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We've carefully selected these videos because they're actively working to educate, inspire, and empower their viewers with personal stories and high-quality information. Nominate your favorite video by emailing us at nominations@healthline.com!
There are so many good reasons to quit smoking. Smoking is the leading cause of preventable death in the United States, claiming according to the Centers for Disease Control and Prevention (CDC).

Quitting smoking is downright hard. Many smokers try multiple times before actually breaking their addiction. They may turn to tools like behavioral therapy, nicotine gum, patches, apps, and other aids to help them stop.

Still, not smoking at all is the safest way forward. And stopping seems to be the best way to quit for good.

These videos offer frank insights from former smokers, including their strategies for quitting. They also hit home the dangers of smoking and why it shouldn't be part of your routine. Maybe they'll give you or someone you love a reason to put down that cigarette for good.

How Does Smoking Affect Your Face?

The harmful effects of smoking have been known for years. However, sometimes you have to see the damage a negative habit may have upon you personally in order to stop. But this is somewhat of a Catch-22. If you wait for nature to take its course, the damage will have already been done.

To hit home a warning about smoking's unappealing repercussions - both inside and out - Buzzfeed hired a makeup artist. Watch three smokers be dramatically transformed to their 30-years-into-the-future selves. Their reactions to smoking's harmful aging effects serve as a wake-up call for everyone.

Health Harms - Mutations 20"

Within only 15 cigarettes, chemicals inhaled during smoking cause mutations in your body. These mutations may be the start of cancer. Imagine what that means for the daily smoker. That's exactly what the U.K.'s National Health Service (NHS) campaign to quit smoking did. Using powerful visual cues, the NHS asks you to take advantage of free support to help you quit.

21 Things I'd Rather Do Than Smoke

This campy video offers some silly alternatives preferable to smoking, but it does make a point: Smoking is ridiculous. Rapping their POV like a Beastie Boys mock band, their absurdity gets your attention. Yet they still make it clear that smoking isn't cool and that you should say no. Share it with a young adult (or a regular adult) to help them stay away from cigarettes.

How to Quit Smoking for Good ... According to Science

Jason Rubin, a former smoker and Think Tank host, shares his take on quitting smoking for good. For Rubin, quitting cold turkey was the only way to quit. His instincts are backed up by research.

A U.K. evaluated smokers who quit abruptly and those who gave up cigarettes gradually. More people in the abrupt group managed to quit. Rubin shares the coping mechanisms that helped him quit, like changes to his mindset, routine, and social habits. His message: Genuinely wanting to quit makes all the difference.

5 Stages of Quitting Smoking

Hilcia Dez knows that quitting is a process. For her, it follows the same path as the stages of grief outlined by Dr. Elizabeth Kubler-Ross. Those five parts are denial, anger, bargaining, depression, and acceptance. Watch her act out each stage and see if you spot any similar tendencies on your own path to quit.

CDC: Tips from Former Smokers - Brian: There's Hope

Brian needed a new heart, but doctors took him off the transplant list while he continued to smoke. He was sent to hospice for his last days, but he and his wife fought to keep him alive.

After surviving a full year, they realized that he may have a chance of living longer. He quit smoking and reapplied for a transplant. Watch his emotional story as he asks you to get rid of your cigarettes. He's proof that "there's life on the other side of cigarettes."

A Simple Way to Break a Bad Habit

Judson Brewer is a psychiatrist interested in what mindful behavior means for addiction. He explains that we're all evolutionarily programmed to go through the same process. We respond to a trigger with a behavior that leads to a reward.

Though once a survival mechanism, this process is now killing us. Reward-seeking is leading to obesity and other addictions. Brewer advocates that mindful smoking naturally turns you off to the behavior. Watch his talk to see how his approach may help smokers, stress eaters, people addicted to tech, and more.

Quit Smoking Now

You don't have to smoke to experience the dangerous repercussions of smoking. Secondhand smoke can be devastating to those close to smokers. That was the case for Ellie, who experienced her first asthma attack due to secondhand smoke.

