Television advertisements that use graphic imagery to communicate the harms of smoking are globally effective, says survey

Television advertisements that graphically communicate the serious harms of tobacco use are likely to be effective with smokers in low- to middle-income countries and can be readily translated and adapted for local use – this was one of the key findings of a recent survey conducted in 10 countries where the non government organisation World Lung Foundation contributed as part of the Bloomberg Initiative to Reduce Tobacco Smoke.

The survey, however, noted that advertisement with complex medical terms or metaphors, or those that feature personal testimonials, are more variable and require more careful pre-testing and adaptation to maximise their potential.

"In order to test the comprehension, acceptability, and effectiveness of advertisements that emphasize the harms of second hand smoke exposure, especially on children (to the extent of getting smokers to quit) and increase awareness of the harms of second hand smoke exposure (and smoking) among both smokers and non-smokers, we conducted the survey," noted a release issued by the World Lung Foundation.

The aim of the study was to assess the comprehension, acceptability and potential effectiveness of five television advertisements in communicating an anti-smoking message and motivating cessation among adults in low- and middle-income countries.

While television advertisements that communicate the serious harms of smoking are effective in prompting quitting related thoughts and actions, little research has been conducted among smokers in low to middle income countries to guide public education efforts.

As part of the study, 2,399 smokers aged 18- 34 years in 10 low to middle income countries (Bangladesh, China, Egypt, India, Indonesia, Mexico, Philippines, Russia, Turkey and Vietnam) viewed and individually rated the same five anti-smoking advertisements on a standard questionnaire and then engaged in a structured group discussion about each advertisements. Three advertisements with graphic imagery performed consistently highly across all countries. ``Two of these showed diseased human tissue or body parts and the third used a disgust provoking metaphor to demonstrate tar accumulation in smokers' lungs. The graphic imagery had a strong emotional impact on participants, with common reactions of disgust, fear and shock. The portrayals of external visible damage as a result of smoking, and serious damage to internal organs, were considered powerful and motivating,'' noted the release.

"Seeing these advertisements made me scared and made me think of quitting. I feel shocked" --- are some of the responses received from smokers in countries like Indonesia, China and India.

"This study suggests that ads that use graphic imagery to communicate the serious harms of smoking are universally understood and are effective in prompting smokers to quit. Disgust is a universal response, and fear can be a strong motivator for behaviour change, if used correctly," says World Lung Foundation, research and evaluation, director, Dr. Nandita Murukutla. "The cost, lead time and expertise involved in producing new media campaigns in countries with limited resources can present considerable barriers in promoting a social cause. One way to reduce these barriers is to translate and adapt advertising material produced elsewhere, thereby saving on production costs and time and concentrating resources for actual campaign broadcast. Advertisements with good potential may include those without people (eg, featuring only body parts or using a simulation) or those where people do not speak directly to the camera, so a voiceover can be recorded. The challenge now is to ensure the application and resourcing of effective media campaigns in low to middle-income countries, consistent with the objectives of Article 12 of the WHO Framework on Tobacco Control," suggested the study.

“Tobacco use is the leading cause of death globally and mass media campaigns are proven to prompt people into quitting. This is all the more urgent in India where people face a triple threat from bidi, smokeless tobacco and cigarettes. We need strong mass media campaigns to warn people about the dangers of second hand smoke on people around them including their loved ones,” says World Lung Foundation policy and communications, senior vice-president Sandra Mullin.