What do effective integrated marketing campaigns have in common?
Integrated marketing campaigns can be a tricky art to perfect. We live in a multi-media world, which means that new media and old media sit alongside one another, sometimes competing, other times working collectively - in the case of integrated campaigns they work together.
However despite saying all of this, what is it that actually leads to successful results? Consistent branding and messaging, frequency of communications and deciding on your primary medium are collectively important points to factor in. Let’s take a look at some of the most impressive integrated campaigns:
#1 Compare the Market - Baby Oleg
On Christmas Day 2013, comparethemarket.com released a television advert revealing new character Baby Oleg. In January 2014 the campaign went into full swing with an advertisement promoting a cuddly toy to accompany the cute Meerkat. Following this announcement a blog was created for Oleg online, for customers to read, encouraging emotional involvement: http://www.comparethemarket.com/meerkat/blog/oleg/.
Connecting the character from the advertisement with the audience has been achieved by creating a toy and the blog, turning Oleg into a character that can create emotional involvement - integrated collectively these separate parts to the campaign have driven consumer engagement successfully.
More recently, in August we were shown Baby Oleg’s life journey.
The continuous roll out and development on this character throughout the year has proven consistency of the brand and messaging - key factors in creating a solid campaign. These friendly Meerkats have almost become part of everyday life, as they quite literally pop up everywhere.
#2 O2 - Be More Dog
Originally launch last year O2’s ‘Be More Dog’ campaign, which featured a ginger cat trying to live a dog’s life had been a huge success for the brand. Granted - being ‘more dog’ has nothing to do with mobile phones, but the quirkiness of the integrated campaign is what led its success.
To promote its revamped priority app in May 2014 launched a £7m campaign using England rugby players, Mike Brown and Alex Goode attempting to Be More Dog: in this, we see the cat become a motivational speaker.
As well as television and cinema, the campaign also features outside and online executions, with geo-located mobile advertisements and homepage takeovers on a range of websites, including MSN and YouTube. The O2 priority app in itself is a marketing tool, offering consumers the chance to buy tickets and experiences before anyone else.
This integrated marketing campaign from O2 is so clever it not only intrigues users due to its kooky nature and offers them something extra in the form of priority.
#3 Three.co.uk - Sorry for all the holiday Spam
Launching a package for customers to use their phone in 16 destinations worldwide like they would at home, with no extra cost for data led to 3 having to make one large apology... to the entire nation.
Due to their poor deal, it mean't everyone was constantly on social media whilst on their holiday, encouraging a shed load of holiday spam: photos of beaches, swimming pools, sunsets, tanned legs and of course, food. Along with this there a website was created dedicated to the cause: http://www.stopholidayspam.com.
The first part of the campaign, the television advertisement was enough to get viewers’ attention, but then came customer engagement and interaction. As predicted or at least as the marketers over at 3 had hoped consumers got involved and took holiday snaps using the hashtag #holidayspam. Of course some of those social media posts wouldn’t have been done consciously because of 3, which makes the campaign so clever.
Relevance is the key to this integrated campaign - it was successful by people being able to relate to it, whether they were on holiday, or fed up of everyone else’s holiday spam. The campaign was also consistent with the hashtag #holidayspam included in every part of the marketing collateral.
#4 Lidl - #lidlsurprises
The most recent Lidl Surprises, ingenious campaign rolled out on the 4th September on television, print and outdoor - accompanied by a larger than normal social media boost.
The TV advertisement shows customers enthusiastically looking at, and purchasing wholesome goods at a little market, which in fact turns out to be a Lidl market - this is followed with the #lidlsurprises tagline, because everyone loves a pun.
The hashtag/tagline has been integrated throughout all channels connecting all elements together. There’s also an interactive website dedicated to #lidlsurprises where you can spin to receive the surprise result of a recipe to cook: https://www.lidlsurprises.co.uk.
The entire campaign is amongst Lidl’s efforts to step away from traditional media, moving into engaging and interacting with its customers on social media and in stores. Mixing both traditional and digital media together offers a smooth transition to a more up to date modern approach for Lidl’s marketing efforts.
This campaign is definitely a step in the right direction, putting Lidl right up against UK supermarket giants like Tesco and Asda. It is difficult to determine the full extent of the success this campaign has achieved yet. Despite this, the social media buzz surrounding it was significant.