Smoking also impacts loved ones in other ways, such as paying for the cost of treatment. Check out the personal stories and statistics shared in this segment of "The Doctors." Perhaps they will help you or someone you love decide to stop smoking.

CDC: Tips from Former Smokers - Kristy: It Wasn't Better for Me

Most people who quit for good do so without transitional aids like nicotine patches or gum. Kristy thought that phasing out her smoking by using electronic cigarettes would end her habit. She and her husband made a plan to use e-cigarettes, believing that they had fewer chemicals.

However, things didn't go as planned. Watch her story before you buy e-cigarettes to see if her strategy is right for you. Need more motivation? Check out other stories from the CDC's campaign.

Celebrate Quitters: Adam Shares His Reason to Quit

Many people assume that they'll stop smoking by a certain age. However, before they know it, that age is upon them and they may still be smoking. That's what happened with Adam. He finally decided to stop after receiving word of his father's lung cancer diagnosis. Learn about his transformation and how he feels so much better now that he's smoke-free.

How I Quit Smoking: Tips on How to Quit Smoking

Sarah Rocksdale wishes she'd never started smoking. When she was about 19, she succumbed to peer pressure from friends. Eventually, she realized she never enjoyed the smell or the feeling of smoking. She was just addicted.

She talks about why and how she quit the first time. Her biggest motivator: watching terrifying health videos about the dangers of smoking. Then, one cigarette slip turned into a relapse. But she got herself back on track. Her story and how great she feels now may inspire you to keep trying. Check out some of her tools linked below the video on YouTube.

This Is the Best Way to Quit Smoking

A large reason that quitting is difficult is due to the addictive nature of nicotine. This is why nicotine replacement is a popular therapy method to help you stop smoking. Trace Dominguez of D News reports that the most effective quitting tool may be no tool at all. He dissects how certain tools work and looks at whether they actually help you stop. Listen to the research in this video before you spend money and energy using these tools or alternative therapies.

Quitting Smoking Is a Journey

Dr. Mike Evans from the Centre for Addiction and Mental Health understands that quitting smoking can be complicated. It's tied up in emotion, and the journey often involves several relapses.

He looks at the different stages and moving parts of quitting and maintenance. He debunks some of the perceived positives of smoking, like stress reduction and weight management. He encourages you to see failures as part of the process and to keep trying. For your best chance of quitting, pay attention to his success rate research and preparedness tips.

This Is What Happens to Your Body When You Quit Smoking

Rather than focus on the harm smoking causes your body, this video focuses on the positive effects of quitting. For example - almost immediately - you may experience a noticeably better heart rate and blood pressure readings. The video highlights other dramatic improvements you could see over the course of your first smoke-free year.
Catherine is a journalist passionate about health, public policy, and women's rights. She writes on a range of nonfiction topics, from entrepreneurship to women's issues as well as fiction. Her work has appeared in Inc., Forbes, The Huffington Post, and other publications. She's a mom, wife, writer, artist, travel enthusiast, and lifelong student.

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We've carefully selected these videos because they're actively working to educate, inspire, and empower their viewers with personal stories and high-quality information. Nominate your favorite video by emailing us at nominations@healthline.com! There are so many good reasons to quit smoking.

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Can the federal government require tobacco companies to put scary pictures on cigarette packs? At least one federal district judge has said "no." You can regulate commercial speech to protect consumers. This means you can punish tobacco companies for making false claims, denying the health risks associated with smoking. And you can even require cigarette packaging to contain labels disclosing those risks. But you can't compel makers of cigarettes to participate in a campaign against smoking. That crosses the line, wrote Judge Richard Leon.

The New York Times, in an editorial this week, defends the government's position, and urges overturning Judge Leon's decision. Anti-smoking warnings don't need to be ineffective, they argue, to be constitutional, and they add: "There is evidence that the current surgeon general warnings on the side of cigarette packs are ineffective and virtually invisible."

Now, I do not want to defend smoking or tobacco companies. Nor do I wish to enter into the niceties of the law of the First Amendment. But it strikes me that there is something very wrongheaded about the government's thinking here, and that of the Times. There are important values at stake here.

