Tobacco Control Mass Media Research Articles

Oral cancer in India.

To describe the epidemiological status of oral cancer (OC) in India along with updates on risk factors, advances and gaps in preventive measures, treatment, costs of care and monitoring. Two national estimates of incidence and mortality were cited, one for 2016 by the Global Burden of Disease India Study and one based on projections for 2020 by GLOBOCAN. The National Cancer Registry Project provided local and regional incidence and trends using data from 2012-2016. Scientific literature, reports of the NCRP, the IARC and government press releases were also consulted. Tobacco and areca nut habits are the major risk factors for OC in India. In the 1980s, intervention studies on oral screening, awareness generation and habit cessation in rural areas reduced tobacco use and oral leukoplakia. Lately, adoption of the tobacco control law and mass media communications have resulted in decreased tobacco use. However, the increasing popularity of highly carcinogenic tobacco products containing areca nut, with evasion of their bans, is increasing OC incidence. Despite advances in care, there is growing incidence of OC, persisting poor awareness about the need to quit tobacco/areca nut/alcohol use and go for screening. Major efforts are needed to implement preventive activities.

Impact of Traditional and New Media on Smoking Intentions and Behaviors: Secondary Analysis of Tasmania's Tobacco Control Mass Media Campaign Program, 2019-2021.

Tasmania, the smallest state by population in Australia, has a comprehensive tobacco control mass media campaign program that includes traditional (eg, television) and "new" channels (eg, social media), run by Quit Tasmania. The campaign targets adult smokers, in particular men aged 18-44 years, and people from low socioeconomic areas. This study assesses the impact of the 2019-2021 campaign program on smokers' awareness of the campaign program, use of Quitline, and smoking-related intentions and behaviors. We used a tracking survey (conducted 8 times per year, immediately following a burst of campaign activity) to assess campaign recall and recognition, intentions to quit, and behavioral actions taken in response to the campaigns. The sample size was approximately 125 participants at each survey wave, giving a total sample size of 2000 participants over the 2 years. We merged these data with metrics including television target audience rating points, digital and Facebook (Meta) analytics, and Quitline activity data, and conducted regression and time-series modeling. Over the evaluation period, unprompted recall of any Quit Tasmania campaign was 18%, while prompted recognition of the most recent campaign was 50%. Over half (52%) of those who recognized a Quit Tasmania campaign reported that they had performed or considered a quitting-related behavioral action in response to the campaign. In the regression analyses, we found having different creatives within a single campaign burst was associated with higher campaign recall and recognition and an increase in the strength of behavioral actions taken. Higher target audience rating points were associated with higher campaign recall (but not recognition) and an increase in quit intentions, but not an increase in behavioral actions taken. Higher Facebook advertisement reach was associated with lower recall among survey participants, but recognition was higher when digital channels were used. The time-series analyses showed no systematic trends in Quitline activity over the evaluation period, but Quitline activity was higher when Facebook reach and advertisement spending were higher. Our evaluation suggests that a variety of creatives should be used simultaneously and supports the continued use of traditional broadcast channels, including television. However, the impact of television on awareness and behavior may be weakening. Future campaign evaluations should closely monitor the effectiveness of television as a result. We are also one of the first studies to explicitly examine the impact of digital and social media, finding some evidence that they influence quitting-related outcomes. While this evidence is promising for campaign implementation, future evaluations should consider adopting rigorous methods to further investigate this relationship.

Examining the influence of tobacco control mass media campaign expenditure on the association between motivation to stop smoking and quit attempts: A prospective study in England

