Social Advertising and Tobacco Demand Reduction in Canada

This case was published in Social Marketing: Theoretical & Practical Perspectives, Eds. M.E. Goldberg, M. Fishbein, S.E. Middlestadt, Lawerence Erlbaum Associates, New Jersey, London, 1997.

James H. Mintz, Neville Layne, Rachel Ladouceur, Jane Hazel, Monique Desrosiers

Abstract

Since 1985, social marketing has been a major component of the Canadian government's efforts to reduce tobacco use. Social advertising has been the linchpin of Health Canada's antitobacco social marketing program. Together with legislative measures and antitobacco programming that targets vulnerable segments of the population, social marketing is part of a centrally coordinated and multipronged strategy to reduce tobacco demand in Canada. This chapter describes how research is used in the design, implementation, and evaluation of antitobacco advertising. It describes ad-concept focus testing, awareness monitoring, and impact assessment, as well as two segmentation frameworks that have helped to define the target audience for new messages and evaluate the impact of advertising in changing the attitudes and behaviors of the population.

Health Canada has been in the health promotion business for 17 years. In that time, much has been learned about what works and what does not. It is apparent that raising awareness of an issue and proposing changes in behavior is not enough to actually cause people to eat nutritiously, exercise, quit smoking, or stop driving while under the influence of alcohol. Changing behavior requires a step that bridges the gap between knowing something and actually acting on it. That step is "internalizing" the knowledge and it involves examining one's values and deciding what is important. The strategy used to walk people through that step is often referred to as social marketing, which is defined as "the design, implementation and control of programs that seek to increase the acceptability of a social idea or cause by a target group" (Kotler & Zaltman, 1971, pp. 3-12).

For Health Canada, social marketing is more than just social advertising. A mix of traditional marketing tactics that include event marketing and corporate sponsorship is used. Resources such as pamphlets on how to talk to your kids about drugs are developed, and various programs, including television programs aimed at particular target groups, are produced. Health Canada also initiates strategic partnerships with other levels of government, as well as nongovernment and private sector organizations, who have wide access to the target audience.

The Role of Research

Health Canada's social marketing campaigns are based on careful analysis of the existing situation and trends, followed by the establishment of clear goals and measurable objectives for the initiatives, and the conception, testing, and development of marketing tools. This approach puts social marketing in the same business as that of the purveyors of breakfast cereal, toothpaste, and cars. Social marketing is different from other types of marketing in that the product of social marketing is a social climate that is conducive to health promotion, disease prevention, and positive lifestyles. Also, unlike most other types of marketing motivated by profit, the motivation behind social marketing is to reduce the incidence of deaths, illness, and health care costs, and to improve quality of life for Canadians. However, many techniques and strategies used by social marketers are similar to those of other marketing professionals, and all of the tools used are based on much market research.

The focus here is on the research that has helped shape Health Canada's antitobacco advertising campaigns. Some of this research, such as the development of psychographic profiles, helps Health Canada make choices about partnerships, special events, and the development and dissemination of its programs. Other studies, such as monitoring levels of recall and tracking changes in behavior and attitudes, are designed specifically to evaluate the reach and impact of antitobacco ads.

History of Health Canada's Antitobacco Efforts

Since the 1960s, Canada has played an active role both in building the case against tobacco products and in developing policies and programs to combat the problem. In 1985, provincial and territorial health ministries and national health associations in Canada joined and launched a National Strategy to Reduce Tobacco Use, with the ambitious vision of producing a generation of nonsmokers by the year 2000.

By the 1980s, it was evident that the tobacco problem was so complex it needed to be attacked on many fronts. The National Strategy identified seven strategic directions to achieve its goals of tobacco use prevention, cessation, and public protection. These strategic directions were legislation, providing access to information, making available services and programs, supporting citizen action, coordinating public policy across government sectors, undertaking research, and message promotion.