#5 Coca-Cola - Coca-Cola Life
Recently, Coca-Cola launched a new product to its long standing line of soft drinks, called 'Coca-Cola Life' along with a month long campaign. Coca-Cola Life fits in the same kind of category as Coke Zero and Diet Coke - another one of Coca-Cola’s attempts to release a healthier option to its main heavily sugary product.
The campaign is being rolled out across 7,000 outdoor locations nationwide with billboards, bus and digital screen ads; these are all being supported by print, digital, experiential and point of sale activity. Although television is not being used the buzz on social media since the drinks’ launch has been mainly positive.
Along with all of the above, Coca-Cola launched a competition - on Saturday 20th September a pop-up shop opened on South Molton Street, London offering customers to not just have a taste of the new Life drink, but also give them a chance of winning a Coca-Cola Life prize - one of those being a long weekend in New York City. Of course, to fulfil the campaign’s integrated position those who were not able to visit the pop-up shop still had the chance to enter the competition by sharing a Coca-Cola Life moment picture online and using the hashtags #CocaColaLife and #comp.
The product is yet to be proven as a success, but as a campaign it’s fulfilling every specification to be a great integrated marketing campaign.
There’s a few lessons that can be learned from these integrated marketing case studies; one of those being that it doesn’t matter if you mix up the media within your campaign, in fact it’s largely positive, you just have to ensure that there is brand consistency across the entire roll out.
The way in which the message is communicated can also alter the effectiveness of the campaign, as can choosing which media should be at the forefront or the driving factor behind your strategy. It can all become a difficult balance to get right but it’s crucial that you do get it right.
[Editor's note: Thanks to Maggie for selecting and describing these case studies of integrated campaigns so well. For our advice on creating better integrated campaigns, see our integrated campaign planning guide and template for Expert members.]
Maggie Majstrova is the Studio Manager at Higher Ground Creative, with a background in Account Management and Web Development. You can connect with Maggie on LinkedIn and Google+
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Legislators and public health officials in the USA are currently debating the expenditure of millions of dollars flowing into their state coffers from the national tobacco settlement. In these debates, it should be recognised that anti-smoking advertising has the potential to be a viable and cost effective deterrent to youth smoking. When the Fairness Doctrine was applied to tobacco related broadcast speech from 1967 to 1970, broadcasters were required to donate an estimated $298 million per year (in 1996 dollars) in free airtime for anti-smoking advertising messages. Research indicates that per capita cigarette consumption, and both adult and adolescent smoking prevalences, fell significantly during this period.1-5
More recently, controlled experiments comparing “test” (intervention) and “control” (non-intervention) communities found that anti-smoking advertising can significantly reduce youth smoking prevalence, particularly when combined with synergistic school and community based activities.6-8 Additional supportive evidence comes from controlled laboratory experiments in which adolescents have been exposed either to anti-smoking or control (smoking unrelated) advertisements, and then asked to complete surveys that assessed their smoking related knowledge, perceptions, and behavioural intentions. Middle school students who viewed anti-smoking (versus control) advertising reported significantly less favourable perceptions of smokers.9 Likewise, showing an anti-smoking advertisement before a feature film significantly diluted the impact of the film's pro-smoking imagery on high school students.10
These prior studies indicate that anti-smoking advertising can work well under fairly controlled circumstances. However, like other advertising, it carries no guarantees. Indeed, several tobacco use prevention media campaigns have been documented failures because of inadequate length, funding or other factors.11-14Officials planning anti-smoking advertising are faced with an array of challenging planning and implementation tasks. The goal of this study is to provide guidance in planning effective anti-smoking advertising campaigns targeting youth, based on an analysis of past campaigns initiated by five US states (Arizona, California, Florida, Massachusetts, and Minnesota), a different country (Canada), and researchers from the University of Vermont who initiated a multicommunity trial.
