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Background on the Need for Global Dialogue

The Global Dialogue for Effective Stop Smoking Campaigns began in January 2005 to address an unmet need for updated and accessible international smoking cessation campaign lessons learned.

For more background information about the need for this type of initiative, please review the following materials from our Concept Paper.

• Negative Consequences of Tobacco Use and Need for Cessation Interventions
• Specific Role of Mass Media and Other Marketing Elements in Cessation
• Need for Updated Cessation Campaign Lessons Learned

On this website, you can also learn about effective campaign strategies and messages and a recommended process for developing a comprehensive public education mass media campaign. You can also become a Global Dialogue member to gain access to campaign experiences and materials from around the world.

Negative Consequences of Tobacco Use and Need for Cessation Interventions

Cigarette smoking and other tobacco use impose a huge and growing global public health burden. Tobacco use is currently estimated to kill nearly five million people worldwide each year, accounting for one of every five deaths among males over age 30 and one in twenty deaths among females over age 30. Based on current smoking patterns, annual tobacco deaths will rise to ten million by 2030. During the 21st century as a whole, we are likely to see 1 billion tobacco deaths, most of them in developing countries. In contrast the 20^th century saw 100 million tobacco deaths and most of them were in developed countries.

Much of tobacco’s substantial death toll is avoidable. Numerous studies from high-income countries, and a growing number from low and middle-income countries, provide strong evidence that tobacco tax increases, dissemination of information about health risks of smoking, restrictions on smoking in public places and in workplaces, comprehensive bans on advertising and promotion, and increased access to cessation therapies are all effective in reducing tobacco use and its consequences. Cessation by the 900 million current smokers in developing countries is central to meaningful reductions in tobacco deaths over the next five decades. Several identified interventions are highly cost-effective. Potentially, tens or hundreds of millions of premature deaths would be avoided if these interventions could be widely applied.

There is overwhelming evidence for the health benefits, effectiveness and cost-effectiveness of quitting smoking and of treatment for tobacco dependence, a disorder recognized in the tenth version of WHO’s International Classification of Diseases (WHO 1992). Treatment for tobacco dependence is safe and efficacious. However, despite availability of cost-effective treatment for tobacco dependence, the public health sector in many countries is not investing in smoking cessation services, nor in the development of an infrastructure that will motivate smokers to quit and support them in doing so. Furthermore, in most countries provisions for treatment, training of health care providers, education and information on wide use of cessation therapies, as well as financial resources, are limited and rarely incorporated into standard health care. Also, smoking cessation is not seen as a public health priority and is not necessarily embraced as a key tobacco control strategy in governmental and institutional work plans. Besides specific interventions for smoking cessation, a general supportive environment that will stimulate smokers to quit is not usually considered a component of smoking cessation policies.

Quitting smoking has immediate as well as long terms benefits, reducing risks for disease caused by smoking and improving health in general (US DHHS 2004). Smoking cessation is a priority for preventing disease and reducing its burden (Doll R et al 1994). At any age, quitting confers substantial and immediate health benefits, including reduced cardiovascular disease risks (USDHHS 1990), improved lipid profiles and platelet reactivity (Terres W et al. 1994), and reduced risk of stroke (USDHHS 1990) and smoking-attributable cancers (Terres W et al. 1994). The World Bank suggests that if adult consumption were to decrease by 50% by the year 2020, approximately 180 million tobacco-related deaths could be avoided (World Bank 1999). Thus promotion of smoking cessation and treatment of tobacco dependence can have great impact in reducing the burden of disease and improving population health.

According to the Commission on Macroeconomics and Health, smoking is on a short list of specific conditions--including HIV/AIDS, malaria, tuberculosis, childhood infectious disease, maternal and perinatal conditions, and micronutrient deficiencies--that need to be a priority in low income countries to save million of lives, reduce poverty, spur economic development, and promote global security (Commission on Macroeconomics and Health 2003). In addition, cessation interventions are described specifically in the WHO Framework Convention on Tobacco Control (FCTC). Signing the FCTC and its ratification will obligate countries to work on cessation as part of a comprehensive effort in tobacco prevention and control (WHO 2003).

