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The case for recycling and adapting anti-tobacco mass media campaigns
  1. Trish Cotter1,
  2. Donna Perez1,
  3. Sally Dunlop1,2,
  4. Wai Tak Hung1,
  5. Anita Dessaix1,
  6. James F Bishop1
  1. 1Cancer Institute NSW, New South Wales, Australia
  2. 2University of Sydney NSW Australia
  1. Correspondence to Trish Cotter, Cancer Institute NSW, PO Box 41 Alexandria NSW 1435, Australia; trish.cotter{at}


Effective mass media campaigns are hard to come by. A delicate blend of art and science is required to ensure content is technically accurate as well as being creatively engaging for the target audience. However, the most expensive component of a media campaign is not its development but its placement at levels that allow smokers to see, engage and respond to its content. This paper uses two examples to illustrate the process of adapting existing effective material to maximise the expenditure of precious resources on the placement of material.

  • Tobacco smoking
  • mass media
  • anti-smoking advertising
  • advertising and promotion
  • cessation

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Media campaigns have evolved as a key component of tobacco control efforts to reduce smoking prevalence.1–3 Well funded and implemented campaigns targeted at the general population are associated with reduced smoking rates in adults and youth.4–7 There is also accumulating evidence that media-led campaigns are a cost effective mechanism for promoting smoking cessation.1 8 However, the delicate blend of art and science that determines an effective media campaign is difficult to achieve and can be a daunting prospect for first time campaigners.

In recent years, the practice of sharing and adapting anti-tobacco mass media campaigns has increased in Australia and internationally. Adapting existing effective material offers many benefits, including confidence that effectiveness may transfer to the new market and significant savings in time and money. However, little has been published on the outcomes of successful adaptation in different markets. To date, research has focused on pretesting advertising material and indicates that advertisements that perform well in one market tend to do well among many population subgroups, at least in more-developed countries.1

Adaptations of television campaigns may range from high-level adaptation, which uses a campaign concept and reproduces the advertisement to better represent the target population, to low-level adaptations where only the end frame of the commercial is changed to represent local sponsors. Discussed here are two examples of adapted or modernised advertisements (Sponge and Artery) that were broadcast to a subpopulation of smokers highly exposed to anti-smoking advertising, but not familiar with these specific advertisements in New South Wales (NSW), Australia.

The Sponge advertisement

The original version of the Sponge advertisement was made for the NSW Department of Health in 1979 and was run as a major campaign in Sydney in 1983. The advertisement demonstrates the damage that occurs each time a smoker inhales cigarette smoke, depicting the tar that goes into the lungs of a pack-a-day smoker each year. It is recognised as one of Australia's most successful advertisements, and was part of a campaign that has been associated with a 3.4% decrease in smoking prevalence.2 The advertisement's iconic imagery of tar being squeezed from a sponge is well known to Australians over 35 years of age, however, by 2007 the advert had not been run in NSW for over 15 years. Qualitative pretesting indicated that there was some value in modernising the advertisement to communicate with the substantial number of smokers in the under 30 age group who had not been exposed to this particular health effects message. The objectives in modernising the advertisement were to retain the original iconic imagery and the simple communication about the health effects of smoking, while updating the graphics and making slight script modifications.

The new version of the Sponge advertisement used modern graphics techniques in postproduction to replace the cut-out cardboard images from the initial advertisement (figure 1) and to superimpose the images on a silhouette of a real person (figure 2) (the remade advert can be viewed at The mass media campaign featuring the new Sponge advertisement was launched in October 2007, with television advertising running for 7 weeks and outdoor advertising running for 9 weeks from the start of November. Since its remake in 2007, the Sponge advertisement has been licensed and adapted in 10 countries; led by the World Lung Foundation for the Bloomberg Initiative it has been used in China, Russia and India.

Figure 1

Original Sponge advert - silhouette of cardboard cut-out.

Figure 2

Remade Sponge advert - silhouette of actor.

The Artery advertisement

The original Artery advertisement was developed in 1997 as part of Australia's National Tobacco Campaign (NTC) Every Cigarette is Doing You Damage. The NTC was developed in order to increase smokers' personal recognition of the certain health effects of smoking.9 In this advert, the health consequences of smoking are presented in a graphic way by showing fatty deposits being squeezed out of the aorta of a 32-year-old smoker (the advert can be viewed at When first aired, the campaign was associated with a 1.4% decline in smoking prevalence in its first 6 months and is recognised as one of Australia's best anti-smoking campaigns.10 The Artery advertisement has since been licensed and adapted by over 40 countries. While the campaign received a significant amount of publicity when it was launched, the Artery advert itself initially had an M rating, restricting its television viewing to after 20:30, and reducing exposure to the advert by a younger audience.

Then, 10 years after the launch of the original Artery advertisement, the image of the aorta (an advertisement still) was used as 1 of 14 graphic health warnings introduced onto Australian cigarette packs in 2006. Exploratory research indicated young smokers (in their 20s) didn't understand the artery image on their cigarette pack. These smokers were too young (as preteenagers) to have seen the television commercial when it was first aired in 1997 and had likely missed the television explanation relating the clogged artery to smoking.

The objective in adapting the Artery advertisement was to complement the new graphic health warnings initiative and strengthen the understanding of the pack warning that ‘smoking clogs your arteries’. This was achieved by linking the advertisement to an image of a cigarette pack, while retaining the key imagery of the artery. The end frame of the original 30 s advertisement was replaced to depict a cigarette pack featuring the artery image (figure 3). The revised Artery advertisement aired on television over 7 weeks in late 2008.

Figure 3

Artery advertisement endframe: image on cigarette pack.

