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Real People, Real Stories: A New Mass Media Campaign That Could Help Smokers Quit FREE

Nancy A. Rigotti, MD; and Melanie Wakefield, PhD
[+] Article and Author Information

This article was published at www.annals.org on 25 September 2012.


From Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, and the Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1724.

Requests for Single Reprints: Nancy A. Rigotti, MD, General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114; e-mail, nrigotti@partners.org.

Current Author Addresses: Dr. Rigotti: General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114.

Dr. Wakefield: Centre for Behavioural Research in Cancer, Cancer Council Victoria, 1 Rathdowne Street, Carlton, Victoria 3053, Australia.

Author Contributions: Conception and design: N.A. Rigotti.

Analysis and interpretation of the data: N.A. Rigotti.

Drafting of the article: N.A. Rigotti, M. Wakefield.

Critical revision of the article for important intellectual content: M. Wakefield.

Final approval of the article: N.A. Rigotti, M. Wakefield.

Collection and assembly of data: N.A. Rigotti.


Ann Intern Med. 2012;157(12):907-909. doi:10.7326/0003-4819-156-1-201201010-00541
Text Size: A A A

Imagine seeing these advertisements on your television or computer: A 31-year-old man with bilateral below-knee amputations describes losing his legs and fingertips to Buerger disease. Three people with head and neck cancer diagnosed before 50 years of age talk about daily life with a stoma (“Don't face the shower head.” and “Be very careful with shaving.”) (Figure). The mother of a young boy with severe asthma advises in English or Spanish, “Don't be too shy to tell people not to smoke around your kids.” Three former smokers talk about how they quit and urge viewers, “Do whatever it takes, no matter how many times it takes. We did it. You can, too.”

Grahic Jump Location
Figure.

Billboard advertisements for the Centers for Disease Control and Prevention's Tips From Former Smokers mass media campaign.

Additional material available from www.cdc.gov/tobacco/campaign/tips/resources/.

Grahic Jump Location

These are some of the real-life Americans featured in Tips From Former Smokers from the Centers for Disease Control and Prevention (CDC), a $54 million national mass media campaign for public education supported by the Prevention and Public Health Fund of the Patient Protection and Affordable Care Act (1). The 12-week campaign, which began on 19 March 2012, was the first federally funded, nationwide mass media effort to encourage smokers to quit.

In 30-second television and radio spots, in print media, and on billboards, real people showed and told in graphic terms what it was like to live with disfiguring or disabling tobacco-related diseases that were diagnosed at a relatively young age. In other spots, former smokers gave tips about how they quit. Each message ended with a tag line referring viewers or listeners to free help available from a national telephone quit line (1-800-QUIT-NOW) and Web site (www.smokefree.gov). The campaign was also delivered online using digital video (for example, YouTube) and social media (for example, Facebook and Twitter) to reach the target audience, smokers aged 18 to 54 years. Advertisements were broadcast in English and Spanish.

The campaign's goal was to prompt smokers to try to quit and to build awareness of free government resources for smoking cessation (1). The short-term goal was achieved. According to Tim McAfee, MD, MPH, director of the CDC's Office on Smoking and Health, calls to the toll-free quit line more than doubled and Web site hits tripled during the 12-week campaign. “It far exceeded our expectations,” he said. The quit line received 207 519 additional calls in 2012 compared with the same 12-week period in 2011, and the Web site recorded 510 571 additional unique visitors, suggesting a substantial untapped public interest in information about quitting smoking (2). Paid advertising ended in June 2012, but public service announcements continued longer and campaign materials (for example, stories, videos, podcasts, and links) remain accessible on the Tips Web site (www.cdc.gov/tobacco/campaign/tips).

Whether the short-term positive response will translate into higher rates of smoking cessation and lower smoking prevalence is the key question. There are several reasons to be hopeful. Good empirical evidence shows that public education campaigns delivered by mass media influence health behaviors, especially tobacco smoking (3). Recent reviews find strong evidence that mass media campaigns increase quitting and reduce smoking prevalence when implemented within the context of a comprehensive tobacco control program (46).

