Comparative responses to radio and television anti-smoking advertisements to encourage smoking cessation

Transcription

1 Health Promotion International, Vol. 25 No. 1 doi: /heapro/dap044 Advance Access published 24 October, 2009 # The Author (2009). Published by Oxford University Press. All rights reserved. For Permissions, please journals.permissions@oxfordjournals.org Comparative responses to radio and television anti-smoking advertisements to encourage smoking cessation SARAH DURKIN * and MELANIE WAKEFIELD Centre for Behavioural Research in Cancer, The Cancer Council Victoria, 1 Rathdowne Street, Carlton, Victoria 3053, Australia *Corresponding author. sarah.durkin@cancervic.org.au SUMMARY While mass media campaigns have been shown to contribute to reductions in smoking prevalence, little research has been undertaken on the effectiveness of radio advertising as a communication medium. This is despite radio being less expensive and having greater reach than television in some low and middle income countries. We aimed to explore the potential of radio as an adjunct or alternative to televised campaigns by comparing reactions to a radio anti-smoking ad with three televised anti-smoking ads, all of which communicated the serious health consequences of smoking in an emotionally evocative way. In pre-exposure interviews, year-old daily smokers (n ¼ 306) were asked to listen to a particular radio time slot/watch a particular television program that they usually listened to/watched, in which the ad was broadcast. Post-exposure interviews were conducted within 3 days of exposure and measured recall, recognition, emotional and cognitive responses, and intentions to quit smoking. Findings indicate that the radio ad showed similar or slightly higher levels than a concurrently aired television ad on understanding (radio: 96%; television: 95%), believability (radio: 89%; television: 90%), concern about smoking (both 77%) and motivation to quit (radio: 51%; television: 45%), and significantly higher levels of unprompted recall (radio: 20%; television: 6%). It also compared well against two subsequent antismoking television ads. Emotionally evocative radio advertising may be an effective adjunct or alternative to television advertising in jurisdictions where there are substantial limits on funds available for airing these campaigns, or where the reach of radio outstrips television. Key words: smoking; advertising; social marketing; radio As most jurisdictions in westernized countries begin to drive smoking prevalence down, tobacco is set to exert an increasing toll upon densely populated developing countries, where smoking prevalence continues to rise and funding for tobacco control initiatives is severely limited. Ongoing televised antismoking campaigns broadcast at sufficient levels of exposure have been found to be a key component of the comprehensive tobacco control strategies credited for reducing smoking rates in high income countries (Pierce et al., 1998; Biener et al., 2000; National Cancer Institute, 2008; Wakefield et al., 2008). However, some low and middle income countries may find the costs of televised advertising prohibitive, and for others, television may be a medium with relatively low reach into the population. Radio-based campaigns may provide a potentially cheaper adjunct or alternative for 5

2 6 S. Durkin and M. Wakefield broadcasting anti-smoking messages and may have even greater reach than television in many low and middle income countries. Even in the USA, recent nationally representative research found that radio showed relatively good population reach and exceeded the reach of television between 6 am and 6 pm among smokers (Nelson et al., 2008). This study also indicated that smokers are heavier users of radio than non-smokers, with a significantly greater proportion of smokers who listen to the radio for two or more hours a day than non-smokers. Although radio provides reasonably good population reach and radio-based ads are comparatively inexpensive to produce and broadcast, investing in this communication medium would only be worthwhile if radio-based anti-smoking messages can be at least as effective in increasing awareness, concern about smoking and motivation to quit, as has been found in response to televised campaigns (National Cancer Institute, 2008). To date, there have been few direct comparisons of the effectiveness of radio versus television ads. A recent comparison of the cost effectiveness of television, radio and print advertisements in driving calls to the New York quitline found that for every $1000 increase in each medium s expenditure, call volume increased by 0.1, 5.7 and 2.8%, respectively (Davis et al., 2007). However, population-based studies in Massachusetts and California have found that televised ads are associated with greater recall than radio ads (Biener et al., 1994, 2001; Gilpin et al., 2003), and recall of antismoking televised messages, but not radio messages, have been related to reduced adolescent smoking (Solomon et al., 2007) and reduced initiation (Biener and Siegel, 2000). However, with these population-based studies, it is difficult to determine whether the null effects for radio campaigns are related to the format per se, to the types of messages typically broadcast in this medium, or to lower levels of population exposure to messages broadcast in this medium. Recent research indicates that messages that produce strong emotional arousal, particularly portrayals of the health effects of smoking, are perceived as more effective, are more likely to be recalled, and generate more thought and discussion (Biener et al., 2004, 2008; Terry-McElrath et al., 2005; Pechmann and Reibling, 2006). It is possible that the radio campaigns broadcast at the population level were not able to achieve adequate levels of emotional arousal, as well as population reach. Experimental studies, where lack of exposure is less of an issue, have shown more positive results for radio campaigns. An early field experimental study by Bauman et al. (Bauman et al., 1991) found that a radio campaign had a modest effect on adolescents expected consequences of smoking and friend approval of smoking, and that this campaign was not less effective than a version of the campaign that also included televised versions of the messages. Also, experimental studies of responses to radio messages about the harms of light and mild cigarettes (Kozlowski et al., 1999, 2001; Shiffman et al., 2001a, b) have indicated these ads increase awareness and knowledge and may encourage quitting. To more accurately explore the potential of radio as an adjunct or alternative to televised campaigns, research is needed to directly compare the effectiveness of radio versus televised anti-smoking ads where the messages are similar in terms of emotional tone and content. In 2005, an anti-tobacco organization in Victoria, Australia (Quit Victoria) produced new advertising material about the smokingrelated disease emphysema, which included an emotive television and radio advertisement similar in emotional tone and content (Durkin et al., 2006). This study aims to compare recall, recognition, emotional and cognitive responses, and intentions to quit smoking after exposure to this emotive anti-smoking radio ad, with smoker s responses after exposure to the concurrent television ad. This radio ad will also be compared to two subsequent televised antismoking ads with a similar type of message and emotional tone, but featuring different smoking-related disease risks. METHOD Description of the radio ad The 60 s Emphysema radio advertisement ( 6871) had the sound of a man breathing in and out accompanying the following script I m going to do a little demonstration and I want you to do it with me. Right, take a deep breath, deep as you can and hold it. Now, take another breathe on top of it, you won t be able to take

