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Theoretical Background and research questions/hypothesis: While television advertisements (ads) that communicate the serious harms of smoking are effective in prompting quitting-related thoughts and actions among smokers, little research has been conducted among smokers in low to middle income countries (LMICs) to guide public education efforts.
Methods: 2,399 smokers aged 18-34 years in 10 LMICs (Bangladesh, China, Egypt, India, Indonesia, Mexico, Philippines, Russia, Turkey, Vietnam) viewed and individually rated the same five anti-smoking ads on a standard questionnaire and then engaged in a structured group discussion about each ad. Multivariate logistic regression analysis was performed to compare outcomes across ads and countries adjusting for covariates.
Results: Three ads with graphic imagery – showing human diseased body parts or using a visceral metaphor to demonstrate tar accumulation in smoker’s lungs – performed consistently highly across all countries. A personal testimonial ad performed more variably, with many smokers not appreciating features of the woman’s smoking-related disease. An ad using a visual metaphor for lung disease was also more variable, due mostly to lack of understanding of medical terms.
Conclusions: Television ads that graphically communicate the serious harms of tobacco use in an emotional manner are likely to be effective with smokers in LMICs, and can be readily translated and adapted for local use. Ads with complex medical terms or metaphors, or those that feature personal testimonials, are more variable and at least require more careful pre-testing and adaptation to maximise their potential.
Implications for research and/or practice: Our study suggests that low and middle income countries concerned to efficiently produce and broadcast anti-tobacco media campaigns would benefit from selecting ads from the World Lung Foundation mass media resource for local pre-testing, translation and adaptation.