Overview of study
The current study is an offshoot of work that we conducted in 1997-98 on adolescents' impressions of anti-smoking advertisements.15 At that time, we obtained copies of all English language television advertisements that had been used in major North American anti-smoking campaigns from 1985 to 1997. All campaigns had identified adolescents as either a primary or sole target audience. In total, we obtained 167 advertisements from six of the campaigns listed above. The Florida initiative had not yet started. We arranged for each advertisement to be viewed by approximately 50 adolescents, half seventh graders (age 12–13 years), half 10th graders (age 15–16 years). The adolescents then completed surveys that were designed to assess each advertisement's message content, the level of agreement (clarity) or disagreement (confusion) over the message content, and the consistency of messages within a campaign (that is, the proportions of advertisements containing the same message). In addition, adults content analysed each advertisement to determine whether the spokesperson appeared to be youthful (under 25 years old) and whether smoking behaviour was depicted. Prior research had indicated that these variables might potentially influence the effectiveness of anti-smoking advertisements targeting youths.16-18
We found that the campaigns differed rather substantially on the advertising message variables (content, clarity, and consistency) and on the executional variables (youthful spokespeople and depictions of smoking). We believed that, based on published reports or data, we could determine which campaigns had been relatively more effective than others at reducing adolescent smoking prevalence. Campaign costs could also be assessed. Hence, we decided to embark on a study to examine whether higher rankings on any of the advertising variables seemed to be associated with greater cost effectiveness. We were able to identify several factors that appeared to improve campaign cost effectiveness as measured by significant reductions in adolescent smoking prevalence. We present our study below, beginning with an explanation of the advertising variables and tentative research hypotheses, followed by our method and findings, and ending with a discussion of limitations and implications.
Advertising variables studied because possible associations with cost effectiveness
In our initial 1997-98 study,15 we reviewed the anti-smoking advertisements that had been provided by campaign sponsors and developed a checklist of messages used. As our adolescent subjects viewed each advertisement, they placed a checkmark next to each message they felt it contained. If 80% or more of the adolescents agreed that an advertisement contained a message, it was put into that message category. Categories with 12 or more advertisements were formally labelled. We identified seven such mutually exclusive categories. These categories are listed below.
Long term effects—advertisements that discuss the long term health effects of smoking, such as cancer and lung disease.
Short term effects—advertisements that highlight the short term cosmetic effects of smoking, such as smelly breath, and related outcomes such as romantic rejection.
Marketing practices—advertisements that describe relatively innocuous tobacco marketing practices, such as the use of glamorous models and the distribution of free promotional items.
Deceptive portrayal of lethal product—advertisements that highlight the deceptive tactics used to sell what is essentially a lethal and addictive product, such as illegally targeting minors and falsely claiming that cigarettes are nonaddictive.
Second hand smoke—advertisements that stress the negative impact of second hand smoke on family members and other people, particularly infants and children.
Smoker as negative role model—advertisements that depict smokers as people who have unwisely chosen a lifestyle that is both unappealing and unhealthy.
Refusal skills—advertisements that feature attractive, personable individuals and show these individuals refusing to smoke.
We relied on prior research to assess the potential efficacy of each message in terms of dissuading adolescents from smoking.15In our own research, hundreds of adolescents were randomly assigned to view advertisements of a particular type and the effects of this exposure (versus exposure to unrelated-to-smoking or control messages) on intentions to smoke were statistically assessed.15Another study examined the transcripts of innumerable focus groups that were convened to evaluate anti-smoking advertisements and looked for consensus as to which advertisements seemed to be the most convincing.19
Both studies concluded that second hand smoke messages work well with adolescents.1519 In addition, the focus group study found that youths responded well to advertisements disclosing the deception used to sell what is essentially a lethal and addictive product.19 Finally, our own experimental study indicated that adolescents were persuaded by social norm appeals, meaning advertisements that portrayed a smoker's lifestyle negatively (as unappealing and unhealthy) or advertisements that showed attractive people refusing to smoke. Other messages were found to be relatively ineffective with adolescents, including those stressing long term effects only,1519 short term effects only,1519 or relatively innocuous tobacco marketing practices.15 Thus, for the current study, we tentatively predicted that the more cost effective prevention campaigns would make greater use of the following messages: deceptive portrayal of lethal product, second hand smoke, smoker as negative role model, and/or refusal skills.
Advertising for most products and services is designed to communicate a single persuasive message for an extended period of time (for example, Crest fights cavities, Listerine kills germs).20-22 The goal is to remind consumers continually of the brand name and its unique selling proposition (positioning) such that, when making consumption or purchase decisions, consumers will immediately think of the brand and remember why to choose it. Also, consumers frequently do not attend to or process advertisements because they are busy or distracted.22 Hence, advertisers rely on repetition, the “oft referred to soul of persuasion” to increase the likelihood of changing behaviour.23 To avoid boring or irritating consumers with repetitive information, advertisers use multiple advertisement executions, that is, variations on the theme (such as different settings).22
Message repetition or consistency should be beneficial for anti-smoking advertising as well. If a campaign has a large budget, it perhaps has more flexibility in terms of conveying multiple messages. However, even cigarette advertisers with substantial budgets tend to utilise single themes. The Marlboro Man (male autonomy) and Virginia Slims (liberated female) campaigns are just two examples of this.24Therefore, we tentatively predicted that an anti-smoking campaign's cost effectiveness would be enhanced by a focus on a single efficacious theme.
