Looking Back, Moving Forward: We’re Not Done With Smoking Yet

1. Looking Back, Moving Forward: We’re Not Done With Smoking Yet Audit of National Reports 1997-2005 Dr Owen Carter, Research Fellow Centre for Behavioural Research in Cancer Control Curtin University of Technology

2. 80% 70% 72% 1982Coordinatedanti-tobacco campaigns 60% 1947 Early studies linking smokingto lung cancer 50% 58% 41% 40% 30% 28% 27% 31% 20% 26% 25% 1964 US Surgeon General’s Report 10% 0% HISTORY OF AUSTRALIAN SMOKING RATES Females Males 1980 1990 1945 1950 1955 1960 1965 1970 1975 1985 1995 2000

3. Audit 1985-1996 • 1996 MTAG commissioned CBRC to review all unpublished Quit research from 1985-1996 to inform a new campaign • 196 studies reviewed • Recommendationsfor new nationaltobacco campaign

4. 80% 70% 72% 1997 National TobaccoCampaign 1982Coordinatedanti-tobacco campaigns 60% 1947 Early studies linking smokingto lung cancer 50% 58% 41% 40% 30% 28% 27% 31% 20% 26% 25% 1964 US Surgeon General’s Report 19% 10% 16% 0% HISTORY OF AUSTRALIAN SMOKING RATES Females Males 1980 1990 1945 1950 1955 1960 1965 1970 1975 1985 1995 2000 2005

5. Where to now? • Smoking prevalence lowest ever (17.5%) • Banned in enclosed public places by 2007 • Tobacco promotion loop-holes ever tightening • 3 million smokers • Single largest preventative cause of death • 43,000 children start smoking per year

6. Audit 1997-2005 • In March 2005 the National Quit Coordinators Group commissioned CBRCC to review all Quit research from 1997-2005(unpublished and published) • Update knowledge of effective Quit communication strategies

7. Reports Contributed by State 10 76 40 40 28 350 150 CBRCC 4

8. Reports analysed 1997-2005 • 350 reports • Average 34 pages each • 11,866 pages total • 1/7th of a tree** @ 80,500 pages per tree 23% 20% 14% 12% 10% 9% 4% 3% 3% 1997 1998 1999 2000 2001 2002 2003 2004 2005

9. formative research (n=72) 37 campaign evaluations (n=77) 34 advocacy research (n=72) 33 pure research (n=40) prevalence research (n=45) 27 intervention evaluations (n=44) 23 19 18 16 14 13 12 12 9 9 6 6 5 5 5 4 4 4 4 4 4 3 3 3 3 2 2 2 1 1 1 1 1 40 35 30 25 Number of Reports 20 15 10 5 0 DoHA NSW Vic Qld WA SA Tas ACT

10. Formative Research (n=72) intercept surveys 5% literature reviews 9% face-to-face interviews 3% focus groups paper surveys 4% 67% telephone surveys 12%

11. Formative Research • Need to make smokers uncomfortable abouttheir smoking • Fear of health consequences most motivating • Disability and/or prolonged illness potentially more disturbing than death itself • New information important to sustain attention of smokers: want to avoid ‘more of the same’ reaction

12. focus groups 4% intercept surveys 17% telephone literature review 1% surveys 56% individual interviews 9% paper surveys 13% Campaign Evaluation (n=77)

13. 100% 90% 77% 80% 70% 60% 50% Average 43% 40% 30% 6% 20% 10% 0% Cut-through of various Quit ads Recognition of various Quit ads (validated unprompted recall n=31)

14. 97% 100% 90% Average 84% 80% 70% 60% 50% 40% 33% 30% 20% 10% 0% Recognition of various Quit ads (prompted recall n=34)

15. Informative – Excuses • Challenged common excuses made by smokers not to quit • Failed to make smokers uncomfortable about their addiction • Extremely poorcut-through andrecognition

16. Health Effects – Artery (NTC) • Considered new information • Very memorable image • Performed very well:high cut-throughand recognition • Some question as tothe lifestyle of the32 y.o. and howheavily he smoked

17. Health Effects – Brain (NTC) • Hard-hitting image liked and performed well • Danger of strokes considered new information • “unnoticed stroke” notconsidered necessarilybad • Preliminary image ofmother smokingoutside consideredpersonally relevant

18. Health Effects – Lung (NTC) • Lung not new information and not hard-hitting • Still admired as strongand personal image • Same TARPs as Arterybut lower cut-throughand recognition • Some overlap andconfusion with P53

19. Health Effects – P53 (NTC) • New information but too technical • Early images of cell division not considered a scary image • Changed to image of ‘ugly’ tumour growing • ‘it only takes only onecell’ tag-line consideredscary • Much lower cut-throughand recognition thanArtery and Lung

20. Health Effects – Eye (NTC) • Considered new information • Older adults particularly sensitive about loss of eye-sight • Image of blood-vesselsbursting not clear figureground execution • Relatively poor cut-through and recognitionbut also low TARPs

21. Call to Action – Call (NTC) • Quitline poorly understood service • Need for education of services available • Important to showhuman face of operator • Considered goodcounter-balance to thehealth effect ads • Consistently poor cut-through despite highTARPs

22. Prolonged Illness – Nice People • Novel information but only of concern to smokers who believe they will become ill • Images of ill smokers more realistic than damaged organs • Achieved goodcut-through andrecognition

23. Tobacco Industry – Recall • Raising issue of tobacco industry resulted in low recall, low personal relevancy, low motivation to quit • But increased awareness of need to regulate tobacco industry

24. Testimony - Jenny • Younger smokers believe they will quit before their smoking leads to health damage • ‘No warning’ new information • ‘If only I’d remained stopped at 25’ pertinent message to this age-group • High cut-through and recall • Female testimony notsex-exclusive

25. What We Have Learnt… • Hard-hitting, visceral ads are highly effective • Clear figure ground executions are more memorable • New information best at gaining attention • High media weights predict high cut-through and recognition (mediated by message and execution) • Sadness and fear are better motivators than humour and entertainment