Quantitative Campaign Effectiveness: Research - Executive Summary October 2011

A. Introduction

Background

The Australian Government Department of Health launched the National Tobacco Campaign - More Targeted Approach - Pregnancy component on 15 May 2011.

The campaign is primarily aimed at 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 also include female smokers aged over 30 who are pregnant or plan to become pregnant.

The communication objectives are to:
  • generate a higher level of salience and personal relevance of the health impacts of smoking (to self and the baby/child); and
  • generate and reinforce intentions among pregnant women, and women considering becoming pregnant and their partners to quit smoking now and to stay quit.

The campaign included advertising in magazines and online over a seven week period in total. The ‘When you smoke, she gets less oxygen’ advertisement first appeared from 15 May 2011 in national women’s consumer magazine titles which included parenting magazines.

The second advertisement ‘Quit for good today, and give your baby a healthy start’ appeared in the media from 6 June 2011 across the same media formats and titles. Both advertisements were rotated in the media buy for a period of three weeks before ceasing on 30 June 2011.

The Department commissioned ORIMA Research to evaluate the effectiveness of the National Tobacco Campaign - More Targeted Measure - Pregnancy component activities in terms of overall campaign awareness and impact among this special audience.

The objectives of the research were to assess, among the target audience:
  • knowledge and awareness of the benefits (to self and the baby/child) of quitting smoking;
  • attitudes towards smoking and quitting;
  • smoking and quitting behaviours;
  • intentions to quit smoking or stay quit; and
  • campaign awareness, including advertising cut-through, message takeout and other diagnostic measures amongst smokers and recent quitters.

Methodology

The evaluation comprised of a tracking survey of n=297 smokers and recent quitters aged 16-40 years deemed to be ‘at risk’ of smoking while pregnant, namely those who:
  • were pregnant and current smokers; or
  • were pregnant and recent quitters; or
  • were pregnant and smoked at all during their pregnancy; or
  • would not rule out becoming pregnant in the next 2 years and would not rule out smoking while pregnant.

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 (which is ARIA1-classified as metropolitan only), and Tasmania and the Northern Territory (which are both ARIA-classified as non-metropolitan only). State and territory quotas were set in line with the approximate population of 16-40 year old females in each geographic location.

Telephone interviewing (supported by the mail out of campaign stimulus material) was the recommended methodology for this target audience. 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. For those who desired it, the option was also provided to access the campaign material online (but not before the interview).

Recruitment and pre-screening of respondents took place throughout late July and August 2011 with survey fieldwork being undertaken between 22 August and 16 September 2011. The time lag between the end of the media buy and the start of survey fieldwork, was largely attributable to the difficulty of recruiting eligible survey respondents.

B. Behaviours and Experiences

The smoking behaviours of individuals were closely linked to that of their immediate family, with the majority of respondents having parents/ guardians who had smoked. Furthermore, smokers were more likely to have partners who smoke than recent quitters.

Most smokers had tried quitting smoking before, and the majority of those who had tried quitting had tried more than once. Health reasons played a dominant role in motivating Smokers’ attempts to quit.

Among recent quitters and smokers, the leading methods used to aid quitting were reducing the amount of cigarettes smoked, giving up on their own, using Nicotine Replacement Therapy and consulting doctors for help.

Most smokers intended to quit smoking, typically within the next six months. Smokers who intended to quit and who were pregnant typically intended to quit at or around the birth of their baby.

For recent quitters, becoming pregnant was the leading reason they had quit smoking.

The target audience generally acknowledged that smoking had lowered their quality of life and health, although they also tended to minimise the level of health damage their smoking had caused. Respondents also tended to perceive more damage to themselves from their smoking than to other people or their unborn babies.

Most respondents recognised the possibility of becoming ill from smoking, with Smokers generally recognising a higher chance of becoming ill than Recent Quitters. Likewise, a high proportion of respondents were worried about health damage in the future due to their smoking, with Smokers being more worried than Recent Quitters. This reflects a widespread understanding that once a person quits, their chances of getting ill from smoking diminishes.

C. Attitudes and Awareness

Smokers were generally motivated to quit but not confident in their ability to carry this out.

Most respondents recognised the harmfulness of smoking and the benefits of quitting, endorsing anti-smoking and pro-quitting attitudes. Recent quitters held stronger views than smokers, particularly in relation to benefits of quitting before and during pregnancy and following birth and the social disapproval of smoking in Australia.

Respondents were widely aware that quitting smoking would improve their health and financial situation, and that a pregnant mother’s quitting would result in her baby being healthier. Most respondents identified significant levels of financial and health benefits as the outcome of quitting.

Findings across demographic groups included:
  • Older respondents were more motivated to quit smoking than younger respondents who tended to perceive lesser health benefits from quitting.
  • More highly educated respondents perceived higher chances of health damage from smoking and were more worried about this.
  • Respondents from higher income households perceived greater chances of health damage from smoking and were more motivated to quit.
  • Non-metropolitan residents perceived greater financial benefits from not smoking, felt more confident of being able to quit permanently, and were more willing and motivated to quit smoking.
  • Respondents from households where the main income earner was professionally employed tended to perceive lower financial benefits from quitting, had less confidence in their ability to quit permanently and showed more reluctance towards quitting.