3 Responses to radio and television anti-smoking advertising 7 much in. Breathe out, just that last bit and breathe in again. Out...in... This is what breathing is like in the later stages of Emphysema. Sufferers describe it as feeling like you re suffocating 24 hours a day. Even if you only smoke low tar cigarettes, chances are you have Emphysema in its early stages, just about every smoker does. So now you know what lies ahead, take a deep breath and call Quitline , The Emphysema radio advertisement was launched in Victoria in February 2005, ran on three radio stations and was aired a total of 146 times over the three week campaign. with a close-up of the pictorial mouth cancer health warning on a cigarette pack. As the camera moves away it reveals a woman with mouth cancer talking: Smoking caused my mouth cancer. If it didn t I wouldn t be needing radiotherapy and chemotherapy. Quitting is hard...not quitting is harder. If you don t like looking at mouth cancer, look at another part of the pack. While the woman is talking, the camera again focuses in on the mouth still talking as part of the pack and then cuts to the Quitline number on the pack. The Mouth Cancer ad was launched in Victoria in July Description of television ads The 30 s Bubblewrap television ad ( quit.org.au/article.asp?contentid=6871) was aired as part of the same campaign as the radio ad with both ads highlighting the smoking related disease emphysema. The Bubblewrap television ad depicted a piece of Bubblewrap cut in the shape of two lungs and a trachea. A hand with a lit cigarette starts at the bottom of the lungs bursting the bubbles one by one with the burning tip of a cigarette. There is a voice-over accompanying these images, Lungs are made up of millions of tiny air sacs... chemicals in tobacco smoke destroy them. It s called emphysema and it s irreversible. Even if you only smoke low tar cigarettes...chances are you have emphysema in its early stages. Virtually every smoker does. The final frame is black and features the Quitline logo and , with the final voice-over, Call Quitline, , The Bubblewrap television advertisement was also launched in Victoria in February 2005 to coincide with the radio ad launch. The 30 s Amputation ad ( org.au/article.asp?contentid=10297) shows a person about to undergo an amputation of their gangrenous leg with a surgeon describing how smoking caused their gangrene: Every time you inhale tobacco smoke...toxic chemicals go into your bloodstream and travel to every part of your body. That s why this smoker has gangrene. I want you to think of what s happening here... every time you look at your cigarette pack... every time. Amputation was launched in Victoria in May The 30 s Mouth Cancer ad ( org.au/article.asp?contentid=13612) begins Procedure A market research agency was commissioned to undertake data collection using a Natural Exposure SM advertising research (NEAR) methodology. The NEAR method is based on the premise that to accurately assess the impact of an advertisement on listeners, it is best to test the ad in real world, natural exposure conditions. The method involves a pre-exposure interview, in which participants are asked to listen to a particular radio timeslot or watch a particular television program, of which they had previously indicated they were listeners/viewers, no more than 12 months earlier. For each evaluation, all respondents were recruited from the market research agency s list of respondents to a survey conducted in the past year of over Australians, which included detailed questions about radio listening, television viewing and the use of a wide range of consumer products including cigarettes. Based on the initial survey, participants who fit the selection criteria were approached to be involved in a survey of people s reactions to a radio program/television program. During the pre-exposure interviews, interviewers confirmed participants fit the selection criteria and that they still listened to/watch the specified programs during which the advertisement was scheduled to be played. They then asked them to listen to those programs this week paying attention to the parts that interest you and ignoring the parts that don t. This pre-exposure interview method ensures that no priming takes place. The natural exposure evaluation of the Emphysema radio ad was conducted in the second week of the campaign. The ad was

