Building Grassroots Support for Smoke-free Movies: Final Evaluation Report Shasta County, 2007-2010 Project Director: Beth Thompson Shasta County Public Health Tobacco Education Program Address: 2650 Breslauer Way, Redding, CA 96002 Phone: (530) 245-6857 Fax: (530) 229-8460 E-mail: bthompson@co.shasta.ca.us Report Authors: Stephanie Taylor, Local Evaluator, Shasta County Public Health Nathan Read, Project Coordinator, Shasta County Public Health Report Submitted: June 30, 2010 Made possible by funds received from the Tobacco Tax Health Protection Act of 1988 Proposition 99, through the California Department of Public Health, TCP contract #07-45, contract term: 7/1/07 6/30/10 Suggested Citation: Taylor, S, and Read, N. 2010. Building Grassroots Support for Smoke-free Movies: Final Evaluation Report. California: Shasta County Public Health Tobacco Education Program.
Table of Contents ABSTRACT... 1 PROJECT DESCRIPTION... 3 Background... 3 Objective... 4 Intervention... 4 EVALUATION METHODS... 5 EVALUATION DESIGN... 5 SAMPLING, DATA COLLECTION, AND ANALYSIS... 6 Key Informant Interviews... 6 Focus Groups... 6 EVALUATION RESULTS... 7 Key Informant Interviews... 7 Focus Groups... 9 Passage of a resolution in support of the UCSF Smoke-free Movies campaign...11 LIMITATIONS... 11 CONCLUSIONS AND RECOMMENDATIONS... 12 APPENDIX... 15 Pre-intervention Key Informant Interview Questions... 15 Post-intervention Key Informant Interview Questions... 17 Smoke-Free Movies Focus Group Questions (7-12 Age Group)... 19 Smoke-Free Movies Focus Group Questions (13-17 Age Group)... 20
Abstract In Shasta County, smoking rates among adolescents and adults are higher than the statewide average. 23.9% of Shasta County 7 th, 9 th, and 11 th graders reported ever having smoked a whole cigarette during their lifetime, while 13.3% of Shasta County adolescents reported smoking a cigarette at least once during the past 30 days. Few opportunities for entertainment exist in the mostly rural community, with movies being one of the few outlets. Research has shown that youth who are exposed to high levels of smoking impressions in movies are more likely to initiate smoking than youth with low exposure to smoking impressions. The Shasta County Public Health Tobacco Education Program developed the following objective for this project: By June 30, 2010, at least 10 organizations, schools and faith-based groups will adopt a resolution supporting the four policies endorsed by the University of California San Francisco (UCSF) Smoke-free Movies Campaign. This is a primary objective and addresses Communities of Excellence indicator # 1.1.11. Gathered information and resources were used to develop a "Tobacco and Media Workshop" to be delivered to community organizations, schools and faith-based groups. The intent was to gather resolutions and letters supporting the UCSF Smoke-free Movies Campaign by increasing the participant s awareness of the way tobacco companies use the media to promote their products and portray tobacco use as a social norm. The workshop was promoted to community organizations, schools and faith-based groups by way of a press release to local media outlets and flyer distribution. The "Tobacco and Media Workshop was delivered to 19 community organizations, schools, and faithbased groups who responded to workshop promotions. This resulted in 10 resolutions. Over 490 letters to movie studio CEOs, the Motion Picture Association of America (MPAA), and the California Youth Advocacy Network were also collected from workshop participants and community members at local events. Additional educational activities included educational packets to video stores and movie theaters; web search activities provided to schools; toolkits for parents; distribution of 120,000 Lives a Year and The Whole World is Watching; and participation in 15 community events. A majority of key informants expressed a belief prior to the intervention that youth are influenced by witnessing actors smoking in the movies. There was a strong feeling of disapproval among key informants for actors and movie producers accepting payment or gifts for including smoking in the movies. All thirteen key informants supported showing brief Public Service Announcements (PSAs) in theaters to counteract the influence of smoking in the movies. Support for automatic R-ratings was mixed; with one-fourth of key-informants opposing the policy, one-third expressing some support for R- ratings but not if it is the only factor in determining the R-rating, and half in support of the policy. All expressed support for a resolution in support of the UCSF Smoke-free Movies campaign. Post-intervention, a majority of key informants said they noticed the depiction of tobacco usage in the movies more often after participation in the workshop. Nearly all key informants indicated some form of action taken by themselves or their organization. Reasons for action included feeling compelled to take action due to the magnitude of the problem of youth tobacco use and effective materials provided at the workshop. 1
Although focus group participants stated that they believed they could be influenced by what they saw in the movies, focus group members in the 13-17 age group tended to believe that they were less influenced by tobacco usage in movies than their younger siblings. However, there was a strong consensus among focus group participants in the 7-12 age group that they were not influenced to smoke by what they saw in the movies. All participants in the adolescent focus group said they had signed a resolution and sent letters to movie studios and the MPAA in support of the Smoke-free Movies Campaign. Participants in the youth focus group were not recruited to adopt resolutions and were unsure what action they could take against the problem of smoking in the movies. 2