Previous U.S. state and national efforts that resembled the Tips campaign had promising results. For example, the 2008 EX campaign, broadcast nationwide on cable television, also targeted adult smokers and promoted cessation. It was associated with an increase in quit attempts by smokers (7). Many other U.S. mass media campaigns targeted adolescents and young adults and aimed to reduce smoking initiation. The national “truth” campaign, which targeted adolescents and young adults from 2000 to 2004, reduced smoking initiation rates (8), as did earlier statewide mass media campaigns in Massachusetts and Florida (910).

The effectiveness of a mass media campaign depends on its reach, intensity, and duration and on the type of messages used (6). The messages of the Tips campaign are grounded in health communication research. Emotive personal testimonials and narratives are powerful strategies for reaching and influencing the broad population of smokers, including those of lower socioeconomic status (6, 1112). The personal story format reduces the tendency for smokers to generate counterarguments (“That couldn't happen to me”) or discount adverse health outcomes as uncommon among the smokers whom they know, because the stories feature real people.

Emotionally laden stories show the risks of tobacco use in a far more potent way than abstract information can, and messages evoking negative emotions have been shown to be more effective than humorous or emotionally neutral ones (13). The intended result is to increase smokers' sense of personal vulnerability to serious disease and increase their sense of urgency for quitting. Pairing the personal testimonial in each advertisement with simple actionable information (a phone number or Web site address) allows smokers to access free assistance with smoking cessation that is effective but underused.

Besides its direct effects on the target audience of adult smokers, the Tips campaign may indirectly benefit nonsmokers and youth. The advertisements could increase the frequency and depth of discussion about tobacco use within individual social networks (1415). Smokers may receive encouragement to make a quit attempt from family and friends. Adolescents may be reminded that tobacco use is harmful. Mass media campaigns can change public attitudes and make tobacco use less socially acceptable, which may be why they can discourage youth tobacco use (4, 16), even when, like the Tips campaign, they are not explicitly aimed at youth.

The Tips campaign's relatively brief 3-month duration, presumably a consequence of resource limitations, will probably limit its effect. As evidence, the excess volume of quit line calls and Web site hits returned to baseline levels soon after paid advertising ended (2). Media campaigns have relatively short-term effects because they are countered by ongoing factors that encourage smoking, such as marketing by the tobacco industry and the addictiveness of nicotine (6). Longer campaigns can reach the population with repeated messages, which is especially important for smokers of lower socioeconomic status (6).

Fortunately, the CDC plans to use funds from the Affordable Care Act to run another 3-month campaign during the first quarter of 2013 and hopes to do so in future years (McAfee T. Personal communication). Meanwhile, the CDC might extend the campaign's effect by partnering with states and private-sector organizations, such as health care systems, that could reuse the advertisements as part of their own public education efforts.

To assess the impact of the Tips campaign, the CDC sponsored a longitudinal study of a national cohort of 5000 adult smokers and 2000 adult nonsmokers. They completed an online survey 1 month before the campaign launch and immediately after the 12-week campaign ended (McAfee T. Personal communication). Surveys assessed awareness of the campaign advertising and attitudes and beliefs about smoking cessation and secondhand smoke exposure. Smokers were asked about their intentions to quit smoking and attempts to quit. Nonsmokers were asked whether they had encouraged a friend or family member to quit. The analysis is statistically powered to detect an increase in the primary outcome measure, quit attempts by smokers, adjusting for campaign exposure. Results are expected by the end of this year.

In a separate effort, the U.S. Food and Drug Administration issued new warning labels for U.S. cigarette packages in 2011 (17). The labels feature large graphic images that, like those in the Tips media campaign, deliver emotionally evocative messages of the health harms of tobacco use and are paired with information on how to get help with quitting. The warning labels were to appear in September 2012, but implementation is delayed until resolution of legal challenges from the tobacco industry. If the U.S. Food and Drug Administration prevails, we urge them and the CDC to coordinate their future efforts. Pictorial warning labels and television advertising can work in a complementary manner to increase awareness of the health consequences of smoking and enhance motivation to quit (18).

