5.25 Media campaigns and young people

Last updated: September 2022

Suggested citation: Hanley-Jones, S, Letcher, T and Wood L. 5.25 Media campaigns and young people. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2022. Available from https://www.tobaccoinaustralia.org.au/chapter-5-uptake/5-25-media-campaigns-young-people

 

Mass media campaigns are a successful and cost effective way to reduce smoking prevalence, initiation and progression,1 as well as change attitudes, beliefs and intentions about smoking in young people. Anti-smoking advertising campaigns are a key component of strong comprehensive tobacco control programs.2

The 2012 report of the Surgeon General on preventing tobacco use among youth and young adults stated that the ‘evidence is sufficient to conclude that mass media campaigns[…] can prevent the initiation of tobacco use and reduce its prevalence among youth.’3 Ch.6, p.812

A 2016 systematic review4 of the effectiveness of mass media interventions for preventing and reducing tobacco use among young people supported the 2012 Surgeon General’s conclusion that there is strong evidence that mass media campaigns positively affect tobacco use intentions and behaviours among young people.4 Campaign exposure was associated with positive changes in smoking intentions and behaviours in the majority of studies included in the review, and no study showed evidence of negative overall effects. Many campaigns that were aimed at adults also had a positive effect on young people. The optimal duration and intensity of campaigns actively requires at least 400 target audience ratings points (TARPs) per month consistently to show population-level effects, or at a higher level of 800 TARPs, inconsistently. The most effective messages were those that used information about the health effects of smoking and secondhand smoke, as well as the actions of the tobacco industry to evoke negative emotional reactions.4

A 2017 Cochrane review on the effects of mass media campaigns on smoking behaviour in young people could not offer reliable conclusions due to a lack of high-quality available evidence.5 However, the effective campaigns included in the review tended to last longer (minimum of three years) and were more intensive, running across multiple media channels.5

See Chapter 14, Section 14.4 for a detailed discussion of the impact of general and targeted campaigns on young people, and Chapter 7, Section 7.19.1.3 for social marketing cessation interventions tailored to young smokers.

5.25.1 Australian mass media campaigns

The Smarter than Smoking campaign is a Western Australian smoking prevention project funded by Healthway since 1996. This comprehensive program has a mass media component, with several media bursts annually targeting 10–15-year-olds. In 2014, a new Smarter than Smoking websitei was launched and since 2016, has been managed by School Drug Education and Road Aware (SDERA), providing information and resources for schools, parents and young people, on tobacco and smoking-related issues. Western Australia is the only state in Australia to have consistently targeted young people through media campaigns.

During 2005 to 2010 the Australian National Tobacco Campaign, as an initiative included in the 2005 Federal Budget, funded four years of a new campaign aimed at reducing smoking among young people.6 A media campaign featuring a series of graphic health warnings was launched and supported by various activities undertaken by states and territories. In 2006 two new phases were launched. The first phase, the ‘Health Warnings Campaign’, was launched to raise awareness of the new graphic health warnings approach on tobacco product packaging. The second phase, the ‘National Tobacco Youth Campaign’ aimed specifically to have an impact on smoking rates among young people.6 See Chapter 14, Section 14.3.2.5 for more on the National Tobacco Youth Campaign 2006-2007.

See Chapter 14, Section 14.4 for a detailed discussion of the impact of general and targeted campaigns on young people in Australia.

5.25.2 Interactive media

Interactive technologies, including internet-based programs, social media, smartphone applications and video games, present a unique opportunity for innovative ways to influence and engage young people in health promotion.7 Although there is limited literature examining the use of interactive technologies in smoking prevention among young people, several potential benefits have been suggested:  

  • Creative message and delivery possibilities that are not available through traditional health education materials.8
  • Interactive technologies provide alternative or more innovative ways to communicate ‘tired’ health messages.9
  • Young people are frequent users of the Internet and other interactive technologies and so the potential to engage them is enhanced.10 11
  • Interactive technologies can be used to reach young people in out-of-school settings,11 including those more at-risk.12
  • Newer technologies can provide an interactive or ‘hands on’ learning approach.9
  • They provide flexibility and privacy in terms of where and how information is accessed.9
  • The capacity to provide responses and feedback through interactive technology enhances learning through reinforcement.13
  • Action Researchii is possible through interactive technologies, and programs can be modified and updated as required.11
  • Messages and strategies can be more individually tailored to different target segments14 rather than ‘one size fits all’.