Building Grassroots Support for Smoke-free Movies: Final Evaluation Report Project Description Background Shasta County is a rural county in far northern California with a 2007 population of approximately 184,000 1. The population mainly centers along the Interstate-5 corridor in the cities of Redding, Anderson, and City of Shasta Lake. The median household income in Shasta County in 2006-2008 was $43,836, 28% below the median income for California 2. The leading industries in Shasta County are educational services, health care, and social assistance (26%), as well as retail trade (13%). 24% of related children aged 18 and younger were living in poverty in 2006-2008 3. Social norms typical of those found in rural areas prevail, with higher smoking rates in both youth and adults compared to the statewide average. In the 2006 California Healthy Kids Survey conducted with 7 th, 9 th, and 11 th grade students in Shasta County, 23.9% reported ever having smoked a whole cigarette during their lifetime, compared to approximately 19% of California students of the same age. 13.3% of Shasta County adolescents reported smoking a cigarette at least once during the past 30 days, compared to approximately 10% statewide 4. Because the community is rural, movies are one of the few entertainment outlets for youth, providing a wealth of opportunity for smoking impressions to be made upon youth. Youth are highly susceptible to depictions of smoking in the movies. A 2003 prospective cohort study found that adolescents who received the most impressions of smoking in the movies were 2.7 times more likely than adolescents who received the fewest impressions to initiate smoking during the study followup period, even after controlling for potentially confounding variables. 5 An analysis of over 1,000 films released between 1999 and 2006 found that 88% of R-rated films, 75% of PG-13 films, and 36% of G and PG films have featured tobacco use. 6 The 2004 administration of the National Youth Tobacco Survey determined that 81% of participants in grades 6 through 12 saw images of smoking on television or in movies 7. The Smoke-free Movies campaign at University of California San Francisco was organized in an effort to sharply reduce tobacco impressions in the U.S. film industry, thereby reducing the effectiveness of Big Tobacco's domestic and global marketing. Efforts to reduce tobacco impressions target the major motion picture studios and the Motion Picture Association with a four point resolution that outlines the most effective means of reducing tobacco impressions in movies. These points include rating new smoking movies R, certifying no payoffs for the depiction of tobacco, requiring strong anti-tobacco ads prior to films that depict tobacco use, and eliminating tobacco brand identification. 8 The UCSF Smoke-free Movies campaign is the global leader in resources and information to address smoking in the movies. In 2007, the California Tobacco Control Program launched a grassroots effort with several Local Lead Agencies (LLAs) to promote the UCSF Smoke-free Movies campaign. This effort provided California Tobacco Control Program-funded communities an opportunity to participate in a larger movement to tell the movie industry that communities are concerned about the health of their youth and their exposure to smoking impressions. A total of 19 LLAs and 2 statewide projects elected to participate in these efforts. 3
LLA objectives focused on any or all of the four points promoted by the UCSF Smoke -free Movies campaign, ranging from efforts with local movie theaters to place anti-tobacco ads to community-based resolution campaigns. A statewide workgroup facilitated by the California Youth Advocacy Network was established to share information and resources. Objective By June 30, 2010, at least 10 organizations, schools and faith-based groups will adopt a resolution supporting the four policies endorsed by the University of California San Francisco Smoke-free Movies campaign. This is a primary objective, addressing Communities of Excellence (CX) Indicator 1.1.11. The CX assessment group noted changes in tobacco advertising strategies due to government regulations and was concerned that regulations were being circumvented. The group felt that children were still being bombarded by tobacco use images in the media. During an advocacy training dealing with media literacy and tobacco companies, the Shasta County Tobacco Education Coalition was outraged by the amount of smoking in movies and some of the advertising strategies the tobacco companies are using to target youth. They felt that other organizations in the community should be made aware of the problem. The combination of the assessment group s concerns and the coalition s desire for the Shasta County Tobacco Education Program to take action as part of the statewide grassroots effort in countering pro-tobacco influences provided the impetus for this objective. Intervention The intervention had two phases. The first phase designed and promoted the intervention. Information and resources on media literacy and the depiction of tobacco in the movies were collected from the California Youth Advocacy Network (CYAN), Tobacco Control Evaluation Center, UCSF Smoke-free Movies campaign, California Smoke-free Movies Partnership, and the New Mexico Media Literacy Campaign. Gathered information and resources were used to develop a "Tobacco and Media Workshop" to be delivered to community organizations, schools and faith-based groups. The intent was to gather resolutions and letters supporting the Smoke-free Movies campaign by increasing the participant s awareness of the way tobacco companies use the media to promote their products and portray tobacco use as a social norm. Topics such as the depiction of tobacco use by the entertainment industry, tobacco advertising, and current research surrounding this issue were covered by the workshop. To support this workshop, five intervention tools were created. Intervention tools included a Smoke-free Movies fact sheet, model resolution, Report Card, Take Action Guide, and Rate Your Movies Guide. These resources were included in a training packet for workshop participants and available at community events. Two one-hour trainings on media literacy, the workshop, and intervention tools were provided to the Shasta County Tobacco Education Coalition. The workshop was promoted to community organizations, schools and faith-based groups by way of a press release to local media outlets and a flyer distributed to 94 individuals via the Smoke-free Movies Email Distribution List. The second phase included workshop delivery and community education activities. The "Tobacco and Media Workshop was delivered to 19 community organizations, schools, and faith-based groups who responded to workshop promotions. This resulted in 10 resolutions. Two additional resolutions were collected from the Shasta County Tobacco Education Coalition and the North State Tobacco Education 4
