The effectiveness of mass media campaigns in reducing smoking in England: An observational study

Background

Little evidence exists for the effectiveness of mass media campaigns in the UK despite campaigns running regularly since 1999. In 2010, the UK Government ceased spending on national public health mass media campaigns in England. Tobacco control (TC) campaigns were reintroduced in 2011, but at a lower level of funding. We need to know whether campaigns are effective to ensure continued funding. We aimed to assess the effect of government-funded televised campaigns for TC shown in England during the 2000s on adult smoking behaviours.


Methods

We measured exposure to government-funded television advertisements for TC using television ratings (TVRs) and coded the advertisements for emotional content using a theoretically based framework. Recall of advertisements from 2005 to 2009 was ascertained from participants of the International Tobacco Four Country Survey and analysed with generalised estimating equations, comparing recall between advertisements with positive and negative emotional content. Data for smoking prevalence and cigarette consumption from 2002 to 2010 were obtained from Opinions and Lifestyle surveys. Measures of smoking cessation behaviour (calls to the NHS quitline 2005—11, text requests for quit support packs 2007—10, smoking cessation website hits 2009—11, attendance and 4-week quitters at NHS Stop Smoking Services [SSS] 2001—11) were obtained from the Department of Health and NHS Information Centre. Data were analysed with generalised additive models with adjustments for seasonality, time trends, and other tobacco policies.


Findings

Between 2002 and April, 2010, 35 282 TVRs for TC were broadcast (mean 42 advertisements per year). An increase in TVRs was associated with a significant increase in recall and a reduction in mean cigarette consumption in the following month and smoking prevalence 2 months later (appendix). 45% of advertisements screened between 2004 and 2010 were coded as having positive emotional content. Negative, but not positive, emotive campaigns resulted in significantly increased and longer durations of recall (appendix). There was a significant decrease in text requests for quit support packs, quitline calls, and web hits after April, 2010, but no effect on the use of the NHS SSS (appendix). We studied recall and tobacco use at the individual level; however, TVRs measure mean potential exposure, and individual-level exposure can vary dependent on frequency of television viewing and attention to advertisements. We cannot completely rule out that other unmeasured variables confound the association with TVRs or the timing of the freeze.


Interpretation

Televised campaigns are effective in changing smoking behaviours in adults. We are now exploring whether the stronger effect of negative emotive campaigns on recall translates to effects on quitting behaviour.