A smoke-free advertising competition among secondary schools in New Zealand

HEALTH PROMOTION INTERNATIONAL O Oxford University Press 1994 Vol. 9, No. 2 Printed in Great Britain A smoke-free advertising competition among secondary schools in New Zealand ROB MCGEE Department of Preventive and Social Medicine, Medical School, University of Otago, Dunedin, New Zealand WARREN STANTON Cancer Prevention Research Centre, Medical School, University of Queensland, Herston, Queensland, Australia SUMMARY We describe the 'Make a Smokefree Ad' competition, an initiative of the Cancer Society of New Zealand, which was held in 1991 in secondary schools throughout the country. While competitions such as these have been used elsewhere to focus upon smoking in the young, Key words: adolescent; health promotion; smoking INTRODUCTION The development of dependence upon tobacco for most adult smokers is a gradual process beginning with the initiation of smoking behaviour in pre-adolescence or the early adolescent years (US Department of Health and Human Services, 1991). Consequently, adolescence has considerable importance in terms of smoking prevention efforts. In New Zealand, levels of current smoking among adolescents appear to be falling in the 1990s after rising over the 1970s and 1980s (McGee and Stanton, 1992). However, significant numbers of adolescents, particularly young women, are still taking up smoking. In 1991, the National Education Committee (now the National Health Promotion Committee) of the Cancer Society of New Zealand began planning a campaign directed at 13 to 16-year-olds with the aim of persuading those in this age group some novel features of this competition made it a particularly well-received health promotion activity by both students and teachers. Most importantly, the activity treated the young participants as important partners in promoting the health of adolescents. to remain 'smoke-free'. The campaign included mass-media advertising as well as the promotion in schools of a 'smoke-free' teaching resource which would be made available at the time of the media campaign. As a lead-in to the campaign, the Cancer Society ran a competition among New Zealand secondary schools to gather ideas which could be useful in developing a successful anti-smoking advertisement. Competitions to design posters and advertisements with an anti-smoking message have been used previously to involve children in smoking prevention (Berry, 1992; Cain et ai, 1992). Such competitions have the potential to alter children's knowledge about and attitudes towards smoking, although they probably do not directly affect smoking behaviour (Burke et al., 1987). One aspect of competitions which may be 89

90 R. McGee and W. Stanton important, particularly where groups are able to compete, is the potential presence of high levels of social support within the group, thereby providing supportive conditions for attitudinal change (Brownell and Felix, 1987). The idea for the Cancer Society contest arose from these and other considerations. Past research indicated that young New Zealanders are very familiar with television advertisements promoting non-smoking and they have definite ideas about advertisements which they regard as effective in communicating the intended message (McClellan, 1987). It was considered, therefore, that involving adolescents in designing a campaign would provide information on what they perceive as important in communicating a smokefree message. Another important consideration was the belief that the task of designing an antismoking advertisement was itself a valuable health promotion activity. The aim was to actively involve adolescents as 'partners' in health promotion rather than as simply passive recipients of health education messages from others (New Zealand Ministry of Education, 1991; Kalnins et al., 1992; Macfarlane, 1993). This paper describes the 'Make a Smokefree Ad' competition, particularly in terms of its value as a health promotion activity for schools. It also reports the results of a process evaluation of the competition. DESIGN OF THE COMPETITION All secondary schools throughout New Zealand were invited to take part in the competition by way of a letter to the school principal. This letter included registration forms, entry forms and detailed teacher notes. The last were designed so the competition could be used as a teaching unit in the English curriculum or media studies. They included 'competition rules', judging criteria, and teaching suggestions to facilitate discussions among students regarding advertising, smoking and its effects, the need for research in developing an advertisement, designing a newspaper advertisement, and designing a 'storyboard' for a television advertisement. Cancer Society information sheets were included ('Statistics on smoking', 'Young people and smoking', 'How smoking affects your lifestyle', 'How smoking affects your health', and 'Quitting smoking'). Sponsored prizes were obtained for both the school and the