Over the last 10 years there has been a steady decline in smoking prevalence in Victoria (see Chapter 5). The social environment in Victoria is also becoming more difficult for smokers, with a dramatic increase in the proportion of people subjected to smoking bans in their workplaces (Borland & Mullins, 1994) and increasing bans in restaurants and other public places. Previous surveys have indicated that the majority of Victorian smokers have made at least one attempt to quit, and many plan to try again "in the next three months" (see Chapter 3).
With these factors in mind, in 1993 the aim of the Quit Campaign was to encourage smokers to have another go at quitting, and to promote the services Quit offers as being helpful to the smoker both during the campaign and throughout the year. Focus group testing indicated that smokers were tired of messages insisting that they should quit now (Murphy & Mullins, 1993) so the message chosen for the campaign was "When you're ready, we're here".
In 1993, Quit expanded the services it offered to smokers, with the introduction of a telephone counselling service, incorporating a system of counsellor callbacks for those who wanted them. A telemarketing company was contracted to handle incoming calls for information, via a new "13" telephone number. The operator would arrange to send the appropriate written materials to the caller and, if the caller required counselling or the call-back service, the operators could transfer them to a counsellor. In addition, a video on how to quit, Ten Steps to Quit for Good, a relaxation cassette and a new booklet for those who had tried to give up previously (Quit for Good) were added to Quit's range of resources.
Two television advertisements were used in this campaign. The first of these was a reworking of one of Quit's best-remembered advertisements, Sponge, first shown in 1983 and most recently shown in 1989. In the advertisement a sponge is wrung out into a beaker, to demonstrate the amount of tar an average smoker puts into his or her lungs each year. In the new version of the advertisement the visuals are the same, but a new voice-over says that, since the advertisement was first shown, two million Australians have given up smoking. She then points out that there is lots of help available if you are ready to try quitting again.
In addition to Sponge - Ten years on, a series of advertisements featuring people talking about quitting smoking, and promoting Quit's services, were produced. A thirty-second version of the advertisement featured three people talking about Quit, and in addition, each person featured in an individual fifteen-second advertisement. The advertisements feature a young woman who talks about the callback service, a young man who talks about the resources Quit can offer and an older man who talks about Quit's new video on quitting step by step. The advertisements stress that quitting is not easy but possible.
Both before and after the campaign, a telephone survey of approximately 500 smokers and recent quitters was undertaken. The aims of the surveys were:
As part of this campaign two telephone surveys were commissioned from a large market research company. The first survey took place four weeks before Quit Week and the second immediately after it. In both the pre- and post-campaign survey the questions first covered general smoking behaviour, such as consumption, attempts to quit and intention of quitting. Questions were then asked about the respondents' previous contact with Quit, opinions about Quit and anti-smoking advertising in general. In the post-campaign survey, awareness of the Services and Sponge - Ten years on advertisements, and reactions to them, were the last areas covered.
The Computer-Assisted Telephone Interviewing (CATI) system was used to conduct the surveys. The CATI system uses randomly selected numbers from current computerised telephone directories which are entered onto the computer before interviewing commences. A telephone number then appears on the screen for the interviewer to call when he or she is ready. If the appropriate person is not available the interviewer enters the date and time to try again and the computer automatically presents the number to be called at the correct time. During the interview, the interviewer enters the response codes or types the answers to open-ended questions straight into the computer.
In these surveys only people who were current smokers or recent quitters were interviewed. The sample selection followed an identical procedure to that used in telephone surveys in previous years. The interviewer always asked to speak to the youngest smoker or recent quitter in the household. This method has been shown to give a distribution of smokers that closely reflects population estimates.
The pre-campaign sample of 501 smokers and recent quitters were interviewed between May 3 and 5, 1993. Half were men and half were women. Thirty-five per cent were aged 16 to 29 years of age, 45% were 30 to 49 and 20% were over 50. Seven per cent had quit smoking in the last four months, that is, since the beginning of 1993, and the rest were current smokers.