5.25.2.1 Mobile phones

5.25.2.1.1 Text messaging (SMS) services as a prevention strategy

Mobile phone short message services (SMS) can be used for delivering health behaviour change interventions. Their wide population reach, ability to be individually tailored with instant delivery and delayed responses, are useful features for this purpose.15 In addition, mobile phone programs have some advantages for young people over other forms of treatment services for smoking cessation, including that they can be delivered anywhere, at appropriate times, confidentially and straight to the young person with minimal direct contact.16

Mobile phone-based interventions specifically targeting adolescents or children for prevention are sparse in the published tobacco-control literature. A 2020 quasi-experimental text messaging trial aiming to improve adolescent sexual and reproductive health and smoking knowledge in Indonesia reported improved smoking knowledge in a low-to-middle-income setting using the SMS intervention. The study focused on the harmful effects of both smoking and passive smoking, and promoted the positive effects of quitting. Overall, the study showed a significant increase in knowledge about smoking and supportive evidence of potential intervention efficacy.17

For information on text messaging (SMS) services for cessation see Chapter 7, Section 7.14.2.

5.25.2.1.2 Smartphone applications (apps) as a prevention strategy

While many smartphone applications (apps) exist for smoking cessation, there are far fewer that focus on prevention for young people. One app has proven effective when incorporated into anti-tobacco education­­—‘Smokerface’, a free photoaging app which requires the user to take a self-portrait, then presents them with four pictures: consequences of smoking and not smoking, smoking one pack per day for a year, and smoking for 15 years. Three studies have used the ‘Smokerface’ app in studies on smoking prevention among young people,18-20 with all three studies reporting the app to be effective at motivating young people not to smoke and educating them about the benefits of not smoking. Moreover, the app was consistently reported by young people as fun and enjoyable to use.

Another study incorporated school students’ perceptions of smoking and mobile phones into the design of a prototype for a smartphone application called ‘Don’t jump in’, that aimed to prevent smoking among adolescents.21 From the qualitative focus groups, the researchers identified behaviours that could potentially be targeted: associating cigarettes with a distraction from problems, peer and family pressures as a trigger to starting smoking, and the perceived association between tobacco use and popularity. The students also provided feedback on what they would like to see in a smoking prevention app, including: features that enable ‘chatting’ with other young people, informational videos on health effects, and a gamification element.21

For more information on Smartphone applications for cessation see Chapter 7, Section, 7.14.3 Smartphone applications (apps).

5.25.2.2 Internet and web-based strategies

Young people are typically among early adopters of new media and have for some time been recognised as a key audience for much of the material on the internet.22 The internet can be used both to encourage (overtly or covertly) and discourage smoking among young people.23 Tobacco companies are using the internet to promote tobacco products and tobacco use to young people, most recently via ‘social media influencers’ (See Chapter, 5 Section 5.15.3 and Chapter 11, Section 11.11 for information on tobacco promotion and the internet).

Conversely, the internet is used by those in public health to engage young people in tobacco prevention. ‘Truth Initiative’, introduced in 1998, is a US non-profit public health organisation dedicated to achieving a smoke and nicotine-free culture among young people. The organisation runs the ‘Truth Campaign’, a long running campaign that targets young people for tobacco prevention by sharing facts about smoking, e-cigarettes, nicotine, and tactics used by the tobacco industry.24

The internet is also being used in tobacco prevention to encourage grassroots advocacy among young people,23 such as ‘Take Down Tobacco’iii an online training program for young people run by ‘Campaign for Tobacco-Free kids’ in the US, and as a part of larger mass media campaigns aimed at young people. For information on the use of Social Media (e.g. Facebook, YouTube) in mass media campaigns see Chapter 14, Section 14.5.4.3.

The internet allows those working on prevention initiatives to tailor information and strategies to particular population groups. Interactive digital technologies for the production and distribution of tobacco prevention messages in Aboriginal and Torres Strait Islander communities enables wide reach and can be tailored appropriately. See Chapter 8, Section 8.10.4.2 for internet interventions targeting Aboriginal and Torres Straits Islander peoples.

