Tobacco Use: Mass-Reach Health Communication Interventions

Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends mass-reach health communication interventions based on strong evidence of effectiveness in:

Decreasing the prevalence of tobacco use
Increasing cessation and use of available services such as quitlines
Decreasing initiation of tobacco use among young people

Evidence was considered strong based on findings from studies in which television was the primary media channel. Economic evidence shows mass-reach health communication interventions are cost-effective, and savings from averted healthcare costs exceed intervention costs.

The full CPSTF Finding and Rationale Statement and supporting documents for Tobacco Use: Mass-Reach Health Communication Interventions are available in The Community Guide Collection on CDC Stacks.

Intervention

Mass-reach health communication interventions target large audiences through television and radio broadcasts, print media (e.g., newspaper), out-of-home placements (e.g., billboards, movie theaters, point-of-sale), and digital media to change knowledge, beliefs, attitudes, and behaviors affecting tobacco use.

Intervention messages are typically developed through formative testing and aim to reduce initiation of tobacco use among young people, increase quit efforts by tobacco users of all ages, and inform individual and public attitudes on tobacco use and secondhand smoke.

About The Systematic Review

The CPSTF finding is based on evidence from a Community Guide systematic review published in 2001 (27 studies, search period 1980-2000) combined with more recent evidence (70 studies, search period January 2000- July 2012). The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure. The finding updates and replaces two previous CPSTF findings on mass media campaigns used to increase cessation and reduce initiation.

Study Characteristics

Included studies assessed mass-reach health communication interventions in the United States (44 studies), Australia (13 studies), Canada (2 studies), Israel (1 study), New Zealand (2 studies), Switzerland (1 study), Taiwan (1 study), the Netherlands (3 studies), and the United Kingdom (3 studies)
Most of the studies evaluated these interventions at the state or regional level (42 studies) with the remaining studies at the national (23 studies) and city or local (5 studies) level
Interventions were implemented alone (17 studies), with other components (21 studies), or as part of a comprehensive tobacco control program (27 studies). Eight studies did not report on this characteristic
Interventions were implemented with adults (49 studies) or young people (21 studies) as the main audience

Summary of Results

The CPSTF finding is based on results from 64 of the studies that evaluated interventions using television as the sole or primary media channel. Mass-reach health communication interventions were associated with decreased tobacco use prevalence, increased cessation and use of available cessation services, and decreased initiation of tobacco use among young people.

Tobacco Use

Prevalence of tobacco use among adults: median decrease of 5.0 percentage points (range of values: -5.2 to -1.9 percentage points; 4 studies)
- Increased exposure to anti-tobacco media messages was significantly associated with decreased tobacco use prevalence (4 studies)
Prevalence of tobacco use among young people (11 to 24 years of age): median decrease of 3.4 percentage points (interquartile interval [IQI]: -5.3 to -1.6 percentage points; 11 studies)
- Increased exposure to anti-tobacco media messages correlated with a decrease in adolescent tobacco users (1 study)
Cessation of tobacco use: median increase of 3.5 percentage points (IQI: 2.0 to 5.0 percentage points; 12 studies)
- Increased intervention intensity was associated with increased odds of quitting (2 studies)
- Exposure to anti-tobacco media did not significantly increase cessation in 3 studies

Use of Cessation Services

Number of calls to quitlines: median relative increase of 132% (IQI: 39% to 378%; 11 studies)
Interventions were effective in increasing use of cessation services, especially quitlines (17 studies)

Tobacco Use Initiation Among Young People

Initiation among young people (11 to 24 years of age): decrease of 6.7 percentage points (95% confidence interval: -13.0 to -0.4 percentage points, 1 study)
Higher intervention exposure or higher intervention recall or appeal was associated with reduced tobacco use initiation (5 studies)

Included studies also reported favorable results of the intervention on other outcomes such as changes in quit attempts (12 studies), exposure to secondhand smoke (1 study), and adoption of smoke-free policies in private homes (3 studies).

Summary of Economic Evidence

Sixteen studies were included in the economic review. Review conclusions are based on results from 13 studies that provided cost-effectiveness measurements and cost-benefit comparisons. All monetary values are reported in 2011 U.S. dollars.

Cost-effectiveness estimates (10 studies)
- Cost per quality-adjusted life year (QALY): median estimate of $577 (range of values: $97 to $1,622; 3 studies)
- Cost per life year saved (LYS): median estimate of $213 (range of values: $128 to $718; 3 studies)
- Cost per additional caller to quitlines (costs of media campaigns and associated increase in calls to quitlines): median estimate of $260 (range of values: $24 to $399; 4 studies)
Cost-benefit estimates (3 studies): Benefit-to-cost ratio estimates ranged from 7:1 to 74:1

Overall, the economic evidence indicates mass-reach health communication interventions are cost-effective and savings from averted healthcare costs exceed intervention costs.

Applicability

Based on results for different settings and populations, findings are applicable to the following:

U.S. and non-U.S. settings
National, state or regional, city and local levels
Adults and young people
Males and females
Population groups with high prevalence of tobacco use or limited access to cessation services, including Arabic speaking, Latino, Spanish speaking, or Maori tobacco users
Population groups with different SES, educational attainment, or race/ethnicity

Evidence Gaps

What are thresholds of effectiveness for intervention intensity, duration of intervention, message placements, and frequency of new message introduction to maintain audience engagement and lead to behavior change?
What are costs associated with different intervention components?
Given that current evidence is dominated by interventions that used television as the only or primary media channel, how will changing media consumption habits affect intervention effectiveness?
How effective are interventions that use newer content delivery formats and media channels, especially digital media?
How effective are these types of interventions at reducing use of tobacco products other than cigarettes, for example cigars, cigarillos, and smokeless tobacco products?

Implementation Considerations and Resources

Mass-reach health communication interventions are most commonly implemented with other tobacco control interventions or as part of a comprehensive tobacco control program. Following are some of the common characteristics of these interventions:

Most primarily broadcast messages through television, as compared with radio or print media (e.g., posters), in order to access a wider audience
Most often, funds are used to purchase broadcast time (e.g., television or radio advertisement) or advertising space in print media (e.g., newspapers or magazines)
Messages from recent interventions commonly use personal testimonials or graphic images of harms caused by tobacco use to generate emotional responses from viewers
Messages are commonly tagged with information about cessation services (e.g., quitlines) to increase use of these services

There are resource centers providing guidance and video libraries to support tobacco control programs and mass-reach health communication interventions, such as the CDC Office on Smoking and Health Media Campaign Resource Center.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.