The post-campaign sample of 509 smokers and recent quitters were interviewed between June 14 and 20, 1993. Again, the sample was evenly split between men and women. Thirty-two per cent were aged 16 to 29 years of age, 47% were 30 to 49 and 21% were over 50. Nine per cent had quit smoking in the last six months (again, since the beginning of 1993) and the rest were current smokers.
To test for the significance of relationships between variables, various statistics have been used, mainly chi-square tests, t-tests and analyses of variance. Details of statistical tests are not given in the text. Where relationships between variables are reported, the probability level of significance was less than 0.05, indicating a less than 1 in 20 chance that the finding is due solely to chance.
Before the campaign, 35 respondents had quit smoking recently. Of these, 17 had quit in the last month, 6 between one and two months ago, and the rest up to four months ago. Of the current smokers, 73% had tried to quit at least once before, and half (51%) had tried more than once. Eight per cent of all the smokers had made their most recent attempt to quit within the last month, another 33% within a year, 20% from one to five years and the rest had not tried to quit for over five years. Most smokers (93%) smoked every day and, of those, 24% smoked up to 10 cigarettes per day, 40% between 11 and 20, and 36% smoked more than 20. Seventy-six per cent of the daily smokers had their first cigarette within an hour of waking up.
In the post-campaign sample, of those who had quit smoking recently (n=48), 17 had quit in the last four weeks, 8 between one month and 2 months ago, and the rest up to six months ago. Of the current smokers, 75% had tried to quit at least once before, and half (52%) had tried more than once. Eleven per cent of all the smokers had made their most recent attempt to quit within the last month, that is, during the campaign period, another 31% within a year, 22% from one to five years and the rest had not tried to quit for over five years. Most smokers (92%) smoked every day and, of those, 27% smoked up to 10 cigarettes per day, 41% between 11 and 20, and 32% smoked more than 20. Seventy-four per cent of the daily smokers had their first cigarette within an hour of waking up.
Current smokers were asked two questions about their intentions to quit. They were first asked to rate how likely they were to quit smoking in the next three months, and then to compare how likely they were to quit now with how likely they were one month ago. Table 1 shows the data on intention to quit in the next three months for both the pre-campaign and post-campaign surveys.
|Definitely will not||13%||10%|
It is apparent that there was no real change in intention to quit after the campaign. There was a slight decrease in the proportion who said they were likely to quit, which corresponded with an increase in the number who said the chance was 50/50.
When asked how likely they were to quit now, compared with one month ago, virtually the same proportion of people asked before the campaign (38%) and after it (39%) said they were now more likely. Very few people in either sample (< 5%) said they were less likely to quit, and the majority said they felt the same. The fact that the same proportion were more likely to quit before and after the campaign indicates the change is not attributable to the media campaign.
Respondents were asked to assume that they tried to stop smoking, and to indicate how likely they would be to stop smoking permanently. This measure was also very stable across the two surveys, with 41% of the pre-campaign sample describing themselves as "certain", "very likely" or "fairly likely" to be able to quit permanently compared with 44% of the post-campaign sample. Seventeen per cent of each sample rated their chances as 50/50, and 25% of each thought it was "fairly unlikely", "very unlikely" or they "definitely will not". The balance was made up of those who could not say, which was slightly higher in the post-campaign group.
Smokers were asked "In the last month, have you done anything at all about quitting smoking, including arranging things to make it easier for you to quit in the future?". Before the campaign 21% said they had, and after the campaign 24% had. All of those who said they had done something were asked to describe what they had done.
|Restricted times or places they smoked||15%||7%|
|Mention of Quit||4%||12%|
As Table 2 indicates, both before and after the campaign the most popular action was to cut down on the number of cigarettes smoked. Other frequently mentioned responses were also really methods of cutting down, either by distraction through eating lollies, exercising or some other means, or restricting the places they smoked - for example, not in the car or not at work. Between the pre- and post-campaigns there was an increase in the proportion of respondents who said they had cut down, but this was accounted for by a corresponding decrease in the proportion who mentioned specific methods of doing so. The proportion who mentioned Quit (either ringing Quit, reading Quit materials or attending a Quit course) had tripled from the low baseline of 4% to 12% of those who did something.
