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Impact of Antitobacco Mass Media on Youth Smoking Initiation
Lois Biener, PhDCenter for Survey Research UMass Boston
Presented at National Conference on Tobacco Or Health, Boston, Dec. 10th 2003
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Massachusetts Media Campaign Average annual expenditure $13
million 1994 through 2001 Multiple Channels
Television Radio Adult Transit Billboards
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Multiple Strategies The truth about the industry
Rebel against industry manipulation Real people, real stories Not smoking is cool, smoking is not. Addiction
Preserve independence by avoiding addiction
Smoking harms the family
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Research GoalsI. Investigate impact on
behaviorII. Investigate effectiveness of
various strategies for different target audiences.
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I. Impact on youth behavior
Compare the rate of smoking initiation between youths who recalled or failed to recall exposure to television, radio, and outdoor anti-smoking advertisements at baseline
Over a four-year follow-up period Control for exposure to anti-smoking
messages from other sources
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Methods: Sample
1993 Baseline:
1,069 youths
Ages 12-15
1997 Follow-up:
618 youths57.8% overall
response rate
Cohort: 592 youths who hadn’t yet smoked 100 cigarettes baseline
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Methods:Measures of Exposure In past month, seen any anti-
tobacco messages... On television ? On radio? On billboards?
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Methods:Measures of Outcome(1997)
Smoked at least 100 cigarettes in lifetime ?
(Yes/No)
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Covariates (1993) Age, race, gender Baseline susceptibility to smoking Smoking by parents and friends Hours of TV viewing Exposure to other anti-smoking
messages (posters, newspapers, school, sporting
events) Interactions
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Results:Exposure to Media Campaign71
33
57
0
10
20
30
40
50
60
70
80
Television Radio Billboards
% R
epor
ting
Exp
osur
e
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Results:Established Smokers in 1997
17.7
27.1
20
05101520253035404550
Perc
ent
Overall Yes No Saw TV Ads
Age 12-13 in 1993
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Results:Established Smokers in 1997
30.2 32.531
05101520253035404550
Perc
ent
Overall Yes No Saw TV Ads
Age 14-15 in 1993
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Results:Multivariate Analysis Effect of exposure to anti-smoking
messages on television: Youths ages 12-13 at baseline
OR = 0.4995% CI = 0.26, 0.93
Youths ages 14-15 at baselineOR = 0.9495% CI = 0.48, 1.83
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Discussion Exposure measure is really high vs.
low exposure, not any vs. none Cannot conclude that all anti-
smoking media campaigns are likely to be effective
Cannot necessarily conclude that radio and outdoor advertisements are not effective
Possibility of unknown confounder
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Conclusion Strong evidence for a significant effect of statewide anti-smoking media campaign on youth smoking initiation
Effect restricted to younger adolescents
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II. Effectiveness by type of TV advertisement
Adult ’93 to ’96 Youth ’93 to ’97 Youth ’99 Youth 2001/2 Hispanic vs non-Hispanic 2001/2
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Research Tools Independent judges (youth and
adults) To establish characteristics of
advertisements Population-based telephone surveys
To assess how adults and youth in Massachusetts have reacted to the campaign
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Independent Judges
View TV spots and rate characteristics “How well do each of following
describe the advertisement?” 1 = Not at all 7 = Very much
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Judges’ Rating Scales(1 to 7) Sad Frightening Funny Emotionally
moving Believable Interesting Phony
Annoying Entertaining Reassuring Helpful Offensive Important Silly
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Advertising parameters Negative Emotion: Sad,
frightening, disturbing Positive Emotion: Happy, funny,
entertaining Level of Emotion: Powerful,
emotionally moving Cognitive quality: Makes you think,
interesting
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Message Identification What was the main message of
the ad? (Check one only).“Cigarettes and cigarette smoke are bad
for people’s health (Illness)“Tobacco companies are bad (Anti-
industry)“Teenagers shouldn’t smoke cigarettes
(Norms)
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Relationships between message and affect Illness message: High negative
affect, high emotion Norms message: Varies – usually
high positive affect, low emotion Anti-industry message: Varies with
execution
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Population Survey Approach Select subset of ads for
theoretical/conceptual purpose Assess recall Assess perceived effectiveness
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Measurement of recall Aided: Gives brief description Confirmed recall: Requests details Unaided: Asks for free recall and
description of ad seen recently
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Measurement of perceived effectiveness How good an anti-tobacco ad? (0
to 10) How it affects feelings about
cigarettes (feel worse, feel better, no change)
How much affects smokers’ motivation to quit (0 to 10)
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4
5
6
7
8
9
10JS VC BM HB CP IC CK ST AD
QuittersSmokersNonsmkr
How Good an Ad by Emotion Level (Adults 1993 to 1996)
Very Good
Hi Emotion
Low Emotion
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Mean Effectiveness Ratings by Ad Type (youth 1999)
0123456789
10
Illness Outraged Other MA PM
Very Good
Not Good
P <.001
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Youth 2001/2Illness: Ronaldo, Rick, (Mass.)Illness + Anti-industry:
Body bags, Daily Dose (truth)Baby monitor (Mass.)
Anti-industry: I know you (Mass.)Norms:
My reasons (Philip Morris)Piercing parlor (Lorillard)
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How Good an Ad by Ad Type
4
5
6
7
8
9
10
RD RK BB BM DD IK RS PC
IllnessI ll & Anti-IndAnti-IndNorms
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Feel Worse about Cigarettes due to Ad
30405060708090
100
RD RK BB BM DD IK RS PCAds
I llnessI ll & Anti-IndAnti-IndNorms
%
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Youth smokers:Motivation to Quit by Ad Type
3456789
10
RD RK BB BM DD IK RS PCAds
I llnessI ll & Anti-IndAnti-IndNorms
High
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Conclusions: Features of Effective Anti-tobacco Ads Evoke strong negative emotion Portray serious harm done by
tobacco use in authentic way
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Ads youth perceived as effective... Target adult smoking Portray harm done to family by
second-hand smoke Reveal industry responsibility for
serious harm in an evocative way Avoid use of humor
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Theoretical basis for emotional advertising Cognitive consistency
Negative emotion -> Increased risk, decreased benefit
Positive emotion -> Decreased risk, increased benefit
Learning theory High emotion ->greater recall
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Published articles on media Siegel, M. and L. Biener. 2000. The impact of an
antismoking media campaign on progression to established smoking: Results of a longitudinal youth study. American Journal of Public Health 90:380-386.
Biener, L., McCallum-Keeler, G., & Nyman, A. L. 2000. Adults' response to Massachusetts Antitobacco Television Advertisements: Impact of viewer and ad characteristics. Tobacco Control 9:401-407.
Biener, L. 2002. Adult and youth response to the Massachusetts anti-tobacco television campaign. J Public Health Management & Practice 3:40-44.
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Biener, L. 2002. Anti-tobacco advertisements by Massachusetts and Philip Morris: What teenagers think. Tobacco Control 11:ii43-ii46.
Biener, L., and Taylor, T.M. 2002. The continuing importance of emotion in tobacco control media campaigns: a response to Hastings and MacFadyen. Tobacco Control 11:76-77.
Biener, L. Ji, M., Gilpin, E and Albers, A.B. (In press). The impact of emotional tone, message and broadcast parameters in youth anti-smoking advertisements. Journal of Health Communication.