Indigenous smokers were more likely than the non-Indigenous to report that the ads contained ‘New information’, and so it is possible that these ads were less likely to have been previously seen among Indigenous people. 2003;12(suppl 2):ii23–9. We see a close-up of an Indigenous toddler, Billy, asleep on his mother’s chest, sweat running down his face. The man lights up a cigarette and breathes in smoke that swirls around in his lungs. Most creative tactics used to create antismoking advertisements in Australia fit into one or more of four categories. I am always afraid of bad news. This challenge is more difficult in the current media landscape where media consumption is more fragmented than ever, requiring multiple channel selections with additional demands on campaign budgets, and consumers have unprecedented opportunities to control what they view. This was followed closely by ‘Cigarettes are eating you alive (Alive), Anthony, Amputation, Who will you leave behind (Leave behind) and Ronaldo—Otolaryngologist (Ronaldo)’. In the case of Ronaldo, Indigenous participants commented on his striking voice, the confronting imagery of the hole in his throat and the fact that this was a real person, all as factors that appeared to have made it an effective ad. Sydney: YouTube Australia; 2014 [cited 2019 Nov 5]. The wheezing sound was attention grabbing across a range of the groups with some commenting that they also made the same sound when breathing: ‘Very relatable, makes you feel like quitting’. J Health Commun. Furthermore, the ads were not rated in the context of an overall campaign but were instead assessed in the controlled environment of a reference group. It may be that the ads depicted in the third person are less salient among Indigenous people who all too frequently experience loss of family. 2012;21(2):127–38. At the beginning of each group testing session, participants completed a demographic questionnaire, were shown a test advertisement for shampoo and completed four practice ad rating items. Elser H, Hartman-Filson M, Alizaga N, Vijayaraghavan M. Exposure to pro- and anti-tobacco messages online and off-line among people experiencing homelessness. However, it remains critical that campaigns are developed and implemented with best practice principles and funded sufficiently to achieve effective reach and engagement with people who smoke. However, with limited Indigenous-specific messages available and given the finite resources of most public health campaigns, exposure to mainstream strong graphic and emotive first-person narratives about the health effects of smoking are also likely to be highly effective with Indigenous smokers. Melbourne: Cancer Council Victoria; 2019 [cited 2019 Nov 4]. Available from: 11. This ad begins with a repetitive whistling and whooshing sound. Zita’s story. The voiceover says ‘It’s called emphysema, and it’s irreversible. The doctor withdraws the scope and pats Ronaldo’s shoulder reassuringly. Back in the clinic, the voiceover says ‘Don’t make your children smoke’. Billy: Indigenous-targeted: Second-hand smoke health effec, Source: Department of Health and Families, Northern Territory Government. I will be alive for that’. Centres for Disease Control and Prevention. Some participants within the non-Indigenous groups felt offended and angered by the ad: ‘It’s not fair that they’re targeting just the Indigenous. Although only included for broad comparison purposes, those advertisements that were more positive in nature (Family time) or reflective (Which disease) were rated much lower by Indigenous smokers on Personalized effectiveness than the ads that depicted serious diseases through graphic imagery or first-person personal stories, further consistent with studies in the general population [21–24, 28]. 22. Part 3 involved a structured group discussion of each of the advertisements, led by the group moderator. The agency’s own study showed that after its first national ads aired in 2012, compared to before the campaign, 1.6 million more people sought help to quit. Further analyses examined clustering at the individual and location level (Adelaide, Port Lincoln, Port Augusta and Ceduna) but found all clustering was due to individual-level effects. Finally, we see a young man in a pub buying a pack of cigarettes from a vending machine bearing the sign: Smoking kills Call the Quitline 137 848. Ronaldo—Otolaryngologist: Strong graphic and narrative health effects, Source: New York City Department of Health and Mental Hygiene, Another strategy to continue to generate discomfort about smoking may be the use of more non-skippable advertisements where possible to increase the likelihood of securing a captive audience. When home, she picks up a cigarette pack and throws it angrily away, while the voiceover says: ‘Do it for your family! 