In summary, the CDC's Tips campaign is bold in size, scope, and content. The $54 million investment of federal funds is unprecedented in U.S. tobacco control, although it pales in comparison to the $27 million spent daily by the tobacco industry to market its products (2, 16). The CDC deserves credit for grounding the design and implementation in the evidence base of health communication research and for supporting a comprehensive evaluation to determine whether it worked and why or why not. It is definitely a program to watch—and to recommend to your patients who smoke (Table).

Table Jump PlaceholderTable. 

Resources for Smokers Related to the Tips From Former Smokers Campaign

References

Centers for Disease Control and Prevention.  Tips From Former Smokers: Campaign Overview. Accessed at www.cdc.gov/tobacco/campaign/tips/resources/about/campaign-overview.html on 3 July 2012.
 
Centers for Disease Control and Prevention (CDC). Increases in quitline calls and smoking cessation website visitors during a national tobacco education campaign—March 19-June 10, 2012. MMWR Morb Mortal Wkly Rep. 2012; 61:667-70.
PubMed
 
Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet. 2010; 376:1261-71.
PubMed
CrossRef
 
National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Bethesda, MD: U.S. Department of Health and Human Services; 2008.
 
Bala M, Strzeszynski L, Cahill K. Mass media interventions for smoking cessation in adults. Cochrane Database Syst Rev. 2008; CD004704.
PubMed
 
Durkin S, Brennan E, Wakefield M. Mass media campaigns to promote smoking cessation among adults: an integrative review. Tob Control. 2012; 21:127-38.
PubMed
CrossRef
 
Vallone DM, Duke JC, Cullen J, McCausland KL, Allen JA. Evaluation of EX: a national mass media smoking cessation campaign. Am J Public Health. 2011; 101:302-9.
PubMed
CrossRef
 
Farrelly MC, Nonnemaker J, Davis KC, Hussin A. The influence of the national truth campaign on smoking initiation. Am J Prev Med. 2009; 36:379-84.
PubMed
CrossRef
 
Siegel M, Biener L. The impact of an antismoking media campaign on progression to established smoking: results of a longitudinal youth study. Am J Public Health. 2000; 90:380-6.
PubMed
 
Sly DF, Trapido E, Ray S. Evidence of the dose effects of an antitobacco counteradvertising campaign. Prev Med. 2002; 35:511-8.
PubMed
CrossRef
 
Durkin SJ, Biener L, Wakefield MA. Effects of different types of antismoking ads on reducing disparities in smoking cessation among socioeconomic subgroups. Am J Public Health. 2009; 99:2217-23.
PubMed
CrossRef
 
Niederdeppe J, Farrelly MC, Nonnemaker J, Davis KC, Wagner L. Socioeconomic variation in recall and perceived effectiveness of campaign advertisements to promote smoking cessation. Soc Sci Med. 2011; 72:773-80.
PubMed
CrossRef
 
Dunlop S, Wakefield M, Kashima Y. Can you feel it? Negative emotion, risk, and narrative in health communication. Media Psychol. 2008; 11:52-75.
CrossRef
 
Southwell B, Yzer MC. When (and why) interpersonal talk matters for campaigns. Commun Theory. 2009; 19:1-8.
CrossRef
 
van den Putte B, Yzer M, Southwell BG, de Bruijn GJ, Willemsen MC. Interpersonal communication as an indirect pathway for the effect of antismoking media content on smoking cessation. J Health Commun. 2011; 16:470-85.
PubMed
CrossRef
 
U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services; 2012.
 
U.S. Food and Drug Administration.  Tobacco Products: Cigarette Health Warnings. Accessed at www.fda.gov/TobaccoProducts/Labeling/Labeling/CigaretteWarningLabels/default.htm on 9 July 9 2012.
 
Brennan E, Durkin SJ, Cotter T, Harper T, Wakefield MA. Mass media campaigns designed to support new pictorial health warnings on cigarette packets: evidence of a complementary relationship. Tob Control. 2011; 20:412-8.
PubMed
CrossRef
 

Figures

Grahic Jump Location
Figure.

Billboard advertisements for the Centers for Disease Control and Prevention's Tips From Former Smokers mass media campaign.

Additional material available from www.cdc.gov/tobacco/campaign/tips/resources/.

Grahic Jump Location

Tables

Table Jump PlaceholderTable. 

