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a Health Development
Agency, London, UK, b Kings College
London
Institute of Psychiatry, Tobacco Research Section, London, UK
Correspondence to: D McVey, Health Development Agency, Trevelyan House, 30 Great Peter Street, London SW1P 2HW, UK; Dominic.McVey{at}HDA-online.org.uk
Received 23 September
1999; Revision received 18 April 2000;
Accepted 6 May 2000
OBJECTIVESTo evaluate
the effectiveness of the Health Education Authority for England's
anti-smoking television advertising campaign in motivating smokers to
give up and preventing relapse in those who had already given up.
DESIGNA prospective,
controlled trial was conducted in four TV regions in central and
northern England. One region received no intervention (controls), two
regions received TV anti-smoking advertising (TV media), and one region
received TV anti-smoking advertising plus locally organised
anti-tobacco campaigning (TV media + LTCN). The TV advertisements were
screened in two phases over 18 months; during the first phase the
intensity of the advertising was varied between TV regions. 5468 men
and women (2997 smokers, 2471 ex-smokers) were selected by two stage
random sampling and interviewed before the intervention, of whom 3610 were re-interviewed six months later, after the first phase of the
campaign. Only those interviewed at six months were followed to the
main end point at 18 months when 2381 subjects were re-interviewed.
MAIN OUTCOME
MEASURESSelf reports of cigarette smoking at the
18 month follow up were compared between the three levels of
intervention. Odds ratios for intervention effects were adjusted for
pre-intervention predictors of outcome and pooled for smokers and
ex-smokers using meta-analytic methods.
RESULTSAfter 18 months, 9.8% of successfully re-interviewed smokers had stopped and
4.3% of ex-smokers had relapsed. The pooled adjusted odds ratio for
not smoking in the TV media only condition compared to controls was
1.53 (95% confidence intervals (CI) 1.02 to 2.29, p = 0.04), and for
TV media + LTCN versus controls, 1.67 (95% CI 1.0 to 2.8, p = 0.05).
There was no evidence of an extra effect of the local tobacco control
network when combined with TV media (odds ratio 1.15, 95% CI 0.74 to
1.78, p = 0.55). The was also no evidence of any intervention effects
after the first phase of the TV media campaign, including no effect of
varying the intensity of the advertising during this initial phase.
Applying these results to a typical population where 28% smoke and
28% are ex-smokers, and where there would be an equal number of
quitters and relapsers over an 18 month period without the campaign,
suggests that the campaign would reduce smoking prevalence by about
1.2%.
CONCLUSIONSThe Health
Education Authority for England's anti-smoking TV campaign was
effective in reducing smoking prevalence through encouraging smokers to
stop and helping prevent relapse in those who had already stopped. The
lack of an effect after the first phase of the campaign indicates that
if advertising at this intensity is to have an impact, a prolonged
campaign is necessary. These results support the UK governments'
recent decision to fund similar campaigns, and suggests that
anti-smoking TV advertising should be undertaken routinely as an
essential component of any population smoking reduction strategy.
Reducing smoking prevalence would make a substantial contribution to
achieving the UK government's target of preventing 300 000 cancer and
heart disease deaths over the next 10 years.
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