Long-term effectiveness of mass media led antismoking campaigns in Australia

A systematic review and network meta-analysis of population-level interventions to tackle smoking behaviour

This preregistered systematic review and meta-analysis (PROSPERO: CRD 42022311392) aimed to synthesize the effectiveness of all available population-level tobacco policies on smoking behaviour. Our search across 5 databases and leading organizational websites resulted in 9,925 records, with 476 studies meeting our inclusion criteria. In our narrative summary and both pairwise and network meta-analyses, we identified anti-smoking campaigns, health warnings and tax increases as the most effective tobacco policies for promoting smoking cessation. Flavour bans and free/discounted nicotine replacement therapy also showed statistically significant positive effects on quit rates. The network meta-analysis results further indicated that smoking bans, anti-tobacco campaigns and tax increases effectively reduced smoking prevalence. In addition, flavour bans significantly reduced e-cigarette consumption. Both the narrative summary and the meta-analyses revealed that smoking bans, tax increases and anti-tobacco campaigns were associated with reductions in tobacco consumption and sales. On the basis of the available evidence, anti-tobacco campaigns, smoking bans, health warnings and tax increases are probably the most effective policies for curbing smoking behaviour.

Evaluation of a Regional Tobacco Control Program (Greater Manchester's Making Smoking History) on Quitting and Smoking in England 2014-2022: A Time-Series Analysis

INTRODUCTION

This study aimed to assess the impact of Greater Manchester's Making Smoking History program-a region-wide smoking cessation programs launched in January 2018-on key smoking and quitting outcomes.

METHODS

Data were from a nationally representative monthly survey, 2014-2022 (n = 171 281). We used interrupted time-series analyses (Autoregressive Integrated Moving Average [ARIMA] and generalized additive models [GAM]) to examine regional differences between Greater Manchester and the rest of England, before and during the program's first five years. Outcomes were rates of quit attempts and overall quits among smokers, quit success rates among smokers who tried to quit (preregistered outcomes), and current smoking prevalence among adults (unregistered outcome).

RESULTS

Results showed mixed effects of the program on quitting. Primary ARIMA models showed comparative reductions in quit success rates (change in quarterly difference between regions = -11.03%; 95% CI -18.96; -3.11) and overall quit rates in Greater Manchester compared with the rest of England (-2.56%; 95% CI -4.95; -0.18), and no significant change in the difference in the quit attempt rate (+2.95%; 95% CI -11.64; 17.54). These results were not consistently observed across sensitivity analyses or GAM analyses. Exploratory ARIMA models consistently showed smoking prevalence in Greater Manchester declined more quickly than in the rest of England following the initiation of the program (-2.14%; 95% CI -4.02; -0.27).

CONCLUSIONS

The first five years of Greater Manchester's Making Smoking History program did not appear to be associated with substantial increases in quitting activity. However, exploratory analyses showed a significant reduction in the regional smoking rate, over and above changes in the rest of England over the same period.

IMPLICATIONS

Taken together, these results show a relative decline in smoking prevalence in Greater Manchester but equivocal data on quitting, introducing some uncertainty. It is possible the program has reduced smoking prevalence in the absence of any substantial change in quitting activity by changing norms around smoking and reducing uptake, or by reducing the rate of late relapse. It is also possible that an undetected effect on quitting outcomes has still contributed to the program's impact on reducing prevalence to some degree. It will be important to evaluate the overall impact of the program over a longer timeframe.

A comparison between online social media discussions and vaccination rates: A tale of four vaccines

The recent COVID-19 pandemic has brought the debate around vaccinations to the forefront of public discussion. In this discussion, various social media platforms have a key role. While this has long been recognized, the way by which the public assigns attention to such topics remains largely unknown. Furthermore, the question of whether there is a discrepancy between people's opinions as expressed online and their actual decision to vaccinate remains open. To shed light on this issue, in this paper we examine the dynamics of online debates among four prominent vaccines (i.e., COVID-19, Influenza, MMR, and HPV) through the lens of public attention as captured on Twitter in the United States from 2015 to 2021. We then compare this to actual vaccination rates from governmental reports, which we argue serve as a proxy for real-world vaccination behaviors. Our results demonstrate that since the outbreak of COVID-19, it has come to dominate the vaccination discussion, which has led to a redistribution of attention from the other three vaccination themes. The results also show an apparent discrepancy between the online debates and the actual vaccination rates. These findings are in line with existing theories, that of agenda-setting and zero-sum theory. Furthermore, our approach could be extended to assess the public's attention toward other health-related issues, and provide a basis for quantifying the effectiveness of health promotion policies.

Are smokers scared by COVID-19 risk? How fear and comparative optimism influence smokers' intentions to take measures to quit smoking

Research suggests that smoking may compound the risk of serious health problems to smokers who contract COVID-19. This study examines whether and how exposure to news stories reporting the severe COVID-19 risk to smokers may influence smokers’ emotional responses (fear, anxiety, and sadness) and intentions to take measures to quit smoking. Current smokers in the US participated in an online experiment (N = 495) and were randomized to read smoking risk news stories or news stories reporting the combined risk of smoking and COVID-19. We found that combined risk news stories lead to participants feeling more fearful and sadder than when they viewed smoking risk news stories (M = 5.74; SD = 2.57 vs. M = 5.20; SD = 2.74; p < .05). Fear fully mediated the effect of news exposure on intentions to take measures to quit smoking (ß = .09; SE = 05; 95% CI [.010, .200]). Moreover, moderated-mediation analyses revealed that the mediating effect of fear was conditioned on the levels of comparative optimism, such that the association between fear and intentions to take measures to quit smoking was only significant among smokers whose comparative optimism was at the mean score (ß = .16; SE = 05; 95% CI [.071, .250]), and for those whose comparative optimism was high (ß = .27; SE = .06; 95% CI [.146, .395]). These results suggest that fear of the pandemic and optimism might play important roles in predicting and explaining the association between exposure to news stories and intentions to take measures to quit smoking. Messages about heightened risk of COVID-19 complications for smokers that increase fear might be an effective strategy to motivate smokers to quit. Such messages should be used to turn the adversity of COVID-19 pandemic into an intervention opportunity to reduce tobacco-related disease.

The Discrepancy between Knowledge of Sleep Recommendations and the Actual Sleep Behaviour of Australian Adults

Introduction: Inadequate sleep is a major public health concern, with large economic, health, and operational costs to Australia. Despite the implementation of public sleep health campaigns, approximately 40% of Australian adults do not obtain the recommended 7-9 hours of sleep. Thus, while people may know how much sleep is required, this knowledge may not be adequately translated to actual sleep behavior. Consequently, this study aims to examine the discrepancy between knowledge of sleep recommendations and self-reported sleep behaviors.Methods: A sample of 1265 Australian adults (54% female, aged 18-65) completed a phone interview as part of the 2017 National Social Survey and were asked questions about their knowledge of sleep guidelines and their actual sleep behavior. Binary logistic regression was used to determine the factors associated with awareness of sleep recommendations and whether this corresponded with reported sleep duration.Results: The final sample size was 998. Although 94% of the sample were aware of current sleep recommendations, 23% of participants did not self-report regularly obtaining 7-9 h sleep per night. These participants were less likely to want to obtain more sleep, less likely to view sleep as a priority before stressful events, and less likely to self-report good health.Conclusion: Although a majority of the sample were aware of sleep recommendations, almost a quarter of the participants' behavior did not align with their knowledge. Future sleep health campaigns should consider options beyond education, including emphasis on practical strategies and modifiable lifestyle factors to assist individuals to obtain the recommended amount of sleep.

