Research and practitioner perspectives of tobacco control mass media campaigns in England

1
Research and practitioner perspectives of tobacco
control mass media campaigns in England

• Dr Tessa Langley
• UK Centre for Tobacco and Alcohol Studies,
  University of Nottingham
• Matthew Walmsley,
• Public Health England

2
Research perspectives of tobacco control mass
media campaigns in England

• Dr Tessa Langley
• UK Centre for Tobacco and Alcohol Studies
• University of Nottingham

3
Outline

• Rationale for MMC
• Intervention evidence
• Recent research on MMC in England
• Ongoing/future research

4
The rationale for mass media campaigns

• Well-defined behaviourally focussed messages
• Potential for widespread and repeated exposure
• Incidental exposure
• Low cost per head

5
International evidence

• Durkin et al. 2012 review of cessation
  campaigns in adults
• Can promote quitting and reduce adult smoking
• Small effect sizes but significant
  population-level effects
• NHE messages perform best
• Rapid decay of campaign effects
• Average of 12 exposures per head per quarter
  needed to reduce adult smoking prevalence

6
Recent research on mass media campaigns in
England Context

• Very little UK evidence
• Freeze on public health campaigns April 2010
• Campaign re-introduced September 2011
• Smokefree as 1 of 4 social marketing programmes
  for public health
• Budget 16m 2012-13 (38m 2009-10)
• ? 2 year MRC funded project

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MRC (NPRI) project

• Aim To evaluate the impact of UK anti-tobacco
  mass media campaigns carried out since 2004 on a
  comprehensive set of key indicators of adult
  smoking behaviours
• Completed/ongoing studies
• Characterisation of recent campaigns in England
  in terms
• of aims, informational and emotional content
  and style
• Effects of mass media campaigns on
  population-level indicators of smoking and
  quitting behaviour calls to the NHS smoking
  helpline, use of SSS, consumption, and prevalence
• Impact of campaigns on smoking behaviour in the
  home
• Cost-effectiveness of tobacco control mass media
  campaigns

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Jargon

• Television ratings (TVRs)
• The of a particular audience that has seen an
  advertisement
• e.g. 100 TVRs each person has viewed ad once,
  or 50 have viewed twice
• e.g. 1200 TVRs each person has viewed ad 12
  times, 25 have seen ad 48 times.
• Gross rating points (GRPs)
• Sum of TVRs for individual adverts (but often
  used interchangeably)
• e.g. Sum of TVRs for all tobacco control adverts

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Are MMC in England maximally effective?

• Evidence suggests that
• 400 GRPs per month are needed to reduce smoking
  prevalence by 0.3
• Sustained behaviour change requires sustained
  campaign exposure due to the short-lived effects
  of campaigns
• Adverts with high emotional content and
  testimonial adverts are most effective at
  increasing quit rates
• ? Study to characterise publically-funded tobacco
  control campaigns in England (2004-2010) - in
  line with recommendations?

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Intensity

• 1 in 5 months had no MMC
• 2 in 5 had 400 GRPs

Total TVRs Jan 04-Mar 10 24507
Langley et al. Addiction 2013.
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Informational content

• From Apr 2008-Mar 2010 over 60 of adverts
  advertised the SSS
• A quarter contained information about negative
  consequences

of TVRs
Langley et al. Addiction 2013.
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Style
TVRs for each style
Langley et al. Addiction 2013.
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Characterisation of campaigns Conclusions

• Based on existing recommendations
• Only a small proportion of tobacco control
  advertisements utilised most effective strategies
  - negative health effects messages and
  testimonials
• Intensity of campaigns was lower than
  international recommendations

However, subsequent research has shown that MMC
in England have been effective both positive
and negative campaigns
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Evidence on campaigns in England

• Langley et al. Addiction 2014
• In 2010 government ceased spending on national
  public health mass media campaigns in England for
  18 months
• Interrupted time series analysis to quantify the
  impact of the campaign freeze on a range of
  measures of quitting behaviour
• Quitline, quit support pack requests, Smokefree
  website hits, NHS Stop Smoking Services

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• Immediate drops in
• Quitline calls 65
• Literature requests 98
• Web hits 34

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No change in use of SSS (intensive support)
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Evidence on campaigns in England cont.

• Sims et al. Addiction 2014
• Analysis of monthly cross-sectional surveys to
  estimate effect of campaigns 2002-2010 on
  prevalence and consumption
• Adjusted for other tobacco control policies,
  cigarette costliness and individual
  characteristics
• 400 point increase in tobacco control GRPs
  associated with a significant 1.80 reduction in
  average consumption in following month
• Campaigns accounted 11.2 of the total decline
  in consumption over the period 2002-2009
• 400 point increase in GRPs was significantly
  associated with 3 lower odds of smoking two
  months later
• Campaigns accounted for 13.5 of decline in
  prevalence over this period

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Our findings suggest that overall, national
tobacco control MMC influence smoking behaviour
But which type of tobacco control mass media
campaign is most effective?
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Recall of campaign types

• Richardson et al. BMC Public Health. 2014.
• Data on recall of televised campaigns from ITC UK
  Survey, 2005-09
• Merged with GRP data
• Campaigns categorised as positive or negative
  according to emotional content
• Negative campaigns For every additional 1,000
  GRPs in the six months prior to survey, 41
  increase in likelihood of recall (OR 1.41, 95
  CI 1.241.61)
• Positive campaigns no significant effect

20
Quitline by campaign type
Note Plots generated using ggplot2 package
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Preliminary results

• Prevalence and consumption
• Increased exposure to both positive and negative
  campaigns associated with lower odds of smoking
• Increase in exposure to negative emotive
  campaigns associated with decrease in average
  cigarette consumption
• No effect of positive campaigns on consumption

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Preliminary results

• Quit attempts
• Increased exposure to both positive and negative
  campaigns is associated with an increase in the
  odds of participants reporting having made a quit
  attempt within the last three months
• Smokefree homes
• Aggregated ads have no effect on smokefree home
  prevalence
• SHS ads increase odds of smokefree home

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Are MMC cost-effective?

• MMC are expensive are costs justified by
  benefits?
• Atusingwize et al. Systematic review of economic
  evaluations (All international studies, under
  review) found that
• evidence on the cost-effectiveness of tobacco
  control mass media campaigns is limited (10
  studies)
• Methods are of acceptable quality, but studies
  highly heterogeneous
• All suggest that TC MMC offer good value for
  money, compared with no campaign

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Conclusions

• Spending cuts have increased the need for high
  quality evidence
• Increasing UK evidence base
• Evidence suggest TCC do influence quitting
  behaviour and reduce smoking
• Both positive and negative emotive campaigns
• More research on what works and optimal level of
  exposure is warranted

25
Ongoing future research

• Scottish study (Stirling)
• Co-ordination re. evaluation of MMC with PHE

26
Acknowledgements

• Funders
• National Prevention Research Initiative
• Action on Smoking and Health
• Colleagues
• Nottingham Sarah Lewis, Lisa Szatkowski
• Bath Michelle Sims, Anna Gilmore, Ruth Salway
• KCL Ann McNeill