Interestingly, although nicotine patches first became available in the period between the two surveys, very few people mentioned them in either survey.
Respondents were asked "To the best of your knowledge, where could smokers get information and help about giving up smoking?". They were asked to give as many places as they could. Before the campaign 85% of people could name at least one place, and 68% could name more than one. After the campaign 89% could name one and 77% could name more than that. Respondents named a wide variety of information sources, and some respondents named up to 11 sources. Only the most frequently mentioned sources are included in Table 3.
|First mention||Subsequent mentions||First mention||Subsequent mentions|
From before the campaign to after it, the percentage of first mentions of the Quit Line as a source of help and information doubled. Before the campaign less than a third of respondents (30%) named the Quit Line either first or subsequently, and after the campaign more than half (55%) did. There was a reduction in the percentage naming the Quit Campaign (28% to 20% overall), which suggests that some of the respondents in the second survey were more specific in their knowledge of Quit's services, and were aware there was a special telephone line to call.
In the first survey, 17 respondents (3%) named both the Quit Campaign and the Quit Line as sources and, in the second one 18 (4%) did, so the total proportion of respondents mentioning Quit was 55% before the campaign and 71% after it. Mentions of doctors increased from 52% to 57%, and chemists from 25% to 29%. Given the extensive advertising campaign associated with nicotine patches around the same time as the Quit Campaign, which advised "There is a way out - see your doctor or pharmacist", it was surprising that references to doctors and pharmacists did not increase more.
As well as being asked about the places smokers could get help or information, respondents were also asked where they had gone for help previously, and where they intended or expected to go in the future, or if in fact they would go anywhere.
Respondents who had already quit were asked what they had done when they stopped smoking. Before the campaign only eight people (23% of quitters) said they had got help, and afterwards 18 people (38% of quitters) said they had. Respondents were asked where they had gone for help, but there was such a diversity of responses that nothing meaningful could be drawn from them. After a free recall question about places they had gone for help, quitters who had not spontaneously mentioned Quit were asked specifically whether they had contacted it. Both before the campaign and after it, four quitters either spontaneously or when prompted said they had contacted Quit for help.
Respondents who smoked were asked a question about their intentions of getting help or information to assist them to quit. "If you decided to give up smoking, would you do it entirely by yourself, or would you get help or information?" Before the campaign 24% of respondents said they would get help and information and after it 29% said they would (95% CI of diff= -0.4% to 10.4%; ns).
Those who had said they would get help or information were then asked to name all the places they would go to get it. Doctors and either the Quit Line or Quit Campaign were the most commonly named sources. Five people before the campaign, and three people after it, named both the Quit Line and the Quit Campaign. Taking this into account, before the campaign doctors and the Quit Campaign or Quit Line were mentioned almost equally (43% and 40% respectively). After the campaign, the proportion mentioning doctors had not changed (44%) but mentions of Quit (either Line or Campaign) had increased to 52%.
Those respondents who had said they would seek help, but did not specifically mention the Quit Campaign were asked how likely they would be to contact Quit. Unfortunately, due to a misunderstanding, those respondents who had said they would contact the "Quit Line", rather than the "Quit Campaign", were treated as if they had not mentioned Quit at all, and were still asked the specific question about contacting Quit. This will not change the results, as it is implausible to think that anyone would spontaneously say they would ring the "Quit Line", but would then go on to say they were unlikely to ring Quit. It does mean however that the number who spontaneously mentioned Quit is underrepresented in the table.
Table 4 presents firstly those who spontaneously said they would contact the "Quit Campaign", then the likelihood of contacting Quit for all others when they were asked directly. These data are only for those people who said they would seek help or information.