As part of the "message promotion" component of the National Strategy, Health Canada launched in 1985 an antitobacco social marketing campaign, "Break Free," and its French counterpart, "Fumer, c'est fini!" The goal of this campaign was to promote the benefits of being smoke-free to young Canadians between the ages of 11 and 17.

"Break Free"

When the campaign was first conceived, Canadians had barely begun to question the social acceptability of smoking. Many young Canadians were growing up in an environment where smoking was rite of passage. Yet, research from other jurisdictions suggested that people who had not taken up the habit by age 19 were unlikely to ever start smoking. For this reason, and because of limited resources, the focus turned to prevention of tobacco use, with a primary target group of 11- to 13-year-olds.

From 1987 to 1993, the campaign used television, radio, bus and transit shelter posters, magazine ads, and targeted publications to promote the "Break Free" message. These efforts were supplemented by special promotions and information activities, such as poster and lyric-riting contests. The campaign featured popular entertainers and sports heroes as role models for the young people, and equated not smoking with such qualities as charisma, stardom, leadership, and having a positive self-concept.

Tracking

Independent tracking and analysis, in 1987-1988, measured the campaign's impact based on six indicators. These were primary impact indicators, consisting of levels of campaign awareness among the target audience, attitudes (Were people persuaded or influenced?), current use, and trends. Secondary impact indicators included behavioral intentions (Did they intend to smoke in the future?) and interpersonal communication (Did they talk with others about smoking?).

From the beginning, the levels of awareness of the social marketing campaign were strong. Aided recall of the new stream of "Break Free" ads, for example, grew from 69% in 1987 to 80% in 1989.

Table 13.1

Selected Reported Reactions of Youth 11 to 17 After Having Seen Antismoking Ads (Multiple Responses)

Note: Health Canada Campaign Tracking, October 1993, Creative Research International (Toronto).

% Nonsmokers	Total	English Canada	French Canada
	(1,374)	(1,014)	(360)
Helped in choice not to smoke	39	35	48
Made it easier not to start	19	15	23
Has had no influence	15	16	13
% Smokers	(290)	(196)	(99)
Made it easier to cut down	15	14	15
Made it easier to quit	4	5	2
Has had no influence	36	31	47

From 1993 to 1994, the last year of the antismoking campaign exclusively targeting Canadian youth, household interviews were conducted with about 2,000 youth (1,500 from English Canada and 500 from French Canada). Respondents were asked about reactions that were applicable to them after having been exposed to the ads.

For smokers, the ads were reportedly successful in helping 39% not to smoke and 19% not to start smoking. Among smokers, 15% reported the ads helped them cut down the amount they smoked, whereas 4% agreed the ads made it easier to quit (see Table 13.1).

Stronger effects were reported among nonsmoking youth in French Canada and smoking youth in English Canada. Smokers were also more than twice as likely as nonsmokers to feel the ads had no influence on them (36% of smokers versus 15% of nonsmokers; see Table 13.1).

Psychographics Research

Demographic classification is quite a blunt instrument when trying to get a better fix on target markets. A more precise tool was needed with which to measure who was and was not being reached by Health Canada's messages so that efforts could be focused more productively. In 1991, work began with a research group in Toronto that had developed psychographic profiles of young people from ages 11 to 17. The youth typology was developed from young people's responses to a 30-item questionnaire on their social activities and interests. Respondents were asked about their lifestyles and personal characteristics, including leisure activities, habits, attitudes, beliefs, opinions, hopes, fears, prejudices, needs, and desires (Creative Research Group Ltd., 1989-1992a, 1989-1992b, 1989-1992c).

