Your smoking is not just about you
Response of 'others' to anti-tobacco advertisements and the impact on smokers' quitting intention.
Background
Mass media campaigns can reach large audiences and deliver new
information efficiently. They can also generate intense
interpersonal discussion. A number of mass media campaigns have
been implemented to directly encourage discussion in the areas of
family planning,1 sex education for adolescents2 and in relation to
alcohol use. 3
Recent research shows that the role of family and friends
(others) in encouraging smokers to quit is an important social
dimension in cessation. A study by Dunlop et al, 2008 found that
current smokers engaged in interpersonal discussion about any
anti-smoking advertising were more likely to have made a quit
attempt. Individuals were also more likely to discuss advertising
content information about the negative health consequences of
smoking using graphic images or simulations of bodily
processes.4
Purpose
To assess the association between response of others to
anti-tobacco advertisements and smokers' quitting intention.
Method
Continuous tracking research
Smokers and recent quitters (quit in the last 12 months) 18+
years were interviewed as part of continuous tracking research to
evaluate the effectiveness of all Cancer Institute NSW
advertisements while on air. The sample was obtained using
list-assisted Random Digit Dialling (LA-RDD) and the interviews
conducted using computer assisted telephone interviewing (CATI).
Fifty interviews were conducted each week.
Eleven campaigns were analysed in this study and were
categorised into four creative types - Emotive, Graphic, Supportive
and Abstract. As shown in Table 1, five of the campaigns studied
were Graphic, four were Emotive and there was one each of the
Supportive and Abstract campaigns.
Table 1: Cancer Institute NSW anti-tobacco campaigns by
type
| Creative type |
Campaign |
Description |
| Graphic:
advertisements that depict the health consequences of smoking and
elicit a 'visceral' response. |
Bronchoscopy |
Sometimes you can hear lung cancer in smokers before you see
it. This campaign introduces the whistling sound of a lung
tumour almost completely blocking the airway. At this stage,
it's often too late to operate. |
| Carotid |
Produced by Quit Victoria, the commercial depicts the build up
of fatty deposits in the arteries leading to the brain, a key
health consequence of smoking that dramatically increases the risk
of stroke. |
| Cigarettes are eating you alive |
Developed by the New York City Department of Health and Mental
Hygiene this ad uses computer-generated imagery of the inside of a
body diseased from cigarettes and real photos to drive home the
damage smoking can do. |
| Everybody Knows |
A montage of smoking-related diseases designed to communicate
the inevitability of a health consequence from smoking, set against
the Leonard Cohen track Everybody Knows. |
| National Tobacco Campaign |
Revised versions of the National Tobacco Campaign
advertisements 'Artery', 'Brain', Tumour' and 'Eye' originally
produced in 1997. A reminder that every cigarette is doing you
damage. |
| Emotive:
advertisements that depict the impact of smoking on the quality of
life of the smoker and their family and premature death. |
Voice Within |
Smoking doubles the risk of stroke. The focus of this campaign
is the reduced quality of life for the smoker and family after a
stroke caused by smoking. |
| Anthony |
A testimonial developed by the Department of Health UK that
shares the story of Anthony, who was diagnosed with throat and lung
cancer caused by smoking. Sadly, he passed away 10days after
filming the commercial. |
| Best intentions |
Focusing on the regret of not quitting, this campaign
highlights the reduced quality of life for the smoker and the
family. |
| Zita |
A testimonial developed by Cancer Council WA that reveals the
story of Zita, a mother diagnosed with smoking-caused lung cancer
who passed away at the young age of 38. |
|
Abstract: advertisements that feature abstract
imagery to simply illustrate the consequences of smoking |
Sponge Remake |
A modernised version of the Sponge campaign, originally
produced in 1979. By using sponges to represent human lungs, it
demonstrates the immediate health consequences of smoking. |
| Supportive:
advertisements that provide information on quit smoking support
services. |
Get off cigarettes |
Adapted from a commercial developed by the Department of Health
UK, this campaign supports and encourages smokers to quit by
increasing awareness of the range of support services
available. |
Statistical analyses
As part of campaign tracking research, smokers reported the
response of others to anti-tobacco advertisements through the
following four statements: "Family, friends or others have talked
to me about quitting"; "Family, friends or others are upset with me
about my smoking"; "Nagging from my children to quit"; and "Nagging
from my partner to quit". A "nag dose" variable was created to
quantify the intensity of discussion generated in response to the
advertising. The five categories are defined as: "None", "Dose 1",
"Dose 2", "Dose 3" and "Dose 4" corresponding to none, one, two,
three, or four of the above situations, which happened to the
respondent respectively. A binary nag variable has the value of
zero (no discussion generated) or one (a respondent has experienced
at least one of the situations). Its proportion of the value "one"
from a survey sample is called "nag proportion".