In consumer advertising, it is widely recognised that messages can be either poorly comprehended or mistakenly comprehended.2526 Despite advertisers' best efforts, consumers frequently misunderstand the specific claims that are made, the general conclusions reached, and/or the sponsors of the advertisements.2728 Hence, it is commonplace for advertisers to test consumers' comprehension of advertisements in rough cut and/or final form, to rectify any problems that might arise.1829 Subtle changes in wording or dramatisation can make a substantial difference in whether a message is generally understood by target audience members.
There are some who believe that people can be subliminally persuaded by advertisements, independent of message awareness or comprehension.30 However, numerous studies by psychologists and consumer researchers have found no link between subliminal messages and consumer behaviour. It appears that subliminal advertising simply does not have the power attributed to it by its advocates.31 As one advertising agency executive put it, “We have enough trouble persuading consumers using a series of up front 30 second advertisements—how could we do it in 1/300th of a second?”.21 The rare instances of documented subliminal advertising effects have been produced in highly contrived and artificial settings that have little relevance to marketers.2232
Anti-smoking messages can be quite complex—for example, those that argue that tobacco marketers use deception to sell a deadly and addictive product. If youths fail to understand what an advertisement is saying, it is unlikely to have the intended effects. At least one study found that an anti-smoking advertisement that was carefully crafted by adult professionals, but subtle in its approach rather than hard hitting, was poorly understood by the adolescents for whom it was intended.33 Hence, we predicted that anti-smoking campaigns with a higher proportion of readily comprehended and strong messages would tend to be more cost effective.
AGE OF SPOKESPERSON
In general, people are more likely to be influenced by a persuasive appeal if they perceive it as coming from a spokesperson with whom they feel a sense of similarity.21 When audiences identify with a spokesperson, they are more likely to accept that person's opinions and recommendations as credible and relevant to their own lives.2234 Advertisers typically try to ensure that target audience members feel a sense of similarity or identification with the spokesperson by using a person that is similar to the audience in age, sex, race and/or lifestyle.161735-37
When advertisers court adolescents, they generally make a concerted effort to use youthful spokespeople who will be believed and respected by the youth subculture.3839 Some cigarette advertisers apparently feel that it is important to use youthful spokespeople as well.1738 According to studies, tobacco advertisers frequently violate their voluntary code to rely on models that look to be at least 25 years old.1740 One study examined magazines that accept cigarette advertisements and are popular with 12–15 year olds (for example, Sports Illustrated and People) and reported that four out of six cigarette models appeared to be under 25, with the median age being 19.40 Adolescents also reportedly prefer younger cigarette models.17 Often the implied message seems to be that, by smoking, they will become like the attractive young people in the advertisements.36 Experts have opined that the Marlboro Man appeals to youth, despite his age, by symbolising autonomy and freedom from authority, two dominant developmental goals for adolescents.35
The general rule of thumb is that, when targeting adolescents, spokespeople should be just slightly older than the target group and hence aspirational.38 Models can sometimes be too young, because teens are looking for images of “independence, adventure seeking, social approval, and sophistication.”35Since the advertising campaigns that we analysed targeted a diverse group of youths from roughly 9–19 years old, we could not address the issue of whether some of the spokespeople might have been too young for some audiences. Instead, we tentatively predicted that campaigns that made greater use of youthful spokespeople would be more effective at lowering adolescent smoking prevalence, holding other factors constant.41
DEPICTIONS OF SMOKING BEHAVIOUR
We also felt that it was important to consider the use of advertisements that depicted people smoking cigarettes. We were concerned that if a campaign depicted smoking too frequently, it might inadvertently imply that the behaviour is prevalent, normal, and accepted and thus convey a contradictory message.4142Adolescents already overestimate smoking rates among both peers and adults, and the more extreme the overestimate the higher the risk of smoking initiation.43 It may sometimes be appropriate to depict smokers to illustrate the negative aspects of tobacco use, model refusal skills, portray tobacco executives or the like. However, many experts feel that depictions of smoking in anti-smoking advertisements should be minimised because of the potential for unintended adverse effects.18
Turning to our research method, we first ranked each focal campaign on each advertising variable that we speculated might be related to cost effectiveness. Next, we obtained data on campaign costs and effects and developed cost effectiveness rankings. Then, we tested our tentative predictions regarding the relation between each advertising variable and cost effectiveness by comparing how the campaigns ranked on each dimension. For instance, we compared how the campaigns ranked in terms of message content versus cost effectiveness. If the rankings seemed to be associated and in the expected direction (for example, positively), we concluded that there was some support for our predictions.
