Tobacco Use: Mass-Reach Health Communication Interventions

The CPSTF 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 CPSTF 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 CPSTF findings on mass media campaigns used to increase cessation and reduce initiation.

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement

The CPSTF 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)

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement

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.

Based on results for different settings and populations, findings are applicable to the following:

• U.S. and non-U.S. settings
• National, state or regional, city and local levels
• Adults and young people
• Males and females
• Population groups with high prevalence of tobacco use or limited access to cessation services, including Arabic speaking, Latino, Spanish speaking, or Maori tobacco users
• Population groups with different SES, educational attainment, or race/ethnicity

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

Many studies from the updated search period evaluated the impact of specific intervention characteristics, but several questions remain for future research.

• What are thresholds of effectiveness for intervention intensity, duration of intervention, message placements, and frequency of new message introduction to maintain audience engagement and lead to behavior change?
• What are costs associated with different intervention components?
• Given that current evidence is dominated by interventions that used television as the only or primary media channel, how will changing media consumption habits affect intervention effectiveness?
• How effective are interventions that use newer content delivery formats and media channels, especially digital media?
• How effective are these types of interventions at reducing use of tobacco products other than cigarettes, for example cigars, cigarillos, and smokeless tobacco products?

• Included studies assessed mass-reach health communication interventions in the United States (44 studies), Australia (13 studies), Canada (2 studies), Israel (1 study), New Zealand (2 studies), Switzerland (1 study), Taiwan (1 study), the Netherlands (3 studies), and the United Kingdom (3 studies).
• Most of the studies evaluated these interventions at the state or regional level (42 studies) with the remaining studies at the national (23 studies) and city or local (5 studies) level.
• Interventions were implemented alone (17 studies), with other components (21 studies), or as part of a comprehensive tobacco control program (27 studies). Eight studies did not report on this characteristic.
• Interventions were implemented with adults (49 studies) or young people (21 studies) as the main audience.

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Economic Review

No content is available for this section.

Effectiveness Review

Summary Evidence Table — Effectiveness Review

Economic Review

Summary Evidence Tables Economic Review

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Studies from the Updated Search (search period January 2000-July 2012)

Bauer JE, Carlin-Menter SM, Celestino PB, Hyland A, Cummings KM. Giving away free nicotine medications and a cigarette substitute (Better Quit) to promote calls to a quitline. Journal of Public Health Management and Practice 2006;12(1):60-7.

Biener L, Reimer RL, Wakefield M, Szczypka G, Rigotti NA, Connolly G. Impact of smoking cessation aids and mass media among recent quitters. American Journal of Preventive Medicine 2006;30(3):217-24.

Borland R, Balmford J. Understanding how mass media campaigns impact on smokers. Tobacco Control 2003;12 Suppl 2:ii45-52.

Bui QM, Huggins RM, Hwang W-H, White V, Erbas B. A Varying Coefficient Model to Measure the Effectiveness of Mass Media Anti-Smoking Campaigns in Generating Calls to a Quitline. Journal of Epidemiology 2010;20(6):473-9.

Burns EK, Levinson AH. Reaching Spanish-speaking smokers: state-level evidence of untapped potential for QuitLine utilization. American Journal of Public Health 2010;100 Suppl 1:S165-710.

Campbell SL, Lee L, Haugland C, Helgerson SD, Harwell TS. Tobacco quitline use: enhancing benefit and increasing abstinence. American Journal of Preventive Medicine 2008;35(4):386-8.

Carroll T, Rock B. Generating Quitline calls during Australia’s National Tobacco Campaign: effects of television advertisement execution and programme placement. Tobacco Control 2003;12(suppl 2):ii40-4.

CDC. Increases in quitline calls and smoking cessation website visitors during a national tobacco education campaign – March 19-June 10, 2012. MMWR 2012;61:667-70.

Chang FC, Chung CH, Chuang YC, Hu TW, Yu PT, Chao KY, et al. Effect of media campaigns and smoke-free ordinance on public awareness and secondhand smoke exposure in Taiwan. Journal of Health Communication 2011;16(4):343-358.

