Public education campaigns are a vital component of a comprehensive tobacco use prevention and cessation program. Aggressive marketing tactics by the tobacco industry demand equally aggressive public education campaigns to prevent smoking initiation among youth, to encourage smokers to quit, and to change the social context of tobacco use so that pro-tobacco messages are no longer dominant.

When planned strategically and executed well, public education campaigns can change individual attitudes and community norms regarding the acceptability of tobacco use, exposure to secondhand smoke and tobacco industry practices.

As attitudes and norms change, behaviors change too, resulting in lower youth initiation, more tobacco users quitting, and fewer people smoking around non-smokers.

Equally important, as attitudes and norms change, the environment becomes more favorable for tobacco control policy changes, such as smoke-free workplace laws, increased tobacco taxes, advertising bans, strengthened tobacco pack warning labels, and services and treatment to help tobacco users quit.

Article 12 of the Framework Convention on Tobacco Control requires Parties to the treaty to promote public awareness and provide access to information on the addictiveness of tobacco, the health risks of tobacco use and exposure to smoke, the benefits of cessation, and the actions of the tobacco industry.

ublic Education Campaigns Are Effective
Effective public education campaigns are a vital component of any comprehensive tobacco control program because they help prevent smoking initiation among youth (when most smokers start), encourage smokers to quit and promote available quitting resources, reduce the acceptability of exposure to secondhand smoke, and change the social context of tobacco use so that pro-tobacco messages are no longer dominant. Furthermore, public education campaigns can help change the overall environment, such that citizens become more supportive of tobacco control policies and other interventions. Public education campaigns achieve these impacts by building awareness and knowledge, changing attitudes and beliefs, and contributing to behavior changes.
Public education campaigns must use multiple channels to reach the target audience(s) with evidence-based messages. Evidence suggests that mass media campaigns can have a greater impact on cessation than other methods due to their ability to reach a large number of smokers.1 To reach key audiences effectively, a campaign should consist of:
• A variety of paid media efforts such as television, radio, print, Internet, cinema, billboards and new electronic media;
• Public relations efforts, including media outreach to generate news coverage of tobacco issues;
• Outreach to, and involvement of, community organizations such as schools, religious institutions and civic organizations; and
• Collateral materials, such as t-shirts, buttons, brochures and posters that can engage the target audience at events, encourage interaction, and have a lasting presence. These materials can be an important part of a public education campaign if developed with strategic messaging and distributed broadly.
Expert Conclusions on Public Education Campaigns
Public health education is a critical component of successful comprehensive tobacco control programs. The scientific evidence on the effectiveness of public education campaigns is strong and continues to grow.
• The U.S. Guide to Community Preventive Services studied the impact of mass media campaigns and other tobacco prevention and cessation methods on prevention of tobacco use and tobacco cessation. The Task Force found “strong evidence” that mass media education campaigns featuring long-term, high intensity counter-advertising, combined with other interventions, are effective in reducing tobacco use initiation, in reducing consumption of tobacco products, and in increasing cessation among tobacco users.2
• The United Kingdom’s National Institute for Health and Clinical Excellence in its draft guidance on smoking cessation interventions cited mass media campaigns as one of 7 proven smoking cessation interventions, based on evidence of effectiveness and cost effectiveness.3
• The U.S. Surgeon General has concluded that mass media campaigns are effective at informing the public, including youth, about the hazards of smoking and at promoting specific cessation actions and services.4

