dying from smoking-related mouth cancer. Highlights the debilitating impact head and neck cancers have on day-to-day quality of life for patients, and the impact on their families.
Break the chain Australian Government 2011
Testimonial-style ad from an Aboriginal mother talking about her family’s history with smoking disease. The points she makes are punctuated, where appropriate, with cutaways to old photographs, sick relatives or other memorabilia. The advertisement finishes with her stating ‘If I can do it, I reckon we all can’. Encourages smokers to break the chain.
Supportive Quitline services Cancer Institute NSW 2006
In six advertisements Quitline advisors talk to camera about cravings, nicotine replacement therapy, planning quit attempts, call-back service, the best ways to quit and previous quit attempts.
Get off cigarettes Cancer Institute NSW, adapted from UK 2009
Was developed in the UK to support and encourage smokers to quit by increasing awareness of the range of support services available.
I can quit/willpower
Cancer Institute NSW 2010
Conveys the message that willpower is like a muscle: the more you use it the stronger it gets. The shows a woman in the process of quitting and how this helps her resist the urge to smoke.
Never give up Quit Victoria 2010 Follows a smoker caught up in the cycle of quitting and relapsing. At first he quits for three days, then six weeks and then one year. The advertisement concludes with him successfully quitting after three years. The campaign is designed to build smokers’ confidence to quit for good rather than focus on the negative effects of smoking.
Smoke-free Pubs and clubs Cancer Institute NSW 2006
Announces changes to state legislation regarding smoking in pubs and clubs.
Smokefree car and home
Quit Victoria 2007 Focuses on the interaction between a smoker and his daughter, and aims to prompt smokers to think about not smoking around others, especially children. It also encourages non-smokers to ensure that others do not smoke around them and their children.
Youth Feeling good Queensland Government 2007
Targets young women 18 to 24 years who smoke, particularly those classified through research as ‘trapped’ smokers. The campaign theme is ‘Discover life without smoking’. Three advertisements feature young women in three different ‘high-risk’ situations and illustrate how they manage to stay quit, given the pressures of these situations. The advertisements culminate with the resulting feelings of success the women experience.
My smoking Queensland Government 2011
Focuses on the importance to young people of making their own choices, as well as the influence of opinions, experiences and voices of their peers. ‘Real people – real stories’ is the main tagline, with real Queenslanders discussing daily smoking-related issues: looks, money, relationships and short-term health implications.
* Thank you to Kate Purcell for research and compilation of information for this table.
17Chapter 14: Social marketing and public education campaigns
Section: 14.3.3Date of last update: 19 Jan 2012
References1. Cancer Council Victoria. Our history, the 1970s. Melbourne, Australia: Cancer Council Victoria, 2005 [viewed November 2011]. Available from: http://www.cancervic.org.au/about/70-
years/history-1970s
2. Egger G, Fitzgerald W, Frape G, Monaem A, Rubinstein P, Tyler C, et al. Results of a large scale media anti-smoking campaign in Australia: the North Coast Healthy Lifestyle Program. British Medical Journal 1983;287:1125-8.
3. Winstanley M, Woodward S and Walker N. Tobacco in Australia: facts and issues, 1995. 2nd edn. Carlton South: Victorian Smoking and Health Program, 1995. Available from: http://www.quit.org.au/quit/FandI/welcome.htm
4. Senate Standing Committee on Social Welfare. Drug problems in Australia: an intoxicated society? Canberra: Australian Government Publishing Service, 1977.
5. National Campaign Against Drug Abuse. Campaign document issued following the Special Premiers’ Conference April 2, 1985. Canberra: Australian Government Publishing Service, 1985.
6. Blewett N. Australia’s achievements and ongoing strategy in the fight against tobacco consumption. In Durston B and Jamrozik K, eds. Tobacco and health 1990: the global war. Proceedings of the Seventh World Conference on Tobacco and Health, 1-5 April 1990. Perth: Health Department of Western Australia, 1990;6-8.
7. Research and Marketing Group. Tracking research for the Drug Offensive 'Smoking. Who needs it?' campaign and evaluation of campaign sponsorship of surfing events and clinics. Drug offensive research report. Sydney: The Department of Health, Housing, Local Government and Community Services, 1983.
8. Hill DJ, White VM and Scollo MM. Smoking behaviours of Australian adults in 1995: trends and concerns. Medical Journal of Australia 1998;168(5):209–13. Available from: http://www.mja.com.au/public/issues/mar2/hill/hill.html
9. Wooldridge M. Preface. In Hassard, K, ed. Australia’s National Tobacco Campaign: evaluation report vol. 1. Every cigarette is doing you damage. Canberra: Commonwealth Department of Health and Aged Care, 1999;Available from: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/national-tobacco-campaign-lp
10. Carter R and Scollo M. Chapter 7: Economic evaluation of the National Tobacco Campaign. In Hassard K, ed. Australia’s National Tobacco Campaign: evaluation report vol. 2 Every cigarette is doing you damage. Canberra: Commonwealth Department of Health and Aged Care, 2000;201–38. Available from: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/national-tobacco-campaign-lp
11. White V, Hill D, Siahpush M and Bobevski I. How has the prevalence of cigarette smoking changed among Australian adults? Trends in smoking prevalence between 1980 and 2001. Tobacco Control 2003;12 (suppl. 2):ii67-74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12878776
12. Wakefield M, Freeman J and Inglis G. Chapter 5: Changes associated with the National Tobacco Campaign: results of the third and fourth follow-up surveys. In Hassard K, ed. Australia’s National Tobacco Campaign: evaluation report vol. 3 Every cigarette is doing you damage. Canberra: Department of Health and Ageing, 2004;Available from: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/national-tobacco-campaign-lp
13. Hill D and Carroll T. Australia’s National Tobacco Campaign. Tobacco Control 2003;12(suppl. 2):ii9–14. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/12/suppl_2/ii9
14. National Public Health Partnership. Preventing Chronic Disease: A Strategic Framework. Melbourne, Australia: National Public Health Partnership, 2001. Available from: http://www.nphp.gov.au/publications/strategies/chrondis-bgpaper.pdf
15. National Tobacco Campaign Research and Evaluation Committee. Australia’s National Tobacco Campaign: evaluation report vol. 1 Every cigarette is doing you damage. Canberra, ACT: Ministerial Council on Drug Strategy, 1999. Available from: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/national-tobacco-campaign-lp
16. National Tobacco Campaign Research and Evaluation Committee. Australia’s National Tobacco Campaign: evaluation report vol. 2. Every cigarette is doing you damage, ed. Hassard, K. Vol. Two. Canberra: Commonwealth Department of Health and Ageing, 2000. Available from: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/national-tobacco-campaign-lp
17. National Tobacco Campaign Research and Evaluation Committee. Australia’s National Tobacco Campaign: evaluation report vol. 3. Every cigarette is doing you damage. Canberra: Commonwealth Department of Health and Ageing, 2004. Available from: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/national-tobacco-campaign-lp
18. Woodward A. Insights from Australia’s National Tobacco Campaign. Tobacco Control 2003;12(suppl. 2):ii0. Available from: http://tobaccocontrol.bmj.com/content/12/suppl_2/ii0.short
19. Australian Institute of Health and Welfare. Statistics on drug use in Australia 2004. Drug statistics series no.15, cat. no. PHE 62. Canberra: AIHW, 2005. Available from: http://www.aihw.gov.au/publications/index.cfm/title/10143
20. Scollo M, Younie S, Wakefield M, Freeman J and Icasiano F. Impact of tobacco tax reforms on tobacco prices and tobacco use in Australia. Tobacco Control 2003;12(suppl. 2):ii59–66. Available from: http://tc.bmjjournals.com/cgi/content/abstract/12/suppl_2/ii59
21. Wakefield M, Freeman J and Donovan R. Recall and response of smokers and recent quitters to the Australian National Tobacco Campaign. Tobacco Control 2003;12(suppl. 2):ii15-22. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/12/suppl_2/ii15
22. Donovan R, Freeman J, Borland R and Boulter J. Chapter 4: Tracking the National Tobacco Campaign. In Hassard K, ed. Australia’s National Tobacco Campaign: evaluation report vol. 1. Every cigarette is doing you damage. Canberra: Commonwealth Department of Health and Aged Care, 1999;127–87. Available from: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/national-tobacco-campaign-lp
23. Donovan RJ, Boulter J, Borland R, Jalleh G and Carter O. Continuous tracking of the Australian National Tobacco Campaign: advertising effects on recall, recognition, cognitions, and behaviour. Tobacco Control 2003;12(suppl. 2):ii30–9. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/12/suppl_2/ii30
24. Hurley SF and Matthews JP. Cost-effectiveness of the Australian National Tobacco Campaign. Tobacco Control 2008;17(6):379-84. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/17/6/379
25. Low yield cigarettes ‘not a healthier option’: $9 million campaign. Canberra: Australian Competition and Consumer Commission, 2006. Available from: http://www.accc.gov.au /content/index.phtml/itemId/719575
26. Australian Government Department of Health and Ageing. Background on the national Tobacco Youth Campaign. National Tobacco Campaign. Canberra: Department of Health and Ageing, 2006 [viewed 8 June 2007]. Available from: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/youth-lp
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27. Australian Government Department of Health and Ageing. Graphic Health Warnings: labelling of tobacco products. Australian Government Department of Health and Ageing, 2006. Available from: http://www.quitnow.info.au/internet/quitnow/publishing.nsf/Content/warnings-lp
28. Holman C, Donovan R, Corti B, Jalleh G, Frizzell S and Carroll A. Banning tobacco sponsorship: replacing tobacco with health messages and creating health-promoting environments. Tobacco Control 1997;6(2):115−21. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1759553&blobtype=pdf
29. Holman CDJ, Donovan RJ and Corti B. Report of the evaluation of the Western Australian Health Promotion Foundation. Department of Public Health and Graduate School of Management. Perth: The University of Western Australia, 1994. Available from: http://heapro.oxfordjournals.org/content/8/3/199.abstract
30. Borland R, Yong H, Wilson N, Fong G, Hammond D, Cummings K, et al. How reactions to cigarette packet health warnings influence quitting: findings from the ITC Four-Country survey. Addiction 2009;104(4):669–75. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19215595
31. Murphy M. Cigarette pack warning labels. Report of exploratory qualitative research for Quit Victoria and Cancer Institute NSW. Melbourne, Australia: Market Access Consulting and Research Pty Ltd, 2005.
