1.

Mass media advertising campaigns work The scientific evidence on the effectiveness of public education campaigns is robust and supported by the World Health Organization and many other public health authorities around the world. Many countries have had positive experience with public education/mass media advertising campaigns. Below are some of the most significant results. In Australia, a mass media advertising campaign has been a key part of the tobacco control strategy for many years. Adult smoking prevalence estimates declined from 22.9% in 1997 to 18.4% in 2005. In addition, in the same period, average cigarette consumption fell from 15.4 cigarettes per day to 13 per day. Results for the National Tobacco Campaign (1997) indicated a 1.4% decline in smoking over the six-month campaign period (23.5% to 22.1%). In England, a mass media, advertising-led, campaign has been a key component of the tobacco control strategy since 1998. Smoking prevalence declined from 28% in 1998 to 24% in 2005, which means an estimated 1.2 million fewer smokers. The US/Massachusetts mass media campaigns contributed to substantial declines in cigarette consumption. A 1997 independent evaluation found that tobacco consumption dropped by 31% in the period 1992 to 1997, more than triple the decline seen in the rest of US states. It has also been found that when such campaigns stop (frequently because of lack of funding) positive behaviour change declines and relatively quickly. a)Mass media advertising can be very cost effective- Mass media advertising campaigns can be cost effective in terms of the following criteria: Cost per quitter versus other tobacco control levers Return on investment in reduced healthcare costs Return on investment in reduced costs to economy and society

b)Mass media campaigns can be a flexible lever - In general, media campaigns can be conducted much quicker than other tobacco control levers such as legislation change or implementation of Stop Smoking clinics. In particular, engaging the news media to cover tobacco control topics can be done extremely quickly and inexpensively. c)Mass media campaigns are needed to counter the efforts of the tobacco industry- The global tobacco companies have used mass media for many decades. The global tobacco control community has joined together to provide The Union mass media resource advertisements to counter this impact. 2. Mass media advertising is a crucial component of a comprehensive tobacco

control programme
As the prevalence of tobacco use varies across the world, so does the combination of actions taken to address this epidemic. However, the global tobacco control community recognises that there are a number of evidence based, population level interventions that can affect the

prevalence of smoking. The WHO Framework Convention on Tobacco Control states the following provisions: Provisions to reduce demand: Price and tax measures to reduce the demand for tobacco Non-price measures to reduce the demand for tobacco -Protection from exposure to tobacco smoke, Regulation of the contents of tobacco products ,Regulation of tobacco product disclosures , (Regulate) Packaging and labelling of tobacco products ,Education, communication, training and public awareness, (Regulate) Tobacco advertising, promotion and sponsorship ,Demand reduction measures concerning tobacco dependence and cessation. Provisions to reduce supply: (Regulate) Illicit trade in tobacco products , (Regulate) Sales to and by minors Provision of support for economically viable alternative activities.

It is widely recognised that price has the most immediate effect on demand for tobacco products. However, many experts believe that mass media campaigns are also critical because they can create population-wide changes in knowledge about tobacco, attitudes toward tobacco use, and behaviour change amongst users and non-users alike.

3. The characteristics of effective campaigns

Below are eight key characteristics that successful tobacco control mass media campaigns share: 1. A strong and sustained presence over time - The most effective campaigns have been running for many years. Their sponsoring organisations recognise that the messages must continue over time and must be refreshed. These are practices that the tobacco companies and other major consumer products companies also follow. 2. Adequate funding -As an example, the US CDC recommends spending levels of $1.36 - $3.90 (USD) per person, per annum for an effective media campaign . This is likely to be considerably less than tobacco companies are spending in a typical market. 3. Integrated communication components -Different communication techniques can complement each other, such as advertising plus public relations, community-based campaigns and events. The impact of the whole can be much greater than the sum of the parts. 4. The campaign is integral to a wider tobacco control programme - Mass media tools should be designed to enhance and improve the impact of other tobacco control interventions such as the introduction of new legislation, availability of Stop Smoking services and cessation products. 5. The campaign is part of a long-term strategic plan -Developing a strategic plan involves consideration of the initiatives that could be taken and then prioritising them. It often involves deciding which limited number of initiatives can be delivered given the available funding and staffing. 6. Strong creative material - Delivering the message in a powerful way has been found to be the most effective way of motivating smokers to quit.