ASSESSMENT OF ADVERTISING VARIABLES
To rank the campaigns on each advertising variable, we relied on the materials submitted by campaign officials. Officials assured us that they provided a complete or virtually complete set of advertisements from 1985 to 1997. Florida advertisements were not included because we completed this phase of the work in 1998 and their campaign started later. Adolescents provided the data used for ranking each campaign on the message variables: content, clarity, and consistency. We felt that adolescents would be the best judges—particularly regarding message clarity—of whether the messages would be comprehended by other youths. We believed that the executional variables (use of youthful spokespeople and depictions of smoking) could be readily assessed by adults trained in content analysis so we used that approach.
Data were collected from adolescents as follows. We recruited 1128 seventh and 10th graders in California from middle class, ethnically diverse school districts.15 The advertisements from the various sponsors were randomly divided into small pods of 8–9. Each adolescent was randomly assigned to evaluate one pod of advertisements. Immediately after viewing each advertisement twice, subjects answered a series of closed ended questions about the advertisement.
We used the data from adolescents in several ways. To assess the extent to which a campaign employed messages that research suggests may be especially efficacious for youth, we did the following. If at least 80% of subjects agreed that an advertisement contained a certain message, it was classified into that category (see earlier discussion). Then, for each campaign, we calculated the total percentage of advertisements that fell into the efficacious categories (deceptive portrayal of lethal product, second hand smoke, smoker as negative role model, and refusal skills). Vermont's score on efficacious message content, for instance, was 79% because 58% of its advertisements were classified as refusal skills, 13% as deceptive portrayal of lethal product, and 8% as smoker as negative role model.
To assess message consistency, we relied on the percentage of advertisements that fell into the most commonly used efficacious category. In the case of Vermont, since the most commonly used efficacious message was refusal skills and 58% of the advertisements used it, the consistency rating was 58%. To judge message clarity, we relied on the percentage of advertisements rated unclassifiable, meaning that fewer than 80% of the adolescents could agree on the message conveyed.
Additionally, three trained adults content analysed each advertisement to assess if the spokesperson (main character) appeared to be under 25 years of age and if any person was shown to be smoking cigarettes.3644 Inter-rater reliability was 81%. Researchers consider reliabilities over 80% to be acceptable.45 For each campaign, we then computed the percentages of advertisements that contained youthful spokespeople and depicted smoking behaviour.
ANALYSES OF CAMPAIGN COSTS
Information on anti-smoking advertising expenditures was obtained from officials in each US state (Arizona, California, Florida, Massachusetts, Minnesota), Canada (Health Canada), and Vermont. We also consulted published sources and the internet. For each campaign, an average expenditure across all available years was computed and then converted to per capita amounts by dividing by the 1996 USA census population estimate for the relevant geographic area. The per capita amount provides a control for differences in population sizes. For instance, since California is a more populated state, it needs a larger advertising budget to reach everyone who is to be targeted.