5.25.2.3 Video games

Video games have overtaken motion pictures as the dominant form of media.25 A report in 2020 estimated that close to 3.1 billion people globally play video games.26 In Australia, an estimated 81% of young people aged 8–17 play online video games.27 The characteristics of games and the popularity of video games among young people provides an ideal medium for health communication and tobacco education.28 ‘Games for health’ or ‘serious games’ are digital games designed specifically for health behaviour education and health promotion.28 According to experts in the fields of gaming, health behaviour, and tobacco including those with experience working with young people and adolescents, features of games that can engage young people in health education include: ‘an intriguing storyline/narrative, a clearly stated health purpose/ goal, the ability to develop/ master skills and solve problems within the gameplay environment (e.g., ability to win or lose), ability to role-play (i.e., simulation of real-world activities or events), health messages and information, and relevant or authentic gameplay’.28 Recommendations on the use of video games as tobacco prevention tools include: using the game as a reinforcement of didactic lessons by making it part of a health education curriculum; and using games as a means to target emotional appeal by showing the negative consequences of smoking, specifically focusing on the cosmetic effects of smoking such as bad breath, yellow skin and teeth, etc. Moreover, video games can provide an excellent medium for counteracting tobacco industry messages and media portrayals of smoking as desirable.28 Existing video games that focus on tobacco prevention among young people include; ‘Flavor Monsters,’ a mobile fact-based, anti–tobacco industry game targeting youth and adolescents 12–17 years old available for the smartphone. Other types of tobacco prevention and smoking cessation related games include ‘Tobacco Free Teens,’ ‘Tunnel Tail,’ ‘Elm City Stories,’ ‘Smoking Rabbit,’ ‘Rex Ronan: Experimental Surgeon,’ ‘Recovery Warrior,’ ‘Cigarette Crush,’ ‘Cigarette Fighter,’ ‘Don’t Blow It,’ ‘Crazy Blowers,’ ‘David Carr: Stop Smoking,’ ‘Escape from Nicotinia,’ and ‘B.A.R.N.’ (Body Awareness Resource Network).28

Unfortunately, many games currently available lack critical elements for behaviour change (i.e., a theoretical foundation) and effective game development (e.g., a narrative), thus limiting their potential to effect change according to a 2016 content analysis of commercially available smoking prevention and cessation games.29

A handful of small pilot studies have reported promising preliminary results on the effectiveness of video games for changing adolescents’ beliefs,30 knowledge,30 risk perceptions31 and understanding of the health consequences32 of tobacco products, as well as being a successfully engaging medium for tobacco education.33, 34

See Chapter 5, Section 5.16.1.4 for more information on the issue of pro-tobacco imagery in video games.

 

ii Action Research Model ‘involves a spiral process where ideas (prototypes) are: generated by/with the community, implemented with the community, evaluated by the community, adjusted according to community feedback, then reimplemented and evaluated. This interactive process is ongoing throughout the life of the

project with evaluation and adjustment continuously taking place.’


Relevant news and research

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References 

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16. Whittaker R, Borland R, Bullen C, Lin RB, McRobbie H, et al. Mobile phone-based interventions for smoking cessation. Cochrane Database Systematic Reviews, 2009; 4( CD006611). Available from: https://www.researchgate.net/publication/317600883_Mobile_phone-based_interventions_for_smoking_cessation

17. Pedrana AE, Pina J, Padmawati RS, Zuhrina R, Lazuardi L, et al. A quasi-experimental text messaging trial to improve adolescent sexual and reproductive health and smoking knowledge in Indonesia. Sexual Healt h, 2020. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32017868

18. Brinker TJ, Seeger W, and Buslaff F. Photoaging mobile apps in school-based Tobacco prevention: The mirroring approach. Journal of Medical Internet Research, 2016; 18(6):e183. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27352819

19. Bernardes-Souza B, Patruz Ananias De Assis Pires F, Madeira GM, Felicio Da Cunha Rodrigues T, Gatzka M, et al. Facial-aging mobile apps for smoking prevention in secondary schools in Brazil: Appearance-focus ed interventional study. JMIR Public Health and Surveillance, 2018; 4(3):e10234. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30021713

20. Marzo RR, Bhattacharya S, Ravichandran S, Lakshmanan P, Jeffery VR, et al. Educating school students and gauging their perception about the harmful effects of smoking using a"facial-ageing app (mobile applic at ion):" An experience from malaysia. Journal of Education and Health Promotion, 2019; 8:250. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32002422

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29. Watson AM, Alber JM, Barnett TE, Mercado R, and Bernhardt JM. Content analysis of anti-Tobacco videogames: Characteristics, content, and qualities. Games for Health Journal, 2016. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27096576

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32. Cocchiara RA, Sestili C, Di Bella O, Backhaus I, Sinopoli A, et al."Giochiamo," a gaming intervention to prevent smoking and alcohol habits among children: A single-arm field trial. Games for Health Journal, 2 019. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31770005

33. Duncan LR, Hieftje KD, Pendergrass TM, Sawyer BG, and Fiellin LE. Preliminary investigation of a videogame prototype for cigarette and marijuana prevention in adolescents. Substance Abuse, 2018:0. Available fr om: https://www.ncbi.nlm.nih.gov/pubmed/29425481

34. Parisod H, Pakarinen A, Axelin A, Loyttyniemi E, Smed J, et al. Feasibility of mobile health game"Fume" in supporting tobacco-related health literacy among early adolescents: A three-armed cluster randomized d esign. International Journal of Medical Informatics, 2018; 113:26-37. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29602430