Download - Research and practitioner perspectives of tobacco control mass media campaigns in England
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Research and practitioner perspectives of tobacco control
mass media campaigns in England
Dr Tessa Langley UK Centre for Tobacco and Alcohol Studies,
University of Nottingham
Matthew Walmsley, Public Health England
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Research perspectives of tobacco control mass media campaigns
in England
Dr Tessa Langley UK Centre for Tobacco and Alcohol Studies
University of Nottingham
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Outline
• Rationale for MMC
• Intervention evidence
• Recent research on MMC in England
• Ongoing/future research
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The rationale for mass media campaigns
• Well-defined behaviourally focussed messages
• Potential for widespread and repeated exposure
• Incidental exposure
• Low cost per head
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International evidence
• Durkin et al. 2012 – review of cessation campaigns in adults
- Can promote quitting and reduce adult smoking- Small effect sizes but significant population-level effects- NHE messages perform best- Rapid decay of campaign effects- Average of 12 exposures per head per quarter needed to reduce adult smoking prevalence
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Recent research on mass media campaigns in England: Context
• Very little UK evidence• Freeze on public health
campaigns April 2010• Campaign re-introduced
September 2011• Smokefree as 1 of 4 social
marketing programmes for public health
• Budget: £16m 2012-13 (£38m 2009-10)
2 year MRC funded project
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MRC (NPRI) project
Aim: To evaluate the impact of UK anti-tobacco mass media campaigns carried out since 2004 on a comprehensive set of key indicators of adult smoking behaviours
Completed/ongoing studies• Characterisation of recent campaigns in England in terms of aims, informational and emotional content and style• Effects of mass media campaigns on population-level
indicators of smoking and quitting behaviour: calls to the NHS smoking helpline, use of SSS, consumption, and prevalence
• Impact of campaigns on smoking behaviour in the home• Cost-effectiveness of tobacco control mass media
campaigns
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Jargon
Television ratings (TVRs):The % of a particular audience that has seen an advertisement
e.g. 100 TVRs = each person has viewed ad once, or 50% have viewed twicee.g. 1200 TVRs = each person has viewed ad 12 times, 25% have seen ad 48 times.
Gross rating points (GRPs):Sum of TVRs for individual adverts (but often used interchangeably)e.g. Sum of TVRs for all tobacco control adverts
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Are MMC in England maximally effective?
Evidence suggests that – 400 GRPs per month are needed to reduce smoking
prevalence by 0.3% – Sustained behaviour change requires sustained
campaign exposure due to the short-lived effects of campaigns
– Adverts with high emotional content and testimonial adverts are most effective at increasing quit rates
Study to characterise publically-funded tobacco control campaigns in England (2004-2010) - in line with recommendations?
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Intensity
Total TVRs Jan 04-Mar 10: 24507
Langley et al. Addiction 2013.
• 1 in 5 months had no MMC• 2 in 5 had 400+ GRPs• 1 in 5 months had no MMC• 2 in 5 had 400+ GRPs
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Informational content
Langley et al. Addiction 2013.
• From Apr 2008-Mar 2010 over 60% of adverts advertised the SSS• A quarter contained information about negative consequences
• From Apr 2008-Mar 2010 over 60% of adverts advertised the SSS• A quarter contained information about negative consequences
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Style
% TVRs for each style
Langley et al. Addiction 2013.
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Characterisation of campaigns: Conclusions
Based on existing recommendations– Only a small proportion of tobacco control
advertisements utilised most effective strategies - negative health effects messages and testimonials
– Intensity of campaigns was lower than international recommendations
However, subsequent research has shown that MMC in England have been effective – both positive and negative campaigns
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Evidence on campaigns in England
Langley et al. Addiction 2014
• In 2010 government ceased spending on national public health mass media campaigns in England for 18 months • Interrupted time series analysis to quantify the impact of the campaign freeze on a range of measures of quitting behaviour• Quitline, quit support pack requests, Smokefree website hits, NHS Stop Smoking Services
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Immediate drops in• Quitline calls – 65%• Literature requests – 98%• Web hits – 34%
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No change in use of SSS (intensive support)
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Evidence on campaigns in England cont.
Sims et al. Addiction 2014• Analysis of monthly cross-sectional surveys to estimate effect
of campaigns 2002-2010 on prevalence and consumption• Adjusted for other tobacco control policies, cigarette costliness
and individual characteristics • 400 point increase in tobacco control GRPs associated with a
significant 1.80% reduction in average consumption in following month
• Campaigns accounted 11.2% of the total decline in consumption over the period 2002-2009
• 400 point increase in GRPs was significantly associated with 3% lower odds of smoking two months later
• Campaigns accounted for 13.5% of decline in prevalence over this period
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Our findings suggest that
overall, national tobacco control MMC influence
smoking behaviour
But which type of tobacco control
mass media campaign is most
effective?
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Recall of campaign types
Richardson et al. BMC Public Health. 2014.• Data on recall of televised campaigns from ITC UK
Survey, 2005-09• Merged with GRP data– Campaigns categorised as “positive” or
“negative” according to emotional content• Negative campaigns: For every additional 1,000
GRPs in the six months prior to survey, 41% increase in likelihood of recall (OR = 1.41, 95% CI: 1.24–1.61)
• Positive campaigns: no significant effect
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Quitline – by campaign type
Note: Plots generated using ggplot2 package
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Preliminary results
Prevalence and consumption
• Increased exposure to both positive and negative campaigns associated with lower odds of smoking
• Increase in exposure to negative emotive campaigns associated with decrease in average cigarette consumption
• No effect of positive campaigns on consumption
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Preliminary results
Quit attempts– Increased exposure to both positive and
negative campaigns is associated with an increase in the odds of participants reporting having made a quit attempt within the last three months
Smokefree homes– Aggregated ads have no effect on smokefree
home prevalence– SHS ads increase odds of smokefree home
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Are MMC cost-effective?
• MMC are expensive – are costs justified by benefits?
• Atusingwize et al. Systematic review of economic evaluations (All international studies, under review) found that– evidence on the cost-effectiveness of tobacco
control mass media campaigns is limited (10 studies)
– Methods are of acceptable quality, but studies highly heterogeneous
– All suggest that TC MMC offer good value for money, compared with no campaign
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Conclusions
• Spending cuts have increased the need for high quality evidence
• Increasing UK evidence base
• Evidence suggest TCC do influence quitting behaviour and reduce smoking– Both positive and negative emotive campaigns
• More research on what works and optimal level of exposure is warranted
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Ongoing & future research
• Scottish study (Stirling)
• Co-ordination re. evaluation of MMC with PHE
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Acknowledgements
FundersNational Prevention Research Initiative
Action on Smoking and Health
ColleaguesNottingham: Sarah Lewis, Lisa Szatkowski
Bath: Michelle Sims, Anna Gilmore, Ruth SalwayKCL: Ann McNeill