Impact of Tobacco Control Interventions on Smoking Initiation, Cessation, and Prevalence: A Systematic Review

Table 7

Effects of antitobacco mass media campaigns on smoking initiation, cessation, and prevalence.

Author, year	Country; (Data source)	Study design	Dates of data collection	Population	Intervention, n	Smoking measure	Effect on smoking initiation, cessation or prevalence
Smoking initiation
Bauman et al., 1991 [145]	US (original data)	Cluster RCT	1985–1987	Youths, ages 12–14	(I) 8 30-second radio messages focused on 7 expected consequences of smoking broadcasted over 3 1-month periods; (C) no mass media campaign*, 951 total nonsmokers at baseline	Ever puffed a cigarette	Among nonsmokers at baseline, differences relative to comparison group at 11–17 months after broadcasts ended; (i) Smoking experimentation: 1% (P = NS); (ii) Regular smoking: 2% (P = NS); (iii) Recent smoking: 1% (P = NS)
Farrelly et al., 2009 [75]	US (NLSY97)	Longitudinal study	1997–2004	Youths, ages 12–17	(I) TV campaign with cumulative exposure between 2000–2004 of 3096–32137 GRPs across 210 media markets, 8904	Ever smoked a cigarette	HR = 0.8 (95% CI: 0.71–0.91; 𝑃=0.001) (per 10,000 GRP cumulative exposure)
Linkenbach and Perkins, 2003 [72]	US (original data)	Longitudinal study	2000–2001	Youths, junior and senior high school students; mean age = 14.6; 50% male	(I) 1500 GRPs (broadcast TV); 78,000 print and promotional items distributed in schools; 4 theater slides were run over 1 month at 2 movie theaters; 1 billboard design appeared in 4 locations for 1 month, 299; (C) control, 314	Having tried cigarette smoking	12-month follow-up smoking prevalence: (I) 10%; (C) 17%; Relative measure: 41% lower rate of initiation in intervention group (𝑃<0.05)
Flynn et al., 1997 [73]	US (original data)	Longitudinal study	1985–1991	Youths, grades 4–6	(I) 540 TV and 350 radio broadcasts per year for 4 years plus school intervention; (C) school intervention	Smoked >0 cigarettes in past week	4-year follow-up smoking prevalence: (I) 7.5%; (C) 13.0%; 6-year followup smoking prevalence: (I) 15.9%; (C) 20.2%; OR = 0.73
Hafstad et al., 1997 [74]	Norway (original data)	Longitudinal study	1992–1995	Youths, ages 14-15	(I) 3 annual campaigns of 1 TV and cinema ad 167 times, 3 full-page ads in 5 newspapers, 1 poster in each location run for 3 weeks; (C) control county	Weekly smoking	Males; 1-year initiation rate; (I) 10.2%; (C) 14.5%; OR=0.67 (95% CI: 0.53; 0.85); Females; 1-year initiation rate; (I) 14.6%; (C) 25.6%; OR=0.77 (95% CI: 0.63; 0.95)
Smoking cessation
Solomon et al., 2009 [80]	US (original data)	Cluster RCT	2001–2004	Youths, grades 7–10; 45% male	(I) radio and TV campaign with 380 GRPs/week over 9 months each year for 3 years, 531; (C) no intervention, 601	Not smoking one cigarette in past 30 days	12-month quit rate; (I) 18.1%; (C) 14.8%; 24-month quit rate; (I) 14.5%; (C) 12.6%; 36-month quit rate; (I) 16.0%; (C) 12.8%; Relative measure: no significant time trend or interaction between condition and time
Terry-McElrath et al., 2011 [81]	US (MTF)	Longitudinal	2001–2008	Adults, age 20–30	24-month sum of antitobacco TV advertising measured in GRPs, 7997	Smoked 0 cigarettes/day in past 30 days	<52 GRPS (ref); 52–103 GRPs; aOR: 1.15 (95% CI: 0.91; 1.45); 104–155 GRPs; aOR: 1.40 (95% CI: 1.07; 1.83); 156–207 GRPs; aOR: 1.21 (95% CI: 0.90; 1.63); 208+ GRPs; aOR: 1.22 (95% CI: 0.90; 1.66)
