Anti-Smoking Campaign Put Down that Smoke and No One Gets Hurt

Australia has been the home to a number of powerful anti-smoking campaigns designed to reduce the harm that smoking causes on the individual level as well as on society as a whole. Smoking is an expensive habit in every way: Not only do cigarettes exact significant costs on an individual level (both financially and, far more importantly, in terms of health) but smoking also enacts an immense financial burden on local, regional, and federal health systems.

Because of these high costs, it is in the interest of the state to design and implement effective anti-smoking campaigns to save its citizens paying the cost of this habit -- whether directly through their being able to stop smoking themselves or indirectly, by freeing up public health money to be used in other areas. However, while Australia (like most developed nations) is fundamentally committed to reducing smoking, many Australians continue to smoke. This is not surprising: The highly addictive nature of nicotine makes it extremely difficult for a smoker to quit, even if s/he has only been smoking for a relatively short period of time.

A few of the statistics concerning smoking rates in Australia are sufficient to indicate how serious the problem of smoking is:

Each year more than 18,000 Australians die prematurely because of smoking. This is equivalent to 50 Australians each day.

Smoking kills more people in Australia than the total number killed by a number of other causes that tend to get more attention. If one were to add together the number of Australians who die each year from alcohol, drugs, murder, suicide, road crashes, rail crashes, air crashes, poisoning, drowning, fires, falls, lightning, electrocution, snakes, spiders and sharks it would still be fewer people than are killed by smoking. (Statistics on smoking, 2006, http://www.nsma.org.au/facts/figures.htm)

A few more figures from the same source (an anti-smoking group) make even clearer the health costs of smoking along with the simple financial costs.

Australian school children spend more than $82,000 each day on cigarettes.

Australia spends $609.6 million in direct health care costs for smokers and $6,028.3 million in indirect mortality costs

The tobacco industry spends upward of $70 million on cigarette advertising and promotion each year, including advertising aimed at children. (Statistics on smoking, 2006, http://www.nsma.org.au/facts/figures.htm)

Given the scope of this problem in terms of both potential individual and social cost, social marketing programs that have a chance of making a significant impact on smoking rates (as well as the age at which an individual starts to smoke) is highly worthwhile.

The Quit Victoria Campaign

One of the most effective anti-smoking campaigns in Australia has been Quit Victoria, a government-sponsored campaign that focuses on smokers of all ages. It contains a number of elements that have been proven to be effective both within the context of this particular campaign as well as in the context of anti-smoking campaigns in other parts of Australia as well as in other industrialized nations.

Among these elements is what can generally be called the "yuck" factor -- the inclusion of facts or images that stress the negative consequences of smoking.

Experimental research on information processing supports the hypothesis that advertisements that evoke high arousal will receive greater viewer attention and will be remembered more readily than those that do not.

Further, negative content tends to produce higher levels of arousal than does positive content. By contrast, advertisements that used humour, whether to make fun of teenagers who smoked, or portray the health benefits of not smoking in an exaggerated way (e.g. A Massachusetts advertisement showing an infant performing gymnastics because of the healthy air in his home), performed relatively poorly. (Scollo & Winstanley, 2008)

The Quit Victoria campaign is centered around a video of a man who depends on oxygen and whose body has clearly been devastated by his smoking. As he lies in a hospital bed, his young daughter looks on, already mourning the father who is about to leave her (Quit Victoria).

Internal and External Threats and Opportunities

This campaign has a number of internal strengths, including the fact that it has been successful at "setting the agenda" -- at influencing not only the tenor of the public discourse about smoking but also in ensuring that smoking is an ongoing element of the public conversation (Casswell, 1997; McCombs & Shaw 1976).

Agenda setting theory can be conceptualised at the individual level and at the community level. The theoretical underpinnings of the National Tobacco Campaign emphasised the critical need to move the decision to quit smoking from the point of quitting some time in...

(Scollo & Winstanley, 2008)
The strength of a campaign built on aspects of social marketing that have been proven to be effective also provides the basis for the internal opportunities.

This campaign relies on proven methods to address an acknowledged and serious problem. These are its key strengths. However, it also could be improved. It faces external threats, for example, as well as external opportunities. The primary external threats are those posed by the immense amount of money that the cigarette companies spend on advertising in various forms. There is relatively little that can be done about this by Quit Victoria; however, Quit Victoria can coordinate its efforts with federal and regional legal restrictions on tobacco marketing.

Quit Victoria has in fact been able to do this, supporting efforts by the Australian government over the past several years to limit the visual appeal of cigarettes, especially as they might appeal to younger people. Quit Victoria is seeking to coordinate with the following proposed policy:

Under the proposed laws, Canberra wants to be the first government in the world to restrict logos, branding, colors and promotional text on tobacco packets beginning in January.

Product names will appear in standard colors and positions in a regular font and size on packets colored a dark olive-brown, which government research has found holds the lowest appeal to smokers. Health warnings with graphic images of the harmful effects of smoking will have to make up 75% of the front of the packaging and 90% of the back. (Curran, 2011)

Coordination with such federal efforts constitutes the most important external opportunity for Quit Victoria, which nicely dovetails with the fact that tobacco company marketing also constitute the greatest external threat.

Tobacco companies have too much money and too much influence for these to be countered by the moves that Quit Victoria can mount on its own. This is something that is understand by Canberra, and so the federal government has brought its weight to bear against the external threat of Big Tobacco and its money.

Alternative Activities

One of the limits of Quit Victoria, along with anti-smoking campaigns across the world, is that anti-smoking social marketing campaigns that have emphasized alternative activities -- such as outdoor exercise -- have been less successful than those that focus on the physical devastation that smoking can bring about. Quit Victoria can use this aspect of anti-smoking campaigns by refocusing or reframing it (Bandura, 1968)

Since marketing messages that focus on overtly healthy activities have not been seen to be particularly effective, Quit Victoria has chosen to emphasize negative imagery. Such negative imagery has implicit in it the idea that quitting smoking will result in the opposite of the images of very sick people. This no doubt is effective for some people (or, more likely, has some effectiveness for most people).

However, Quit Victoria can use a more overtly positive message (and method) that helps people quit smoking by creating a sense of non-smoking as the social norm. This program has done so to a certain extent, but it could be emphasized to a greater degree.

In a related perspective, the norm reinforcement approach suggests that mass communication interventions can effectively contribute to reducing health damaging behaviours by reinforcing social norms. This approach posits that unfavourable depiction of behaviours in the media directly reduces their perceived social acceptability.

This offers a complementary model to that of direct media effects on health behaviour in considering how mass media health campaigns can work. Drawing from the constructs of Bandura's social cognitive theory104, the norm reinforcement approach suggests health behaviours such as smoking can be influenced by:

convincing smokers that being a non/ex smoker is the social norm, and that smokers are quitting addressing inflated perceptions of the prevalence of smoking, and attaching social stigma to smoking. (Scollo & Winstanley, 2008)

The above description of a different emphasis and focus that Quit Victoria might take is not meant to suggest that it be the sole focus of the campaign. Certainly, using past research as a guide, the inclusion of terrible and/or terrifying imagery will continue to be effective and necessary part of anti-smoking campaigns.

However, it also seems clear that anti-smoking campaigns like Quit Victoria must also seriously consider including more and more of an emphasis on social norms that exclude cigarette smoking. This should be especially effective for younger people who are in general more likely to be influenced…