Recharging Tobacco Control Efforts

Be prepared. The next large wave of tobacco control activities is about to begin, led by the FDA's 'The Real Cost' campaign (TRC). The TRC will be launching next week across the US with TV, radio, print and online components with a priority group of 12-17 year olds who are open to smoking (teens who have never smoked a cigarette but are open to trying it and those who have already smoked between 1 puff and 99 cigarettes in their lifetime and are at risk of becoming regular users). The camapign has even developed a Persona - Pete. 

 

 

TRC has two behavioral objectives:

• Reduce cigarette smoking initiation rates 
• Reduce the number of Petes who are already experimenting with cigarettes and then progress to regular use.

 

 

 

The campaign identifies its key messages as:
    • Health Consequences:  A focus on consequences that are aligned with what concerns teens, e.g., cosmetic consequences like tooth loss and skin damage. The “cost” is the main theme, getting teens to think about the range of costs associated with smoking, beyond money.
    • Loss of Control Leading to Addiction:  A focus on how cigarettes can take away the control teens are just beginning to have in their lives. This theme portrays nicotine addiction as an unwanted presence in a young person’s life.

The tone or personality of TRC is described as "candid, empowering and respectful…speaking to teens in a straightforward, authentic and peer-to-peer manner." They don't make any mention of a brand strategy, a little surprising given the effectiveness of brands in other teen smoking prevention projects. But then, who publishes their brand strategy? We'll see how it unfolds. I just hope they remember that brands happen while you're busy doing something else.

There are several campaign sites where you can view the ads, download campaign materials and get content for social media use.
TV ads
Print ads
Digital ads
Digital games
Downloadable materials - including education pieces, posters and postcards
Social media content

But before you jump into action, you may also want to look at your resources and current tobacco control efforts and see how they compare to the new Best Practices for Comprehensive Tobacco Control-2014 guide from the CDC. Here's a summary of what is in the report that covers far more than just media campaigns.

Tobacco control programs should design and coordinate activities that focus on:

• Preventing initiation among youth and young adults
• Promoting quitting among adults and youth
• Eliminating exposure to secondhand smoke
• Identifying and eliminating tobacco-related disparities among population groups

State and community coalitions are essential to facilitate and sustain changes in behavior and social norms. Research has demonstrated the importance of community support and involvement at the grassroots level to achieve effective policy change, including increasing the unit price of tobacco products and creating smokefree public and private environments.

The available evidence suggests that tobacco control programs with the largest population impact integrate activities with the greatest span (including economic and regulatory approaches) and reach (number of people covered). For more about how span and reach can be integrated in tobacco control programs, see Social Marketing and Tobacco Control Policy.

Tobacco control strategies should be positioned to (a) reduce the current burden of tobacco-related diseases, (b) ensure wide dissemination of tobacco control strategies through increasing the number of stakeholders, and (c) mobilize public support and action for tobacco control.

Identifying and eliminating tobacco-related disparities among population segments should be a goal for tobacco control programs. "[T]obacco control programs and policies must be implemented in a way that achieves equitable benefits for all."

Community programs should focus on changing the knowledge, attitudes, and practices of tobacco users and nonusers and implement strategies that address how tobacco is promoted; the time, manner, and place in which tobacco is sold; and how and where tobacco is used (see The 4Ps of Demarketing Tobacco Use).

There is strong evidence for the effectiveness of communication campaigns to (a) decrease the prevalence of tobacco use, (b) increase smoking cessation, (c) increase the use of available smoking cessation services such as quitlines, and (d) decrease initiation of tobacco use among young people. See for example The Effects of Media on Health Behaviors: Evidence from Tobacco Control.

Consumer research and evaluations of media campaigns find that advertising that elicits negative emotions through graphic and personal portrayals of the health consequences of tobacco use is especially effective in motivating smokers to quit. There is also evidence that these types of advertising messages reduce tobacco use among youth and young adults. However, there have been few studies that explore the effectiveness of tobacco campaigns among population segments that bear a disproportionate burden of tobacco-related disease and death. And it is important to bear in mind that these campaigns must have the resources to support adequate reach, frequency and duration in order to be successful.

