June 22, 2007 — The immediate effects of two comprehensive antitobacco media campaigns confirm their importance in reducing smoking prevalence, according to a report in the June 22 issue of the Morbidity and Mortality Weekly Report.
"In 2002, after a decade with no decrease in smoking prevalence, New York City began implementation of a five-point tobacco-control program consisting of increased taxation in 2002, establishment of smoke-free workplaces in 2003, public and health-care-provider education, cessation services, and rigorous evaluation, including annual cross-sectional, citywide telephone surveys using the same measures as [the Centers for Disease Control and Prevention's] CDC's state-based Behavioral Risk Factor Surveillance System (BRFSS)," write J. A. Ellis, PhD, and colleagues from the New York City Department of Health and Mental Hygiene. "During 2002-2004, estimated adult smoking prevalence decreased from 21.5% to 18.4%, representing nearly 200,000 fewer smokers. However, in 2005, no change in adult smoking prevalence occurred, either among New York City residents overall or among demographic subpopulations."
To further reduce smoking in New York City, in 2006 the New York City Department of Health and Mental Hygiene (DOHMH) began an extensive, television-based antitobacco media campaign using graphic imagery of the health effects of smoking, which aired simultaneously with a large New York state antitobacco media campaign.
During the first year of the media campaigns, adult smoking prevalence decreased significantly in men (11.6% decrease) and in Hispanics (15.2% decrease), confirming the importance of comprehensive tobacco-control programs and suggesting that this intensive, broad-based media campaign has reduced smoking prevalence among certain subgroups.
The 2006 DOHMH media campaign, with advertisements in both English and Spanish, focused on increasing smokers' motivation to quit by providing testimonials from sick and dying smokers and graphic images of the diseased lungs, arteries, and brains of smokers. During January to October 2006, the television campaign broadcast for 23 of 40 weeks, with 100-600 gross ratings points (GRPs) per week (total, approximately 6500 GRPs).
At the same time, the New York State Department of Health aired a separate, simultaneous statewide television-based antitobacco media campaign that also targeted New York City, with advertisements featuring graphic images of the effects of smoking and highlighting the effects of secondhand smoke on children. From January through December 2006, New York City adult smokers were exposed to nearly 11,000 GRPs as a result of both campaigns combined, equating to the average viewer in NYC seeing an advertisement approximately 110 times during the year.
Population-based, random-digit-dialed health surveys of approximately 10,000 adult New York City residents conducted by the DOHMH annually since 2002 has evaluated smoking status. Smoking prevalence data for 1993-2001 were obtained from surveys of New York City residents, excerpted from the annual New York state BRFSS.
For New York City residents, smoking prevalence decreased from 21.5% in 2002 to 18.4% in 2004 (P < .001), with decreases in all major age, race/ethnicity, sex, and education subgroups and by location of birth. From 2004 to 2005, smoking prevalence did not change significantly among New York City residents overall, and there were no changes within any subgroup.
In 2006, during the television campaigns, smoking prevalence did not change significantly among New York City residents overall (17.5% in 2006 vs 18.9% in 2005; P = .055). However, smoking prevalence did decrease in men (from 22.5% to 19.9%; P = .021) and in Hispanics (from 20.2% to 17.1%; P =.027).
The 17.5% smoking prevalence in New York City residents during 2006 corresponds to a 19% decrease from 2002, representing 240,000 fewer adult smokers and an average annual rate of decrease of 5%. Young adults (aged 18-24 years) had the largest decrease (35%) from 2002 to 2006.
An accompanying editorial notes that the foremost measure proven to reduce tobacco use is taxation; other measures include legislation that makes workplaces and other public areas smoke-free.
Limitations of these survey data include an inability to draw conclusions regarding causality of the relation between any decreases and any intervention, including the media campaign; reliance on self-reported smoking behaviors; exclusion of certain populations; and lack of nationwide data for comparison purposes.
"Jurisdictions can make additional progress in reducing tobacco use, particularly by further increasing taxes, expanding smoke-free public places, and airing sustained, graphic, and pervasive anti-tobacco advertising," the editorial concludes. "The data presented in this report suggest that, in the context of increases in taxation and implementation of smoke-free workplace legislation, additional well-funded media campaigns that have graphic content and are aired with high frequency might further reduce smoking prevalence."
MMWR Morb Mortal Wkly Rep. 2007;56(24):604-608.
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