student winners and runners-up. The stated aims were to give students experience in how an advertising agency creates an advertisement. A detailed entry form was designed for the students working in teams. This was highly structured to provide a 'step-by-step' guide to making an advertisement. It stressed the need for basing the concepts for the advertisement on research and provided guidelines for developing a key message, a slogan summing up the key message, a print advertisement, and a storyboard. These materials were developed with the help of an advertising agency and they were piloted in two large secondary schools before being finalised. Details regarding the materials used in this competition are available from the Cancer Society of New Zealand. PARTICIPATION IN THE COMPETITION In New Zealand in 1991, there were 336 secondary schools (New Zealand Department of Statistics, 1993). A total of 101 teachers from 78 secondary schools (23% of eligible schools) registered for the competition, and 81 completed entries were received from 34 schools (10% of schools) throughout the country. As we subsequently learned from many teachers, the main limitation on use of the materials was an inability to fit the program into an already planned curriculum for the third term of the academic year. The entries revealed that those who took part carried out extensive research. For example, those students who sent in entries had interviewed an average of 19 of their peers about their smoking behaviours. On the basis of their own survey results, the prevalence of current smoking among these students was 29%. The students had researched topics including reasons for smoking, negative aspects of smoking, positive aspects of smoking, effects of tobacco advertising and sponsorship, friends smoking, family smoking, and what would deter young people from smoking. The students came up with a variety of ideas for an anti-smoking message. The winning concept for an advertisement cleverly linked cigarette smoking with pollution of the environment. Other entries linked smoking with physical harm to self and others, or concentrated on the addictive nature of smoking. Overall, there was a high standard of entries both in terms of posters, slogans and storyboards. The competition results were reported in several newspaper articles.

TEACHER EVALUATION OF THE COMPETITION The materials were offered to all schools to maximise participation rates so it was not feasible to carry out an experimental investigation of the effect of the materials on smoking rates. Our more limited goal was to evaluate the acceptability of the competition as a health promotion activity to both teachers and students. This kind of evaluation is generally referred to as process evaluation (Hawe et al., 1990). The teachers from schools submitting entries were sent a two page questionnaire assessing numbers of students taking part and class hours devoted to the competition as a teaching project. They were asked to rate the competition on three 10-point rating scales assessing interest shown by pupils, difficulty of the project, and how worthwhile they believed it was. The teaching material was similarly rated for clarity and helpfulness in organising the project within the class. The teachers were asked to rate how interesting they found this project as a teacher and whether they would be happy to undertake this type of project again. Teachers were asked what they liked and did not like about the project, and suggestions regarding improvements to the materials and general procedure were also sought. Evaluations were obtained from 20 teachers from the 34 secondary schools which had submitted entries. On average, in each school about 24 students from forms 3 6 (predominantly aged 13-16 years) spent an average of 9 h of class time involved with the competition. If these results are applied to all schools originally registering and sending entries, somewhere between 800 and 1800 students took part. Table 1 presents a summary of the teachers' assessment of the project and it is clear from the table that overall impressions of the project were very favourable. A smoke-free advertising competition 91 All teachers stated they would be happy to take part in this type of project again. When asked what they liked about the project as far as teaching was concerned, teachers reported such things as the fact that it was a student-based activity, treating the students as the 'experts'; it worked in well with the curriculum particularly relating to media; it was relevant to the students' lives; a variety of activities were involved; it was possible to get smokers involved; and there was plenty of scope for students to work in cooperation. However, the main shortcoming was that schools needed more lead-time to incorporate projects such as these into their curriculum. STUDENT EVALUATION OF THE COMPETITION At the same time that the teacher evaluations were sought, we asked the teachers to distribute student evaluations to those who took