Evaluation of the London Smoking Cessation Transformation Programme: a time-series analysis

BACKGROUND AND AIM

National social marketing campaigns have been shown to promote smoking cessation in England. There is reason to believe that regional and city-wide campaigns can play a valuable role in reducing smoking prevalence over and above any national tobacco control activity. This study aimed to assess the impact of the London Smoking Cessation Transformation Programme, a multi-component citywide smoking cessation programme, on quit attempts and quit success rates.

DESIGN AND SETTING

Interrupted time-series analyses, using Autoregressive Integrated Moving Average (ARIMA) and generalized additive models (GAM) of population trends in the difference between monthly quit attempts and quit success rates among smokers who made a quit attempt in London versus the rest of England before and during the first year of the programme.

PARTICIPANTS

A total of 55 528 past-year adult smokers who participated in a monthly series of nationally representative cross-sectional surveys in England between November 2006 and August 2018. Twelve and a half per cent of smokers lived in London (intervention region) and 87.5% lived in the rest of England (control region).

MEASUREMENTS

Monthly prevalence of quit attempts and quit success rates among smokers who made a quit attempt.

FINDINGS

The monthly difference in prevalence of quit attempts in London compared with the rest of England increased by 9.59% [95% confidence interval (CI) = 4.35-14.83, P < 0.001] from a mean of 0.04% pre-intervention to 9.63% post-intervention. The observed increase in success rates among those who tried was not statistically significant (B = 4.72; 95% CI = -2.68 to 12.11, P = 0.21); Bayes factors indicated that these data were insensitive. GAM analyses confirmed these results.

CONCLUSION

The promotion of the London Smoking Cessation Transformation Programme during September 2017 was associated with a significant increase in quit attempts compared with the rest of England. The results were inconclusive regarding an effect on quit success among those who tried.

Birth-cohort estimates of smoking initiation and prevalence in 20th century Australia: Synthesis of data from 33 surveys and 385,810 participants

The aim of our study was to quantify sex-specific patterns of smoking prevalence and initiation in 10-year birth cohorts from 1910 to 1989 in Australia. We combined individual data of 385,810 participants from 33 cross-sectional surveys conducted between 1962 and 2018. We found that age-specific smoking prevalence varied considerably between men and women within birth cohorts born before 1960. The largest difference was observed in the earliest cohort (1910-1919), with up to 37.7% point greater proportion of current smokers in men than in women. In subsequent cohorts, the proportion decreased among men, but increased among women, until there was no more than 7.4% point difference in the 1960-69 birth cohort. In the 1970-79 and 1980-89 cohorts, smoking among men marginally increased, but the proportion was at most ~11.0% points higher than women. Our analysis of initiation indicated that many women born before the 1930s who smoked commenced smoking after age 25 years (e.g., ~27% born in 1910-19); compared to at most 8% of men in any birth cohort. The earliest birth cohort (1910-1919) had the greatest difference in age at initiation between sexes; 26.6 years in women versus 19.0 in men. In later cohorts, male and female smokers initiated increasingly earlier, converging in the 1960-69 cohort (17.6 and 17.8 years, respectively). While 22.9% of men and 8.4% of women initiated smoking aged < = 15 in the 1910-1919 cohort, in the latest cohort (1980-89) the reverse was true (21.4% and 28.8% for men and women, respectively). Marked differences in smoking prevalence and age at initiation existed between birth cohorts of Australian men and women born before 1960; after this, sex-specific trends in prevalence and initiation were similar. Understanding these patterns may inform the evaluation of tobacco control policies and the targeting of potential interventions for exposed populations such as lung cancer screening.

Impact of a negative emotional antitobacco mass media campaign on French smokers: a longitudinal study

BACKGROUND

Mass media campaigns to encourage smoking cessation have been shown to be effective in a context of comprehensive tobacco control programme. The effectiveness of antismoking ads that evoke negative emotions remains unclear, in particular in countries with high smoking prevalence and among smokers with low perceived susceptibility, low self-efficacy or who are not users of smoking cessation services.

OBJECTIVE

To evaluate short-term and long-term effects of a 1-month French national highly emotional media campaign, with a focus on these specific targets.

DESIGN

A 6-month longitudinal survey by Internet. A sample of 3000 smokers were interviewed before the media campaign (T0). They were contacted again just after (T1) and 6 months after the campaign (T2).

OUTCOMES

Perceived susceptibility to the risks of smoking, self-efficacy to quit smoking, use of smoking cessation services (quitline and website) and 7-day quitting.

METHODS

The analysis was carried out on 2241 individuals who answered at T1 and T2. Multiple logistic regressions were computed to test the association between the change in each outcome at T1 and T2 and the level of exposure based on self-reported recall.

RESULTS

Self-reported recall was associated with an increase in perceived susceptibility and with use of cessation services. Campaign recall was also associated with higher 7-day quitting immediately after the campaign (OR=1.8 (1.0 to 3.2), P<0.05).

CONCLUSIONS

Fear-appeal mass media campaigns can be effective in encouraging cessation among smokers in a country with high smoking prevalence (France), but should be accompanied by convincing self-efficacy messages.

Mass media interventions for smoking cessation in adults

BACKGROUND

Mass media tobacco control campaigns can reach large numbers of people. Much of the literature is focused on the effects of tobacco control advertising on young people, but there are also a number of evaluations of campaigns targeting adult smokers, which show mixed results. Campaigns may be local, regional or national, and may be combined with other components of a comprehensive tobacco control policy.

OBJECTIVES

To assess the effectiveness of mass media interventions in reducing smoking among adults.

SEARCH METHODS

The Cochrane Tobacco Addiction Group search strategy was combined with additional searches for any studies that referred to tobacco/smoking cessation, mass media and adults. We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) and a number of electronic databases. The last search was carried out in November 2016.

SELECTION CRITERIA

Controlled trials allocating communities, regions or states to intervention or control conditions; interrupted time series.Adults, 25 years or older, who regularly smoke cigarettes. Studies which cover all adults as defined in studies were included.Mass media are defined here as channels of communication such as television, radio, newspapers, billboards, posters, leaflets or booklets intended to reach large numbers of people, and which are not dependent on person-to-person contact. The purpose of the mass media campaign must be primarily to encourage smokers to quit. They could be carried out alone or in conjunction with tobacco control programmes.The primary outcome was change in smoking behaviour. This could be reported as changes in prevalence, changes in cigarette consumption, quit rates, or odds of being a smoker.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed all studies for inclusion criteria and for study quality (MB, LS, RTM). One author (MB) extracted data, and a second author (LS) checked them.Results were not pooled due to heterogeneity of the included studies and are presented narratively and in table form.

MAIN RESULTS

Eleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow-up, methods of evaluation and also in definitions and measures of smoking behaviour used. Among seven campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large-scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. Among the eight studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex-smokers combined.

