Aversion Therapy ebooksclub.org Tobacco or Health Physiological and Social Damages Caused by Tobacco Smoking Second Edition

treated฀with฀this฀technique฀did฀not฀detect฀any฀major฀negative฀effects฀ [30] .฀In฀10฀studies฀of฀ rapid฀smoking,฀compared฀with฀control,฀the฀overall฀odds฀ratio฀for฀abstinence฀was฀2.08฀CI:฀ 1.39–3.12฀ [77] .฀However,฀this฀inding฀should฀be฀interpreted฀cautiously฀because฀the฀funnel฀ plot฀of฀included฀studies฀was฀asymmetrical฀due฀to฀the฀relative฀absence฀of฀small฀studies฀with฀ negative฀results฀Table฀ 10.2 ฀ [77] .฀The฀single฀trial฀using฀biochemical฀validation฀of฀all฀self- reported฀cessation฀did฀not฀show฀a฀signiicant฀result. Other฀aversion฀methods฀e.g.฀application฀of฀electric฀shocks,฀intensive฀pufing,฀holding฀the฀ smoke฀in฀the฀mouth฀for฀longer฀periods฀while฀continuing฀to฀breathe฀through฀the฀nose,฀cough฀ stimulus฀provocation,฀taking฀bitter฀pills฀before฀smoking฀a฀cigarette,฀silver฀acetate฀chewing฀ gum฀are฀reported฀to฀be฀only฀marginally฀effective฀OR฀=฀1.19;฀CI:฀0.77–1.83฀ [77] .

