Massachusetts Ex-Smokers Rated Negative Ads as Most Effective; Enforcement of Workplace Bans is Associated with Smoking Cessation
From February 1996 to August 1998, Lois Biener, Ph.D., and colleagues at the University of Massachusetts at Boston Center for Survey Research examined the reactions of adult residents in Massachusetts to the Massachusetts Tobacco Control Program.
Launched in 1993, the program included a media campaign, worksite initiatives and other efforts to improve the public health of residents by reducing death and disability from tobacco use. Researchers resurveyed 1,544 adults who had participated in the 1993 Massachusetts Tobacco Survey, the baseline assessment for the program.
- Non-smokers and those who quit smoking rated anti-tobacco advertisements that elicited strong negative emotions (e.g., those that were sad or frightening) as most effective.
- All respondent groups (smokers, non-smokers and quitters) rated anti-tobacco advertisements scoring high on positive emotions (e.g., those that were humorous or entertaining) as ineffective.
- Many smokers working in places with "smokefree" policies reported people smoking in the workplace and exposure to environmental tobacco smoke. As a result, workplace smoking policies, in general, had no effect on smoking cessation among workers since these policies are often not enforced.
- Continuous employment in workplaces that enforce smoking bans (as evidenced by only minimal exposure to environmental tobacco smoke) is associated with smoking cessation. Smokers who worked continuously in such workplaces between baseline and follow-up were seven times more likely to have quit smoking than smokers continuously employed in workplaces with higher levels of exposure.
RWJF supported this project with $220,152.
According to the National Cancer Institute, tobacco use is the single most preventable cause of death in the United States. Cigarette smoking is directly responsible for approximately 30 percent of all cancer deaths annually in the United States and causes chronic lung disease, heart disease, strokes and cataracts.
With funds from a surcharge on tobacco products, the Commonwealth of Massachusetts launched the Massachusetts Tobacco Control Program in 1993 to improve public health in Massachusetts by reducing death and disability from tobacco use. Initial Tobacco Control Program efforts included:
- A 1993 tobacco control media campaign.
- Initiatives to reduce smoking at worksites.
- Grants to help local boards of health to implement ordinances that restrict smoking in public places and reduce teen access to tobacco.
- The 1993 baseline Massachusetts Tobacco Survey of smokers, former smokers and non-smokers.
From July to December 1996, Lois Biener, Ph.D., and colleagues at the University of Massachusetts at Boston Center for Survey Research resurveyed by telephone 1,544 adults who had participated in the 1993 Massachusetts Tobacco Survey, the baseline assessment for the Massachusetts Tobacco Control Program. The original sample size from the 1993 survey was 3,316 1,658 smokers and 1,658 non-smokers. Thus 46.9 percent of the original sample was reinterviewed in 1996.
In addition to support from RWJF, the Massachusetts Department of Public Health provided $30,000 for the project.
The re-survey addressed:
- Familiarity with and reactions to tobacco control television advertisements aired as part of the Massachusetts Tobacco Control Program's media campaign.
- The effects of workplace smoking policy on smoking and smoking cessation.
Researchers used the following methodology to examine reactions to the television advertisements:
- Researchers asked respondents to indicate whether they recalled any of nine television advertisements aired as part of the 1993 tobacco control media campaign and, if so, how effective they perceived each advertisement to be, on a scale from 0 (not at all effective) to 10 (very effective).
- A panel of "judges" (15 adults recruited through newspaper advertisements) rated each advertisement on a set of characteristics. Staff combined these ratings into five scales:
- Negative emotion (sad, frightening).
- Positive emotion (funny, entertaining).
- Strength of emotional appeal (emotionally moving).
- Cognitive quality (interesting, thought-provoking, believable).
- Utility (helpful, reassuring).
- Researchers matched respondent ratings of advertisements to these dimensions to ascertain which dimensions of the advertisements respondents perceived as most and least effective.
Researchers also conducted a separate analysis of the subset of 369 respondents who were employed and who had been continuous smokers from baseline (1993) to follow-up (1996). This analysis focused on the effect of workplace smoking policy on smoking and smoking cessation.
In addition, a University of Massachusetts graduate student analyzed survey data related to women's concerns about weight gain due to smoking cessation as the basis of her doctoral dissertation.
Biener presented findings from the project at a 1997 meeting of tobacco control program staff from Massachusetts, California, Arizona and Oregon as well as Massachusetts congressional staff.
In 1998, she also made presentations at the annual meeting of the Society of Behavioral Medicine and at the First International Conference on Tobacco Control Media Campaigns.