The U.S. Centers for Disease Control and Prevention’s recently updated publication, Best Practices for Comprehensive Tobacco Control Programs, states that “Health communication interventions can be powerful tools for preventing smoking initiation, promoting and facilitating cessation and shaping social norms related to tobacco use. Effective messages that are targeted appropriately can stimulate public support for tobacco control interventions and create a supportive climate for policy and programmatic community efforts.” The CDC recommends that US states spend in the range of $1.30-$3.90 per capita per year on their tobacco control mass media campaigns in order to counter tobacco industry marketing and effectively reduce tobacco use initiation and increase cessation.5
• The World Health Organization’s international Framework Convention on Tobacco Control (FCTC) cites public education campaigns as a priority. Article 12 of the FCTC states that “Each Party shall promote and strengthen public awareness of tobacco control issues, using all available communication tools, as appropriate. Towards this end, each Party shall adopt and implement effective legislative, executive, administrative or other measures to promote…broad access to effective and comprehensive educational and public awareness programmes on the health risks including the addictive characteristics of tobacco consumption and exposure to tobacco smoke… [and] public awareness about the health risks of tobacco consumption and exposure to tobacco smoke, and about the benefits of the cessation of tobacco use and tobacco-free lifestyles as specified in Article 14.2”6
Public Education Campaigns Reduce Tobacco Use
The evidence that public education campaigns reduce tobacco use is solid and extensive, as the additional examples illustrate.
• A study published in the Archives of Pediatric and Adolescent Medicine provides powerful evidence that state-sponsored anti-tobacco media campaigns are working to change youth attitudes about tobacco and to reduce youth smoking. The study found strong associations between exposure to state-sponsored TV anti-tobacco advertisements and general recall of anti-tobacco advertising, anti-smoking attitudes and beliefs, and smoking prevalence.7 In other words, the more exposure youth had to anti-tobacco ads, the stronger were their anti-tobacco attitudes and beliefs, and the lower was their smoking prevalence.
• The tobacco control programme conducted by the Department of Health England is split into six 'strands', which each contribute to the overall reduction in smoking. A key strand of the Government's tobacco control programme is the provision of an ongoing mass media public education campaign. Adult smoking rates in England fell from 28% in 1998 to 25% in 2004 which translates to 1.2 million fewer smokers. The campaign is the number one reason cited by smokers in the UK as to why they decided to try and quit.8
• Research has shown that the antismoking messages required by the U.S. Federal Communications Commission (FCC) during the late 1960s resulted in a decline in per capita cigarette consumption of at least five percent, and a reduction in the prevalence of teenage smoking of three percentage points. During the three years the program ran, antismoking ads were aired in only a one-to-three ratio versus tobacco industry ads, and yet the antismoking ads were found to be nearly six times more effective than the cigarette advertising at influencing smoking behavior. 9- 13Subsequently, tobacco companies volunteered to take their own ads off television in order to have the antismoking ads removed.
• U.S./California’s Tobacco Control Program, which includes a large public education campaign, produced a 10-percent to 13-percent decline in cigarette consumption. A study in the American Journal of Public Health found that the California anti-tobacco media campaign reduced sales of cigarettes by 232 million packs between the third quarter of 1990 and the fourth quarter of 1992.14-15
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The U.S./Massachusetts tobacco control program, which once had a sizeable public education campaign, contributed to substantial declines in cigarette consumption.16-17 A 1997 independent evaluation of the Massachusetts campaign found that tobacco consumption dropped by 31 percent from 1992 to the first half of 1997, more than triple the rate of decline observed for the rest of the nation. 18
• Youth tobacco use in US/Florida, US/Minnesota and the United States nationally declined in large part due to comprehensive mass media campaigns. As evidence of the importance of sustaining media campaigns, within six months of the Minnesota campaign being dismantled due to funding cuts, awareness of the main message had eroded and the likelihood of youth to start smoking increased from 43% to 53%.19,20,21
Public Education Campaigns Increase Quit Attempts and Cessation Rates
Evidence supporting mass media messages as a mechanism to promote smoking cessation is widespread, and many tobacco control programs around the world have conducted stop smoking campaigns as part of their comprehensive efforts to reduce tobacco use. These campaigns seek to build knowledge about the negative consequences of tobacco use and the resources available to aid in quitting, change attitudes and beliefs regarding tobacco use and readiness to quit and change tobacco-related behaviors. Evidence from several countries suggests that stop smoking campaigns build knowledge, change key beliefs and attitudes, increase calls to quit lines, and contribute to overall decreases in tobacco consumption and increases in quit rates among tobacco users.
• A study published in the March 2006 issue of the American Journal of Preventive Medicine found that anti-smoking TV advertisements were the most frequently mentioned source of help among recent quitters. Television advertising reached many more smokers, and thus, it’s not surprising that more people claimed it helped them to quit (30.5%) than any of the other methods, including nicotine replacement therapy (NRT), professional help, self-help, prescription, program, website and quitline. 22
• In Australia, sixty percent of recent quitters surveyed reported that the National Tobacco Campaign advertising made them more likely to remain tobacco free.23
• Several countries have documented a clear correlation between the times when ads are aired and when people call their quitlines, indicating their immediate impact.24
• A study published in the June 2006 issue of Health Education Research found that increased exposure to state sponsored anti-tobacco media campaigns increases stop smoking rates, even after controlling for other factors that may affect smoking cessation. Specifically, researchers found that the quit rate among adult smokers increased by about ten percent for each 5000 GRPs (gross rating points) of state anti-tobacco advertising they were exposed to over two years (about two additional ad exposures per person per month).25
• A study published in Tobacco Control in 2003 found an increased frequency of negative thoughts about smoking and an increase in quitting related thoughts and actions in the four weeks following the introduction of the National Tobacco Campaign (NTC) campaign in Australia. There was also evidence of sustained increase in cessation activity for a month following onset of the campaign. 26
• In U.S./New York, smokers who were aware of state stop smoking mass media messages were significantly more likely to be planning to quit than smokers who were not aware of these media messages.27
Public Education Campaigns Are Cost-Effective
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Public education campaigns that help adult and youth smokers quit, help former smokers from relapsing, and prevent youth from ever starting to smoke will produce enormous healthcare cost savings because of reductions in smoking-caused illnesses and deaths. 28
• A 2005 study found that a television campaign used to generate calls to a quitline in New Zealand was cost-effective, as the total advertising cost was NZ$304,560 (US$193,844 in today’s dollars), resulting in costs of NZ$30 to $48 (US$19 to $30) for each new registrant to the quitline and recruitment of 8 percent of all Maori adult smokers in New Zealand.29
• A study of Turkish-speaking people in England showed that it may be more cost-effective to direct campaigns towards populations with high prevalence of smoking than to those populations with lower smoking prevalence. The estimated cost-effectiveness of this campaign was US$198 (£105) per life year gained, and resulted in a reduction in smoking prevalence of 3-7 percent.30
• Mass media campaigns can be extremely cost effective versus other healthcare interventions, and sometimes even versus other tobacco control interventions.