The effectiveness of mass media campaigns in reducing smoking, second-hand smoke exposure and smoking-related disease in England & Wales

Tobacco control mass media campaigns involve communication which aims to encourage smokers to stop smoking or avoid smoking in front of others, particularly children. The campaigns may be communicated via television, radio, newspapers and/or billboards. It is likely that they contribute to changes in smokers' behaviour and reductions in smoking, and this in turn helps to reduce the number of people suffering the diseases caused by smoking. There is almost no evidence on how effective mass media campaigns in the UK have been, nor on whether this has been money well spent. The lack of UK evidence enabled the government to stop funding mass media campaigns in April 2010. Very recently, however, the government indicated that it might begin such campaigns again. Research on this topic is therefore very timely and would help ascertain how best to do this.
This project will measure the effectiveness of individual mass media campaigns, and of different types of campaign, in England and Wales over recent years. We will initially identify the characteristics of individual campaigns, such as whether the campaign aimed to encourage smokers to stop or to protect their children from smoke, its emotional and informational content and style, and how it was delivered (eg whether via television, radio or print media and the balance between the three). Then we will consider how much impact each campaign and campaign type has had by looking at a range of indicators of smoking behaviour in the adult population, such as the proportion of people who smoke, the numbers of smokers trying to stop and the proportion who smoke in the home. We will also measure whether the impact of mass media campaigns reduce the health problems caused by smoking. We will do this by measuring, for example, the number of people admitted to hospital with heart attacks or strokes, and the number of children consulting the GP for respiratory infections.
We will use statistical methods that enable us to examine how any changes in these indicators relate to the timing of mass media campaigns. These methods will also allow us to examine whether it is the mass media campaign that is important, or other factors, such as changes in other tobacco policies at the same time, that are responsible. We will look at these changes in smoking behaviour and health in datasets representative of England and Wales as a whole and where available, in data from specific sectors of the population, such as the more socio-economically deprived, to see whether the impact of mass media campaigns is the same in these groups. We will look at the effects of specific regional campaigns by comparing changes in smoking behaviour between regions. We will also look at what changes occurred in smokers behaviour and health at the point when government spend on advertising ceased prior to the election in 2010.
This work will provide essential information to guide future decisions on anti-tobacco mass media spend at national and regional levels.

This research will evaluate the effectiveness and cost-effectiveness of anti-tobacco mass media campaigns in England and Wales since 2004 using key indicators of smoking behaviour and smoking-related health outcomes in the general population, and in specific population groups. We will use a combination of time series analysis and longitudinal panel study analysis, using data from national datasets.
Our outcomes will include smoking prevalence, rates of smoking cessation medication prescriptions, and GP consultations for children's respiratory disease (The Health Improvement Network primary care data), NHS quitline calls, NHS stop smoking service (SSS) attendees and 4 week quitters, NRT sales, Health Survey for England children's cotinine measurements, and Hospital Episode Statistics on acute MIs.
Autoregressive time series models will be used to estimate population-level change in smoking behaviours and health outcomes in response to specific campaigns, or month-to-month change in advertising reach and spend, specifying the appropriate autoregressive process and transfer function, and modelling underlying trends, seasonality, and impacts of other tobacco control policies. Longitudinal analysis will use International Tobacco Control (ITC) UK data of over 2000 adult smokers and recent ex-smokers to assess individual changes in smoking behaviour and attitudes pre and post campaigns using random effects regression models.
The economic model will link mass-media campaigns (via expenditure and coverage) to intermediate stop-smoking outcomes (calls to quit helplines, SSS attendance), the impact of those stop-smoking outcomes on intermediate health outcomes (AMI and respiratory disease) and the costs avoided following reductions in those health outcomes.
The study will provide evidence as to whether government spending on mass media campaigns is effective and cost-effective, and for prioritising future funding to maximise its impact and reach its target audience.

The research will be of immediate benefit to policy makers, at local, national and international levels. Our results will provide an essential UK-specific evidence base on the effectiveness and cost-effectiveness of recent national and regional campaigns on a comprehensive set of short and long term smoking behaviour and health outcomes. Policy makers at local and national levels will gain information to evaluate the impact of previous spending on anti-tobacco campaigns, and to help to prioritise future spending in terms of medium (television, radio etc) and type of campaign to optimise efficiency and effectiveness. The findings will be used by organisations such as ASH and UKCTCS to engage policy makers, nationally and internationally, with evidence for the impact of campaigns, and if appropriate of the potential public health consequences of decisions made on mass media spending, including the recent halt in spending in England & Wales. It is expected that the results will therefore have a considerable influence on future decisions regarding anti-smoking mass media spend in this country and elsewhere. We have developed this work in collaboration with ASH, who are actively involved in tobacco control policy development in the UK and are ideally placed to ensure that the results of this work are taken into consideration in future policy development.
The research will also be of immediate benefit to several national charities, such as Cancer Research UK & the British Heart Foundation, which have also historically funded anti-tobacco mass media campaigns, by demonstrating whether such campaigns are effective in reducing the heath consequences of active and passive cigarette smoking and, if so, how their impact can be maximised.
The proposed project also has the potential to be of benefit to the commercial sector, notably advertising and pharmaceutical companies. Although we will not directly examine the effectiveness of NRT advertising in this project (as that is the one of the focuses of our funded TAG work), we will be examining, for example, factors that influence NRT sales, which will be valuable to pharmaceutical companies. Cuts in government funding may place greater reliance on pharmaceutical company funded campaigns in the future, and this study which looks at the important characteristics of government funded campaigns is likely also to provide valuable information for the content and style of pharmaceutical company advertising.
Commercial, public and third sector bodies involved in health behaviour change more generally may also benefit from this research.
Finally, and most importantly, the study will be of benefit to smokers, and those exposed to second-hand cigarette smoke. In the UK the prevalence of smoking in 2007 was about 21%, equivalent to 10 million people. One in two of these smokers will die prematurely as a result of smoking - half of these in middle age. Smoking cessation reduces the risk of several cancers, as well as other smoking-related diseases such as chronic obstructive pulmonary disease and coronary heart disease, with some of these health benefits happening quite quickly, others taking a number of years. Increasing rates of smoking cessation is therefore crucial to reducing morbidity and premature death. Moreover, second-hand smoke exposure has been estimated to be responsible for more than 10,000 premature deaths per year in the UK. Smoking also has significant cost implications for society; the cost to the NHS of treating diseases caused by smoking is approximately £2.7 billion a year. Smoking also results in lost productivity caused by smoking breaks and increased absenteeism amongst smokers due to ill-health. By establishing the most effective use of mass media to increase smoking cessation and reduce second-hand-smoke exposure, this research has huge potential to contribute to the nation's health and wealth.