Can anti-smoking television advertising affect smoking behaviour? Controlled trial of the Health Education Authority for England's anti-smelting TV campaign

Objectives-To evaluate the effectiveness of the Health Education Authority for England's anti-smoking television advertising campaign in motivating sm okers to give up and preventing relapse in those who had already given up. Design-A prospective, controlled trial was conducted in four TV regions in central and northern England. One region received no intervention (controls ), two regions received TV anti-smoking advertising (TV media), and one reg ion received TV anti-smoking advertising plus locally organised anti-tobacc o campaigning (TV media + LTCN). The TV advertisements were screened in two phases over 18 months; during the first phase the intensity of the adverti sing was varied between TV regions. 5468 men and women (2997 smokers, 2471 ex-smokers) were selected by two stage random sampling and interviewed befo re the intervention, of whom 3610 were reinterviewed six months later, afte r the first phase of the campaign. Only those interviewed at six months wer e followed to the main end point at 18 months when 2381 subjects were re-in terviewed. Main outcome measures-Self reports of cigarette smoking at the 18 month fol low up were compared between the three levels of intervention. Odds ratios for intervention effects were adjusted for preintervention predictors of ou tcome and pooled for smokers and ex-smokers using meta-analytic methods. Results-After 18 months, 9.8% of successfully re-interviewed smokers had st opped and 4.3% of ex-smokers had relapsed. The pooled adjusted odds ratio f or not smoking in the TV media only condition compared to controls was 1.53 (95% confidence intervals (CI) 1.02 to 2.29, p = 0.04), and for TV media LTCN versus controls, 1.67 (95% CI 1.0 to 2.8, p = 0.05). There was no evi dence of an extra effect of the local tobacco control network when combined with TV media (odds ratio 1.15, 95% CI 0.74 to 1.78, p = 0.55). The was al so no evidence of any intervention effects after the first phase of the TV media campaign, including no effect of varying the intensity of the adverti sing during this initial phase. Applying these results to a typical populat ion where 28% smoke and 28% are ex-smokers, and where there would be an equ al number of quitters and relapsers over an 18 month period without the cam paign, suggests that the campaign would reduce smoking prevalence by about 1.2%. Conclusions-The Health Education Authority for England's anti-smoking TV ca mpaign was effective in reducing smoking prevalence through encouraging smo kers to stop and helping prevent relapse in those who had already stopped. The lack of an effect after the first phase of the campaign indicates that if advertising at this intensity is to have an impact, a prolonged campaign is necessary. These results support the UK governments' recent decision to fund similar campaigns, and suggests that anti-smoking TV advertising shou ld be undertaken routinely as an essential component of any population smok ing reduction strategy, Reducing smoking prevalence would make a substantia l contribution to achieving the UK government's target of preventing 300 00 0 cancer and heart disease deaths over the next 10 years.