Burns and Levinson, 2010 [82]	US (original data collection)	Longitudinal	2007	Adults, age 18+; 41–50% male	(I) Spanish-language TV campaign with 1387.4 GRPs for 1 month, radio ads, and 1900 30-second spots on movie screens, 117; (C) non-Spanish speaking population, 193	6-month abstinence	Quit rate prior to campaign; (I) 9.6%; (C) 16.5%; Quit rate post campaign; (I) 18.8%; 𝑃<0.05; (C) 8.8%; 𝑃=0.01
Durkin et al., 2009 [146]	US (UMass Tobacco Study)	Longitudinal	2001–2004	Adults; mean age = 41; 45% male	24-month GRPs	1-month abstinence	Quit rate, 16%
Hyland et al., 2006 [147]	US (COMMIT)	Longitudinal study	1988–2001	Adults, ages 24–64	(I) TV campaign above 1218 GRPs in 1999-2000; (C) TV campaign below 1218 GRPs in 1999-2000	NR	24-month quit rate; (I) 12.9%; (C) 11.0%; RR = 1.1 (95% CI: 0.98–1.24) (per increase in 5000 GRPs of exposure)
Ronda et al., 2004 [76]	Netherlands (original data)	Longitudinal study	1998–2001	Adults, ages 18+; 39–47% male; Mean age: 46–50 years	(I) Billboard, print, radio, TV, posters and postcards in waiting rooms and public buildings; 4 months spread over 2 years^†	Not having smoking any tobacco in last 7 days	24-month quit rate; (I) 12.3%; (C) 14.3%; 36-month quit rate; (I) 18.7%; (C) 18.6%; relative measure: no association between intervention and smoking outcome in regression models (not reported)
McVey and Stapleton, 2000 [148]	England (original data)	Longitudinal study	1992–1994	Adults, ages 16+; 41-42% male; Mean age: 46 years	(I) 18-month TV campaign, 1744; (C) no intervention, 719	No smoking at all nowadays	18-month quit rate; (I) 9.7%; (C) 8.7%; OR = 1.27 (95% CI: 0.77–2.08; 𝑃=0.35)
Hafstad et al., 1997 [74]	Norway (original data)	Longitudinal study	1992–1995	Youths, ages 14-15	(I) 3 annual campaigns of 1 TV and cinema ad 167 times, 3 full-page ads in 5 newspapers, 1 poster in each location run for 3 weeks, 1061; (C) control county, 1288	Weekly smoking	Males; 1-year quit rate; (I) 12.7%; (C) 19.1%; OR=0.63; Females; 1-year quit rate; (I) 25.6%; (C) 17.6%; OR=1.9
Smoking prevalence
Flynn et al., 2010 [83]	US (original data collection)	Cluster RCT	2001–2005	Youths, grades 7–12,; 46% male	(I) 380 GRPs from TV ads per week, 215 GRPs from radio ads, 10,412; (C) no intervention, 9544	Smoking in past 30 days	Baseline smoking prevalence; (I) 18.9%; (C) 17.8%; Smoking intervention at 4 year followup; (I) 16.9%; (C) 15.5%; 𝑃=0.95
Wakefield et al., 2008 [27]	Australia (Roy Morgan Single Source)	Time series	1995–2006	Adults, age 18+	138-month TV campaign, 288.5 mean monthly GRPs, 343,835	Smoke factory-made cigarettes	Prevalence percentage point change two months later (i.e., 2 month lag) per 1 GRP per month increase:−0.00077 (95% CI: −0.00144, −0.0001; 𝑃=0.025)
Hafstad et al., 1997 [74]	Norway (original data)	Longitudinal study	1992–1995	Youths, ages 14-15	(I) 3 annual campaigns of 1 TV and cinema ad 167 times, 3 full-page ads in 5 newspapers, 1 poster in each location run for 3 weeks, 2742; (C) control county, 3438	Weekly smoking	OR = 0.74 (95% CI: 0.64; 0.86); Males; Baseline prevalence; (I) 6.9%; (C) 9.9%; 1-year prevalence; (I) 13.7%; (C) 20.4%; Females; Baseline prevalence; (I) 10.1%; (C) 11.4%; 1-year prevalence; (I) 18.7%; (C) 23.8%
