Mass media campaigns against tobacco use

Mass media campaigns use television, print, digital or social media, radio broadcasts, or other displays to share messages with large audiences (Cochrane-Carson-Chahhoud 2017*). Tobacco-specific campaigns educate current and potential tobacco users about the dangers of tobacco and often include graphic portrayals or emotional messages to influence attitudes and beliefs about tobacco use (CG-Tobacco use).

Note: The term “tobacco” in this strategy refers to commercial tobacco, not ceremonial or traditional tobacco. County Health Rankings & Roadmaps recognizes the important role that ceremonial and traditional tobacco play for many Tribal Nations, and our tobacco-related work focuses on eliminating the harms and inequities associated with commercial tobacco.

Expected Beneficial Outcomes (Rated)

  • Reduced youth smoking

  • Reduced number of tobacco users

  • Increased quit rates

Other Potential Beneficial Outcomes

  • Reduced tobacco consumption

  • Increased use of cessation treatment

Evidence of Effectiveness

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 (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 (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 (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 (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 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 2015*), calls to quitlines (Davis 2015c, CDC MMWR-Augustson 2012), quit attempts (Davis 2018*, McAfee 2013*), and cessation (Murphy-Hoefer 2018, McAfee 2013*); greater exposure to such a campaign may contribute to a stronger intent to quit (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 (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 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 2013*). However, both messages targeted to disadvantaged populations and those intended for broader audiences have demonstrated effects among disadvantaged populations (CG-Tobacco use, Guillaumier 2012*). Campaign effects may also vary by race and ethnicity (Das 2016*).

Mass media campaigns included in comprehensive tobacco control programs appear to reduce smoking prevalence (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 (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).

Impact on Disparities

No impact on disparities likely

Implementation Examples

Mass media campaigns against tobacco use can be implemented on the national, state, and local levels. The Centers for Disease Control and Prevention’s (CDC’s) Tips From Former Smokers includes stories from real people living with tobacco-related diseases and disabilities; it features tips, tools, and connections to quitlines to support quitting (CDC-Tips). The Real Cost, from the US Food and Drug Administration (FDA), is a youth-oriented campaign with materials focused on the cosmetic effects of tobacco, the loss of control caused by addiction, and the dangerous mix of toxic chemicals in tobacco products (US FDA-Real Cost). The Truth campaign uses its website, social media platforms, and text messages to share information on the dangers of tobacco and methods to prevent youth use (Truth).

The Massachusetts Tobacco Cessation and Prevention Program (MTCP) is an example of a state-based effort that uses a comprehensive approach to reduce tobacco and nicotine use which includes social media (MTCP). The New York City Department of Health launched an anti-smoking campaign in March 2018 which runs on television, subways, social media, daily newspapers, and the Staten Island Ferry (NYC Health-Smoking number).

Implementation Resources

CDC-Tips - Centers for Disease Control and Prevention (CDC). Tips From Former Smokers.

CDC-MCRC - Centers for Disease Control and Prevention (CDC). Media campaign resource center (MCRC).

ACS-Stop smoking campaigns - American Cancer Society (ACS). Global dialogue for effective stop smoking campaigns.

Truth Initiative-Tobacco free - Truth Initiative. Inspiring tobacco-free lives through education, research, community activism, and engagement.

CPHSS TCLC-Brossart 2014 - Brossart L, Moreland-Russell S, Walsh H, et al. Policy strategies: A tobacco control guide. St. Louis: Center for Public Health Systems Science (CPHSS), George Warren Brown School of Social Work, Washington University, Tobacco Control Legal Consortium (TCLC); 2014.

HealthPartners-CHA - HealthPartners Institute for Education and Research. Community health advisor (CHA): Resource for information on the benefits of evidence-based policies and programs: Helping communities understand, analyze, and model costs.

US FDA-Real Cost resources - US Food and Drug Administration (US FDA). Tobacco products. The Real Cost Campaign: Campaign resources.

Citations - Evidence

* Journal subscription may be required for access.

CG-Tobacco use - The Guide to Community Preventive Services (The Community Guide). Tobacco.

AHA-Mozaffarian 2012 - Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity, and smoking habits: A scientific statement from the American Heart Association (AHA). Circulation. 2012;126(12):1514–63.

Cochrane-Bala 2017* - Bala MM, Strzeszynski L, Topor-Madry R. Mass media interventions for smoking cessation in adults. Cochrane Database Systematic Reviews. 2017;(11):CD004704.

Durkin 2012 - Durkin S, Brennan E, Wakefield M. Mass media campaigns to promote smoking cessation among adults: An integrative review. Tobacco Control. 2012;21(2):127–38.

Murphy-Hoefer 2018 - Murphy-Hoefer R, Davis KC, Beistle D, et al. Impact of the Tips From Former Smokers campaign on population-level smoking cessation, 2012-2015. Preventing Chronic Disease. 2018;15.

Cochrane-Secker-Walker 2002* - Secker-Walker R, Gnich W, Platt S, Lancaster T. Community interventions for reducing smoking among adults. Cochrane Database of Systematic Reviews. 2002;(2):CD001745.

CDC MMWR-Augustson 2012 - Augustson E, Bright AM, Babb S, et al. Increases in quitline calls and smoking cessation website visitors during a national tobacco education campaign, March 19–June 10, 2012. Morbidity and Mortality Weekly Report (MMWR). 2012;61(34);667-670.

Cochrane-Mosdol 2017* - 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).

Duke 2014 - Duke JC, Mann N, Davis KC, MacMonegle A, Allen J, Porter L. The impact of a state-sponsored mass media campaign on use of telephone quitline and web-based cessation services. Preventing Chronic Disease. 2014;11.

Das 2016* - 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.

Duke 2015* - 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.

Davis 2015c - Davis KC, Alexander RL, Shafer P, Mann N, Malarcher A, Zhang L. The dose-response relationship between tobacco education advertising and calls to quitlines in the United States, March-June, 2012. Preventing Chronic Disease. 2015;12.

Davis 2018* - 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.

McAfee 2013* - 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.

Cochrane-Carson-Chahhoud 2017* - 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.

Wilson 2012 - Wilson LM, Avila Tang E, Chander G, et al. Impact of tobacco control interventions on smoking initiation, cessation, and prevalence: A systematic review. Journal of Environmental and Public Health. 2012;2012(961724):1-36.

Duke 2018* - 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.

CDC MMWR-Farrelly 2017 - Farrelly MC, Duke JC, Nonnemaker J, et al. Association between The Real Cost media campaign and smoking initiation among youths - United States, 2014-2016. MMWR Morbidity and Mortality Weekly Report. 2017;66(02):47-50.

Lorenc 2013* - 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.

Guillaumier 2012* - 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.

MacMonegle 2018 - MacMonegle AJ, Nonnemaker J, Duke JC, et al. Cost-effectiveness analysis of The Real Cost campaign's effect on smoking prevention. American Journal of Preventive Medicine. 2018;55(3):319-325.

Citations - Implementation Examples

* Journal subscription may be required for access.

CDC-Tips - Centers for Disease Control and Prevention (CDC). Tips From Former Smokers.

US FDA-Real Cost - US Food and Drug Administration (US FDA). Center for Tobacco Products. The Real Cost Campaign.

Truth - Truth Initiative. Truth: Inspiring tobacco-free lives through education, research, community activism, and engagement.

MTCP - Massachusetts Tobacco Cessation and Prevention Program (MTCP). Commonwealth of Massachusetts.

NYC Health-Smoking number - NYC Health. Health department launches new anti-smoking media campaign featuring Commissioner Bassett and her quit smoking “number.” City of New York. 2018.

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