ObjectiveTo explore whether expenditure on national tobacco control mass media campaigns moderates the association between motivation to stop smoking and future quit attempts. MethodData were from 2601 people who smoke participating in a population survey with 12-month follow-up between April 2015 and February 2021. We used logistic regression to test associations of (i) baseline level of motivation to stop smoking, (ii) mean monthly tobacco control mass media campaign expenditure in England between baseline and follow-up, and (iii) their interaction, on past-year quit attempts assessed at 12-month follow-up. Covariates included age, sex, occupational social grade, and region. ResultsBetween baseline and follow-up, 38.6% of participants made a quit attempt. Each one-point increase in baseline motivation to stop smoking was associated with 1.37 times greater odds (95%CI = 1.31–1.43) of making a quit attempt over 12-month follow-up. Each one standard deviation increase in tobacco control mass media expenditure between baseline and 12-month follow-up was associated with 13% greater odds of making a quit attempt (95%CI = 1.05–1.23). There was no significant interaction between mass media expenditure and motivation to stop on quit attempts (OR = 1.01, 95%CI = 0.97–1.05); the data provided strong evidence for the null (Bayes factors = 0.07 and 0.04 based on expected effect sizes of OR = 1.5 and OR = 0.67, respectively). ConclusionsAmong people who smoke, self-reported level of motivation to stop strongly predicted whether they made a quit attempt in the subsequent year. Increased expenditure on tobacco control mass media campaigns was associated with increased quit attempts. The association between motivation and quit attempts did not differ according to tobacco control mass media expenditure over this period.

Hope and sadness: Balancing emotions in tobacco control mass media campaigns aimed at smokers.

Australia has smoking prevalence of less than 15% among adults, but there are concerns that the rates of decline have stabilised. Sustained mass media campaigns are central to decreasing prevalence, and the emotions evoked by campaigns contribute to their impact. This study investigates the association between potential exposure to campaigns that evoke different emotions on quitting salience (thinking about quitting), quitting intentions and quitting attempts. Data on quitting outcomes were obtained from weekly cross-sectional telephone surveys with adult smokers and recent quitters between 2013 and 2018. Campaign activity data were collated, and population-level potential campaign exposure was measured by time and dose. Using multivariate analyses, a positive association between potential exposure to 'hope' campaigns and thinking about quitting and intending to quit was noted, but no association was seen with quit attempts. Potential exposure to 'sadness' evoking campaigns was positively associated with quitting salience and negatively associated with quit attempts, whereas those potentially exposed to campaigns evoking multiple negative emotions (fear, guilt and sadness) were approximately 30% more likely to make a quit attempt. This study suggests a relationship between the emotional content of campaigns, quitting behaviours. Campaign planners should consider campaigns that evoke negative emotions for population-wide efforts to bring about quitting activity alongside hopeful campaigns that promote quitting salience and quitting intentions. The emotional content of campaigns provides an additional consideration for campaigns targeting smokers and influencing quitting activity. SO WHAT?: This study demonstrates the importance of balancing the emotional content of campaigns to ensure that campaign advertising is given the greatest chance to achieve its objectives. Utilising campaigns that evoke negative emotions appear to be needed to encourage quitting attempts but maintaining hopeful campaigns to promote thinking about quitting and intending to quit is also an important component of the mix of tobacco control campaigns.

Differences in Quitline Registrants’ Characteristics During National Radio Versus Television Antismoking Campaigns

The Centers for Disease Control and Prevention's Tips From Former Smokers® campaign encourages smokers to get help with quitting smoking by promoting 1-800-QUIT-NOW. Campaign advertisements featuring an offer of help with obtaining free cessation medication aired nationally on radio for 2 weeks in 2016. Similar advertisements aired nationally on TV for 3 weeks in 2017. The comparison period of 2016 radio campaign and 2017 TV campaign was used to examine the characteristics of quitline registrants by a media referral source (TV or radio). Data on the number and demographics of quitline registrants in 2016 and 2017 were obtained from the Centers for Disease Control and Prevention's National Quitline Data Warehouse. The investigators conducted t-tests to assess the demographic differences between registrants who heard about the quitline through the radio advertisements and those who heard about it through the TV advertisements during the comparison period. This analysis was conducted in 2019. The registrants who heard about the quitline from radio advertisements were more likely to be male, younger, and have more years of education. However, the registrants who heard about the quitline from TV advertisements were more likely to be Black, non-Hispanic, and have fewer years of education. The findings suggest that the demographic profiles of quitline registrants vary significantly based on how registrants hear about the quitline (via radio or TV). These differences in the characteristics of registrants can help inform the tobacco control mass media purchasing strategies and may enable media efforts to target the specific subgroups of smokers in a better way.

