There is strong evidence that mass media campaigns reduce the number of tobacco users, increase quit rates (CG-Tobacco use), and reduce youth initiation and smoking (CG-Tobacco use, AHA-Mozaffarian 2012). Evidence is strongest for high intensity, well-funded television campaigns (CG-Tobacco use) and campaigns that are part of a comprehensive tobacco control program (Bala MM, Strzeszynski L, Topor-Madry R. Mass media interventions for smoking cessation in adults. Cochrane Database Systematic Reviews. 2017;(11):CD004704.
Link to original source (journal subscription may be required for access)Cochrane-Bala 2017, AHA-Mozaffarian 2012).

Mass media campaigns reduce tobacco use among adults and youth (CG-Tobacco use, Durkin 2012, Murphy-Hoefer 2018), and reduce or delay tobacco use initiation among young people (CG-Tobacco use). Such campaigns can also reduce tobacco consumption, increase quit rates (Bala MM, Strzeszynski L, Topor-Madry R. Mass media interventions for smoking cessation in adults. Cochrane Database Systematic Reviews. 2017;(11):CD004704.
Link to original source (journal subscription may be required for access)Cochrane-Bala 2017, Durkin 2012), and increase use of cessation services (CG-Tobacco use). Campaigns may be more effective for light smokers than heavy smokers (Secker-Walker R, Gnich W, Platt S, Lancaster T. Community interventions for reducing smoking among adults. Cochrane Database of Systematic Reviews. 2002;(2):CD001745.
Link to original source (journal subscription may be required for access)Cochrane-Secker-Walker 2002).

Campaigns with messages that include quitline information increase quitline use (CG-Tobacco use, CDC MMWR-Augustson 2012). Such campaigns have been shown to increase calls to quitlines in communities with majority black populations (Mosdøl A, Lida IB, Straumann Gyri H, Vist Gunn E. Targeted mass media interventions promoting healthy behaviours to reduce risk of non-communicable diseases in adult, ethnic minorities. Cochrane Database of Systematic Reviews. 2017;(2).
Link to original source (journal subscription may be required for access)Cochrane-Mosdol 2017). State-sponsored campaigns can increase quitline registrations and the use of internet-based cessation interventions (Duke 2014).

Intense campaigns that reach many current and potential tobacco users typically yield stronger effects than less intense campaigns (CG-Tobacco use, Durkin 2012). Research from the Centers for Disease Control and Prevention (CDC) suggests that campaigns must reach 75% to 85% of their target audience and last at least 18 to 24 months to affect behavior (AHA-Mozaffarian 2012). Effects on quit attempts may fade shortly after a campaign ends (Durkin 2012). Emotional messages such as personal testimonials with compelling narratives, intense images, and sounds (Das JK, Salam RA, Arshad A, Finkelstein Y, Bhutta ZA. Interventions for adolescent substance abuse: An overview of systematic reviews. Journal of Adolescent Health. 2016;59(4):S61-S75.
Link to original source (journal subscription may be required for access)Das 2016), or graphic portrayals of negative health consequences appear more effective than other approaches (CG-Tobacco use, Durkin 2012, AHA-Mozaffarian 2012). Studies of the CDC’s Tips From Former Smokers, an example of such an approach, suggest such efforts can increase beliefs about the harms of smoking (Duke JC, Davis KC, Alexander RL, et al. Impact of a US antismoking national media campaign on beliefs, cognitions and quit intentions. Health Education Research. 2015;30(3):466-483.
Link to original source (journal subscription may be required for access)Duke 2015), calls to quitlines (Davis 2015c, CDC MMWR-Augustson 2012), quit attempts (Davis KC, Patel D, Shafer P, et al. Association between media doses of the Tips From Former Smokers campaign and cessation behaviors and intentions to quit among cigarette smokers, 2012-2015. Health Education and Behavior. 2018;45(1):52-60.
Link to original source (journal subscription may be required for access)Davis 2018, McAfee T, Davis KC, Alexander RL, Pechacek TF, Bunnell R. Effect of the first federally funded US antismoking national media campaign. Lancet. 2013;382(9909):2003–11.
Link to original source (journal subscription may be required for access)McAfee 2013), and cessation (Murphy-Hoefer 2018, McAfee T, Davis KC, Alexander RL, Pechacek TF, Bunnell R. Effect of the first federally funded US antismoking national media campaign. Lancet. 2013;382(9909):2003–11.
Link to original source (journal subscription may be required for access)McAfee 2013); greater exposure to such a campaign may contribute to a stronger intent to quit (Duke JC, Davis KC, Alexander RL, et al. Impact of a US antismoking national media campaign on beliefs, cognitions and quit intentions. Health Education Research. 2015;30(3):466-483.
Link to original source (journal subscription may be required for access)Duke 2015).