Cotter T, Perez DA, Dessaix AL, Bishop JF. Smokers respond to anti-tobacco mass media campaigns in NSW by calling the Quitline. New South Wales Public Health Bulletin 2008;19(3-4):68-71.

Davis KC, Farrelly MC, Messeri P, Duke J. The impact of national smoking prevention campaigns on tobacco-related beliefs, intentions to smoke and smoking initiation: results from a longitudinal survey of youth in the United States. International Journal of Environmental Research and Public Health 2009;6(2):722-40.

De Gruchy J, Coppel D. “Listening to Reason”: a social marketing stop-smoking campaign in Nottingham. Social Marketing Quarterly 2008;14(1):5-17.

Dietz N, Westphal L, Arheart K, Lee D, Huang Y, Sly D, et al. Changes in youth cigarette use following the dismantling of an antitobacco media campaign in Florida. Preventing Chronic Disease 2010;7(3):A65.

Durkin SJ, Biener L, Wakefield MA. Effects of different types of antismoking ads on reducing disparities in smoking cessation among socioeconomic subgroups. American Journal of Public Health 2009;99(12):2217-23.

Durkin SJ, Wakefield MA, Spittal MJ. Which types of televised anti-tobacco campaigns prompt more quitline calls from disadvantaged groups? Health Education Research 2011;26(6):998-1009.

Emery S, Kim Y, Choi YK, Szczypka G, Wakefield M, Chaloupka FJ. The effects of smoking-related television advertising on smoking and intentions to quit among adults in the United States: 1999-2007. American Journal of Public Health 2012;102(4):751-7.

Etter JF, Laszlo E. Evaluation of a poster campaign against passive smoking for World No-Tobacco Day. Patient Education and Counseling 2005;57(2):190-8.

Evans DW, Price S, Blahut S, Hersey J, Niederdeppe J, Ray S. Social imagery, tobacco independence, and the Truth Campaign. Journal of Health Communication 2004;9(5):425-41.

Evans WD, Crankshaw E, Nimsch C, Morgan-Lopez A, Farrelly MC, Allen J. Media and secondhand smoke exposure: results from a national survey. American Journal of Health Behavior 2006;30(1):62-71.

Evans WD, Renaud J, Blitstein J, Hersey J, Ray S, Schieber B, et al. Prevention effects of an anti-tobacco brand on adolescent smoking initiation. Social Marketing Quarterly 2007;13(2):2-20.

Farrelly MC, Davis KC, Haviland ML, Messeri P, Healton CG. Evidence of a dose-response relationship between “truth” antismoking ads and youth smoking prevalence. American Journal of Public Health 2005;95(3):425-31.

Farrelly MC, Hussin A, Bauer UE. Effectiveness and cost effectiveness of television, radio and print advertisements in promoting the New York smokers’ quitline. Tobacco Control 2007;16 Suppl 1:i21-3.

Farrelly MC, Nonnemaker J, Davis KC, Hussin A. The influence of the national truth campaign on smoking initiation. American Journal of Preventive Medicine 2009;36(5):379-84.

Farrelly MC, Davis KC, Nonnemaker JM, Kamyab K, Jackson C. Promoting calls to a quitline: quantifying the influence of message theme, strong negative emotions and graphic images in television advertisements. Tobacco Control 2011;20(4):279-84.

Fellows JL, Bush T, McAfee T, Dickerson J. Cost effectiveness of the Oregon quitline “free patch initiative”. Tobacco Control 2007;16 Suppl 1:i47-52.

Flynn BS, Worden JK, Bunn JY, Solomon LJ, Ashikaga T, Connolly SW, et al. Mass media interventions to reduce youth smoking prevalence. American Journal of Preventive Medicine 2010;39(1):53-62.

Gagne L. The 2005 British Columbia Smoking Cessation Mass Media Campaign and short-term changes in smoking. Journal of Public Health Management and Practice 2007;13(3):296-306.

Haviland L, Thornton AH, Carothers S, Hund L, Allen JA, Kastens B, et al. Giving infants a great start: launching a national smoking cessation program for pregnant women. Nicotine and Tobacco Research 2004;6 Suppl 2:S181-8.