A Predictive Tobacco Control Mass Media Programming Model to Achieve Best Buys in Low –and Middle-Income Country Settings

Background Evidence based message design and efficient dissemination of messages are critical to the success of tobacco control mass media campaigns. Although evidence to measure effectiveness of messages is emerging within low -and middle-income country (LMIC) settings, evidence-based approaches for mass media message dissemination is currently lacking due to challenges in accurate assessment of gross rating points (GRPs) for efficient delivery of campaign messages. Approaches to more accurately predict optimal campaign impact are required to achieve best-buys in resource constrained settings Method A case study approach compared findings from two national tobacco control mass media campaigns implemented in Bangladesh. Stage one reviewed protocols to assess the efficacy of message designs. Second stage analysis involved a review of the mass media campaign recall findings from cross-sectional, post-intervention surveys. Last, a post assessment of GRPs for both campaigns was conducted to support the development of an algorithm to better predict campaign impact at the greatest cost-efficiencies. Results Message mean pre-test scores identified that the Baby Alive campaign scored approximately 20% lower than mean pre-test scores of messages for the Graphic Health Warning campaign. Media dissemination for the Baby Alive campaign was also relatively low at 165GRPs achieving 16.8% prompted recall while the Graphic Health Warning campaign delivered 292GRPs to achieve 47.0% prompted recall. The analytic-predictive model identified that for messages with high pre-test scores an increase of only 1.5GRPs was required to the existing media plan to potentially achieve an additional percentage point of recall. Discussion Given the weaknesses in GRP calculations in LMIC settings, analysis of multiple metrics should be considered to achieve best buys for tobacco control mass media campaigns. Based on optimal message mean pre-test scores of 90%+ and delivery of 292GRPs, which achieved 47% campaign recall, optimal recall of 70% could be predicted with a media plan delivering 342GRPs. More analytical-predictive mass media programming models need to be developed in other LMIC settings examining multiple campaign findings to confirm if this algorithm can provide better returns on investment with efforts directed toward delivering interventions that are supported by a strong evidence base.

Are anti-smoking social norms associated with tobacco control mass media campaigns, tax and policy changes? Findings from an Australian serial cross-sectional population study of smokers

BackgroundAnti-smoking social norms are associated with subsequent quitting behaviours. We examined if exposure to tobacco control advertisements and policy changes predict subjective (perceived disapproval of smoking among close family and...

Population-level predictors of changes in success rates of smoking quit attempts in England: a time series analysis.

AimsTo quantify associations between the success of smoking quit attempts and factors that have varied throughout 2007–2018 at a population level.Designtime series analysis using Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling.Setting and ParticipantsData were aggregated from 54 847 past‐year smokers taking part in the Smoking Toolkit Study which involves monthly repeated cross‐sectional household surveys of individuals aged 16+ in England.MeasurementsThe input series were: (1) attempts at smoking reduction using (a) e‐cigarettes and (b) nicotine replacement therapy (NRT); (2) use during a quit attempt of (a) e‐cigarettes, (b) NRT over‐the‐counter, (c) medication on prescription and (d) face‐to‐face behavioural support; (3) use of roll‐your‐own tobacco; (4) prevalence of (a) smoking and (b) non‐daily smoking; (5) tobacco control mass media expenditure; (6) expenditure on smoking; (7) smoker characteristics in the form of (a) high motivation to quit, (b) average age, (c) socio‐economic status and (d) cigarette consumption; (8) implementation of tobacco control policies; and (9) quit attempt rate.FindingsThe licensing of NRT for harm reduction was associated with a 0.641% [95% confidence interval (CI) = 0.073–1.209, P = 0.027] increase in the mean point prevalence of the success rate of quit attempts. For every 1% increase in the mean point prevalence of e‐cigarette use and use of prescription medication during a quit attempt, the mean point prevalence of successful quit attempts increased by 0.106% (95% CI = 0.011–0.201, P = 0.029) and 0.143% (95% CI = 0.009–0.279, P = 0.038), respectively. For every 1% increase in the mean expenditure on tobacco control mass media, the mean point prevalence of successful quit attempts increased by 0.046% (95% CI = 0.001–0.092, P = 0.046). Other associations were not statistically significant.ConclusionIn England between 2007 and 2018, licensing of nicotine replacement therapy for use in harm reduction, greater use of e‐cigarettes and prescription medications during a quit attempt and higher expenditure on tobacco control mass media were all associated with higher success rates of quit attempts.

