14.7 Challenges and opportunities for tobacco control campaigns

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14.7.1 Media fragmentation and the continuing emergence of new communication channels

Potentially one of the greatest challenges for tobacco control campaigns is the ongoing fragmentation of media channels, particularly those engaged in by young people. As the amount of free-to-air television watched by young people declines and is to varying degrees displaced by a number of subscription television channels and online activities, the cost of reaching these audiences with the desired frequency is increasing.

At the same time, while depiction and potential promotion of smoking on free-to-air television, at the cinema, and to a lesser degree through subscription television and movie DVD release, are subject to public scrutiny, user-generated content delivered though more recent internet communication channels such as YouTube and MySpace, and other social networking websites more generally, tend to operate in ways that elude such monitoring. For instance anyone can upload their video onto the popular youth website/channel YouTube under an 'alias' username, providing anonymity to the video producer. With more than half of Australian 15–24 year olds using the internet on a daily basis in 2006,131 the virtually limitless potential promotional opportunities for tobacco marketers are obvious.132

A recent search of YouTube videos featuring smoking reported many depictions of 'sexy or glamorous teenagers and young women smoking' with many of them extolling the 'virtues' of smoking.133 A recently published examination of the YouTube channel also reported the presence of pro-smoking videos on the site with the most watched of these being 'smoking fetish and female smoking videos'.132 As these channels become more popular with young people spending more time engaged through cyber-entertainment and dialogue, their exploitation for the promotion of smoking needs to be carefully examined and responses developed. One such course of action may be to lobby the YouTube operators to broaden its definitions of unacceptable material that it currently bans from the site (e.g. pornography, racism, violence) to include smoking.132

But along with the challenges that a medium like this offers are also opportunities. The YouTube study noted that while more of the smoking videos in their search sample of 'smoking' videos identified on the site had pro-smoking content, the anti-smoking videos in the sample were viewed more often, particularly a 'darkly humourous' advertisement. This points to the opportunity for disseminating appropriate existing anti-smoking and smokefree content and messages or producing content specifically for this medium, as well as using this open forum to comment on pro-smoking content and engage in debate.132 Around World No Tobacco Day 2007 Quit Tasmania launched a presence on MySpace with the fashion theme 'Cigarettes are so last season' (www.myspace.com/cigarettesaresolastseason).

As these ever emerging new communication technologies and channels will inevitably represent ongoing challenges and opportunities, constant monitoring of this dynamic environment seems prudent. While the buzz may be around MySpace, YouTube, and increasingly Facebook at present, this social networking interest will likely pass on to the next new channels in the near future.

14.7.2 Cigarette smoking on the cinema screen

In further considering the potential competitive communication environment within which tobacco control interventions are operating, one area that has received increasing attention over the last decade is the depiction of smoking in the cinema. A number of responses have been offered, including banning product placement, applying restricted-adults only classifications, industry self regulation and the screening of anti-smoking messages prior to films which depict smoking.134 Noting the frequent depiction of smoking in films shown in Australia135, there has been increasing calls for cinema interventions to potentially diminish the impact of these depictions. A recent study was conducted in New South Wales to assess whether placing a cinema advertisement about smoking depiction in films prior to the screening of a film could influence young women's perceptions of smoking in movies and their personal intentions to smoke.136 The advertisement featured the voice-over of a well known Australian 'soap' star. Consistent with findings from a similar Californian study137, results suggested this type of approach can help to, in the authors' terms, 'immunise' against the influences of film stars smoking.

The SmokeFree movies project at the University of California in San Francisco138 currently identifies four specific areas for action on this issue:

• rate new movies which show or imply smoking as 'R' (with exceptions where the negative consequences of smoking are clearly depicted or for historical reference)
• certify that no payment has been made to include the depiction of smoking in the movie
• require that a strong anti-smoking advertisement be shown before a movie which depicts smoking
• prohibit any depiction of tobacco brands or brand imagery in movies.