2004. Bold figures highlight those ads that were not rated significantly lower than the highest rated ad for each outcome at P < .05. A key to achieving this engagement is to continue to present smokers with new information about how smoking creates harms, as identified in medical research. The results of this study, together with the results from the three Australian studies previously published [18–20], have some important implications for practice. Indigenous groups commonly reported that Alive made them think about the damage that their smoking was doing to their bodies, especially the external damage caused by mouth cancer. Each item was measured on a five-point Likert scale, where 1 represented ‘strongly disagree’, 2 ‘slightly disagree’, 3 ‘neither agree nor disagree’, 4 ‘slightly agree’ and 5 ‘strongly agree’. Some participants found the reality of the ad to be both confronting and scary: ‘Makes me want to cry’. The camera then cuts to a photo of his father, this time looking quite ill. Table 2 demonstrates trends in how frequently smokers of low SES status consume free-to-air television. Advertisements with strong graphic imagery depicting the health effects of smoking were rated highest by Indigenous smokers. These were among the top rated ads for at least three of the six outcome measures. Health Educ Res. Data collection was undertaken in August to September 2010. Further multivariate logistic regression analyses were conducted on the combined sample of all participants, in order to examine any differences in Indigenous and non-Indigenous participants’ ad ratings for the six outcomes, separately for each of the 10 ads. Five-year media consumption trends – Smokers 18–49. The World Health Organization has expressed concern about the high levels of tobacco use by Indigenous peoples [2], encouraging greater attention to redress this important public health disparity. This ad was regarded as effective by some respondents because it was a true story: ‘This is real life and a real bloke talking; that’s effective’. The CDC noted that the cost-effectiveness of anti-smoking campaigns can include expenses related to medications, counseling and other treatments to help people quit smoking. Significant difference between groups *P < 0.01; **P < 0.001. These discussions focused primarily on message comprehension, acceptance and appropriateness of the ad content. In addition, as smoking rates continue to fall, characteristics of current smokers are becoming increasingly relevant considerations for anti-smoking messaging and placement within a media environment that is becoming more expensive and fragmented. A limited number of studies in New Zealand, Canada and Australia have evaluated the attitudinal or behavioural impact of anti-smoking television advertisements on their respective Indigenous communities. In addition, only one Indigenous-targeted advertisement was available at the time of this research and it was of relatively poor quality compared with the other advertisements tested. The burden of disease for Indigenous Australians is 2.5 times that of the total Australian population [4] and the overall mortality rates are approximately twice those of non-Indigenous people. Canberra: ABS; 2019 [cited 2020 Aug 10]. A Caucasian man, approximately 30 years old, begins by addressing the camera from his lounge room: ‘Smoking-related lung cancer is a long, painful way to die’ he says, ‘There’s no other way to describe it—it was absolutely hellish’. This ad was described as targeting everyone because it did not use a specific person. In online environments, negative advertisements face significant barriers. Cutting to a scene of a remote health clinic, Billy’s mother tells the health worker he has been coughing a lot and she’s worried. Anti-smoking campaigns can thus also focus on the benefits of not smoking. The highest rated ad for each outcome (columns) is indicated by * and bold; the lowest rated ad for each outcome is indicated by ∧. Just about every smoker does’. However, there is a dearth of research and evaluation of tobacco interventions in Indigenous populations in Australia [11–14], and so it is not possible to determine whether the apparent null effects of these campaigns for Indigenous smokers (as compared with the general population) might be due to differences in ‘meaningful exposure’ to these campaigns, differences in ‘opportunities and support to sustain long-term quitting’ and/or differences in the these mainstream campaigns’ ability to ‘motivate smokers to quit’ [15]. Averaged predicted probabilities of positive ad ratings for Indigenous smokers (95% confidence intervals). Before they did this they found out I’d got lung cancer as well. Potential effectiveness of specific anti-smoking mass media advertisements among Australian Indigenous smokers. groups and effectiveness of the anti - smoking message. Well-known examples include Zita’s Story and Terrie’s Tips.9,10 The third category involves help-to-quit advertisements that promote strategies or tools to help people quit, such as quit-smoking helplines. Effect of varenicline for smoking cessation in adolescents - Authors' reply. Also, further research may explore why Indigenous smokers reported that they would be more likely to discuss these ads than non-Indigenous smokers, especially in light of growing evidence that health message prompted conversations can affect important campaign outcomes in both positive [30–32] and negative ways [33]. TR was responsible for drafting and reviewing the manuscript and TC was responsible for reviewing and editing the manuscript. Some participants liked the metaphor and felt that it conveyed an important message. His chest wheezes under the stethoscope. There were also no differences between Indigenous and non-Indigenous participants for Bronchoscopy, which rated highly and was strong graphic in