and Prevention Partnership (NSTEPP). The resolutions supported the four policies (new movies with smoking R rating, certify no pay-offs, require strong anti-smoking ads, stop identifying tobacco brands) endorsed by UCSF Smoke-free Movies campaign. Letters to movie studio CEOs, the Motion Picture Association of America (MPAA), and California Youth Advocacy Network (CYAN) were also collected from workshop participants and community members at local events. In an effort to increase participation, letters took the form of postcards, with space for personal comments. A total of 493 personalized postcards were collected and sent to the following studios and organizations (including quantities): Viacom (66); Time Warner (58); CYAN (55); Sony (52); Disney (98); General Electric (48); Fox (55); MPAA (61). A number of community education activities supported the campaign. Educational packets were mailed to 12 video stores and four movie theaters in Shasta County and were followed up by phone calls with offers for additional resources. The Tobacco Use Prevention Education (TUPE) Coordinator at the Shasta County Office of Education received 100 copies of a Smoke-free Movies Web Search created for distribution to the seven participating school districts. Copies of the videos 120,000 Lives a Year and The Whole World is Watching were distributed to 269 individuals (175 DVDs/94 download links) through an email blast, informational packets at community events, meetings, and presentations. A total of 219 advocacy campaign materials were distributed at workshops and community events. A total of 150 "Smoking in the Movies Toolkits" were created and distributed to the community. These resources and intervention tools created for the "Tobacco and Media Workshop, were available at 15 community events that had an approximate attendance of 9,350 community members. Evaluation Methods Evaluation Design The evaluation for this objective was process-oriented and of non-experimental design. Prior to the intervention, key informant interviews were conducted with members of local organizations working in the areas of violence prevention, health improvement, substance abuse prevention, minority population advocacy, and teen leadership. The purpose of the wave of interviews was to gather information on the level of support for each of the four components of the UCSF Smoke-free Movies policy, potential willingness for the informant s organization to adopt a resolution requesting the MPAA create more rigorous guidelines for smoking in the movies, support for a letter-writing campaign requesting more rigorous guidelines, and willingness to host a smoke-free movies workshop at the organization. The information gathered in the interviews was used to gauge the receptiveness of the informants to the intervention and to develop the Tobacco and Media workshop. The Tobacco and Media workshops were developed to be age-appropriate for three groups: youth age 7-12, adolescents age 13-17, and adults. To evaluate the effectiveness of the Tobacco and Media workshop for each of these groups and make any necessary changes to improve future workshops, two focus groups were conducted with groups that participated in the earliest Tobacco and Media workshops. One focus group was held with adolescents age 13-17, and a second was held with youth age 7-12. Originally three focus groups were planned, with an additional group to be held with adults. However, volunteers could not be recruited for the adult focus group, so the activity associated with the adult focus group could not be completed. 5
After the intervention, a second wave of key informant interviews was conducted with members of the organizations that participated in the Tobacco and Media workshop. The purpose of these interviews was to assess the effectiveness of the workshop in prompting participating groups to take action in support of the local Smoke-free Movies campaign. Interview topics included post-workshop changes in perception of the depiction of tobacco use in the movies and its influence on youth, changes in awareness of the frequency of depiction of smoking in movies that are marketed to children, support for equating the depiction of tobacco use with depiction of violence or sexual conduct in the determination of a movie rating, perception of how the information shared in the workshop influenced the way the respondent interacted with youth, feelings about the effectiveness of the workshop Power Point presentation and fact sheets, and actions taken as a result of attending the workshop. Sampling, Data Collection, and Analysis Key Informant Interviews For the pre-intervention wave of key informant interviews, informants were chosen from local organizations working in the areas of violence prevention, health improvement, substance abuse prevention, minority population advocacy, and teen leadership. Organizations were chosen based on their prior history of advocacy work in the areas of substance abuse prevention and youth enrichment in the community. One member of each of the chosen organizations was recruited as a key informant. Depending on the receptiveness of the key informant, these organizations were later targeted to participate in the Tobacco and Media workshop. For the post-intervention wave of key informant interviews, informants were chosen from the pool of organizations that had