7. Cultural acceptability - No single campaign will be equally effective in all populations and therefore campaigns may need to be tailored and made culturally appropriate for specific target audiences 8. Thorough pre- and post-campaign evaluation. - The total evaluation process enables the programme to identify what is working, what is not and why, which in turn informs the changes that should be made to help the campaign achieve its goals.

4. Successful creative strategies - some observations a) A combination of Why to stop and How to stop messages used together
Why to stop messages are hard hitting and communicate the consequences of tobacco use. Such messages can bring the dangers of smoking closer to the individual and prompt stopping behaviour. How to stop messages offer a solution to the negative emotions prompted by the Why to quit messaging. They are positive, should communicate the support available to help smokers to stop and emphasise that success is achievable. How to stop messages can promote any type of quitting support. Most often this is a telephone service, but can also be specialist clinics or referrals to health care professionals Messages that build awareness that stopping smoking with help increases a smokers likelihood of success. Testimonials and real life stories. There have been positive experiences with using real people or actors, provided they convey a credible message. In general real people deliver more effective campaigns because the media often picks up their stories. Therefore the impact of the campaign can be increased beyond just its paid elements. (However, in some countries advertising laws require that testimonials using actors in place of the actual individual in a real life story be identified as a dramatisation) Messages that emphasise that stopping is a journey and that it is all right if it takes smokers many attempts before being successful. A message tone that is non judgemental to smokers. Messaging that blames the smoke or the tobacco product, and not the smoker, has been found to be more effective. Advertisements need to communicate empathy for the challenges and difficulties that people face in stopping tobacco use. Secondhand smoke messages, particularly those that highlight the dangers of secondhand smoke to loved ones, especially children, can be effective in prompting some smokers to stop. Messages comparing risks are not well understood. Focussing on the health consequences of smoking has, to date, been the most effective strategy to motivate smoking cessation

b) c)

d) e)

f)

g)

5. What not to do
Accept funding or support from the tobacco industry. Conduct campaigns targeting children and teens only. Run Why to quit campaigns that are positive in content and tone.

The advertising will not change their views or behaviour. The advertising is so shocking or troubling that they turn away or turn off the TV or radio. Few people like to admit to being influenced by advertising and yet, time and time again, such campaigns are seen to work. (This is true of many products and services, not just tobacco control, which is why many industries use advertising)

Campaign planning and implementation stages

1. A campaign management team -Successful implementation of a campaign requires a team of people with an appropriate mix of experience and expertise. To implement campaign we recommend you establish four work streams: a) Tobacco control organisation staff - accountable for the overall campaign b) Communications specialists to develop and place the campaign. c) Evaluation specialists to monitor the implementation of the campaign and measure the results. d) Community stakeholders to support the campaign. To manage a campaign requires at least one dedicated person. However if the campaign has a large budget then a number of roles are recommended: a) A campaign manager to oversee the team and the total campaign. b) An advertising manager to manage the work of the advertising agency or the direct development of materials. c) A press secretary or media relations officer to manage the work of the PR firm or handle relations with the news media directly. d) A manager of stakeholders, community relations or local programmes. This role often involves leveraging the support of non-governmental and local health organisations. e) An evaluation manager to commission and report on the measurement of the campaign. f) A financial manager to administer the monetary aspects of the campaigns and support in the agreement of supplier contracts. The campaign team (or campaign manager) must be prepared for opposition, with a communication plan backed with evidence and key stakeholders to support the campaign. 2. Strategic planning - Strategic planning is the process that enables the campaign manager to set clear objectives, identify and select specific audiences, set priorities and select the activities of the mass media campaign. A strategic plan is a key document to gain consensus from stakeholders on the objectives, audiences and activities of the campaign. It is recommended that a campaign strategic plan states the following information: a) Problem statement and situation analysis

