An Overview of Australia’s National Tobacco Campaign The Role of Social Marketing in Tobacco Control: An Overview of Australia’s National Tobacco Campaign Presentation to Policy & SSMU on 16/03/2004 8th wave - including benchmark Results not approved for release Jenny Taylor Jodie Grieve

Introduction Role of Social Marketing Context of National Tobacco Strategy Background to the National Tobacco Campaign Campaign Strategy, Implementation & Evaluation International Use of the Campaign

Principles of social marketing Social marketing is the adaptation of commercial marketing technologies to the analysis, planning, execution and evaluation of programs designed to influence the behaviour of target audiences in order to improve their physical and mental well-being and that of the society of which they are a part.” (Andreasen, 1995)

Social marketing differs from commercial marketing in a number of ways: the products are more complex the demand is varied target audiences are more challenging to reach consumer involvement is more intense competition is more subtle and varied

Social Marketing….particularly appropriate: - when new information and practices need to be disseminated; - when activation is needed; and - when counter-marketing is needed. (Fox and Kotler, 1980)

Social Marketing and Health Promotion Approaches Were Developed In Response To: The limited reach of individual and small group programs; 2. Low penetration of programs to some segments of the population; and 3. The desire to develop programs to achieve change in populations. (Le Febvre and Flora, 1988)

Mass Communication Approaches Can: reach a large proportion of the population; reach groups who are not currently being reached; reach target audiences cost effectively; develop effective messages; and potentially create support for behaviour change by reaching many people at the same time. (Redman et al., 1990)

Literature, data review The Marketing Process and Corresponding Research Stages Literature, data review & segmentation Developmental research 1 Analysis 1 Analysis 2 Planning Implications 6 Concept development & pre-testing 3 Feedback to stage 1 Develop test refine elements 5 Outcome evaluation 4 Assess in-market effectiveness Implement- ation Benchmark Process evaluation

Key Principles of Social Marketing and Public Health 1. A Consumer Orientation The importance of viewing the issue to be addressed through the eyes of the target audience.

The application of exchange theory Recognising that people will only accept what we are promoting if they perceive the benefits justify or outweigh the costs.

Assessments of Internal and External Environments Assessing the nature and scope of the problem to be addressed, the environment within which it will be addressed and the resources available to address it.

Channel Analysis Analysing the most effective ways of reaching and communicating with the target audience. Efficiency Environment

Market Segmentation and Audience Analysis Identifying target audience segments Analysing target audience segments.

Use of Marketing Research and the Role of Formative Research Applications of marketing research Formative research for communication campaigns - Pre-production research - Pre-testing research

Formative Research Pre-production Research Audience analysis Segmentation Identification within target audience of: - knowledge of lexicon - beliefs and perceptions - attitudes and values - salience priorities - efficacy and skills

Pre-testing Research Concept development Testing message executions - assess the attention value of the message execution - measure its comprehensibility - determine its relevance to the target audience - identify strengths and weaknesses - gauge any sensitive, or controversial elements

Use of the Marketing Mix Considerations of:- Product Price Place Promotion

Process Tracking and Outcome Evaluation Assessing the effectiveness of campaign implementation Assessing the achievement of campaign goals

A Profit Orientation Recognising the need for cost-effectiveness .

An Integrated Planning and Management System Recognising the need for all elements of the social marketing campaign to be managed effectively and to be considered in a cyclical approach Importance of a strategic planning process: setting goals setting objectives delineation of strategies and tactics management and feedback systems

Television advertsing

Television advertising

National Tobacco Strategy (NTS) “A framework for action”, with commitment from all governments in Australia to take action on tobacco control across a range of key strategy areas; Endorsed by the Ministerial Council on Drug Strategy; The goal is “to improve the health of all Australians by eliminating or reducing their exposure to tobacco in all its forms”

NTS represents a national collaborative approach to tobacco control issues, nominating a range of government, non-government and community partnerships and linkages, under six key strategy areas: Strengthening community action Promoting cessation of tobacco use Reducing availability and supply of tobacco Reducing tobacco promotion Regulating tobacco; and Reducing exposure to environmental tobacco smoke

National Tobacco Campaign addresses key strategy area of “Promoting cessation of tobacco use” Social marketing strategies can achieve optimum outcomes when operating within a comprehensive strategy (ie NTS) and evidence based approach employed

Social Marketing in Tobacco Control Social Marketing can achieve: Agenda Setting Increasing the salience of tobacco control issues Facilitating acceptance of tobacco control policy initiatives to achieve structural change Behaviour change Increased preparedness to quit Prompting quit action Prompting supportive action for quitters Providing reinforcement for ex-smokers and never smokers.

