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Should anti-tobacco media messages be culturally targeted for Indigenous populations? A systematic review and narrative synthesis
  1. Gillian Sandra Gould1,
  2. Andy McEwen2,
  3. Tracey Watters3,
  4. Alan R Clough4,
  5. Rick van der Zwan5
  1. 1School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia
  2. 2Cancer Research UK Health Behaviour Research Centre, Epidemiology and Public Health, University College London, London, UK
  3. 3Southern Cross University, East Lismore, New South Wales, Australia
  4. 4School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia
  5. 5Rural Clinical School, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Gillian S Gould, PO Box 9077, Moonee Beach 2450, NSW, Australia; gillian.gould1{at}


Objective To summarise published empirical research on culturally targeted anti-tobacco media messages for Indigenous or First Nations people and examine the evidence for the effectiveness of targeted and non-targeted campaigns.

Methods Studies were sought describing mass media and new media interventions for tobacco control or smoking cessation in Indigenous or First Nations populations. Studies of any design were included reporting outcomes of media-based interventions including: cognitions, awareness, recall, intention to quit and quit rates. Then, 2 reviewers independently applied inclusion criteria, which were met by 21 (5.8%) of the studies found. One author extracted data with crosschecking by a second. Both independently assessed papers using Scottish Intercollegiate Guidelines Network (SIGN; quantitative studies) and Daly et al (qualitative studies).

Results A total of 21 studies were found (4 level 1 randomised controlled trials (RCTs), 11 level 2 studies and 6 qualitative studies) and combined with narrative synthesis. Eight evaluated anti-tobacco TV or radio campaigns; two assessed US websites; three New Zealand studies examined mobile phone interventions; five evaluated print media; three evaluated a CD-ROM, a video and an edutainment intervention.

Conclusions Although Indigenous people had good recall of generic anti-tobacco messages, culturally targeted messages were preferred. New Zealand Maori may be less responsive to holistic targeted campaigns, despite their additional benefits, compared to generic fear campaigns. Culturally targeted internet or mobile phone messages appear to be as effective in American Indians and Maori as generic messages in the general population. There is little research comparing the effect of culturally targeted versus generic messages with similar message content in Indigenous people.

  • Cigarette smoking
  • mass media
  • indigenous populations
  • health communication
  • health promotion

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  • Funding This work was supported by a National Health and Medical Research Council (Australia) and National Heart Foundation (Australia) cofunded postgraduate training scholarship for Indigenous Health Research, grant number APP1039759.

  • Competing interests None.

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