AUTHORS' CONCLUSIONS

There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality. One state-wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign. Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme. Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney). The intensity and duration of mass media campaigns may influence effectiveness, but length of follow-up and concurrent secular trends and events can make this difficult to quantify. No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender.

Mass media interventions for preventing smoking in young people

BACKGROUND

Mass media interventions can be used as a way of delivering preventive health messages. They have the potential to reach and modify the knowledge, attitudes and behaviour of a large proportion of the community.

OBJECTIVES

To assess the effects of mass media interventions on preventing smoking in young people, and whether it can reduce smoking uptake among youth (under 25 years), improve smoking attitudes, intentions and knowledge, improve self-efficacy/self-esteem, and improve perceptions about smoking, including the choice to follow positive role models.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group Specialized Register, with additional searches of MEDLINE and Embase in June 2016. This is an update of a review first published in 1998.

SELECTION CRITERIA

Randomized trials, controlled trials without randomization and interrupted time-series studies that assessed the effect of mass media campaigns (defined as channels of communication such as television, radio, newspapers, social media, billboards, posters, leaflets or booklets intended to reach large numbers of people and which are not dependent on person-to-person contact) in influencing the smoking behaviour (either objective or self-reported) of young people under the age of 25 years. We define smoking behaviour as the presence or absence of tobacco smoking or other tobacco use, or both, and the frequency of tobacco use. Eligible comparators included education or no intervention.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted information relating to the characteristics and the content of media interventions, participants, outcomes, methods of the study and risks of bias. We combined studies using qualitative narrative synthesis. We assessed the risks of bias for each study using the Cochrane 'Risk of bias' tool, alongside additional domains to account for the nature of the intervention. We assessed the quality of evidence contributing to outcomes using GRADE.

MAIN RESULTS

We identified eight eligible studies reporting information about mass media smoking campaigns, one of which is new for this update. Seven of the studies used a controlled trial design and one an interrupted time-series analysis. Risks of bias were high across all included studies and there was considerable heterogeneity in study design, intervention and population being assessed.Three studies (n = 17,385), one of which compared a mass media intervention to no intervention and two of which evaluated mass media interventions as adjuncts to school-based interventions, found that the mass media interventions reduced the smoking behaviour of young people. The remaining five studies (n = 72,740) did not detect a significant effect on smoking behaviour. These included three studies comparing a mass media intervention to no intervention, one study evaluating a mass media intervention as an adjunct to a school-based intervention, and one interrupted time-series study of a social media intervention. The three campaigns which found a significant effect described their theoretical basis, used formative research in designing the campaign messages, and used message broadcast of reasonable intensity over extensive periods of time. However, some of the campaigns which did not detect an effect also exhibited these characteristics. Effective campaigns tended to last longer (minimum 3 years) and were more intense (more contact time) for both school-based lessons (minimum eight lessons per grade) and media spots (minimum four weeks' duration across multiple media channels with between 167 and 350 TV and radio spots). Implementation of combined school-based components (e.g. school posters) and the use of repetitive media messages delivered by multiple channels (e.g. newspapers, radio, television) appeared to contribute to successful campaigns.

AUTHORS' CONCLUSIONS

Certainty about the effects of mass media campaigns on smoking behaviour in youth is very low, due to inconsistency between studies in both design and results, and due to methodological issues amongst the included studies. It would therefore be unwise to offer firm conclusions based on the evidence in this review. Methodologically rigorous studies investigating the effect of social media and novel forms of technology as part of tobacco prevention campaigns for youth are needed.

Media Advocacy and Public Education in the Community Intervention Trial to Reduce Heavy Smoking (COMMIT)

The Community Intervention Trial (COMMIT) is designed to reduce the rate of heavy smoking in eleven pairs of North American communities over an eight-year period. The intervention, consisting of a minimum of fifty-one activities, is being implemented through local community boards and task forces. This article describes the goals and activities for the public education task force with a specific focus on “media advocacy,” an innovative use of mass media that follows more closely political activist models than traditional public service models. Two brief case studies are presented to illustrate some applications of media advocacy. The reasons for relatively infrequent use of media advocacy are discussed.

Introduction to the Community Intervention Trial for Smoking Cessation (COMMIT)

The Community Intervention Trial for smoking cessation (COMMIT) is sponsored by the National Cancer Institute and involves eleven pairs of communities in North America. COMMIT emphasizes a partnership between the eleven research institutions and their respective intervention communities in developing the structures needed to implement the intervention protocol. We summarize the epidemiological data and describe the prior community interventions that set the stage for COMMIT, and discuss how COMMIT may inform state-wide tobacco reduction demonstration programs. An overview of the articles that describe the COMMIT intervention and evaluation plan is presented.

A population study on the time trend of cigarette smoking, cessation, and exposure to secondhand smoking from 2001 to 2013 in Taiwan

Background

In 2001, the National Health Interview Survey (NHIS) commenced in Taiwan. This survey, conducted on a sample of the whole Taiwanese population, is nationally representative and has a high response rate (>80 %). As a result, the four already completed surveys from 2001 to 2013 can be used to investigate the time trend of smoking prevalence, the rate of cessation, and exposure to secondhand smoking.

Methods

There were 72918 adults combined from the 2001, 2005, 2009 and 2013 National Health Interview Surveys (NHIS). Smoking status, exposure to secondhand smoking, and smoking cessation were asked, as well as demographic characteristics and other variables. Statistical analyses with sampling weights were carried out using SAS and SUDAAN.

Results

In males, the prevalence of smoking significantly decreased (rates in 4 surveys were 44.4 %, 44.6 %, 38.9 %, and 34.2 %, respectively). Since 2005 the rate of smoking cessation increased significantly (p = 0.033). The odd ratio (OR) exposure of secondhand among non-smokes (OR) in 2009 and 2013 were 0.96 (CI = 0.85–1.08) and 0.78 (CI = 0.70–0.88) comparing to 2005. In females, the prevalence of smoking was stable over time. The rate of smoking cessation only appeared significantly high in the older age group. The OR for exposure to secondhand smoking were 0.81 (CI = 0.74–0.89) and 0.68 (CI = 0.62–0.74), for 2009 and 2013 comparing to 2005, respectively.

Conclusion

Early anti-smoking legislation in Taiwan might have raised the awareness of the harm of smoking. However, the implementation of the Tobacco Hazards Prevention Act (THPA) in 2009 had great contribution to the reduction of smoking rate, especially in males.

Electronic supplementary material

The online version of this article (doi:10.1186/s12963-016-0109-x) contains supplementary material, which is available to authorized users.

Health promotion in Australia: twenty years on from the Ottawa Charter

Australia has a longstanding history of promoting health through programs that reflect the principles of the Ottawa Charter and recognising the importance of social determinants of health. Health promotion programs are delivered by a wide range of organisations, in a wide range of settings and sectors for, or with, multiple groups. Since the mid-1980s aspects of infrastructure and capacity for health promotion, such as human and financial resources, have been put in place including the establishment of health promotion foundations via tobacco hypothecation. Following neo-liberal reforms in the 1990s, however, government policies have increasingly focused more narrowly on specific diseases and risk factors. Chronic disease has become the new banner under which health promotion, social determinants and efforts to address health inequalities fit. While the importance of social determinants is often recognised within and outside the health sector, health promotion practitioners are seldom at the centre of policy development. ( Promotion & Education, 2007, XIV (4): pp 203-208)

Public awareness and knowledge of oral cancer in Yemen

BACKGROUND

Oral cancer is in increasing in incidence in Yemen and indeed worldwide. Knowledge regarding risk factors and early signs in the general population can help in prevention and early detection of the disease.

