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A new image for Birmingham
  1. Paul Hooper
  1. P Hooper, Smoke Free Birmingham, Southern Birmingham Community Health NHS Trust, Springfields Centre for Health Promotion, Raddlebarn Road, Selly Oak, Birmingham B29 6JB, UK.sfbham{at}

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Birmingham is the United Kingdom’s second largest city and has a population of approximately a million. Since 1985, it has had a prominent role in tobacco control in Britain, initially through the work of Birmingham City Council with its pioneering policies, and then through its collaborative work with various agencies including the Health Authorities and the commercial sector.

For many years, the local tobacco control campaign in Birmingham has been generating its own resources for use within the city. Sometimes this has occurred when a demand for a particular type of resource could not be met by other providers. At other times resources have developed out of other initiatives.

In 1986, when the Birmingham City Council first got involved in tobacco control, it found there was a great demand for clear signs designating areas as being non-smoking. A simple A4 (21×30 cm) vinyl adhesive sticker was developed along with materials for use in restaurants such as front adhesive stickers stating that smoke-free tables were available, and pyramid table signs. The stickers proved to be so popular that I am reliably informed that they can be found in many different countries across the globe, and several organisations have “amended” the sticker by replacing the original logo with their own.

In 1993, with funding from the then West Midlands Regional Health Authority, a multi-agency intersectorial group was formed with specific funding to carry innovative activities with the aim of reducing smoking prevalence. The specific funding and the innovative remit enabled a variety of new resources to be developed, many of which have now been disseminated worldwide.

Body messages

Three of the earlier images were centred on a use of the human body as an art form and message delivery system. It followed collaborative work among the North Birmingham Community Health Trust, the City Council’s Youth Service, and local communities. The “Cut it out” initiative included young people amending the then fashion trend of head shaving and hair sculpting to include health logos (figure 1). This was not only fun and fashionable, but generated media interest and wide publicity. The young men who agreed to have their heads shaved were also contracted to tour youth centres to impart health messages to other youngsters.

As part of the “Cut it out” initiative, these young men had their heads shaved with health messages. Posters and postcards of this image were produced during a peer education exercise initiated by North Birmingham Community Health NHS Trust, Health Promotion Service.

“Face facts” (shown on the cover of this issue of Tobacco Control) was generated from work with local play leaders who turned their children into mobile colourful “No smoking” signs by the use of face paints. Initially, this was part of a fun-filled activity day. Photographs were taken and mounted in a special cover that provided information on the dangers of passive smoking in the home, and these were then passed on to parents or guardians. Parents were considered unlikely to throw away photographs of their children, whereas a leaflet with a similar message would have quickly found itself in the bin! Again, this initiative was extremely visual and attracted local media interest. As a result of the above campaigns, the best images were selected and developed into poster and postcard resources for use in youth and wider community settings.

The “Face facts” initiative has since been further developed and enhanced. It is now part of the City’s mainstream smoking prevention programme, and approximately 5000 young children took part in this activity last year (1997/8).

A further idea picked up on local youth culture and a demand for temporary “tattoos”. A heart-shaped image with the caption “Smoke Free—Breathe Easy” was developed by a graphic design student from the University of Central England (UCE), and high-quality transfers were printed and then distributed through youth and community settings (for example, discos). These tattoos had a high perceived street value—with some even being re-sold. The initial print run of 28 000 sheets with five tattoos on each was soon used up. A second print run used a new technique where some of the colours in the tattoo fluoresced under ultraviolet light. A poster was developed using an image of a “tattooed” but otherwise bare-chested black male youth. The poster, coincidentally, pre-empted the national teenage smoking campaign slogan “Respect”.

Minority ethnic groups

Birmingham remains one of the few organisations in the United Kingdom that has produced materials for use with minority ethnic groups. The Southern Birmingham Community Health NHS Trust has worked through minority ethnic communities to develop bilingual materials on passive smoking issues and advice on how to quit. Nationally, there has been a lack of materials in community languages, and those working on this initiative soon discovered why that was the case, as it took more than two years to develop these materials. Being mindful of the need to produce culturally acceptable images and for the languages to be translated sympathetically and accurately meant that numerous checking procedures were needed. The result of the initiative was two leaflets in each of eight languages: Urdu, Punjabi, Bengali, Hindi, Gujerati, Arabic, Chinese, and Vietnamese. These materials have been widely distributed in the city and purchased by others. They also form the basis of materials used by the freephone (toll-free) Asian Quitline—a service provided nationally—which gives friendly and helpful advice in a number of community languages on how to quit or remain abstinent.