Influence of new tobacco control policies and campaigns on Quitline call volume in Korea.

INTRODUCTIONWhile tobacco control policies have been adopted and enforced, and anti-smoking campaigns have been conducted, the evaluation of their impact on tobacco quitting is lacking in Korea. Therefore, the effectiveness of tobacco control policies and mass media campaigns to encourage use of the Quitline were evaluated by monitoring call volume on Quitline, which has been in operation since 2006, in Korea.METHODSTobacco control policies and mass media campaigns, from 1 January of 2007 to 31 December of 2016, were assessed from the review of government documents and the history of law and regulation changes. The corresponding period incoming call volumes of the Quitline were assesed. The average monthly call volume, when policies and anti-smoking advertising were implemented, was compared with that of the whole year or baseline years (2007 and 2008).RESULTSPeak call volume occurred in 2010 when the Quitline was directly promoted on television. The call volume in the month the TV campaign aired was 5.5 times higher than the average monthly call volume in the year 2010. A relatively gradual rise in call volume was found from 2013 to 2016 when the tobacco control policies and campaigns, such as Quitline number included on cigarette packs, a fear-oriented anti-tobacco campaign on mass media, and a tax increase on tobacco was implemented, were introduced sequentially. In that period, the average monthly call volume was about five times higher than in 2007 and 2008.CONCLUSIONSContinuous efforts to contribute to tobacco control policies and campaigns by the promotion of the Quitline is a most effective approach to raise quitting attempts. Based on the Korean experience, Quitline data may be useful for assessing the impact of tobacco control policies and campaigns in Asian Pacific countries.

Evaluation of the national tobacco control mass media campaign in China

Evaluation of the national tobacco control mass media campaign in China

The Effectiveness and Cost-Effectiveness of Tobacco Control Mass Media Campaigns In Scotland

Objectives: Television-based smoking cessation mass media campaigns (MMCs) aimed at preventing uptake of smoking and encourage cessation are an important mode of tobacco control. With vast coverage, they can target specific populations. The aim of this study was to assess the effectiveness and potential cost-effectiveness of anti-tobacco TV advertising MMCs in reducing smoking prevalence. Methods: A different dataset for the Scottish population (2003- 2009) was used to examine the reduction in the number of adult smokers due to MMCs. Time series regression with ARIMA error was used. The cost-effective of the MMC intervention in comparison to background quit attempts (do-nothing), was estimated by extrapolating number of quit attempts attributable to MMCs, to 4-week and 52-week sustained quits, calculating an incremental cost per 52-week sustained quitter. Markov modelling was employed for lifetime analysis, reporting the incremental cost per quality-adjusted life-year (QALY) gains. Results: Each month, one increase in television viewer ratings (TVRs) led to 40 additional quit attempts in the Scottish population. Given an average of 243.5 TVRs per month, the MMCs led to an additional 116,885 quit attempts per annum compared to no TV. TV MMC resulted in an incremental 0.0065 quits per annum compared to no MMC, with an additional cost of £0.66 per smoker in the Scottish population. The incremental cost per 52-week quitter was £102. The lifetime model which incorporated the future cost of smoking related diseases to the NHS, resulted in a discounted cost saving of £319 per person (95% CI: -£974, -£31) and a gain of 0.016 QALYs (95% CI: 0.0017, 0.048). Conclusions: The 1 year outcomes show MMCs to be extremely cost-effective in comparison to a do- nothing, while the lifetime analysis determined MMC to be dominant strategy, demonstrate little uncertainty in both the cost and QALY outcomes over a wide range of cost-effectiveness thresholds.

