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Reducing Tobacco Use and Secondhand Smoke Exposure: Mass-Reach Health Communication Interventions

Task Force Finding

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

  1. Decreasing the prevalence of tobacco use
  2. Increasing cessation and use of available services such as quitlines
  3. 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.

Read the full Task Force Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

Intervention Definition

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 Task Force 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 Task Force 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 Task Force findings on mass media campaigns used to increase cessation and reduce initiation.

Results

Updated Review (search period January 2000-July 2012)

The Task Force 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).
      • Increased exposure to and appeal of anti-tobacco media messages were associated with an increased sense of tobacco independence and positive social imagery of not smoking, both of which strongly correlated with not smoking (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).
    • Awareness of anti-tobacco advertising was associated with reduced smoking initiation among high-sensation-seeking young people (1 study).

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).

Previous Review (search period 1980-2000)
  • Tobacco Use
    • Prevalence of tobacco use among adults: median decrease of 3.4 percentage points (range of values: -7.0 to 0.2 percentage points; 7 studies)
    • Prevalence of tobacco use among young people (11 to 24 years of age): median decrease of 6 percentage points (range of values: -11 to 0.02 percentage points; 6 studies)
      • Prevalence of tobacco use was significantly lower among young people who were exposed to mass-reach health communication interventions (odds ratio [OR] = 0.60, range of values: 0.49 to 0.74; 4 studies).
    • 2 studies found no effect.
    • Tobacco consumption (measured as state per capita consumption compared to rest of the U.S.): median decrease of 15 cigarette packs per capita per year (range of values: 24.5 to -9; 3 studies); and relative decrease of 12.8% (range of values: 17.5% to 9.8%; 3 studies)
    • Cessation of tobacco use: median increase of 2.2 percentage points (range of values: -2 to 35 percentage points, 5 studies)
  • Use of Cessation Services
    • Number of calls to quitlines increased by 392% (1 study)

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

Estimates of cost-effectiveness were assessed in comparison to a conservative threshold of $50,000 per QALY saved. Overall, the economic evidence indicates mass-reach health communication interventions are cost-effective and savings from averted healthcare costs exceed intervention costs.

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

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 External Web Site Icon and World Lung Foundation Tobacco Control Mass Media Resource External Web Site Icon.

Supporting Materials

Publication Status

Full peer-reviewed articles of this systematic review will be posted on the Community Guide website when published. Subscribe External Web Site Icon to be notified when we post these publications or other materials. See our library for previous Community Guide publications on this and other topics.

Promotional Materials

Community Guide News

More promotional materials for Community Guide reviews about Reducing Tobacco Use and Secondhand Smoke Exposure.




Disclaimer

The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Reducing tobacco use and secondhand smoke exposure: mass-reach health communication interventions. www.thecommunityguide.org/tobacco/massreach.html. Last updated: MM/DD/YYYY.

Review completed: April 2013