For California4647 (telephone conversation with Curt Fallor, California Tobacco Control Section, December 1999), Massachusetts4748 (email correspondence with Mark LaPlante, Massachusetts Department of Health Services, February 2000), Florida,4749 Canada,50 and Arizona (telephone conversation with Robert Suiter, Arizona Tobacco Education and Prevention, February 2000)4751 the per capita figure reflects the average annual budget from campaign inception to 1999. The per capita cost for Minnesota reflects the average annual budget for the complete campaign that occurred from 1986 to 1990. This figure was then adjusted to 1996 dollars using the consumer price index.4752-54 The Vermont campaign was conducted in communities across several states in the USA between 1985 and 1989. The researchers estimated that it would cost $84.5 million, in 1996 dollars, to replicate nationally. We divided this amount by the 1996 USA population to obtain a per capita estimate.4755
Figure 1 shows, for each campaign, the estimated per capita cost for all anti-smoking advertising, across all audiences. Information about the money spent strictly on youth was generally not available and thus not reported. We do not report how campaign expenditures changed over the years, because of incomplete data, but this issue is discussed in relevant places in the text. Figure 1 further illustrates the minimum and optimal per capita funding levels recommended by the Centers for Disease Control and Prevention (CDC) (in 1999 dollars),56and the estimated value of the anti-smoking advertisements run during the Fairness Doctrine Era ($1.12 in 1996 dollars).145As a basis for comparison, tobacco firms currently spend over $7 per capita per year in the USA on advertising, promotional items, and sponsorships.53
Comparison of adjusted per capita anti-smoking advertising expenses, 1985 to present. For California, Massachusetts, Florida, Canada, per capita expenditures were calculated from average annual budget allocated from campaign inception to 1999 and 1996 population estimates.46-51 Per capita cost for Minnesota reflects the average annual budget from the entire campaign (1986 to 1990) and 1996 population estimates, adjusted to 1996 dollars.475253 Costs for Vermont were calculated from published estimates for replicating the campaign at national level (in 1996 dollars) and 1996 national population estimate.4754Funding level during Fairness Doctrine was calculated from estimated expenditures of $298 million (in 1996 dollars) divided by 1996 US population estimates.414754
ANALYSES OF CAMPAIGN EFFECTIVENESS
Reports on the Minnesota and Vermont campaigns have appeared in academic journals, so we relied on those publications to assess the effects.7852 Both campaigns were evaluated by tracking weekly smoking prevalences over time in intervention and control communities using school based surveys. In Canada, current (last 30 day) adolescent smoking prevalences have been tracked since 1970 using personal and confidential home surveys. The data, and trends over time, have been reported in an academic article so we relied on that article.50
To evaluate the remaining campaigns, we used data from the sponsoring state and an appropriate comparison area (see below) to provide a baseline or control group.57 Since multiple data sources were available, we used the following selection criteria to minimise potential bias. First, we relied on academic journals or official government or university reports. Second, we used sources with two or more years of data so that we could assess changes in smoking prevalence. Third, the intervention and control (baseline) data pertained to youth in the same grade in school, collected in the same year, using the same measure: 30 day prevalence or current smoking (that is, any smoking within the past 30 days). Finally, we used surveys completed by random pools of subjects from randomly selected schools. We relied on school based surveys because, in phone surveys, youth generally report substantially less smoking behaviour.58 It seems that youths are hesitant to respond honestly about illicit tobacco use over the phone because they fear being overheard by family members.5859
Following these criteria, in virtually all cases, we relied on data collected by the states in cooperation with the CDC and its Youth Risk Behavior Survey (YRBS). The single exception was California where state specific data from Monitoring the Future were available and where the state's own surveys were phone based. Monitoring the Future also provided regional comparison data for Massachusetts and Florida, and US comparison data for California. California uses national (versus regional) data as its benchmark since the state represents roughly 69% of the western region, according to the US census.47 For Arizona, there was only one state specific data point available, stemming from a phone survey conducted more than two years after the campaign had commenced.51 Hence, we do not report on the effects of Arizona's campaign.
Tables 1 to 6 indicate the changes in adolescent smoking prevalence in the campaign and control (baseline) areas across relevant comparison years. Results for the Vermont study, Minnesota, and Canada are summarised as published.85052 Vermont researchers used a stepwise regression procedure to assess treatment effects between the intervention and control groups.78 Minnesota evaluators analysed that state's results using a hierarchical ANCOVA that compared the mean square effect for the state by year interaction against the mean square effect for school within state by year.52 This approach, while appropriate, was conservative and could possibly have underestimated the effects for Minnesota. The Canadian data were fit to stochastic models that estimated coefficients for trends, changes in trends, and random fluctuations in prevalences, by sex.50 If the Canadian advertising campaign had lowered adolescent smoking prevalence, a significant change in trend would have been observed.
For California, Massachusetts, Florida, and each selected comparison area, we calculated relative risk ratios using the PROC FREQ function in SAS. The ratios reflect between year comparisons of the proportions of adolescents who reported smoking within the past 30 days, with the uncertainty in each estimate being expressed by the 95% confidence interval (CI). The higher the ratio, the higher the smoking prevalence (risk). A confidence interval that does not contain 1.00 indicates a significant change (increase or decrease) in the risk of smoking over time.60
For example, the relative risk from 1997 to 1999 among Massachusetts 10th graders was 0.82. This value is significant because the 95% CI of 0.72 to 0.92 does not contain 1.00. The value also indicates that the overall risk for 30 day smoking prevalence was significantly lower in 1999 than in 1997. Absolute changes in prevalence are also reported in tables 1 to 6 and significant effects are flagged. Tests of absolute changes were conducted using the z statistic, but the results are identical to those using relative risk. All comparisons controlled for grade in school and geographic area—for example, Massachusetts 10th graders in 1997 were compared to that state's 10th graders in 1999, and so forth. Table 7 contains the estimated sample sizes used for the calculations in tables 1 to 6. For details on the sample sizes, see notes at the foot of table 7.