part in the competition. This consisted of a two page survey assessing the competition and additional questions assessing frequency of smoking. Information sought included age, sex, and ethnic background. Students were asked to describe their involvement in the different components of the project, and they rated the project as did the teachers using similar 10-point bipolar scales for interest, difficulty and worthwhileness. They also provided ratings of how much encouragement they got from others not taking part in the competition and how much influence making the advertisement had had on their attitude to smoking. Information was also sought concerning their likes and dislikes of the project. It was originally planned to get student evaluations from both 4th and 5th form classes who had taken part. However, the competition had been held in the third school term and consequently the Table 1: Summary of teacher evaluations of the advertisement competition; values shown are mean ratings of the 20 teachers on the 10-point bipolar scales 'What did your students think of this project?' Interesting X Difficult X « ««Worthwhile X 'How did you find the accompanying instructional material?' Clear X Helpful X 'How interesting did you find this project as a teacher?' Interesting»X Not interesting Easy Not worthwhile Unclear Not helpful Not interesting

92 R. McGee and W. Stanton evaluation was delayed to the end of the term. It soon became apparent that many of these students were not available because they were involved in public examinations at the 5th form level. Ultimately, we were only able to obtain evaluations from 125 students (60% female and 40% male) from eight schools. Their average age was 15 years 4 months. Most (77%) were from a European background; 12% were from a Maori background and 8% were from other Polynesian backgrounds. The ethnic composition of the sample was similar to that of the wider community. Of these 125 students, 11% reported smoking daily, 9% had smoked at least in the last month and 12% reported smoking less often. These percentages are similar to those from a larger sample of 15-year-olds surveyed shortly before the competition (McGee and Stanton, 1992). Table 2 shows a summary of the students' assessments of the competition. When asked what they liked about the competition, most frequent likes were learning about smoking (22%); making the advertisement, logo or storyboard (19%); doing the research and finding out what other students think (16%); working as a group (9%); and feeling that they were doing something about smoking (7%). Some 10% stated they liked very little or nothing about the competition. Dislikes included the amount of time and work required and simply the project in general. However, dislikes also included finding out about the size of the smoking problem and people not listening to their smoke-free message. A comparison of the ratings of the competition made by students who reported smoking and those who did not smoke indicated that those smoking rated the competition as less interesting, easier to do, and less worthwhile than those not smoking. However, these differences were not particularly large, amounting to about 1 point or half a standard deviation unit for each rating. There was no difference on a rating of the degree of encouragement they received from others who were not taking part in the competition. The largest difference was on the rating of 'how much influence has making the advertisement had on your attitude to smoking' rated from 'more in favour 1' to 'less in favour 10'. The average rating of smokers was 6.3 versus 7.7 for nonsmokers. Nevertheless, the direction of the ratings suggest that smokers still found the project more worthwhile and interesting than not, and they rated themselves as less in favour of smoking than more. CONCLUDING COMMENTS While competitions are not new, the competition described here has several novel features which may make this a useful project for health promotion activities. First, it was acknowledged at the outset that the overall project was a relatively complex one for school students. Consequently, the materials were presented to both teachers and students in a structured format both to assist teachers in assimilating the project into the curriculum and to help the students develop their own research and ideas. Second, it was a prerequisite of submitting an entry that students should have developed their own research questions and carried out the research. Many produced excellent research questions and had clearly carried out careful interviews with their fellow students. In the evaluation, several students noted that what they liked about the project was finding out what other students thought about smoking. This approach, therefore, has the potential for clarifying misconceptions about how others view smoking and how many of their peers smoke. This is significant given the incorrect beliefs that many adolescents may have about smoking (Leventhal et al., 1987). Third, as Table 2: Summary of student evaluations of the advertisement competition; values shown are mean ratings of the 125 students on the 10-point bipolar scales 'What did you think of this competition?' Interesting X Not interesting Difficult X Easy Worthwhile X» Not worthwhile 'How much encouragement did you get from others (e.g. parents or friends)?' A little X A lot 'How much influence has making the advertisement had on your attitude to smoking?' More in favour «X More against