From the survey data, seven character types were identified. These character types and their profile summaries are:

1. Big City Independents

• Independent of spirit; not easily influenced
• Self-focused
• Outgoing and gregarious, but not likely to commit to only one person; more of a loner than a team player; not a "flag waver" in terms of belief in national pride
• Relatively free of sexual discrimination; supporter of human rights
• New products, brands, fashion, hold little interest; personal appearance not important

2. Passive Luddites

• Homebody; family important; traditional family structure
• Universe is close to home
• More old-fashioned views on morality
• More tolerant of, if not involved in, substance use/ abuse
• Claims some degree of independence, but is concerned about how seen by others
• Not as ready as some to support the disadvantaged
• Lacks optimism; has lower level of ambition
• Jobs are an issue
• Not comfortable with technology

3. Quiet Conformers

• A strong work ethic
• Has a social conscience
• Tends to be more placid than others; a little shy
• More of a listener; will follow rather than lead
• Against smoking and other substance abuse

4. Concerned Moralists

• Very traditional - almost old fashioned - in attitudes toward family, sex roles, sexuality, etc.
• A team player, but more of a follower than a leader
• A little less optimistic than some and not comfortable with technology; however, looks to the future and has career ambitions
• A little quiet and shy
• Insecure and needs the support and approval of others
• Very conscious about how they look; interested in material things; fashion; quite brand conscious and looks to advertising for information

5. Small-town Traditionalists

• Traditional outlook - even old fashioned - on values, sex roles, sex, work ethic, family, religion
• Monogamous
• Has national pride; believes in government's role
• Ambitious; self-confident; tries new things
• Socially active but confined to traditional value system; has a social conscience for the less fortunate, but draws the line on certain issues such as abortion, drug use, AIDS, etc.
• (less tolerant in these areas)
• Antisubstance use/abuse - cigarettes, drugs

6. Tomorrow's Leaders

• Quite ambitious with strong leadership tendencies
• A participator; team person; gregarious; outgoing
• Not really traditional; embraces mores of today; nevertheless has at least some faith in "the system"
• The future is important; optimistic about that future
• Likes to be thought of as fashionable, up-to-date, modern; fitness is important
• Very antismoking

7. TGIF (Thank Goodness It's Friday)

• Concern is more for today than the future
• No particular work ethic; not ambitious; not disciplined
• Lacking in traditional values and without a strong social conscience; not quite a redneck, but pointed in that direction
• Culture of any sort is not a priority
• Not entirely self-sufficient; needs company of others, particularly the opposite sex
• Substance use/abuse is part of the TGIF lifestyle. This includes cigarettes, drugs, and alcohol.

The character types accounted for the percentages shown in Table 13.2 of the sample population.

Table 13.2

Psychographic Types: Percentages of Sample Canadian Population (Age 11-17)

Psychographic Type	% of Sample Population Age 11-17
Big City Independents	18%
Tomorrow's Leaders	15%
Passive Luddites	10%
Quiet Conformers	20%
Concerned Moralists	11%
Small Town Traditionalists	8%
TGIFs	18%

Among these character types, smoking behaviors are very different. Within these identified groups of young people ages 11-17 (see Table 13.2), the percentages of those who smoke at least on occasion is as follows: Big City Independents - 13%, Tomorrow's Leaders - 7%, Passive Luddites - 20%, Quiet Conformers - 6%, Concerned Moralists - 17%, Small Town Traditionalists - 1%, TGIFs - 49%.

The 1993 national average of smoking among youth was 17% (estimated 459,000 people), compared with 14% (360,000) in 1992 and 18% (466,000) in 1987.

The most striking result of this research was that one of the seven character types, the TGIF group, contained a dramatically higher proportion of smokers and other substance abusers than the target group as a whole. For instance, in 1993, the national average of daily smoking among youth was 17%. Among TGIFs it was a stunning 49%. These findings started new research that led to the development in 1993 of the Morphing Cigarette ad, an ad designed specifically for the TGIFers. This ad depicted an adolescent girl being transformed into a distorted, life-size cigarette as she shared a smoke in the schoolyard with her peers. In a moment of epiphany, she resumes her human form and throws away the cigarette.