4 8 S. Durkin and M. Wakefield scheduled to play within the morning and evening drive time program slots from 7 am to 9 am and 5 pm to 7 pm across the three highest rating radio stations. Participants who indicated that they listened to any of these stations during these times or who switched between these three stations during these times could be recruited. The post-exposure interviews were conducted within 2 days of each of the radio programs being aired. The natural exposure evaluation of the Bubblewrap television ad was conducted in the second and third weeks after the launch of the ad. The natural exposure evaluations of the other campaigns occurred within the first week of the launch of each campaign. Outcome measures Recall The post-exposure interviews were conducted within 2 3 days of each of the programs being aired. Respondents were screened to determine whether they had listened to or watched the specified program. If respondents had listened to/watched the program, they were then asked whether they listened to/watched any of the advertisements in the program. Respondents who did listen to/watch at least some of the advertisements were then asked which ads they could recall (unprompted). If they did not mention the anti-smoking ad, they were prompted about whether they had heard/seen an ad on the dangers of smoking (semiprompted recall). If they said no, the ad was described in full, and then respondents were asked whether they remembered hearing/seeing an ad like that (fully-aided recall). Reactions, attitudes and intentions All respondents who recalled having heard/seen the ad were asked a number of questions about their cognitive and emotional reactions to the ad. Respondents indicated whether they strongly agreed, agreed, neither agreed nor disagreed, disagreed or strongly disagreed with a number of statements. Those who somewhat agreed or strongly agreed with each statement were combined to determine the proportion of respondents who reported they had understood and believed the ad, who felt the ad had made them stop and think (cognitive reactions), feel uncomfortable, concerned about their smoking (emotional reactions) and motivated to try to quit (behavioural intention). Finally, participants were asked whether they discussed the ad with anyone. Those who were exposed to the radio ad were also asked whether they followed the breathing instructions in the ad. Logistic regression analyses were used to examine reactions to the different ads, with the Emphysema ad as the referent and agreement with each statement (or not) as the dichotomous dependent variable. Gender, age, education level, household income and country of birth were covariates. Participants Daily smokers aged between 18 and 59 years and who resided in the capital city of Victoria (Melbourne) were recruited for each ad evaluation. One hundred such smokers agreed to listen to one of the radio time slots during which the Emphysema radio ad was aired. In practice, the Emphysema ad was not played in two timeslots specified. Five respondents reported listening to only these time slots and were therefore excluded from further analyses. Two thirds (66%, n ¼ 63) of the respondents listened to one of the radio program time slots during which the Emphysema radio ad was aired. Of those who did listen to one of the radio programs, 3% (n ¼ 2) reported that they did not listen to any of the commercial breaks while listening to the program/s, leaving a final sample of n ¼ 61 respondents who were potentially exposed to the Emphysema radio ad (Table 1). The number of daily smokers who were Table 1: Number of smokers recruited and potentially exposed to each anti-smoking ad Ad name Emphysema radio ad Bubblewrap television ad Amputation television ad Mouth Cancer television ad Number recruited Number potentially exposed to ad % Potentially exposed % % % %