In the absence of resources for paid advertising campaigns, or in conjunction with them, local and statewide public relations efforts, including media advocacy, can effectively support key tobacco control goals. Evidence shows that these activities can lead to increased calls to a state quitline; changes in smoking knowledge, attitudes, and behavior among youth; and changes in local tobacco control policy.

The report does note that while the use of digital media, including websites, mobile apps and social network sites is becoming very popular in tobacco control programs, there is not enough evidence available yet for how effective they are in achieving tobacco control objectives or what their ideal place might be in the tobacco control program mix.

Research to develop audience insights, testing of potential concepts and strategies with priority groups, and pretesting of materials with these same groups are recommended activities in developing effective communication efforts.

Public sector tobacco control programs should not be focused on the direct provision of smoking cessation services (how to co-create these services is another topic I have touched on here). Instead, these programs should engage in efforts to reconfigure policies and healthcare systems to normalize quitting and integrate tobacco use screening and treatment in health care practice. Expanding insurance coverage and utilization of cessation services, including quitlines, should also be part of these efforts.

Statewide tobacco control surveillance systems should monitor (a) tobacco use initiation among youth and young adults, (b) quit attempts and success among adults and youth, (c) exposure to second-hand smoke, and (d) reducing disparities among population segments.

The challenge facing the FDA RTC campaign is how it will align itself with existing state and local tobacco control efforts as well as other campaigns that focus not only on tobacco issues, but other health issues (especially when they focus on teens). As the CDC guide nicely summarizes the ideal world of tobacco control:

"Linking state and community interventions creates synergistic effects, greatly increasing the effects of each comprehensive tobacco control component. Effective actions are those that reinforce one another, including: raising community awareness and mobilization efforts; developing health communication interventions; collecting, analyzing, and disseminating data; and providing cessation interventions. Evidence indicates that interventions that promote changes in social norms appear to be the most effective approach for sustained behavior change."

But the infrastructure must be in place to implement effective tobacco control programs. Among the activities that should be staffed for are:

• Strategic planning to guide program efforts and resources to accomplish their goals
• Recruiting and developing qualified and diverse technical, program, and administrative staff
• Awarding and monitoring program contracts and grants
• Coordinating implementation across program areas, and assessing grantee program performance
• Developing and maintaining a real-time fiscal management system
• Increasing capacity at the local level by providing ongoing training and technical assistance
• Coordinating across chronic disease programs and with local coalitions and partners
• Educating the public and decision makers on the health effects of tobacco and effective, evidence-based program and policy interventions

So if you are currently involved in tobacco control efforts, or contemplating how to scale up in your state, region or country, there are many new resources available to you that are based on the latest evidence. Now what can you do with it (Shifting from Individual Skills to Organizational Competence)? And how could social marketing serve you as an integrative, managerial framework to develop and implement more effective, efficient, equitable and sustainable tobacco control efforts?

Comments

[Stephen Hamill]

While I don't find the materials all that inspiring - then again I am not the target audience! - I hope that these are foundational materials for a well-coordinated effort that brings together stakeholders and resources from other government agencies, NGO's etc. I can certainly see these being adapted to more specific audiences in order to address segmentation issues - a Spanish language, Latino version for Los Angeles youth groups, for instance. I'm surprised, and maybe a little disappointed that, given the media consumption habits of this demographic, we aren't seeing a more social media-focused attempt - tools that cause these images to become a source of conversation, ways to provoke sharing or re-interpretation/re-purposing. Maybe that's too experimental and risky for government . . .

[TahirTturk]

Excellent overview on Tobacco control social marketing efforts and the importance of synergies to further leverage limited resources. The idea of segmentation can also be a good one although many reviews identify that cessation campaigns directed to the broader audience of tobacco users usually perform as well in supporting prevention as campaigns to specific youth audience segments. Worth noting when trying to get the best bang for your campaign funds.