participated in the Tobacco and Media workshop. Nineteen organizations participated in the workshop. Fifteen organizations were selected and one member from each organization was recruited as a key informant. The sample size determination for both waves of interviews was set at 15 to capture multiple key informants per type of organization being targeted for the intervention. Fifteen informants could not be recruited for the pre-intervention wave; 13 informants were interviewed. Fifteen informants participated in the post-intervention wave. Both waves of interviews were conducted by the Project Coordinator. The Project Coordinator took notes while conducting the interviews, summarizing the responses of the informants and in some cases including exact quotes. The data for the pre-intervention wave consisted of thirteen sets of interview notes, each between two and three pages long. The data for the postintervention wave consisted of fifteen sets of interview notes, each two pages. For both waves, the evaluator then compared the notes for the interviews to look for common themes. A content analysis was performed and the results were summarized. Focus Groups Focus group participants were chosen as a convenience sample from the pool of organizations that participated in the earliest Tobacco and Media workshops. Rather than randomly selecting individuals to participate in the workshop, one youth and one adolescent organization that received an early Tobacco and Media workshop were chosen to participate in the focus groups. This method was employed in order 6
to obtain the earliest possible feedback and make any necessary changes to improve the workshops for the youth and adolescent age groups. Seven youth participated in the focus group from the youngest age group, and fourteen youth participated in the focus group from the adolescent age group. The focus groups were recorded and the tapes were summarized. Discussion topics included participants level of recall of smoking scenes in movies, whether they were influenced by what they see people doing in movies, whether the workshop made them want to take action against the problem of smoking in the movies, and how the workshop could be improved. Evaluation Results Key Informant Interviews Pre-intervention: The responses to the pre-intervention wave of key informant interviews were analyzed and the key findings are summarized below. Thirteen members of local organizations working in the areas of violence prevention, health improvement, substance abuse prevention, minority population advocacy, and teen leadership participated in the interviews. Beliefs about influence of smoking in the movies on youth behavior o A majority of key informants expressed a belief that youth are influenced by witnessing actors smoking in the movies. o A common feeling was that youth will feel that if someone they think is cool or a role model is smoking, then that makes the act of smoking OK. Beliefs about allowance of incentives for showing smoking in the movies o There was a strong feeling of disapproval among key informants for actors and movie producers accepting payment or gifts for including smoking in the movies. o Another common theme was that people shouldn t be allowed to benefit from encouraging unhealthy behaviors. o Two respondents stated that they disagreed with the idea of product placement in general, and two respondents felt that it was a form of bribery. o One respondent who felt that incentives should be allowed did not like the idea but that it s a free country so it should be allowed. o One respondent stated that companies other than tobacco companies were allowed to place products in movies, so it was important to be fair. Beliefs about brand name or logo placement in movies o Four key informants felt brand name or logo placement was a form of subliminal marketing, with bombardment being used to influence teens into using those brands. o Two informants were not sure that showing brand names made as much of a difference in teen smoking as showing the act of smoking. o One key informant felt that companies who pay for brand name or logo placement should get their product shown regardless of who the company is. o One key informant felt that while brand name or logo placement was not preferable, it s a free country so it should be allowed. 7
Beliefs about showing Public Service Announcements preceding movies depicting smoking o All thirteen key informants supported showing brief Public Service Announcements (PSAs) in theaters to counteract the influence of smoking in the movies. Support for R rating for movies depicting smoking o Three key informants said they would not support an R-rating. o Four informants said smoking should be considered part of the guidelines for determining a movie s rating, but should not warrant an automatic R rating, especially if smoking was the only factor warranting an R rating. o Six informants expressed support for R-ratings for movies depicting smoking. o Most informants felt that depicting the negative effects of smoking should not warrant an R-rating. o Two informants felt that depiction of smoking in a historical figure should merit an R- rating while the others were opposed. Support for resolution requesting more rigorous guidelines for smoking in the movies o All thirteen informants expressed support for the possibility that their organization may adopt a resolution in support of the UCSF Smoke-free Movies policy. Support for letter writing campaign requesting more rigorous guidelines for smoking in the movies o Most informants expressed some level of support for a letter writing campaign, if the time commitment was minimal. Post intervention: The responses to the post-intervention wave of key informant interviews were analyzed and the key findings are summarized below. Fifteen members of local organizations who participated in the Tobacco and Media workshop were interviewed. Post-workshop perceptions about tobacco depiction in movies o Twelve key informants said they noticed the depiction of tobacco usage more often after