5 Table 2: Characteristics of smokers potentially exposed to each ad Responses to radio and television anti-smoking advertising 9 Total sample characteristics, %(N ¼ 306) Emphysema radio ad, % (n ¼ 61) Bubblewrap TV ad, % (n ¼ 113) Amputation TV ad, % (n ¼ 79) Mouth Cancer TV ad, % (n ¼ 53) Chi-square of differences between ads (p-value) Occupation 6.7 (0.66) Professional, manager, 17.7 (n ¼ 54) owner, farmer Sales, semi-professional 11.1 (n ¼ 34) Skilled, semi-skilled, 69.9 (n ¼ 214) unskilled manual, clerk, farm worker No occupation 1.3 (n ¼ 4) Income 2.3 (0.89),AUD $60K 45.1 (n ¼ 138) AUD $60K 38.2 (n ¼ 117) No answer 16.7 (n ¼ 51) Country of birth 6.1 (0.11) Australian/New Zealand 85.6 (n ¼ 262) born Other country 14.4 (n ¼ 44) Education 11.2 (0.08) Year 11 or less 51.6 (n ¼ 158) Year 12 or trade 24.5 (n ¼ 75) At least some university 23.9 (n ¼ 73) Age 0.3 (0.95) years old 77.8 (n ¼ 238) years old 22.2 (n ¼ 68) Gender 4.6 (0.20) Male 36.6 (n ¼ 112) Female 63.4 (n ¼ 194) recruited and potentially exposed to the other three television anti-smoking ads are presented in Table 1 and the characteristics of the total sample exposed to all four ads is presented in Table 2. RESULTS Respondents recall and recognition of the emphysema radio ad compared to the concurrent television ad and two subsequent anti-smoking television ads Unprompted recall When asked to name any ads they could remember airing during the nominated radio program, 20% of listeners spontaneously recalled the Emphysema ad (Table 3). This level of unprompted recall was significantly higher than for the concurrently televised Bubblewrap television ad (OR ¼ 0.27, 95% CI: 0.10; 0.74, p, 0.05), and no different to the four other televised ads (Table 3). Semi-prompted recall Another 18% recalled hearing the Emphysema ad after being asked do you remember hearing an advertisement on the dangers of smoking? This level of semi-prompted recall was lower than that found for the Bubblewrap television ad (OR ¼ 2.27, 95% CI: 1.05; 4.90, p, 0.05) and the Amputation ad (OR ¼ 2.37, 95% CI: 1.02; 5.51, p, 0.05). Recognition Another 39% recognized the radio ad after a description was read out to them, and this level of recognition did not significantly differ from the televised anti-smoking ads. Total recall and recognition Overall, 77% of those who listened to at least some of the commercial breaks recalled or recognized the Emphysema ad, also comparable to the five anti-smoking television ads.

6 10 S. Durkin and M. Wakefield Table 3: Recall, recognition and reaction to an anti-smoking radio ad compared to anti-smoking television ads % Agree or strongly agree Emphysema radio (ref) Bubblewrap television Amputation television Mouth Cancer television Recall and recognition (%) n ¼ 61 n ¼ 113 n ¼ 79 n ¼ 53 Unprompted 20 a 6* Semi-prompted 18 a 34* 32^ 21 Recognition Total recall and recognition Reactions (%) n ¼ 47 n ¼ 76 n ¼ 67 n ¼ 41 Understood Believed 89 a * Stop and think 81 a 71 60** 66* Uncomfortable Concerned Motivated to quit Discussed ad 19 a 26 42* 37^ a Reference group; *p, 0.05, **p, 0.01, ^p, 0.10; all analyses controlled for gender, age, education level, income, country of birth. Reactions to the emphysema radio ad Almost all respondents reported that they understood (96%) and believed (89%) the Emphysema ad (Table 3) a significantly higher level of believability than that found for the Mouth Cancer television ad (OR ¼ 0.23, 95% CI: 0.07; 0.76, p, 0.05), but not the other television ads (Table 3). Over three quarters of daily smokers interviewed agreed that the Emphysema ad made them stop and think (81%) a significantly higher proportion than found for the Amputation television ad (OR ¼ 0.23, 95% CI: 0.09; 0.61, p, 0.01) and the Mouth Cancer ad (OR ¼ 0.30, 95% CI: 0.10; 0.86, p, 0.05). More than half reported that the ad made them feel uncomfortable (60%), around three quarters reportedthattheadmadethemfeelconcerned about their smoking (77%) and half reported that the ad had made them feel motivated to try to quit (51%) all comparable to the levels found for the other anti-smoking television ads. Nearly a third of the respondents who heard the ad followed the breathing instructions (30%), while almost a fifth (19%) had discussed the ad with someone else. This level of discussion was significantly lower than that found for the Amputation televised ad (OR ¼ 3.57, 95% CI: 1.40; 9.12, p, 0.01) and the Mouth Cancer ad (OR ¼ 3.22, 95% CI: 1.15; 9.05, p, 0.05). DISCUSSION Overall, the results of this study indicate there was high awareness and understanding of the Emphysema radio ad, and most agreed it was thought provoking and made them feel more concerned about their smoking. Around half also agreed the ad had motivated them to try to quit smoking. The radio ad achieved similar or slightly higher appraisals than the concurrently broadcast Bubblewrap television ad (about the same disease) in terms of understanding, believability, concern about smoking and motivation to quit, and significantly higher levels of unprompted recall. The Emphysema radio ad also compared very well on most of these measures with the two other anti-smoking television ads that were aired over the following three years in the same jurisdiction and that were similar in highlighting the health effects of smoking using graphic and emotive depictions. Therefore, emotive radio ads may be a very cost effective method of informing and motivating smokers to quit given the approximately equivalent cognitive and emotional responses and the lower costs of producing and airing radio ads. The radio ad cost AU $8000 to produce and AU $ per week to air, compared to an average of AU $ for production and AU $ per week to air each of the television ads. The radio ad had high levels of unprompted recall, indicating that it stood out among the other radio advertising that was aired around the same time. Also, significantly more respondents reported that the Emphysema radio ad made them stop and think than those exposed to the Amputation and Mouth Cancer ads. This indicates that although this ad did not have the advantage of visual imagery, it was