32. Quit Victoria and The Cancer Institute NSW. Health warnings campaigns. Sydney: Quit Victoria and The Cancer Institute NSW, 2007.
33. Brennan E, Durkin S, Cotter T, Harper T and Wakefield M. Mass media campaigns designed to support new pictorial health warnings on cigarette packets: evidence of a complementary relationship. Tobacco Control 2011;[Epub ahead of print]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21474501
34. Cotter T, Perez D, Dunlop S, Hung WT, Dessaix A and Bishop JF. The case for recycling and adapting anti-tobacco mass media campaigns. Tobacco Control 2010;19(6):514–17. Available from: http://tobaccocontrol.bmj.com/content/19/6/514.abstract
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Section: 14.4.1 Date of last update: 19 Jan 2012
14.4
Examining the effectiveness of public education campaignsContributors: Trish Cotter, consultant to the NSW Cancer Institute, and Sarah Durkin, Ph D Centre for Behavioural Research in Cancer, Cancer Council Victoria
Advertising in the mass media allows public health campaigners to repeatedly expose the population to messages about the negative effects of tobacco use and the benefits of quitting. This exposure occurs incidentally (during routine media use) rather than being explicitly sought,1 so it provides a way of reaching individuals who are already thinking about quitting as well as those who are not yet at this point. Exposure to messages in the mass media can directly influence individual decision-making about quitting as smokers view or hear campaign messages, gain new insights and reflect on the implications for their own lives. It can also operate indirectly by influencing interpersonal discussion about tobacco use within family and friendship networks or by influencing social norms. Changes in broader social norms in turn can increase the likelihood of adoption of tobacco-control policies (such as smokefree policies or increases in taxes on tobacco) and these policies might also prompt further quit attempts.2
If they are to be effective, mass media campaigns must be noticed (using appropriate media channels and placement to reach the target group), perceived as persuasive (experienced by the target group as engaging, relevant and/or emotionally affecting) and remembered (seen often enough for them to be recalled and acted upon). Campaigns can generally expect small effect sizes, but, because they reach mass numbers of individuals within populations, the degree of change is of high practical significance.3
Several notable reviews examining the effect of mass media campaigns on smoking behaviour,4–6,2 on youth smoking7,8 and across health behaviours8,9 have helped to consolidate knowledge from research and practice. All these comprehensive reviews reach a similar conclusion—that mass media campaigns can positively change smoking behaviour in adults and youth. Where they differ is in the strength of their conclusions. The most comprehensive review on the effects of media campaigns on smoking behaviour was a major monograph published by the US National Cancer Institute in 2008.4 This 650-page document reviewed scientific studies conducted in numerous countries across several decades.10 This included scientific literature relevant to the role of advertising in forming opinions about and attitudes to smoking.11 The monograph systematically assessed several different sources of evidence about the effects of advertising by tobacco companies and by health campaigns12 as well as the portrayal of smoking in the media and popular culture.13 On the basis of its broad-ranging expert analysis of direct and indirect evidence from within health, communication and broader psychological fields, it found that there was sufficient evidence to conclude that anti-smoking campaigns can reduce population smoking and that both mass media advertising of tobacco products and portrayal of smoking in the media also can exert causal effects on population smoking among both youth and adults.14 The most recent review2 provides the strongest evidence of effectiveness of anti-smoking campaigns in reducing smoking; confidence grows as study design improves and data accumulate from multiple campaigns in different places over many years. The content of this chapter draws largely on the content and conclusions of this most recent review.
14.4.1
Population-level effectivenessWith its long history of running mass media-led campaigns to discourage smoking, Australia has made a major contribution to the evidence base about population-level effectiveness. Beginning with the ‘Quit. For Life’ Sydney–Melbourne pre–post (before-and-after) trial in the early 1980s,15,16 then the National Tobacco Campaign in the late 1990s,17–19 and with successful exports of campaigns such as ‘Bubblewrap’ and ‘Sponge’,20 Australia has developed an international reputation for excellence in developing and evaluating anti-smoking television advertising. In more recent years Australian researchers have focused on campaign elements that optimise effectiveness, such as themes and content,17,21–23 media type,24 media placement25,26 and the intensity and duration of campaigns.27–29
20 Tobacco in Australia:Facts and Issues
Section: 14.4.1.2 Date of last update: 19 Jan 2012
14.4.1.1
Population-level effectiveness: adultsDue to the difficulties in conducting such research, there have been few large-scale evaluations of adult-focused anti-tobacco campaigns. In early evaluation studies of Australia’s National Tobacco Campaign, smokers reported that the campaign had helped them move towards quitting and ex-smokers reported it had helped them remain quit.30 Importantly, evaluation studies were able to demonstrate that the first phase of the National Tobacco Campaign achieved a reduction of 190,000 smokers.31,32 More recently, studies from the American Legacy Foundation’s ‘EX’ campaign showed a significant increase in quit attempts and a trend towards higher quit rates among smokers with confirmed campaign recall.33,34
A systematic review by the Cochrane Collaboration in 2008 examined 11 mass media campaigns to assess associated adult smoking behaviour changes.5 Weighted towards studies using conventional control group designs, this review concluded that comprehensive tobacco-control programs that included mass media campaigns could positively change smoking behaviour in adults, but noted that studies were variable in their methodological design and quality. The authors further concluded that intensity and duration of mass media campaigns might influence effectiveness.
Also in 2008, the National Cancer Institute4 found that, of 11 population-based government-funded mass media campaigns conducted as part of state or national tobacco-control programs and evaluated to that time, all demonstrated positive effects on smoking prevalence and/or per capita tobacco consumption.
In recent years studies relating commercial TV ratings data with individual-level data have consistently demonstrated that an individual’s potential exposure to televised anti-smoking campaigns is related to numerous desirable outcomes. In a prospective population study in Massachusetts, greater population exposure to aggregated televised media campaigns among adult smokers was associated with a higher likelihood of quitting at a two-year follow-up.21 Higher levels of exposure have also been associated with increased calls to quitlines,35–39,22,23 increased quitting behaviours among adults21,27 and decreased adult smoking prevalence.28
A time series analysis of monthly smoking prevalence in Australia over 11 years found that greater population exposure to televised media campaign advertising was associated with a faster decline in adult smoking prevalence, after adjusting for variation in tobacco prices, smokefree restaurant laws, tobacco marketing restrictions and availability of smoking cessation products.28
A recent cohort study using Australian data from the International Tobacco Control Project, demonstrated that the likelihood of making a quit attempt at follow-up was associated with increased exposure to anti-tobacco advertising in the three months before follow-up, but not to advertising in more distant months.29
The research shows that campaigns need to be of sufficient intensity and duration to have an effect and have relatively short-term carry-forward effects on quit attempts and that repeated cycles of broadcasting achieve sustainable population changes in smoking behaviour. Durkin and colleagues’ review for Tobacco Control2 concluded that mass media campaigns to promote quitting are important investments as part of comprehensive tobacco-control programs to reduce adult smoking prevalence. Jurisdictions should aim for high reach and consistent exposure over time and favour messages that contain effective ‘negative health effects’ messages.
Summary
Adult-focused mass media campaigns focusing on the negative health consequences of smoking broadcast with sufficient duration and intensity can reduce adult smoking prevalence.
14.4.1.2
Population-level effectiveness: youthWhether tobacco-control campaigns should primarily focus on youth (because most people start smoking before age 18) or on adults (who make up the vast majority of current smokers) has been extensively debated.40,41 The
21Chapter 14: Social marketing and public education campaigns
Section: 14.4.2.1 Date of last update: 19 Jan 2012
findings to date suggest there is no need to choose between the two options, since an effective adult-targeted campaign appears to be as effective in communicating with youth as with adults.14 This may be because they change broader social norms about smoking, including the perception that smoking is common and accepted.8,40
Reviews of early field trials provided some support for media interventions combined with school programs, but more recent population-based research on adult- and youth-focused mass media campaigns provides convincing evidence that these campaigns can reduce youth smoking.42–45 The National Cancer Institute review concludes that: ‘in isolation, each study might be considered imperfect, yet when considered together, there is a high degree of consistency in findings, which provide good support for the notion that anti-smoking advertising can influence youth smoking’.14
Recent studies46–48 provide further support for mass media campaigns in maintaining reductions in youth smoking. Several studies have demonstrated a rapid decay of campaign effects when anti-smoking advertising is suspended;49 when funding was reduced for the youth-focused Florida ‘truth’ campaign in 1999, immediate reductions in anti-smoking beliefs were observed and smoking intentions began to increase. The launch of the national ‘truth’ campaign six months later may have mitigated some of these effects on anti-industry beliefs, but not on smoking intentions.50 Studies examining the exposure of youth to advertising have shown that higher levels of exposure are associated with better smoking-related attitudes, beliefs and behaviours among youth.46,51–53
Summary
Adult and youth focused campaigns can influence youth smoking.
14.4.2
Campaign content and themeAnti-smoking mass media campaigns are increasingly characterised by their message content and style.4 Recent work has tended to first categorise messages by purpose in order to identify the most effective message strategy.54,55 Several categories provide useful differentiation—‘why to quit’ (messages that encourage cessation by advising smokers why they should quit smoking), ‘how to quit’ (messages that promote cessation by educating smokers how to quit), ‘keep trying to quit’, ‘secondhand smoke health effects’ (which can include some elements of ‘why to quit’) and advertising that reveals ‘tobacco industry manipulation’.
