Trish Cotter

Mass media campaigns designed to support new pictorial health warnings on cigarette packets: evidence of a complementary relationship

Background In Australia, introduction of pictorial health warnings on cigarette packets was supported by a televised media campaign highlighting illnesses featured in two of the warning labels—gangrene and mouth cancer. Methods Two studies examined whether the warnings and the television advertisements complemented one another. Population telephone surveys of two cross-sections of adult smokers measured changes in top-of-mind awareness of smoking-related health effects from before (2005; n=587) to after the pack warnings were introduced (2006; n=583). A second study assessed cognitive and emotional responses and intentions to quit after smokers watched one of the campaign advertisements, comparing outcomes of those with and without prior pack warning exposure. Results Between 2005 and 2006, the proportion of smokers aware that gangrene is caused by smoking increased by 11.2 percentage points (OR=23.47, p=0.000), and awareness of the link between smoking and mouth cancer increased by 6.6 percentage points (OR=2.00, p=0.006). In contrast, awareness of throat cancer decreased by 4.3 percentage points, and this illness was mentioned in the pack warnings but not the advertisements. In multivariate analyses, smokers who had prior exposure to the warnings were significantly more likely to report positive responses to the advertisements and stronger post-exposure quitting intentions. Conclusions Television advertisements and pictorial health warnings on cigarette packets may operate in a complementary manner to positively influence awareness of the health consequences of smoking and motivation to quit. Jurisdictions implementing pictorial warnings should consider the benefits of supportive mass media campaigns to increase the depth, meaning and personal relevance of the warnings.

Impact of the 2010 tobacco tax increase in Australia on short-term smoking cessation: a continuous tracking survey.

Objective: To use population‐level data to monitor the impact on smoking cessation activity of the April 2010 Australian tobacco tax increase.

The natural history of antismoking advertising recall: the influence of broadcasting parameters, emotional intensity and executional features

Background The necessary first steps for televised media campaign effects are population exposure and recall. To maximise the impact of campaign funding, it is critical to identify modifiable factors that increase the efficiency of an advertisement reaching the target audience and of their recalling that advertisement. Methods Data come from a serial cross-sectional telephone survey with weekly interviews of adult smokers and recent quitters from the state of New South Wales, Australia, collected between April 2005 and December 2010 (total n=13 301). Survey data were merged with commercial TV ratings data (Gross Rating Points (GRPs)) to estimate individuals’ exposure to antismoking campaigns. Results Multivariable logistic regression analyses indicated that GRPs and broadcasting recency were positively associated with advertisement recall, such that advertisements broadcast more at higher levels or in more recent weeks were more likely to be recalled. Advertisements were more likely to be recalled in their launch phase than in following periods. Controlling for broadcasting parameters, advertisements higher in emotional intensity were more likely to be recalled than those low in emotion; and emotionally intense advertisements required fewer GRPs to achieve high levels of recall than lower emotion advertisements. There was some evidence for a diminishing effect of increased GRPs on recall. Conclusions In order to achieve sufficient levels of population recall of antismoking campaigns, advertisements need to be broadcast at adequate levels in relatively frequent cycles. Advertisements with highly emotional content may offer the most efficient means by which to increase population recall.

Out of sight and out of mind? Evaluating the impact of point-of-sale tobacco display bans on smoking-related beliefs and behaviors in a sample of australian adolescents and young adults

INTRODUCTION The Australian states of New South Wales (NSW) and Queensland implemented bans on tobacco pack displays at point-of-sale (PoS) in July 2010 and November 2011, respectively. This study evaluated the medium-term impact of the bans on youth. METHODS Data were drawn from the Tobacco Promotion Impact Study, a repeated cross-sectional survey of youth (12-24 years) in NSW and Queensland conducted yearly 2010-2012 (n = 6,014). Regression analyses examined differences in youths recall of PoS tobacco displays, smoking-related beliefs, and smoking behaviors in relation to the timing of the PoS display bans. RESULTS Recall of PoS tobacco displays was significantly less likely for youth interviewed after the bans versus before (OR = 0.45, 95% CI = 0.39, 0.52, p < .01). They were also less likely to report tobacco brand awareness (OR = 0.76, 95% CI = 0.62, 0.92, p < .01), to over-estimate peer smoking (OR = 0.84, 95% CI = 0.74, 0.96, p < .01), or be current smokers (OR = 0.73, 95% CI = 0.55, 0.96, p < .05). Stratified analyses showed that these differences were primarily apparent in the group of youth most likely to be affected by tobacco PoS displays: those who visit tobacco retailers most frequently. After the bans, smokers were less likely to report that they think about smoking as a result of seeing PoS tobacco displays (OR = 0.60, 95% CI = 0.37, 0.97, p < .039). CONCLUSIONS Our findings suggest an immediate impact of display bans on youths exposure to tobacco pack displays, and likely impacts on smoking-related outcomes. These results suggest that removing tobacco displays from retail environments can positively contribute to the denormalization of smoking among youth.

