Australia: the healthiest country by 2020
National Preventative Health Strategy – the roadmap for action

Key action area 2: Increase the frequency, reach and intensity of social marketing campaigns

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Well-funded, sustained media campaigns rank second only to price as a key to reducing smoking.

Media campaigns help to personalise the health risks of smoking and increase people’s sense of urgency about quitting. To successfully challenge strongly held personal opinions and entrenched self-exempting beliefs, campaigns need to be bold and to take some risks. In order to encourage people to make numerous attempts to quit, to persist through any withdrawal symptoms and to stay a non-smoker, media campaigns need to be on air most of the year. Effective campaigns need to draw on solid behavioural and communications research, and be funded at commercially realistic levels.

Commercially realistic funding
‘Evidence on the value of social marketing (mass media) quitting campaigns is clear: effectively developed and implemented, mass media campaigns can reduce adult smoking prevalence, increase quitting activity and drive calls to cessation services such as Quitlines. As such they form an integral component of any comprehensive tobacco control strategy’ (Quote from submission)

Studies of smoking trends in jurisdictions with and without media campaigns in the early 1980s in Australia[57, 58] and elsewhere[59, 60] indicate that they can be extremely effective in reducing smoking prevalence. As part of a comprehensive scientific review of all available international evidence concerning the impact of the media on smoking attitudes and behaviour,[61] the US National Cancer Institute concluded in its 2008 landmark report that well-funded campaigns can reduce smoking prevalence, with the extent of reductions highly related to levels of media expenditure.[62]

Experience in the United States shows that increases in per capita spending on tobacco control programs are clearly associated with accelerated declines in smoking in both adults[63] and youth.[64] A cohort study in Massachusetts found that, compared to smokers who had the lowest level of tobacco control media campaign exposure, about 280 Target Audience Rating Points (TARPs) per month, those who had the highest (about 838 TARPs per month) were over four times more likely to have quit two years later.

Based on the levels of response to social marketing campaigns observed over the past 15 years in Australia,[40] and taking into account the findings from studies internationally, members of the expert panel overseeing the production of the US National Cancer Institute report on the use of media in tobacco control5 [62] advise that media spending on Quit campaigns should be high enough to achieve at least 700 TARPs per month. In Australia, achieving an average of 700 TARPs per month would currently cost around $40 million per year, a figure likely to increase over time with increased media costs and an increasingly fragmented media market.[65]

Media advertising outside New South Wales, Western Australia and Victoria appears to be sporadic. Other than the NSW Cancer Institute (which spent more than $12 million in 2007),[66] spending on Quit campaigns is considerably lower than the advertising budgets of major commercial retailers in Australia. To maximise the reach and impact of advertising messages, it will be important to capitalise on the remaining years in which free-to-air advertising is still predominant, and also to start moving towards a greater mix of media channels, including free-to-air and subscription television, cinema, print, radio and magazines. To ensure continuing impact over time, funds will also be needed each year for production of new material.
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Action 2.1
Run effective social marketing campaigns at levels of reach demonstrated to reduce smoking.

Impact of media on disadvantaged groups
Analysis of smoking prevalence over the first two periods of the Australian National Tobacco Campaign shows that changes in smoking rates among blue-collar groups were of a similar magnitude to changes among white-collar groups.[67] This is consistent with the results of earlier research that showed no increase in the disparity between smoking rates among groups with different levels of education after the early Quit campaigns in Sydney and Melbourne.[68, 69]

A study of smoking among children in suburbs with varying degrees of socioeconomic disadvantage across Australia between 1987 and 2005[70] found that the level of tobacco-control activity affected the consistency of change in teenage smoking prevalence across different SES groups. Prevalence increased very sharply in low SES teenagers during the period of low tobacco control activity, whereas there was little change among the higher SES teenagers.

A review of the literature published in 2008 has concluded that media campaigns can be equally effective with low and higher SES groups, but that attention must be paid to the placement and style of advertising.[71] A new cohort study has reported that emotional and narrative advertising messages produced a greater quitting response after two years among lower SES smokers than among higher SES smokers.[72] Emotional narrative communication may be a better method for low SES groups because it enables people to fully and vividly imagine how it would feel to suffer a smoking-related disease.[73-75] Advertising can be placed in television programs more likely to be watched by low SES groups, and additional more localised advertising can be focused on low SES neighbourhoods.

Action 2.2
Choose messages most likely to reduce prevalence in socially disadvantaged groups and provide extra reach to these groups through skewing of placement to television programs most likely to be watched by low SES groups, and by targeting radio, outdoor, transit and other local advertising to low SES neighbourhoods.

5 Australia’s Professor Melanie Wakefield was one of the two senior scientific editors of this report.


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