14.4.2.1
Campaign content and theme: adultsIn recent years, strong evidence has emerged suggesting that advertisements that arouse strong negative emotions perform better than those that do not.4,21,56–58 These advertisements tend to depict serious harm done by smoking or secondhand smoke in an authentic way and sometimes include depictions of tobacco industry awareness of the harm of smoking. Experimental research on information processing supports the hypothesis that advertisements that evoke high arousal will receive greater viewer attention and will be remembered more readily than those that do not.59 Further, negative content tends to produce higher levels of arousal than does positive content.
The National Cancer Institute review demonstrated that messages that elicited negative emotions by describing the serious health consequences of smoking scored higher on ratings on perceived effectiveness57 and memorability60 and were more likely to be recalled by recent quitters who believed that anti-smoking advertisements had contributed to their quit attempt.61 Durkin and colleagues found that exposure to messages with high levels of emotion and/or a personal testimonial (typically negative health effects advertisements) significantly increased the likelihood of being quit at two-year follow-up, whereas messages that were low in emotion and did not feature a personal testimonial were not related to the likelihood of quitting.21
The effect on Quitline call volume generated by different message types also provides useful insights into the potential effectiveness of different styles of advertising. Mosbaek and colleagues found that ‘why to quit’ family
22 Tobacco in Australia:Facts and Issues
Section: SummaryDate of last update: 19 Jan 2012
testimonial advertisements were the most cost-effective advertisements for generating Quitline calls.38 A study of calls to the Victorian Quitline over a two-year period found that exposure to higher emotion ‘why to quit’ testimonial messages were the strongest driver of Quitline calls.22 Farrelly and colleagues found that exposure to advertising with graphic imagery was associated with the greatest increases in calls to the New York Quitline.23
Dunlop and colleagues reported that advertisements evoking moderate or high levels of emotion were more likely to stimulate interpersonal pressure from family and friends on smokers to quit, and that this pressure was associated with increased likelihood of recent quit attempts. Interpersonal pressure generated by highly and moderately emotional advertisements was positively associated with salient quitting thoughts.62 In a later review,2 the authors conclude that the negative health effects advertisements with graphic imagery and/or testimonial stories to elicit negative emotions tend to perform better than ads without these features.
Summary
Negative health effects advertisements with high levels of emotion and personal testimony have the greatest potential impact on adult smokers.
14.4.2.2
Campaign content and theme: youthResearch and reviews of youth campaigns have begun to focus on which message characteristics work best, the ideal level of exposure and which types of youth are most and least affected by mass media anti-smoking campaigns.
Biener and colleagues56 noted particular advertisements were effective with adults and youth. Advertisements that young people perceived as most effective were those that evoked a strong negative emotion such as fear or sadness and conveyed a thought-provoking and believable message about the serious long-term consequences of smoking. These were perceived as more effective than advertisements that were designed as humorous or entertaining, or normative advertisements that had low emotional content or generated low cognitive engagement. These perceptions were consistent between teenage boys and girls.
Population-based research also indicates that recall of campaign messages has been associated with reduced smoking behaviour in youth42,43 and a recent study by Biener and colleagues58 of adolescents aged 12–17 years found that the level of the advertisements emotional intensity was a significant predictor of advertising recall.
While the ‘tobacco industry manipulation’ approach has not been extensively employed in Australia there is evidence of its effective use in the US. Evaluation of the American Legacy Foundation’s national ‘truth’ campaign, a strong ‘tobacco industry manipulation’ campaign, found significantly changed attitudes towards smoking among young people in a relatively short period.63 The national campaign delivered stark facts about the tobacco industry and its marketing practices, and built on positive results achieved by the campaign in Florida.64
The context or circumstances in which youth are exposed to messages also seems to be important in that discussions about such advertising can enhance the impact of anti-smoking messages on quitting intentions and quit attempts in adolescents.26,65 Dunlop66 found that for smokers, talking about the ‘truth’ campaign was associated with beliefs, attitudes, and intentions in greater agreement with campaign messages, but only if associated with positive campaign evaluation. For smokers who evaluate a campaign negatively, talking about that campaign was associated with beliefs and attitudes counter to the campaign messages.
Summary
Advertisements that evoke high levels of emotion and discussion by describing the serious long-term consequences of smoking or by highlighting tobacco industry deception have been found to be most effective for youth.
23Chapter 14: Social marketing and public education campaigns
Section: SummaryDate of last update: 19 Jan 2012
14.4.3
Campaign exposureAdvertising research reveals that the effects of advertising linger over the days and weeks after broadcast ends, but are unlikely to linger over weeks to months.67,50 Although people may recall anti-tobacco advertisements long after they are discontinued, especially memorable ads, behavioural effects decay relatively quickly.50,51,68 This means that campaign advertising only exerts effects on smoking behaviour during periods of advertising activity, and effects rapidly diminish once advertising is withdrawn. This is why advertising is sometimes referred to as acting ‘like a spring, rather than a screw’69 in pushing down smoking prevalence. That is, advertising will not have a once-and-for-good effect in reducing smoking prevalence, but creates a prompt (and a reminder for those battling not to relapse) as to why people need to avoid smoking, and where help can be accessed.
14.4.3.1
Campaign exposure: adultsIdentifying the level and duration of media placement required to achieve optimum population response is critical for campaign planners and funding agencies, informing decisions about the campaign placement strategy and the investment that will most efficiently result in behavioural changes.
Studies that relate exposure to commercial TV with data on smoking prevalence28 or other smoking-related outcomes21,27,51–53 have consistently demonstrated that an individual’s potential exposure to televised anti-smoking campaigns is related to a range of positive outcomes. In these studies estimates of audience exposure to advertising are usually measured by gross ratings points (GRPs) or target audience ratings points (TARPs)i.
Attempts to quantify the optimal level and duration of campaign exposure to achieve a significant impact on behaviour are challenging and a consensus across studies internationally has not yet been reached.21,27
The optimal timing of exposure to anti-smoking media campaigns also requires more research to answer important questions, such as, does the effect of increased advertising occur within a few weeks, or does it require a more sustained exposure? An Australian study using monthly tobacco control GRPs and a time-series analysis provides some guidance.28 This study demonstrated that an increase in the level of tobacco control GRPs is associated with an accelerated rate of decline in smoking prevalence two months later. It was estimated that, to achieve a temporary 0.3 percentage-point decline in smoking prevalence, a 390-monthly GRP increase two months earlier would be required (equating to approximately one ad exposure per person in the population per week). Further, a cohort study29 and a serial cross-sectional analysis of the aggregate effects of tobacco-control campaign exposure70 concluded that advertising is associated with short-term increases in the likelihood of smokers making a quit attempt. Consistent with Wakefield and colleagues’ time-series analyses, which found an increase in advertising exposure was associated with an accelerated decline in smoking prevalence two months later,28 Dunlop and colleagues’ analysis concluded that the association between increased advertising exposure and quit attempts was detectable only after an average of nine weeks of cumulative exposure. Their findings suggest that exposures of more than 100 TARPs per week (equating to approximately one or two exposures per week) produce the greatest effects on quitting thoughts and quit attempts.
Summary
Recognising that smokers are cycling through stages of readiness to quit at different times throughout the year, it is important that sufficient funding be provided to enable repeated cycles of advertising of sufficient weight throughout the year to sustain high levels of quit attempts.29,70
i TARPs and GRPs provide an estimate of the reach and frequency of an advertisement in a particular media market for a specific target audience.
24 Tobacco in Australia:Facts and Issues
Section: 14.4.4 Date of last update: 19 Jan 2012
14.4.3.2
Campaign exposure: youthSeveral studies of youth campaigns in the US provide more insights into the effectiveness of different levels and duration of media exposure on youth. In their national study of the effects of state-sponsored campaigns across the US, Emery and colleagues found that after controlling for a range of other potential influences, media campaigns were associated with stronger anti-smoking attitudes and beliefs among youth and reduced youth smoking.51 Their analysis suggested that it was important in terms of maintaining anti-smoking attitudes and beliefs and reduced smoking that youth were exposed to an anti-tobacco advertisement at a minimal mean exposure rate of at least one advertisement every four months.
Farrelly and colleagues also found a dose–response relationship between exposure to the ‘Truth’ campaign and youth smoking in the last 30 days.52 However, this effect diminished at very high levels of exposure. Positive effects of the campaign were increasingly found with increasing GRPs up to 10,000 GRPs over a two-year period (an average of four exposures per month per individual), but at higher levels the effect began to attenuate, although still remaining in a positive direction.
Removing anti-smoking advertising can cause smoking behaviour to regress. A study examining the impact of de-funding the Minnesota youth tobacco-use prevention program68 found that a range of measures of susceptibility to smoking among youth—including openness to smoking, and beliefs, attitudes and intentions to smoke—consistently increased following the de-funding of the campaign.
Summary
Similar to adults, the impact of media on smoking behaviour among youth appears to be dose-related and removing advertising can result in regression in smoking behaviour.
14.4.4
Targeting and demographic sub-groupsStudies examining the effectiveness of targeted campaigns for age, education, ethnicity and gender5 and low socio-economic status (SES) populations71 have found mixed or inconsistent relationships between campaigns and effectiveness. However, differences in effectiveness of media campaigns between SES groups may be the result of low levels of exposure and promotion.71
Australia’s National Tobacco Campaign is an example of a general audience campaign and its effect on demographic sub-groups. The media buy for the National Tobacco Campaign was designed to maximise exposure of campaign advertising, with a lower socio-economic bias, reflecting a similar bias in the prevalence of smoking in the Australian population.72 An examination of the demographic trends in smoking over the course of the National Tobacco Campaign was undertaken to assess whether the campaign was achieving a similar impact across socio-demographic groups.73,74 The study examined data from the baseline and annual National Tobacco Campaign evaluation surveys from May 1997 to November 2000. It looked at three age groups—18–34 years, 35–60 years and over 60 years—and three occupation groups: professional, white collar and blue collar. Calculating odds ratios between age groups and occupational categories revealed that within the downward trend observed in smoking prevalence over the period of the National Tobacco Campaign, the socio-demographic differences observed between age and occupational categories at baseline remained stable. This indicated that the National Tobacco Campaign appeared to achieve an equal impact across socio-demographic groups, thereby achieving greater relative decline in the groups with highest prevalence at baseline, younger smokers and those in the blue collar occupation category.
