1. Impact of Antitobacco Mass Media on Youth Smoking Initiation Lois Biener, PhD Center for Survey Research UMass Boston Presented at National Conference on Tobacco Or Health, Boston, Dec. 10 th 2003

2. Massachusetts Media Campaign Average annual expenditure $13 million 1994 through 2001 Multiple Channels Television Radio Adult Transit Billboards

3. Multiple Strategies The truth about the industry Rebel against industry manipulation Real people, real stories Not smoking is cool, smoking is not. Addiction Preserve independence by avoiding addiction Smoking harms the family

4. Research Goals I. Investigate impact on behavior II. Investigate effectiveness of various strategies for different target audiences.

5. I. Impact on youth behavior Compare the rate of smoking initiation between youths who recalled or failed to recall exposure to television, radio, and outdoor anti-smoking advertisements at baseline Over a four-year follow-up period Control for exposure to anti-smoking messages from other sources

6. Methods: Sample 1993 Baseline: 1,069 youths Ages 12-15 1997 Follow-up: 618 youths 57.8% overall response rate Cohort: 592 youths who hadn’t yet smoked 100 cigarettes baseline

7. Methods: Measures of Exposure In past month, seen any anti-tobacco messages... On television ? On radio? On billboards?

8. Methods: Measures of Outcome(1997) Smoked at least 100 cigarettes in lifetime ? (Yes/No)

9. Covariates (1993) Age, race, gender Baseline susceptibility to smoking Smoking by parents and friends Hours of TV viewing Exposure to other anti-smoking messages (posters, newspapers, school, sporting events) Interactions

10. Results: Exposure to Media Campaign

11. Results: Established Smokers in 1997 Percent Overall Yes No Saw TV Ads Age 12-13 in 1993

12. Results: Established Smokers in 1997 Percent Overall Yes No Saw TV Ads Age 14-15 in 1993

13. Results: Multivariate Analysis Effect of exposure to anti-smoking messages on television: Youths ages 12-13 at baseline OR = 0.49 95% CI = 0.26, 0.93 Youths ages 14-15 at baseline OR = 0.94 95% CI = 0.48, 1.83

14. Discussion Exposure measure is really high vs. low exposure, not any vs. none Cannot conclude that all anti-smoking media campaigns are likely to be effective Cannot necessarily conclude that radio and outdoor advertisements are not effective Possibility of unknown confounder

15. Conclusion Strong evidence for a significant effect of statewide anti-smoking media campaign on youth smoking initiation Effect restricted to younger adolescents

16. II. Effectiveness by type of TV advertisement Adult ’93 to ’96 Youth ’93 to ’97 Youth ’99 Youth 2001/2 Hispanic vs non-Hispanic 2001/2

17. Research Tools Independent judges (youth and adults) To establish characteristics of advertisements Population-based telephone surveys To assess how adults and youth in Massachusetts have reacted to the campaign

18. Independent Judges View TV spots and rate characteristics “How well do each of following describe the advertisement?” 1 = Not at all 7 = Very much

19. Judges’ Rating Scales (1 to 7) Sad Frightening Funny Emotionally moving Believable Interesting Phony Annoying Entertaining Reassuring Helpful Offensive Important Silly

20. Advertising parameters Negative Emotion: Sad, frightening, disturbing Positive Emotion: Happy, funny, entertaining Level of Emotion: Powerful, emotionally moving Cognitive quality: Makes you think, interesting

21. Message Identification What was the main message of the ad? (Check one only). “ Cigarettes and cigarette smoke are bad for people’s health (Illness) “ T obacco companies are bad (Anti- industry) “ Teenagers shouldn’t smoke cigarettes (Norms)

22. Relationships between message and affect Illness message: High negative affect, high emotion Norms message: Varies – usually high positive affect, low emotion Anti-industry message: Varies with execution

23. Population Survey Approach Select subset of ads for theoretical/conceptual purpose Assess recall Assess perceived effectiveness

24. Measurement of recall Aided: Gives brief description Confirmed recall: Requests details Unaided: Asks for free recall and description of ad seen recently

25. Measurement of perceived effectiveness How good an anti-tobacco ad? (0 to 10) How it affects feelings about cigarettes (feel worse, feel better, no change) How much affects smokers’ motivation to quit (0 to 10)

26. How Good an Ad by Emotion Level (Adults 1993 to 1996) Very Good Hi Emotion Low Emotion

27. Mean Effectiveness Ratings by Ad Type (youth 1999) Very Good Not Good P <.001

28. Youth 2001/2 Illness: Ronaldo, Rick, (Mass.) Illness + Anti-industry: Body bags, Daily Dose (truth) Baby monitor (Mass.) Anti-industry: I know you (Mass.) Norms: My reasons (Philip Morris) Piercing parlor (Lorillard)

29. How Good an Ad by Ad Type

30. Feel Worse about Cigarettes due to Ad %

31. Youth smokers:Motivation to Quit by Ad Type High

32. Conclusions: Features of Effective Anti-tobacco Ads Evoke strong negative emotion Portray serious harm done by tobacco use in authentic way

33. Ads youth perceived as effective... Target adult smoking Portray harm done to family by second- hand smoke Reveal industry responsibility for serious harm in an evocative way Avoid use of humor

34. Theoretical basis for emotional advertising Cognitive consistency Negative emotion -> Increased risk, decreased benefit Positive emotion -> Decreased risk, increased benefit Learning theory High emotion ->greater recall

35. Published articles on media Siegel, M. and L. Biener. 2000. The impact of an antismoking media campaign on progression to established smoking: Results of a longitudinal youth study. American Journal of Public Health 90:380-386. Biener, L., McCallum-Keeler, G., & Nyman, A. L. 2000. Adults' response to Massachusetts Antitobacco Television Advertisements: Impact of viewer and ad characteristics. Tobacco Control 9:401-407. Biener, L. 2002. Adult and youth response to the Massachusetts anti-tobacco television campaign. J Public Health Management & Practice 3:40-44.

36. Biener, L. 2002. Anti-tobacco advertisements by Massachusetts and Philip Morris: What teenagers think. Tobacco Control 11:ii43-ii46. Biener, L., and Taylor, T.M. 2002. The continuing importance of emotion in tobacco control media campaigns: a response to Hastings and MacFadyen. Tobacco Control 11:76-77. Biener, L. Ji, M., Gilpin, E and Albers, A.B. (In press). The impact of emotional tone, message and broadcast parameters in youth anti-smoking advertisements. Journal of Health Communication.