Media communications play a key role in shaping tobacco-related knowledge, opinions, attitudes, and behaviors among individuals and within communities. The Centers for Disease Control and Prevention (CDC) recommends that state programs use a wide range of efforts, including broadcast, print, outdoor advertising in conjunction with other public relations techniques and on-line marketing.
Cigarettes are one of the most heavily marketed products in Indiana. In 2006, the tobacco industry spent an estimated $426 million marketing their products in Indiana. Their spending outstrips tobacco control spending 46 to 1.
In 2008, the National Cancer Institute released a report, The Role of the Media in Promoting and Reducing Tobacco Use. The report concluded that:
1. The evidence demonstrates a causal relationship between tobacco industry advertising and promotion and increased tobacco use.
2. A causal relationship between exposure to smoking in movies and youth smoking initiation.
3. Mass media campaigns designed to discourage tobacco use can change youth attitudes about tobacco use, curb smoking initiation, and encourage adult cessation.The underlying rationale behind all of the media campaigns was the idea that creating awareness and generating knowledge of the issue would lead to changes in attitudes and behavior. Mass media campaigns have been effective in reducing initiation of tobacco use and increasing cessation when combined with other actions, such as increasing the cigarette tax, enacting smoke-free air laws, and providing adequate program funding. The majority of ITPC media campaigns were multi-tiered to reach multiple audiences.
As part of its ongoing efforts to assess the impact and effectiveness of tobacco control initiatives and public education campaign, ITPC regularly conduct annual media tracking surveys. Responses measure awareness of anti-tobacco efforts and changes in important tobacco-related knowledge, attitudes, and beliefs among Hoosier adults. Such awareness and changes have been demonstrated to be key predecessors to changes in behavior. The telephone surveys have been part of the overall evaluation plan to assess ITPC's comprehensive tobacco control program and its individual components.
The first survey was conducted in September 2001 prior to the launch of the statewide campaign. Subsequent annual surveys were administered from 2002 through 2005. ITPC used the results to measure the effectiveness of the counter marketing campaigns, by connecting exposure to the ITPC media messages with changing attitudes and beliefs.
Advertisement awareness is the first major step in an effective campaign. After all, people must be aware of advertisements to be influenced by them. Findings from other state and national campaigns suggest that greater advertisement awareness increases ant-smoking knowledge, attitudes, and beliefs, which in turn leads to a reduction in smoking:
- Hoosier adults who were aware of at least one ITPC radio advertisement were 94 percent more likely to be knowledgeable about (strongly agree with) the dangers of tobacco use than those with no awareness of radio advertisements.
- Adults who were aware of at least one ITPC radio advertisement were more than twice as likely (222 percent) to strongly agree that they would feel comfortable telling people their age not to smoke, refuse cigarettes if someone offered them, and participate in community activities against tobacco use.
Campaigns resonate with people for various reasons, yet some in ITPC's history remain quite memorable with Hoosiers, based upon statements from Quitline callers and media evaluation results.
With a presentation based on a Massachusetts anti-tobacco campaign, Rick Stoddard became an icon for Indiana youth through his work with Voice. One of the first television campaigns used by ITPC, the Rick series featured stories about losing his wife to cancer from tobacco use. "I never thought of 23 as being middle age" became one of the most memorable lines from the campaign.
Echoing the personal testimony of Rick Stoddard, the Lorene series featured the story of Gary and Lorene Sandifur. Gary lost his life to cancer caused by tobacco use but pledged to educate Hoosiers about the risks associated with tobacco use before his death. Lorene has carried on his legacy, inspiring hundreds of Hoosiers to quit smoking.
The first series, run in 2002, told of Lorene and Gary's struggles and his challenge to her that se one day run the Boston Marathon in his memory. The second series, aired in 2009 and 2010, returned to that challenge as Lorene realized a dream by completing the Boston Marathon.
A lighthearted take on a serious subject generated a good amount of conversation when ITPC launched its "When I" television ad. The commercial featured children sharing their thoughts on things they would like to do when they grew up, with a tobacco slant. "When I grow up, I want to have stained teeth and smelly clothes" is not a typical childhood aspiration, but it delivers a compelling message.
Every Cigarette Does You Damage
During SFY 2009, ITPC featured graphic depictions of the effects of tobacco use on human organs. These ads were part of the "Every Cigarette Does You Damage" campaign, which was created in Australia.
"Artery" showed a doctor removing fatty deposits from an artery of a deceased 32-year-old man. The second ad - "Brain" - showed the devastatingly visible effects of tobacco on the interior surfaces of a human brain. A correlating radio commercial, "Hard Hitting," ran during SFY 2010, generating a high number of calls to the Quitline.
Evaluation data on ad effectiveness show that Hoosiers are aware f the ads, find them convincing, and make them think about tobacco use issues. Overall confirmed awareness of any part of the ITPC public education campaign reached 53 percent in 2008, up from 2007 when awareness was at 14 percent. However, measures of confirmed awareness of media messages are highly dependent on funding. In SFY 2009, per capita spending on public education campaigns was at 31 cents, down from 86 cents in 2004, when confirmed awareness was over 70 percent. If Hoosiers are to be aware of anti-tobacco messages, they must be able to view those messages through media advertising.
Quit Now Indiana
During 2009-10, ITPC ran two statewide advertising campaigns that focused on smoking's impact on everyday lives.
The first, which ran from December 2009 to February 2010, then from April through June 2010, featured long-time spokeswoman Lorene Sandifur in both television and radio commercials.
The campaign then transitioned to a new hard-hitting factual commercial about the devastating effects of smoking, as well as a new testimonial commercial featuring Molly. Molly began smoking at an early age after living among friends and family members who smoked every day. She was diagnosed at age 30 with stage four lung cancer - and had to explain the horrible diagnosis to her children. Her cancer treatment was a painful and grueling process, but she went into remission. Molly has taken her story public to encourage others to quit smoking.
Both advertising campaigns were supported by news releases and media outreach. A new website - QuitNowIndiana.com - was developed to provide additional support to these messages, as well as to guide people to cessation resources. This website has become the central site for all audiences, allowing for ITPC to transition its branding from the former WhiteLies.tv to Quit Now Indiana.
Both campaigns led to significan increases in calls to the Quitline. In fact, during the Spring 2010 campaign, weekly calls reached record levels, hitting more than 1,000 callers in two consecutive weeks (compared with a previous average weekly rate of approximately 230 callers).
The impact of secondhand smoke became a central part of ITPC's media campaign as Hoosiers' understanding of the issue evolved. The efforts included several significant campaigns that resonated strongly with viewers. Among those campaigns were:
Right to Breathe
One of the first ITPC commercials to emphasize smoking's impact on others, "Right to Breathe" generated strong feedback. The commercial features a mother who is smoking while driving. Even though the car window is cracked, the mother is oblivious to the secondhand smoke that her daughter is breathing as she rides in the backseat.
As a nationally known comedian, Rene Hicks frequently performed in smoky clubs and venues to earn her living. Although she never smoked, in 2001, Rene was diagnosed with lung cancer. Featured in a 2005 media campaign, encompassing television, radio, print, and outdoor, Rene's personal story of the toll of working in a smoky environment was very memorable, particularly among African Americans. Rene's efforts to tell others about the dangers of secondhand smoke led to her participation in the U.S. Surgeon General's 2006 video, "Secondhand Smoke: Triumphs and Tragedies."
Task Force on Community Preventive Services, American Journal of Preventive Medicine, Feb. 2001, supplemental reports;
2007-2008 Indiana Adult Tobacco Survey