If we've seen a "denormalization of smoking," as the CDC
describes it, do we need to drop hundreds of millions of dollars on
a familiar message during cash-strapped times? If all those appeals
to the brain, wallet and pride don't work, how will a bunch of
As it turns out, anti-smoking ads actually do work. There's
plenty of academic research proving it. And there's circumstantial,
but no less compelling, evidence that in the absence of
advertisements, smoking rates don't go down as quickly as they
would without the nagging. And that entails its own costs.
Smoking's steady decline, which began in the 1960s after the
Surgeon General's initial warning, has leveled off in recent years.
Between 1998 and 2005, the adult smoking rate dropped 13%, but
since 2005, any changes have been minimal. For the better part of
six years, it has been at the 20% mark or just below. All-important
youth-smoking rates declined 40% between 1997 and 2003, but between
2003 and 2009, that decline slowed to 21%.
Meanwhile, during those years funding decreased dramatically for
the main national anti-tobacco advertising player, Legacy, the
foundation funded by the 1998 settlement between tobacco companies
and the attorneys general of 46 states. According to Kantar,
Legacy's media budget between 2007 and 2010 totaled about $100
million. That's the amount Legacy would spend in a single year in
its early days. And, at the state level, average household exposure
to anti-smoking ads peaked in 2006 and 2007 and has been coming
down since, according to a
study of Nielsen data by the University of
"There's no consistency at the state level," said Eric Asche,
chief marketing officer at Legacy. "And the general trend has been
to spend less, not more."
Connecting the slowing decline in smoking with the steeper drop
in anti-tobacco ad spending is to draw a broad correlation. It's a
mug's game to chart smoking-rate changes directly to the rise and
fall of advertising budgets. Media spending is not the only factor
in smoking prevention, and probably not even the most important.
That distinction goes to taxes. There are other factors, especially
smoke-free-air laws that effect bans in workplaces and other public
places. With all the activity, it's difficult to isolate the
effects of advertising.
But there's no doubt that the leveling off of the smoking rate
has occurred at a time when many states, amid deep cuts to
tobacco-prevention budgets, are spending next to nothing on ads and
have been getting little air cover from the national level. This is
bad news when you consider how effective those ads have been.
Research scientists have been studying the impact of
anti-smoking ad campaigns for decades, even before the "Truth"
campaign launched in 2000, when the job was mainly the province of
Many have found what Sherry Emery, a health economist who has
studied the impact of media campaigns at the state level, has. Ms.
Emery said that analyses of youth and adult reaction "showed that
higher levels of exposure to the state media campaigns were
associated with less smoking and more anti-smoking attitudes and
The Truth campaign, currently handled by Arnold , is the most
important national anti-tobacco ad effort in recent years and has
yielded positive results. A 2005 study in the American Journal of
Public Health reported that about 22 % of the decline in youth
smoking between 1999 and 2002 was attributable to the Legacy
foundation ads -- not bad when you consider that the ads weren't
even running through the entire period. Since 2003, Legacy's
funding has been just a fraction of what it started with, a
function of the master-settlement agreement.
That's because the agreement required the Big Four tobacco
companies that signed it to fund Legacy only through 2003 if their
collective market share fell below 99.05%. (By 2001, that share was
already below the threshold, at 96%.) Settlement payments to states
continue, but it's a sore spot with some that a small percentage of
that revenue -- just under 2% of $25 billion in 2011 by the
Campaign for Tobacco-Free Kids' count -- goes to fight tobacco use.
As for the states, the dire economic conditions of recent years
have led many to cut back their tobacco programs. The group
estimates that total state spending has dropped 36 % over the past
Kentucky, a tobacco-growing state tied for the highest smoking
rate, and with a tiny budget to fight it, is as particular as it
can be about what ads it will run. Rather than use off-the-shelf
ads for its just-launched $370,000 secondhand-smoke campaign,
the state developed creative
via Doe Anderson, Louisville. It's a big
investment, as average expenditure on media campaigns is in the
neighborhood of $100,000 (but can be much less).
"I think it's very hard at the national level for a government
agency to make ads that both can stand out and be acceptable to
everyone," said Gwenda Bond, assistant communications director at
Kentucky's Cabinet for Health and Family Services. "It's sort of a
Catch-22 in some ways. I think the states have a little more
freedom and flexibility to go a little bit further afield with
The good news is that there's evidence that various styles of
advertising work, from the industry-as-manipulator ads of Truth to
campaigns focusing on the nasty health effects of smoking.
Ms. Emery is currently analyzing what kinds of ads work best.
Preliminary results show that the answer is not what you might
expect, and seem to have little to do with state-smoking laws or
whether the state is a tobacco grower. Ms. Emery's hunch is that in
"media markets that are dominated by one primary message, like a
health-effects ad or secondhand-smoke ad, their overall campaign is
a little less effective than media markets that have a diverse
portfolio of messages."
OK, so you're not swayed by science. Then what about money? Do
anti-smoking ads pay for themselves?
Return on investment is a knottier problem than whether the ads
work with audiences on an emotional level, and it hasn't been
studied as much. But there is one informative study.
Three years ago, the American Journal of Preventive Medicine
published a cost-utility analysis of the Truth campaign between the
years 2000 and 2002. The researchers found that campaign efforts
costing $324 million averted about $1.9 billion in medical costs.
That's a return of about 6 to 1 for one of the most intense -- in
terms of reach and cost -- anti-smoking ad campaigns ever done.
California has been another relatively big spender, and its program
is a model for anti-smoking campaigns. Between 1989 and 2011, the
state's tobacco-control program said, the smoking rate fell from
23.7% to 11.9%. That drop has averted more than $86 billion in
smoking-related health-care costs, according to the state's public
health department. Over that time, it spent more than $1.3 billion
on its tobacco-control program, $450 million of which went to media