10.8 Mass Media Communication Strategies

Over฀the฀past฀10–15฀years,฀several฀attempts฀have฀been฀made฀via฀the฀mass฀media฀to฀inlu- ence฀smoking฀behaviour฀among฀the฀wider฀population.฀The฀following฀media฀formats฀have฀ been฀utilised฀for฀this฀purpose:฀television,฀cinema,฀radio฀broadcasts,฀print฀media฀of฀all฀types,฀ posters,฀personal฀discussions,฀smoker฀helplines฀and฀even฀personal฀direct฀mailings.฀These฀ campaigns฀communicated฀factual฀information฀or฀they฀took฀the฀form฀of฀appeals;฀they฀also฀ employed฀a฀counter-advertising฀strategy,฀tantamount฀to฀a฀condemnation฀of฀the฀tobacco฀ industry’s฀marketing฀strategies.฀When฀assessing฀the฀usefulness฀of฀such฀methods,฀of฀course,฀ the฀decisive฀point฀is฀the฀achievement฀of฀smoking฀cessation฀or฀at฀least฀a฀deinite฀reduction฀ in฀smoking฀over฀a฀period฀of฀several฀months฀³6฀months. In฀citing฀a฀number฀of฀such฀campaigns฀from฀the฀past,฀attention฀here฀will฀focus฀primarily฀ on฀Australia฀and฀the฀UK฀ [78] : • ฀ “Every฀cigarette฀is฀doing฀you฀damage”฀Australia.฀This฀campaign฀gained฀international฀ recognition฀because฀it฀used฀hard-hitting฀TV฀adverts,฀in฀conjunction฀with฀radio฀broad- casts,฀billboards฀and฀full-page฀magazine฀adverts,฀to฀depict฀the฀adverse฀consequences฀of฀ tobacco฀consumption฀ [79] .฀The฀initially฀positive฀results฀were฀seen฀most฀clearly฀among฀ adolescents฀14–17-years฀old,฀even฀though฀this฀group฀was฀not฀part฀of฀the฀intended฀ target฀audience;฀nevertheless,฀67฀of฀them฀were฀motivated฀to฀quit฀smoking.฀The฀mean฀ national฀smoker฀prevalence฀was฀lowered฀by฀1.7฀from฀23.5฀to฀21.8.฀The฀campaign฀ was฀run฀again฀in฀Singapore฀with฀slight฀modifications฀ [80] . • ฀ The฀John฀Cleese฀Campaign฀featured฀this฀celebrity฀comic฀actor฀to฀stimulate฀the฀interest฀of฀ smokers฀between฀the฀ages฀of฀25฀and฀44฀years;฀it฀sought฀to฀promote฀smoking฀cessation฀by฀ presenting฀serious฀messages฀e.g.฀“Smoking฀can฀kill,”฀“Smoking฀harms฀your฀children,”฀ “Smoking฀is฀not฀the฀only฀way฀to฀enjoy฀yourself ”฀in฀a฀humorous฀way.฀The฀campaign฀was฀ supported฀by฀a฀telephone฀helpline.฀Following฀the฀campaign,฀smoking฀prevalence฀fell฀by฀ 1.2฀from฀28.0฀to฀26.8฀over฀a฀3-year฀period฀1992–1995฀ [78,฀81,฀82] . • ฀ The฀target฀group฀for฀the฀“Break฀Free฀Campaign”฀was฀smokers฀who฀were฀already฀seri- ously฀considering฀quitting฀smoking.฀The฀“You฀can฀be฀free”฀slogan฀was฀shown฀on฀TV฀ and฀posters.฀This฀2-year฀campaign฀had฀minimal฀success,฀relected฀in฀the฀fact฀that฀a฀high฀ proportion฀ of฀ the฀ key฀ target฀ audience฀ no฀ longer฀ recalled฀ the฀ adverts฀ and฀ only฀ 49฀ believed฀they฀could฀be฀motivated฀to฀quit฀smoking฀by฀these฀campaigns฀ [78,฀82] . • ฀ The฀“Quit฀for฀Life”฀campaign฀used฀TV฀and฀radio฀adverts฀to฀deliver฀messages฀designed฀ to฀encourage฀smoking฀cessation,฀primarily฀with฀practical฀tips฀on฀quitting.฀Despite฀posi- tive฀pre-testing,฀the฀TV฀adverts฀were฀not฀suficiently฀powerful฀to฀stimulate฀smokers฀into฀ taking฀action,฀whereas฀the฀radio฀adverts฀were฀received฀more฀favourably฀ [78,฀82] . • ฀ Running฀ from฀ 1997–1999,฀ the฀ “Testimonials”฀ campaign฀ used฀ older฀ smokers฀ to฀ tell฀ younger฀ smokers฀ about฀ their฀ tobacco-related฀ illnesses฀ in฀ the฀ hope฀ that฀ for฀ younger฀ smokers฀the฀future฀consequences฀of฀smoking฀would฀be฀brought฀into฀a฀more฀immediate฀ time฀ frame.฀ Special฀ TV฀ adverts฀ also฀ drew฀ the฀ attention฀ of฀ female฀ smokers฀ to฀ these฀ problems.฀Surveys฀revealed฀that฀72฀of฀women฀agreed฀that฀the฀adverts฀were฀aimed฀at฀ people฀like฀them฀and฀67฀stated฀that฀the฀adverts฀made฀them฀realise฀the฀possible฀health฀ risks฀of฀smoking.฀The฀adverts฀were฀ineffective฀among฀younger฀16–24-year฀old฀female฀ smokers฀ [78,฀82] . As฀shown฀by฀data฀from฀the฀various฀campaigns฀Table฀ 10.3 ,฀the฀“John฀Cleese฀Campaign”฀ produced฀the฀most฀sustained฀effect฀92฀recognition.฀One฀year฀after฀the฀campaign฀ended,฀ 90฀of฀those฀surveyed฀could฀still฀remember฀it. Smoking฀ cessation฀ programmes฀ using฀ a฀ range฀ of฀ mass฀ media฀ were฀ initiated฀ almost฀ simultaneously฀ in฀ Holland฀ “Quit฀ smoking฀ together”฀ and฀ in฀ the฀ USA฀ Bellingham,฀ Washington:฀ “Broadcast฀ cessation฀ clinics”฀ [83,฀ 84] ;฀ these฀ showed฀ initial฀ successes฀ in฀ terms฀of฀smoking฀cessation,฀with฀the฀combination฀of฀TV฀and฀radio฀proving฀to฀be฀beneicial฀ and฀having฀a฀lasting฀effect฀ [84] . Population฀surveys฀indicate฀that฀the฀combined฀use฀of฀various฀mass฀media฀components฀ TV,฀ radio,฀ billboards,฀ print฀ media,฀ as฀ in฀ the฀ California฀ Tobacco฀ Control฀ Program,฀ is฀ Question Campaign “Cleese”฀ 1992–1995 “Break”฀ 1995–1996 “Quit”฀ 1996–1997 “Testimonial”฀ 1997–1999 Prompted฀awareness฀of฀the฀ campaign 92 54 63 66 “Fed฀up฀with฀seeing฀the฀ adverts” 20–22 16 – – “Encouraged฀me฀to฀think฀ about฀giving฀up” – 50 44 57–60 “More฀conidence฀to฀give฀up” 35 42 49 41 “Made฀me฀feel฀guilty฀about฀ smoking” 42–43 38 38 49–55 “Unfair฀to฀smokers” 20–24 19 23 20–21 Cost฀in฀£฀millions 3,183 2,326 2,484 4,886 Table 10.3 ฀฀฀Results฀reported฀from฀four฀UK฀anti-smoking฀campaigns฀and฀their฀associated฀media฀cost฀ [79–82] –฀Question฀not฀asked;฀Statistics฀from฀various฀surveys