While recent moves have been made to virtually eliminate smoking from movies in India and Thailand, this area of tobacco control action has recently generated controversy. For instance, Chapman argues that there would be general agreement among tobacco control advocates for requiring certification that no payment has been made to ensure depiction of smoking of movies, or of specific brands and brand imagery. However he raises concerns that advocacy for the total banning of the depiction of smoking in movies may potentially generate a negative backlash for tobacco control efforts resulting from what some would see as promotion of censorship that goes too far.139

This is an area that shows promise for further research and investigation. Like YouTube it is an example of identifying media opportunities to deliver pre-emptive or competitive communication designed to mediate against positive depictions of smoking that circumvent advertising restrictions.

14.7.3 Branded content and promotional marketing

There is also an ongoing need to monitor below-the-line tobacco company marketing activities. Producing branded merchandise is a standard marketing tool to build positive brand attitudes and customer loyalty. There is some evidence that suggests owning tobacco company merchandise can potentially diminish the effects of tobacco counter-marketing efforts. A US study of teenagers' response to anti-smoking advertisements found that after controlling for smoking status and other likely predictors of attitudes to smoking, teenagers who owned a tobacco brand promotional item rated anti-smoking advertisements less effective than did teenagers who didn't own one of these items.84

Recent below-the-line promotional marketing of tobacco products and merchandise in Australia has been shown to take a number of forms, from word-of mouth' viral marketing140 to staged fashion events.141 Like the communication technology environments it would seem prudent to constantly be alert to these promotional activities in settings such as bars, music festivals and alternative youth press.139

14.7.4 Pharmaceutical advertising

Advertising for quitting adjuncts such as nicotine replacements and other pharmaceutical aids now has a significant presence within the total tobacco control communication environment in Australia. Smokers have been exposed to this advertising during phases of the NTC and subsequent state and national campaign activity. US research suggests this type of advertising does not have the same degree of cut-through for smokers as the more hard-hitting health effects advertising but it nevertheless has a role to play for smokers who are ready to quit and looking for some sort of pharmaceutical aid to assist them in this process.83 It may be that this form of advertising works in a similar way as the Call for help advertisement was found to operate within the NTC. That is, the advertisement had low levels of recall but high levels of recognition126, and its broadcast resulted in immediate responses relating to the promoted behaviour, calling the Quitline.47 An important area for future research about how this pharmaceutical advertising may interact with anti-tobacco advertising is the examination of the impact on smokers' self efficacy regarding quitting. For instance, do the pharmaceutical advertisements increase smokers' confidence because of the availability of this aid, or does the suggestion that you may need a pharmaceutical aid to quit smoking make the task seem more difficult and less achievable for some smokers?

14.7.5 Radio as a medium

Much of the research on effectiveness of campaign advertising discussed in this chapter has focussed on the medium of television. This is not surprising as television advertisements can more easily generate emotion through the skilful fusion of sound and vision, and the medium of television can achieve broad reach of a target population in a short period of time. Television advertisements are also commonly used in cinema and, as discussed earlier, the internet is now providing further opportunities for exposure of these advertisements. However, other media channels are also often used as part of the campaign media mix and should not be downplayed in terms of potential impact. One recent example of a very powerful radio advertisement was developed as part of the 2005 Quit Victoria Bubblewrap142 campaign focussing on emphysema that ran in three states. This advertisement was a clever and engaging invitation to the listener to participate in what became a self-demonstration of the experience of emphysema.

14.7.6 The Bloomberg Global Tobacco Control Initiative in developing countries

The August 2006 announcement143 of the US$125 million global tobacco initiative by New York mayor Michael Bloomberg heralded a major new opportunity for tobacco control efforts in the developing world. Social marketing has a significant role to play and the initiative is poised to capitalise on this opportunity by facilitating the sharing of tobacco control campaign materials from around the world. Without limiting the efficacy of campaigns for application in their own country, future production of anti-tobacco advertisements and resources can support this initiative by careful consideration of how the materials can be made more easily adaptable for use in other countries and by careful negotiation of talent agreements and licensing arrangements for broader future use.