I did a double take when I read the Times' editorial. The current warnings are "virtually invisible"? Hogwash! The current warnings on cigarette packages are perfectly visible. They are legible, clear and informative. Why would you say they are invisible when this is not true? Why would you falsely claim that there is evidence that they are invisible, when there is surely no evidence for such a preposterous claim?

What's really doing the work here is the idea that the warnings are ineffective. And now we get to the point. The warning labels are certainly effective conveyers of truth and information. But they are not an effective means of influencing or controlling behavior. In a word, the warning labels, as they now stand, are not effective propaganda. Propaganda, by definition, is communication that aims to promote or further a cause. In this case, the "cause" is public health.

Should the government be in the propaganda business? Should we, as a people, seek to use fear and sensational images to dictate behavior? How about only when it's for a good cause and backed by sound science? Maybe.

Does the government have the right to compel companies to carry out propaganda campaigns for the government? Maybe.

Reasonable people will differ on how to answer these questions. And constitutional law scholars will have something to say.

But what concerns me is the general tendency - nicely on display in The New York Times editorial - to obscure the difference between propaganda - speech that aims to further an end - and other forms of informed and informative speech.

The thing about propaganda, is that it seeks to achieve an end, but by whatever means necessary. Even when propaganda is in the service of propagating sound advice backed up by good science, propaganda aims to manipulate or control. Propaganda measures its success by its effectiveness, not by its truthfulness or informativeness, as the Times editorial makes explicit.

Argument also seeks to persuade or convince. But this does not mean argument aims at manipulation. It is cynical and immoral to suppose otherwise. And it is a striking fact about contemporary American life that we seem to have lost a grip on this difference.

Whereas propaganda frequently seeks to by-pass judgment and independent thinking - for example, by using images to promote fear and so to bring about a change in behavior - argument targets the autonomous judgment of the other person. Argument takes for granted that the one you are arguing with can understand and assess information just as you can. Whereas the propagandist views not only rhetoric and imagery, but other people, as means to be manipulated in the pursuit of certain ends, the proponent of argument shows a basic respect for others.

Perhaps defenders of the FDA's new packaging requirement will point out that what is at stake here are children. Children are below the age of reason. They are not informed citizens or consumers. Maybe the point is to protect them, and it is right to use the same means to protect them that tobacco companies use to try to ensnare them. We don't aim to persuade children. We rightly aim to control them.

But this is a bad argument. It's wrong to manipulate people, even children, to do what you want or what you believe is right. And that's the problem: propaganda, even when it is based on firm fact and good science, has more to do with manipulation than it does with truthful communication.
You can keep up with more of what Alva Noë is thinking on Facebook and Twitter.

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Anti-Smoking Campaign: Good Public Policy Or Heavy Handed Propaganda?

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Can the federal government require tobacco companies to put scary pictures on cigarette packs? At least one federal district judge has said "no." You can regulate commercial speech to protect consumers. This means you can punish tobacco companies for making false claims, denying the health risks associated with smoking.

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How long has tobacco been around?

Tobacco has been growing wild in the Americas for nearly 8000 years.

Around 2,000 years ago tobacco began to be chewed and smoked during cultural or religious ceremonies and events.

Who discovered tobacco and where?

The first European to discover smoking was Christopher Columbus

In 1531 tobacco was cultivated for the first time in Europe (at Santo Domingo). By 1600 tobacco use had spread across Europe and England and was being used as a monetary standard, a practice that continued throughout the following century

By the 1700s smoking had become more widespread and a tobacco industry had developed industry

When was tobacco first considered to be dangerous to health?

In 1602 an anonymous English author published an essay titled Worke of Chimney Sweepers (sic) which stated that illnesses often seen in chimney sweepers were caused by soot and that tobacco may have similar effects. This was one of the earliest known instances of smoking being linked to ill health.