Impact of the revised advertisements

During the time that the two revised advertisements were broadcast in NSW, smokers and recent quitters (quit in the last 12 months) aged 18 years and older completed telephone interviews as part of continuous tracking research to evaluate the effectiveness of all Cancer Institute NSW advertisements on air. The sample was obtained using list-assisted random digit dialling. A total of 50 interviews were conducted each week, resulting in a sample of 453 for Sponge and 456 for Artery (includes interviews conducted during the campaigns and 2 weeks following). Analyses were conducted with sample weights to reflect the Australian population. For a full report of methods and analyses, see

Both advertisements achieved high levels of recognition (more than 80% for Sponge and almost 50% for Artery) that, given variations in media schedules, were comparable to awareness levels of the original adverts.2 11 Both adverts were also rated as attention grabbing (86% for both), relevant (Sponge 73%, Artery 78%) and believable (Sponge 83%, Artery 91%) by large proportions of the respondents. The adverts generated thoughts of quitting, with more than two-thirds of smokers agreeing that Sponge made them think again about quitting, and more than 70% agreeing that Artery made them ‘stop and think’. Encouragingly, more than half of the respondents indicated that they were not at all tired of seeing either of the remade adverts, and this was true of smokers of all ages, even older smokers who were likely to have seen the original adverts.

The rationale for remaking the Sponge advertisement was to reach young smokers who were not likely to have seen the original advert. The tracking research confirmed the modernised Sponge advertisement had a strong impact on younger smokers in NSW. Ratings of believability and relevance were highest among the younger smokers. Encouragingly, those aged 18–39 years were significantly more likely than older smokers to indicate that the advert made them stop and think (74% agreed, compared to 61% of those over 40 years old), and 71% of 18–24-year-old smokers agreed that the advert made them think again about quitting.

To investigate whether Artery advert had achieved the objectives of raising awareness and understanding of the related graphic pack warning, respondents who had seen the pack warnings were asked to describe any messages they could recall. Comparisons were made in levels of recall of the artery image and the message ‘smoking clogs your arteries’ for the precampaign period (9 weeks) and during the campaign (7 week campaign plus 2 weeks follow-up), differentiating between respondents who did or did not see the advertisement. Though there was no increase in awareness of the artery image during the broadcast period, recall of the ‘smoking clogs your arteries’ message was significantly higher for those who had seen the Artery advertisement compared to those interviewed in the precampaign period (from 4.1% precampaign to 8.2% for those who had seen the advert; p<0.05).


Modernising these advertisements, making them more current and relevant, enabled these previously successful advertisements to be rebroadcast as part of an ongoing comprehensive mass media strategy. In the case of Sponge, a reshoot and modern graphic techniques brought this advert up to date for today's television audiences. Changes to Artery were minor but addressed a key deficit in the understanding of one of the Australian graphic health warnings, which was based on the Artery still image. Rebroadcasting these advertisements was successful in reaching the target audience and generating similar levels of awareness and quitting-related thoughts as when the advertisements were originally run.

Mass media campaigns are expensive to produce and broadcast; effective campaigns need a careful blend of medical and marketing expertise to ensure that their content is scientifically accurate and their presentation effective.12 Perhaps the most delicate part of this process is the creative presentation that, in the space of 30 s, has to grab attention, communicate complex information simply and stimulate motivation. Advertisements that achieve this are rare. By adapting existing advertisements that have proved their ability to grab attention and communicate the serious consequences of smoking, time and money savings can be considerable. For example, to develop a new advertisement in Australia, from exploratory research through concept development and production, might take 6 months or longer and cost on average $400 000AUD. To customise an existing advertisement, including pretesting and changes to voiceovers and end tag, might take less than 6 weeks and cost less than $30 000AUD.

Just as not all advertisements are worthy of adaptation, not all advertisements are easily adaptable. Those that are most likely to adapt well are those that have been successful in their primary market and present simple, well framed messages. Issues of cultural transferability need to be addressed through pretesting. Qualitative pretesting helps identify small but significant changes needed to enhance believability and relevance, and to create a stronger cultural synergy. Advertisements like Sponge with no people (talent) in them, or those with talent who don't speak directly to the camera (such as Artery), are easy to adapt because the voiceover can be recorded in any language. In addition, well branded end frames can easily address those politically sensitive issues of perception of ownership allaying concerns about development of new local material.

In summary, some key guidelines to ensure that a campaign is adapted successfully include:

  • Conducting pretesting with the target audience before adaptation. This ensures that the campaign concept and messages have the desired impact and identifies areas that require alteration.

  • Consideration of budgets available to determine level of adaptation. Budget availability would determine if the whole advertisement can be reshot locally or if only some parts of the advertisement would need to be changed such as the end frame or voiceover.

  • Ensuring copyright and intellectual property is acknowledged and talent fees paid. Organisations looking to license and adapt campaigns would need to consider costs relating to talent, music and license fees.

  • Retaining the key messages and objectives of the original campaign. This is a key factor to a successful campaign. Distortion of the key messages of the original campaign may result in the adapted version having less impact than the original.

Adapting and rebroadcasting mass media advertisements can be an effective and economical strategy, and the case studies presented here provide examples of successful adaptations. Successful adaptation is dependent on the creative strength of the original material, faithful adherence to its creative integrity, and matching the material to local policy and behavioural or cultural differences. Such an approach might provide the potential for developing countries to access and use proven campaigns to reduce smoking rates in their country.

What this paper adds

  • Sharing and adapting mass media campaign advertisements is increasing internationally. To date, research has focused on pretesting and little has been published on the outcomes of successful adaptation in different markets.

  • This paper documents the process of and lessons learned from adapting advertisements using two examples in Australia. The experience supports the indications published on pretesting studies that good material can often be customised to suit different markets, and adds that adaptations save time, money and allow a level of creative excellence that is often elusive.



  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.