We concluded that an advertising campaign lowered adolescent smoking prevalence from time t to t+n (for example, 1997 to 1999) if (a) the focal area showed a significant decrease in prevalence and there was either no significant change or a significant increase in the comparison area, or (b) the prevalence was flat in the focal area and increased significantly in the comparison area. If there was no significant difference between the focal and comparison areas (that is, if both experienced increases in, decreases in, or constant prevalences), we concluded that the campaign had no effect during that period for that grade. In a few cases smoking prevalence significantly increased in the intervention (versus comparison) area. Factors extraneous to the campaign (for example, societal norms) or conceivably the campaign itself could have contributed to the increase. Since we could not distinguish between these competing explanations, we do not interpret these results.
Figure 2 provides data about each sponsor on each advertising message variable—namely, content, efficacious content, clarity, and consistency. For each sponsor, we used SPSS to compute crosstabs and χ2 tests comparing the frequency (prevalence) of use of different message content. The results of these within sponsor analyses are included in fig 2. The messages shown by black bars were used by the sponsor significantly more than the messages designated by white bars (p < 0.05). The messages depicted by grey bars were not used significantly more or less than any other messages.
Messages used in advertisements as identified by middle school and high school students (within campaign comparisons). Solid black and white bars within each figure differ significantly (p < 0.05). Grey bars do not differ significantly from each other or from black and white bars.
Figure 3 contains data about each sponsor on each advertising execution variable, namely, use of youthful spokespeople and depictions of smoking. We used SPSS crosstabs and χ2 tests to make the between sponsor comparisons shown. A black (versus white) bar indicates significantly greater use of the designated executional device by one sponsor versus another (p < 0.05). Grey bars indicate no significant differences.
Use of youthful spokespeople and depiction of people smoking (across campaign comparisons). Solid black and white bars within each figure differ significantly (p < 0.05). Grey bars do not differ significantly from each other or from black and white bars.
Trends in youth smoking prevalence: Vermont campaign, 1985 to 1989
Trends in youth smoking prevalence: California campaign, 1990 to present
Trends in youth smoking prevalence: Massachusetts campaign 1993 to present
Trends in youth smoking prevalence: Florida campaign 1998 to present
Trends in youth smoking prevalence: Minnesota campaign 1986 to 1990
Trends in youth smoking prevalence: Canada 1985 to present
Approximate sample sizes for youth smoking prevalence results
Detailed results for each advertising campaign
COST EFFECTIVENESS RANKINGS
Table 8 ranks the advertising campaigns from best to worst in terms of their cost effectiveness at dissuading youth from smoking. The findings indicate that one campaign was highly cost effective, three achieved modest effects at varying funding levels, two did not work, and the results for Arizona are unknown. Vermont's campaign worked very well by achieving significant effects inexpensively ($0.32 per capita).55 California is ranked after Vermont on cost effectiveness because its campaign resulted in modest effects at a low per capita cost ($0.4646; telephone conversation with Curt Fallor, California Tobacco Control Section, December 1999). Massachusetts and Florida rank next because they attained modest effects while spending substantially more per capita ($2.1648; email correspondence with Mark LaPlante, Massachusetts Department of Health Services, February 2000 and $1.2949 respectively). Minnesota's campaign was inexpensive ($0.51 per capita)53 but did not achieve any significant effects. Canada's campaign, with a per capita budget of $0.47,50 was not successful either. Arizona spent $2.35 per capita but a lack of behavioural outcome data prevents an analysis of cost effectiveness (telephone conversation with Robert Suiter, Arizona Department of Tobacco Education and Prevention, February 2000)51 (see both fig 1 and table 8).
PREDICTORS OF COST EFFECTIVENESS
Table 8 further ranks the campaigns on each advertising variable that was measured due to its potential association with cost effectiveness (in terms of lowering adolescent smoking prevalence). All but one of the variables does seem to be associated with cost effectiveness. The more cost effective campaigns generally utilised a larger percentage of messages that, based on prior research, seem to be especially efficacious at dissuading youth from smoking. Typically, the more cost effective campaigns showed greater consistency in terms of emphasising a single efficacious message. Campaigns that ranked higher on cost effectiveness generally avoided unclear messages and employed youthful spokespeople more often. The frequency of depictions of smoking behaviour did not seem to be associated with cost effectiveness, however (table 8).