The effectiveness of different types of media messages on demographic sub-groups has also been analysed.21,54,55,75 Durkin and colleagues21 found that exposure to high emotion and/or personal testimonial-style ads was associated with quitting and increased quitline calls for low- and mid-level SES smokers, but not high-level SES smokers. Niederdeppe and colleagues55 found that differences in perceived effectiveness between ‘why to quit’ and ‘how to
25Chapter 14: Social marketing and public education campaigns
Section: 14.4.6 Date of last update: 19 Jan 2012
quit’ ads were more pronounced among lower educated smokers compared to higher educated smokers. Given that ‘why to quit’ ads were more effective than ‘how to quit’ ads across all educational levels, the authors concluded that these types of ads may work best for all smokers, while at the same time contributing to a reduction in the SES disparities in smoking.
In another examination of SES effects, Niederdeppe and colleagues55 found that differences in perceived effectiveness between graphic and testimonial-style ‘why to quit’ ads and ‘how to quit’ ads were more pronounced among lower educated smokers compared to higher educated smokers. They found that baseline recall of ‘keep trying to quit’ ads was associated with a lower quit attempts among those with high school or less education, but with a greater probability of making a quit attempt among higher educated smokers. In contrast, they found no association between baseline recall of ‘secondhand smoke health effects’ messages on quit attempts or behaviour at 12-month follow-up.76
The National Cancer Institute review4 concluded that advertisements that perform well do so among many population groups. In their updated review, Durkin and colleagues2 acknowledge that though targeting anti-smoking ads to specific audience groups may increase message relevance and persuasion, the increased costs of this strategy may result in a lower proportion of their funds being available for broadcast, resulting in lower rates of overall campaign effectiveness.
Summary
Negative health consequences (‘why to quit’) advertisements may work best for all smokers, and may contribute to reductions in SES disparities in smoking.
14.4.5
Reaching Australians from culturally and linguistically diverse backgroundsExamples of mass media campaigns for demographic sub-groups include a mass media campaign aimed at Māori smokers and recent quitters in New Zealand, which found that 54% reported the campaign made them more likely to quit, but there was no movement in ‘stage of change’ before versus after the campaign.77 A study in Sydney reported beneficial effects of a localised mass media campaign for Arabic-speaking smokers on reducing Arabic smoking prevalence, compared with state and Sydney area non-Arabic smoking prevalence.78
14.4.6
Reaching Indigenous smokersVery few studies have evaluated the impact of media campaigns on Australian Indigenous communities. A qualitative research study conducted with Indigenous communities in Victoria in the early years of the National Tobacco Campaign found high levels of awareness of the campaign television advertisements and message take-out, similar to the broader population evaluation studies.79 The health issues conveyed were generally understood, with young people in particular frequently describing the health effects of smoking in the language and imagery of these advertisements. However, smoking was not perceived as a major health concern and quitting intention was observed to be lower than in the general population.
Johnston and Thomas,80 in their qualitative review of tobacco-control activities in three remote communities in the Northern Territory, reported generally good recall of mainstream anti-tobacco mass media messages. Boyle and colleagues,81 in their evaluation of the ‘Bubblewrap’ campaign among Aboriginal smokers in Western Australia, suggested that mainstream mass media campaigns could positively influence the thoughts and behaviours of Aboriginal smokers. However, they also suggested that advertisers look for better ways to integrate Aboriginal themes in mainstream messages and ensure campaigns reach the large Aboriginal populations in regional and remote Australia. Stewart and colleagues82 recently used a quantitative ad rating study to compare responses to
26 Tobacco in Australia:Facts and Issues
Section: 14.4.7.2 Date of last update: 19 Jan 2012
different styles of anti-smoking advertisement from Indigenous and non-Indigenous participants. They found that Indigenous people rated mainstream advertisements higher than non-Indigenous people and were more likely to report that they provided new information. Advertisements with strong graphic imagery depicting the health effects of smoking and those with emotive first person narratives were rated highly by Indigenous smokers, indicating that these styles of campaigns are likely to be highly motivating for Indigenous smokers.
14.4.7
Media channels (including new media)Understanding communication channels and their audiences makes it possible to develop messages most likely to resonate with target audiences and reach them more frequently.83 Knowledge of communication channels is especially important, given the substantial costs required to mount effective mass media campaigns.
14.4.7.1
TelevisionThere is limited Australian analysis of the media channels smokers use and their media consumption habits. One US study examines the communication channels through which cigarette smokers regularly receive information, and whether they differ from those used by non-smokers.83
Data collected by Roy Morgan Research are routinely used by media strategists on behalf of campaign planners to inform advertising placement. Despite the introduction of new media and the proliferation of media channels (subscription and digital), free-to-air television is still considered the most cost-effective means of reaching large numbers of Australian smokers. For example, according to the Roy Morgan single source data, Australian smokers are 19% more likely than the average person aged 18+ to watch more than three hours of TV per day and 60% of all smokers nationally are either ‘medium’ (2–3 hours/day) or ‘heavy’ (3+ hours/day) TV viewers. Australian smokers with lower SES profiles are more likely to be heavy consumers of TV. Smokers in the bottom two SES quintiles are 46% more likely than the average to be categorised as heavy TV viewers (3+ hours/day). Forty-five per cent of all lower SES smokers watch more than three hours per day, which gives TV a natural advantage over other media in its ability to reach smokers cost efficiently.84
Potentially one of the greatest challenges for tobacco-control campaigns is the changing media environment and changing media habits of smokers, particularly younger smokers. As the amount of free-to-air television watched by young people declines and is displaced by digital and subscription television channels and online activities, the cost of reaching these audiences with the desired frequency is increasing.
14.4.7.2
Radio and cinemaMuch of the research in this chapter has focused on television. This is not surprising: television can more easily generate emotion through the skilful fusion of sound and vision, and the medium can reach a broad range of a target population in a short period of time. Television advertisements are commonly used in cinema and the Internet is now providing further opportunities for exposure to these advertisements. However, the potential impact of other media channels should not be downplayed. One study comparing the responses to radio and television anti-smoking advertisements24 showed emotionally evocative radio advertising could be an effective adjunct or alternative to television advertising in areas where there are substantial limits on funds available for broadcast or where the reach of radio outstrips other media.
27Chapter 14: Social marketing and public education campaigns
Section: 14.4.8 Date of last update: 19 Jan 2012
14.4.7.3
Social mediaThe participatory web, which encompasses social networking and user generated content (UGC), continues to foster intense online participation. During June 2010, 8.7 million Australians visited mainstream social networking/UGC sites including Facebook and YouTube from home, spending 41.5 million hours on these sites. Facebook continues to dominate the social networking/UGC network in Australia, accounting for 81% of time spent on these sites and 82% of web pages viewed.85
Social media can potentially play a powerful adjunct role in mass media campaigns, crossing the divide from broadcast media (offering passive delivery of campaigns) to interpersonal communication (offering personalised, responsive two-way messaging). With more than 10 million Facebook users in Australia and almost 50% penetration,i this social media network is almost ubiquitous in popular culture and represents an opportunity (for engagement) and challenge to develop approaches to both message delivery and evaluation. In one of the few published papers to evaluate this approach, van den Putte86 described how an anti-tobacco mass media campaign generated conversations among personal and online social networks and demonstrated that those conversations generated quit attempts in people not exposed to the media campaigns. Figure 14.4.1 shows some of the potential areas for engaging with social media.
Summary
Regardless of whether they are new or old, choices of which media to use in communicating with smokers must balance cost, accessibility, effort, timeliness and most importantly ability to deliver access to the target group (reach) measurable against campaign objectives.
14.4.8
Cigarette smoking in moviesIn considering the potential competitive communication environment within which tobacco-control interventions are operating, one area that has received increasing attention over the last decade is the depiction of smoking in movies. In its review of the role of entertainment media in promoting or discouraging tobacco use, the National Cancer Institute concluded that there was a causal relationship between exposure to movie smoking depictions and youth smoking initiation but that research has not yet determined the role that such depictions of smoking may play in maintaining experimental smoking or in prompting relapse among smokers who have quit.13 See Chapter 5. Uptake, Section 5.16 for further discussion.
A number of responses to the problem of smoking in movies have been suggested, including banning product placement, applying restrictive adults-only classifications, industry self-regulation and the screening of anti-smoking messages prior to films that depict smoking.87 A New South Wales study examined whether placing a cinema advertisement about smoking depiction in films before the film screening could influence young women’s perceptions of smoking in movies and their intentions to smoke. Results suggest that this type of approach can help
i For latest statistics, see http://www.socialbakers.com/facebook-statistics/. Australia ranked 19th in September 2011.
Figure 14.4.1 Model of media in the digital ageSource: Hamil S 2011. Innovation and Social Media. Presentation at World
Lung Foundation Global Communications meeting, Bangkok, Thailand. March 2011
Social media
Micro blogging
Imagesharing
Videosharing
Socialnetworks
Socialbookmarks
‘New’ mediaWebsites
Online advertisementsEmail marketing
Mobile
Blogs
Podcasts andslidesharing
BroadcastHigh impact
InterpersonalHigh e�ort
28 Tobacco in Australia:Facts and Issues
Section: 14.4.9 Date of last update: 19 Jan 2012
to, in the authors’ terms, ‘immunise’ against the influences of film stars smoking.88 This is an example of identifying media opportunities to pre-empt positive depictions of smoking that circumvent advertising restrictions.
14.4.9
Pharmaceutical advertisingAdvertising for quitting adjuncts such as nicotine replacement therapy (NRT) and other pharmaceutical aids now has a significant presence in Australia.
In considering the relative contribution of smoking cessation aids and anti-tobacco advertising campaigns, Biener and colleagues undertook a study in Massachusetts with nearly 800 ex-smokers who had quit within the previous two years and investigated what these ex-smokers thought offered the greatest help for them to quit.61 They were more likely to cite anti-tobacco television advertisements than conventional cessation aids. Few individuals mentioned NRT advertisements as having influenced their quitting; the authors question whether those advertisements might be able to achieve the goal of informing people about the availability of their product as well as increasing motivation to quit.