Use of new media to support passage of Vietnam's national tobacco control legislation

In November 2012, the National Assembly (NA) of Vietnam passed the country's first comprehensive tobacco control legislation.1 Following guidelines of the Framework Convention on Tobacco Control, the legislation was implemented...

OC08_04 Impact of New Graphic Health Warnings and Their Increased Size on Conventional and Plain Tobacco Packs: Perceptions of Asian Indians

Introduction: Evidence from high-income countries has shown tobacco control mass media campaigns to be cost-effective in reducing tobacco consumption, but similar evidence from low-income countries is rarely reported. An evaluation of the Government of India’s 2009 smokeless tobacco campaign, titled Surgeon, which ran nationally on television and radio for 5 weeks, provided an opportunity to test its cost-effectiveness. Objectives: To determine the cost-effectiveness of mass media campaigns in low and middle-income countries, using a national anti-smokeless tobacco mass media campaign from India as an example. The cost-benefit of the Indian campaign and the health savings accrued from the campaign were calculated. Methods: Standard methods of cost-benefit analysis using a societal perspective were employed. Primary data for the analysis was obtained from a nationally representative household survey of 2,898 smokeless tobacco users that was designed to test the Surgeon campaign’s impact. Campaign costs were estimated to be US$ 1,005,000. Based on the estimated additional quit attempt among smokeless users due to the national campaign compared to status quo, the burdens of smokeless population such as health expenditure, disabled adjusted life-years (DALYs). Results: The Surgeon campaign was found to be highly cost-effective: It resulted in an estimated additional 869,436 successful smokeless quitters after 1 year with a cost per net quit at US$1.16. It was further estimated that the campaign resulted in 20,106 Disability Adjusted Life Years gained and savings from direct medical costs worth US$ 4.9 million. The savings from the total medical costs (considering caregiver cost and labor loss) was worth US$ 21.9 million. The Incremental Cost-Effectiveness Ratio (ICER) of the campaign was US$ 50 per disabled-adjusted life year, which is significantly lower than India’s 2010 GDP/Capita of US$ 1400, the World Health Report recommended benchmark for identifying cost-effective interventions. Conclusion: These findings replicate evidence from high-income countries and suggest that anti-tobacco mass media campaigns can be highly cost-effective, with significant returns on investment, in low-income countries. They are recommended even in resourcelimited settings to combat tobacco related morbidity and mortality. Disclosure of Interest: None Declared

The effectiveness of tobacco control television advertisements in increasing the prevalence of smoke-free homes.

BackgroundThere is considerable evidence that tobacco control mass media campaigns can change smoking behaviour. In the UK, campaigns over the last decade have contributed to declines in smoking prevalence and been associated with falls in cigarette consumption among continuing smokers. However, it is less evident whether such campaigns can also play a role in changing smokers’ behaviour in relation to protecting others from the harmful effects of their smoking in the home. We investigated whether exposure to English televised tobacco control campaigns, and specifically campaigns targeting second hand smoking, is associated with smokers having a smoke-free home.MethodsWe used repeated cross-sectional national survey data on 9872 households which participated in the Health Survey for England between 2004 and 2010, with at least one adult current smoker living in the household. Exposure to all government-funded televised tobacco control campaigns, and to those specifically with a second hand smoking theme, was quantified in Gross Rating Points (GRPs), an average per capita measure of advert exposure where 100 GRPs indicates 100 % of adults exposed once or 50 % twice. Our outcome was self-reported presence of a smoke-free home (where no one smokes in the home on most days). Analysis used generalised additive models, controlling for individual factors and temporal trends.ResultsThere was no association between monthly televised campaigns overall and the probability of having a smoke-free home. However, exposure to campaigns specifically targeting second hand smoke was associated with increased odds of a smoke-free home in the following month (odds ratio per additional 100 GRPs, 1.07, 95 % CI 1.01 to 1.13), though this association was not seen at other lags. These effects were not modified by socio-economic status or by presence of a child in the home.ConclusionsOur findings provide tentative evidence that mass media campaigns specifically focussing on second hand smoke may be effective in reducing smoking in the home, and further evaluation of campaigns of this type is needed. General tobacco control campaigns in England, which largely focus on promoting smoking cessation, do not impact on smoke-free homes over and above their direct effect at reducing smoking.

