BackgroundThe Australian Government Department of Health and Ageing (Department) launched the National Tobacco Campaign - More Targeted Approach - Pregnancy component in 2011. Phase 1 of the campaign activity ran from May to the end of June 2011. Phase 2 of the campaign, which ran from January to June in 2012, aimed to build on and reinforce the messaging from this previous activity.
The primary target audiences for the campaign were pregnant women who smoke aged 16 to 30 years and women who are planning to become pregnant within the next two years and who smoke, aged 18 to 30 years. Secondary target audiences included older female smokers (aged over 30) who are pregnant or plan to become pregnant.
The communication objectives were to raise and reinforce awareness of:
- the range of health harms associated with smoking before and during pregnancy and around children;
- benefits of quitting to self and the baby / child; and
- support and tools available to help pregnant women, women considering becoming pregnant and their partners to quit.
This evaluation was conducted via a survey of 300 female smokers and recent quitters aged 16-40 years deemed to be at risk of smoking while pregnant.
MethodologyConsistent with the approach pursued in the evaluation of Phase 1 of the campaign, the research approach consisted of telephone recruitment followed by a phone (Computer Assisted Telephone Interviewing) survey.
The sample included representation from each State and Territory across both metropolitan and non-metropolitan locations except for the Australian Capital Territory, Tasmania and the Northern Territory. State and Territory quotas were set in line with the approximate population of 16-40 year old females in each location.
Respondents to the survey were recruited through GP clinics. In all cases, potential respondents were screened for eligibility over the phone before being booked for an appointment to conduct the main survey. After being screened for eligibility and recruited to participate, a pack containing the campaign materials (with instructions not to open the pack prior to interview) was mailed out to each respondent prior to the CATI interview.
B. Behaviours, Attitudes and AwarenessConsistent with the previous phase (2011), the majority of women surveyed were smokers who were smoking on a daily basis. Among the relatively smaller proportion of those who had quit smoking in the last 12 months, the majority did so because they had become pregnant or were planning on becoming pregnant. The perceived likelihood of being able to continue not to smoke among these respondents was high, with the vast majority confident that they would not smoke again.
The majority of smokers reported they had tried giving up smoking in the past - multiple times and typically within the last year.
Those who had attempted to quit most commonly indicated that they were driven to do so due to family reasons; including becoming pregnant, children’s health and wellbeing, being prompted by family, partner or parents and planning to become pregnant.
Encouragingly, the majority of smokers intended to quit smoking. Whilst such intentions were stronger among heavier daily smokers (i.e. those who smoked more than 10 cigarettes per day), these respondents also tended to be more non-committal in relation to when they would quit smoking.
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Generally, the respondents believed that their current / past smoking had at least somewhat negatively impacted their own quality of life and health, as well as that of others around them. Consistent with the findings from the previous phase of research, attitudes towards quitting were mostly positive. However, despite ‘widespread’ agreement in relation to thinking about quitting and being eager for a life without smoking, confidence in own ability to quit smoking was relatively low.
Awareness of the harmful impacts of smoking and the benefits of quitting was high. Furthermore, consistent with the results from Phase 1, the majority of women interviewed recognised that quitting smoking would result in both financial and health-related benefits.
Heavier smokers (i.e. those who smoked more than 10 cigarettes per day) were more likely than lighter smokers to be concerned about their future health and believe that they were likely to become ill as a result of their smoking. Not surprisingly, heavier smokers were also more likely to indicate that quitting smoking would result in both financial and health-related benefits.
Despite being somewhat reluctant to admit that their smoking was having a negative effect on their unborn child, the majority of pregnant smokers did acknowledge that their smoking was damaging their unborn child at least ‘a little’.
Those who had quit smoking in the last 12 months were more inclined to recognise the pregnancy related health benefits of quitting smoking. This is not surprising given that the majority of recent quitters reported that they had quit because they had become pregnant.
C. Campaign Awareness and Impact
Recall of Campaign AdvertisementsAlthough the majority of women interviewed recalled seeing or hearing information or advertisements about the dangers of smoking in the past 6 months, unprompted recall of the ‘Smoking During Pregnancy’ advertisements was limited and consistent with that found in Phase 1 in 2011. This is reflective of the modest media buy associated with the campaign, particularly in relation to the mainstream campaigns which had higher spontaneous recall among the target audience.
‘Smoking During Pregnancy’ advertisements were more likely to be mentioned by those who were pregnant and smoking than other respondents, suggesting a stronger campaign salience among this key target group.
Campaign recognition was solid and significantly higher than in Phase 1. This higher effective reach of the campaign in 2012 largely reflects increased recall of the ‘Foetus’ print advertisement. Recognition of the ‘Smiling Baby’ print and poster advertisements was consistent with that recorded in the previous phase.
Key Message Take-OutOverall, the campaign advertisements were effective in disseminating the key messages to the target audience.
Among those exposed to the ‘Foetus’ print advertisement, the key (unprompted) message derived was that ‘smoking when pregnant can damage your baby’. Other typically mentioned messages included:
- Smoking when pregnant deprives your baby of oxygen;
- You shouldn’t smoke if you are pregnant; and
- Every cigarette you smoke is damaging your unborn child.
- Quit smoking and give your baby a healthy start; and
- Don’t smoke when pregnant.
- Your smoking affects your unborn baby;
- You should quit smoking for your baby;Top of page
- Every cigarette you smoke is damaging your unborn child;
- There are many short and long term health benefits to quitting smoking;
- Every cigarette you don’t smoke is doing you good; and
- Talk to your doctor about quitting smoking.
Perceptions of Print Campaign AdvertisementsBoth the ‘Foetus’ and the ‘Smiling Baby’ advertisements were found to be believable, easy to understand, and engaging.
Nevertheless, the findings also suggested the presence of some wear-out for the ‘Foetus’ print advertisement, with lower proportions of respondents indicating that it made them ‘stop and think’ and ‘taught them something new’. This is not surprising given that this campaign element had been used previously in the National Tobacco Campaign - More Targeted Approach, and was therefore not new to the target audience.
Despite this potential wear-out, both advertisements were effective in eliciting the desired emotional / attitudinal responses from the target audience. Moreover, self-identification with both advertisements remained solid with the majority of respondents reporting that it ‘related to them’.
Campaign InfluencePhase 2 of the campaign delivered a solid call-to-action in terms of encouraging the target audience to take action in relation to quitting / reducing smoking, with around one half of respondents exposed to the advertisements indicating that they had taken at least one such action as a result.
D. ConclusionsThe target audience generally held anti-smoking, pro-quitting attitudes, with the majority of women interviewed in 2012 recognising the adverse impacts of smoking and the benefits of quitting.
Phase 2 of the campaign achieved a significantly higher effective reach in 2012, largely due to increased recall of the Foetus print advertisement.
Phase 2 of the campaign material was effective in delivering key messages and eliciting desirable emotional and behavioural responses from members of the target audience exposed to the campaign. The research found that a substantial proportion of those exposed to the campaign was encouraged to either quit smoking, reduce the amount they smoke, or to consider doing either of these actions over the next month.
The campaign advertisements were generally perceived as believable, easy to understand, and engaging.
There was some evidence of wear-out of the Foetus print advertisement - with lower proportions of respondents in 2012 than in 2011 indicating that the advertisement made them stop and think and taught them something new.
While the reach of Phase 2 of the campaign among the target audience was wider than that of Phase 1, there appears to be scope to further increase exposure by extending the current campaign mix. The reach achieved by the current campaign mix was at the upper limit of what can be expected for a print / poster campaign suggesting that inclusion of other reach-building media would be beneficial to further build on the success of the campaign to date.