Mass media campaigns, while often expensive, are proven, cost-effective interventions and should not be considered out-of-reach, especially where governments have some sway over media markets, where large media discounts are possible or where other novel strategies can be employed.
- Advertising and promotion
- harm reduction
- public policy
Statistics from Altmetric.com
Russia has among the highest rates of smoking in the world.1 Nearly one in three Russians smoke, including 60.2% of men and 21.7% of women,2 with an alarming 36% of women aged 18–19 years old being smokers.3
Cigarettes in Russia are ubiquitous and inexpensive, and tobacco taxes are low. The average pack of Russian cigarettes costs about US$0.75. Smoking is most popular among urban populations, where more than 40% of adults smoke,2 and smoking is a common practice in bars, restaurants and nightclubs. Smoke-free environments are rare; not even schools and healthcare facilities are smoke free.
As a result, as many as 400 000 Russians die each year of smoking-related diseases, contributing to the country's declining life expectancy and population decline.3 Between 1989 and 2007, the average male life span dropped from 64 to 59 years, while the population of the country fell nearly half a per cent each year.
Tobacco control mass media campaigns are a proven and effective way to educate the public about the health harms of smoking and to reduce tobacco use among large target populations.4 Such campaigns—especially in conjunction with other tobacco control interventions, such as adopting 100% smoke-free laws and increasing tobacco taxes—can reduce smoking prevalence and change social norms.
While often a significant financial investment, mass media campaigns are cost effective. It is estimated that for every dollar spent on tobacco control programmes, two dollars in healthcare costs are saved.5 Costs can be further reduced by making use of existing research and adapting materials proven effective elsewhere6 and by putting political will to work.
Sponge comes to Moscow
In the winter of 2009, World Lung Foundation and the Moscow Duma Health Committee (the equivalent of a city council committee) joined forces to run a tobacco control mass media campaign, timed to coincide with an international annual quit day in late November and with the Russian New Year. Moscow, Russia's capital and largest city, is the political, financial and cultural centre of Russia, so it was an obvious choice for a campaign.
The purpose of the campaign was to begin to make a dent in a vastly pro-tobacco advertising landscape and to educate the public about tobacco's harms. Although the ultimate goal of an anti-tobacco campaign is to encourage quitting and thereby reduce prevalence, this was not expected from this initial communication.
The Moscow Duma selected an Australian public service announcement (PSA) called ‘Sponge’ for the campaign, following results from rigorous message-testing research,7 because it was a simple graphic PSA that was easy and inexpensive to adapt and had been shown to be effective at encouraging cessation in several countries, including Australia and the USA.8
Originally created by the Health Department of New South Wales, ‘Sponge’ encourages quitting by educating smokers about the cancer-producing tar that collects in the lungs of a pack-a-day smoker every year—about half a cup. When the PSA first aired in Sydney in 1983, a decrease of nearly 3% in Sydney's smoking rate that year was attributed to the campaign, compared with no decline in Melbourne, where the announcement was not shown.9
Moscow is a sophisticated, expensive, saturated media market, and the funds available for the campaign were not nearly enough to reach the 17 million people that live in the region. Nevertheless, the Civil Initiative, a Moscow-based non-governmental organisation that works in partnership with the Moscow Duma Health Committee, was able to make the most of a US$175 000 mass media grant. The Civil Initiative staff negotiated with the owners of television stations and billboard and metro media companies, requesting discounts and allotments reserved for PSAs. They made calls and sent letters with a copy of the PSA to personal contacts and to media owners who had taken a public stand against tobacco. Those media owners who were less inclined to offer discounts, especially media companies that accepted tobacco advertisements, were reminded by the Civil Initiative staff of their civil duty towards public health.
These efforts resulted in more than US$900 000 worth of free mass media, turning the Moscow ‘Sponge’ message into a million-dollar tobacco control campaign. The health committee was able to obtain deep discounts and free time on 10 channels. In addition, 200 free light boxes and posters were strategically placed in the Moscow metro.
The PSA in the metro appeared in the very spaces that the tobacco industry favours—near the metro exits, where tobacco advertisements are allowed and could trigger the urge to light up or buy cigarettes.
Free or deeply discounted ‘Sponge’ PSAs also ran on the radio, in major print newspapers and on 2500 street billboards across the city, as well as posters placed in bars and restaurants. The Civil Initiative also reached out to pulmonologists and to NGOs to make sure that posters were displayed in medical facilities and schools. The campaign ran from November 2009 to January 2010.
In addition to paid media, the Moscow Duma held a press conference to launch the campaign. This extended the reach of the campaign, as some 90 stories appeared in the news in the 2 weeks after the campaign first aired, including broadcasts of the advertisement as part of news segments on popular TV programmes. The advertisement was also reprinted in some of the city's most important newspapers to illustrate the articles written about the campaign.
Evaluating the Moscow ‘Sponge’ campaign
The campaign was evaluated in Moscow with a post-campaign household survey of smokers 18–45 years of age, the campaign's primary target audience. Fieldwork was conducted by the Russian Public Opinion Research Centre (VCIOM). Due to resource and timing issues, it was not possible to conduct a baseline survey.
The evaluation survey measured smokers' recall of the campaign PSA and their assessment of the campaign message in terms of its relevance, its ability to make them stop and think, provide new information and the concern it created about the harms of smoking. Knowledge, attitudes and behaviours in relation to smoking were also measured. Logistic regression analysis was conducted to compare the knowledge, attitudes and behaviours of those who were aware of the PSA with those who were not aware of the PSA, while controlling for potential socio-demographic confounders.