nature. Scollo M, Winstanley M. Tobacco in Australia: facts and issues. That said, the changing profile of current smokers places even more importance on understanding audience segments and designing messaging in line with consumer insights. Evidence-based creative approaches must continue to generate discomfort about smoking while enticing and engaging the smoker audience to listen to the message. Accessed: 25 November 2010, The Burden of Disease and Injury in Aboriginal and Torres Strait Islander peoples 2003, School of Population Health, The University of Queensland, Australian Institute of Health and Welfare (AIHW), Heart, Stroke and Vascular Diseases—Australian Facts 2004, Cat. ‘By the time, most lung cancers are discovered, it’s already too late to operate’, he adds, shaking his head. A total of 10 anti-smoking advertisements were tested ( Appendix 1). This study aimed to assess whether mainstream ads representative of those typically aired in Australia influence Indigenous smokers to consider quitting and to assess the potential effectiveness of various anti-smoking messages for communicating with Indigenous Australians. Dunlop SM, Cotter T, Perez D. When your smoking is not just about you: antismoking advertising, interpersonal pressure, and quitting outcomes. Participants referred to Bronchoscopy as gross, disturbing and frightening. Significant difference between groups: *P < 0.05; **P < 0.01; ***P < 0.001. The samples in Tables 1–3 are taken from a larger dataset of the projected population of Australians aged over 14 years. The final category involves non-reality executions based on credible analogies showing the mechanism of health effects. Some Indigenous individuals noted that they are used to seeing individuals with gangrene, and therefore, they considered the ad to be serious and to have personal resonance. ‘Bronchoscopy’ was the highest rated ad overall with Indigenous smokers rating this ad above 80% for five of the six outcome measures, where more than 80% of Indigenous smokers agreed this ad delivered on these five measures (Table III). 17. 7. Statement of review process: This work was endorsed by the Aboriginal Health Council of South Australia Inc. and received ethical approval from both the Aboriginal Health Council of South Australia Research Ethics Committee and the Cancer Council South Australia Human Research Ethics Committee. Family time: Narrative of positives of quitting, Some felt that the ad was telling them if they did not want to quit smoking for themselves, they should at least consider quitting for their family: ‘Think of the people who will miss you’. Five-year reach potential trends – smokers 18–49. This study was based on a protocol that has been successfully implemented with appropriate translation and other minor procedural amendments among smokers in 10 low- to middle-income countries [27]. (AIF18-25). Public Health Res Pract. Budgets for producing anti-smoking campaigns and purchasing mass media air time are often limited and cannot usually be tailored specifically for Indigenous people, so a balance between what will be effective in the population as a whole and Indigenous people needs to be struck. (RIM18-25). California: YouTube USA; 2012 [cited 2019 Nov 5]. 2003;12(suppl 2):ii9–14. Averaged predicted probabilities of positive ad ratings for non-Indigenous smokers (95% confidence intervals). In: Alcohol warning label survey report. While these approaches have been effective in prompting people to make a quit attempt, the challenge today is finding new ways to effectively engage current smokers and provide new information to maintain their interest. Significant difference between groups *P < 0.05; **P < 0.01; ***P < 0.001. However, it is not yet clear whether these effects also hold for Indigenous people. Findings indicated that, based on the number of people estimated to have quit smoking for good (about 100,000), the campaign will also prevent at le… The authors would like to thank Michael Murphy from the Social Research Centre for preparation and management of the reference groups and Scott Wilson and Byron Wright from the Aboriginal Drug and Alcohol Council for their assistance with the groups and recruitment. Significant differences were also observed between groups in education level, parental status and previous quitting attempts (Table II). However, the ranking of responses to the different ads from both Indigenous and non-Indigenous smokers was very similar, with four of the five ads nominated as most motivating of all ads, the same in both groups (Anthony, Ronaldo, Bronchoscopy and Alive). I will have to do this for the rest of my life’. Firstly, the sample of this study was limited to metropolitan and rural centres and did not sample Indigenous people living in remote communities (which account for approximately 24% of the Indigenous population [3]). For full access to this pdf, sign in to an existing account, or purchase an annual subscription. 26. Left ventricular and atrial global strain evaluation within subtypes of ventricular remodeling. Methods: We present a commentary on the established creative and media strategies proven to be effective in prompting quit attempts among smokers, discuss new challenges facing anti-smoking campaign managers today and propose considerations for the future. 