b) Describe the problem the campaign is seeking to address. Be as specific as possible in terms of the target group and the evidence base that identifies the problem. In addition, the situation analysis should identify what is happening, what you want to happen, and why there is a difference. c) Tobacco control goal This goal should reflect the contribution the campaign is expected to play in the overall tobacco control programme d) Target audience(s) Describe the target audience for the campaign. Prioritise those segments of the population most likely to deliver the proposed goals. Describe each audience in as much detail as possible - consider segmentation by: Age, Sex, Lifestage, Socio- economic group ,Geography , Psychographics (attitudes and beliefs the group share) Smoking behaviour (smokers/non-smokers) This information can help clarify the most effective messages and the most efficient media to reach the identified priority audiences. e) Campaign objective(s) The campaign objective(s) should articulate exactly what is hoped and expected to be achieved as a result of the campaign. It is best stated as an intended outcome (a change in behaviour in the target audience) rather than intended process (reaching X percent of the audience) In addition, it is helpful to express each objective as a SMART objective: Specific Measurable, Achievable, Relevant, Time bound f) Strategy summary This should be a summary of the action you expect the target audience to take as a result of the campaign. It could read as follows : X% of Target Audience will take action to stop smoking by contacting the quitline during the period that the campaign is on air (from X date to Y date). g) Activities and channels Select the most effective media and activities given the budget and time that you have available. The selection should: Consider the best ways to reach your target audience(s). Consider which marketing approaches to use: Advertising, public relations, media advocacy, community based marketing, etc h) Opportunities for collaboration Consider organisations that have similar goals and may be willing to work with you. Such partners may be able to offer: Access to a target audience, Enhanced credibility for your campaign, Additional resources, either financial or in kind, Expertise, Co -sponsorship of events, Evaluation plan State plans for the 3 stages of research and evaluation: Formative, Process and Outcome Formative research is undertaken to guide the development of campaign content and choice of media. Formative evaluation is the pre testing of campaign materials to determine whether the materials are communicating as intended and to predict how the audience may respond. Process evaluation measures whether the campaign was implemented as planned. Outcome evaluation measures the achievements of the campaign: the extent to which the campaign objectives have been delivered.

i) Timeline This should state all the activities of the campaign and the time allotted to complete them. The timeline should highlight key dates and who is responsible for completing each item. Delivering campaigns by specific supplier deadlines can often save funds. j) Budget and Resources This should: List all resources available: financial, in kind, staff. List all anticipated expenses related to your campaign 3. Formative research and pre-testing This is research conducted among your target audiences prior to conducting a mass media campaign, to ensure that the campaign messages, creative approaches and media vehicles you choose are likely to be the most effective choices and to highlight any changes necessary. There are two typical stages: a) Research on the target audience before the development of the campaign. This is undertaken to gain insights to help choose (or create) the advertisements most likely to be effective. b) Pre-testing, or piloting, of the advertisements to check that those chosen are communicating as intended and to predict how the audience may respond to them. Campaign planners look to gain the following kind of information from pre-testing: Overall reaction to the campaign - how does it make them feel? Key message communication - What is the message they get from seeing/hearing the campaign? Like and dislikes - What specifically do they like and /or dislike about the message /campaign? Why? What, if anything, in the advertisement, is confusing? Is the message relevant? Is it for them or for someone else? Why/why not? Is the message believable? Why/why not? What new information (if any) did they learn from the advertisement? Will they talk about the campaign after they have seen it? Why /why not? Is the advertisement controversial? Why/Why not? Will the advertisement prompt respondents to change their views or behaviour? Why/ why not? Research can be qualitative or quantitative, and if the budget allows, both techniques should be used. Quantitative techniques question representative samples of a target group in order that statistical techniques can be used to provide estimates of awareness, attitudes and behaviours at a population level. Quantitative techniques are used to answer what and how many questions. Various survey techniques can be used: Face to face Interviews, Mailed questionnaires, Telephone surveys, Internet questionnaires