Overall, before the campaign 63% of those who said they would seek help said they would contact Quit, either with or without being specifically asked and 70% said the same thing afterwards (95% CI of diff= -4.8% to 18.8%, ns). It should be kept in mind that, although these proportions are quite high, only about one-quarter of respondents said they would seek help and the rest maintained they would give up by themselves.
|Spontaneously mentioned Quit Campaign||24%||19%|
|Total likely (spontaneous or prompted response)||63%||7%|
|Neither likely nor unlikely||4%||1%|
|Not at all likely||4%||7%|
In addition to measures of smokers' intention to contact Quit in the future, all respondents except those recent quitters who already said they had contacted Quit, were asked "Have you ever contacted the Quit Campaign to get help or information, either for yourself or someone else?". Excluding the recent quitters not asked this question, 15% of the pre-campaign respondents and 15% of the post-campaign respondents had contacted Quit before. No age, gender or occupation differences were seen in either the pre-campaign or post-campaign samples.
The smokers who had contacted Quit were asked how satisfied they had been with the contact, and most reported being satisfied with Quit's help and information (60% before the campaign, 77% after the campaign). Of the twenty people from the pre-campaign survey who were not satisfied, the most frequent complaint was that Quit didn't understand or was no help (7 respondents). Other complaints were that they heard a recorded message (4 people), no materials were ever received (2 people) or that they were only sent leaflets (2 people). The nine people in the post-campaign survey who were dissatisfied offered the same criticisms, with no dominant theme. We did not ask how long ago they called Quit, so we do not know when these problems occurred.
All respondents were asked an open-ended question about the services Quit already offered for smokers "What services are you aware of that the Quit Campaign offers for smokers who want to give up?".
More people were aware Quit offered written resources rather than any other form of support. The campaign doubled the number of people aware of the telephone counselling service (13% to 25%), without having any impact on the proportion who mistakenly believed face-to face counselling was available.
As a measure of public opinion about Quit, respondents were asked how well they thought the people at Quit understood smokers' problems.
After the campaign there was a non-significant trend for more respondents who had contacted the campaign to feel that the people at Quit understood smokers' problems "very well". This was only associated with a decrease in the proportion who said "quite well", rather than a change in the proportion giving negative responses. The only real difference in the opinions of those who had or had not been in contact with Quit was that, quite understandably, more of those who had not been in touch with Quit did not have an opinion.
Respondents were also asked whether they thought the Quit Campaign was supportive of smokers who wanted to stop smoking. Most agreed that it was (78% before the campaign, 80% after the campaign). The majority of those who did not think it was supportive couldn't say (17% before and after), with very few saying it was not supportive.
Before being asked specific questions about Quit's 1993 advertising, respondents were asked some general questions about their responses and feelings about anti-smoking advertising in general. They were asked "Would you say anti-smoking advertising on television was sympathetic to smokers, or unsympathetic to smokers?". They were then asked the same question about anti-smoking advertising being "effective" or "ineffective", and finally whether it was "helpful to you" or "unhelpful to you". They responded on a five-point scale, "very sympathetic/effective/helpful" to "very unsympathetic/ineffective/unhelpful".
There was little change in smokers' views on anti-smoking advertising after the campaign. There was a slight trend for more respondents after the campaign to regard anti-smoking advertising as "helpful", with 33% saying it was "very" or "fairly" helpful before the campaign, compared with 39% saying this afterwards, but confidence intervals indicated this difference was not significant (95%CI of diff= -0.15 to 12.15; ns).
|Sympathetic||Effective||Helpful to you|
On the whole, smokers did not think advertising was sympathetic to them, with only about one in five finding it "very" or "fairly" sympathetic. Around half the smokers found the advertising "effective", but given the fact that they were still smoking, it clearly had not had a long-term effect on them personally. Finally, about a third of smokers found the advertising "helpful", though again their concept of "helpful" is uncertain, as they still smoked.
The following data were collected only as part of the post-campaign survey, as it relates only to awareness of, and reactions to, advertising.
