Integrated mass media campaigns: the Australian

experience

Judith WattHead of SmokeFree London programme

Former member, Ministerial Tobacco Advisory Group, Australia

Tobacco Control – Lessons and Experiences

Kells, Northern Ireland, March 2001

Rise and fall in tobacco controlexpenditure - adults

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1982/3 1983/4 1984/5 1985/6 1986/7 1987/8 1988/9 1989/90 1990/1 1991/2 1992/3 1993/4 1994/5 1995/6

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Adult anti-smoking expenditureSmoking prevalence total

Costsperadult

%smoking

Ministerial Tobacco Advisory Group

Chaired by an acknowledged expert

Included government and non-government

people

Small (five members)

Had direct access to the Minister (if needed)

Ministerial Tobacco Advisory Group

National Tobacco Campaign National Tobacco Strategy Best practice model for sales to minors

Research to inform nicotine regulation

Review of the national Quitline service

Development of national response to ETS

Review of health warnings

Negotiations with tobacco industry ondisclosure of ingredients

Focus on adult cessation

Impact on tobacco-related disease

Credibility for teen-directed interventions

Prospects of success good

Why?

Before the campaign started

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18-29 30-40 41-59 60+Age

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Ex-smoker

Smoker

Age group by smoker/ex-smoker

NTC Evaluation data

Before the campaign started

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40

Lower bluecollar

Upper bluecollar

Lower whitecollar

Upper whitecollar

%

Smokers by occupational group

NTC Evaluation data

Campaign target

Smokers 18-39 years

Blue-collar skew

Preparatory research

Published research

107 pieces unpublished research

Recent qualitative research

Smokers said ...

I want to quit sometime

Tell me something new!

Shock me!

“We should not be frightened of using fear in our efforts to induce change in health-related attitudes and behaviours.

Arousing fear is unlikely to be counter-productive or to produce ‘boomerang’ effects, particularly if the message … provides clear advice on what to do (and the benefits).”

Sutton, Shock Tactics and the Myth of the Inverted U.Brit. J. Addiction (1992)

Does fear arousal work?

Communication brief (1)

The personal agenda Today Tomorrow Some time soon When I get around to it

Intention action Today’s personal agenda

Actions that occur over time need resources and reinforcements

Communication brief (2)

gain fresh insights on the recommended behaviour

reassess the importance of the behaviour

reassess the urgency of carrying out the behaviour

reassess the personal relevance of the behaviour

have confidence in their own ability to carry out the behaviour (self-efficacy)

remember or be reminded to do it

for long-term change, gain more than is lost by carrying out the behaviour (response efficacy)

To potentiate intention, stimulate individuals to:

Smoker’s translation

"Smoking is like buying a ticket in a lottery that’s drawn when you’re 70 … I’ll chance that.”

Appointing the agency

Agencies invited to a credentials pitch

not a concept pitch

Five agencies invited to pitch

Four turned up with concepts anyway

We appointed the one which didn’t

Expert briefings

Evening briefings with medical and scientific experts

Visits to pathology labs and hospital wards

Responding to their many requests for information and explanation

Structure of advertisements

1. Empathy device

2. Conditioning device

3. New news

4. Certain effects

1. Empathy device

2. Conditioning device

3. New news

4. Certain effects

“The people behind this ad understand me”

Conditions association between act of smoking and images of damage

“This affects me and I did not know it”“I can’t bear to think I’m doing that to myself”

“These are immediate and certain effects of smoking, not just a chance I take”

Stimulus element Stimulus element Smoker response Smoker response

Evaluation Measures

Implementation monitor Media monitor (paid, unpaid) Price monitor Quitline calls Tracking survey Pre - post surveys

Prevalence Consumption

Media buy: May 1997 - Dec 1998

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New Year PR activity

WNTD 31 May

Brain & Call for help launched 22 April

Artery & Lung launched 12 June

Tumourlaunched 16 July

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7

Fe

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c 9

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Media buy vs Quitline calls

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TARPs

CALLS

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s Call sNew Year

PR activity

Tumour launched 16 July

Artery & Lung launched 12 June

WNTD 31 May

Brain & Call for help launched 22 April

Ma

y 9

7

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b 9

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8

Main findings after 6 months

More people thinking about quitting• Thought about quitting at least daily -

up 18% from baseline

More people trying to quit• Tried to quit in past 2 weeks -

up 100% from baseline (3% to 6%)

More people had quit• Quit in past year -

up 37% from baseline (8.3% to 11.4%)

Fewer people were smoking• Smoking prevalence: Benchmark = 23.5%

Nov 1997 = 22.1%

Positive shiftthrough stages of change

1515

1313

88

-10-10

Baseline

%increase

%decrease

Pre-contemplation

Contemplation

Preparation

Pre-contemplationContemplationPreparation

(Not considering quitting in next 6 months:(Considering quitting in next 6 months:(Planning to quit in next 30 days:

48% at baseline)36% at baseline)16% at baseline)

Main findings after 18 months

Behaviouralresponses tothe campaign

Bench-mark

Follow-up 1

Follow-up 2

Rang the Quitline 2% 4% 5%

Used nicotine gumor patches

7% 10% 15%

Read ‘how to quit’literature

16% 16% 24%

What might have confounded results?

Pricing of cigarettes

“There is no evidence that discounting became more prevalent or more extensive over the period of the campaign …”

Scollo M, Owen T, Boulter JNTC Evaluation, 2000

Did the campaign affect young people?

96% of smokers and recent quitters were aware of the campaign.

85% of smokers and recent quitters found the campaign relevant to them.

49% reported new learning about the health effects of smoking cigarettes.

67% said the campaign made them more likely to quit smoking.

Did the campaign affect young people?

A majority of teenage recent quitters (68%) said it helped them to stay quit.

A majority of teenage non-smokers (86%) said it helped them remain non-smokers.

An average of 8 out of 10 teenagers felt that the campaign did not increase the appeal of smoking for teenagers – it made smoking seem less cool and desirable.

What happened to smoking prevalence?

By end of 1998 it had reduced by around

1.8% from baseline

Enumeratedhousehold

sampleInformant

sample

Benchmark 23.5% 23.7%

Follow-up 1 22.1% 22.0%

Follow-up 2 21.8% 21.8%

Economic evaluationa

Based on measured prevalence reduction: 920 premature deaths averted 3,358 additional years of life to age 75

£9.6m in health care cost offsetsb

£19 per quitterb

£3,913 per premature death avertedb

£1,574 per year of life “saved”

b

a Carter and Scollo, 2000b Approx £3.6m was spent on the campaign

International use of campaign

TV campaign used in New Zealand, Massachusetts, Singapore and Poland

Smokers changed in Singapore to Chinese and Malay people in local settings

Canadian health warnings used images from Australian campaign

And, finally …

Two new ads in the same format but with younger people

New phase of the campaign being developed now with parents being the main target