In 1795 Sammuel Thomas von Soemmering of Maine (Germany) reported that he was becoming more aware of cancers of the lip in pipe smokers

In 1798 the US physician Benjamin Rush wrote on the medical dangers of tobacco

During the 1920s the first medical reports linking smoking to lung cancer began to appear. Many newspaper editors refused to report these findings as they did not want to offend tobacco companies who advertised heavily in the media

A series of major medical reports in the 1950s and 1960s confirmed that tobacco caused a range of serious diseases.

When were cigarettes developed?

Cigarette making machines were developed in the latter half of the 1800s. The first such machines produced about 200 cigarettes per minute (today's machines produce about 9,000 per minute). Cheap mass production and the use of cigarette advertising allowed tobacco companies to expand their markets during this period.

What caused the growth and later decline of smoking in traditional markets?

The prevalence of cigarette smoking continued to grow in the early 20th Century mainly as a result of:

The development of new forms of tobacco promotion

The ability of the tobacco industry through its power and wealth to influence the policies of political parties.

Smoking increased dramatically during the world wars, mainly due to the policy of providing free cigarettes to allied troops as a 'morale boosting' exercise.

Later in the twentieth century, smoking became less popular due to a rapid increase in knowledge of the health effects of both active and passive smoking.

People also became aware of the tobacco industry's efforts to mislead the public about the health effects of smoking and to manipulate public policy for the short-term interests of the industry.

The first successful lawsuits against tobacco companies over smoking-related illness happened in the latter part of the 20th Century.

What are current global smoking trends?

As smoking prevalence rates have declined in the traditional markets of North America and Western Europe, the tobacco industry has re-focussed its promotional efforts onto the less developed and emerging nations in Africa, Asia, the Middle East, the former Soviet Union and Latin America. The often weak regulatory environment in these countries has further encouraged the industry to target populations in these nations.

If current patterns continue, tobacco use will kill approximately 10 million people every year throughout the world by 2020; 70% of these deaths will occur in less developed and emerging nations.

Useful references and links

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A brief history of smoking - Cancer Council NSW

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How long has tobacco been around? Tobacco has been growing wild in the Americas for nearly 8000 years. Around 2,000 years ago tobacco began to be chewed and smoked during cultural or religious ceremonies and events. Who discovered tobacco and... Read More

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Abstract

OBJECTIVE To assist in planning anti-smoking advertising that targets youth. Using five US state campaigns, one US research study, and a Canadian initiative as exemplars, an attempt is made to explain why certain advertising campaigns have been more cost effective than others in terms of reducing adolescent smoking prevalence. Several factors which prior research and theory suggest may be important to cost effectiveness are examined. Specifically, three variables pertaining to the advertising message (content, consistency, and clarity) and two variables related to the advertising execution or style (age of spokesperson and depiction of smoking behaviour) are studied.

DESIGN A case study approach has been combined with supplemental data collection and analysis. To assess campaign effects, published articles and surveys of adolescent smoking prevalence in campaign versus control (non-campaign) locations were utilised. Adolescent subjects provided supplemental data on the advertising message variables. Trained adults content analysed each advertisement to assess the executional variables.

SUBJECTS A total of 1128 seventh grade (age 12-13 years) and 10th grade (age 15-16 years) students participated in the supplemental data collection effort.

RESULTS An anti-smoking advertising campaign initiated by Vermont researchers was found to be the most cost effective in that it significantly reduced adolescent smoking prevalence at a low per capita cost. Next in order of cost effectiveness were California, Massachusetts, and Florida because behavioural outcomes were inconsistent across time and/or grades. California was ranked higher than the other two because it spent less per capita. Minnesota and Canada were ineffective at reducing adolescent smoking prevalence, and no comparison outcome data were available for Arizona. Four factors were found to be associated with increased cost effectiveness: (1) a greater use of message content that prior research suggests is efficacious with youth; (2) a more concentrated use of a single efficacious message; (3) an avoidance of unclear messages; and (4) an increased use of youthful spokespeople that adolescents could more readily identify with. No indication was found that depictions of smoking undermined campaign effectiveness by inadvertently implying that smoking was prevalent.