Genesis of the Campaign A collaborative infrastructure Pooling of expertise and knowledge Funding commitment Minister Commonwealth Dept. of Health & Aged Care National Expert Advisory Committee on Tobacco State/Territory Quit Coordinators Research & Evaluation Committee Campaign Technical Advisory Committee

Literature, data review The Marketing Process and Corresponding Research Stages Literature, data review & segmentation Developmental research 1 Analysis 1 Analysis 2 Planning Implications 6 Concept development & pre-testing 3 Feedback to stage 1 Develop test refine elements 5 Outcome evaluation 4 Assess in-market effectiveness Implement- ation Benchmark Process evaluation

The Competitive Marketplace: The ‘product’ “We are searching explicitly for a socially acceptable addictive product……” British American Tobacco “The cigarette is an inexpensive, extremely effective nicotine delivery device, engineered to rapidly provide the user with nicotine, thus maximising the addicting and toxic effects of the drug.” The American Medical Association

The Product Consumption Pattern “ a pattern of repeated self-administration that usually results in tolerance, withdrawal and compulsive drug taking behaviour” “a pattern of maladaptive use that continues despite adverse consequences….” The American Medical Association

The Tobacco Industry Massive infrastructure Billion dollar budgets Ingenious product marketing

The Anti-tobacco ‘Industry’ Quit campaigns Health departments - State/Territory and Commonwealth Cancer councils National Heart Foundation Action on Smoking and Health Peak medical bodies Quitline x 8 Pharmaceutical companies x 3 Fragmented infrastructure Cooperative rather than coordinated approach Limited funding Smokers targeted through multiple approaches with varying research to support

Government Influences on Marketplace Restrictions on advertising and sales Phasing out of tobacco sponsorship Smoke free public place legislation Increases in excise duties

Theoretical model Transtheoretical stages of change model Quitting is a process not a single action Stages Precontemplation: do not intend to change behaviour Contemplation: considering quitting in the next 6 months Preparation: making plans to quit within the next 30 days Action: have quit (but for less than 1 year) Maintenance: have successfully quit for more than 1 year Cyclical process

Strategy Development Review of existing literature and reports from previous anti-tobacco campaigns Identification of target group & cessation focus Development of an individual model of behaviour change, most smokers do want to quit but not today Unwritten personal agenda Long term behaviours need resources and reinforcement to remain on that agenda

Campaign Strategy Development Knowledge about negative health effects is universal but basic The campaign should: Achieve identification with the smoker Provide new information that is relevant and can be recalled with the behaviour of smoking Graphically display the consequences of smoking Provide a positive call to action 5 rounds of concept testing research showed the potential of the strategy on both an emotional and rational level Further phases of research to develop later executions

Campaign Components Powerful advertising Promotion of National Quitline number Upgraded cessation services Promotional events Involvement of general practitioners, pharmacists, opthamologists, optometrists, and cardio-vascular specialists Campaign website

Implementation Timetable 1997 June Campaign launch (June - November) 3 new TVCs ‘Artery’ ‘Lung’ ‘Tumour’ 1998 January New Year’s Eve Campaign February Launch of campaign targeting NESB communities May World No Tobacco Day Campaign 2 new TVCs ‘Brain’ ‘Call for help’ 1999 January New Year’s Eve Campaign May World No Tobacco Day Campaign September Spring Campaign 2000 January New Year’s Eve Campaign May World No Tobacco Day Campaign 2 new TVCs ‘Tar/Lung’ ‘Eye’ 2001 January New Year’s Eve Campaign May World No Tobacco Day Campaign 2002 January New Year’s Eve Campaign May World No Tobacco Day Campaign 2003 May World No Tobacco Day Campaign 2004 May World No Tobacco Day Campaign