Biener and colleagues reported the following findings in articles published in Tobacco Control and the Journal of Occupational and Environmental Medicine (see the Bibliography for publication details):
- The anti-smoking tobacco campaign reached a lot of people and was generally well received. (Tobacco Control)
- Some 56 percent of respondents reported seeing tobacco control advertisements at least once a week during the preceding three years.
- Some 59 percent recalled seeing at least one advertisement that was especially good, while only 12 percent reported seeing one that was particularly poorly done.
- The average effectiveness rating for all advertisements recalled was 7.29, on a scale from 0 (not at all effective) to 10 (very effective).
- Effectiveness ratings differed according to the emotional tone of advertisements and the educational level of respondents. (Tobacco Control)
- Non-smokers and those who quit smoking rated advertisements that elicited strong negative emotions (sad, frightening) as most effective.
- All respondent groups (smokers, non-smokers and quitters) rated advertisements scoring high on positive emotions (humorous, entertaining) as ineffective.
- Among smokers, respondents with education beyond high school rated the advertisements as significantly less effective than did respondents with only a high school education or less.
- Many smokers working in places with "smokefree" policies reported people smoking in the workplace and exposure to environmental tobacco smoke. As a result, workplace smoking policies, in general, had no effect on smoking cessation among workers since these policies are often not enforced. (Journal of Occupational and Environmental Medicine)
- Some 12.3 percent of smokers in workplaces that banned indoor smoking reported either smoking themselves or seeing someone else smoking in their work area during the previous two weeks.
- Over 40 percent of workers in these workplaces reported at least one hour of exposure to environmental tobacco smoke in the previous week.
- Continuous employment in workplaces that enforce smoking bans (as evidenced by only minimal exposure to environmental tobacco smoke) is associated with smoking cessation. Smokers who worked continuously in such workplaces between baseline and follow-up were seven times more likely to have quit smoking than smokers continuously employed in workplaces with higher levels of exposure. (Journal of Occupational and Environmental Medicine)
The researchers reported to RWJF the initial findings from the doctoral dissertation research on women's concerns about post-smoking-cessation weight gain:
- Women who said at baseline that smoking helped them to control their weight were three times more likely to be smoking at follow-up than women who did not report that belief.
- When conducting a follow-up study, design questions that ensure that the person interviewed at Time 2 is the same person interviewed at Time 1. (Project Director)
- Plan sufficient staff time for the analysis phase of the project. Both principal investigators and research assistants need to set aside significant and continuous blocks of time to keep analyses moving after data collection is complete. It is inefficient to stop and start analyses. (Project Director)
AFTER THE GRANT
A second SAPRP-supported project (see Grant Results on ID# 031587), The Influence of Tobacco Marketing and Counter Advertising on Smoking Initiation Among Youth, re-surveyed Massachusetts teens who were first interviewed in 1993.
In addition, Biener received a subsequent SAPRP grant (ID# 040427) entitled Consequences of Adult-Only Exceptions to Tobacco Marketing Regulations.
GRANT DETAILS & CONTACT INFORMATION
Project to Track Changes in Response to the Massachusetts Tobacco Control Program
University of Massachusetts at Boston Center for Survey Research (Boston, MA)
Dates: February 1996 to July 1998
Lois Biener, Ph.D.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Biener L. "Commentary: Adult and Youth Response to the Massachusetts Anti-Tobacco Television Campaign." Journal of Public Health Management Practice, 6(3): 4044, 2000.
Biener L, McCallum-Keeler G and Nyman A. "Adults' Response to Massachusetts Anti-Tobacco Television Advertisements: Impact of Viewer and Advertisement Characteristics." Tobacco Control, 9: 401407, 2000. Available online.
Biener L and Nyman AL. "Effect of Worksite Smoking Policies on Smoking Cessation: Results of a Longitudinal Study." Journal of Occupational and Environmental Medicine, 41(12):11211127, 1999. Abstract available online, but full text requires subscription or fee.
Biener L and Taylor T. "The Continuing Importance of Emotion in Tobacco Control Media Campaigns: A Response to Hastings and MacFadyen." Tobacco Control, 11: 7577, 2002. Available online.
Celebucki C, Biener L and Koh HK. "Evaluation: Methods and Strategy for Evaluation Massachusetts." Cancer, 83(S12A): 27602765, 1998. Abstract available online, but full text requires subscription or registration.
"Follow-Up of Adults Interviewed for the 1993 Massachusetts Tobacco Survey." Center for Survey Research, University of Massachusetts Boston, fielded JulyDecember 1996.
Report prepared by: Mary Nakashian
Reviewed by: Mary B. Geisz
Reviewed by: Molly McKaughan
Program Officer: Seth L. Emont
Program Officer: Nancy J. Kaufman