21. An end tag with the words: ‘No smoker can breathe easily’ and ‘Quitline 137848’, appear on the screen across the image of the doctor. It was common for parents to describe feeling selfish after watching this ad. Consistent with studies in the general population, the ads that depicted serious diseases through graphic imagery or first-person personal stories were rated highly by Indigenous smokers on personalized effectiveness, general perceptions of ad effectiveness and emotional impact [21–24, 28]. Available from: 16. Perth: Gatecrasher; 2015 [cited 2019 Nov 6]. (RIM18-25). The sound of Ronaldo’s electrolarynx and the image of the hole in his throat were regarded as strong and lasting aspects of the ad: ‘Seeing the throat is enough to make my skin crawl’. Prev Med Rep. 2019;15:100944. ‘Chemicals in tobacco smoke destroy them’, he says, as the cigarette tip, held by an anonymous hand, repeatedly burns the individual ‘bubbles’ within the wrap, leaving behind numerous sizzling black-rimmed holes. Published by Oxford University Press. Where significant differences in ad ratings between Indigenous and non-Indigenous participants were observed, these were always in the direction of Indigenous smokers giving higher ad ratings than non-Indigenous smokers (Tables IV and V). The lungs. The CDC’s campaign tactic was to create “edgy” posters to attract as much attention as possible to point out the fact that smoking was unattractive and damaging. And I think that would have been hard for Dad’. Bronchoscopy and Bubblewrap were the only ads that were rated similarly between groups. Pettigrew S, Jongenelis M, Phillips F, Slevin T, Allom V, Keightley S, et al. Tob Control. There are several factors which impact the successful use of non-television platforms for antismoking campaigns. The authors were cognizant of the National Health and Medical Research Council Guidelines for Ethical Aboriginal and Torres Strait Islander Research and have used these values and ethics to underpin this research (NHMRC, 2003; available at: /guidelines/e52.pdf). Ieremia states there was always ‘Break time! Canberra, Australia, Australian Institute of Health and Welfare and National Heart Foundation of Australia, National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, Long-term effectiveness of mass media-led anti-smoking campaigns in Australia, How has the prevalence of cigarette smoking changed among Australian adults? Anthony: Narrative health effects, first person, A graphic image of the badly damaged ‘lungs’ remains. There may be other specific examples of health effects that are more salient to Indigenous people and further research on this issue is recommended. This finding could be confounded by the fact that the production quality of Billy was not as good as the other ads, but it was the best quality Indigenous ad available at the time of data collection. People aged 18+ who smoke factory-made cigarettes, by socio-economic quintile. Anti-Smoking Campaign Effectiveness. It is clear there has been a modest reduction in free-to-air viewing while online channels have experienced strong growth. Lessons learnt: Although it is known that hard-hitting, emotional and/or testimonial anti-smoking advertisements can be effective in prompting quit attempts, optimal media channel selection and media mix for reaching and engaging audience segments is dynamic in an ever-changing media landscape. The reactions to Bubblewrap were mixed. Advertising policies. A Cost-Effectiveness Analysis of the First Federally Funded Antismoking Campaign Summary: This study analyzed the cost-effectiveness of the 2012 Tips campaign. We watch what he sees—the raw-looking, bubbling and largely blocked internal airway. Bronchoscopy was the highest rated ad overall and was considered equally confronting and memorable by the Indigenous groups as it was by the non-Indigenous groups. Research has shown that national mass media communication campaign is one of the most effective means of raising awareness of the real health harms of tobacco and second-hand smoke, deterring youth from initiating tobacco use, urging smokers to comply with smoke-free laws and encouraging smokers to stop smoking. Five-year reach potential trends: smokers aged 18–49 years in market segments D, E, FGa. Overall, non-Indigenous smokers reported smoking significantly more cigarettes per day than Indigenous smokers (t(276) = 2.85, P = 0.005). The challenge remains for adequate financial investment to be committed to ensure mass media campaigns can productively reach and engage these audiences with an effective media channel mix and personally relevant, meaningful communication that can prompt them to quit. Each session lasted approximately 1.5–2 hours, with the quantitative ratings sections typically lasting 30–40 minutes. This video is unavailable because we were unable to load a message from our sponsors. People within low SES segments (segments D, E and FG, which are defined by Roy Morgan as the three lowest SES quintiles) have higher rates of smoking than those in more advantaged SES segments (AB and C, which are defined as the two highest SES quintiles).11 This is an important consideration when planning and buying media. Were new information was consistently rated higher among Indigenous smokers ( 95 % confidence intervals ) away at nearly vital. 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