Impact of Antitobacco Mass Media on Youth Smoking Initiation

Lois Biener, PhDCenter for Survey Research UMass Boston

Presented at National Conference on Tobacco Or Health, Boston, Dec. 10th 2003

Massachusetts Media Campaign Average annual expenditure $13

million 1994 through 2001 Multiple Channels

Television Radio Adult Transit Billboards

Multiple Strategies The truth about the industry

Rebel against industry manipulation Real people, real stories Not smoking is cool, smoking is not. Addiction

Preserve independence by avoiding addiction

Smoking harms the family

Research GoalsI. Investigate impact on

behaviorII. Investigate effectiveness of

various strategies for different target audiences.

I. Impact on youth behavior

Compare the rate of smoking initiation between youths who recalled or failed to recall exposure to television, radio, and outdoor anti-smoking advertisements at baseline

Over a four-year follow-up period Control for exposure to anti-smoking

messages from other sources

Methods: Sample

1993 Baseline:

1,069 youths

Ages 12-15

1997 Follow-up:

618 youths57.8% overall

response rate

Cohort: 592 youths who hadn’t yet smoked 100 cigarettes baseline

Methods:Measures of Exposure In past month, seen any anti-

tobacco messages... On television ? On radio? On billboards?

Methods:Measures of Outcome(1997)

Smoked at least 100 cigarettes in lifetime ?

(Yes/No)

Covariates (1993) Age, race, gender Baseline susceptibility to smoking Smoking by parents and friends Hours of TV viewing Exposure to other anti-smoking

messages (posters, newspapers, school, sporting

events) Interactions

Results:Exposure to Media Campaign71

33

57

0

10

20

30

40

50

60

70

80

Television Radio Billboards

% R

epor

ting

Exp

osur

e

Results:Established Smokers in 1997

17.7

27.1

20

05101520253035404550

Perc

ent

Overall Yes No Saw TV Ads

Age 12-13 in 1993

Results:Established Smokers in 1997

30.2 32.531

05101520253035404550

Perc

ent

Overall Yes No Saw TV Ads

Age 14-15 in 1993

Results:Multivariate Analysis Effect of exposure to anti-smoking

messages on television: Youths ages 12-13 at baseline

OR = 0.4995% CI = 0.26, 0.93

Youths ages 14-15 at baselineOR = 0.9495% CI = 0.48, 1.83

Discussion Exposure measure is really high vs.

low exposure, not any vs. none Cannot conclude that all anti-

smoking media campaigns are likely to be effective

Cannot necessarily conclude that radio and outdoor advertisements are not effective

Possibility of unknown confounder

Conclusion Strong evidence for a significant effect of statewide anti-smoking media campaign on youth smoking initiation

Effect restricted to younger adolescents

II. Effectiveness by type of TV advertisement

Adult ’93 to ’96 Youth ’93 to ’97 Youth ’99 Youth 2001/2 Hispanic vs non-Hispanic 2001/2

Research Tools Independent judges (youth and

adults) To establish characteristics of

advertisements Population-based telephone surveys

To assess how adults and youth in Massachusetts have reacted to the campaign

Independent Judges

View TV spots and rate characteristics “How well do each of following

describe the advertisement?” 1 = Not at all 7 = Very much

Judges’ Rating Scales(1 to 7) Sad Frightening Funny Emotionally

moving Believable Interesting Phony

Annoying Entertaining Reassuring Helpful Offensive Important Silly

Advertising parameters Negative Emotion: Sad,

frightening, disturbing Positive Emotion: Happy, funny,

entertaining Level of Emotion: Powerful,

emotionally moving Cognitive quality: Makes you think,

interesting

Message Identification What was the main message of

the ad? (Check one only).“Cigarettes and cigarette smoke are bad

for people’s health (Illness)“Tobacco companies are bad (Anti-

industry)“Teenagers shouldn’t smoke cigarettes

(Norms)

Relationships between message and affect Illness message: High negative

affect, high emotion Norms message: Varies – usually

high positive affect, low emotion Anti-industry message: Varies with

execution

Population Survey Approach Select subset of ads for

theoretical/conceptual purpose Assess recall Assess perceived effectiveness

Measurement of recall Aided: Gives brief description Confirmed recall: Requests details Unaided: Asks for free recall and

description of ad seen recently

Measurement of perceived effectiveness How good an anti-tobacco ad? (0

to 10) How it affects feelings about

cigarettes (feel worse, feel better, no change)

How much affects smokers’ motivation to quit (0 to 10)

4

5

6

7

8

9

10JS VC BM HB CP IC CK ST AD

QuittersSmokersNonsmkr

How Good an Ad by Emotion Level (Adults 1993 to 1996)

Very Good

Hi Emotion

Low Emotion

Mean Effectiveness Ratings by Ad Type (youth 1999)

0123456789

10

Illness Outraged Other MA PM

Very Good

Not Good

P <.001

Youth 2001/2Illness: Ronaldo, Rick, (Mass.)Illness + Anti-industry:

Body bags, Daily Dose (truth)Baby monitor (Mass.)

Anti-industry: I know you (Mass.)Norms:

My reasons (Philip Morris)Piercing parlor (Lorillard)

How Good an Ad by Ad Type

4

5

6

7

8

9

10

RD RK BB BM DD IK RS PC

IllnessI ll & Anti-IndAnti-IndNorms

Feel Worse about Cigarettes due to Ad

30405060708090

100

RD RK BB BM DD IK RS PCAds

I llnessI ll & Anti-IndAnti-IndNorms

%

Youth smokers:Motivation to Quit by Ad Type

3456789

10

RD RK BB BM DD IK RS PCAds

I llnessI ll & Anti-IndAnti-IndNorms

High

Conclusions: Features of Effective Anti-tobacco Ads Evoke strong negative emotion Portray serious harm done by

tobacco use in authentic way

Ads youth perceived as effective... Target adult smoking Portray harm done to family by

second-hand smoke Reveal industry responsibility for

serious harm in an evocative way Avoid use of humor

Theoretical basis for emotional advertising Cognitive consistency

Negative emotion -> Increased risk, decreased benefit

Positive emotion -> Decreased risk, increased benefit

Learning theory High emotion ->greater recall

Published articles on media Siegel, M. and L. Biener. 2000. The impact of an

antismoking media campaign on progression to established smoking: Results of a longitudinal youth study. American Journal of Public Health 90:380-386.

Biener, L., McCallum-Keeler, G., & Nyman, A. L. 2000. Adults' response to Massachusetts Antitobacco Television Advertisements: Impact of viewer and ad characteristics. Tobacco Control 9:401-407.

Biener, L. 2002. Adult and youth response to the Massachusetts anti-tobacco television campaign. J Public Health Management & Practice 3:40-44.

Biener, L. 2002. Anti-tobacco advertisements by Massachusetts and Philip Morris: What teenagers think. Tobacco Control 11:ii43-ii46.

Biener, L., and Taylor, T.M. 2002. The continuing importance of emotion in tobacco control media campaigns: a response to Hastings and MacFadyen. Tobacco Control 11:76-77.

Biener, L. Ji, M., Gilpin, E and Albers, A.B. (In press). The impact of emotional tone, message and broadcast parameters in youth anti-smoking advertisements. Journal of Health Communication.