Context.— Active and passive smoking are the first and third leading preventable
causes of death. Many states are running or initiating antitobacco media campaigns.
Objective.— To review research on the effectiveness of different antismoking messages
and published evidence of the effectiveness of paid antismoking advertising.
Data Sources.— Focus group studies conducted by professional advertising agencies that
contract with California, Massachusetts, and Michigan to run their antismoking
advertising campaigns, the Centers for Disease Control and Prevention's Media Campaign Resource Book, and copies of the advertisements.
In total, we reviewed the results of 186 focus groups involving more than
1500 children and adults dealing with 118 advertisements that had actually
been aired and additional concept advertisements that were not produced. Published
literature was located using MEDLINE and standard bibliographic sources on
the effectiveness of large, paid antitobacco media campaigns. We also reviewed
reports and studies conducted by, or for, the California and Massachusetts
health departments on program effectiveness, and conducted our own comparison
of California vs Massachusetts using cigarette consumption data from the Tobacco
Study Selection.— All available studies.
Data Synthesis.— Eight advertising strategies to prevent people from starting to smoke
and persuading them to stop were reviewed: industry manipulation, secondhand
smoke, addiction, cessation, youth access, short-term effects, long-term health
effects, and romantic rejection. These focus groups identified strategies
that would be expected to be effective and ineffective. Regression analysis
was used to compare the cost-effectiveness of the California and Massachusetts
Conclusions.— Focus group participants indicated that industry manipulation and secondhand
smoke are the most effective strategies for denormalizing smoking and reducing
cigarette consumption. Addiction and cessation can be effective when used
in conjunction with the industry manipulation and secondhand smoke strategies.
Youth access, short-term effects, long-term health effects, and romantic rejection
are not effective strategies. More aggressive advertising strategies appear
to be more effective at reducing tobacco consumption.