CONCLUSIONS The highly cost effective Vermont campaign can be used as a model for future efforts. It is estimated that 79% of the Vermont advertisements conveyed efficacious messages, 58% concentrated on a single efficacious message, 70% showed youthful spokespeople, and only 4% contained unclear messages. The results suggest that, in the less effective campaigns, as few as 25% of the advertisements contained messages that prior research indicates should be efficacious with youth, as few as 10% of the advertisements focused on one efficacious message, and up to 32% of the advertisements lacked clearcut messages.

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

MESSAGE CONTENT

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.

Both studies concluded that second hand smoke messages work well with adolescents. 15 19 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, 15 19 short term effects only, 15 19 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.

MESSAGE CONSISTENCY

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. 24 Therefore, we tentatively predicted that an anti-smoking campaign's cost effectiveness would be enhanced by a focus on a single efficacious theme.

MESSAGE CLARITY

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. 22 32

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

When advertisers court adolescents, they generally make a concerted effort to use youthful spokespeople who will be believed and respected by the youth subculture. 38 39 Some cigarette advertisers apparently feel that it is important to use youthful spokespeople as well. 17 38 According to studies, tobacco advertisers frequently violate their voluntary code to rely on models that look to be at least 25 years old. 17 40 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

DEPICTIONS OF SMOKING BEHAVIOUR

Method

OVERVIEW

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.

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 California 46 47 (telephone conversation with Curt Fallor, California Tobacco Control Section, December 1999), Massachusetts 47 48 (email correspondence with Mark LaPlante, Massachusetts Department of Health Services, February 2000), Florida, 47 49 Canada, 50 and Arizona (telephone conversation with Robert Suiter, Arizona Tobacco Education and Prevention, February 2000) 47 51 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. 47 52-54 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. 47 55

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). 1 4 5As a basis for comparison, tobacco firms currently spend over $7 per capita per year in the USA on advertising, promotional items, and sponsorships. 53

ANALYSES OF CAMPAIGN EFFECTIVENESS

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.

STATISTICAL ANALYSES

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. 8 50 52 Vermont researchers used a stepwise regression procedure to assess treatment effects between the intervention and control groups. 7 8 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

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 χ ² 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.

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 χ ² 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.

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 ($0.46 46; 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 ($2.16 48; email correspondence with Mark LaPlante, Massachusetts Department of Health Services, February 2000 and $1.29 49 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).

Vermont

COST EFFECTIVENESS

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

COST EFFECTIVENESS

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.

Massachusetts

COST EFFECTIVENESS

PREDICTORS OF COST EFFECTIVENESS

The moderate success experienced in Massachusetts may be owed to the fact that 53% of the advertisements appeared to contain efficacious content for youth, including: deceptive portrayal of lethal product (17%), smoker as negative role model (17%), second hand smoke (11%), and refusal skills (8%). Just 19% of the Massachusetts advertisements were found to be unclassifiable; the majority contained clearcut messages. However, the campaign distributed advertisements across several themes instead of concentrating on a few themes with a consistency rating of only 17%. While youths were prominently featured in 44% of the Massachusetts advertisements, other sponsors utilised youths more. Finally, the Massachusetts advertisements were significantly less likely to depict people smoking than some of the other sponsors.

Florida

COST EFFECTIVENESS

Florida seeks to incite youths to activism against the tobacco industry to punish it for deception and immorality. The campaign tagline is "Their brand is lies. Our brand is truth". 73 Florida youth are involved in campaign planning and are encouraged to form SWAT (Students Working Against Tobacco) clubs to support its goals. 74 The highly visible campaign commenced in 1998. It has had modest success in its first year, in that there is evidence that smoking prevalence decreased in one grade level. Hence, we rank Florida as tied with Massachusetts in terms of cost effectiveness.

PREDICTORS OF COST EFFECTIVENESS

Minnesota

COST EFFECTIVENESS

Minnesota has the distinction of being the first US state to initiate an anti-smoking advertising campaign. The campaign started in 1986 but a state budget crisis reportedly led to its demise around 1990. 52 Minnesota chose to utilise the short-term cosmetics effects theme. Specifically, it decided to focus on the "unpleasant social and personal consequences such as bad breath [and] smelly clothes". Minnesota further stated that it wanted to avoid anti-industry messages. 76 The Minnesota campaign was reportedly unsuccessful in terms of significantly reducing adolescent smoking prevalence, so we rank it fourth on cost effectiveness.