Wakefield and colleagues28 found that higher monthly sales of NRT and bupropion did not have a detectable impact on monthly smoking prevalence even though NRT sales increased in response to NRT advertising. They postulate that because NRT and bupropion are designed and used by heavier smokers, the population reach is limited; it may only help those who are already motivated to try to quit as opposed to motivating more smokers overall to try to quit, which can be increased by tax increases and mass media campaigns.
An important area for future research about how this pharmaceutical advertising may interact with anti-tobacco advertising is the impact on smokers’ self-efficacy regarding quitting. For instance, do the pharmaceutical advertisements increase smokers’ confidence because of the availability of this aid, or does the suggestion that you may need a pharmaceutical aid to quit smoking make the task seem more difficult and less achievable for some smokers?
* Thank you to Dr Tom Carroll who wrote the previous version of this document. Thank you also to Dr Sally Dunlop and Professor Melanie Wakefield for advice and comments on this section.
29Chapter 14: Social marketing and public education campaigns
Section: 14.4.9 Date of last update: 19 Jan 2012
References1. Hornik RC. Public health communication: evidence for behavior change. LEA’s communication series. Mahwah, New Jersey: L. Erlbaum Associates, 2002. Available from: http://www.loc.
gov/catdir/enhancements/fy0662/2001033784-d.html
2. Durkin S, Brennan E and Wakefield M. Mass media campaigns to promote smoking cessation among adults: an integrative review. Tobacco Control 2012;accepted for publication (World Conference special issue) Available from: http://tobaccocontrol.bmj.com/content/early/recent
3. Snyder LB, Hamilton MA, Mitchell EW, Kiwanuka-Tondo J, Fleming-Milici F and Proctor D. A meta-analysis of the effect of mediated health communication campaigns on behavior change in the United States. Journal of Health Communication 2004;9(suppl. 1):71–96. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14960405
4. National Cancer Institute. Monograph 19: the role of the media in promoting and reducing tobacco use. Bethesda, Maryland: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2008. Available from: http://cancercontrol.cancer.gov/tcrb/monographs/19/index.html
5. Bala M, Strzeszynski L and Cahill K. Mass media interventions for smoking cessation in adults. Cochrane Database of Systematic Reviews 2008(1):Art. no. CD004704. Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004704/frame.html
6. Wakefield M, Loken B and Hornik R. Use of mass media campaigns to change health behaviour. The Lancet 2010;376(9748):1261–71. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20933263
7. Brinn M, Carson K, Esterman A, Chang A and Smith B. Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2010(11):CD001006. Available from: http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD001006/pdf_standard_fs.html
8. Wakefield M, Flay B, Nichter M and Giovino G. Effects of anti-smoking advertising on youth smoking: a review. Journal of Health Communication 2003;8(3):229–47. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12857653
9. Abroms LC and Maibach EW. The effectiveness of mass communication to change public behavior. Annual Review of Public Health 2008;29:219–34.
10. National Cancer Institute. Part 1-Overview and conclusions. Monograph 19: the role of the media in promoting and reducing tobacco use. Bethesda, Maryland: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2008;Available from: http://cancercontrol.cancer.gov/tcrb/monographs/19/index.html
11. National Cancer Institute. Chapter 2. Theoretical underpinnings of media research in tobacco control and tobacco promotion. Monograph 19: the role of the media in promoting and reducing tobacco use. Bethesda, Maryland: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2008;Available from: http://cancercontrol.cancer.gov/tcrb/monographs/19/index.html
12. National Cancer Institute. Part 5-Media, tobacco control interventions and tobacco industry mitigation effects. Monograph 19: the role of the media in promoting and reducing tobacco use. Bethesda, Maryland: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2008;Available from: http://cancercontrol.cancer.gov/tcrb/monographs/19/index.html
13. National Cancer Institute. Part 3-Tobacco in news and entertainment media. Monograph 19: the role of the media in promoting and reducing tobacco use. Bethesda, Maryland: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2008;Available from: http://cancercontrol.cancer.gov/tcrb/monographs/19/index.html
14. National Cancer Institute. Part 4-Tobacco control and media interventions. Monograph 19: the role of the media in promoting and reducing tobacco use. Bethesda, Maryland: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2008;429–546. Available from: http://cancercontrol.cancer.gov/tcrb/monographs/19/index.html
15. Pierce J, Dwyer T, Frape G, Chapman S, Chamberlain A and Burke N. Evaluation of the Sydney ‘Quit For Life’ anti-smoking campaign. Part 1. Achievement of intermediate goals. Medical Journal of Australia 1986;144(7):341–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3959949
16. Pierce J, Macaskill A and Hill D. Long-term effectiveness of mass media led antismoking campaigns in Australia. American Journal of Public Health 1990;80(5):565–9. Available from: http://www.ajph.org/cgi/content/abstract/80/5/565
17. Donovan R, Freeman J, Borland R and Boulter J. Chapter 4: Tracking the National Tobacco Campaign. In Hassard K, ed. Australia’s National Tobacco Campaign: evaluation report vol. 1. Every cigarette is doing you damage. Canberra: Commonwealth Department of Health and Aged Care, 1999;127–87. Available from: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/national-tobacco-campaign-lp
18. White V, Hill D, Siahpush M and Bobevski I. How has the prevalence of cigarette smoking changed among Australian adults? Trends in smoking prevalence between 1980 and 2001. Tobacco Control 2003;12 (suppl. 2):ii67–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12878776
19. Woodward A. Insights from Australia’s National Tobacco Campaign. Tobacco Control 2003;12(suppl. 2):ii0. Available from: http://tobaccocontrol.bmj.com/content/12/suppl_2/ii0.short
20. Cotter T, Hung W, Perez D, Dunlop S and Bishop J. Squeezing new life out of an old Sponge: how to modernise an anti-smoking media campaign to capture a new market. Australian and New Zealand Journal of Public Health 2011;35(1):75–80. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.2010.00654.x/pdf
21. Durkin S, Biener L and Wakefield M. Effects of different types of antismoking ads on reducing disparities in smoking cessation among socioeconomic subgroups. American Journal of Public Health 2009;99(12):2217–23. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775761/
22. Durkin S, Wakefield M and Spittal M. Which types of televised anti-tobacco campaigns prompt more quitline calls from disadvantaged groups? Health Education Research 2011;26(6):998–1009. Available from: http://her.oxfordjournals.org/content/26/6/998.abstract
23. Farrelly M, Davis K, Nonnemaker J, Kamyab K and Jackson C. Promoting calls to a quitline: quantifying the influence of message theme, strong negative emotions and graphic images in television advertisements. Tobacco Control 2011;Epub ahead of print. Available from: http://tobaccocontrol.bmj.com/content/early/2011/02/02/tc.2010.042234.full
24. Durkin S and Wakefield M. Comparative responses to radio and television anti-smoking advertisements to encourage smoking cessation. Health Promotion International 2010;25(1):5–13. Available from: http://heapro.oxfordjournals.org/cgi/content/full/dap044v1
25. Durkin S and Wakefield M. Interrupting a narrative transportation experience: program placement effects on responses to antismoking advertising. Journal of Community Health 2008;13(7):667–80. Available from: http://www.informaworld.com/smpp/content~db=all?content=10.1080/10810730802412248
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26. Durkin S and Wakefield M. Maximizing the impact of emotive antitobacco advertising: effects of interpersonal discussion and program placement. Social Marketing Quarterly 2006;12(3):3–14. Available from: http://www.informaworld.com/smpp/content~content=a756639862~db=all~order=page
27. Hyland A, Wakefield M, Higbee C, Szczypka G and Cummings K. Anti-tobacco television advertising and indicators of smoking cessation in adults: a cohort study. Health Education Research 2006;21(3):348–54. Available from: http://her.oxfordjournals.org/cgi/content/full/21/3/348
28. Wakefield M, Durkin S, Spittal M, Siahpush M, Scollo M, Simpson J, et al. Impact of tobacco control policies and mass media campaigns on monthly adult smoking prevalence: time series analysis. American Journal of Public Health 2008;98:1443–50. Available from: http://www.ajph.org/cgi/content/abstract/98/8/1443
29. Wakefield M, Spittal M, Yong H-H, Durkin S and Borland R. Effects of mass media campaign exposure intensity and durability on quit attempts in a population-based cohort study. Health Education Research 2011;36(6):988–97. Available from: http://her.oxfordjournals.org/content/26/6/988.abstract?sid=f5a17ab0-77ed-47f6-a4f9-73e9feee4d85
30. National Tobacco Campaign Research and Evaluation Committee. Australia’s National Tobacco Campaign: evaluation report vol. 1 Every cigarette is doing you damage. Canberra, ACT: Ministerial Council on Drug Strategy, 1999. Available from: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/national-tobacco-campaign-lp
31. Wakefield M, Freeman J and Boulter J. Chapter 2: Changes associated with the National Tobacco Campaign: pre and post campaign surveys compared. In Hassard K, ed. Australia’s National Tobacco Campaign: evaluation report vol. 1. Every cigarette is doing you damage. Canberra: Commonwealth Department of Health and Aged Care, 1999;23–81. Available from: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/national-tobacco-campaign-lp
32. Carter R and Scollo M. Chapter 7: Economic evaluation of the National Tobacco Campaign. In Hassard K, ed. Australia’s National Tobacco Campaign: evaluation report vol. 2 Every cigarette is doing you damage. Canberra: Commonwealth Department of Health and Aged Care, 2000;201–38. Available from: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/national-tobacco-campaign-lp
33. Vallone D, Duke J, Mowery P, McCausland K, Xiao H, Costantino J, et al. The impact of EX: results from a pilot smoking-cessation media campaign. American Journal of Preventive Medicine 2010;38(suppl. 3):S312–8. Available from: http://www.ajpm-online.net/article/PIIS0749379709008629/fulltext
34. Vallone D, Duke J, Cullen J, McCausland K and Allen J. Evaluation of EX: a national mass media smoking cessation campaign. American Journal of Public Health 2011;101(2):302–9. Available from: http://ajph.aphapublications.org/cgi/content/full/101/2/302?view=long&pmid=21164094
35. Carroll T and Rock B. Generating Quitline calls during Australia’s National Tobacco Campaign: effects of television advertisement execution and programme placement. Tobacco Control 2003;12(suppl. 2):ii40–4. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/12/suppl_2/ii40