A further link with the UCE saw the development of a poster aimed specifically at the city’s Muslims during the holy month of Ramadan. A Muslim graphic design student developed a design for a poster that has now been used for the past four years. The poster design had to allow for the late insertion of prayer and fast times that are determined by committee and the cycle of the moon. These times vary each year. The design has also been offered to other communities across the country as it allows local information to be inserted easily. This is particularly important as the prayer times for Ramadan, which form the basis of the calendar poster, will vary from city to city.

During the month of Ramadan, Muslims must refrain from eating, drinking, smoking, and sexual intercourse from dawn until sunset. The original Ramadan poster had a simple smoke-free message of “Give up smoking for Ramadan? Give up for good!”. However, in 1997, after negotiations with local Muslim religious leaders, the message was changed to “Allah forbids self harm and harm to others. In this holy month of Ramadan—why not give up smoking forever and conform to Allah’s will?”. This much stronger message was surprisingly well received and was featured on local and regional television. The poster also included details of the new Freephone Asian Quitline counselling service.

Other previous involvement with the University of Central England has included the design of a poster for use in waiting areas, showing the benefits of quitting smoking over time, and advertising for the London Science Museum’s Passive Smoking Exhibition, which was brought to Birmingham for a period of six weeks. In addition, a three-dimensional static display was developed for No-smoking Day 1996, and which included newly fashionable “mini display boxes” and even a zoetrope showing a cigarette being stubbed out. This display was featured in a shopping centre around the time of No-smoking Day, and was then transferred for a year to the city’s nature centre where it would have been seen by all the centre’s visitors, including many schools groups.

Further collaboration with the UCE

The most ambitious link so far with the UCE was prompted by the “Put smoking out of fashion” concept developed by the national Health Education Authority (HEA). The HEA had approached the fashion industry with a goal of reducing smoking images being used to advertise new collections of clothes and other fashion apparel, and with a desire to generate media interest in the problem.

Smoke Free Birmingham approached the UCE with the idea of extending that concept to making smoking not fashionable in a broader sense. During discussion it became clear that in addition to graphic design students, photographers, and illustrators, the UCE has courses for fashion and textile students. The visual communications course and the fashion courses had never previously worked together. In conjunction with Smoke Free Birmingham, the various course tutors designed a brief for the second-year BA course “team project”. A presentation was given to all the students involved in the project, including a brief history of tobacco control and examples of tobacco control visual materials from the United Kingdom and elsewhere.

In all, more than 120 students were involved in the project, split into 22 separate project groups—each of which had a fashion student as part of the team. The students were instructed to develop a new concept for promoting smoking as being unfashionable, and a broader concept involving displays or street theatre to take their designs further. Each fashion student was to produce a related garment that complemented or enhanced the concept.

The students were given six weeks before the first assessment stage, during which time the course tutors provided technical support and the Smoke Free Birmingham team provided additional advice on smoking issues. Although the theme was to “put smoking out of fashion” and should have been aimed at young people, certain groups were given permission to broaden the concept into other areas such as smoking in pregnancy and themes that would appeal to younger children.

At the time of the first assessment stage, it became clear that we had created a monster that was beginning to take on a life of its own. Fortunately, at this time (March 1997) the Birmingham Health Authority had committed itself to tackling smoking prevention in the city with a new three-year programme developing the work of Smoke Free Birmingham and its partners from previous years. This gave us an ideal opportunity to use some of the UCE materials in the launch of the new smoking programme. The 22 concepts were judged, and then one (“Make history”) was selected for further development as a street theatre launch event. Each garment design was prepared for a fashion show, and the other materials were developed to final artwork stage for an exhibition.

Figures 2–6 are students’ designs which form part of the Smoke Free Birmingham/University of Central England joint project. This image, “Exposed”, implies that in the future cigarettes will be consigned to the history books.

The Smoke Free Birmingham team assisted the students in the production of some of the materials and, in particular, the realisation of the street theatre concept. Another concept—“Serial killer”—was also selected for later us in the smoking programme and was deliberately left out of the launch exhibition so as to preempt the use of the materials by others.

