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Special Communication |

Evaluation of Antismoking Advertising Campaigns

Lisa K. Goldman, MPP; Stanton A. Glantz, PhD
JAMA. 1998;279(10):772-777. doi:10.1001/jama.279.10.772.
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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 Institute.

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 programs.

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.

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Figure 1.—The long-term pattern of decline in tobacco consumption in California tracked the presence or absence of the media campaign. Reproduced from Glantz36 with permission of American Journal of Public Health.
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Figure 2.—"Nicotine Soundbites" is a California advertisement that uses footage from the April 14, 1994, Congressional hearings before Henry A. Waxman's Subcommittee on Health and Environment in which the chief executive officers of the 7 major tobacco companies testified before Congress that they did not believe nicotine was addictive. The advertisement contained messages about industry deception, nicotine addiction, and secondhand smoke. Shortly after "Nicotine Soundbites" aired, lawyers for RJ Reynolds threated to sue both the California Department of Health Services and the television stations airing the advertisement on the basis that the spot implied RJ Reynolds' chief executive officer, James Johnston, perjured himself before Congress. When the California Department of Health Services stood by the advertisement and continued to run it, Reynolds dropped its complaint. The department later quietly dropped the advertisement from its rotation and has refused to run it despite repeated requests from the American Heart Association and Americans for Nonsmokers Rights and later the American Cancer Society45 and the Tobacco Education and Research Oversight Committee, which has statutory oversight over the California antitobacco program.46 Photograph courtesy of the California Department of Health Services.

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