Respondents were asked "At any time this year, have you read, seen or heard any anti-smoking advertising?", and 85% said that they had. The most commonly seen advertising was the Sponge advertisement, which 24% of respondents recalled having seen. Only 4% described the Services advertisement, but 19% said the main thing said or shown was "Call the Quit Line/Quit Campaign". "Smoking is bad for your health" was the main message reported by 13%.
There was a decrease in the proportion of people who said the message of the advertising related to specific health problems in 1993. Only 12 people mentioned lung problems compared with 50 in 1992, despite the use of the Sponge advertisement which stresses the lungs.
By far the most frequently reported place for seeing or hearing anti-smoking advertising was on television (73% of respondents). Newspapers were the second most frequent (29%), followed by magazines (17%), billboards (16%) and the radio (15%). No other source was mentioned by more than 10% of the respondents.
Of the people who had seen some form of anti-smoking advertising, 44% said they had not taken any action in response to it, and another 23% could not say if they had done anything. Of those who had tried to do something (n=139), cutting down was the most common action (27%), and trying to give up (18%) or actually giving up (12%) the next most popular. Ten per cent said they had rung Quit or the Quit Line, 10% said they had thought about quitting and unfortunately another 10% said they had done something negative, for example, "lit up another smoke".
Respondents were also asked "Apart from advertising about not smoking, in the last two weeks have you read any articles or seen any programs about smoking?". Only 20% of respondents said that they had, and it was apparent that some of them were actually referring to advertising. When asked what the articles or programs had said, few respondents gave an answer which could be tied to a specific article or program; in fact, the most common response was "smoking is bad for health". Ten respondents said they had seen something on nicotine patches, and six had seen a story discussing filter tips and tar levels.
In 1993, two television advertisements were produced, both on the theme "When you're ready, we're here". The first of these was a reworking of the Sponge advertisement, first shown in 1983. In the advertisement a sponge is wrung out into a beaker, to demonstrate the amount of "cancer-causing tar" a smoker puts into their lungs each year. In the 1993 version, the visuals are the same, but the voice-over talks about the number of Australians who have quit smoking since the advertisement was first shown.
In addition to Sponge - Ten years on, a series of advertisements featuring people talking about quitting smoking, and promoting Quit's services, were produced. A thirty-second version of the advertisement featured three people talking, and in addition, each person featured in an individual fifteen-second advertisement. In one advertisement, a young woman talks about never thinking that she would have the will-power to give up smoking until she rang Quit and found that having someone else to talk to about it was really helpful. In another, a man talks about having given up heaps of times before calling Quit and being given free brochures about Quit courses and learning about the phone-counselling service. In the other one, an older man talks about how he got hold of Quit's new video on how to give up over two weeks saying, "It makes sense, take it step by step".
At the same time as the Quit advertisements were screened, an advertisement produced by Ciba-Geigy was also being shown. This advertisement featured a man pacing in a sparsely furnished room giving the impression of being in a jail cell. Columns of cigarette smoke appear from the floor to form bars, trapping the man. The voice over says, "There is a way out. See your doctor or pharmacist". It was clear from responses to the survey that many people believed that this advertisement was produced by Quit.
Each of the Quit advertisements shown during the campaign period was described to respondents, and they were asked whether they had seen the advertisement. If they had, they were asked how thought-provoking, believable and relevant they had found it, and also whether it encouraged them to quit. Table 8 presents this data for each advertisement.
It is apparent from the data in Table 8 that awareness of Sponge - Ten years on was far higher than it was for Services, even allowing for a level of false recall which it generates every year, even when it has not been shown.
|Sponge - Ten years on||Services|
|% recalling advertisement||77%||34%|
Percentage of smokers who had seen the advertisement reporting it as 'very' or 'somewhat'...
|Relevant to you||73%||66%|
|Encouraged to quit||42%||35%|
Print advertisements were placed in the Sunday Age and Sunday Herald-Sun on the day of the campaign launch. Both advertisements promoted the Quit for Good book and the Quit for Good video with a coupon order form. On the next day (World No Tobacco Day, 31 May) the same advertisement was run in the Age and a flyer promoting the video was inserted in the Herald-Sun newspaper. The same advertisement was run again in the Herald-Sun on the Tuesday and in the Age on the Wednesday. On the Thursday of Quit Week a full-page advertisement in the Herald-Sun promoted Fresh Start courses. Full-page advertisements were also placed in Beat and In Press newspapers. Overall, 32% of respondents said they had seen newspaper advertising about the Quit Campaign or Quit Week in the past three weeks.
