In Ontario the smoking rate has declined substantially over the past decade, but slowed in recent years. In order to have measureable impact, public health needs to continually explore ways to increase quit attempts among smokers. Public education campaigns have been shown to be effective at increasing quit attempts.1
Public health departments in Ontario have a long history of using the media to educate the public about the harms of smoking and are well positioned to utilize the media to help promote quit attempts in their communities.
How to strategically use the media to increase quit attempts
Comprehensive media strategies that employ multiple media channels have been shown to be effective in encouraging quit attempts among the population. But when developing a campaign, the message is just as important as the medium.
Evidence to date shows that utilizing testimonials that communicate the negative health effects of smoking are most effective at motivating quit attempts.2,3
This is because negative health messages can elicit a strong emotional response from the message recipient and create a sense of urgency around quitting. This has been shown to be particularly effective when graphic images and testimonials from smokers, former smoker or affected family member are part of the campaign.4,5,6,7,8
One strong example of this type of media strategy is the CDC's TIPs campaign
. The campaign resulted in over 1.6 million quit attempts and over 100,000 successful attempts that lasted at least six months.9
Video Credit: Centers for Disease Control and Prevention, Tips From Former Smokers
In addition to the use of testimonials, one of the most important learnings from the CDC’s TIPs campaign is that the ads were equally effective across different segments of the population.10
What this indicates is that well-designed ads focused on negative health messages via testimonials can have broad appeal and transcend the need for creating targeted materials for specific ethnographic groups which can be very costly. These broad-based advertising materials have the added benefit of being easier to share in different markets and can more easily be replicated by health departments in other jurisdictions.
Effective Use of Media Channels
Once you have established your campaign message, the next step in the planning process is to determine where, when and how to distribute the message.
Given that comprehensive media campaigns that employ multiple channels work best – it can sometimes be daunting to know where to start. One of the easiest ways to begin is to determine what media channels are available to you. One way to catalogue media channels or outlets that you could use is a tool called the PESO model. The PESO model breaks down media channels through the following categories: paid, earned (news), shared (social) and owned (websites etc). Cataloguing media outlets using this tool can be helpful in developing a multi-channel media strategy.
Under each section of the PESO model, there are several different tactics (or outlets) that could be leveraged as part of a campaign. The ones that you will select will often be determined by availability and dependent on your budget and capacity to develop the appropriate resources for the channel. As it relates to encouraging quit attempts, evidence shows the following are effective and should be taken into consideration when planning a campaign:
- PAID: Radio ads have been shown to be effective and can be a low cost option.11
- EARNED: Pitching news stories12, utilizing local testimonials or content. Note: Community news outlets are often looking for local stories to feature.
- SHARED: Social media that uses targeted messages. Note: Although negative health messages are effective at delivering the 'why to quit' message to smokers via traditional media channels (TV, radio etc.), positive messages are more likely to be shared via social than negative ones,13 which can impact how you plan your social strategy.
- OWNED: Simple, interactive websites that not that only inform but engage users are ideal.
For many health departments, media campaigns that require video production, graphic design or use television or other expensive ad buys may not be achievable due to resource constraints. So is it still possible to develop a comprehensive media campaign? The answer is yes. Within the PESO model there are several low costs or no cost options that can be leveraged to create a campaign on a limited budget. These include:
- Focusing more efforts on earned media (pitching a series of news stories).
- Using or adapting existing ads or materials from other campaigns to reduce costs (Consider campaigns like the CDC's TIPs campaign and other materials that will have broad impact and appeal). The CDC's Media Campaign Resource Center houses numerous resources that could be helpful.
- Working with community partners and leveraging their owned media channels (e.g. social media websites, newsletters).
When working with community partners this can often be as simple as providing them with predeveloped content to distribute or post via their owned media channels. Community partners can also be helpful in locating smokers or former smokers for testimonials or by serving as additional spokespersons for the campaign. Working with community partners is a critical part of any campaign whether it be a low cost or a well-resourced initiative.
Message Framing – Avoid Unintended Consequences
As the majority of smokers quit unaided,14,15
it is important to ensure that the messages developed as part of any campaign promote increased quit attempts of all types (aided and unaided), and do not discourage unaided quitting. Campaigns which overemphasize cessation counselling and medications and suggest that they are necessary for quitting success could inadvertently reduce quit attempts. Similarly, campaigns which suggest that unaided quitting will lead to failure should be avoided.
One way to avoid inadvertently discouraging unaided quit attempts, is to ensure your campaign has a strong call to action that focuses clearly on making a quit attempt. Information about treatment should be provided as a secondary message for smokers who need additional support to quit.
The CDC's TIPs campaign
is a strong example of this approach. The campaign used negative health consequences messaging to highlight 'why' to quit and supported that message with complementary messaging on 'how' to quit to ensure they were building self-efficacy among smokers.16
Opportunities for public health
Throughout the year, opportunities exist for public health units to engage the media to encourage quit attempts in their community. Traditionally, the majority of media outreach on the topic of cessation is generated between January and April in Ontario. This has been when programs like the STOP study or campaigns like the Canadian Cancer Society's Driven to Quit Challenge and Leave the Pack Behind's wouldurather
contest have been most heavily promoted in the media. The remaining months of the year often see very little in the way of media engagement, especially September which is the second most popular time of the year for smokers to quit.