participation in the workshop. Post-workshop perceptions about the influence on youth of tobacco depiction in the movies o Ten key informants said their opinions about the influence of smoking in the movies on children didn t change after participation in the workshop, although six of those ten added the caveat that they were already well aware of the impact of the depiction of tobacco use in the movies on youth. Another two of those ten said their previously held beliefs about the level of influence were reinforced or enhanced. o Six informants said they became more aware of the impact of smoking in the movies on youth after participating in the workshop. o Two informants said that they believed youth were more strongly impacted than they had previously thought. Changes in thinking about interactions with youth o Ten key informants said that the information they received did not encourage them to think differently about their interactions with youth. However, nearly all added reasons that they didn t change, with most responding that they already are anti-tobacco advocates. 8
o Two informants said they now have more avenues for discussion with the youth that they interact with. o Two said they were more likely to consider the depiction of tobacco use when choosing movies to view. Support for equating the depiction of tobacco use with depiction of violence or sexual conduct in the determination of a movie rating o Nine key informants said they thought tobacco use should be treated the same as violence or sexual conduct when the MPAA ratings board is assigning a rating to a movie. o Five informants gave more weight to the depiction of sex or violence in the determination of a movie s rating. Actions taken as a result of participation in the workshop o Fourteen informants indicated some form of action taken by themselves or their organization. o Nine informants indicated that they had shared the information they received in the workshop with other programs, organizations, or with friends and family. o Nine informants said their organization signed a resolution in support of the UCSF Smokefree Movies campaign. o Five informants said their organization sent postcards to the MPAA in support of the UCSF Smoke-free Movies campaign. o Reasons for action included feeling compelled to take action due to the magnitude of the problem of youth tobacco use and effective materials provided at the workshop. o Reasons for inaction among the groups that didn t sign a resolution or send postcards to the MPAA include that the organization the informant belongs to was an inappropriate forum, that it would be difficult to take the issue to their board, and that the opportunity to act didn t materialize. Focus Groups Youth Group: A focus group was conducted with a local youth group that attended the Tobacco and Media Workshop in 2009. Seven youth aged approximately 11 to 12 years old were in attendance. The discussion from the focus group was analyzed and the key findings are summarized below. Recall of movies featuring tobacco usage o Focus group participants did not overwhelmingly remember portrayals of tobacco use in some of the movies that were offered by the facilitator as examples. Influence of movies on focus group participants o There was a strong consensus among focus group participants that they were not influenced to smoke by what they saw in the movies. o One participant said she wasn t influenced because she had already made the decision not to use tobacco, but that she thought it was possible that a person her age who hadn t decided might be more influenced by seeing tobacco use in the movies. 9
Reaction to statistics shared in the Tobacco and Media Workshop o Most participants were surprised by the statistics illustrating the pervasiveness of smoking in the movies. o One participant said he was surprised when he heard the statistic given about the number of kids under 19 years old that smoke. o A comment was made that smoking seemed like an adult problem, but there was general disagreement and uncertainty that this was the truth. Taking Action o When asked whether the information presented in the workshop made them want to take action about the problem of smoking in the movies, one participant said that he didn t really know what could be done because a person who wants to smoke will smoke. Adolescent Group: A focus group was conducted with a local adolescent group that attended the Tobacco and Media Workshop in 2009. Fourteen adolescents ranging in age from 12 to 17 participated. The discussion from the focus group was analyzed and the key findings are summarized below. Recall of movies featuring tobacco usage o Focus group participants remembered portrayals of tobacco usage in several movies, including both recent movies and movies that were five or more years old. o Participants could also name actors or characters in movies in which tobacco usage was shown. Influence of movies on focus group participants o Participants stated that some of the depictions of tobacco usage that they could recall were by actors who they thought individuals their age might think were cool and could influence them. o One participant remembered tobacco usage in James Bond movies and stated that he (James Bond) makes everything look cool. Another said that the use of cigars in Independence Day was celebratory and made it appear that it was OK to use tobacco in a celebratory situation. o One participant mentioned that smoking was often shown in movies when a character is having a bad day and that this type of portrayal can lead teens their age to believe that they can go have a cigarette and it will make things better. o Although they stated that they believed they could be influenced by what they saw in the movies, focus group members tended to believe that they were less influenced by tobacco usage in movies than their younger siblings were. Reaction to statistics shared in Tobacco and Media Workshop o Reactions were mixed when statistics were given in the workshop about the amount of smoking depicted in the movies. Some participants were surprised and shocked, while others were appalled but not surprised. o Participants said that the 120,000 lives a year statistic was scary and expressed shock at the money that tobacco companies are making from portrayals of smoking in the movies. 10