The case for recycling and adapting anti-tobacco mass media campaigns

Effective mass media campaigns are hard to come by. A delicate blend of art and science is required to ensure content is technically accurate as well as being creatively engaging for the target audience. However, the most expensive component of a media campaign is not its development but its placement at levels that allow smokers to see, engage and respond to its content. This paper uses two examples to illustrate the process of adapting existing effective material to maximise the expenditure of precious resources on the placement of material.

Potential effectiveness of anti-smoking advertisement types in ten low and middle income countries: Do demographics, smoking characteristics and cultural differences matter?

Unlike high income countries, there is limited research to guide selection of anti-tobacco mass media campaigns in low and middle income countries, although some work suggests that messages emphasizing serious health harms perform better than other message types. This study aimed to determine whether certain types of anti-smoking advertisements are more likely to be accepted and perceived as effective across smokers in 10 low to middle income countries. 2399 18-34 year old smokers were recruited in Bangladesh, China, Egypt, India, Indonesia, Mexico, Philippines, Russia, Turkey and Vietnam to view and rate 10 anti-tobacco ads. Five ads were shown in all countries and five ads were chosen by country representatives, providing a total of 37 anti-smoking ads across all countries (10 graphic health effects ads, 6 simulated health effects, 8 emotional stories of health effects, 7 other health effects and 6 non-health effects). Smokers rated ads on a series of 5-point scales containing aggregated measures of Message Acceptance and Perceived Effectiveness. All ads and materials were translated into the local language of the testing regions. In multivariate analysis, graphic health effects ads were most likely to be accepted and perceived as effective, followed by simulated health effects ads, health effects stories, other health effects ads, and then non-health effects ads. Interaction analyses indicated that graphic health effects ads were less likely to differ in acceptance or perceived effectiveness across countries, gender, age, education, parental status and amount smoked, and were less likely to be affected by cultural differences between characters and contexts in ads and those within each country. Ads that did not emphasize the health effects of smoking were most prone to inconsistent impact across countries and population subgroups. Graphic ads about the negative health effects of smoking may be most suitable for wide population broadcast in low and middle income countries.

OUTCOMES FROM A MASS MEDIA CAMPAIGN TO PROMOTE CERVICAL SCREENING IN NSW, AUSTRALIA

Background Despite the decline in the incidence of cervical cancer in Australia as a result of population screening, a substantial proportion of women in NSW screen less regularly than the recommended two-yearly interval or do not screen. With higher rates of cervical cancer in unscreened and underscreened women, and despite the introduction of the human papillomavirus vaccine, there remains a need to continue to remind women to screen. The mass media has been shown to be effective at improving participation in cervical screening. A 2007 television advertising campaign to promote cervical screening in New South Wales (NSW) was examined. Methods Data from the NSW Papanicolaou (Pap) Test Register were used to compare weekly numbers of Pap tests for NSW overall and in metropolitan local government areas with low screening rates by age group and by time since the last Pap test. Time series regression analysis incorporating seasonal effects was used to estimate the strength of the association between screening and the media campaign. Results Overall during the advertising campaign, 15% more screens (16 700) occurred than expected for 2007 without the advertising campaign. Increases were evident among unscreened and underscreened women, with little overscreening occurring. Women living in low screening areas also showed a significant increase in mean weekly screens of 21% (388) over that expected in the absence of the media campaign. Conclusions Despite the ecological nature of this study, the mass media campaign appears to have been successful in increasing screening in unscreened and underscreened women in NSW.