36. Miller C, Wakefield M and Roberts L. Uptake and effectiveness of the Australian telephone Quitline service in the context of a mass media campaign. Tobacco Control 2003;12(suppl. 2):ii53–8. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/12/suppl_2/ii53
37. Wilson N, Grigg M, Graham L and Cameron G. The effectiveness of television advertising campaigns on generating calls to a national Quitline by Maori. Tobacco Control 2005;14(4):284–6. Available from: http://tc.bmjjournals.com/cgi/content/abstract/14/4/284
38. Mosbaek CH, Austin DF, Stark MJ and Lambert LC. The association between advertising and calls to a tobacco quitline. Tobacco Control 2007;16(suppl. 1):i24–9. Available from: http://pubmedcentralcanada.ca/picrender.cgi?artid=1746047&blobtype=pdf
39. Cotter T, Perez D, Dessaix A and Bishop J. Smokers respond to anti-tobacco mass media campaigns in NSW by calling the Quitline. New South Wales Public Health Bulletin 2008;19(3–4):68–71. Available from: http://www.publish.csiro.au/?act=view_file&file_id=NB07098.pdf
40. Hill D. Why we should tackle adult smoking first. Tobacco Control 1999;8(3):333–5. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/8/3/333
41. Myers ML. Adults versus teenagers: a false dilemma and a dangerous choice. Tobacco Control 1999;8(3):336–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10599581
42. Siegel M and Biener L. The impact of an antismoking media campaign on progression to established smoking: results of a longitudinal youth study. American Journal of Public Health 2000;90(3):380–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10705855
43. Sly DF, Trapido E and Ray S. Evidence of the dose effects of an antitobacco counter-advertising campaign. Preventive Medicine 2002;35(5):511–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12431900
44. Terry-McElrath YM, Wakefield MA, Emery S, Saffer H, Szczypka G, O’Malley PM, et al. State anti-tobacco advertising and smoking outcomes by gender and race/ethnicity. Ethnicity & Health 2007;12(4):339–62. Available from: http://www.informaworld.com/smpp/content~db=all?content=10.1080/13557850701300723
45. White V, Tan N, Wakefield M and Hill D. Do adult focused anti-smoking campaigns have an impact on adolescents? The case of the Australian National Tobacco Campaign. Tobacco Control 2003;12(suppl. 2):ii23–9. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/12/suppl_2/ii23
46. Davis KC, Nonnemaker JM and Farrelly MC. Association between national smoking prevention campaigns and perceived smoking prevalence among youth in the United States. Journal of Adolescent Health 2007;41(5):430–6. Available from: http://www.scopus.com/inward/record.url?eid=2-s2.0-35248891617&partnerID=40&md5=79e2b26b915bb0a5cbb5c9359e3f1028
47. Farrelly M, Davis K, Duke J and Messeri P. Sustaining ‘truth’: changes in youth tobacco attitudes and smoking intentions after 3 years of a national antismoking campaign. Health Education Research 2009;24(1):42–8. Available from: http://her.oxfordjournals.org/content/24/1/42.full
48. Solomon L, Bunn J, Flynn B, Pirie P, Worden J and Ashikaga T. Mass media for smoking cessation in adolescents. Health Education & Behavior 2009;36(4):642–59. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17602098
49. Sly DF, Arheart K, Dietz N, Trapido E, Nelson D and McKenna J. Effect of ending an antitobacco youth campaign on adolescent susceptibility to cigarette smoking - Minnesota, 2002–2003. Morbidity and Mortality Weekly Report 2004;53:301–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15085073
50. Niederdeppe J, Farrelly MC, Hersey JC and Davis KC. Consequences of dramatic reductions in state tobacco control funds: Florida, 1998–2000. Tobacco Control 2008;17(3):205–10. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/17/3/205
51. Emery S, Wakefield MA, Terry-McElrath Y, Saffer H, Szczypka G, O’Malley PM, et al. Televised state-sponsored antitobacco advertising and youth smoking beliefs and behavior in the United States, 1999–2000. Archives of Pediatrics & Adolescent Medicine 2005;159(7):639–45. Available from: http://archpedi.ama-assn.org/cgi/content/abstract/159/7/639
52. Farrelly MC, Davis KC, Haviland ML, Messeri P and Healton CG. Evidence of a dose-response relationship between ‘truth’ antismoking ads and youth smoking prevalence. American Journal of Public Health 2005;95(3):425–31. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15727971
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53. Wakefield M, Terry-McElrath Y, Emery S, Saffer H, Chaloupka FJ, Szczypka G, et al. Effect of televised, tobacco company-funded smoking prevention advertising on youth smoking-related beliefs, intentions, and behavior. American Journal of Public Health 2006;96(12):2154–60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17077405
54. Niederdeppe J, Fiore MC, Baker TB and Smith SS. Smoking-cessation media campaigns and their effectiveness among socioeconomically advantaged and disadvantaged populations. American Journal of Public Health 2008;98(5):916–24. Available from: http://www.ajph.org/cgi/doi/10.2105/AJPH.2007.117499
55. Niederdeppe J, Farrelly MC, Nonnemaker J, Davis KC and Wagner L. Socioeconomic variation in recall and perceived effectiveness of campaign advertisements to promote smoking cessation. Social Science & Medicine 2011;72(5):773–80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21316830
56. Biener L, Ji M, Gilpin EA and Albers AB. The impact of emotional tone, message, and broadcast parameters in youth anti-smoking advertisements. Journal of Health Communication 2004;9(3):259–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15360037
57. Biener L, McCallum-Keeler G and Nyman A. Adults’ response to Massachusetts anti-tobacco television advertisements: impact of viewer and advertisement characteristics. Tobacco Control 2000;9(4):401−7. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/9/4/401
58. Biener L, Wakefield M, Shiner C and Siegel M. How broadcast volume and emotional content affect youth recall of anti-tobacco advertising. American Journal of Preventive Medicine 2008;35(1):14–9. Available from: http://www.ajpmonline.org/article/S0749-3797%2808%2900280-8/fulltext
59. Lang A, Dhillon K and Dong Q. The effects of emotional arousal and valence on television viewers’ cognitive capacity and memory. Journal of Broadcasting and Electronic Media 1995;39:313–27. Available from: http://heinonline.org/HOL/LandingPage?collection=journals&handle=hein.journals/jbem39&div=34&id=&page=
60. Donovan RJ, Boulter J, Borland R, Jalleh G and Carter O. Continuous tracking of the Australian National Tobacco Campaign: advertising effects on recall, recognition, cognitions, and behaviour. Tobacco Control 2003;12(suppl. 2):ii30–9. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/12/suppl_2/ii30
61. Biener L, Reimer R, Wakefield M, Szczypka G, Rigotti N and Connolly G. Impact of smoking cessation aids and mass media among recent quitters. American Journal of Preventive Medicine 2006;30(3):217–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16476637
62. Dunlop S, Cotter T and Perez D. When your smoking is not just about you. Anti-smoking advertising, interpersonal pressure and quitting outcomes Journal of Health Communication 2012;accepted for publication
63. Farrelly MC, Healton CG, Davis KC, Messeri P, Hersey JC and Haviland ML. Getting to the truth: evaluating national tobacco countermarketing campaigns. American Journal of Public Health 2002;92(6):901–7. Available from: http://www.ajph.org/cgi/reprint/92/6/901
64. Sly D, Hopkins R, Trapido E and Ray S. Influence of a counteradvertising media campaign on initiation of smoking: the Florida ‘truth’ campaign. American Journal of Public Health 2001;91(2):233–8. Available from: http://www.ajph.org/cgi/content/abstract/91/2/233
65. Dunlop S, Wakefield M and Kashima Y. The contribution of antismoking advertising to quitting: intra- and interpersonal processes. Journal of Health Communication 2008;13(3):250–66. Available from: http://www.informaworld.com/smpp/content~db=all?content=10.1080/10810730801985301
66. Dunlop S. Talking ‘truth’: predictors and consequences of conversations about a youth antismoking campaign for smokers and nonsmokers. Journal of Health Communication 2011;Epub ahead of print:1–18. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21476165
67. Tellis G. Effective Advertising: Understanding When, How and Why Advertising Works. Thousand Oaks, California: Sage Publications, 2004. Available from: http://www.worldcat.org/title/effective-advertising-understanding-when-how-and-why-advertising-works/oclc/52721157
68. Sly DF, Arheart K, Dietz N, Trapido EJ, Nelson D, Rodriguez R, et al. The outcome consequences of defunding the Minnesota youth tobacco-use prevention program. Preventive Medicine 2005;41(2):503–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15917046
69. Hill D and Marks R. Health promotion programs for melanoma prevention: screw or spring? Archives of Dermatology 2008;144(4):538–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18427051
70. Dunlop S, Cotter T, Perez D and Wakefield M. When does televised anti-smoking advertising generate quitting outcomes? The effects of level and duration of exposure. American Journal of Preventive Medicine, September 2011 under review
71. Niederdeppe J, Kuang X, Crock B and Skelton A. Media campaigns to promote smoking cessation among socioeconomically disadvantaged populations: what do we know, what do we need to learn, and what should we do now? Social Science & Medicine 2008;67(9):1343–55. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18691793
72. Siahpush M and Borland R. Sociodemographic variations in smoking status among Australians aged 18 years and over: multivariate results from the 1995 National Health Survey. Australian and New Zealand Journal of Public Health 2001;25:438–42. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1467-842X.2001.tb00289.x/pdf
73. Siahpush M, Wakefield M, Spittal M and Durkin S. Anti-smoking television advertising and socio-economic variations in calls to Quitline. Journal of Epidemiology and Community Health 2007;61(4):298–301. Available from: http://jech.bmj.com/cgi/content/full/61/4/298
74. Siahpush M and Borland R. Trends in sociodemographic variations in smoking prevalence, 1997–2000. Australia's National Tobacco Campaign: evaluation report Vol. 3. Canberra: Commonwealth Department of Health and Aged Care, 2002;Available from: http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/88ED1349FD03EB05CA257331000C3A17/$File/tobccamp3.pdf
75. Davis KC, Nonnemaker JM, Farrelly MC and Niederdeppe J. Exploring differences in smokers’ perceptions of the effectiveness of cessation media messages. Tobacco Control 2011;20(1):26–33. Available from: http://tobaccocontrol.bmj.com/content/20/1/26.abstract
76. Niederdeppe J, Kuang X, Crock B and Skelton A. Critical steps in building the evidence base regarding media campaign effects on disadvantaged populations: a response to Fagan. Social Science & Medicine 2008;67(9):1359–60. Available from: www.elsevier.com/locate/socscimed
77. Grigg M, Waa A and Kawenata Bradbrook S. Response to an indigenous smoking cessation media campaign - it’s about whānau. Australian and New Zealand Journal of Public Health 2008;32(6):559–64. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19076749
