Posted by Behavioural Insights Unit on Friday August 9th, 2013

Issue: Smoking is the largest cause of preventable death and disease in Australia.

Campaign: The ‘Best Intentions’ advertising campaign emphasises the need to quit immediately, and recognises that smokers often try to quit many times without success.

Behaviour: The advertisements make use of emotional cues and time triggers, such as how life milestones are a popular time to give up. The character was designed specifically, through prior research, to be relatable with the target audience of middle-aged adults.

Outcome:  Results suggested 84% of smokers who viewed the adverts reported it made them think seriously about quitting.

The Policy Issue

Tobacco smoking is the largest cause of preventable death and disease in Australia[1]. It increases the risk of cancer, as well as various heart and lung diseases, and is estimated to cause over 6,600 deaths in NSW alone each year[2]. One in two lifetime smokers will die from their habit, with a third of those deaths occurring in middle age[3].

While there are serious health consequences of smoking, quitting at any time in life results in substantial and immediate health gains[4]. Research shows that mass media campaigns, including television advertisements, are one of the most effective means to encourage quitting, especially when these campaigns are supported by back-up services and resources for smokers. Indeed, it has been estimated that for every $1 spent on tobacco control programs to date, $2 has been saved on health care[5].

The Policy Objective was to encourage smokers to quit, and to increase awareness of the impact and health consequences of smoking, not just on the smoker, but on their family as well.

Behavioural Analysis of the Policy Issue

Understanding smoking behaviour is crucial to inform attempts to reduce smoking. While smoking is highly addictive due to nicotine, which forms a strong physical chemical dependence, this alone does not explain smoking behaviour sufficiently. Smoking also has psychological as well as chemical foundations, some of which are outlined below:

  • Social Learning Theory can help to explain why smoking behaviour begins in the first place. This describes how we learn by example from others and are strongly influenced by our parents, and peers. Studies into smoking in young people suggest the influence of friends and parental smoking is significantly associated with smoking behaviour regardless of age and background[6].
  • Smoking behaviour is positively reinforcing, as there is an almost immediate effect on our brains through smoking (an increase in dopamine levels which promotes feelings of pleasure and reward). The reverse effect is also true, as quitting is punished by withdrawal symptoms – including irritability, snappiness and lack of concentration. Having a cigarette alleviates these symptoms, which negatively reinforces the desire to carry on smoking.
  • We learn to associate smoking with other activities such as drinking coffee, going to the pub, and spending time with some friends. These activities will act as triggers, such that the sight of a cup of coffee can cause some smokers to reach for their cigarettes without any conscious thought.

Research Underpinning the Campaign

In February 2008, the Cancer Institute NSW commissioned exploratory research with NSW smokers aged 18+, to provide insights to assist in the development of advertising concepts for the 2008 campaigns. New behavioural insights uncovered by the research included:

1. Previous Attempts to Quit

Particularly among participants aged 35-49, there was an acceptance of having made several quit attempts and a realisation that quitting is not as easy as they had originally thought.  Participants in this age group related strongly to the guilt of missing specific self-imposed deadlines to quit, and the associated excuses, such as not quitting because of the stress they were experiencing. 

2. Effects of Smoking on Family

The research showed that the reduced quality of life for the smoker and the family remains a strong contributing factor to smokers’ intentions to quit, particularly the impact of smoking on children within the household.

Participants said these factors encouraged a greater resolve to be successful in their next quit attempt. These insights were drawn upon to create a campaign emphasising the regret people feel from not quitting, regret from unsuccessful quit attempts and the reduced quality of life for the smoker and other members of the family. 

The Campaign

The Cancer Institute NSW ran the ‘Best Intentions’ Campaign from December 2008 to February 2009. The campaign was designed to remind smokers that there is never going to be a perfect time to quit smoking, and to highlight the negative effect of smoking on families. The ad campaign features a father at home, clearly very ill and receiving medical treatment, saying, ‘I quit every year, I was sure I was going to stop before it did me any serious damage’.

The ad goes on to encourage smokers to act now, stating ‘Face it, there's never going to be a perfect time to quit. You have to beat your habit once and for all … now’.

The 30 second television advertisement aired on all major metropolitan commercial and regional stations in 2008/2009 and was then repeated from September to October 2011. The target audience for the campaign was adult smokers (aged 25 to 54 years), particularly those of lower socio-economic status given the higher prevalence of smoking among this demographic. 