Tobacco promotion 'below-the-line': Exposure among adolescents and young adults in NSW, Australia

BACKGROUND Exposure to tobacco advertising and promotion increases the likelihood of smoking amongst young people. While there is a universal ban on traditional or ‘above-the-line’ advertising in Australia, the types and extent of exposure of young people to ‘below-the-line’ tobacco advertising and promotion is largely unknown. In this study we aim to identify levels of exposure of New South Wales (NSW) adolescents and young adults to tobacco promotion at the point-of-sale (PoS), on the internet, in entertainment media and at venues such as events or festivals and pubs, clubs, nightclubs, or bars; and to identify those most at risk of exposure. METHODS A telephone survey of 1000 NSW adolescents and young adults aged 12 to 24 years was conducted. Self-reported exposure to tobacco promotions or advertising in the last month were measured in four areas: (1) promotions or advertising at (a) events or festivals and (b) pubs, clubs, nightclubs or bars, (2) on the internet, (3) people smoking cigarettes in (a) movies, (b) TV shows, (c) video games and (d) on the internet, and (4) displays of cigarette packs for sale at (a) large supermarkets, (b) grocery stores or small supermarkets, (c) convenience stores, and (d) service or petrol stations. Smoking status and susceptibility to smoking was also assessed. RESULTS A substantial proportion of the young people surveyed reported seeing tobacco promotion sometimes or often in the last month over most of the channels studied.The highest levels of exposure were at the PoS (approx. two-thirds) and to people smoking cigarettes in movies(77%). Lower levels of exposure to tobacco promotions and imagery were reported on the internet (20%); at events or festivals (22.5%); in pubs, clubs, nightclubs or bars (31%); and in video games (23%). However, the odds of exposure through video games increased by 8% for every additional hour spent on the internet per day. CONCLUSIONS This study shows that adolescents and young adults in NSW are exposed to tobacco advertising or promotion at the PoS, on the internet, in entertainment media and at venues such as events or festivals and pubs, clubs, nightclubs or bars, despite the restrictions on the marketing of tobacco in Australia.

Finding the keys to successful adult-targeted advertisements on obesity prevention: an experimental audience testing study

BackgroundMass media communications are an important component of comprehensive interventions to address population levels of overweight and obesity, yet we have little understanding of the effective characteristics of specific advertisements (ads) on this topic. This study aimed to quantitatively test audience reactions to existing adult-focused public health television ads addressing overweight and obesity to determine which ads have the highest levels of message acceptance, argument strength, personalised perceived effectiveness and negative emotional impact.Methods1116 Australian adults aged 21-55 years recruited from a national online panel participated in this web-based study. Quotas were applied to achieve even numbers of males and females, those aged 21-29 years and 30-55 years, and those with a healthy weight (BMI = 18.5-24.9) and overweight/obesity (BMI = 25+). Participants were randomly assigned to view and rate four of eight ads that varied in terms of message content (health consequences, supportive/encouraging or social norms/acceptability) and execution style (graphic, simulation/animation, positive or negative testimonial, or depicted scene).ResultsToxic fat (a graphic, health consequences ad) was the top performing ad on all four outcome measures and was significantly more likely than the other ads tested to promote strong responses in terms of message acceptance, argument strength and negative emotional impact. Measure up (a negative testimonial, health consequences ad) performed comparably on personalised perceived effectiveness. Most ads produced stronger perceptions of personalised perceived effectiveness among participants with overweight/obesity compared to participants with healthy weight. Some ads were more likely to promote strong negative emotions among participants with overweight/obesity.ConclusionsFindings provide preliminary evidence of the most promising content and executional styles of ads that could be pursued as part of obesity prevention campaigns. Ads emphasising the negative health consequences of excess weight appear to elicit stronger cognitive and emotional responses from adults with overweight/obesity. However, careful pre-testing of these types of ads is needed prior to their inclusion in actual campaigns to ensure they do not have unintended negative impacts such as increased stigmatisation of vulnerable individuals and increased levels of body dissatisfaction and/or eating-disordered behaviour among at-risk population sub-groups.

Smokers respond to anti-tobacco mass media campaigns in NSW by calling the Quitline

OBJECTIVE One aim of the anti-tobacco mass media campaigns in NSW is to increase the numbers of smokers calling the Quitline to seek assistance to quit. METHODS Investigation of the relationship between the weight of television advertising (Target Audience Rating Points: TARPs) and number of calls to the Quitline. RESULTS There is a high correlation between weekly Quitline calls and TARPs. CONCLUSIONS Anti-tobacco mass media campaign advertising that promotes the Quitline number encourages smokers to seek assistance to quit.