1. Supporting pack warnings with mass media advertising in Egypt Mass media in low- and middle-income countries: evidence from World Lung Foundation campaigns Mohamed Ghamrawy Communications Officer

2. Outline About Egypt Learnings from pre-testing “Save yourself, NOW” Campaign Campaign results Lessons learned

3. About Egypt Country name : Arab republic of Egypt (MISR) Population: 80 million # of smokers: 16.5 million 3.1% of total income (8 milliards L.E yearly) spent on tobacco 5% of family monthly income spent on tobacco 22% of smoker income spent on tobacco Source: TC department, MOH Egypt 2007

4. WLF in Egypt WLF worked with MOH to conduct mass media campaign Opportunity: Egypt implemented graphic pack warnings in January 2008 Evidence suggests that TV ads make pack warnings more effective Mass media is an effective intervention on its own, but can also be extremely powerful in conjunction with others MOH/WLF contracted a Cairo ad agency familiar with the market to direct the campaign Used message testing, best practices, to ensure that ads are as effective as possible

5. Learnings from pre-testing

6. Discover which types of messages will motivate Egyptians smokers to make a quit attempt Gain insights into how to improve the ad concepts Explore whether smokers would recognize to the graphic pack warning – “oxygen mask” Learnings from pre-testing Pre-testing objectives

7. Tested Material New concept Adaptation

8. Tested Material Overall winning copy ‘Artery’ Key findings: Addresses a vital issue familiar to most respondents: Heart Disease Presents new information in an innovative, attractive format. Thought-provoking, credible and memorable

9. Selected Ad ‘Artery’ BUT...

10. While quantitative measure indicated artery was the most effective qualitative results showed some problems with “artery”: Egyptian audiences thought that the man lighting the cigarette from the stove was unbelievable Almost every group mentioned that the man in the pack warning had no credibility and made the ad unbelievable

12. Smoker not lighting cigarette from stove, shown in a more typical environment Removed pack warning shot at the end. Because other two pack warnings incirculation dealt with SHS and impotence, it was felt they wouldn’t work well with “artery.” Result: “Save Yourself, NOW” campaign Communication routes and executions pre-test Changes to ad made to address problems

13. “Save yourself, NOW” campaign

14. Original Ad: Artery Duration: 30 second

15. 1 st wave ad: Mechanic Duration: 30 second Airing duration: 3 weeks

16. 2 nd wave ad: Office Duration: 30 second Airing duration: 3 weeks

17. Media Plan Duration of the campaign: 6 weeks 3 weeks before Ramadan (Mechanic Ad) 3 weeks after Ramadan (Office Ad) Selective Local and satellite channels to achieve: 900 GRPs and reach levels of ~ 75% 75% of target audience saw the ad an average of 12 times Many observant Muslims change cigarette consumption habits during Ramadan, “Save Yourself” could influence quit attempts or help them stay quit Ramadan air time prohibitively expensive, but by “sandwiching” Ramadan amplify quit attempts

18. Campaign results

19. MOH and WLF contracted with Ipsos Egypt to conduct pre- and post- evaluation of smokers and nonsmokers to gauge campaign impact Campaign evaluation

20. Q24. Thinking about when you saw, read or heard the advertising, was it on? Advertisement Mediums  Most respondents recalled seeing the ad on television. Current smokers (Base: 95) Former smokers (Base: 2) Non smokers (Base: 52)

21. Campaign evaluation Attitudes towards smoking  Higher scores were mentioned arguing that people have the right of breathing clean smokeless air 306871 727681 878893 899694 Post Campaign Post Campaign Base Current smokers = 800 Former smokers = 25 Non smokers = 400 C: Current smokers:795 F: Former smokers:43* N: Non smokers: 400 Q15. Now, we would like to know your attitudes on issues. I am going to read to you some statements about smoking and tobacco smoke. Please tell me how much you agree or disagree with each one of them on this 5 points scale?

22. Campaign evaluation Smoking Consequences – Definitively Yes  No significant difference between current, former and non-smokers. Q20. Based on what you know or believe, does smoking tobacco cause the following… Post Campaign Baseline Base C: Current smokers:795 F: Former smokers:43* N: Non smokers: 400 Post Campaign Base Current smokers = 800 Former smokers = 25 Non smokers = 400 638077 596070 758886 626473

23. Samples of Media Coverage

24. Lessons learned Prepare to respond to the tactics of tobacco industry; look for TI influence Hard hitting, graphic ads are the most effective across all cultures and media landscapes What people want to see is not necessarily the most effective at behavior change Suffering and disfigurement more persuasive than death Some things consistently test poorly: humorous ads, complicated messages, spokespeople

25. Thank you. Mohamed Ghamrawy melghamrawy@worldlungfoundation.org