Taking Action o All participants said that they had signed a resolution and sent letters to movie studios and the MPAA in support of the Smoke-free Movies campaign. o Many participants also said that they told others about what they had learned. o Most of the participants expressed interest in taking action, although they were uncertain what else they could do. Passage of a resolution in support of the UCSF Smoke-free Movies campaign Ten local organizations adopted a resolution in support of the UCSF Smoke-free Movies campaign. These included three 4-H groups, three youth leadership groups, one faith-based organization, one minority population advocacy group, one adult group advocating for youth, and one youth health improvement organization. Additionally, the Shasta County Tobacco Education Coalition and the North State Tobacco Education Prevention Partnership (NSTEPP) adopted resolutions. Personalized postcards to movie studio CEOs, the Motion Picture Association of America (MPAA), and California Youth Advocacy Network (CYAN) were also collected from workshop participants and community members at local events. A total of 493 postcards were collected and sent to the following studios and organizations (including quantities): Viacom (66); Time Warner (58); CYAN (55); Sony (52); Disney (98); General Electric (48); Fox (55); MPAA (61). The postcard campaign resulted in a letter of response from Time Warner CEO, Jeff Bewkes. Limitations The key informant interview results may be limited due to selection bias. Only one informant was chosen per organization, although the sample size was set high enough that multiple informants were chosen per type of organization (i.e., faith-based and youth-serving organizations). However, the type of organizations in the pre-intervention wave of key informant interviews was fairly representative of the types of organizations that received the Tobacco and Media Workshop. Additionally, due to the large number of key informant interviews that had to be conducted and limitations in staffing, the interviews could not be transcribed. The interviews were summarized with notes by the interviewer and the notes were later analyzed for content. Therefore, some data may not have been captured. Also, because it was felt that the existing relationships between some of the local organizations recruited for the key informant interviews and the Shasta County Tobacco Education Program would enhance the discussion about tobacco control issues, the Project Coordinator conducted both waves of interviews. However, it is possible that some key informants may have been more open or candid with a neutral interviewer, particularly in the post-intervention wave of interviews when key informants were asked about how effective the intervention was in prompting the individual and their organization to take action. The results of the focus group may be limited due to the non-random method of choosing participants. Because time was of the essence and the number of workshops was limited, it was decided to select whole organizations rather than choose individual participants at random as a cross-section of organizations that participated in the workshop. Opinions expressed by the participants may therefore have been influenced by the nature of the organizations that were chosen to participate. Additionally, the adolescent focus group was rather large because it was conducted during a regular meeting of that organization. It was logistically challenging to select fewer participants and exclude others who were there for their regular 11
meeting, which took place following the focus group. Therefore, some participants may not have had the chance to express differing opinions than those given during the focus group by other, more talkative participants. Additionally, due to unavailability of the evaluator, the youth focus group was conducted by the Project Coordinator, who also delivered the workshops. It is possible that the young age group and the presence of the workshop leader as the person conducting the focus group may have influenced the youth to respond in a manner that would have been perceived by the Project Coordinator as favorable. Finally, due to resource limitations and the need for a quick turnaround of the focus group analysis, the adolescent focus group was summarized from notes taken on the day of the focus group and from a recording by an extra help assistant but the recording was not transcribed. Some of the opinions expressed during the focus group may have been lost. Conclusions and Recommendations The results of the pre-intervention key informant interview show that the organizations were receptive to two of the four components of the intervention. Informants felt strongly that youth were influenced by depictions of tobacco use in the media. Informants were in favor of banning incentives received by movie producers or actors for depicting tobacco use in the movies, and they were strongly in favor of antitobacco public service announcements shown prior to movies that portray tobacco use. There were mixed feelings about equating the depiction of tobacco use in the movies with the depiction of sexual conduct or violence in the assignment of a movie s rating. There were also mixed feelings about the allowance of brand name or logo placement. In spite of the mixed feelings on two components of the UCSF Smokefree Movies campaign, all informants expressed support for their organization adopting a resolution in support of the campaign. Additionally, most informants were in favor of the idea of a letter or postcard writing campaign, if the time involved would not be too great. The results of the post-intervention key informant interviews show that the workshop was effective in prompting participants to pay closer attention