PURPOSE

The aim of this study was to assess the level of awareness and knowledge of oral cancer in the general population in Yemen.

MATERIALS AND METHODS

A cross-sectional survey using a self-administered questionnaire was conducted on Yemeni adults aged ≥15 years old. A total of 543 persons participated, the collected data being analyzed using SPSS software. The significance level was set at p<0.05.

RESULTS

Two thirds (71.5%) of the participants had heard about oral cancer. Smoking and smokeless tobacco usage were identified as the major risk factors by 71.5% and 73.7% of the participants, respectively. Only 24.1% and 21.4%, respectively, were able to correctly identify red and white lesions as early signs of oral cancer. Knowledge of oral cancer was significantly associated with age (p<0.01), gender (p<0.05) and education level (p<0.001).

CONCLUSIONS

The findings suggest that the knowledge regarding oral cancer in this population is low. Therefore, educational programs are highly needed to improve such knowledge.

Evaluation of the pilot phase of the 'Give up smokes for good' social marketing campaign

ISSUE ADDRESSED

The prevalence of tobacco smoking among Aboriginal and Torres Strait Islander people in Australia is comparatively high. To help combat this, an Aboriginal-specific social marketing campaign, 'Give up smokes for good', was piloted in South Australia in 2011.

METHODS

To evaluate the campaign, a face-to-face survey was conducted with two samples of convenience through Aboriginal Health services in South Australia (city and regional locations; n=190). Surveys assessed the cultural appropriateness of the campaign, campaign awareness and recognition, knowledge of the harms of smoking and smoking/quit smoking behaviours.

RESULTS

Campaign awareness was high with 76.3% of participants aware of at least one aspect of the campaign. Participants indicated campaign materials (posters and radio ads) to be culturally appropriate. Knowledge that smoking and passive smoking caused illness was high (85.8% and 86.8%); however, knowledge of specific illnesses was not as high. Large proportions of participants had imposed bans on smoking in homes (73.2%) and in cars (75.9%).

CONCLUSIONS

Our findings suggest the 'Give up smokes for good' campaign reached the intended audience with high levels of campaign awareness. Results also suggest the pilot campaign made progress in achieving its communication objectives. SO WHAT?: High quality, culturally targeted anti-tobacco poster and radio campaigns can be effective ways to reach Aboriginal Australians. Future research could explore the impact of this type of social marketing campaign, particularly in regards to the impact on quitting intention and behaviour.

The support for smoke free policy and how it is influenced by tolerance to smoking - experience of a developing country

This cross sectional survey was conducted to determine the support in making Penang UNESCO World Heritage Site (GTWHS) smoke free and to determine the influence of tolerance towards smoking on this support. This is the first phase in making Penang, Malaysia a smoke free state. A multistage sampling process was done to select a sample of respondents to represent the population of GTWHS. Attitude towards smoking was assessed using tolerance as a proxy. A total of 3,268 members of the community participated in the survey. A big majority (n = 2969; 90.9%) of the respondents supported the initiative. Support was lowest among the owners and residents/tenants, higher age groups, the Chinese, men, respondents who had poor knowledge of the places gazetted as smoke free, and respondents with poor knowledge of the health effects on smokers and on passive smokers. The odds (both adjusted and unadjusted) of not supporting the initiative was high among those tolerant to smoking in public areas. Tolerance towards smoking was associated with 80.3% risk of non-support in the respondents who were tolerant to smoking and a 57.2% risk in the population. Health promotion and education concerning the harm of tobacco smoke in Malaysia, which has mainly targeted smokers, must change. Health education concerning the risks of second hand smoke must also be given to non-smokers and efforts should be made to denormalize smoking.

Mass media interventions for smoking cessation in adults

BACKGROUND

Mass media tobacco control campaigns can reach large numbers of people. Much of the literature is focused on the effects of tobacco control advertising on young people, but there are also a number of evaluations of campaigns targeting adult smokers, which show mixed results. Campaigns may be local, regional or national, and may be combined with other components of a comprehensive tobacco control policy.

OBJECTIVES

To assess the effectiveness of mass media interventions in reducing smoking among adults.

SEARCH METHODS

The Cochrane Tobacco Addiction Group search strategy was combined with additional searches for any studies that referred to tobacco/smoking cessation, mass media and adults. We also searched the Cochrane Register of Controlled Trials (CENTRAL) and a number of electronic databases. The last search was carried out in February 2013.

SELECTION CRITERIA

Controlled trials allocating communities, regions or states to intervention or control conditions; interrupted time series. Adults, 25 years or older, who regularly smoke cigarettes. Studies which cover all adults as defined in studies were included. Mass media are defined here as channels of communication such as television, radio, newspapers, billboards, posters, leaflets or booklets intended to reach large numbers of people, and which are not dependent on person-to-person contact. The purpose of the mass media campaign must be primarily to encourage smokers to quit. They could be carried out alone or in conjunction with tobacco control programmes. The primary outcome was change in smoking behaviour. This could be reported as changes in prevalence, changes in cigarette consumption, quit rates, odds of being a smoker.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed all studies for inclusion criteria and for study quality. One author (MB) extracted data, and a second author (LS) checked them.Results were not pooled due to heterogeneity of the included studies and are presented narratively and in table form.

MAIN RESULTS

Eleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow-up, methods of evaluation and also in definitions and measures of smoking behaviour used. Among nine campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large-scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. Among the seven studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex-smokers combined.

AUTHORS' CONCLUSIONS

There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality. One state-wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign. Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme. Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney). The intensity and duration of mass media campaigns may influence effectiveness, but length of follow-up and concurrent secular trends and events can make this difficult to quantify. No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender.

Early mental health morbidity and later smoking at age 17 years

BACKGROUND

We examined the relationship between the onset and pattern of childhood mental health disorders and subsequent current smoking status at age 17 years.

METHOD

Data were from a prospective cohort study of 2868 births of which 1064 supplied information about their current smoking at 17 years of age. The association between the onset and pattern of clinically significant mental health disorders in the child and subsequent smoking at age 17 years was estimated via multivariable logistic regression.

RESULTS

Relative to 17 year olds who never had an externalizing disorder, 17-year-olds who had an externalizing disorder at age 5, 8 or 14 years were, respectively, 2.0 times [95% confidence interval (CI) 1.24-3.25], 1.9 (95% CI 1.00-3.65) or 3.9 times (95% CI 1.73-8.72) more likely to be a current smoker. Children with an ongoing pattern of externalizing disorder were 3.0 times (95% CI 1.89-4.84) more likely to be smokers at the age of 17 years and those whose mothers reported daily consumption of 6-10 cigarettes at 18 weeks' gestation were 2.5 times (OR 2.46, 95% CI 1.26-4.83) more likely to report smoking at 17 years of age. Associations with early anxiety and depression in the child were not found.