In recent years governments at all levels have adopted a variety of macro-level interventions. These include tobacco tax increases, restrictions on smoking in public places, limits on youth access to tobacco products, bans on advertising and other promotions, tobacco counter-advertising, and efforts to increase information about the harmful consequences of tobacco use. Most of these interventions aimed at reducing the demand (consumption) for tobacco products and are considered preventive policies.

Demand for smoking cessation interventions is increased in an environment that discourages and de-normalizes tobacco use. Smoke-free indoor air policies, tobacco taxation to increase price, and public information campaigns increase interest in stopping smoking. Banning the use of misleading labeling on tobacco products, for example, ‘light’ and ‘mild’, can also help prevent smokers from relapsing and increase quitting (Novotny et al, 2000).

Specific Role of Mass Media and Other Marketing Elements in Cessation

A growing number of tobacco control programs around the world have conducted cessation-focused mass media campaigns as part of their comprehensive efforts to reduce tobacco use, with some of these campaigns in the field for many years. 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. Evaluations of these cessation campaign efforts and evaluations of the overall tobacco control programs have indicated that cessation campaigns can indeed build knowledge, change key beliefs and attitudes, increase calls to quit lines, and contribute (along with other tobacco control program elements) to overall decreases in tobacco consumption and increases in cessation among smokers.

In addition to paid mass media campaigns, other marketing interventions have been used to improve the results of cessation campaigns, such as earned media/news coverage, public relations, grassroots efforts, communication with health care professionals, and posters, brochures, and other collateral material. Fewer of these interventions have been evaluated than paid mass media campaigns, so there is an opportunity to learn more about their results.

Previous reviews relevant to this project include the following:

• In 2001, the Guide to Community Preventive Services reviewed the published literature on tobacco counter-marketing (media-based efforts to counter pro-tobacco influences and increase pro-health messages and influences) and, based on its rules of evidence, strongly recommended the use of mass media campaigns, both to reduce initiation and to increase cessation of tobacco use.
• In 2001, CDC and WHO released a review conducted to summarize lessons learned from smoking cessation media campaigns around the world. The report provided conclusions and recommendations about targeting, message content and tone, media presence and campaign measurement. Countries included in the analysis were Australia, Canada, France, Iceland, New Zealand, Philippines, Poland, Singapore, UK, and US.
• The 2000 US Surgeon General’s Report, Reducing Tobacco Use, summarized the current evidence of the effectiveness of counter-marketing as part of a multi-faceted tobacco control program including educational, clinical, regulatory, economic, and social approaches.
• In 1999, CDC published Best Practices for Comprehensive Tobacco Control Programs to help US states plan and establish effective tobacco control programs. The document provides a brief justification for tobacco counter-marketing as a key program component and recommends funding levels for a moderately intense counter-marketing campaign ($1- $3 per capita annually).

Other evidence-based review documents focusing on broader issues in tobacco control and health promotion include Tobacco Control in Developing Countries (Jha and Chaloupka, 2000) and The Evidence of Health Promotion Effectiveness (IUHPE, 1999).

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Need for Updated Cessation Campaign Lessons Learned

Since 2001, there has not been any comprehensive review of smoking cessation mass media campaign findings, and even the 1999-2001 reviews were based on data that spanned the 1980s and 1990s. Meanwhile, cessation media campaigns have been in place for the last several years in Australia, the UK, Canada, the US and elsewhere yet few lessons learned have been published or synthesized. As mentioned above, there is also a great need to better quantify the impact of other marketing interventions that may contribute to cessation campaigns’ success.

Clearly there is an opportunity to update the body of lessons learned related to these campaigns and to share them globally, so that others can benefit from them as they plan and conduct their own campaigns. The idea is not to develop “absolute truths” but rather to synthesize the existing literature and expert opinion, gleaned from campaign practitioners and researchers, and develop practical guidance to assist countries in implementing effective country-specific smoking cessation campaigns as part of their overall tobacco control programs. In the current environment of limited budgets, it is particularly important that programs maximize their funding by focusing on proven strategies.

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