to the depiction of smoking in the movies, as well as reinforcing awareness of the impact on youth and pervasiveness of the portrayal of tobacco use in the movies. As indicated by the majority of informants stating they did not change their interactions with youth, most were already well-equipped to interact with youth in a manner that included sending an antitobacco message. Most informants said their organization took some form of action, either by adopting a resolution in support of the campaign or participating in the postcard writing campaign. The results of the focus groups show that the youth cohort felt they are not influenced by depictions of smoking in the movies. The adolescent focus group felt as though their younger siblings were probably influenced by smoking in the movies more than they were, although the adolescents also felt that they and their peers may be influenced by portrayals of cool movie stars or characters. Both age groups were surprised by the statistics shared in the workshop about how frequently smoking is shown in the movies. In general, both groups were unsure of how to act against the problem of smoking in the movies. The objective of getting ten local organizations to adopt resolutions in support of the UCSF Smoke-free Movies campaign has been met. Ten local organizations adopted resolutions. Two additional organizations affiliated with the Shasta County Public Health Tobacco Education Program adopted resolutions. Educational materials were provided at community events and to movie theaters. Additionally, over 490 postcards were sent to major motion picture studios and the MPAA. 12
Lessons learned from this project and recommendations for future interventions include the following: Focus groups should be scheduled at the same time as the scheduling of the workshops, instead of after receiving the workshops. It was thought that adult focus group participants could be recruited at the time of the workshop; however due to the relatively infrequent nature of the organizational meetings this did not work well. Members for an adult focus group could not be recruited within a reasonable amount of time after the workshop, demonstrating the importance of recruiting for the workshop and the focus group simultaneously. The focus group for youth between the ages of 7 and 12 was not an effective use of time. Youth of that age typically are shy and do not participate well in formal discussions with a group of strangers. The youth in this particular focus group gave short answers and it was difficult to engage the youth in an in-depth conversation. Additionally, the youth were not being asked to take action in support of the UCSF Smoke-free Movies campaign beyond submitting postcards. The intervention was primarily designed for an older demographic capable of taking independent action. Paper evaluation surveys would be more effective in gathering data from pre-teens to improve the workshop. Fewer than half of the ten resolutions were adopted by adult organizations. The organizations in some cases were reluctant to adopt resolutions because they weren t the appropriate venue for authorizing the resolution, or it would be difficult to take the issue to their board. Future interventions may be more appropriately targeted to organizations capable of adopting resolutions by using a combination of key-informant interviews and surveys. A survey can be conducted prior to the round of key informant interviews to gauge the level of interest among local organizations in hosting the Tobacco and Media Workshop and the ability of the organization to adopt a resolution. A follow-up wave of key informant interviews can be utilized to gather information about the issues surrounding the support of each of the four components of the Smoke-free Movies campaign. Quantitative data showing the level of community support for smoke-free movies may have been a valuable tool in prompting adult organizations to take action in support of the Smoke-free Movies campaign. If resources permit, local public opinion polls should be gathered in future projects and data should be incorporated into community education activities with the targeted organizations. Organizations were reluctant to commit a large amount of time to showing support for the UCSF Smoke-free Movies campaign. Instead of the originally planned letter writing campaign which would have involved time and resources on the part of the participating organizations, a postcard writing campaign was highly successful. Postcards that are pre-written and include a space for personal comment facilitate the process of organizations participating in the mailings. Additionally, postcards were simple to take to community events and were made available to members of the general public to send to movie studios and the MPAA. The volume of postcards that were collected and mailed far exceeded the original goal of sending 20-30 letters. This volume contributed to a letter of response from Time Warner CEO, Jeff Bewkes. 13
References 1 State of California, Department of Finance, Race/Ethnic Population with Age and Sex Detail, 2000 2050. Sacramento, CA, July 2007. 2 US Census Bureau. American Community Survey 2006-2008 Three-year estimates. American Factfinder. http://factfinder.census.gov/servlet/nptable?_bm=y&-geo_id=04000us06&-qr_name=acs_2008_3yr_g00_np01&- gc_url=null&-ds_name=&-_lang=en&-redolog=false 3 US Census Bureau. American Community Survey 2006-2008 Three-year estimates. American Factfinder. http://factfinder.census.gov/servlet/nptable?_bm=y&-qr_name=acs_2008_3yr_g00_np01&-geo_id=05000us06089&- gc_url=&-ds_name=&-_lang=en 4 California Healthy Kids Survey. 2006. California Department of Education (Safe and Healthy Kids Program Office) and WestEd (Health and Human Development Department). 5 Dalton M, et al. 2003. Effect of viewing smoking in movies on adolescent smoking initiation: a cohort study. Lancet 362(9380):281-5. 6 Polansky JR, Glantz SA. First-run smoking presentations in US movies 1999-2006. UCSF Center for Tobacco Control Research and Education. http://repositories.cdlib.org/ctcre/tcpmus/movie2004/ 7 Duke JC, et al. 2009. Reported exposure to pro-tobacco messages in the media: trends among youth in the United States, 2000-2004. Am J Health Promot 23(3):195-202. 8 UCSF Smoke Free Movies. http://www.smokefreemovies.ucsf.edu/solution/index.html 14