Overall, effective youth campaigns generally last more than three years, are based on target audience research, and include school-based lessons, media spots, and multiple media methods (e.g., newspapers, radio, television). Additional evidence is needed about the use of social media and novel forms of technology for tobacco prevention campaigns for youth (Carson-Chahhoud KV, Ameer F, Sayehmiri K, et al. Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews. 2017;(6):CD001006.
Link to original source (journal subscription may be required for access)Cochrane-Carson-Chahhoud 2017). Youth appear more responsive to messages about tobacco industry manipulation than adults (Wilson 2012). Studies of the US Food and Drug Administration’s (FDA’s) The Real Cost campaign suggest that youth-targeted campaigns can alter population-level perceptions of tobacco-related harms (Duke JC, Farrelly MC, Alexander TN, et al. Effect of a national tobacco public education campaign on youth’s risk perceptions and beliefs about smoking. American Journal of Health Promotion. 2018;32(5):1248-1256.
Link to original source (journal subscription may be required for access)Duke 2018) as well as reduce smoking initiation by youth (CDC MMWR-Farrelly 2017). Campaigns to prevent youth uptake may require less reach than campaigns to promote quitting to yield effects (Durkin 2012).

Some campaigns appear more likely to yield stronger effects among low income individuals than higher income individuals (CG-Tobacco use). Other campaigns, often those with limited reach (Durkin 2012), increase quit rates most among high income individuals (Durkin 2012, Lorenc T, Petticrew M, Welch V, Tugwell P. What types of interventions generate inequalities? Evidence from systematic reviews. Journal of Epidemiology and Community Health. 2013;67(2):190-3.
Link to original source (journal subscription may be required for access)Lorenc 2013). However, both messages targeted to disadvantaged populations and those intended for broader audiences have demonstrated effects among disadvantaged populations (CG-Tobacco use, Guillaumier A, Bonevski B, Paul C. Anti-tobacco mass media and socially disadvantaged groups: A systematic and methodological review. Drug and Alcohol Review. 2012;31(5):698–708.
Link to original source (journal subscription may be required for access)Guillaumier 2012). Campaign effects may also vary by race and ethnicity (Das JK, Salam RA, Arshad A, Finkelstein Y, Bhutta ZA. Interventions for adolescent substance abuse: An overview of systematic reviews. Journal of Adolescent Health. 2016;59(4):S61-S75.
Link to original source (journal subscription may be required for access)Das 2016).

Mass media campaigns included in comprehensive tobacco control programs appear to reduce smoking prevalence (Bala MM, Strzeszynski L, Topor-Madry R. Mass media interventions for smoking cessation in adults. Cochrane Database Systematic Reviews. 2017;(11):CD004704.
Link to original source (journal subscription may be required for access)Cochrane-Bala 2017).

Mass media campaigns save more in averted health care costs than they cost to implement; media expenditures for such campaigns have ranged from 25 cents to $3.35 per capita per year (Bala MM, Strzeszynski L, Topor-Madry R. Mass media interventions for smoking cessation in adults. Cochrane Database Systematic Reviews. 2017;(11):CD004704.
Link to original source (journal subscription may be required for access)Cochrane-Bala 2017). An evaluation of the FDA’s The Real Cost Campaign found a return on investment of $128 for every dollar spent (MacMonegle 2018). Campaigns to increase quitline use are estimated to cost about $260 per additional call made to the quitline (CG-Tobacco use).