The Tobacco Demand Reduction Strategy

The success of Health Canada's antitobacco efforts was being threatened on another front. The rising cost of tobacco products in Canada was being offset by a growing trade in contraband cigarettes from the United States. As a result, in February 1994, the federal and some provincial governments dramatically cut tobacco excise taxes.

The tax cuts alleviated the smuggling problem. At the same time, a strong new imperative was created to mitigate the increase in tobacco consumption that the tax cuts might cause. Therefore, the government earmarked $185 million for a comprehensive, 3-year Tobacco Demand Reduction Strategy (TDRS), financed by a surtax on tobacco manufacturers. TDRS was designed to minimize the impact of the tax reduction on tobacco consumption in Canada and buttress efforts to marginalized tobacco usage across society.

Cuts to the 1995-1996 federal budget reduced the overall budget for the Tobacco Strategy, but all of its original components have survived. The TDRSs objectives are to minimize the increase in tobacco consumption expected in those groups most likely to succumb to the opportunity presented by lower prices of tobacco, increase the priority of tobacco control as a public health measure, increase public knowledge of the dangers associated with tobacco product use, and enhance public awareness of the health risks associated with environmental tobacco smoke. To meet its objectives, the new strategy provides for programming in research, legislation, programs, and message promotion.

In the area of legislation, the federal government in 1994 proclaimed the Tobacco Sales to Young Persons Act, raising the legal age for buying tobacco from 16 to 18 and increasing the penalties to retailers for noncompliance. The government also stepped up enforcement of regulations under the Tobacco Products Control Act, which bans tobacco advertising and mandates health messages on tobacco products.

To improve access to information, the government increased its funding to the National Clearinghouse on Tobacco and Health, a national information and referral center that also serves as a resource base to support citizen action and community initiatives.

New programs and services are being developed for specific target groups, including women, youth, immigrants, aboriginals, low-income groups, high risk-takers, and groups with low education levels and literacy skills.

Besides programs at the national level , the strategy also provides funding for community-based tobacco programming and activities, both for the general population and for priority target groups.

The new tobacco control strategy targets a much wider audience than previous strategies. Consequently, Health Canada's social marketing initiatives must consist of messages that target not only teens and preteens, but also adults - both smokers and nonsmokers - particularly caregivers, young families, opinion leaders, and influencers of children and youth.

The significant declines in Canada's tobacco market since 1986 had not been uniform across the population. The data showed tobacco control measures had better results with smokers who were less addicted to tobacco, more averse to taking risks, or more amenable to quitting. Tobacco use in Canada was higher among aboriginals, youth with low literacy skills, adults of lower socioeconomic status, and some immigrant groups. Theses groups, along with pregnant women, therefore became secondary targets of Health Canada's newest antitobacco social marketing campaign.

Campaign Objectives

The campaign objectives are to move the issue of tobacco use from a personal choice to a public health issue, to increase pro-health choices over smoking through greater respect for nonsmokers' health and recognition of the toxic nature of tobacco products, to build and strengthen negative images of tobacco, and to increase awareness about the issue of tobacco access by minors.

Due to the strong performance of Health Canada's antitobacco media campaigns dating back to 1985, and the positive evaluations of similar campaigns in other jurisdictions, it was decided that antitobacco advertising should again form the centerpiece of the social marketing strategy.

This time, however, a different approach in advertising was necessary because attitudes toward smoking had changed significantly since the 1980s. A decade of antitobacco legislation and social marketing had transformed Canada from a society where smoking was passively accepted by nonsmokers, to a much more polarized society that pitted nonsmoker's rights against the profit motives of the tobacco industry and against the claims of smokers that tobacco use is an issue of personal choice. Antitobacco messages designed for earlier campaigns had had a positive spin. They linked nonsmoking with high self-esteem and avoided shaming tobacco users. Now that public opinion had taken a more belligerent turn, it was time to use a much more hard-hitting array of messages.