CONCLUSIONS

Current smoking in 17-year-olds may be underpinned by early emergent, and then, ongoing, externalizing disorder that commenced as young as age 5 years as well as exposure to early prenatal maternal smoking. The associations documented in adults and adolescents that link tobacco smoking and mental health are likely to be in play at these early points in development.

Potential effectiveness of specific anti-smoking mass media advertisements among Australian Indigenous smokers

Aboriginal and Torres Strait Islander Australians (Indigenous Australians) have more than twice the smoking prevalence of non-Indigenous Australians. Anti-smoking campaigns have demonstrated success in the general population but little is known about their impact among Indigenous people. A total of 143 Indigenous and a comparison group of 156 non-Indigenous smokers from South Australia were shown 10 anti-smoking advertisements representing a range of advertisements typically aired in Australia. Participants rated advertisements on a five-point Likert scale assessing factors including message acceptance and personalized effectiveness. On average, Indigenous people rated the mainstream advertisements higher than non-Indigenous people and were more likely to report that they provided new information. Advertisements with strong graphic imagery depicting the health effects of smoking were rated highest by Indigenous smokers. Advertisements featuring real people describing the serious health consequences of smoking received mixed responses. Those featuring an ill person were rated higher by Indigenous people than those featuring the family of the person affected by a smoking-related disease. With limited Indigenous-specific messages available and given the finite resources of most public health campaigns, exposure to mainstream strong graphic and emotive first-person narratives about the health effects of smoking are likely to be highly motivating for Indigenous smokers.

Knowledge and perceptions regarding oral and pharyngeal carcinoma among adult dental patients

BACKGROUND

The aim of this study was to assess awareness and knowledge of oral and pharyngeal carcinoma and risk perception for developing the cancer among adult patients attending a major dental centre in Perth. Influence of socio-demographic factors on awareness, knowledge and perception was ascertained.

METHODS

A random sample of 120 potential participants over the age of 18 who attended the Oral Health Centre of Western Australia between 14 and 18 June 2010 were invited to participate in the survey. A total of 100 participants completed a face-to-face interview guided by a questionnaire.

RESULTS

Seventy-two per cent of the participants had heard of oral and pharyngeal carcinoma. Sixteen per cent knew that both smoking and drinking increased the risk of oral and pharyngeal carcinoma and 49% knew at least one sign or symptom of the cancer. Language spoken at home, education, and employment influenced cancer awareness and knowledge. Sixty-two per cent of the participants considered themselves not at risk of developing the cancer.

CONCLUSIONS

The findings suggest that knowledge concerning oral and pharyngeal carcinoma in the community may be limited and educational strategies may be required to improve such knowledge.

Who's afraid of noncommunicable diseases? Raising awareness of the effects of noncommunicable diseases on global health

Public-health priorities are in part driven by fear, yet fear has long been recognized as posing a threat to effective public health interventions. In this article, the authors review the role of fear in global health by focusing on the leading global cause of death and disability: noncommunicable diseases. Taking an historical perspective, first the authors review Samuel Adams' 1911 analysis of the role of fear in generating public health priority and his recommendations about mass educating the public. Next, they show that Adams' analysis still applies today, drawing on contemporary responses to H1N1 and HIV, while illustrating the ongoing neglect of long-term threats such as noncommunicable diseases. Then, they pose the question, "Is it possible, necessary, or useful to create a fear factor for noncommunicable diseases?" After reviewing mixed evidence about the effects of fear on social change (on individual behaviors and on building a mass movement to achieve collective action), the authors conclude by setting out an evidence-based, marketing strategy to generate a sustained, rational response to the noncommunicable disease epidemic.

Ill Effects of Smoking: Baseline Knowledge among School Children and Implementation of the "AntE Tobacco" Project

Introduction. Cigarette smoking contributes to the deaths of more than 400,000 Americans annually. Each day >3,000 children and adolescents become regular smokers. This paper details a new antitobacco educational program titled “AntE Tobacco” Method. Children in grades 1–3 were administered a 10-item questionnaire to ascertain their baseline knowledge about the ill effects of smoking, shown an educational cartoon video depicting the ill effects of tobacco, and given a story book based on the video. At the end of video, children were administered a questionnaire to determine short-term recall of the antitobacco educational objectives of the program. Four to 6 weeks later, the children were then administered a follow-up survey to determine long-term retention of the anti tobacco educational program. Result. Eighty two percent of the children answered the outcome questions correctly immediately following the video. At follow-up, 4–6 weeks later, 83% of children answered all questions correctly. Conclusion. The anti tobacco education program used in this study effectively conveyed most of the educational objectives. The results of this study indicate that a multimedia (i.e., video and book) educational program can be used to educate and reinforce anti tobacco messages. This program may be very useful as a part of a comprehensive anti tobacco curriculum in school systems.

Squeezing new life out of an old Sponge: how to modernise an anti-smoking media campaign to capture a new market

OBJECTIVES

The iconic Sponge anti-smoking television advertisement was first made in Sydney, Australia, in 1979. In 2007, it was re-made for a new generation of smokers. This paper examines the impact of the re-made Sponge advertisement.

METHODS

Qualitative evaluation of the original Sponge ad by younger and older smokers (n=51) was followed by an online pre-test survey of the modernised version (n=301). A continuous tracking telephone survey of smokers and recent quitters (quit in past 12 months) over 18 years monitored performance of the modernised version while on air in late 2007 (total n=453; seen ad n=380).

RESULTS

Qualitative research found that the concept of the original Sponge ad may motivate younger smokers--who had not previously seen the ad--to quit. Online pre-testing demonstrated that the modernised version provided new information to 54% of 18-24 year olds (compared to 31% of older smokers). Tracking survey results indicated that believability of the modernised version was highest among 18-24 year olds (92%), that the ad was 'attention-grabbing' (86%), and that it was effective at influencing quitting intentions. Effects were amplified by the generation of pressure from family and friends.

IMPLICATIONS

The re-made Sponge advertisement had a positive impact on smokers, and was particularly effective among the new market of smokers aged less than 40 years. Adapting successful mass media campaign material can be an effective and economical strategy to influence smokers.

Mass media interventions for preventing smoking in young people

BACKGROUND

The mass media have been used as a way of delivering preventive health messages. They have the potential to reach and to modify the knowledge, attitudes and behaviour of a large proportion of the community.

OBJECTIVES

To evaluate the effectiveness of mass media interventions to prevent smoking in young people in terms of reduced smoking uptake, in addition to secondary outcomes including improved smoking outcomes, attitudes, behaviours, knowledge, self-efficacy and perception.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group Specialised Register and conducted additional searches of MEDLINE and EMBASE in July 2010.

SELECTION CRITERIA

Randomized trials, controlled trials without randomization and time series studies that assessed the effectiveness of mass media campaigns (defined as channels of communication such as television, radio, newspapers, bill boards, posters, leaflets or booklets intended to reach large numbers of people and which are not dependent on person to person contact) in influencing the smoking behaviour (either objective or self-reported) of young people under the age of 25 years.

DATA COLLECTION AND ANALYSIS

Information relating to the characteristics and the content of media interventions, participants, outcomes, methods of the study and risk of bias was abstracted by two independent reviewers. Studies were combined using qualitative narrative synthesis.