Impact of the 'Giving Cigarettes is Giving Harm' campaign on knowledge and attitudes of Chinese smokers.

To date there is limited published evidence on the efficacy of tobacco control mass media campaigns in China. This study aimed to evaluate the impact of a mass media campaign 'Giving Cigarettes is Giving Harm' (GCGH) on Chinese smokers' knowledge of smoking-related harms and attitudes towards cigarette gifts. Population-based, representative data were analysed from a longitudinal cohort of 3709 adult smokers who participated in the International Tobacco Control (ITC) China Survey conducted in six Chinese cities before and after the campaign. Logistic regression models were estimated to examine associations between campaign exposure and attitudes towards cigarette gifts measured post-campaign. Poisson regression models were estimated to assess the effects of campaign exposure on post-campaign knowledge, adjusting for pre-campaign knowledge. Fourteen percent (n=335) of participants recalled the campaign within the cities where the GCGH campaign was implemented. Participants in the intervention cities who recalled the campaign were more likely to disagree that cigarettes are good gifts (71% vs 58%, p<0.01) and had greater levels of campaign-targeted knowledge than those who did not recall the campaign (mean=1.97 vs 1.62, p<0.01). Disagreeing that cigarettes are good gifts was higher in intervention cities than in control cities. Changes in campaign-targeted knowledge were similar in both cities, perhaps due to a secular trend, low campaign recall or contamination issues. These findings suggest that the GCGH campaign increased knowledge of smoking harms, which could promote downstream cessation. This study provides evidence to support future campaign development to effectively fight the tobacco epidemic in China.

Time series analysis of the impact of tobacco control policies on smoking prevalence among Australian adults, 2001-2011.

To determine the impact of tobacco control policies and mass media campaigns on smoking prevalence in Australian adults. Data for calculating the average monthly prevalence of smoking between January 2001 and June 2011 were obtained via structured interviews of randomly sampled adults aged 18 years or older from Australia's five largest capital cities (monthly mean number of adults interviewed: 2375). The influence on smoking prevalence was estimated for increased tobacco taxes; strengthened smoke-free laws; increased monthly population exposure to televised tobacco control mass media campaigns and pharmaceutical company advertising for nicotine replacement therapy (NRT), using gross ratings points; monthly sales of NRT, bupropion and varenicline; and introduction of graphic health warnings on cigarette packs. Autoregressive integrated moving average (ARIMA) models were used to examine the influence of these interventions on smoking prevalence. The mean smoking prevalence for the study period was 19.9% (standard deviation: 2.0%), with a drop from 23.6% (in January 2001) to 17.3% (in June 2011). The best-fitting model showed that stronger smoke-free laws, tobacco price increases and greater exposure to mass media campaigns independently explained 76% of the decrease in smoking prevalence from February 2002 to June 2011. Increased tobacco taxation, more comprehensive smoke-free laws and increased investment in mass media campaigns played a substantial role in reducing smoking prevalence among Australian adults between 2001 and 2011.

The freeze on mass media campaigns in England: a natural experiment of the impact of tobacco control campaigns on quitting behaviour

To measure the impact of the suspension of tobacco control mass media campaigns in England in April 2010 on measures of smoking cessation behaviour. Interrupted time series design using routinely collected population-level data. Analysis of use of a range of types of smoking cessation support using segmented negative binomial regression. England. Use of non-intensive support: monthly calls to the National Health Service (NHS) quitline (April 2005-September 2011), text requests for quit support packs (December 2007-10) and web hits on the national smoking cessation website (January 2009-March 2011). Use of intensive cessation support: quarterly data on the number of people setting a quit date and 4-week quitters at the NHS Stop Smoking Services (SSS) (quarter 1, 2001 and quarter 3, 2011). During the suspension of tobacco control mass media spending, literature requests fell by 98% [95% confidence interval (CI) = 96-99], and quitline calls and web hits fell by 65% (95% CI = 43-79) and 34% (95% CI: 11-50), respectively. The number of people setting a quit date and 4-week quitters at the SSS increased throughout the study period. The suspension of tobacco control mass media campaigns in England in 2012 appeared to markedly reduce the use of smoking cessation literature, quitline calls and hits on the national smoking cessation website, but did not affect attendance at the Stop Smoking Services. Within a comprehensive tobacco control programme, mass media campaigns can play an important role in maximizing quitting activity.