For example, research showed that 65% of respondents who said they had quit smoking in the year preceding the Health Promotion Survey of 1990 most frequently cited increased knowledge of health risks as their reason for quitting. In the Health Promotion Survey of 1990, 625 of Canadians 15 and over reported they felt adverse effects from tobacco smoke. Most Canadian smokers (81%) now believe that stopping smoking will help improve their health and well-being.

This research indicated the tone of the messages needed to be serious and adult oriented, and focus on the public health and social consequences of smoking.

The New Ad Campaign

First, 16 television ad concepts were developed in four genres. Later the selection was narrowed to 13 ads of which 5 were antitobacco industry ads, 3 were health effects ads, 4 were secondhand smoke ads, and 1 was an ad that vilified retailers who sold tobacco to minors.

Instead of producing all 13, animated versions of the concepts were created and focus tested in July 1994 in 45-minute interviews with 300 randomly chosen representatives from 10 target groups.

More ads were tested in the antitobacco industry genre than in any of the others. This reflected the initial thought that a "hard-hitting" approach should focus on the tobacco industry. However, field results showed conclusively that the ads in the antitobacco industry genre were not a big hit and were soundly outperformed by the secondhand smoke and health effects ads.

All the ads were evaluated based on scores obtained from the 300 respondents responding to five criteria. These were:

Fit - Did the elements of the ad hang together?
Appeal - Did the ad make smoking much less/ a little less appealing?
Credence - Was the ad's main point believable?
Enjoyableness - Did respondents enjoy watching the ad?
Thrust - Did the ad have a powerful message about smoking:
Smoking Feelings -
(a) Smokers - did the ad make the respondent much more or more likely to quite smoking?
(b) Nonsmokers - did the ad make the respondent much less or less likely to take up smoking?

Ads in the health effects genre scored higher than any other genre in the categories of appeal, thrust, and smoking feelings. Those in the secondhand smoke genre scored most highly in the categories of fit and enjoyableness. The ad in the retail genre scored highest in the category of credence (see Table 13.3).

Meanwhile, the five ads in the antiindustry genre scored well below average in thrust and enjoyableness, and underperformed the other genres in the critical area of changing feelings about smoking (see Table 13.3).

Results showed there was much disparity in receptiveness to the antiindustry ads, with more negative than positive scores. There was some limited positive support from male youth and susceptible nonsmokers, but responses from adult males, French Canada, opinion leaders, and emphatic smokers were negative.

The secondhand smoke genre garnered both a high average score and positive scores in all five criteria. Target groups in support of this genre were youth of both sexes, French Canadians, as well as emphatic and susceptible nonsmokers. Only emphatic smokers rated the ads negatively, and only in the appeal category.

Table 13.3

Reported Scores from Test Responses to Different Genres of Antitobacco Ads

"Facets" Responses	Fit	Appeal	Credence	Enjoyableness	Thrust	Smoking Feelings
Total	76	67	57	45	73	31
Average of antitobacco industry (ATI) ads	68	59	47	38	61	23
Average of secondhand smoke ads	81	76	62	56	83	38
Average of health effects ads	80	79	61	43	84	41
Retail ad	80	54	73	40	67	80
Average of non-ATI ads	80	74	63	50	81	37
Average of Health Canada campaign ads	82	85	69	55	89	47

The health effects ads received as many positive responses as did the secondhand smoke ads, and from similar target groups. Health effects ads also won support from adult females.

In the end, the three leading advertisements in the secondhand smoke and health effects genres were selected. The launch of these ads was accompanied by the placement of three print ads in Canadian newspapers in January 1995.

Monitoring Study

To measure the campaign's impact on awareness levels of the major target groups, a monitoring study consisting of two surveys was devised - a Benchmark Monitoring Wave in December 1994, immediately preceding the campaign's major media launch in January 1995, and a Post Implementation Wave in February and March 1995.

