Tahir Turk Technical Advisor – Mass Media World Lung Foundation

1. Low Cost Media Campaigns • Achieving cost efficiencies through population level communication campaigns to warn about the dangers of tobacco Tahir Turk Technical Advisor – Mass Media World Lung Foundation

2. Presentation Today About World Lung Foundation Why ‘population level’ media campaigns provide value for money Adaptation of best practise spots – A Global approach Raw and real - testimonials from credible sources and tobacco victims Leveraging media activities through synergised approaches Cost effective Campaigns - Lessons Learned

3. World Lung Foundation (WLF) • Headquartered in New York City – WLF staff work globally. • Works in partnership with organizations throughout the world that share our mission of improving lung health. • Our core areas of work: • Capacity Building • Operational Research • Project Management • Health Communications

4. Since 2008, WLF hasassisted governments with… of which in

5. The Tobacco Atlas

6. WLF Mass Media Support Strategic communications planning Pretested messages ready for easy adaptation via our Online Mass Media Library Technical assistance with media planning and communications branding and integration Monitoring and evaluation of target audience - Knowledge, Attitudes and Behaviors (KAB)

7. Strategic Health Communication Strategic approach used acknowledging that behavior change takes time to achieve and complex processes need to be reduced to manageable stages to achieve cost effective health outcomes.

8. Tobacco Control Mass Media Campaigns are Effective • Mass media campaigns have tremendous reach and can deliver impactful messages • Associated with decline in smoking among adults and reduced uptake among youth • Growing evidence from low and middle income countries cancercontrol.cancer.gov/tcrb/monographs/19/m19_complete.pdf

9. Challenges for Cost Efficient Tobacco Control • Multinational tobacco industry actively promoting tobacco. • Big Tobacco uses lifestyle associations to create interest to a new generation of tobacco users. • Tobacco promotion has occurred primarily through mass media. Sydney Morning Herald Feb 2012

10. Getting Value for Money Population level mass media campaigns can provide efficient return on investment, particularly in high population countries such as China, India, Russia, Indonesia, Bangladesh, etc. Evidence-based planning in creative approaches and message design can have strong behavioral impact Media dissemination needs to be carefully considered

11. Low Cost or Just Good Value? “Today, we realize that the media, tobacco use, and tobacco control efforts all interact at multiple levels of a system, each of which may affect stakeholders ranging from individuals to society itself. We have already seen the fruits of many of these efforts in the form of reducing per capita cigarette consumption rates by approximately one-half in the United States since their peak in the 1960s” P 42. National Cancer Institute (2008). The Role of the Media in Promoting and Reducing Tobacco Use.

12. Getting Value for Money Strategic long term approach required: 3-5 years to achieve sustainable behavioral impact Campaigns can also help support policies Governments should include media planning costs in annual budgets Synergizing of mass media campaigns with partner activities can leverage program impact Monitoring of target audience - Knowledge, Attitudes and Behaviors (KAB) critical to success

13. Synergized ProgrammingMass Media Umbrella - Supporting an Integrated Raft of Campaign Activities Enabling Enforcement Working with Advocates

14. Communication CurrencyGetting the Best Run for our Rupee Effective Message Design Effective Message Delivery Effective Message Design Effective Message Delivery

15. Adapting Message Designs Global Message testing study implemented in 10 LMICs in 2008-2009; a 3 country study on (SHS) conducted in 2009; and a 4 country study in African region currently underway. Results showed that 4-5 International best practice spots consistently outperformed all others across all country settings Cost of adaptation of these spots for multi-country usage is minimal – Global messaging approach

16. Best-Practice Spots Pre-tested best practise spots are available from the World Lung Foundation’s global mass media resource: http://www.worldlungfoundation.org/

17. Sponge Adaptations 1979-1211 Since the concept was first developed in 1979, Sponge has been adapted for use in 17 HMLICs

18. Sponge – A Global Campaign

19. Raw and Real Messages Another low cost approach is to use a news gathering documentary style to spots Requires small crew – camera, sound and reporter Shot and story selection to focus on personal loss, loss of the breadwinner, and deformity Post production editing , music selection important as well as post production pre-test

20. India ‘Mukesh’ Campaign

21. Raw and Real Messages Testimonials can be very cost effective – excluding staff time, these 2 PSAs cost around US$1500 to produce (staff time, travel, etc add to costs) Approach is forgiving as it is the story that is important rather than the ‘production values’ Evidence shows that inclusion of graphic imagery, and negative effects messages are important Need staff with production experience to assemble scenarios

22. Leveraging Media Delivery Need to negotiate up-front with media suppliers prior to campaigns going to air Use of powerful advocates – Ministers for Health/Communications etc to coerce media providers to provide better value is a useful tool Rates should be negotiated which provide at least 50% no-charge bonus spots (1 for 1) during the same programming period Should aim for other benefits (station promo’s, crawls, program naming rights etc.)

23. Cost Efficient Media Delivery • Participant Recall of Sponge N = 7338

24. Cost benefits of media to achieve behavioral impact Impact of Campaign Awareness on Attitudes Towards Smoking Smokers * * N = 4352 * Denotes statistically significant at p < 0.05

25. Cost Efficient Behavior Change Impact of Campaign Awareness on Behavioral Intentions and Behaviors - Smokers N = 4352 *Denotes statistically significant at p < 0.05 Adjusted for confounding variables

26. Leveraging Media Delivery Build public private partnerships with the media – Sponsorships with credits provided Earned media opportunities to media providers through Government ministers launching the program on outdoor or transport signage Conducting other earned media activities – use of tobacco victims, sporting, actor celebrities at launch activities

27. Adding Value through Earned Media • Earned media (real news) provides 3-6 times the value of paid media activity

28. Synergising activities with partners Operating in resource constrained settings of LMICs requires a multisectoral approach with all stakeholders working together Evidence indicates that combination of mass media, supporting community advocacy and interpersonal communication can achieve the best health gains Combination of activities closely timed in a concentrated programming period 4-6 weeks can be most cost effective

29. Synergising activities with partners • Training, community resource distribution and community events.

30. Cost Effective Campaigns - Lessons learned Tobacco control mass media campaigns have proven to be effective at reducing tobacco prevalence in HICs and evidence emerging now from LMICs Adaptation of existing pre-tested best-practice spots is more cost effective than developing your own Use of testimonials of victims and opinion leaders (raw and real approach) could be considered for cultural resonance

31. Cost Effective Campaigns - Lessons learned Efficient Media planning and negotiation of best rates and bonus spots/other benefits will extend campaign reach and behavioral impact Resource constrained settings require a multisectoral/multilevel approaches – mass media supporting community based approaches Academically rigorous monitoring and evaluation is important for future campaign planning as well as advocacy for continued funding

32. Low Cost Media Campaigns Discussion tturk@worldlungfoundation.org http://www.worldlungfoundation.org/