A major advantage of quantitative formative research is that it can form a benchmark of a populations smoking attitudes and behaviours. The major disadvantage is that such surveys are time consuming and expensive. Qualitative techniques question a small group of a target population to gain an in depth understanding of motivations and behaviours. Qualitative techniques are used to determine why people think what they think and do what they do. When using qualitative techniques, remember that the findings are indicative and not predictive, and should be analysed and used accordingly. Various techniques can be used: Focus groups, One to one interviews, Friendship pairs or groups, In-home observation, Intercept interviews at shopping malls (or other gathering places of the target audience),Video diaries. There is a third type of research - quasi-quantitative research. This is a hybrid of the two techniques where more people are questioned than in typical qualitative research and a mix of what and why questions are asked of all respondents. This has the advantage of being quicker and cheaper than a thorough quantitative research survey, but will not have statistically robust findings. It also has the advantage of finding out why the respondents think what they do, but without the opportunity of further probing or discussion allowed by qualitative research. This technique is often used for pre-testing campaigns. Planning all research for the campaign will depend very much on the funds available and the campaign teams information needs. It is believed by some practitioners that the use of quasi quantitative techniques, or even just qualitative research, is adequate to pre-test campaigns that have been successful in other markets. 4. Campaign evaluation Evaluation measures the progress made in achieving the set objectives of the campaign and/or goals for the larger program. The World Health Organizations Framework Convention on Tobacco Control highlights evaluation as a critical process for effective and comprehensive tobacco control. In the US the CDC (Centers for Disease Control & Prevention) recommend that 10% of an overall tobacco control budget should be spent on evaluation. This could serve as a guide for your market. Remember that to have a measure of the impact of a campaign you need a pre measure or baseline as a comparison for the post measure. Therefore its important that evaluation is one of the first things planned. Process evaluation measures whether the campaign was implemented as planned. One of the main ways that process measures are used is to assess media buying performance against targets. Such measures could be: % of target audience exposed to campaign Frequency at which target audiences were exposed to campaign Gross Rating Points (or Television Ratings) achieved over campaign period % of spots delivered in time slots planned Number of billboards or advertisements placed.

Process measures are also frequently used to measure performance of a public relations (PR) campaign against the targets planned. Such measures could be: Number of journalists attending press conference Number of news articles appearing as a result of press release Number of positive articles appearing as a result of press release Number of articles featuring key messages included in press release Number of publications/programmes featuring key messages Coverage of target audience and frequency of messages achieved by PR campaign Advertising equivalent spend achieved by PR

Outcome evaluation measures the achievements of the campaign: the extent to which the campaign objectives have been delivered. Quantitative research techniques are recommended for outcome evaluation because statistically significant findings will be needed to prove the effects of the campaign. Plan evaluation early in the campaign development process to ensure that sufficient funding is allowed and that there is time for pre campaign measures to be taken. Any research findings must be useful, therefore before you commission research decide how you will use the findings. This process may help you prioritise your research needs. Ensure the evaluation of the campaign is used effectively to: demonstrate the need for the campaign, measure the outcomes of the campaign, plan future campaigns

5. Adapting existing advertising No single advertisement can claim to be effective for every tobacco user, in every market, in every country. However, the advertisements in The Union mass media resource have been chosen because They have proven to be effective in at least one country , They provide a range of different messages to choose from, They represent approaches that, it is believed, could easily be adapted to other countries Even some countries with established and well-funded tobacco control campaigns have chosen to borrow effective creative and media strategies from other countries. If possible, select advertisements that have a strong visual impact and therefore may require only voiceover changes into appropriate languages. Pre-test advertisements even if they are in your countrys own language to determine whether the voiceover should be changed to offer a more appropriate local accent, tone or emphasis. Broadcast media should be used and prioritised whenever possible. It may be better to have a well-funded TV campaign than a campaign that uses many media but compromises TV impact. Testimonial type advertisements should be re-made featuring local people. Finding real people to appear in such advertisements and making the ads effective can be challenging

6. Media planning and placement Effective media planning involves ensuring that your campaign will be in the right place at the right time to reach and affect your target audience. A media plan should consider: Where the ads and other communications materials will be placed When the ads and materials will be placed How often they will be placed How much it will cost for the desired placements and at what cost-efficiencies