In 2016, health departments have been provided with a unique opportunity to more regularly engage with local media through the introduction of the Canadian Cancer Society's First Week Challenge
. As the campaign is in market year-round, it provides more flexibility around engaging local media on the topic of cessation and making a quit attempt. Other campaigns delivered by the Ministry or partners can also be opportunities for health departments to engage local media on the topic.
With different opportunities available to public health departments to engage their local media throughout the year, it is important to develop a mechanism to do so strategically. One tool that can assist in this manner is the development of a media calendar. A media calendar can help health departments choose when to proactively engage the media and when to support or leverage provincial or partner campaigns to extend or complement their own local campaigns.
To assist public health intermediaries in planning local communications initiatives, the Program Training and Consultation Centre offers consultative support through its Media Network department. Consultations can be requested by emailing Jason.firstname.lastname@example.org
Increasing the number of quit attempts is critical for helping drive down smoking rates17
in Ontario. Media campaigns are an effective, evidence-based strategy for promoting quit attempts. Local public health departments can play a leadership role in promoting quit attempts through local campaigns which feature testimonials from former smokers and family members about the negative health effects of smoking and which utilize community-based paid, earned, and social media.
Durkin S, Brennan E, Wakefield M. Mass media campaigns to promote smoking cessation among adults: an integrative review. Tobacco Control
Wakefield, M. A., Loken, B., & Hornik, R. C. (2010). Use of mass media campaigns to change health behaviour. The Lancet
, 376, 1261–1271. doi:10.1016/S0140-6736(10)60809-43
Farrelly, M. C., Duke, J. C., Davis, K. C., Nonnemaker, J. M., Kamyab, K., Willett, J. G., & Juster, H. R. (2012). Promotion of smoking cessation with emotional and/or graphic antismoking advertising. American Journal of Preventive Medicine
, 43,475–482. doi:10.1016/j.amepre.2012.07.0234
Dunlop S, Wakefield M, Kashima Y. Can you feel it? negative emotion, risk, and narrative in health communication. Media Psychology
. 2008;11(1):52-75. 5
Durkin S, Wakefield M, Spittal M. Which types of televised anti-tobacco campaigns prompt more quitline calls from disadvantaged groups? Health Educ Res
Nonnemaker JM, Farrelly MC, Kamyab K, MacMonegle AJ. Do different styles of antismoking ads influence the types of smokers who call quitlines? Health Educ Res
Leas EC, Myers MG, Strong DR, Hofstetter CR, Al-Delaimy WK. Recall of anti-tobacco advertisements and effects on quitting behavior: Results from the California Smokers Cohort. Am J Public Health
. 2015;105(2):e90-e97. 8
Durkin S, Biener L, Wakefield M. Effects of different types of antismoking ads on reducing disparities in smoking cessation among socioeconomic subgroups. Am J Public Health
McAfee T, Davis KC, Alexander Jr R, Pechacek T, Bunnell R. Effect of the first federally funded US antismoking national media campaign. The Lancet
. Published online Sept 9, 2013: http://dx.doi.org/10.1016/S0140-6736(13)61686-4
Kevin C. Davis, Jennifer Duke, Paul Shafer, Deesha Patel, Robert Rodes & Diane Biestle (2016): Perceived Effectiveness of Antismoking Ads and Association with Quit Attempts Among Smokers: Evidence from the Tips From Former Smokers Campaign, Health Communication
, DOI: 10.1080/10410236.2016.1196413. Page 711
Durkin S, Brennan E, Wakefield M. Mass media campaigns to promote smoking cessation among adults: An integrative review. Tob Control
. 2012;21(2):127-138. 12
Chaiton M, Diemert L, Zhang B, Bondy S (April 2016). Busting Myths About Smoking Cessation. A Synthesis of Population Level Findings from the Ontario Tobacco Survey. http://otru.org/busting-myths-about-smoking-cessation/13
Chung JE. Antismoking campaign videos on YouTube and audience response: Application of social The media assessment metrics. Comput Hum Behav
. 2015;51(PA):114-121. 14
Edwards SA, Bondy SJ, Callaghan R, Mann RE. Prevalence of unassisted quit attempts in population-based studies: a systematic review of the literature. Addictive Behaviours
2014; 39: 512-519.15
Roeseler A, Andersen CM, Hansen K, Arnold M, Zhu SH. Creating Positive Turbulence. A Tobacco Quit Plan for California. Sacramento, California. California Department of Public Health, California Tobacco Control program, 2009. Available at: https://www.cdph.ca.gov/programs/tobacco/Documents/Cessation/Quit%20Plan%20Summit-web.pdf.16
Duke JC, Nonnemaker JM, Davis KC, Watson KA, Farrelly MC. The impact of cessation media messages on cessation-related outcomes: Results from a national experiment of smokers. American Journal of Health Promotion
Zhu SH, Lee M, Zhuang YL, Gamst A, Wolfson T. Interventions to Increase Smoking Cessation at the Population Level: How Much Progress Has Been Made in the Last Two Decades? Tob Control