Hersey JC, Niederdeppe J, Evans WD, Nonnemaker J, Blahut S, Farrelly MC, et al. The effects of state counterindustry media campaigns on beliefs, attitudes, and smoking status among teens and young adults. Preventive Medicine 2003;37(6 Pt 1):544-52.

Hersey JC, Niederdeppe J, Evans WD, Nonnemaker J, Blahut S, Holden D, et al. The Theory of “truth”: how counter-industry campaigns affect smoking behavior among teens. Health Psychology 2005a;24(1):22-31.

Hersey JC, Niederdeppe J, Ng SW, Mowery P, Farrelly M, Messeri P. How state counter-industry campaigns help prime perceptions of tobacco industry practices to promote reductions in youth smoking. Tobacco Control 2005b;14(6):377-383.

Hurd AL, Augustson EM, Backinger CL, Deaton C, Bright MA. Impact of national ABC promotion on 1-800-QUIT-NOW. American Journal of Health Promotion 2007;21(6):481-3.

Hyland A, Wakefield M, Higbee C, Szczypka G, Cummings KM. Anti-tobacco television advertising and indicators of smoking cessation in adults: a cohort study. Health Education Research 2006;21(2):296-302.

Kandra KL, McCullough A, Summerlin-Long S, Agans R, Ranney L, Goldstein AO. The evaluation of North Carolina’s state-sponsored youth tobacco prevention media campaign. Health Education Research 2013;28(1): 1-14.

Klein JD, Havens CG, Carlson EJ. Evaluation of an adolescent smoking-cessation media campaign: GottaQuit.com. Pediatrics 2005;116(4):950-6.

Langley TE, McNeill A, Lewis S, Szatkowski L, Quinn C. The impact of media campaigns on smoking cessation activity: a structural vector autoregression analysis. Addiction 2012;107(11):2043-50.

Levy DT, Mumford EA, Compton C. Tobacco control policies and smoking in a population of low education women, 1992-2002. Journal of Epidemiology & Community Health 2006;60 Suppl 2:20-6.

Liu H, Tan W. The effect of anti-smoking media campaign on smoking behavior: The California experience. Annals of Economics and Finance 2009;10(1):29-47.

McAlister A, Morrison TC, Hu S, Meshack AF, Ramirez A, Gallion K, et al. Media and community campaign effects on adult tobacco use in Texas. Journal of Health Communication 2004;9(2):95-109.

McVey D, Stapleton J. Can anti-smoking television advertising affect smoking behaviour? Controlled trial of the Health Education Authority for England’s anti-smoking TV campaign. Tobacco Control 2000;9(3):273-82.

Meshack AF, Hu S, Pallonen UE, McAlister AL, Gottlieb N, Huang P. Texas Tobacco Prevention Pilot Initiative: processes and effects. Health Education Research 2004;19(6):657-68.

Miller CL, Wakefield M, Roberts L. Uptake and effectiveness of the Australian telephone Quitline service in the context of a mass media campaign. Tobacco Control 2003;12 Suppl 2:ii53-8.

Miller CL, Hill DJ, Quester PG, Hiller JE. Impact on the Australian Quitline of new graphic cigarette pack warnings including the quitline number. Tobacco Control 2009;18(3):235-7.

Mosbaek CH, Austin DF, Stark MJ, Lambert LC. The association between advertising and calls to a tobacco quitline. Tobacco Control 2007;16(Suppl 1):i24-9.

Niederdeppe J, Farrelly MC, Haviland ML. Confirming “truth”: more evidence of a successful tobacco counter-marketing campaign in Florida. American Journal of Public Health 2004;94(2):255-7.

Niederdeppe J, Fiore MC, Baker TB, Smith SS. Smoking-cessation media campaigns and their effectiveness among socioeconomically advantaged and disadvantaged populations. American Journal of Public Health 2008;98(5):916-24.

Owen L. Impact of a telephone helpline for smokers who called during a mass media campaign. Tobacco Control 2000;9(2):148-54.

Perusco A, Poder N, Mohsin M, Rikard-Bell G, Rissel C, Williams M, et al. Evaluation of a comprehensive tobacco control project targeting Arabic-speakers residing in south west Sydney, Australia. Health Promotion International 2010;25(2):153-65.