MAIN RESULTS

Seven out of a total of 84 studies reporting information about mass media smoking campaigns met all of the inclusion criteria. All seven studies used a controlled trial design. Three studies concluded that mass media reduced the smoking behaviour of young people. All of the effective campaigns had a solid theoretical basis, used formative research in designing the campaign messages, and message broadcast was of reasonable intensity over extensive periods of time.

AUTHORS' CONCLUSIONS

There is some evidence that mass media can prevent the uptake of smoking in young people, however the evidence is not strong and contains a number of methodological flaws.

Awareness effects of a youth suicide prevention media campaign in Louisiana

Research on the efficacy of mediated suicide awareness campaigns is limited. The impacts of a state-wide media campaign on call volumes to a national hotline were analyzed to determine if the advertisements have raised awareness of the hotline. We use a quasi-experimental design to compare call volumes from ZIP codes where and when the campaign is active with those where and when the campaign is not active. Multilevel model estimates suggest that the campaign appears to have significantly and substantially increased calls to the hotline. Results from this study add evidence to the growing public health literature that suggests that mediated campaigns can be an effective tool for raising audience awareness.

Assessing the relationship between ad volume and awareness of a tobacco education media campaign

BACKGROUND

The relation between aided ad recall and level of television ad placement in a public health setting is not well established. We examine this association by looking back at 8 years of the California's Tobacco Control Program's (CTCP) media campaign.

METHODS

Starting in July 2001, California's campaign was continuously monitored using five telephone series of surveys and six web-based series of surveys immediately following a media flight. We used population-based statewide surveys to measure aided recall for advertisements that were placed in each of these media flights. Targeted rating points (TRPs) were used to measure ad placement intensity throughout the state.

RESULTS

Cumulative TRPs exhibited a stronger relation with aided ad recall than flight TRPs or TRP density. This association increased after log-transforming cumulative TRP values. We found that a one-unit increase in log-cumulative TRPs led to a 13.6% increase in aided ad recall using web-based survey data, compared to a 5.3% increase in aided ad recall using telephone survey data.

CONCLUSIONS

In California, the relation between aided ad recall and cumulative TRPs showed a diminishing return after a large volume of ad placements These findings may be useful in planning future ad placement for CTCP's media campaign.

Awareness and impact of the 'Bubblewrap' advertising campaign among Aboriginal smokers in Western Australia

BACKGROUND

Antismoking mass media campaigns have been shown to reduce smoking prevalence in the mainstream community, however there is little published research on their effect on Aboriginal Australian smokers.

OBJECTIVES

To evaluate the awareness and impact of a mainstream mass media advertising campaign (the 'Bubblewrap' campaign) on Aboriginal smokers in the state of Western Australia.

METHODS

A personal intercept survey was conducted in July 2008 across three sites (the Perth metropolitan area and the non-metropolitan towns of Kalgoorlie and Broome). An opportunity or convenience sampling strategy was used to recruit Aboriginal participants, and face-to-face interviews were conducted with 198 Aboriginal smokers to ascertain awareness of the campaign advertisements, whether they were seen as believable and relevant, and the impact the advertisements had on smoking behaviour.

RESULTS

The majority of the participants interviewed had seen and/or heard the 'Bubblewrap' campaign advertisements, although there was considerably greater awareness of the television advertisement than the radio advertisements. Both forms of advertising were considered to be believable and relevant by the majority of Aboriginal smokers. Most of the smokers interviewed thought about cutting down and/or quitting after seeing or hearing the advertisements.

CONCLUSIONS

Our findings suggest that mainstream antismoking mass media campaigns can positively influence the thoughts and behaviours that Aboriginal smokers have, and exhibit, towards quitting smoking. Notwithstanding this, advertisers should continue to look for better ways to incorporate Aboriginal themes in campaign messages. Future mainstream antismoking campaigns should source sufficient funds to ensure that advertising messages reach the large Aboriginal populations in regional and remote Australia.

Legislation to institutionalize resources for tobacco control: the 1987 Victorian Tobacco Act

AIM

  To describe the process surrounding the creation of the first organization in the world to be funded from an earmarked tax on tobacco products, the Victorian Health Promotion Foundation (VicHealth), and to outline briefly its subsequent history.

DESCRIPTION

The genesis of VicHealth came from an interest of the Minister for Health in the Victorian State Government to address the tobacco problem, and the strategic capacity of Dr Nigel Gray from the Anti-Cancer Council of Victoria to provide a vehicle and help the government to muster support for its implementation. Success involved working with government to construct a Bill it was happy with and then working with the community to support the implementation and to counter industry attempts to derail it. The successful Bill led to the creation of VicHealth. VicHealth has played a creative and important role in promoting health not only in Victoria (Australia), but has been a stimulus for similar initiatives in other parts of the world.

CONCLUSIONS

Enacting novel advances in public policy is made easier when there is a creative alliance between advocates outside government working closely with governments to develop a proposal that is politically achievable and then to work together to sell it. Health promotion agencies, once established, can play an important role in advancing issues like tobacco control.

Evaluation of an Eye Health Program: The Vision Initiative

PURPOSE

The aim of this study was to develop an innovative, rapid and economical assessment methodology to determine the knowledge, attitudes and behaviours regarding eye health and to determine the rates of the most common causes of visual impairment and undiagnosed eye disease.

METHODS

Letters were posted to Seniors Card holders aged 70-79 in 18 randomly selected areas, stratified by socio-economic status. A questionnaire was developed to measure knowledge, attitudes and behaviours regarding eye health. Uncorrected refractive error was determined by measuring presenting and best-corrected visual acuity (VA). Diabetic retinopathy and age-related macular degeneration were assessed using digital non-mydriatic retinal photography. Glaucoma was assessed using Frequency Doubling Technology (FDT) and digital images of the optic nerve head. Cataract was determined using digital retro-illumination images of the lens taken with a non-mydriatic camera. The cost for recruiting, examining and grading images for each participant was calculated by dividing the total study cost by the number of participants examined.

RESULTS

Of the 13,483 participants invited to participate in the study, appointments were made for 1860 (13.8%) people with 1,701 (91%) actually attending. Overall, missing data from the 1,695 questionnaires represented less than 1.0% and all participants attended the vision screening over a three-month period. Presenting and best-corrected visual acuity and FDT results on both eyes were obtained on 99% of the sample. The proportion of gradable digital images of the fundus in both eyes in the sample was 89%, while 90% of participants with bilateral presenting VA<6/12 had assessable lens images. The cost for recruiting, examining and grading images for each participant was approximately 150 AUS dollars.

CONCLUSION

The recruitment from a mailing obtained the required sample size for the study, allowing a large sample of participants to be examined efficiently over a short period of time. It is important that the most common causes of visual impairment and undiagnosed eye disease can be determined using this rapid assessment methodology.

Health beliefs relating to alcohol and other drug use in the Australian population

This study uses data from a nationally representative population survey conducted in March and April 1993 to examine alcohol and other drug-related health beliefs within the Australian population. The results show widespread ignorance about the causes of drug-related mortality, with 43 percent of respondents believing that alcohol is the major cause of drug-related premature death. Only 32 percent of the respondents mentioned tobacco as the major cause of death. Those who identified tobacco as the drug causing the greatest number of deaths were more likely to be male, young, Australian or British-born, and better educated. Women were more accurate in their assessment of the risk levels associated with alcohol consumption than men, as were the young and the better educated. There is widespread public knowledge about the risks that are associated with passive smoking. Overall, the results point to the need to focus health promotion and awareness campaigns on the groups that have so far proved most immune to health messages, namely, heavy drinkers and smokers.