The students had just six weeks to complete the project. The Smoke Free Birmingham team used its networks to identify venues for the premiere of the fashion show and the “Make history” theatre event. The Holiday Inn, Crowne Plaza, Birmingham, donated its exhibition and conference suites and the City Council, International Convention Centre, and the Birmingham Repertory Theatre gave space for the street theatre event. Local companies donated materials for costumes, and other materials were borrowed (or begged) from a variety of sources, including the BBC props department!

The first fashion show, held at the Holiday Inn, was principally targeted at decision makers within Birmingham, promoting the need to increase the level of prevention activity in the city, and formally launching the city’s smoking programme in an unusual way. This “all ticket” event received wide media coverage, and was then followed by the public event in a city square with the theme “Make smoking history”. The concept was to look into the future to see what a non-smoking community would make of cigarettes found on an archaeological dig, and for them to then travel into the past to warn present-day smokers of their impending doom. Home-made futuristic costumes and use of school pedestrian crossing wardens’ “lollipop” signs were literally traffic stopping aspects of the event. Links with local sports organisations helped to make the day interactive and participative.

The total cost to the health authority in cash terms for the two events and exhibition was approximately £10 000(US$166 000). However, the estimated real cost is in excess of £150,000 (US$249 000), and we now have 88 panels worth of original artwork to draw upon for future projects. A few examples of this artwork are reproduced here (figures 2–6). However, more than 80 images from the project can be found on our web site <> in the “UCE Gallery” section. (See Web Watch on page 190 for a review of this web site.—ed) Although copyright is held by the UCE and Smoke Free Birmingham, we would welcome requests from those who would like to use images with permission.

“Serial killer” was a title for the concept from another group, which was developed into a “Who dunnit?” event for an open day in Birmingham City Centre. A police-like incident room was set up where the general public was invited to find out how tobacco is a “serial killer” and to get advice for themselves or others on quitting. The “evidence” consisted of the statements and artefacts of “witnesses”. There were white body-outline shapes taped to the floor, representing the number of people killed in Birmingham each week from smoking-related diseases, and the staff were dressed in uniforms reminiscent of those in the Men in Black movie which was popular at the time. This concept has now been developed further for others to use as a form of street theatre.

The future

Birmingham is competing with others to become the United Kingdom’s first, truly smoke-free city. The smoke-free city will provide effective help for people wanting to quit smoking, will discourage people—especially the young—from starting to smoke, and will protect everyone from the effects of passive smoking. To do this, we are aware that we will have to overcome the tactics of the tobacco industry and its sophisticated marketing and artistic promotions.

Birmingham has committed significant resources to combating smoking (more than £550 000 (US$913 000 in 1998/9)). However, these resources pale into insignificance when compared with the resources available to the tobacco industry. By forming mutually beneficial partnerships with organisations such as the UCE, we can enhance our materials while at the same time providing valuable experience for young people. We recommend these collaborations—they are challenging and educational for all involved, and are extremely cost effective as well.

Note to readers

We hereby solicit your ideas and contributions for future covers of Tobacco Control. As with previous covers, we would like future covers to be colourful and creative—with a tobacco control theme. Original artwork, anti-tobacco posters, photographs, and cartoons may all be considered. Material with an international flavour would be particularly desirable. A cover essay will generally appear in each issue to provide appropriate background information and commentary on the cover.  Please send ideas and submissions (original or high-quality, camera-ready photographs) to the editor at the address on the inside front cover.—ed


The Author acknowledges the contributions made to the initiatives described by individuals too numerous to mention.

Figure 3

“Monster” is part of a set of light-hearted cartoons with a serious message.

Figure 4

Although seen here as a stand-alone image, “Pressure” was intended for use as part of a multimedia presentation.

Figure 5

“Wrinkles” is part of a set of images showing different effects of smoking on the human body. Others include a foot pump illustrating impotence, an air freshener, toilet brush and a clothes peg.

Figure 6

“Janet Smells a Flower—Jon Smells” is visually attractive but with a hard message. Reminiscent of early primary school reading books, it is one of a series that looks at the two sides of the smoking issue. Other images in the series vary the sex, race and cultural background of the characters, which reflects the mixed population of Birmingham.

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