Both waves used random selection to obtain a nationally representative sample of 1,300 youth and adult respondents. Teens and French Canadians were oversampled to ensure statistically acceptable sample sizes. Data was gathered through telephone interviews.

Results from the postimplementation wave indicate that 89% of Canadians age 11 and over recalled, with prompting, the new campaign's television ads. Without prompting, the rate of recall for Health Canada's new campaign ads was 38%, compared to 20% in the Benchmark wave measuring unprompted recall of Health Canada ads from previous campaigns. Among adults, the increase in recall between the two waves doubled, from 19% to 38%. Among youth, it increased from 29% to 37% (Tandemar study; see Table 13.4).

Table 13.4

Rates of Recall of Health Canada's Ads

* Recognition of new Health Canada ads
** Recognition of Health Canada ads from previous campaigns

	Benchmark Wave	Postimplementation Wave
	Without** Prompting	With* Prompting	Without Prompting
Total	20	89	38*
			49**
Adults	19	88	38*
			48**
Youth	29	96	37*
			61**

Both French and English Canada so exceeded the industry norm as to place the campaign in the top 10% of ads tracked.

Continuum Model

As earlier tracking studies, data will continue to be collected on smoking behavior, attitudes, and trends. However, one significant change is the adoption of a classification system, developed from studies in California, that rejects the classification of respondents as either smokers or nonsmokers, replacing it with a six-part continuum, ranging from the most committed smokers to the most emphatic nonsmokers. Changes in attitudes, beliefs, and behavior in each of the six segments of the population will be measured.

This classification system (see Table 13.5) has already proven useful in ensuring hat the creative concepts chosen for the media campaign were well received by susceptible nonsmokers - those most at risk in joining the ranks of the smoking population.

Another advantage of the susceptibility analysis is that it allows researchers to project what the future profile of the population could look like in the absence of tobacco control measures.

Finally, by adding such categories as "susceptible smokers" and "quitters" to the analysis, it will be easier to evaluate how respondents' reported beliefs, attitudes, and behavioral intentions are reflected in their subsequent behaviors.

Although the monitoring study has shown the new ads are highly memorable, the results of a tracking study indicated the ads were having an effect on attitudes and behaviors of the population.

For example, the 1994-1995 tracking study showed that 67% strongly agreed with the idea that the ads successfully brought out the issue of the harmfulness of tobacco; 61% strongly agreed that the ads clearly got across the need to respect the health of nonsmokers; 85% agreed strongly that the ads made them stop and think about the harmful effects of smoking cigarettes around children and infants; 47% felt the ads had changed their own smoking behavior, and 59% felt the ads had some influence on other people's smoking behavior; and 35% had a discussion about smoking because of the ads.

Table 13.5

Prevalence of Smoking Among Canadian Youth 11-17, Smoking Continuum

Note: Research Review Report, March 1995 (p.3), Sage Research Corporation, Toronto.

	Total	11-13	14-17
Regular smokers who intend to continue	9	3	13
Regular smokers who intent to quit	3	1	5
Occasional smokers	5	3	7
Susceptible nonsmokers	16	20	13
Quitters	8	5	10
Emphatic nonsmokers	57	66	50

Conclusions

This chapter has outlined the major research tools that have helped to shape Health Canada's antitobacco advertising campaigns during the last decade. As new research methodologies evolve, there will be better methods of influencing public behavior and evaluating advertisers' effectiveness in bringing about positive changes in tobacco use attitudes and behaviors.

References

• Kotler, P., & Zaltman, G. (1971). Social marketing: An approach to planned social change. Journal of Marketing, 35, 3-12.
• The Creative Research Group Ltd. (1989-1992a). Activity and interests questionnaire. Ontario: Author.
• The Creative Research Group Ltd. (1989-1992b). Campaign tracking: Author.
• The Creative Research Group Ltd. (1989-1992c). Youth target. Ontario: Author.