The PSA was recalled by 50% of respondents (see figure 1).10 The vast majority (63%) recalled the PSA through television, followed by metros (21%). Of smokers who recalled the PSA, 57% found it personally relevant, while 47% said that it made them concerned about their smoking and 43% said that they thought about quitting after seeing the advertisements.11 Campaign awareness was associated with significantly greater knowledge about the harms of smoking and increased interpersonal communication about smoking (see table 1), which is an important precursor to behaviour change.
The campaign met its objectives, by making smokers think more about the health harms of smoking, creating concern about smoking, increasing knowledge and encouraging discussion about the harms of smoking at home—all precursors to quitting.
Emboldened by the success of this initial campaign, the Duma Health Committee used the campaign as a springboard to call for a smoke-free Moscow—an issue that had failed to gain any real traction up until this point. Standing behind their commitment to tobacco control, their first piece of action was to remind the Duma of a 1998 law that required smoke-free Duma buildings and enforcement.
Then, in the spring of 2010, the health committee initiated a plan to broaden the effort to include all municipal buildings and healthcare facilities in Moscow, a first step towards a smoke-free city. They also followed this campaign with a second Duma Committee-supported Civil Initiative mass media campaign, focusing on the consequences of second-hand smoke, which aired in the autumn of 2010.
On 23 September 2010, the Russian government approved the National Tobacco Control Concept, a blueprint for tobacco control in the country based on the international Framework Convention on Tobacco Control. The concept stresses the importance of mass media communications, and campaigns have already appeared evoking this recent support. Recent initiatives have also called for eliminating tobacco advertising in the Moscow metro.
Beyond Moscow: discussion
Campaign reach is not simply a matter of media placement. Myriad studies indicate that hard-hitting, graphic emotive ads like ‘Sponge’, which teach smokers something new about the health harms of smoking and illicit strong, visceral, negative emotions about it, have a greater impact, and encourage quitting more effectively with fewer dollars, than advertisements that rely on softer messaging such as humour.4 In this way, graphic messaging requires fewer resources to communicate the intended message.
Unfortunately, too many governments across the world are reluctant to use strong advertising messaging or are simply unfamiliar with the value of hard-hitting mass media as a tobacco control intervention. Armed with the evidence, advocates can play an important role in this area by encouraging governments to put their weight behind effective, proven campaign materials and strategies. Where governments are reluctant to act on tobacco control measures, such as increasing taxes or passing smoke-free laws, mass media campaigns can act as catalysts.
In addition, too many opportunities are being overlooked, even in Russia. In St Petersburg, in recent years, the metro was awash with pictures of cats—media placeholders—as no one was buying the advertising space due to an economic crisis in the country, nor was anyone taking advantage of the free space (figure 2).
Nonetheless, the Moscow campaign was not the only one to harness mass media for an effective effort. In the Krasnoyarsk region, in the spring of 2010, the government paid US$10 000 to obtain US$100 000 worth of free and deeply discounted media.11 In Samara, the health officials were able to capitalise on funds available at the end of the year to negotiate discounted campaigns.
In the neighbouring Ukraine, tobacco control advocates appealed to media owners sympathetic to their cause and were able to obtain 65% discounts for television time for campaigns that began in 2008, in support of tax increases and smoke-free policies that are now in place.12 And in China, local authorities in several cities leveraged their status to secure discounts as high as 90% for tobacco control campaigns.
Some countries have laws requiring that a certain amount of airtime be given over to PSAs. In Russia, 5% is set aside; in China, 3%—something tobacco control advocates should investigate and take advantage of where possible.
In recognition of the power of mass media to educate and the challenge of sustaining it, Turkey's 2008 comprehensive tobacco control legislation includes a provision for 90 min a month of free TV and radio time, including 30 min of prime time. This legislation offers a model that other governments might follow.
What this paper adds
Mass media campaigns are effective tobacco control interventions and should not be dismissed as out-of-reach financially, especially where governments have some sway over the media landscape and can assist in achieving free or deeply discounted media.
Where tobacco control activity is stymied, mass media campaigns can work as catalysts for action.
Governments committed to tobacco control should consider enacting legislative solutions that allow for affordable and sustainable mass media campaigns.
The authors wish to thank their colleagues at World Lung Foundation for their assistance, in particular Mego Lien, Sandra Mullin, Trish Cotter and Tom Carroll. Special thanks also to Melanie Wakefield at the Cancer Council Victoria and to Fiona Godfrey at the International Union Against Tuberculosis and Lung Disease. The authors also gratefully acknowledge Bloomberg Philanthropies and the Bill & Melinda Gates Foundation, as part of the Bloomberg Initiative to Reduce Tobacco Use, for their generous support and ongoing commitment to international tobacco control.
Funding The campaign described was funded with seed money from the World Lung Foundation (Rebecca Perl, Irina Morozova, Nandita Murukutla, Alexey Kotov) via a grant to the Civil Initiative, a NGO affiliated with the Moscow Duma Health Health Committee (Ludmila Stebenkova, Veronika Kochetova). Russian Public Opinion Research Center (VCIOM) (Tatiana Voylokova and Julia Bakakova) received payment from World Lung Foundation for conducting the impact evaluation study described in this paper.
Provenance and peer review Not commissioned; externally peer reviewed.
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