Smokers were also asked to report their quitting intention as a
result of seeing the advertisements, as measured through the
statements: did the ad 'make you want to stop smoking now' or 'make
you think about quitting smoking in the future'.
The Chi-square test was used to investigate the association
between variables. Proportions were tested for a linear trend if
appropriate. All quantitative analyses were performed using SPSS
software for Windows. A two-tailed p-value below 0.05 was regarded
as significant.
Results
A significant association was found between intensity of
discussion (nag dose) and quitting intention for each of the
campaigns being studied (p<0.05). In addition there was a
strong significant trend where a higher proportion of quitting
intention occurred with higher levels of discussion by family
members/friends in response to each campaign. Table 2 shows the
details of the results.
Table 2: Impact of campaign focussed discussions on
quitting intention
| Campaign |
Creative |
None |
Dose 1
%(n) |
Dose 2
%(n) |
Dose 3
%(n) |
Dose 4
%(n) |
| Anthony |
Emotive |
47.7(86) |
74.6(59) |
84.7(59) |
85.7(42) |
89.7(29) |
| Best intentions |
Emotive |
52.7(131) |
76.8(82) |
85.1(47) |
86.2(29) |
84.6(39) |
| Bronchoscopy |
Graphic |
35.9(39) |
79.2(24) |
84.4(32) |
85.0(20) |
100.0(27) |
| Carotid |
Graphic |
49.4(89) |
75.6(41) |
85.7(35) |
84.0(25) |
95.8(24) |
| Cigarettes eating you alive(adult) |
Graphic |
53.7(41) |
90.9(11) |
75(16) |
100(7) |
90.9(11) |
| Everybody Knows |
Graphic |
47.7(65) |
72.5(51) |
86.8(38) |
88.9(27) |
93.3(30) |
| Get off cigarettes |
Supportive |
28.3(92) |
59.1(22) |
53.3(15) |
62.5(8) |
70.6(17) |
| National Tobacco Campaign |
Graphic |
42.9(77) |
52.5(40) |
82.4(34) |
87.1(31) |
77.4(31) |
| Sponge |
Abstract |
50.3(149) |
66.7(66) |
81.4(70) |
79.6(54) |
77.3(44) |
| Voice Within |
Emotive |
58.3(132) |
64.9(74) |
76.8(56) |
76.5(34) |
90.9(44) |
| Zita |
Emotive |
50.9(112) |
83.1(59) |
76.9(52) |
86.8(38) |
86.1(36) |
However, not all campaigns generated similar levels of nag
proportion (Fig 1). The top five ranked nag proportions were
dominated by Graphic and Emotive creative types (however
Sponge performed similarly to Voice Within). The
nag proportion of Get off cigarettes was significantly
lower than that of most campaigns, but not significantly different
from Carotid or Cigarettes eating you alive.
Figure 1: Levels of nag proportion by campaign
 |
Conclusion
This study shows that the response of others to anti-tobacco
campaigns, through various levels of discussion, significantly
impacts on smokers' intention to quit. The more discussion by
family and friends, the higher the level of quitting intention.
Graphic and Emotive style creatives play a key role in generating
interactive communication and enhance the likelihood of an
advertisement being talked about and the likelihood of
quitting.
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