Ronda G, Van Assema P, Candel M, Ruland E, Steenbakkers M, Van Ree J, et al. The Dutch heart health community intervention ‘Hartslag Limburg’. European Journal of Public Health 2004;14(2):191-3.

Schillo BA, Mowery A, Greenseid LO, Luxenberg MG, Zieffler A, Christenson M, et al. The relation between media promotions and service volume for a statewide tobacco quitline and a web-based cessation program. BMC Public Health 2011;11:939.

Siahpush M, Wakefield M, Spittal M, Durkin S. Antismoking television advertising and socioeconomic variations in calls to Quitline. Journal of Epidemiology & Community Health 2007;61(4):298-301.

Sly DF, Trapido E, Ray S. Evidence of the dose effects of an anti-tobacco counter-advertising campaign. Preventive Medicine 2002;35(5):511-8.

Smith PB, MacQuarrie, C., Herbert, R., Begley, L. Beyond “reach”: evaluating a smoke-free homes social marketing campaign. International Journal of Health Promotion & Education 2009;46(2):57-62.

Solomon LJ, Bunn JY, Flynn BS, Pirie PL, Worden JK, Ashikaga T. Mass media for smoking cessation in adolescents. Health Education and Behavior 2009;36(4):642-59.

Spurlock AY. Policy predictors of participation in adult tobacco cessation programs. Policy, Politics and Nursing Practice 2005;6(4):296-304.

Tamir D, Polachek D, Zivlin O, Amikam Y, Weinstein R. Smoking prevention campaign for youth in Israel. Public Health Review 2001;29(2-4):185-94.

Terry-McElrath YM, Wakefield MA, Emery S, Saffer H, Szczypka G, O’Malley PM, et al. State anti-tobacco advertising and smoking outcomes by gender and race/ethnicity. Ethnicity & Health 2007;12(4):339-62.

Terry-McElrath YM, Emery S, Wakefield MA, O’Malley PM, Szczypka G, Johnston LD. Effects of tobacco-related media campaigns on smoking among 20 30-year-old adults: longitudinal data from the USA. Tobacco Control 2013;22(1): 38-45.

Vallone DM, Duke JC, Mowery PD, McCausland KL, Xiao H, Costantino JC, et al. The impact of EX: Results from a pilot smoking-cessation media campaign. American Journal of Preventive Medicine 2010;38(3 Suppl):S312-8.

Vallone DM, Duke JC, Cullen J, McCausland KL, Allen JA. Evaluation of EX: a national mass media smoking cessation campaign. American Journal of Public Health 2011;101(2):302-9.

van den Putte B, Yzer M, Southwell BG, de Bruijn GJ, Willemsen MC. Interpersonal communication as an indirect pathway for the effect of antismoking media content on smoking cessation. Journal of Health Communication 2011;16(5):470-85.

Wakefield M, Freeman J, Donovan R. Recall and response of smokers and recent quitters to the Australian National Tobacco Campaign. Tobacco Control 2003;12 Suppl 2:ii15-22.

Wakefield MA, Durkin S, Spittal MJ, Siahpush M, Scollo M, Simpson JA, et al. Impact of tobacco control policies and mass media campaigns on monthly adult smoking prevalence. American Journal of Public Health 2008;98(8):1443-50.

Wakefield MA, Spittal MJ, Yong HH, Durkin SJ, Borland R. Effects of mass media campaign exposure intensity and durability on quit attempts in a population-based cohort study. Health Education Research 2011;26(6):988-97.

Wetter DW, Mazas C, Daza P, Nguyen L, Fouladi RT, Li Y, et al. Reaching and treating Spanish-speaking smokers through the National Cancer Institute’s Cancer Information Service. A randomized controlled trial. Cancer 2007;109(2 Suppl):406-13.

White V, Tan N, Wakefield M, Hill D. Do adult focused anti-smoking campaigns have an impact on adolescents? The case of the Australian National Tobacco Campaign. Tobacco Control 2003;12 Suppl 2:ii23-9.

