Anti-smoking advertising campaigns targeting youth: case studies from USA and Canada.

OBJECTIVE To assist in planning anti-smoking advertising that targets youth. Using five US state campaigns, one US research study, and a Canadian initiative as exemplars, an attempt is made to explain why certain advertising campaigns have been more cost effective than others in terms of reducing adolescent smoking prevalence. Several factors which prior research and theory suggest may be important to cost effectiveness are examined. Specifically, three variables pertaining to the advertising message (content, consistency, and clarity) and two variables related to the advertising execution or style (age of spokesperson and depiction of smoking behaviour) are studied. DESIGN A case study approach has been combined with supplemental data collection and analysis. To assess campaign effects, published articles and surveys of adolescent smoking prevalence in campaign versus control (non-campaign) locations were utilised. Adolescent subjects provided supplemental data on the advertising message variables. Trained adults content analysed each advertisement to assess the executional variables. SUBJECTS A total of 1128 seventh grade (age 12-13 years) and 10th grade (age 15-16 years) students participated in the supplemental data collection effort. RESULTS An anti-smoking advertising campaign initiated by Vermont researchers was found to be the most cost effective in that it significantly reduced adolescent smoking prevalence at a low per capita cost. Next in order of cost effectiveness were California, Massachusetts, and Florida because behavioural outcomes were inconsistent across time and/or grades. California was ranked higher than the other two because it spent less per capita. Minnesota and Canada were ineffective at reducing adolescent smoking prevalence, and no comparison outcome data were available for Arizona. Four factors were found to be associated with increased cost effectiveness: (1) a greater use of message content that prior research suggests is efficacious with youth; (2) a more concentrated use of a single efficacious message; (3) an avoidance of unclear messages; and (4) an increased use of youthful spokespeople that adolescents could more readily identify with. No indication was found that depictions of smoking undermined campaign effectiveness by inadvertently implying that smoking was prevalent. CONCLUSIONS The highly cost effective Vermont campaign can be used as a model for future efforts. It is estimated that 79% of the Vermont advertisements conveyed efficacious messages, 58% concentrated on a single efficacious message, 70% showed youthful spokespeople, and only 4% contained unclear messages. The results suggest that, in the less effective campaigns, as few as 25% of the advertisements contained messages that prior research indicates should be efficacious with youth, as few as 10% of the advertisements focused on one efficacious message, and up to 32% of the advertisements lacked clearcut messages.