Summary of case study findings: advertising cost effectiveness and possible predictors
The campaign that was undertaken by Vermont researchers sought to stress the positive consequences of non-smoking, model refusal skills, convey the immediate social and physical problems associated with smoking, and teach adolescents about cigarette marketing.761 It ranks as the most cost effective because it achieved significant reductions in smoking prevalence with a low per capita budget.61 The campaign ran from 1985 to 1989 as a part of a multi-community experimental trial.55
The two intervention communities received mass media advertisements and a school program; the two control communities received only the school program. At the onset, the students were in grades 6 and their weekly smoking prevalence was less than 2%. By the time they had reached grade 8, the intervention group was smoking significantly less than the control group (intervention 5.0%, control 9.3%; p < 0.05). Two years later, smoking prevalence in the intervention group remained significantly lower (intervention 12.8%, control 19.8%; p < 0.05).861 The effects were sustained for at least two years after the campaign ceased (intervention 16%, control 24%; p < 0.05).8
PREDICTORS OF COST EFFECTIVENESS
It appears that the success of the Vermont campaign can be attributed to a variety of factors. Based on our results, 79% of the advertisements communicated message content that prior research found to be efficacious with youth. Advertisements with the refusal skills theme comprised 58% of the campaign which indicates a very high degree of consistency over time. Two other efficacious themes were used: deceptive portrayal of lethal product (13%) and smoker as negative role model (8%). Only 4% of Vermont's messages were deemed unclassifiable (meaning low agreement on message).
Executional factors may have also contributed to Vermont's success. In particular, 70% of Vermont's advertisements featured youthful spokespeople which may have enhanced the campaign's relevance to its target audience. While 46% of the advertisements depicted smoking, apparently the depictions were unflattering and reinforced the anti-smoking messages. Overall, the Vermont researchers mounted a homogeneous and effective campaign that can serve as a model for states considering anti-smoking advertising.
California chose to emphasise the health effects of second hand smoke and to attack the tobacco industry for selling a lethal and addictive product and targeting kids.6263 The campaign, started in 1990 after voters approved a tobacco excise tax hike, has had moderate success.1964 Since the campaign was relatively inexpensive, it ranks second in terms of cost effectiveness.
Our findings indicate that from 1993 to 1995 the California campaign realised some positive results. Although smoking prevalences among California eighth and 10th graders remained flat during this time, nationally there were significant increases in smoking prevalences in both grades (for eighth graders: California relative risk 1.00, 95% CI 0.74 to 1.35; US relative risk 1.14, 95% CI 1.05 to 1.25; for 10th graders: California relative risk 1.00, 95% CI 0.78 to 1.29; US relative risk 1.13, 95% CI 1.05 to 1.21). From 1995 to 1997, there is little indication that California's campaign was impacting youth. For grades 8 and 10, while smoking prevalences continued to be flat in California, nationally the prevalences were flat as well.6566 One reason may be that the California advertising budget was cut; it has also been speculated that the California advertisements became less hard hitting.4667
PREDICTORS OF COST EFFECTIVENESS
There are several reasons why California seems to have had some success. First, 58% of its advertisements used message themes that prior research identified as being efficacious with adolescents. One such theme—deceptive portrayal of lethal product—was used in 32% of the advertisements. This indicates a relatively high degree of consistency over time. California used additional efficacious themes: second hand smoke (14%), smoker as negative role model (7%), and refusal skills (5%). Only 17% of California's advertisements were rated as unclassifiable, meaning that the majority were readily comprehended. Executionally, 50% of the California advertisements featured youthful spokespeople which was about average across the sponsors. Smoking behaviour was modelled in 42% of the California advertisements which was also about average.
Convincing 9 to 17 year olds not to smoke is one of three major objectives of the Massachusetts campaign.68 A primary message is to communicate the “harsh medical realities of the effects of smoking”.6269 Additional messages include second hand smoke, cosmetic effects, and testimonials from ex-employees and former supporters of the tobacco industry.6270 The surtax funded campaign started in 1993 and has had modest success.71 Similar to California, there is evidence that adolescent smoking prevalence decreased in some instances, but the per capita spending to achieve this result was higher. As such, we rank Massachusetts third (tied with Florida) on cost effectiveness.