PREDICTORS OF COST EFFECTIVENESS

There are some apparent factors that may have contributed to Minnesota's lack of success. The theme that was used most often, short term cosmetics effects (30%), now does not appear to be particularly efficacious among youth. While 30% of the advertisements apparently contained more efficacious messages, the campaign's consistency score was just 10% (deceptive portrayal of lethal product 10%, smoker as negative role model 10%, refusal skills 10%). Forty two per cent of the Minnesota advertisements utilised youthful spokespeople, which was slightly lower than some of the other campaigns. Minnesota also portrayed people smoking in 58% of its advertisements which was significantly higher than some of the other sponsors.

Canada

COST EFFECTIVENESS

Canada's advertising campaign is designed to promote "the benefits of being smoke free to young Canadians between 11-17". 77 It also seeks to highlight the negative long term health effects of smoking and the dangers of second hand smoke. 77 We rank Canada last on cost effectiveness because there is no evidence that the campaign has succeeded in reducing adolescent smoking prevalence.

PREDICTORS OF COST EFFECTIVENESS

It is not entirely clear why Canada's campaign has not been more successful with adolescents. We estimate that 51% of the Canadian advertisements communicated efficacious messages for this group including: second hand smoke (22%), refusal skills (17%), deceptive portrayal of lethal product (6%), and smoker as negative role model (6%). Sixty eight per cent of the Canadian advertisements featured youthful spokespeople and only 21% showed people smoking, which was significantly less than some of the other sponsors. However, we detect two possible shortcomings with the campaign. First, Canada used several, disparate messages which it could probably ill afford to do because its per capita expenditures were low. The most commonly used efficacious message (second hand smoke) appeared in just 22% of the advertisements. Second, the largest message type by a significant margin was unclassifiable (32%), suggesting that nearly one third of the Canadian advertisements were poorly comprehended.

Arizona

COST EFFECTIVENESS

PREDICTORS OF COST EFFECTIVENESS

It is unclear whether Arizona's campaign will succeed in reducing adolescent smoking prevalence. Based on our findings, just 25% of the advertisements used messages that researchers have identified as especially efficacious for youth. Half of the advertisements strictly discussed short term cosmetic effects. Another 25% of the advertisements were deemed unclassifiable, indicating disagreement or confusion as to the messages conveyed. Executionally, 50% of the advertisements used youthful spokespeople which is about average across the sponsors. Arizona showed people smoking in 67% of the advertisements, significantly more than some of the other sponsors.

Research limitations

A limitation of the study we have presented is that it does not address the impact of anti-smoking advertisement campaigns on adult smoking prevalence or societal attitudes toward smoking. Our data primarily pertain to adolescents' views of anti-smoking advertising, and the effects of the advertisements on adolescents. This is not to say, however, that anti-smoking advertisements should strictly target adolescents. In fact, advertising can play an important role in encouraging adults to be non-smoking role models and to fight for smoke free policies, restricted tobacco access, and similar initiatives. 79 80

Another weakness of our research is that we could not assess the independent contribution of each measured advertising factor to campaign effectiveness. One reason is that the campaigns' ratings on the advertising variables were highly correlated. In particular, Vermont's campaign was strong on several dimensions. Also, we were precluded from running statistical tests linking our advertising variables to specific behavioural outcomes because, with the exception of Vermont, promising outcomes were attained inconsistently. For instance, Massachusetts was successful (versus the region) with 12th graders during the period from 1995 to 1997, but could not replicate this effect during 1997 to 1999. California's results were promising from 1993 to 1995, but not from 1995 to 1997. It is possible that California's impact on adolescents was undermined in the mid 1990s by budget cuts, 46 but we were unable to determine specific information about how the adolescent (versus adult) budget was affected by those cuts. Unfortunately, sponsors generally do not report specific budget allocations for youth versus adults. Such information would be very helpful to future researchers.