Willemsen MC, Simons C, Zeeman G. Impact of the new EU health warnings on the Dutch quit line. Tobacco Control 2002;11(4):381-2.

Wilson N, Grigg M, Graham L, Cameron G. The effectiveness of television advertising campaigns on generating calls to a national Quitline by Maori. Tobacco Control 2005;14(4):284-6.

Wilson N, Li J, Hoek J, Edwards R, Peace J. Long-term benefit of increasing the prominence of a quitline number on cigarette packaging: 3 years of Quitline call data. New Zealand Medical Journal 2010;123(1321):109-11.

Zucker D, Hopkins RS, Sly DF, Urich J, Kershaw JM, Solari S. Florida’s “truth” campaign: a counter-marketing, anti-tobacco media campaign. Journal of Public Health Management and Practice 2000;6(3):1-6.

Studies from the 2000 Reviews (search period 1980-2000)

Bauman KE, LaPrelle J, Brown JD, Koch GG, Padgett CA. The influence of three mass media campaigns on variables related to adolescent cigarette smoking: results of a field experiment. American Journal of Public Health 1991;81(5):597-604.

CDC. Cigarette smoking before and after an excise tax increase and an antismoking campaign–Massachusetts, 1990-1996. MMWR 1996;45(44):966-70.

CDC. Decline in cigarette consumption following implementation of a comprehensive tobacco prevention and education program–Oregon, 1996-1998. MMWR 1999;48(7):140-3.

CDC. Tobacco use among middle and high school students–Florida, 1998 and 1999. MMWR 1999;48(12):248-53.

Cummings KM, Sciandra R, Davis S, Rimer BK. Results of an antismoking media campaign utilizing the Cancer Information Service. Journal of National Cancer Institute. Monographs 1993;14:113-8.

Flay BR, Hansen WB, Johnson CA, Collins LM, Dent CW, Dwyer KM, et al. Implementation effectiveness trial of a social influences smoking prevention program using schools and television. Health Education Research 1987;2(4):385-400.

Flay BR, Miller TQ, Hedeker D, Siddiqui O, Britton CF, Brannon BR, et al. The television, school, and family smoking prevention and cessation project. VIII. Student outcomes and mediating variables. Preventive Medicine 1995;24(1):29-40.

Flynn BS, Worden JK, Secker-Walker RH, Pirie PL, Badger GJ, Carpenter JH. Long-term responses of higher and lower risk youths to smoking prevention interventions. Preventive Medicine 1997;26(3):389-94.

Fortmann SP, Taylor CB, Flora JA, Jatulis DE. Changes in adult cigarette smoking prevalence after 5 years of community health education: the Stanford Five-City Project. American Journal of Epidemiology 1993;137(1):82-96.

Hafstad A, Stray-Pedersen B, Langmark F. Use of provocative emotional appeals in a mass media campaign designed to prevent smoking among adolescents. European Journal of Public Health 1997;7(2):122-7.

Jenkins CN, McPhee SJ, Le A, Pham GQ, Ha NT, Stewart S. The effectiveness of a media-led intervention to reduce smoking among Vietnamese-American men. American Journal of Public Health 1997;87(6):1031-4.

Johnson CA, Pentz MA, Weber MD, Dwyer JH, Baer N, MacKinnon DP, et al. Relative effectiveness of comprehensive community programming for drug abuse prevention with high-risk and low-risk adolescents. Journal of Consulting and Clinical Psychology 1990;58(4):447-56.

Kaufman JS, Jason, LA, Sawlski LM, and Halpert JA. A comprehensive multi-media program to prevent smoking among Black students. Journal of Drug Education 1994;24:95-108.

Ledwith F. Immediate and delayed effects of postal advice on stopping smoking. Health Bulletin 1984;42(6):332-44.

Luepker RV, Murray DM, Jacobs DR, Jr, Mittelmark MB, Bracht N, Carlaw R, et al. Community education for cardiovascular disease prevention: risk factor changes in the Minnesota Heart Health Program. American Journal of Public Health 1994;84(9):1383-93.

Mar n G, P rez-Stable EJ. Effectiveness of disseminating culturally appropriate smoking-cessation information: Programa Latino Para Dejar de Fumar. Journal of National Cancer Institute. Monographs 1995;18:155-63.

