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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. 10 th 2003. Massachusetts Media Campaign. Average annual expenditure $13 million 1994 through 2001

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impact of antitobacco mass media on youth smoking initiation

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

massachusetts media campaign
Massachusetts Media Campaign
  • Average annual expenditure $13 million 1994 through 2001
  • Multiple Channels
    • Television
    • Radio Adult
    • Transit
    • Billboards
multiple strategies
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
research goals
Research Goals
  • Investigate impact on behavior
  • Investigate effectiveness of various strategies for different target audiences.
i impact on youth behavior
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
methods sample
1993 Baseline:

1,069 youths

Ages 12-15

1997 Follow-up:

618 youths

57.8% overall

response rate

Methods: Sample

Cohort: 592 youths who hadn’t yet smoked 100 cigarettes baseline

methods measures of exposure
Methods:Measures of Exposure
  • In past month, seen any anti-tobacco messages...
    • On television ?
    • On radio?
    • On billboards?
methods measures of outcome 1997
Methods:Measures of Outcome(1997)
  • Smoked at least 100 cigarettes in lifetime ?
      • (Yes/No)
covariates 1993
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
results established smokers in 1997
Results:Established Smokers in 1997

Age 12-13 in 1993



Yes No

Saw TV Ads

results established smokers in 19971
Results:Established Smokers in 1997

Age 14-15 in 1993



Yes No

Saw TV Ads

results multivariate analysis
Results:Multivariate 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

  • 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
  • Strong evidence for a significant effect of statewide anti-smoking media campaign on youth smoking initiation
  • Effect restricted to younger adolescents
ii effectiveness by type of tv advertisement
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
research tools
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
independent judges
Independent Judges
  • View TV spots and rate characteristics
    • “How well do each of following describe the advertisement?”
      • 1 = Not at all
      • 7 = Very much
judges rating scales 1 to 7



Emotionally moving











Judges’ Rating Scales(1 to 7)
advertising parameters
Advertising parameters
  • Negative Emotion: Sad, frightening, disturbing
  • Positive Emotion: Happy, funny, entertaining
  • Level of Emotion: Powerful, emotionally moving
  • Cognitive quality: Makes you think, interesting
message identification
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)

relationships between message and affect
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
population survey approach
Population Survey Approach
  • Select subset of ads for theoretical/conceptual purpose
  • Assess recall
  • Assess perceived effectiveness
measurement of recall
Measurement of recall
  • Aided: Gives brief description
  • Confirmed recall: Requests details
  • Unaided: Asks for free recall and description of ad seen recently
measurement of perceived effectiveness
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)
youth 2001 2
Youth 2001/2

Illness: Ronaldo, Rick, (Mass.)

Illness + Anti-industry:

Body bags, Daily Dose (truth)

Baby monitor (Mass.)

Anti-industry: I know you (Mass.)


My reasons (Philip Morris)

Piercing parlor (Lorillard)

conclusions features of effective anti tobacco ads
Conclusions: Features of Effective Anti-tobacco Ads
  • Evoke strong negative emotion
  • Portray serious harm done by tobacco use in authentic way
ads youth perceived as effective
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
theoretical basis for emotional advertising
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
published articles on media
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.

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.