Impact of Antitobacco Mass Media on Youth Smoking Initiation

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Impact of Antitobacco Mass Media on Youth Smoking
Initiation

• Lois Biener, PhD

• Center 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

3
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

4
Research Goals

• Investigate impact on behavior
• 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 youths
• 57.8 overall
• response rate

Cohort 592 youths who hadnt yet smoked 100
cigarettes baseline
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MethodsMeasures of Exposure

• In past month, seen any anti-tobacco messages...
• On television ?
• On radio?
• On billboards?

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MethodsMeasures 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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ResultsExposure to Media Campaign
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ResultsEstablished Smokers in 1997
Age 12-13 in 1993
Percent
Overall
Yes No Saw TV Ads
12
ResultsEstablished Smokers in 1997
Age 14-15 in 1993
Percent
Overall
Yes No Saw TV Ads
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ResultsMultivariate Analysis

• Effect of exposure to anti-smoking messages on
  television
• Youths ages 12-13 at baseline
• OR 0.49
• 95 CI 0.26, 0.93
• Youths ages 14-15 at baseline
• OR 0.94
• 95 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
  peoples health (Illness)
• Tobacco companies are bad (Anti- industry)
• Teenagers shouldnt 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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How Good an Ad by Emotion Level (Adults 1993 to
1996)
Very Good
Low Emotion
Hi Emotion
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Mean Effectiveness Ratings by Ad Type (youth 1999)
Very Good
P Not Good
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Youth 2001/2

• Illness 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
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Feel Worse about Cigarettes due to Ad

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Youth smokersMotivation to Quit by Ad Type
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
  90380-386.
• Biener, L., McCallum-Keeler, G., Nyman, A. L.
  2000. Adults' response to Massachusetts
  Antitobacco Television Advertisements Impact of
  viewer and ad characteristics. Tobacco Control
  9401-407.
• Biener, L. 2002. Adult and youth response to the
  Massachusetts anti-tobacco television campaign. J
  Public Health Management Practice 340-44.

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• Biener, L. 2002. Anti-tobacco advertisements by
  Massachusetts and Philip Morris What teenagers
  think. Tobacco Control 11ii43-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 1176-77.
• 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.