Awareness of the health problems caused by smoking was high, with higher awareness for effects on the smokers themselves than on smokers’ unborn babies, and lower awareness for effects to other non-smoking people. Recent quitters tended to have higher awareness of risks to unborn babies and health effects to non-smoking people compared to smokers. Respondents from disadvantaged demographic groups (lower education levels, lower income, unemployed) had lower awareness about some health effects from smoking.

D. Campaign Execution Quality

Recall of Campaign Advertisements

The vast majority of respondents reported exposure to smoking-related advertisements, but spontaneous recall of the Pregnancy campaign advertisements was very low and significantly lower than baby-related graphic warnings advertising on cigarette packaging.

Among the Pregnancy campaign advertisements, prompted recognition of the ‘When you smoke, she gets less oxygen’ print ad was the highest (20% overall), followed by the ‘Quit for good today, and give your baby a healthy start’ ads (print – 13%, poster – 8%). More than one third of respondents recognised the mainstream ‘Health Benefits’ print advertisement (female version) which also carries a pregnancy related health fact.

Respondents from disadvantaged demographic groups (lower education levels, lower income, unemployed, residing in non-metropolitan locations) were more widely exposed to the ‘Quit for good today, and give your baby a healthy start’ print ad, while respondents with higher education had greater awareness of the mainstream ‘Health Benefits’ print ad (female version).

Key Message Take-Out

For the ‘When you smoke, she gets less oxygen’ print advertisement, the messages achieving the highest rate of unprompted recall included:
  • smoking when pregnant deprives your baby of oxygen (41%);
  • smoking when pregnant can damage your baby (38%);
  • smoking when pregnant may stop your baby developing properly (29%);
  • every cigarette you smoke is damaging your unborn child (28%); and
  • you should not smoke if you are pregnant (22%).

For the ‘Quit for good today, and give your baby a healthy start’ advertisement, the leading messages recalled without prompting were:
  • quit smoking and give your baby a healthy start (42%); and
  • do not smoke when pregnant (23%).

Large proportions of respondents recalled campaign messages upon prompting – the most widely recalled were that:
  • they should quit smoking for their baby (99%);
  • their smoking affects their unborn baby (91%); and
  • every cigarette they smoke is damaging their unborn child (90%).

Opinions of Campaign

Respondents’ opinions of the ‘When you smoke, she gets less oxygen’ print advertisement suggested that it was effective as more than three quarters (at least 79%) indicated that it was easy to understand, made them stop and think, was believable, made them feel worried about their smoking and made them feel uncomfortable.

Opinions of the ‘Quit for good today, and give your baby a healthy start’ print advertisement also reflected its effectiveness as more than four fifths (at least 82%) of respondents agreed that it was believable, easy to understand, made them more likely to attempt quitting, made them stop and think, and made them feel worried about their smoking.

Campaign Influence

Although almost half of those exposed to the Pregnancy campaign advertisements (48%) did not take action as a result of this exposure, at least one tenth (at least 10%) had quit smoking, reduced their smoking or sought medical help on quitting. Despite not taking action, many other respondents had either considered quitting (n=10) or reconsidered their smoking (n=5).

As a result of exposure to Pregnancy campaign advertisements, more than a third (38%) of respondents planned to quit smoking within the next month. In addition, smokers also planned to either reduce smoking or seek medical help on quitting. However, one quarter (25%) of respondents expressed no intention of taking any further actions.

Mainstream Campaign

Upon prompting, more than one third of respondents indicated awareness of the mainstream ‘Health Benefits’ print advertisement featuring a woman.

The leading messages recalled from this advertisement were that:
  • quitting smoking has many health benefits;
  • the day they stop smoking, their bodies start repairing;
  • the slogan “stop smoking, start repairing”;
  • smoking affects the body; and
  • it is never too late to stop smoking.

Respondents’ opinions of this advertisement also reflected its effectiveness. More than four fifths (at least 82%) found it believable and easy to understand, claimed that it related to them, made them stop and think or taught them something new.

E. Conclusions

The Pregnancy campaign had a limited media buy (magazines and online) and was only active for a short period of time (seven weeks). This was likely to have contributed to the Pregnancy campaign having a moderate level of exposure among the target audience.

The ‘When you smoke, she gets less oxygen’ print advertisement achieved the highest level of reach.

Take-out of campaign messages was good, with solid understanding among the target audience of the link between smoking during pregnancy and damage to the unborn child.

Opinions of the campaign generally reflected its effectiveness in eliciting intended sentiments among this audience.

The campaign delivered a solid call to action, prompting quitting behaviours, plans to quit in near future and considerations of quitting.

The Pregnancy campaign had a relatively low reach among the target audience (with relatively low levels of prompted and unprompted recall) – which is not surprising given the campaign’s limited media buy (print and online) and short time period (seven weeks).
The research suggests that achieving greater reach via the extension of the campaign therefore has significant potential to further impact the behaviour of the target audience.

1 Accessibility/Remoteness Index of Australia provides a systematic geographic analysis using population centres as the basis for qualifying for services hence remoteness.