How to make anti-smoking campaigns more persuasive

From the iconic 1979 “sponge” advertisement to “every cigarette is doing you damage” – unforgettable tobacco control campaigns have put a sizeable dent in Australian smoking rates. But as smoking persists in our communities, how can today’s mass-media campaigns portray the harms of smoking and convince people to quit?

A new paper published in Public Health Research & Practice, a peer-reviewed journal of the Sax Institute, analysed the evidence around which marketing strategies worked best for anti-smoking campaigns. We talked to the paper’s lead author, Sarah Beasley, Make Smoking History Campaign Coordinator at Cancer Council WA, for her tips on what makes an effective campaign.

Sax Institute: The past 40 years have produced some tremendously effective anti-smoking ads. Why are these mass media advertising campaigns so important to tobacco control?
Sarah Beasley: Anti-smoking campaigns are an important part of a comprehensive approach to tobacco control, and really work to de-normalise smoking as a behaviour and remind people it’s as dangerous as ever. While obviously our primary target audience is smokers, putting this message on TV and other mediums provides a rich cross over, where you’re also reaching ex-smokers who will see the ads and stay on track, as well as people who haven’t ever taken up smoking and will hopefully stay smoke free.

Q: What are the new challenges facing anti-smoking campaign managers today?
A: Funding is a challenge, because people can forget that smoking is still the number one cause of preventable death and disease in Australia. We’ve come so far, but lung cancer still causes the largest number of cancer deaths in men and women – and most lung cancers are still caused by smoking. In Western Australia, there’s just under 230,000 people who are still smoking, so it’s a major issue and we need to ensure that people know this is worthwhile to fund, because there’s still a lot of work to do in the area.

Our paper also looks at the challenge of Australia’s rapidly changing media landscape. You used to be able to capture a huge audience just on free-to-air TV and radio, whereas today you have to also go into digital and other channels to pick up the rest of the people who might have moved away from TV. Ultimately, we need budget increases because TV’s not gotten any cheaper!

Q: From your research, what would be your top tips for creating an effective anti-smoking campaign?

Focus on the negative health effects: At Make Smoking History, we evaluate all our campaigns, and it’s always the hard-hitting, graphic, emotive ads about the negative health effects of smoking that are most remembered and most likely to prompt quit attempts – especially when it includes real people. When someone shares a personal experience of cancer or respiratory disease, it shows that this can happen to anyone.

Find the right topic: Focusing on negative health effects works well because it shocks people, but it also has to be believable. Most people can’t name more than two or three types of cancer caused by smoking, when there are actually 16 and counting – there are also many lesser-known diseases such as rheumatoid arthritis and type 2 diabetes (to name a few!) You need to use stories that make more sense to people, like respiratory disease or cancer, because if people don’t understand it, they will dismiss it. And since ads are generally about 30 seconds or less, you don’t have a lot of time to explain and convince people to quit.

Keep language simple: We read the literature and understand terminology like carcinogens, relative risk and causal relationships, but that means nothing to the general population, so we have to be really conscious of that. We do ad testing to make sure that what we think we’re saying is actually being picked up on the other end as well.

Craft your message for different platforms and audiences: If you have the budget, you would ideally create bespoke messages for each of your media channels. Even better, you would tailor the messages to different segments of your audience. For example, we know that smokers today are increasingly from lower socio-economic areas. Their smoking rates are a lot higher than the general population, not because they don’t want to quit, but because they may face more barriers to getting support and they’ve got other competing life issues for which smoking is a coping mechanism. Figuring out how to reach these parts of the population is key.

Test test test: Often we’ll try a few different creative treatments and see which ads perform best. We also do online surveys with a basic, storyboard style of ad, which we’ll run past smokers to see if they believed it, if they were shocked by it, and if they thought it was effective. Then we can make changes from there.
If you have the opportunity to run focus groups beforehand, that can also really help. And of course, evaluating the success of your campaign is crucial. At Make Smoking History we’re really fortunate to have 20 years of evaluations that we can go back through, which is really powerful. And you can see that the ads that have done really well over those two decades have common themes of being emotionally hard-hitting, and focussing on the negative health effects of smoking.

Q: Which campaigns do you think got it right? Any personal favourites?
A: Of course I’m very biased to WA! But back in 2006, we aired an ad called Zita’s story about a young 36-year-old mother who was a smoker and had terminal lung cancer and wanted to share her story to stop others from getting into her situation. Her ad was absolutely heart-breaking, but one of the most successful in terms of people making a quit attempt afterwards. She passed away about a year afterwards, but she would have directly helped so many people who have gone on to live longer, healthier lives.

The other one is Terrie’s Tips, which is from the US, but also aired in WA in 2017. Terrie had throat cancer and her ads were incredibly effective across America and Australia.

Sarah Beasley is the Make Smoking History Campaign Coordinator at Cancer Council WA. Read her full paper here.

Public Health Research & Practice is an Australian health journal that is committed to publishing innovative, high-quality papers that inform public health policy and practice. Find out more here.