There were three radio advertisements for the campaign. The Quit Week radio advertisement promoted all the services offered by Quit and the new "13" number. There were also individual radio advertisements promoting the Quit for Good book and Fresh Start courses. Twenty-six per cent of respondents had heard the advertising.
The last question respondents were asked was whether the Quit Campaign had any effect on how they thought or felt about their smoking. Slightly more respondents said it had (52%) than said it had not (46%), and there was no difference in the proportion of smokers and recent quitters who said it had had an effect. Those who thought it had an effect were asked if it had made them more likely to quit, and the majority (81%) said that it had. No information was collected about the effect the campaign had on those who said it had not made them more likely to quit (13%) or who could not say if it had or not (6%).
One of the aims of this campaign was to increase the perception of Quit as an organisation which is sympathetic to smokers and which understands their needs. It is apparent that there has been little change in smokers' perceptions, but given the low level of awareness of the advertisements intended to change these views it is not surprising this has not changed. On the whole, smokers still do not perceive anti-smoking advertising as sympathetic, or personally helpful, although about half do believe it is effective.
Awareness of the Services advertisement was very low. This is the second time that 15-second advertising has been shown to generate little awareness (see Chapter 9). It may be that 15-second advertisements only work as backup for longer advertisements shown within the same commercial break, as many major advertisers are currently doing. Alternatively, brief advertisements may be effective if there is a very heavy media buy, and most television viewers are exposed to them multiple times. However, it seems that high awareness of such advertisements is difficult to achieve when they are scattered across programs. In this instance there was also a thirty-second version of the advertisement, but it still may have been poorly recalled because it was not shown often, and it was not attention-grabbing enough.
At the same time as the Quit Campaign was running, Ciba-Geigy also ran a campaign which rather obscurely promoted nicotine patches. It was apparent that most people attributed this advertisement to Quit, but we cannot be certain about what impact this may have had. The message of the advertisement was reasonably positive: "There is a way out", but the imagery had quite negative connotations, that is of being "caged" or "trapped" by smoking. We do not have any data on the proportion of people who were aware of this advertisement, or what they thought of it, but it is quite possible that it had some influence on the respondents.
It is important for Quit to acknowledge that there is a group of smokers who say that if they give up smoking they will do it by themselves rather than seek help or information from any source. This applies to about three-quarters of smokers. It is unlikely that these smokers would ever contact Quit, no matter what services or resources were offered. This does not mean that these smokers are not important targets for Quit, or that they will not ultimately be influenced by the campaign. They may still be reached via wide distribution of resources, such as through doctors' surgeries, which would ensure that resources are available to smokers who would never ask for them. This group may also be important targets of fact-based advertising campaigns, since they are unlikely to request health information.
Among those who did think they would get help or information, Quit was a commonly cited source, with only doctors being as popular. Among those who had already contacted Quit, some reported they were not satisfied with the help or information they received. Mostly commonly, this seemed to be associated with not getting enough assistance or with not being understood. The introduction of a dedicated counselling service, rather than having staff members deal with "quitter calls" while doing their other tasks, should have gone a long way to addressing that problem, although there are always likely to be people who are disappointed to find Quit does not have the "magic bullet" they want.
Borland R, Mullins, R. The increasing prevalence of workplace smoking bans in Victoria. Journal of Occupational Health And Safety - Australia New Zealand 1994; 10: 35-40.
Murphy M, Mullins R. Pre-testing of the Quit 1993 advertisement concepts. Centre for Behavioural Research in Cancer, 1993. Unpublished report.