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Shame-based appeals in a tobacco control public health campaign: potential harms and benefits
  1. Cati G Brown-Johnson,
  2. Judith J Prochaska
  1. Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, California, USA
  1. Correspondence to Dr Judith J Prochaska, Department of Medicine, Stanford Prevention Research Center, Stanford University, Medical School Office Building, X316, 1265 Welch Road, Stanford, CA 94305-5411, USA; JPro{at}

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Smoking is the leading preventable cause of death worldwide, responsible for 1 in 10 deaths globally (>5 million a year). Tobacco use adversely impacts not just smokers, but also those around them through secondhand smoke exposure. Given the significant personal and societal costs of tobacco use, any strategy to reduce smoking should be considered.

In this issue, Amonini et al1 report on development and evaluation of a shame-based public health campaign in Perth, Australia. Public health media campaigns in Australia, in particular, have raised awareness and instigated behaviour change via approaches ranging from direct and forceful (eg, ‘Belt Up or Suffer the Pain’ seatbelt campaign2) to humorous and memorable (eg, ‘Slip! Slop! Slap!’ for skin cancer prevention3).

In developing their tobacco control ad campaign, Amonini et al conducted focus groups with smokers and interviewed former smokers, identifying salient themes of social isolation (eg, “you feel like a ‘leper’”). Next, they created and piloted an ad prototype in an experimental setting, which demonstrated believability/relevance and perceived efficacy in stopping smokers from smoking. Finally, they created the shame-based ad, evaluating it in a publicly launched campaign where a majority of respondents self-reported in the first several weeks that they reduced cigarette consumption (36%), attempted cessation (16%) or quit (2%).

While suggestive as a promising public health approach, …

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