Smoke-free Movies Appendix Pre-intervention Key Informant Interview Questions Contact: Organization: Purpose: Questions exploring the issues related to their existing knowledge of pro-tobacco influences in the media and their receptiveness to the intervention. 1. Do you believe that smoking in movies influences young people to try smoking? Why? 2. Do you believe movie producers and actors should be allowed to accept money or other items in exchange for including smoking in movies? Why? 3. Do support showing brief public service announcements in theaters to counteract the influence of smoking in movies on children? Should those announcements be required before movies that show smoking? Why? 4. Do you believe cigarette brands (names and logos) should be allowed to appear in movies? Why? 15
5. As with violence and sex, should movies with smoking in them be rated R? Why? What if that smoking was historical or showed the negative effects of smoking? 6. Would you support a resolution requesting that the Motion Picture Association of America and media production companies create more rigorous guidelines for smoking in the movies? 7. Would you support writing letters to media companies, the Motion Picture Associate of America, and the Attorney General regarding more rigorous guidelines for smoking in the movies? 8. Would you be willing to have a 30 minute workshop at your organization on the topic of smoking in the movies and its effects on children? Why? 16
Smoke-free Movies Post-intervention Key Informant Interview Questions Contact: Organization: Purpose: Gather data on what worked and what didn t work with the intervention in the informant s organization/agency. 1. After participation in the workshop, how do you feel when you see tobacco being used in a movie? 2. Did your opinion about the influence of smoking in the movies on children change after you participated in the workshop? (If yes: How did it change?) 3. Before the workshop, were you aware of how often tobacco use is shown in G and PG movies? Were you aware that there is more tobacco use shown in the movies today than in the 1950 s, when twice as many people were smokers? 4. Did the information that you received during the workshop encourage you to think differently about the way you interact with youth? (If yes: What changed?) 17
5. Do you feel that tobacco use should be treated the same as violence or sexual conduct when the MPAA ratings board is assigning a rating to a movie? Why or why not? 6. How well did the fact sheets and PowerPoint contribute to describing the problem of smoking in the movies? (Were they effective?) 7. Have you shared the information that you received in the workshop with any other programs or organizations? Why or why not? 8. Did participating in the workshop prompt you or your agency to sign a resolution? Did you or your agency send postcards to the MPAA and movie studios? (If yes: Why did you or your agency choose to take action?) (If no: Why did you or your agency choose not to take action?) 18
Smoke-Free Movies Focus Group Questions (7-12 Age Group) Have any of you seen the movie X-Men/ Four Christmases/ Incredible Hulk/ Spiderman/ any movie with smoking in it? Did you like the movie? Do you remember if any actors were smoking or using tobacco in the movie? Were any of those actors people who you think could be role models for you or kids your age and younger? Are you influenced by what you see people doing in the movies? (Do they make you want to take a certain way, drive a certain car, do a certain thing)? How do you feel when you see an actor smoking in a movie? Do you think that showing actors/movie stars smoking in movies can influence kids to smoke? How did you feel when the presenter gave you statistics like 80% of PG-13 movies and 50% of G & PG movies show someone using tobacco? Did any other statistics stick out in your head? Did hearing that make you want to do anything about the problem? Like what? Was the video about product placement an effective part of the workshop? What is the 1 st thing that comes to your mind when you think about movies being paid to use tobacco? Did it make you want to take action? Did the workshop in general make you want to take action about the problem of smoking in the movies? Do you have any plans/have you already done anything about it? How did the presenter s style or communication skills help or hurt the workshop? 19
Smoke-Free Movies Focus Group Questions (13-17 Age Group) Have any of you seen the movie The Curious Case of Benjamin Button/ Juno/Spiderman/any movie with smoking in it? Did you like the movie? Do you remember if any actors were smoking or using tobacco in the movie? Were any of those actors people who you think could be role models for you or kids your age and younger? Are you influenced by what you see people doing in the movies? (Do they make you want to take a certain way, drive a certain car, do a certain thing)? How do you feel when you see an actor smoking in a movie? Do you think that showing actors/movie stars smoking in movies can influence kids to smoke? How did you feel when the presenter gave you statistics like 70% of PG movies and 35% of G & PG movies show someone using tobacco? Did any other statistics stick out in your head? Did hearing that make you want to do anything about the problem? Like what? Was the short film 120,000 Lives a Year an effective part of the workshop? What is the 1 st thing that comes to your mind when you think about that movie? Did it make you want to take action? Did the workshop in general make you want to take action about the problem of smoking in the movies? Do you have any plans/have you already done anything about it? How did the presenter s style or communication skills help or hurt the workshop? 20