Resources for Smokers Related to the Tips From Former Smokers Campaign

Videos

The CDC Tips from Former Smokers campaign uses multimedia and social media to feature real people suffering as a result of smoking and exposure to secondhand smoke. For more information, go to http://www.cdc.gov/tobacco/campaign/tips/.

The CDC Tips from Former Smokers campaign uses multimedia and social media to feature real people suffering as a result of smoking and exposure to secondhand smoke. For more information, go to http://www.cdc.gov/tobacco/campaign/tips/.

The CDC Tips from Former Smokers campaign uses multimedia and social media to feature real people suffering as a result of smoking and exposure to secondhand smoke. For more information, go to http://www.cdc.gov/tobacco/campaign/tips/.

References

Centers for Disease Control and Prevention.  Tips From Former Smokers: Campaign Overview. Accessed at www.cdc.gov/tobacco/campaign/tips/resources/about/campaign-overview.html on 3 July 2012.
 
Centers for Disease Control and Prevention (CDC). Increases in quitline calls and smoking cessation website visitors during a national tobacco education campaign—March 19-June 10, 2012. MMWR Morb Mortal Wkly Rep. 2012; 61:667-70.
PubMed
 
Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet. 2010; 376:1261-71.
PubMed
CrossRef
 
National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Bethesda, MD: U.S. Department of Health and Human Services; 2008.
 
Bala M, Strzeszynski L, Cahill K. Mass media interventions for smoking cessation in adults. Cochrane Database Syst Rev. 2008; CD004704.
PubMed
 
Durkin S, Brennan E, Wakefield M. Mass media campaigns to promote smoking cessation among adults: an integrative review. Tob Control. 2012; 21:127-38.
PubMed
CrossRef
 
Vallone DM, Duke JC, Cullen J, McCausland KL, Allen JA. Evaluation of EX: a national mass media smoking cessation campaign. Am J Public Health. 2011; 101:302-9.
PubMed
CrossRef
 
Farrelly MC, Nonnemaker J, Davis KC, Hussin A. The influence of the national truth campaign on smoking initiation. Am J Prev Med. 2009; 36:379-84.
PubMed
CrossRef
 
Siegel M, Biener L. The impact of an antismoking media campaign on progression to established smoking: results of a longitudinal youth study. Am J Public Health. 2000; 90:380-6.
PubMed
 
Sly DF, Trapido E, Ray S. Evidence of the dose effects of an antitobacco counteradvertising campaign. Prev Med. 2002; 35:511-8.
PubMed
CrossRef
 
Durkin SJ, Biener L, Wakefield MA. Effects of different types of antismoking ads on reducing disparities in smoking cessation among socioeconomic subgroups. Am J Public Health. 2009; 99:2217-23.
PubMed
CrossRef
 
Niederdeppe J, Farrelly MC, Nonnemaker J, Davis KC, Wagner L. Socioeconomic variation in recall and perceived effectiveness of campaign advertisements to promote smoking cessation. Soc Sci Med. 2011; 72:773-80.
PubMed
CrossRef
 
Dunlop S, Wakefield M, Kashima Y. Can you feel it? Negative emotion, risk, and narrative in health communication. Media Psychol. 2008; 11:52-75.
CrossRef
 
Southwell B, Yzer MC. When (and why) interpersonal talk matters for campaigns. Commun Theory. 2009; 19:1-8.
CrossRef
 
van den Putte B, Yzer M, Southwell BG, de Bruijn GJ, Willemsen MC. Interpersonal communication as an indirect pathway for the effect of antismoking media content on smoking cessation. J Health Commun. 2011; 16:470-85.
PubMed
CrossRef
 
U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services; 2012.
 
U.S. Food and Drug Administration.  Tobacco Products: Cigarette Health Warnings. Accessed at www.fda.gov/TobaccoProducts/Labeling/Labeling/CigaretteWarningLabels/default.htm on 9 July 9 2012.
 
Brennan E, Durkin SJ, Cotter T, Harper T, Wakefield MA. Mass media campaigns designed to support new pictorial health warnings on cigarette packets: evidence of a complementary relationship. Tob Control. 2011; 20:412-8.
PubMed
CrossRef
 

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