Over-the-counter nicotine replacement therapy: can its impact on smoking cessation be enhanced?

Nicotine replacement therapies (NRTs) are efficacious smoking-cessation aids. However, only minimal increases in smoking cessation followed NRTs being made available over-the-counter (OTC), which presumably made these treatments more readily available. To better understand why the United States did not experience improvements in smoking cessation following the OTC availability of NRTs, it is useful to review factors that determine NRT's impact on smoking cessation and how these factors played out with the introduction of OTC NRT. The authors contend that for NRTs to have a greater impact on public health, increases are needed in the number of individuals making a quit attempt, the proportion using NRTs in a quit attempt, and the effectiveness of each quit attempt. Even small increases in the impact of OTC NRTs could yield significant benefits in terms of morbidity and mortality. The remainder of this article provides examples of interventions designed to target each of the aforementioned factors individually as well as examples of interventions that link increased cessation attempts, increased NRT reach, and increased NRT efficacy in order to synergistically enhance the impact of OTC NRTs.

Global health assistance for chronic illness: a look at the practical

The changing pattern of disease in the developing world calls for a change in the structure, goals, and personnel of global health assistance. Chronic diseases are now the dominant threat to health and are becoming a challenge to economic advancement in developing economies. Because confronting these diseases, heart disease and diabetes mellitus in particular, requires long-tem, ongoing programs, the support and funding must come from within and therefore must reflect a nation's commitment to combat them. One model for this change is a 3-legged stool or platform upon which an assault on chronic disease can be built. The 3 legs are (1) an effective primary health care delivery system, (2) effective health promotion, and (3) a macroeconomic repositioning of health within the government bureaucracy and the world of commerce. To construct each of these legs requires changes in the structure and roles of global health assistance organizations.

Smoking-cessation media campaigns and their effectiveness among socioeconomically advantaged and disadvantaged populations

OBJECTIVES

We examined whether the impact of televised smoking cessation ads differed by a population's education and income.

METHODS

We used longitudinal data from the Wisconsin Behavioral Health Survey, a statewide sample of 452 adult smokers who were interviewed in 2003 to 2004 and followed up 1 year later. Logistic regression was used to assess whether baseline recall of secondhand smoke ads and "keep trying to quit" ads was associated with quit attempts and smoking abstinence at 1 year. Interaction terms were used to assess whether these associations differed by the smokers' education and income levels.

RESULTS

Overall, neither keep-trying-to-quit nor secondhand smoke ad recall was associated with quit attempts or smoking abstinence. Keep-trying-to-quit ads were significantly more effective in promoting quit attempts among higher-versus lower-educated populations. No differences were observed for secondhand smoke ads by the smokers' education or income levels.

CONCLUSIONS

Some media campaign messages appear less effective in promoting quit attempts among less-educated populations compared with those who have more education. There is a need to develop media campaigns that are more effective with less-educated smokers.

The contribution of antismoking advertising to quitting: intra- and interpersonal processes

This study explored the roles of transportability-the tendency to become absorbed in a narrative-and interpersonal discussion in the use of televised antismoking advertising in attempts to quit smoking. We used data from a representative population survey of adults (n = 2,999), examining responses from current smokers (n = 594) and former smokers who had quit in the last 5 years (n = 167). Logistic regression analysis revealed that current and former smokers higher in transportability were more likely to recall an antismoking ad (OR = 1.08, p < .001), and to perceive they had been helped by antismoking advertising in their attempts to quit smoking (OR = 1.05, p < .01). Transportability also was related to the recall of narrative antismoking advertisements (OR = 1.06, p < .05). Among current smokers, those who engaged in interpersonal discussion about any antismoking advertising were more likely to have made a quit attempt (OR = 2.76, p < .001). Finally, individuals were most likely to discuss advertising containing information about the negative health consequences of smoking using graphic images or simulations of bodily processes. These results suggest that the effectiveness of antismoking advertising is dependent upon both intra- and interpersonal processes that are triggered by the advertisements.

Mass media interventions for smoking cessation in adults

BACKGROUND

Mass media tobacco control campaigns can reach large numbers of people. Much of the literature is focused on the effects of tobacco control advertising on young people, but there are also a number of evaluations of campaigns targeting adult smokers, which show mixed results. Campaigns may be local, regional or national, and may be combined with other components of a comprehensive tobacco control policy.

OBJECTIVES

To assess the effectiveness of mass media interventions in reducing smoking among adults.

SEARCH STRATEGY

The Cochrane Tobacco Addiction Group search strategy was combined with additional searches for any studies that referred to tobacco/smoking cessation, mass media and adults. We also searched the Cochrane Register of Controlled Trials (CENTRAL) and a number of electronic databases. The last search was carried out in March 2007.

SELECTION CRITERIA

Controlled trials allocating communities, regions or states to intervention or control conditions; interrupted time series.Adults, 25 years or older, who regularly smoke cigarettes. Studies which cover all adults as defined in studies were included. Mass media are defined here as channels of communication such as television, radio, newspapers, billboards, posters, leaflets or booklets intended to reach large numbers of people, and which are not dependent on person-to-person contact. The purpose of the mass media campaign must be primarily to encourage smokers to quit. They could be carried out alone or in conjunction with tobacco control programmes.The primary outcome was change in smoking behaviour. This could be reported as changes in prevalence, changes in cigarette consumption, quit rates, odds of being a smoker.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed all studies for inclusion criteria and for study quality. One author (MB) extracted data, and a second author (LS) checked them.Results were not pooled due to heterogeneity of included studies and are presented narratively and in table form.

MAIN RESULTS

Eleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow up, methods of evaluation and also in definitions and measures of smoking behaviour used. Among nine campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large-scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. Among the seven studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex-smokers combined.

AUTHORS' CONCLUSIONS

There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality. One state-wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign, while another (California) showed positive results only during the period of adequate funding and implementation. Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney). The intensity and duration of mass media campaigns may influence effectiveness, but length of follow up and concurrent secular trends and events can make this difficult to quantify. No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender.

Tobacco industry marketing, population-based tobacco control, and smoking behavior

Two of the major influences of cigarette smoking behavior are tobacco industry marketing and public health tobacco-control activities. These vie with each other to influence the proportion of each generation who initiate smoking, the intensity level reached by smokers, and the time before smokers are able to quit successfully. This article provides a brief summary of the evidence associating tobacco marketing practices (organized under the four "Ps" of marketing), with smoking behavior. The evidence for causality in this association is considered convincing. Publicly funded, comprehensive, statewide tobacco-control programs were introduced into the United States in the late 1980s, with money either from tobacco taxes or from legal settlements of states with the tobacco industry. These programs use organized statewide approaches to implement current recommendations on "best practices" to discourage tobacco use, recommendations that have changed over time. During the 1990s, "best practices" evolved to include protection against secondhand smoke, sale of cigarettes to minors, and restrictions on tobacco advertising. Evaluations have been published on four statewide tobacco-control programs (Sydney/Melbourne, California, Massachusetts, and Florida) and a national program aimed at youth (American Legacy Program). For each program, there was a positive association with reduced smoking. The evidence supporting the conclusion that tobacco-control programs reduce smoking behavior is evaluated as strong.