78. Perusco A, Poder N, Mohsin M, Rikard-Bell G, Rissel C, Williams M, et al. Evaluation of a comprehensive tobacco control project targeting Arabic-speakers residing in south west Sydney, Australia. Health Promotion International 2010;25(2):153–65. Available from: http://heapro.oxfordjournals.org/content/25/2/153.long
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79. Murphy M and Mee V. Chapter 6. The impact of the National Tobacco Campaign in Indigenous communities: a study in Victoria. In Hassard K, ed. Australia’s National Tobacco Campaign: evaluation report vol. 1. Every cigarette is doing you damage. Canberra: Commonwealth Department of Health and Aged Care, 1999;237–53. Available from: http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/national-tobacco-campaign-lp
80. Johnston V and Thomas DP. What works in Indigenous tobacco control? The perceptions of remote Indigenous community members and health staff. Health Promotion Journal of Australia 2010;21(1):45–50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20406152
81. Boyle T, Shepherd CCJ, Pearson G, Monteiro H, McAullay D, Economo K, et al. Awareness and impact of the ‘Bubblewrap’ advertising campaign among Aboriginal smokers in Western Australia. Tobacco Control 2010;19(1):83–6. Available from: http://tobaccocontrol.bmj.com/content/19/1/83.long
82. Stewart HS, Bowden JA, Bayly MC, Sharplin GR, Durkin SJ, Miller CL, et al. Potential effectiveness of specific anti-smoking mass media advertisements among Australian Indigenous smokers. Health education research 2011;Epub ahead of print. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21893685
83. Nelson D, Gallogly M, Pederson L, Barry M, McGoldrick D and Maibach E. Use of consumer survey data to target cessation messages to smokers through mass media. American Journal of Public Health 2008;98(3):536–42. Available from: http://www.ajph.org/cgi/reprint/98/3/536
84. Roy Morgan Research. Roy Morgan Single Source, April 2010–March 2011. Melbourne, Australia: RMR, 2011 [viewed 1 September 2011]. Available from: http://www.roymorgan.com/products/single-source/single-source_home.cfm
85. Australian Communications and Media Authority. Australia in the digital economy: the shift to the online environment. Communications report 2009–10 series, no. 1. Canberra: ACMA, 2010. Available from: http://www.acma.gov.au/WEB/STANDARD/pc=PC_312356
86. van den Putte B, Yzer M, Southwell B, de Bruijn G and Willemsen M. Interpersonal communication as an indirect pathway for the effect of antismoking media content on smoking cessation. Journal of Health Communication 2011;Epub ahead of print:1–16. Available from: http://www.informaworld.com/smpp/ftinterface~content=a933671920~fulltext=713240928~frm=content
87. Chapman S and Davis RM. Smoking in movies: is it a problem? Tobacco Control 1997;6(4):269–71. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9583619
88. Edwards CA, Harris WC, Cook DR, Bedford KF and Zuo Y. Out of the Smokescreen: does an anti-smoking advertisement affect young women’s perception of smoking in movies and their intention to smoke? Tobacco Control 2004;13(3):277–82. Available from: http://tc.bmjjournals.com/cgi/content/abstract/13/3/277
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14.5
News media coverageContributor: Trish Cotter, September 2011
The news media can provide unparalleled mass reach, allowing information about health issues to be received by a very large proportion of the population.1,2 Early research linked decreases in tobacco consumption and smoking prevalence to news and publicity surrounding some of the first widely publicised reports on smoking and health.3 Notably, unpaid publicity has been credited as the main factor contributing to the 30% decline in smoking prevalence among British males between 1960 and 1980—substantial falls followed the publication of the 1962 and 1971 Royal College of Physicians’ reports. Declines in the prevalence of smoking among US males have been attributed chiefly to the influence of the mass media and especially the publicity given to the early US Surgeon General’s reports.4
Tobacco-control efforts often attract significant news media attention5–8 and aggregated news coverage sometimes outweighs even the most intensive exposure gained through paid anti-smoking campaigns.9 Quit Victoria has estimated, for instance, that its 40 media mentions on average per week between January 2007 and December 2010 resulted in an additional 9000 stories in Australian media over the same period that mentioned smoking or tobacco control.10
By influencing public perceptions about the importance of issues, news media can influence public health behaviour directly and indirectly.11 Indirectly, news coverage can influence attitudes and behaviours by attracting institutional attention and prompting related environmental or policy changes.12 This strategic use of news coverage to influence public policy (media advocacy) seeks to develop and shape news stories to build public support for public policies and ultimately influence those who have the power to change or preserve laws, enact polices and fund interventions that can influence whole populations.13,14 This requires active engagement in the process and a good understanding of how the media works. A study by Wakefield and colleagues quantified the recognition of Australian tobacco control advocacy groups by the news media. They found advocacy groups were explicitly mentioned in about one in five newspaper articles on tobacco use, were increasingly likely to be mentioned as the prominence of the article increased and were sought out by journalists for comment on issues.15 News coverage can also directly influence public health behaviours by providing information that changes knowledge, attitudes or intentions,16 or by increasing the perceived importance of a health issue17 such that priming effects occur.18
The volume of news coverage is also a significant factor in shaping opinions. Australian adults are potentially exposed to a significant amount of tobacco-related news coverage and smoking is a leading health news focus in Australia.19 While the amount of coverage may vary considerably across states/territories and across a given year19 one estimate puts this exposure at one tobacco-related news article every week from 2001 to 2006—comparable with or higher than the level of paid advertising.20 Despite this high level of exposure and research exploring the ways in which mass media can influence smokers by paid anti-smoking advertising,21–24 research on the role of the news media in directly shaping individual-level smoking outcomes has been limited. Studies have shown correspondence between patterns of news media coverage of tobacco to cigarette purchasing patterns25 and annual rates of cessation.26 Emerging evidence suggests that the volume of newspaper coverage about tobacco-control efforts is important for getting and keeping tobacco control on the agenda8, and is also related to youth smoking-related cognitions27 and behaviours.27,28 To date, only one study has linked adults’ self-reported exposure to tobacco news content with any smoking-related beliefs, in this case, support for policies to limit smoking in movies.29 Only a small number of studies have examined smokers’ recall of tobacco-related news.18,29,30
In an Australian study, Dunlop and colleagues explored smokers’ and recent quitters’ recall of tobacco news, and associations between tobacco news recall and smoking-related cognitive and behavioural outcomes. High levels of self-reported exposure to tobacco news were associated with important smoking-related cognitions, including beliefs about harm from smoking and frequent thoughts about quitting. The relationship between news recall and these outcomes was maintained when controlling for known predictors of news exposure such as education. News recall was not, however, related to an increased probability of having made a recent quit attempt.31
New developments in scientific knowledge, public policy initiatives and debates are particularly likely to attract major news coverage.26,20 Given that one of the goals of media advocacy is to raise awareness of health issues by
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generating news coverage (which can in turn lead to support for and actual policy changes),32 it is imperative to understand how the news media works,8,32 as well as how smokers receive, hear and see tobacco news, in order to make the most of their everyday media habits.
With the exception of MacKenzie’s analysis of news portrayals of lung cancer in Australian television news,33 most research examining news coverage of tobacco control has focused on print media.5,27,20 However, the ways in which news is disseminated has changed dramatically. While Australians continue to rate television as the most important source of news information for a range of topics, usage of online news sites is growing.34 By one estimate, in 2005 between 30% and 37% of the Australian population was already using the Internet for news.35
It is important to understand which tobacco issues are most likely to be covered, the nature of the coverage19 and the role the information disseminated by the news media has in shaping smokers’ beliefs, intentions and behaviours,33,36 because news can be an accessible and low-cost intervention8 as well as a useful adjunct to a paid media strategy.
AcknowledgementThank you to Dr Sally Dunlop and Professor Melanie Wakefield for advice and assistance.
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References1. Benelli E. The role of the media in steering public opinion on healthcare issues. Health Policy 2003;63(2):179−86. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12543530
2. Brodie M, Hamel E, Altman D, Blendon R and Benson J. Health news and the American public, 1996−2002. Journal of Health Politics, Policy and Law 2003;28(5):927−50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14604217
3. Warner KE. The effects of the anti-smoking campaign on cigarette consumption. American Journal of Public Health 1977;76(7):645−50. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1653696/
4. Reid D, Killoran A, McNeill A and Chambers J. Choosing the most effective health promotion options for reducing a nation’s smoking prevalence. Tobacco Control 1992;1(3):185–97. Available from: http://tobaccocontrol.bmj.com/cgi/content/citation/1/3/185
5. Clegg Smith K, Wakefield M and Edsall E. The good news about smoking: how do US newspapers cover tobacco issues? Journal of Public Health Policy 2006;27(2):166−81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16961195
6. Long M, Slater MD and Lysengen L. US news media coverage of tobacco control issues. Tobacco Control 2006;15(5):367−72. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16998170
7. Chapman S. The news on tobacco control: time to bring the background into the foreground. Tobacco Control 1999;8(3):237−9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10599562
8. Chapman S and Dominello A. A strategy for increasing news media coverage of tobacco and health in Australia. Health Promotion International 2001;16(2):137–43. Available from: http://heapro.oxfordjournals.org/cgi/content/full/16/2/137
9. Stevens C. Designing an effective counteradvertising campaign − California. Cancer 1998;83(12 suppl Robert):S2736−41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9874388
10. Pearce E, Melbourne, Australia: Quit Victoria. Estimated number of media stories (personal communication). Scollo, M, 2011.