7 Responses to radio and television anti-smoking advertising 11 particularly effective in getting smokers to reflect on the message. This may have been due to the interactive nature of the ad, in which listeners were guided to conduct their own breathing self-experiment to experience what it might be like to have late-stage emphysema. Nearly a third of those who heard the Emphysema radio ad reported that they had tried the breathing exercise. As a smoker, this personal experience of emphysema may have triggered emotional responses such as dread and fear, which may have increased perceptions of risk associated with smoking (Finucane et al., 2000; Slovic, 2001; Dunlop et al., 2008). However, the Emphysema radio ad prompted lower levels of discussion than the Amputation and Mouth Cancer ad. The particularly high levels of discussion of these two television ads is likely due to the very strong graphic depiction of the negative health consequences of smoking in these ads. Additionally, the Amputation ad was the first in a series linked to the introduction of the new graphic health warnings on cigarette packs, an additional feature which may have prompted greater discussions. Given the radio ad was aired primarily in the morning and evening drive time slots when most listeners are typically alone in their cars, it is encouraging that around a fifth of those exposed to the Emphysema radio ad had discussed the ad with someone else. Research indicates interpersonal communication of media health messages is important in increasing perceptions of risk to oneself and changes in behaviour (Rogers and Storey, 1987; Hafstad et al., 1996; Korhonen et al., 1998; Morton and Duck, 2001). The relatively small sample sizes and the absence of a long-term follow-up assessment limited our ability and power to examine the comparative effects of the different ads on actual quitting behaviour. Rather the focus of this paper was on smokers recall and cognitive, emotional and motivational responses, which have been found to be predictive of future quit attempts (Xiaolei et al., 2009). Future studies with larger samples and longer follow-up periods are needed to examine the extent to which these cognitive and emotional responses to emotive radio ads might lead to equivalent quitting behaviour as those prompted by emotive television ads. The relatively small sample size also limited our ability to examine sub-group differences in reaction to this radio ad. However, the sample size was adequate for the focus of this paper, which was to compare overall responses to this radio ad with overall responses to other similar television ads. It should be noted that we did not compare the exact same ad in the two different media (TV and radio) as this was an opportunistic study in which we aimed to assess the real world impact of an emotive radio anti-smoking ad with that of similar television ads. Future experimental research could be conducted to isolate the effects of the media from that of the specific ad content. Smokers were recruited from a list of people who had previously agreed to complete the market research agency s previous omnibus survey, and so the ability to generalize these findings to the broader community may be limited, although this would not have compromised comparisons between ads. A strength of this study was the unique natural exposure methodology to examine reactions to these ads, which likely reduced the potential that smokers were primed to our intentions, and so responses should not have been influenced by smokers expectations of listening to or watching an anti-smoking ad. This method also permitted evaluation of responses within a usual home viewing situation rather than a more artificial laboratory setting. In conclusion, these findings suggest that this particular emotive radio anti-smoking ad generated equivalent recall, cognitive and emotional responses and motivation to quit smoking as other televised anti-smoking ads that were similar in content and emotional tone. Emotionally evocative radio advertising may be an effective adjunct for communicating antismoking messages to smokers in jurisdictions and countries where there are substantial limits on funds available for airing televised campaigns, or where the reach of radio outstrips television. Further experimental and populationbased research that can evaluate the impact of comparable television and radio antismoking ads would be helpful to clarify message formats that can exploit the medium of radio to effectively communicate the risks of smoking. ACKNOWLEDGEMENTS We thank the Graphic Health Warnings Campaign Research and Evaluation Committee, including Caroline Miller, David Hill, Robert

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