Evaluation Issues What would equal success? Methodology developed to enable reliable detection of a change in prevalence of 1% Series of surveys Evaluation surveys - prevalence and process measures Continuous tracking surveys - measures of campaign ‘cut-through’, response to campaign communication and impact of specific strategies Monitoring calls to the Quitline

Relationship Between Calls to the Quitline and TARPs

Process Measures (Wakefield and Miller, 2000) Call volume during the Campaign increased by 500% 1 in 25 smokers called the Quitline in first year of national promotion Improvement in accessibility, quality and promotion of the services through a national number Strong link to campaign advertising Almost 80% of callers to the Quitline were in the Campaign’s target age group (18-40) A follow up study found 29% of smokers who contacted the Quitline were not smoking at the 12 month point

Evaluation Findings* The Campaign remains highly memorable with high levels of advertising recognition by the target group Prompted recall of the Campaign among smokers and those who quit within the past 12 months was 95%. In the first follow-up in November 1997, prompted recall was 87%. The Campaign continues to have a positive impact on quitting behaviour. Campaign-attributed encouragement to quit was reported by one in two smokers (48%). This has been maintained across the years. At benchmark, 37% reported anti-smoking advertising had made them more likely to quit. Smokers and recent quitters indicated they believed the health effects demonstrated through the Campaign to be true Highest for ‘smoking causes a build up of tar on the lungs’ (99%). *Source: 2004 survey

Smoking Prevalence in Australia 1997 – 2004* Benchmark (May 1997) 22.9% Follow-up 1 (Nov 1997) 21.7% Follow-up 2 (Nov 1998) 21.4% Follow-up 3 (Nov 1999) 20.4% Follow-up 4 (Nov 2000) 20.5% Follow-up 5 (Nov 2001) 20.5% Follow-up 6 (Nov 2002) 20.3% Follow-up 7 (Nov 2003) 20.0% Follow-up 8 (Nov 2004) 19.4% *Source: Smoking prevalence & consumption, 1997-2004

Impact / Outcome measures (Carter and Scollo, 2000) CESSATION as a result of the first six months campaign* activity is estimated at 190,000 fewer smokers DECREASE IN PREVALENCE of smoking is estimated at 1.4% DECREASE IN INCIDENCE OF DISEASE associated with smoking eg. lung cancer (1.76%), COPD (0.93%) and various cardio-vascular diseases (3.64%) 920 FEWER PREMATURE DEATHS REDUCED HEALTH CARE COSTS ($24.2 M) *Australian Govt. expenditure $7.1 million in 1997

Success of Campaign Based on: Strong Ministerial commitment Unprecedented coalition of government and non-government organisations Pooling of expertise, resources and funding from Commonwealth, State and Territory governments and key non-government organisations Powerful creative strategy/advertising grounded in theory and research Supporting high quality cessation services ie QUIT lines

International Use of NTC Earned national and international awards and recognition for excellence in advertising Campaign’s partnership base has grown to an international level with in excess of 40 countries using/applying to use the campaign Enables countries to access a campaign rich in research and proven outcomes for minimal investment

International Use of NTC Countries that have used/applied to use NTC TVCs: Singapore, Philippines, New Zealand, Cambodia, Tonga, USA, Canada, Norway, Poland, Iceland, Northern Ireland, Germany, Armenia, Bosnia & Herzegovina, Croatia, Greece, Kazakhstan, Kyrgyzstan, Malta, Republic of Srpska, Russian Federation, Tajikistan, Belgium, Costa Rica, East Timor, India, Indonesia, Italy, Japan, Malaysia, Mongolia, Netherlands, Republic of Ireland, Thailand, Sweden, Philippines, UK Use of TVCs in documentary/current affairs programs: Holland, USA (including Oprah Show), UK, India, Japan, Germany Educational Use of TVCs (schools, universities) Canada, Venezuela, Japan, Costa Rica , Brazil , Italy, Republic Of Ireland

Conclusion The National Tobacco Campaign has been the most collaborative and sustained anti-tobacco campaign in Australia’s history Approximately $24 million of Australian Government funding was spent on the Campaign from 1997 to 2004 $25 million over 4 years has been committed by the Australian Government in 2005 to a new tobacco campaign targeting youth smoking

THE NATIONAL TOBACCO CAMPAIGN A federal, state and territory health initiative www.quitnow.info.au