McAlister AL, Ramirez AG, Amezcua C, Pulley L, et al. Smoking cessation in Texas-Mexico border communities: A quasi-experimental panel study. American Journal of Health Promotion 1992;6(4):274-9.

McPhee SJ, Jenkins CNH, Wong C, Don F, Lai KQ, Bird JA, et al. Smoking cessation intervention among Vietnamese Americans: a controlled trial. Tobacco Control 1995;4:S16-24.

Meyer AJ. Skills training in a cardiovascular health education campaign. Journal of Consulting and Clinical Psychology 1980;48(2):129-42.

Mudde AN, Devries H, Dolders MGT. Evaluation of a Dutch community-based smoking cessation intervention. Preventive Medicine 1995;24(1):61-70.

Murray DM, Prokhorov AV, Harty KC. Effects of a statewide antismoking campaign on mass media messages and smoking beliefs. Preventive Medicine 1994;23(1):54-60.

Perry CL, Kelder SH, Murray DM, Klepp KI. Communitywide smoking prevention: long-term outcomes of the Minnesota Heart Health Program and the Class of 1989 Study. American Journal of Public Health 1992;82(9):1210-6.

Pierce JP, Macaskill P, Hill D. Long-term effectiveness of mass media led antismoking campaigns in Australia. American Journal of Public Health 1990;80(5):565-9.

Pierce JP, Gilpin EA, Emery SL, White MM, Rosbrook B, Berry CC. Has the California tobacco control program reduced smoking? JAMA 1998;280(10):893-9.

Siegel M, Biener L. The impact of an antismoking media campaign on progression to established smoking: results of a longitudinal youth study. American Journal of Public Health 2000;90(3):380-6.

Vartiainen E, Puska P, Jousilahti P, Korhonen HJ, Tuomilehto J, Nissinen A. Twenty-year trends in coronary risk factors in North Karelia and in other areas of Finland. International Journal of Epidemiology 1994;23(3):495-504.

Vartiainen E, Paavola M, McAlister A, Puska P. Fifteen-year follow-up of smoking prevention effects in the North Karelia youth project. American Journal of Public Health 1998;88(1):81-5.

Economic Review

Boyd NR, Sutton C, Orleans CT, et al. Quit Today! A targeted communications campaign to increase Use of the Cancer Information Service by African American smokers. Preventive Medicine 1998;27(5):S50-60.

Burns EK, Levinson AH. Reaching Spanish-speaking smokers: state-level evidence of untapped potential for QuitLine utilization. Journal Information 2010;100(S1).

CDC. Increases in quitline calls and smoking cessation website visitors during a national tobacco education campaign. MMWR 2012; 61(34): 667-70.

Farrelly MC, Hussin A, Bauer UE. Effectiveness and cost effectiveness of television, radio and print advertisements in promoting the New York smokers’ quitline. Tobacco Control 2007;16(Suppl 1):i21-i3.

Fellows JL, Bush T, McAfee T, Dickerson J. Cost effectiveness of the Oregon quitline “free patch initiative”. Tobacco Control 2007;16(Suppl 1):i47-i52.

Fishman PA, Ebel BE, Garrison MM, Christakis DA, Wiehe SE, Rivara FP. Cigarette tax increase and media campaign: cost of reducing smoking-related deaths. American Journal of Preventive Medicine 2005;29(1):19-26.

Holtgrave DR, Wunderink KA, Vallone DM, Healton CG. Cost utility analysis of the National Truth Campaign to Prevent Youth Smoking. American Journal of Preventive Medicine 2009;36(5):385-8.

Hurley SF, Matthews JP. Cost-effectiveness of the Australian national tobacco campaign. Tobacco Control 2008;17(6):379-84.

Kotz D, Stapleton JA, Owen L, West R. How cost-effective is ‘No Smoking Day’? Tobacco Control 2011;20(4):302-4.

Mosbaek CH, Austin DF, Stark MJ, Lambert LC. The association between advertising and calls to a tobacco quitline. Tobacco Control 2007;16(Suppl 1):i24-i9.

