Research and practitioner
perspectives of tobacco control
mass media campaigns
in England
Dr Tessa Langley
UK Centre for Tobacco and Alcohol Studies,
University of Nottingham
Matthew Walmsley,
Public Health England
Research perspectives of tobacco
control mass media campaigns
in England
Dr Tessa Langley
UK Centre for Tobacco and Alcohol Studies
University of Nottingham
Outline
• Rationale for MMC
• Intervention evidence
• Recent research on MMC in England
• Ongoing/future research
The rationale for
mass media campaigns
• Well-defined behaviourally focussed messages
• Potential for widespread and repeated exposure
• Incidental exposure
• Low cost per head
International evidence
• Durkin et al. 2012 – review of cessation
campaigns in adults
- Can promote quitting and reduce adult smoking
- Small effect sizes but significant populationlevel effects
- NHE messages perform best
- Rapid decay of campaign effects
- Average of 12 exposures per head per quarter
needed to reduce adult smoking prevalence
Recent research on mass
media campaigns in England:
Context
• Very little UK evidence
• Freeze on public health
campaigns April 2010
• Campaign re-introduced
September 2011
• Smokefree as 1 of 4 social
marketing programmes for
public health
• Budget: £16m 2012-13
(£38m 2009-10)
 2 year MRC funded project
MRC (NPRI) project
Aim: To evaluate the impact of UK anti-tobacco mass media
campaigns carried out since 2004 on a comprehensive set
of key indicators of adult smoking behaviours
Completed/ongoing studies
• Characterisation of recent campaigns in England in terms
of aims, informational and emotional content and style
• Effects of mass media campaigns on population-level
indicators of smoking and quitting behaviour: calls to the
NHS smoking helpline, use of SSS, consumption, and
prevalence
• Impact of campaigns on smoking behaviour in the home
• Cost-effectiveness of tobacco control mass media
campaigns
Jargon
Television ratings (TVRs):
The % of a particular audience that has seen an
advertisement
e.g. 100 TVRs = each person has viewed ad once, or 50%
have viewed twice
e.g. 1200 TVRs = each person has viewed ad 12 times, 25%
have seen ad 48 times.
Gross rating points (GRPs):
Sum of TVRs for individual adverts (but often used
interchangeably)
e.g. Sum of TVRs for all tobacco control adverts
Are MMC in England
maximally effective?
Evidence suggests that
– 400 GRPs per month are needed to reduce smoking
prevalence by 0.3%
– Sustained behaviour change requires sustained
campaign exposure due to the short-lived effects of
campaigns
– Adverts with high emotional content and testimonial
adverts are most effective at increasing quit rates
 Study to characterise publically-funded tobacco
control campaigns in England (2004-2010) - in
line with recommendations?
Intensity
25
% of months
20
• 1 in 5 months had no MMC
• 2 in 5 had 400+ GRPs
23
19
20
20
15
13
10
5
0
3
0
0-200
200-400
400-600
600-800
3
800-1000 1000-1200
Total GRPs
Total TVRs Jan 04-Mar 10:
24507
Langley et al. Addiction 2013.
Informational content
• From Apr 2008-Mar 2010 over 60% of
adverts advertised the SSS
• A quarter contained information about
negative consequences
61.4
45.9
% of TVRs
40.1
26.3
Negative consequences of smoking Benefits of quitting using particular
methods
Jan 04-Mar 10
Langley et al. Addiction 2013.
Apr 08-Mar 10
Style
Other (e.g.
Graphical aid)
11%
Testimonial
17%
Acted
72%
% TVRs for each
style
Langley et al. Addiction 2013.
Characterisation of
campaigns: Conclusions
Based on existing recommendations
– Only a small proportion of tobacco control
advertisements utilised most effective strategies negative health effects messages and
testimonials
– Intensity of campaigns was lower than
international recommendations
However, subsequent research has shown that
MMC in England have been effective –
both positive and negative campaigns
Evidence on campaigns
in England
Langley et al. Addiction 2014
• In 2010 government ceased spending on
national public health mass media campaigns in
England for 18 months
• Interrupted time series analysis to quantify the
impact of the campaign freeze on a range of
measures of quitting behaviour
• Quitline, quit support pack requests,
Smokefree website hits, NHS Stop Smoking
Services
Immediate drops in
• Quitline calls – 65%
• Literature requests –
98%
• Web hits – 34%
No change in
use of SSS
(intensive
support)
Evidence on campaigns
in England cont.
Sims et al. Addiction 2014
• Analysis of monthly cross-sectional surveys to estimate effect
of campaigns 2002-2010 on prevalence and consumption
• Adjusted for other tobacco control policies, cigarette costliness
and individual characteristics
• 400 point increase in tobacco control GRPs associated with a
significant 1.80% reduction in average consumption in
following month
• Campaigns accounted 11.2% of the total decline in
consumption over the period 2002-2009
• 400 point increase in GRPs was significantly associated with
3% lower odds of smoking two months later
• Campaigns accounted for 13.5% of decline in prevalence over
this period
Our findings
suggest that
overall, national
tobacco control
MMC influence
smoking
behaviour
But which type of
tobacco control
mass media
campaign is most
effective?
Recall of campaign types
Richardson et al. BMC Public Health. 2014.
• Data on recall of televised campaigns from ITC UK
Survey, 2005-09
• Merged with GRP data
– Campaigns categorised as “positive” or
“negative” according to emotional content
• Negative campaigns: For every additional 1,000
GRPs in the six months prior to survey, 41%
increase in likelihood of recall (OR = 1.41, 95% CI:
1.24–1.61)
• Positive campaigns: no significant effect
Quitline –
by campaign type
Note: Plots generated using ggplot2 package
Preliminary results
Prevalence and consumption
• Increased exposure to both positive and negative
campaigns associated with lower odds of smoking
• Increase in exposure to negative emotive
campaigns associated with decrease in average
cigarette consumption
• No effect of positive campaigns on consumption
Preliminary results
Quit attempts
– Increased exposure to both positive and
negative campaigns is associated with an
increase in the odds of participants reporting
having made a quit attempt within the last
three months
Smokefree homes
– Aggregated ads have no effect on smokefree
home prevalence
– SHS ads increase odds of smokefree home
Are MMC cost-effective?
• MMC are expensive – are costs justified by
benefits?
• Atusingwize et al. Systematic review of economic
evaluations (All international studies, under
review) found that
– evidence on the cost-effectiveness of tobacco
control mass media campaigns is limited (10
studies)
– Methods are of acceptable quality, but studies
highly heterogeneous
– All suggest that TC MMC offer good value for
money, compared with no campaign
Conclusions
• Spending cuts have increased the need for high
quality evidence
• Increasing UK evidence base
• Evidence suggest TCC do influence quitting behaviour
and reduce smoking
– Both positive and negative emotive campaigns
• More research on what works and optimal level of
exposure is warranted
Ongoing & future research
• Scottish study (Stirling)
• Co-ordination re. evaluation of MMC
with PHE
Acknowledgements
Funders
National Prevention Research Initiative
Action on Smoking and Health
Colleagues
Nottingham: Sarah Lewis, Lisa Szatkowski
Bath: Michelle Sims, Anna Gilmore, Ruth Salway
KCL: Ann McNeill