A brief summary of the pro and cons of different media is given here. The relative strengths and cost of media can vary greatly by country. a) TV + Reaches many people + Has a high impact because it uses moving visuals and sound -Airtime Expensive ( but not necessarily in cost per thousand viewers reached) -Limited time for complex explanations b) Cinema + Reaches specific, captive audiences + Has a high impact because it uses moving visuals and sound +Airtime less expensive than TV (but not necessarily in cost per thousand viewers reached) Reaches fewer people than TV in most countries - Limited time for complex explanations c) Radio + Reaches many people and can easily target specific audiences + Airtime cheaper than TV + Can be made and put on air very quickly - Lacks the impact of visuals d) Outdoor posters (sometimes called billboards) + Reach many people + Relatively inexpensive to broadcast media, in most countries + Allow for powerful visuals

+ Very public media that can prompt public debate - May not be available in desired locations - Less able to target specific audiences - Lack the impact of sound - Roadside exposure is typically 3 or 4 seconds, so message must be short e) Newspapers /Magazines + Reach many people + Relatively inexpensive + Allow for complex explanations - Lack the impact of moving or large visuals and sound - Require literate audience and ability to purchase or access, so may not reach key audiences f) Printed materials, such as leaflets and handouts + Can be relatively inexpensive to distribute + Allow for lengthy explanations - Lack the impact of other media - More difficult to measure reach because distribution is hard to tightly control g) Web sites + Relatively inexpensive to upload + Unique global medium with potential for very broad reach + Can be updated quickly and inexpensively + Allow for lengthy explanations and links to other support + Allow for greater interactivity compared to more passive media - Need to drive traffic from other media - Viewers need access to a computer - Difficult to control exposure h) Web banners + Relatively inexpensive

+ Can be accessed from across the globe + Can be changed quickly and inexpensively - Very limited messaging - Viewers need access to a computer i) Sponsorship + Can offer access to a target audience + Can offer credibility to a message - Usually limited message - Can be expensive - Often has limited reach The same advertisement can be more or less effective depending on when it is placed. Below are just a few of the many considerations regarding when to place ads. a) Time of year - For example, it is traditional in England to make New Year Resolutions that will start on January 1st. Therefore, in England Stop Smoking campaigns that run from January to March have been found to prompt a greater response than those in other months. b) Day of the week -In England helplines and websites typically take more responses on weekdays than during weekends. In Australia, Monday and Wednesday placements led to more quitline calls than other days. c) Time of day - People tend to call helplines very quickly after experiencing an impactful advertisement. Therefore it is important that such services are available when the ads are running. d) Type of programming -One study in Australia found that placements in comedy programming prompted fewer calls to the Helpline than in reality /game show programming. How often? This is a difficult question to answer, as different advertisements require different levels of exposure to deliver a similar response. Most advertisements need to be placed more than once. Typically campaign planners try to achieve a coverage level of about 80% of a target audience and a frequency level of at least four times per four-week period, for new TV campaign. The evidence also suggests that campaigns need to be sustained over long periods of time. Advertising does not work as a vaccine. And just as the worlds global brands have continued to advertise over many years (some over a century now), tobacco control campaigns also need to be sustained and evolve to meet the needs of a changing environment.

In order to build salience amidst the constraint of limited budgets, many campaigns appear in four to six week bursts with gaps between each burst. This is called flighting.

7. Advertising and unpaid media The key benefit of paid advertising is the complete control it gives over the content and placement of the message. Unpaid media or earned media (often loosely called media relations, public relations or PR) has the benefit of being free but the disadvantage of less, and often very little, control over content and placement. For this reason it is unwise to plan a campaign without any paid advertising element, unless funds are very limited. There is a role for both paid and earned media in effective mass media campaigns. Even countries with well-funded tobacco control advertising campaigns choose to use public relations because of the unique and complementary benefits it can bring to a campaign. Unpaid or earned media can amplify the effectiveness of paid campaigns by: Generating more target audience exposure to the message. Placing the message in new and different media and environments, such as the evening news. Appearing to come from new, independent and authoritative sources; for example, in an editorial article in a respected newspaper. Responding quickly to any issues arising as a result of the campaign. Ensuring opinion formers and stakeholders are aware of the campaign, even if they are not the primary target audiences. PR or earned media planning should be part of the campaign strategy development process, with stated objectives, audiences and key messages. PR activities such as press releases, launch events and press packs should be used to support advertising campaigns.