Pechmann C, Reibling ET. Anti-smoking advertising campaigns targeting youth: case studies from USA and Canada. Tobacco Control 2000;9(suppl 2):ii18-i31.

Perusco A, Poder N, Mohsin M, et al. Evaluation of a comprehensive tobacco control project targeting Arabic-speakers residing in south west Sydney, Australia. Health Promotion International 2010;25(2):153-65.

Raikou M, McGuire A. Cost-effectiveness of a Mass Media Campaign and a Point of Sale Intervention to Prevent the Uptake of Smoking in Children and Young People: Economic Modelling Report. London: London School of Economics and Political Science 2008.

Stevens W, Thorogood M, Kayikki S. Cost-effectiveness of a community anti-smoking campaign targeted at a high risk group in London. Health Promotion International 2002;17(1):43-50.

Villanti A. Smoking Cessation Interventions for US Adults and Young Adults: Evaluating Effects and Cost-effectiveness: Johns Hopkins University; 2010.

Wilson N, Grigg M, Graham L, Cameron G. The effectiveness of television advertising campaigns on generating calls to a national quitline by M ori. Tobacco Control 2005;14(4):284-6

Implementation Resource

Rural Health Information Hub, Tobacco Control and Prevention Toolkit
This toolkit compiles information, resources, and best practices to support development and implementation of tobacco control and prevention programs in rural communities. Modules include program models, implementation and evaluation resources, and funding and dissemination strategies.

• Mass-Reach Health Communication Interventions

The Community Preventive Services Task Force finding is based on evidence from a Community Guide systematic review published in 2001 (Hopkins et al., search period January 1980-May 2000) combined with more recent evidence (search period January 2000-July 2012).

Effectiveness Review

For the updated search, the following eight bibliographic databases were searched between January 2000 and July 2012, using the search terms listed below.

• Cochrane library
• EMBASE (OVID)
• Medline (OVID)
• OSH (CDC’s Office on Smoking & Health Database)
• PsycINFO (OVID)
• PubMed (NLM)
• Sociological Abstracts (ProQuest)
• Web of Science (Thomson)

All years of publications available in the databases were searched. The databases searched covered publications in medical, social, and behavioral sciences, and grey literature. The types of documents retrieved by the search included journal articles, books, book chapters, reports, handbooks, economics evaluations, dissertations, theses, technical reports, government reports, and conference papers.

The resulting English-language papers that evaluated tobacco control interventions were screened twice to identify papers specific to mass-reach health communication interventions.

Following are search strategies specific for PubMed. These strategies were adapted to other databases, based on controlled and uncontrolled vocabularies and search software.

1. PubMed Search Strategy for Tobacco Cessation Part 1

#1 (“quit”[title] or “quitting”[title] or “quit line”[title] or “quit lines”[title] or “quitline”[title] or “quitlines”[title] or “abstinence”[title] or “abstinent”[title] or “stop” [title] or “stopped”[title] or “stopping”[title] or “cessation”[title] or “telephone”[title] or “hotline”[title] or “hotlines”[title] or “telephone”[MeSH] or “hotlines”[MeSH])

#2 “Smoking”[MeSH] or “tobacco”[MeSH] or “tobacco, smokeless”[MeSH] or “tobacco use disorder”[MeSH] or cigar*[title] or tobacco*[title] or hookah*[title] or “hubble-bubble”[title] or “narghile”[title] or “shisha”[title] or “smokeless”[title] or “snuff”[title] or “snuffs”[title]

#3 (“waterpipe” or “waterpipes” or “water pipe” or “water pipes”) and (tobacco or smoking or smoke)

#4 (“pipe” or “pipes”) and (smoke or smoking or tobacco))

#5 “Tobacco use cessation”[MeSH] or “smoking cessation” or “tobacco cessation”

#6 #1 AND (#2 OR #3 OR #4)

#7 #6 OR #5

#8 #7 Filters: Publication date from 2011/01/01 to 2012/12/31; English

2. PubMed Search Strategy for Tobacco Cessation Part 2

#1 telephone or telephones or quitline or quitlines or “quit line” or “quit lines” or helpline or helplines or “help line” or “help lines”

