Ending the Tobacco Problem - Resources for Local Action
Institute of Medicine

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Youth-Oriented Anti-Smoking Campaigns


Media efforts to reduce use of tobacco products have been used frequently and effectively since the 1990s. Anti-smoking ad campaigns have been launched in several states and by various organizations. California, Massachusetts, and Florida all have used aggressive media campaigns in recent years in an effort to combat youth tobacco use.


What Works: Ads That Use Personal Stories

A researcher asked 268 teenagers in Boston and Chicago to examine fifty anti-smoking ads produced between 1997 and 2001. The youth included smokers and non-smokers who were willing to consider smoking. Youth who had smoked more than 100 cigarettes in their lives were excluded. 

The ads used either “personal testimonials” or “negative visceral images” to make the case against smoking. Personal testimonials, in which real people tell their own stories about how smoking had a negative impact on their lives, rely upon emotional appeals such as sadness, fear, or empathy. They can focus on the health effects of smoking or on some other aspect of their lives and relationships.   

The teenagers rated personal testimonials more highly than negative messages. Because the two personal testimonials dealt with the effect of addiction and the death of a spouse, it is not known whether all personal testimonials would be as effective as these two ads. However, this study illustrates the importance of personal testimonials as an effective way to reach young people and suggests that these are more effective than negative health messages that rely upon fear. The case also shows that media ad campaigns can be very effective when the style is researched thoroughly and developed fully. 


Further Information

After the Master Settlement Agreement in 1998, the American Legacy Foundation launched a nationwide media campaign with four distinct targeted campaigns. All four campaigns had positive outcomes and also offered opportunities for improvement. Of nine specific message strategies for the content of the media campaigns, four were effective and five were not. 

California was the first state in the U.S. to begin a media campaign. In 1988, the state government raised cigarette taxes and used the money to fund a mass media campaign. The campaign began in 1990 with ads about secondhand smoke, youth tobacco prevention, and smoking cessation. The campaign had an effect on smoking prevalence, which declined almost five percent during the first four years after the launch, before flattening out. This decline was almost double the decline rate for the rest of the United States.

Massachusetts began its program in 1993, also increasing cigarette taxes for funding. Its efforts were aimed primarily at youth and involved television, radio, and billboard ads.  Results showed that 12-13-year-olds exposed to the campaign were about half as likely to smoke as those in that age group who were not exposed. For older adolescents, there was no difference. After the campaign, all Massachusetts residents were less likely to believe "light" cigarettes might reduce health problems and were more knowledgeable about filter vents (small rings of holes in cigarettes that, if blocked, increase tar) than residents in other states [1].

Florida launched a "truth" campaign in 1998, with ads focused on attacking the tobacco industry. The ads appealed to "edgy," trend-setting youth who might influence their peers. The evaluators found that youth smoking rates dropped about three-and-one-half percent among middle school children and more than two percent among high school students. Four years after the campaign began, Florida's overall youth smoking rates were below the national average.

The American Legacy Foundation used Florida's "truth" campaign as the basis for a national anti-smoking campaign. Short-term results of the campaign included significant shifts in attitudes about smoking and increased opposition to statements that smoking helped young people look cool. These results contrast to the "Think. Don't Smoke." campaign by Phillip Morris USA which ran in the late 1990s. Following that campaign, greater exposure to the tobacco company’s campaign resulted in a greater likelihood of smoking the following year and, in some cases, improved respondents’ impressions of the tobacco industry.  Experts suggest this happened because the ads portrayed smoking as attractive but forbidden. 

While encouraged by the results of these four campaigns, effective media campaigns are expensive, take a long time to develop, and are a lot of work. Ads tend to loose their novelty and effectiveness over time and need to be replaced frequently. Many of these media campaigns were also undertaken in conjunction with local community and school-based programs, suggesting that there is a synergistic effect among them. 

A meta-analysis of 17 studies found an overall change of six percent based on mass media smoking prevention campaigns. Long-term effects are harder to estimate as youth habituate to messages over time, and the effectiveness of certain strategies may lessen unless they are revised and updated. The youth most prone to influence will most likely be reached in the first one or two years of a campaign [2]. With the target ages of 12-16 years the target is replaced every four-to-five years, and the campaign can be recycled.  Without an ongoing national media campaign, the reductions in smoking rates documented thus far could stop or even be reversed.

Two studies from Massachusetts and California using a variety of advertisements from the American Legacy Foundation, Philip Morris and state campaigns from Massachusetts, California, and Florida, found that messages about endangering others, negative life circumstances, refusing cigarettes, and messages using strong negative emotion reduced participants’ intentions to smoke [3]. In contrast, messages about normative influence, health consequences, the cosmetic effects of smoking, negative messages about the tobacco industry, and humorous messages were not effective in changing intentions. 

Personal testimonial ads rely on emotional appeals that may enhance message relevance and credibility. Young people often think that they have heard all there is to hear about smoking and that they are not vulnerable to harm.  Under these conditions, highly emotional messages may be one of the best ways to get their attention. There is still debate among researchers about which ads are most effective but there is increasing evidence that ads using personal stories are effective.

[1] Kozlowski, L., Goldberg, M., Yost, B., Ahern, F., Aronson, K. & Sweeney, C. (1996). Smokers are unaware of the filter vents now on most cigarettes: Results of a national survey, Tobacco Control, 5 (4): 265-270.
[2] Snyder L., Hamilton M., Mitchell E., Kiwanuka-Tondo J, Fleming-Milici F, & Proctor D. (2004).  A meta-analysis of the effect of mediated health communication campaigns on behavior change in the United States.  Journal of Health Communication,  9 (Suppl 1):71-96.
[3] Biener L, J. M, Gilpin E, & Albers A. (2004). The impact of emotional tone, message, and broadcast parameters in youth anti-smoking advertisements.  Journal of Health Communication, 9(3):259-274 and Pechmann, C, & Reibling E. (2006). Antismoking advertisements for youths: an independent evaluation of health, counter-industry, and industry approaches.  American Journal of Public Health,  96 (5):906-913.