You can view the video of the campaign here.  

In addition to digital advertising, the campaign was promoted on radio and through print, being placed in community language media (Arabic, Chinese, Italian and Vietnamese), due to these communities being identified with significantly higher than average smoking prevalence[7]

Alongside campaigns like ‘Best Intentions’, smokers are offered support to quit smoking via the Quitline, a free and professional telephone service, and the 13QUIT website, the website address of which was included in the campaign material.

The behavioural aspects of the campaign can be explained using the EAST framework.

EASY: The campaign reminded people of the need to quit alongside promoting practical services like Quitline and 13QUIT. Services like these can act as a first step towards a program of quitting, and can help provide support and assure people they are not alone, making the process of quitting easier. Framing the advertisements with personalised stories which highlighted the reduced quality of life of smokers, also suggests that quitting is easier than the myriad health problems that could result from smoking.

ATTRACTIVE: People identify more with people they see as like themselves, and are therefore more likely to listen to a message coming from such a person. As the adverts were targeted at specific groups (middle-aged smokers), the message was made more salient to these groups by featuring a middle-aged smoker and his family in the advertisement.

The campaign captured the audience’s attention and used persuasive messaging through its use of loss aversion. The advertisements framed the message by emphasising the losses associated with not quitting, specifically to the persons health, with the character appearing to be terminally ill and coughing.

SOCIAL: The campaign highlights the negative effect of smoking on a person’s family; forcing others to look after the ill smoker. The use of such emotional messages can help to create new social norms, whereby the general public respond more negatively to smokers, whose habit will hurt others as well as themselves.

TIMELY: The timing of the campaign (starting late in the year) was chosen to coincide with smokers considering quitting as a New Year’s resolution. Commitment devices like using specific dates can be powerful cues, because people are biased by time inconsistency, meaning they would always prefer to quit tomorrow and live for today. The advert targets this, encouraging smokers to act now: “Face it, there's never going to be a perfect time to quit. You have to beat your habit once and for all … now”. 

Outcomes and Reuslts

The Cancer Institute NSW conducts continuous tracking research as part of the evaluation of the effectiveness of its tobacco control mass media campaigns.  The total awareness (i.e. cued recall and prompted awareness combined) of the ‘Best Intentions’ television advertisement was 74%. Among the respondents who were aware of the advertisement, 84% found the advertisement ‘convincing’ (‘very convincing’: 44%).

There was a good understanding of campaign messages amongst respondents who recalled the television advertisement without prompting, with around 84% responding with at least one correct message. Among respondents who were spontaneously aware, around 84% reported that the ‘Best Intentions’ television advertisement made them seriously think about quitting smoking.

References
  1. Jump up ^

    Scollo, M. M., Winstanley, M. H. (2008). Tobacco in Australia: Facts and Issues. Third Edition. Cancer Council Victoria, Melbourne.

  2. Jump up ^

    NSW Health (2004). Report of the New South Wales Chief Health Officer 2004, 'Health-Related Behaviours. Death and Illness Attributable to Smoking'.

  3. Jump up ^

    Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug statistics series no. 25. Cat. no. PHE 145. Canberra: AIHW.

  4. Jump up ^

     Cancer Society. Cancer Facts & Figures 2013. Atlanta, Ga. 2013.

  5. Jump up ^

    Returns on Investment in Public Health. An epidemiological and economic analysis prepared for the Department of Health and Ageing.

  6. Jump up ^

    De Vries, H., Engels, R. C. M. E., Kremers, S. P. J., Wetzels, J. J. L. & Mudde, A. N. (2003) Parents’ and friends’ smoking status as predictors of smoking onset: findings from six European Countries. Health Education Research, 18, 627–636.Naqvi.

  7. Jump up ^

    Ranney, L., Melvin, C., Lux, L., McClain, E. & Lohr, K. N. (2006). Systematic review: Smoking cessation intervention strategies for adults and adults in special populations. Annals of Internal Medicine, 145, 845–856.

This case study is part of a series of behavioural insights (BI) case studies compiled by the Department of Premier and Cabinet (DPC). While DPC is working with the UK Cabinet Office to push forward the use of BI in NSW, these case studies show how the NSW Government has already successfully applied BI techniques in a number of programs. 

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