Antismoking television advertising and socioeconomic variations in calls to Quitline

OBJECTIVE

To assess the socioeconomic variations in call rates to the Quitline (Victoria, Australia) and in the impact of anti-tobacco television advertising on call rates.

DESIGN

The outcome measure was the number of calls to the Quitline in Victoria for each week for each socioeconomic group for the period January 2001 to March 2004. Socioeconomic status (SES) was derived from the caller's postcode using the Index of Socioeconomic Disadvantage provided by the Australian Bureau of Statistics. The exposure measure was weekly Target Audience Rating Points (TARPs, a standard measure of television advertising weight) for anti-tobacco advertising broadcast in Victoria over the same period. Negative binomial regression was used to examine the interaction of SES and TARPs in their effect on the number of Quitline calls.

RESULTS

SES and call rates were positively associated. Adjusted call rate was 57% (95% CI 45% to 69%) higher in the highest than the lowest SES quintile. SES differences in call rates were stable over time. In the study period, the effect of the presence or increasing levels of antismoking TARPs on call rates did not vary across categories of SES.

CONCLUSIONS

In the study period, different SES groups had a similar level of responsiveness to antismoking television advertisements, at least as measured by the rate of calls to the Quitline. However, the present media campaigns are not likely to diminish SES differences in call rates, and more needs to be done to encourage disadvantaged groups to call the Quitline.

Tobacco advertisements and promotion industry on smoking in Tanzania: a review of negative public health implications for current and future generations

Smoking places a burden on the health care system in developed countries but even more so in the already compromised health services in developing countries. The promotion of tobacco is a root cause of continued consumption even after highlighting the effects. The main aim of this news analysis is to discuss various strategies used by the tobacco industry in promoting tobacco use in Tanzania.

22 years on: the impact and relevance of the UK No Smoking Day

OBJECTIVES

To evaluate the impact and relevance of the national awareness day "No Smoking Day" 22 years after it was launched.

DESIGN

Triangulation of data from a variety of sources. Retrospective surveys conducted one week and three months after No Smoking Day, media coverage, website activity, and volume of calls to national smokers' helplines.

MAIN OUTCOME MEASURES

Self reports of awareness and smoking behaviour changes one week and three months after No Smoking Day. Volume of media coverage, visits to No Smoking Day website, and volumes of calls to smokers' helplines.

RESULTS

Follow up at one week indicates awareness of No Smoking Day is lower in 2004 than in 1986 but still high at 70% for all smokers. The decline in participation from 18% of aware smokers in 1994 to 7% in 2001 has been reversed and in 2005 19% quit or reduced their smoking on No Smoking Day. Three months after No Smoking Day awareness was 78% in 2004, lower than in previous studies but still high and equivalent to 9,965,000 smokers when applied to the population estimate of UK smokers. Likewise participation has decreased but at 14% in 2004 is equivalent to an estimated 1,840,000 (1 in 7 of UK smokers) claiming to quit or reduce their consumption on the Day. Among those who participated, 11% were still not smoking more than three months after the Day, equivalent to an estimated 85,000 smokers (0.7% of UK smokers). Media volume has increased even though campaign spend has remained relatively constant and calls to national smokers' helplines on No Smoking Day are typically four times those received on an average day.

CONCLUSIONS

These data suggest that after 22 years No Smoking Day continues to be successful in reaching smokers. With a budget insufficient to pay for advertising, this public awareness campaign supported by local activities appears to be effective in helping smokers to stop.

Mixed messages on tobacco: comparative exposure to public health, tobacco company- and pharmaceutical company-sponsored tobacco-related television campaigns in the United States, 1999-2003

AIMS

To describe and compare the extent of exposure among youth and adults to antitobacco advertising funded by tobacco control agencies, and to smoking-related advertising from tobacco and pharmaceutical companies.

DESIGN

Archival records of television advertising exposures from Nielsen Media Research for the largest 75 media markets in the United States from 1999 to 2003.

MEASUREMENTS

Mean monthly advertising exposures for households with televisions and adolescents aged 12-17 years for: state tobacco control programs; the national American Legacy Foundation (Legacy) program; tobacco company advertising for youth smoking prevention, parent advertising and corporate image; pharmaceutical company advertising for nicotine replacement therapy and Zyban; and other miscellaneous tobacco-related advertising.

FINDINGS

Combined tobacco company youth/parent advertising exposures matched those for combined State/Legacy campaigns (4.56 advertisements/month versus 4.97 advertisements/month among households; 3.05 advertisements/month versus 3.38 advertisements/month among adolescents). Tobacco company corporate image advertising averaged 3.25 advertisements/month among households and 0.73 advertisements/month among adolescents. Tobacco company advertising exceeded public health-sponsored advertising by a factor of 1.57-1, and among youth by 1.11-1. Pharmaceutical companies were the largest sponsor of tobacco-related advertising for households (10.37 advertisements/month) and provided significant exposure among adolescents (2.61 advertisements/month).

CONCLUSIONS

This is the first study to demonstrate systematically that public health-sponsored antitobacco campaigns in the United States are matched or exceeded by tobacco company advertising, as well as pharmaceutical cessation product advertising. Research is needed to determine whether such advertising may dilute or undermine the established benefits of tobacco control-sponsored campaigns.

Assessing the validity of confirmed AD recall measures for public health communication campaign evaluation

Evidence strongly suggests that public health communication campaigns can succeed in changing health-related cognitions and behaviors. For many evaluation studies, however, inferences of campaign effects are only valid to the extent that measures of campaign exposure are themselves valid. This study compares the validity of "aided" and "confirmed" ad recall measures in the context of a statewide tobacco countermarketing campaign using data from the Florida Anti-Tobacco Media Evaluation (FAME) surveys. Both aided and confirmed ad recall measures exhibited positive associations with cumulative gross ratings points (GRPs), a measure of the relative availability of specific countermarketing ads on broadcast television. In addition, both recall measures were significant predictors of campaign-targeted beliefs. Confirmed ad recall, however, was not a significantly better predictor of cumulative GRPs or campaign-targeted beliefs than aided ad recall, and the magnitude of association between both recall measures and targeted beliefs was quite small. These findings raise questions about the marginal utility of confirmed ad recall measures, compared with aided ad recall, in public health communication campaign evaluations. Nevertheless, results do provide evidence that both aided and confirmed ad recall measures are valid measures of campaign exposure.

The dirty dozen: 12 myths that undermine tobacco control

Cigarette smoking is the leading cause of preventable death in the United States. The health risks of smoking are well documented, as is the effectiveness of clinical and public health interventions to prevent and reduce smoking. However, many myths about smoking either encourage people to begin or continue smoking or deter them from quitting. Some myths stem from a misapplied understanding of what might seem to be common sense; others are deliberately promulgated by the tobacco industry to induce people--especially children--to start smoking and to keep them smoking as adults. These myths undermine tobacco control. However, comprehensive tobacco control programs that include anti-smoking public education campaigns can effectively counter these myths and prevent illness and premature death.