#2 Smoking

#3 #1 and #2

#4 #3 Filters: Publication date from 2011/01/01 to 2012/12/31; English

Combine Part 1 OR Part 2

3. PubMed Search Strategy for Tobacco Youth Update Part 1

#1 Smoking[title] or tobacco[title] or cigar[title] or cigars[title] or cigarette[title] or cigarettes[title] or smoking/psychology[mesh] or smoking[mesh] or tobacco[mesh] or tobacco use disorder[mesh] or tobacco, smokeless[mesh]

#2 (initiation[title] or initiate[title] initiates[title] or initiated[title] or delay[title] or delays[title] or delayed[title] or uptake[title] or “take up'[title] or ‘taking up” [title] or begin[title] or begins[title] or beginning[title] or beginnings[title] or causality[title] or preventive[title] or grade[title] or grader[title] graders[title] or student[title] or students[title] or preteen[title] or preteens[title] or “pre-teen” [title] or “pre-teens” [title] or development[title] or prevalence[title] or discourage[title] or discouraged[title] or religious[title] or prevention[title] or preventing[title] or prevent[title] or prevents[title] or prevented[title] or school[title] or schools[title] or middle[title] or adolescent[title] or adolescents[title] or adolescence[title] or initial[title] or start[title] or starts[title] or started[title] or starting[title] or protective[title] or causation[title] or contributing[title] or contributed[title] or contribute[title] or contributes[title] or try[title] or trying[title] or “pre-contemplating”[title]or “pre-contemplation”[title] or precontemplating[title] or precontemplation[title] or contemplate[title] or contemplated[title] or contemplating[title] or precontemplated[title] or “pre-contemplated”[title] or gateway[title] or gateways[title] or avert[title] or averts[title] or averted[title] or never[title] or genetic[title] or genetics[title] or genetically[title] or onset[title] or “never smoker” [title] or “never smokers” [title] or program[title] or programs[title] or programming[title] or intervention[title] or interventions[title])

#3 (youth[title] or youths[title] or adolescent[title] or adolescents[title] or adolescence[title] or child[title] or children[title] or kid[title] or kids[title] or gradeschool[title] or gradeschools[title] or gradeschooler[title] or gradeschoolers[title] or “grade school”[title] or “grade schools”[title] or “grade schooler”[title] or “grade schoolers”[title] or “elementary school”[title] or “elementary schooler”[title] or “elementary schoolers” [title] or “high school”[title] or “high schools”[title] or “high schooler”[title] or “high schoolers”[title] or college[title] or colleges[title] or preteen[title] or preteens[title] or “pre-teen”[title] or “pre-teens”[title] or tween[title] or tweens[title or tweenage[title] or tweenager[title] or tweenagers[title] or young[title] or youngster[title] or youngsters[title])

#4 #1 and #2 AND #3

#5 (#1 and #2) AND (infant[MeSH] OR child[MeSH] OR adolescent[MeSH])

#6 #4 OR #5

#7 #6 Filters: Publication date from 2011/01/01 to 2012/12/31; English

4. PubMed Search Strategy for Tobacco Youth Update Part 2

#1 “tobacco use prevention”

#2 (tobacco AND “sales to minors”)

#3 #1 OR #2

#4 #3 Filters: Publication date from 2011/01/01 to 2012/12/31; English

Combine PART 1 OR PART 2

Economic Review

No content is available for this section.

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.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Reduce current tobacco use in adults — TU‑01
• Reduce current cigarette smoking in adults — TU‑02
• Reduce current cigarette, cigar, and pipe smoking in adults — TU‑03
• Reduce current tobacco use in adolescents — TU‑04
• Reduce current cigarette smoking in adolescents — TU‑06
• Reduce current cigar smoking in adolescents — TU‑07
• Reduce current use of smokeless tobacco products among adolescents — TU‑08
• Eliminate cigarette smoking initiation in adolescents and young adults — TU‑10
• Increase past-year attempts to quit smoking in adults — TU‑11
• Increase use of smoking cessation counseling and medication in adults who smoke — TU‑13
• Increase successful quit attempts in adults who smoke — TU‑14