11. McCombs M. A look at agenda-setting: past, present and future. Journalism Studies 2005;6(4):543−7. Available from: http://www.mendeley.com/research/a-look-at-agendasetting-past-present-and-future/
12. Yanovitzky I. Effect of news coverage on the prevalence of drunk-driving behavior: evidence from a longitudinal study. Journal of Studies on Alcohol 2002;63(3):342−51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12086135
13. Chapman S. Public health advocacy and tobacco control: making smoking history. Queensland, Australia: Wiley-Blackwell, 2007. Available from: http://www.blackwellpublishing.com/contents.asp?ref=9781405161633&site=1
14. Chapman S. Advocacy for public health: a primer. Journal of Epidemiology and Community Health 2004;58(5):361−5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15082730
15. Wakefield M, Brennan E, Durkin SJ, McLeod K and Smith KC. Making news: the appearance of tobacco control organisations in newspaper coverage of tobacco control issues. American Journal of Health Promotion 2011;In press
16. Shim M, Kelly B and Hornik R. Cancer information scanning and seeking behavior is associated with knowledge, lifestyle choices, and screening. Journal of Health Communication 2006;11(suppl. 1):i157−72. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16641081
17. Ogata Jones K, Denham BE and Springston JK. Effects of mass media and interpersonal communication on breast cancer screening: advancing agenda-setting theory in health contexts. Journal of Applied Communication Research 2006;34(1):94−113. Available from: http://www.tandfonline.com/doi/abs/10.1080/00909880500420242
18. Stryker JE, Moriarty CM and Jensen JD. Effects of newspaper coverage on public knowledge about modifiable cancer risks. Health Communication 2008;23(4):380−90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18702002
19. Durrant R, Wakefield M, McLeod K, Clegg-Smith K and Chapman S. Tobacco in the news: an analysis of newspaper coverage of tobacco issues in Australia, 2001. Tobacco Control 2003;12(suppl. 2):ii75–81. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/12/suppl_2/ii75
20. Wakefield M, Brennan E, Durkin S, McLeod K and Smith K. Still a burning issue: trends in the volume, content and population reach of newspaper coverage about tobacco issues. Critical Public Health 2011;21(3):313−25. Available from: http://www.tandfonline.com/doi/abs/10.1080/09581596.2010.502930#preview
21. Durkin S, Biener L and Wakefield M. Effects of different types of antismoking ads on reducing disparities in smoking cessation among socioeconomic subgroups. American Journal of Public Health 2009;99(12):2217–23. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775761/
22. Biener L. Adult and youth response to the Massachusetts anti-tobacco television campaign. Journal of Public Health Management and Practice 2000;6(3):40−4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10848481
23. Biener L, Reimer R, Wakefield M, Szczypka G, Rigotti N and Connolly G. Impact of smoking cessation aids and mass media among recent quitters. American Journal of Preventive Medicine 2006;30(3):217–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16476637
24. Farrelly MC, Davis KC, Haviland ML, Messeri P and Healton CG. Evidence of a dose-response relationship between ‘truth’ antismoking ads and youth smoking prevalence. American Journal of Public Health 2005;95(3):425−31. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15727971
25. Laugesen M and Meads C. Advertising, price, income and publicity effects on weekly cigarette sales in New Zealand supermarkets. British Journal of Addiction 1991;86(1):83−9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2009401
26. Pierce JP and Gilpin EA. News media coverage of smoking and health is associated with changes in population rates of smoking cessation but not initiation. Tobacco Control 2001;10(2):145−53. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/10/2/145
27. Smith KC, Wakefield MA, Terry-McElrath Y, Chaloupka FJ, Flay B, Johnston L, et al. Relation between newspaper coverage of tobacco issues and smoking attitudes and behaviour among American teens. Tobacco Control 2008;17(1):17−24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18218802
36 Tobacco in Australia:Facts and Issues
Section: 14.5 Date of last update: 19 Jan 2012
28. Niederdeppe J, Farrelly MC, Thomas KY, Wenter D and Weitzenkamp D. Newspaper coverage as indirect effects of a health communication intervention: the Florida tobacco control program and youth smoking. Communication Research 2007;34(4):382−406. Available from: http://crx.sagepub.com/content/34/4/382
29. Blake KD, Viswanath K, Blendon RJ and Vallone D. The role of reported tobacco-specific media exposure on adult attitudes towards proposed policies to limit the portrayal of smoking in movies. Tobacco Control 2010;19(3):191−6. Available from: http://tobaccocontrol.bmj.com/content/19/3/191.long
30. Blake K, Viswanath K, Blendon R and Vallone D. The role of tobacco-specific media exposure, knowledge, and smoking status on selected attitudes toward tobacco control. Nicotine & Tobacco Research 2010;12(2):117–26. Available from: http://ntr.oxfordjournals.org/content/12/2/117.long
31. Dunlop S, Cotter T, Perez D and Chapman S. Tobacco in the news: associations between news coverage, news recall and smoking related outcomes in a sample of Australian smokers and recent quitters. Health Education Research 2012;in press Available from: http://her.oxfordjournals.org/content/early/2011/12/08/her.cyr105.short?rss=1
32. Chapman S, Holding SJ, Ellerm J, Heenan RC, Fogarty AS, Imison M, et al. The content and structure of Australian television reportage on health and medicine, 2005−2009: parameters to guide health workers. Medical Journal of Australia 2009;191(11−12):620−4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20028286
33. MacKenzie R, Chapman S and Holding S. Framing responsibility: coverage of lung cancer among smokers and non-smokers in Australian television news Australian and New Zealand Journal of Public Health 2011;35(1):66–70. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.2010.00614.x/pdf
34. Roy Morgan International. Australian media viewed with scepticism − TV remains first stop when chasing the news. Finding no. 4117. Melbourne, Australia: RMI, 2006 [viewed 23 Aug 2011]. Available from: http://www.roymorgan.com/news/polls/2006/4117/.
35. Nguyen A, Ferrier E, Western M and McKay S. Online news in Australia: patterns of use and gratification. Australian Studies in Journalism 2005;15:5−34. Available from: http://espace.library.uq.edu.au/view/UQ:8065
36. McLeod K, Wakefield M, Chapman S, Clegg Smith K and Durkin S. Changes in the news representation of smokers and tobacco-related media advocacy from 1995 to 2005 in Australia. Journal of Epidemiology and Community Health 2009;63:215–20. Available from: http://jech.bmj.com/cgi/content/full/63/3/215
1Appendix 1 National, State and Territory Contacts
Section: Appendix 1Date of last update: 19 Jan 2012
Appendix 1
National, State and Territory ContactsQuit and other tobacco-control campaign contact details in each state and territory.
AUSTRALIAN GOVERNMENTAustralian National Preventive Health Agency GPO Box 462 Canberra ACT 2601 ph 02 62892879 email [email protected] www.anpha.gov.au
Social Marketing Unit Australian Government Department of Health & Ageing GPO Box 9848 Canberra City ACT 2601 ph 02 6289 7913 fax 02 6289 3671 www.quitnow.gov.au
NEW SOUTH WALESCancer Institute NSW PO Box 41 Alexandria NSW 1435 ph 02 8734 5600 fax 02 8374 5700 www.cancerinstitute.org.au
VICTORIAQuit Victoria PO Box 888 Carlton VIC 3053 ph 03 9663 7777 fax 03 9635 5510 www.quit.org.au
QUEENSLANDQueensland Health Alcohol, Tobacco and Other Drugs Branch GPO Box 48 Brisbane QLD 4001 ph 07 3234 1709
fax 07 3234 1699 http://www.health.qld.gov.au/atod/
Cancer Council Queensland PO Box 201 Spring Hill Qld 4004 ph 07 3258 2200 fax 07 3257 1306 www.cancerqld.org.au
SOUTH AUSTRALIAQuit South Australia PO Box 929 Unley SA 5061 ph 08 8291 4141 fax 08 8291 4194 http://www.quitsa.org.au
WESTERN AUSTRALIAQuit WA Tobacco Control Branch Department of Health PO Box 8172 Perth Business Centre Perth WA 6849 ph 08 9242 9633 fax 08 9242 9634 www.health.wa.gov.au/tobaccocontrol www.quitwa.com
Cancer Council Western Australia Make Smoking History 46 Ventnor Avenue West Perth WA 6005 ph 08 9212 4333 fax 08 9212 4399 www.cancerwa.asn.au/prevention/tobacco/makesmokinghistory
Smarter Than Smoking C/- National Heart Foundation of Australia (WA Division) PO Box 1133 Subiaco WA 6904
ph 08 9382 5917 fax 08 9388 3383 www.OxyGen.org.au www.heartfoundation.org.au
TASMANIAQuit Tasmania 2 Midwood Street New Town TAS 7008 ph 03 6228 2921 fax 03 6228 4149 http://www.quittas.org.au
AUSTRALIAN CAPITAL TERRITORYCancer Council ACT 5 Richmond Ave Fairbairn ACT 2609 ph 02 6257 9999 fax 02 6257 5055 http://www.actcancer.org
NORTHERN TERRITORYDepartment of Health and Community Services Alcohol and Other Drugs Program PO Box 40596 Casuarina NT 0811 ph 08 8999 2661 fax 08 8999 2420 www.smokefree.nt.gov.au