several teachers noted, the project treated the students as the 'experts', and in this respect it was in accord with a view of adolescents as partners in health promotion (Ministry of Education, 1991; Kalnins et al, 1992; Macfarlane, 1993). Finally, the project combined elements of health, advertising and the media, and research skills as a practical demonstration for the students of how health promotion works. While there were clear limitations on the evaluation of this project, it is worth noting that competitions such as the present one are rarely evaluated in any sense of the word. We found that teachers rated the project very highly for both student interest and being a worthwhile use of time, and they rated the accompanying teacher notes as very clear and helpful. They uniformly gave the project a high rating in terms of how interesting they found this project as a teacher. This would seem very important so far as getting teachers to use class time on this kind of project is concerned. Overall, students rated the project highly in terms of interest and being worthwhile. It is important that students who smoke are interested enough to take part in activities which on the face of it are critical of one aspect of their behaviour. However, by presenting such students with a highly structured set of tasks, as was the case here, it may be possible to engage their interest in a relatively non-threatening way. Our evaluations suggest that students who smoke perceived the overall project as less worthwhile and interesting than those who did not smoke, but their ratings suggest they did see it as having value. ACKNOWLEDGEMENTS We wish to acknowledge the help of national office staff of the Cancer Society of New Zealand, in organising the student and teacher evaluations. In particular, we acknowledge the help of Ms Helen Glasgow, National Health Promotion Coordinator. We wish to thank all those students and teachers who made the smoke-free ad competition a success. Prizes for the competition were kindly provided by Sony (New Zealand). Rob McGee was supported in this work by the Cancer Society of New Zealand. Warren Stanton was supported by the Health Research Council of New Zealand. A smoke-free advertising competition 93 Address for correspondence: Rob McGee Social and Behavioural Research in Cancer Hugh Adam Cancer Epidemiology Unit Department of Preventive and Social Medicine Medical School University of Otago PO Box 913 Dunedin New Zealand REFERENCES Berry, J. (1992) Youth and prevention of tobacco use. Tobacco Control, 9,63. Brownell, K. D. and Felix, M. R. (1987) Competitions to facilitate health promotion: review and conceptual analysis. American Journal of Health Promotion, 2, 28-36. Burke, J. A., Naughton, M. K., Becker, S. L., Arbogast, R., Lauer, R. M and Krohn, M. D. (1987) The short-term effects of competition and rewards in an adolescent smoking prevention program. Health Education Quarterly, 14, 141-152. Cain, J.J., Dudley, T. E. and Wilkerson, M. K. (1992) Tar wars a community-based tobacco education project. Journal of Family Practice, 34,267-268. Hawe, P., Degeling, D. and Hall, J. (1990) Evaluating Health Promotion: A Health Workers' Guide. Maclennan & Petty, Sydney. Kalnins, I., McQueen, D. V., Backett, K. G, Curtice, L. and Currie, C. E. (1992) Children, empowerment and health promotion: some new directions in research and practice. Health Promotion International, 7, 53-59. Leventhal, H., Glynn, K. and Fleming, R. (1987) Is the smoking decision an informed choice? Journal of the American Medical Association, 257, 3373-3376. Macfarlane, A. (1993) Health promotion and children and teenagers. British Medical Journal, 306,81. McClellan, V. (1987) A National Survey of the Smoking Habits of Form One Students in New Zealand Schools. Occasional paper no. 30. Department of Health, Wellington. McGee, R. and Stanton, W. (1992) Smoking among fourth formers in Wellington. Paper presented at the National Conference, Public Health Association of New Zealand, Lincoln University, Christchurch. New Zealand Ministry of Education (1991) Drug Education: Guidelines for Schools and Boards of Trustees. Ministry of Education, Wellington. New Zealand Department of Statistics (1993) New Zealand Official Yearbook 199.1 Department of Statistics. Wellington. US Department of Health and Human Services (1991) Strategies to Control Tobacco Use in the United States: A Blueprint for Public Health Action in the 1990s. Smoking and Tobacco Control Monographs 1. NIH Publication No. 92-3316.