The 2010 freeze on mass media campaigns in England: A natural experiment of the impact of tobacco control campaigns

Background In England, until 2010, tobacco control mass media campaigns were run regularly. In April of that year the government ceased spending on public health mass media campaigns. We investigated the impact of the 18-month suspension of tobacco control mass media campaigns on a range of measures of smoking cessation behaviour. Methods We used quarterly data on attendance and 4-week quitters at National Health Service (NHS) Smoking Cessation Services (SSS) from 2001 to …

What is the role of tobacco control advertising intensity and duration in reducing adolescent smoking prevalence? Findings from 16 years of tobacco control mass media advertising in Australia

To examine how the intensity and duration of tobacco control advertising relate to adolescent smoking prevalence. Australian students (aged 12-17 years) participating in a national survey conducted triennially between 1993 and 2008 (sample size range 12 314-16 611). The outcome measure was students' smoking in the previous 4 weeks collected through anonymous, self-completed surveys. For each student, monthly targeted rating points (TRPs, a measure of television advertising exposure) for tobacco control advertising was calculated for the 3 and 12 months prior to surveying. For each time period, cumulative TRPs exposure and exposure to three intensity levels (≥100 TRPs/month; ≥400 TRPs/month; ≥800 TRPs/month) over increasing durations (eg, 1 month, 2 months, etc) were calculated. Logistic regression examined associations between TRPs and adolescent smoking after controlling for demographic and policy variables. Past 3-month cumulative TRPs were found to have an inverse relationship with smoking prevalence. Low TRPs exposure in the past 12 months was positively associated with adolescent smoking prevalence. However, smoking prevalence reduced with cumulative exposure levels above 5800 cumulative TRPs. Additionally, exposure to ≥400 TRPs/month and ≥800 TRPs/month were associated with reduced likelihood of smoking, although the duration needed for this effect differed for the two intensity levels. When intensity was ≥400 TRPs/month, the odds of smoking only reduced with continuous exposure. When intensity was ≥800 TRPs/month, exposure at levels less than monthly was associated with reductions in smoking prevalence. Both antismoking advertising intensity and duration are important for ensuring reductions in adolescent smoking prevalence.

Characterizing tobacco control mass media campaigns in E ngland

Aims To characterize publically funded tobacco control campaigns in England between 2004 and 2010 and to explore if they were in line with recommendations from the literature in terms of their content and intensity. International evidence suggests that campaigns which warn of the negative consequences of smoking and feature testimonials from real-life smokers are most effective, and that four exposures per head per month are required to reduce smoking prevalence. Design Characterization of tobacco control advertisements using a theoretically based framework designed to describe advertisement themes, informational and emotional content and style. Study of the intensity of advertising and exposure to different types of advertisement using data on population-level exposure to advertisements shown during the study period. Setting England. Measurements Television Ratings (TVRs), a standard measure of advertising exposure, were used to calculate exposure to each different campaign type. Findings A total of 89% of advertising was for smoking cessation; half of this advertising warned of the negative consequences of smoking, while half contained how-to-quit messages. Acted scenes featured in 72% of advertising, while only 17% featured real-life testimonials. Only 39% of months had at least four exposures to tobacco control campaigns per head. Conclusions A theory-driven approach enabled a systematic characterization of tobacco control advertisements in England. Between 2004 and 2010 only a small proportion of tobacco control advertisements utilized the most effective strategies—negative health effects messages and testimonials from real-life smokers. The intensity of campaigns was lower than international recommendations.