Flynn et al., 1995 [149]; Worden et al., 1996 [150]; Flynn et al., 1992 [151]; Flynn et al., 1994 [152]; Worden and Flynn, 2002 [153]; Flynn et al., 1997 [73]	US (original data)	Longitudinal study	1985–1991	Youths, grades 4–6; mean age: 10.6 years,; 48–54% male	(I) 540 TV and 350 radio broadcasts per year for 4 years plus school intervention; (C) school intervention	Smoked >0 cigarettes in past week	Baseline prevalence; (I) 1%; (C) 1.6%; 6-year prevalence; (I) 16.5%; (C) 24%; OR = 0.62 (95% CI: 0.49; 0.78); Females; 4-year prevalence; (I) 12.7%; 𝑃<0.01; (C) 21.1%; 6-year prevalence; (I) 16.5%; (C) 29.4%; 𝑃<0.01; Males; 4-year prevalence; (I) 9.8%;, 𝑃=0.16; (C) 14.4%; 6-year prevalence; (I) 13.0%; (C) 17.1%; 𝑃=0.23
Steenkamp et al., 1991 [77]	South Africa (original data)	Longitudinal study	1979–1983	Adults, ages 15–64; 46% male	(I) 48-month billboard, print, poster, and mailing campaign^‡, 1531; (C) control, 1308	Smoking an average of at least 1 cigarette or 1 gram of tobacco per day	Baseline prevalence; (I) 28.1%; (C) 29.5%; 4-year prevalence; (I) 18.8%; (C) 19.9%; percentage Reduction; (I) −32.6%; (C) −33.3%; Net percentage change in smoking prevalence relative to control; Males: 2.0%; Females: −19.2%
Meshack et al., 2004 [154]	US (original data)	Before/after with comparison	Spring 2000–December 2000	Youths, grade 6; 52% male	(I) 3×3 media and community program; media programs involved TV, radio, billboard, and print; $0.50 per capita in low-intensity group; $1.00 per capita in high-intensity group, 3618	Tobacco use in past 30 days	Percent change in prevalence at 8.5 months (among groups with no community program): High intensity: −20.8%; Low intensity: −45.3%; Comparison: −28.3%
Sly et al., 2001 [79]	US (original data)	Before/after with comparison	1998-1999	Youths, ages 12–17	(I) 12-month campaign with TV, radio, billboard, display ads, promotional items (stickers, lanyards, hats, t-shirts, etc.), 1600 GRPs per quarter, 1800; (C) control, 1000	At least a puff or two in the past 30 days	Baseline prevalence; (I) 13.8%; (C) 12.6%; 12-month prevalence; (I) 12.6%; (C) 14.1%; Percentage change; (I) −8.9%; (C) 11.9%; 𝑃<0.05%
Farrelly et al., 2005 [78]	US (MTF)	Before/after w/o comparison	1997–2002	Youths, grades 8, 10, and 12	(I) 24-month TV campaign with 3867–20367 GRPs (cumulative exposure over 2-year period for the lowest and highest quintiles of exposure)	Any smoking in past 30 days	Percentage annual change in prevalence at 0–2 years prior to intervention: Total: −3.2% (−3.8, −2.6); 8th: −3.4% (−4.6, −2.1); 10th: −4.6% (−5.6, −3.6); 12th: −1.8% (−2.7, −1.0); Percentage annual change in prevalence at 0–2 years after intervention: Total: −6.8% (−7.5, −6.1); 8th: −9.0% (−10.4, −7.6); 10th: −8.7% (−9.8, −7.5); 12th: −5.1% (−6.1, −3.9)

*Additionally, there were 2 other intervention groups that included sweepstakes. Since sweepstakes are not a focus of this paper, they are not included here.
^†This was part of a cardiovascular disease prevention campaign.
^‡This was part of a coronary risk factor campaign.
C: control group; CI: confidence interval; COMMIT: Community Intervention Trial for Smoking Cessation; GRPs: gross rating points; HR: hazard ratio; I: intervention group; MTF: Monitoring the Future: a Continuing Study of American Youth; NLSY97: National Longitudinal Survey of Youth 1997; NR: not reported; NS: not significant; OR: odds ratio; RCT: randomized controlled trial; RR: relative risk; TV: television; US: United States.