General recommendations

When developing anti-smoking advertisements that are intended to lower adolescent smoking prevalence, messages and executions should be geared to adolescents. Experts repeatedly warn that advertising that works with adults generally will not work with teens. 39Youth advertising is more effective when "this subculture is addressed in a language it understands and appreciates." 38 In advertising, a "one size fits all" approach is widely recognised as unsuitable. 16 21 83 Specifically, when targeting adolescents, officials should consider using spokespeople who are just slightly older than the intended audience. In addition, the following message themes should be examined seriously, since they seem to have the greatest potential for dissuading youths from smoking: second-hand smoke, smoker as negative role model, refusal skills, and deceptive portrayal of a lethal product.

Acknowledgments

Funding from the California Tobacco-Related Disease Research Program is gratefully acknowledged. We also thank Charles LaFlamme, Raana Jarrahian, and Maria E Reneteria for their contributions to this project, and Stanton Glantz and the anonymous reviewers for their helpful suggestions.

View Abstract

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Anti-smoking advertising campaigns targeting youth: case studies from USA and Canada

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OBJECTIVE To assist in planning anti-smoking advertising that targets youth. Using five US state campaigns, one US research study, and a Canadian initiative as exemplars, an attempt is made to explain why certain advertising campaigns have been more cost effective than others in terms of reducing adolescent smoking prevalence.

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Anti-smoking zealots hypocritically condemn alledged tobacco industry advertisment targeting youth, claiming their persuasive nature of capturing youngsters by the smoking message.

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Smoking is an unfashionable habit, and rightly so. If you've ever kissed a smoker, you'll appreciate why this should be the case. People who smoke heavily are more prone to coughing, certain illnesses, they may be short of breath, and so on, but does smoking really cause depression? That is what the latest research from University College London indicates, or could it be that depressives smoke more?

The lunacy that is peddled by the anti-smoking lobby in this country beggars belief, but it never stops. This includes attacks on secondhand smoking, or passive smoking as it is usually called; passive smoking means being in the same room as a smoker, or in the same town if you believe Action on Smoking and Health, but who does? A few years ago there was a big crusade against passive smoking using all manner of scientific studies to prove both how obnoxious and how deadly it is. At least one study appeared to show that passive smoking was more dangerous than regular smoking, something that borders on the absurd. Save for the smokers' rights organisation FOREST, the propaganda has been all one way, and has had a profound effect on public policy; smokers are now treated almost like pariahs in some places.

Since July 2007, smoking has been banned in all public buildings in the UK, that includes private buildings like shops. If you see your local shopkeeper standing outside having a quick drag, that is because he is banned by law from smoking on his own premises, even if he owns the freehold. Later this year it will become a criminal offence to smoke in a car if a child is present; as that great Libertarian Chris Tame used to say, when they talk about protecting children, what they really mean is destroying your rights.

The propaganda campaign and legal restrictions would probably be even more vicious if the Government were not caught in a bind. This official table shows the staggering taxation on cigarettes in the UK; the less people smoke, the less revenue for the Treasury. A side-effect of this repressive taxation is the trade in contraband cigarettes; it was partly this that led to the controversial death of Eric Garner in New York. He was trying to make an honest living by selling cigarettes bought from outside New York State where the taxes are lower; he ended up being arrested over a victimless crime and dying as a result of overzealous policing.

What is behind this campaign? Most knowledgable observers believe it is more about power than concern for people's welfare. Does smoking really kill as many people prematurely as its enemies claim? The comedian Bob Hope and the songwriter Irving Berlin were both smokers; Hope died at 100, Berlin at 101!

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SHARES Sming is an unfashionable habit, and rightly so. If you've ever kissed a smer, you'll appreciate why this should be the case. People who sme heavily are prone to coughing, certain illnesses, they may be short of breath, and so on, but does sming really cause ...

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Smoking and its effects on Health - Stop today!

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Why you should stop smoking or not smoke at all?

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Why you should stop smoking or not smoke at all?

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Here are a couple reasons and facts that you should stop smoking.