University of Vermont

Office of Health Promotion Research

College of Medicine

One South Prospect Street

Burlington, Vermont 05401-3444

(802) 656-4187, FAX (802) 656-8826

Program Description

This project was designed to assess the cigarette smoking prevention effects of television and radio messages delivered to young people developing from late childhood into adolescence. Results six years after initiation of the program demonstrated that these carefully-tailored mass media campaigns reduced cigarette smoking by over 30% through the end of high school. Cost analyses indicated that this is a highly cost-effective method for long-term reduction of cigarette smoking prevalence in young people.

Mass media messages were created using intensive diagnostic and formative research with the target audiences. All messages were based on a common set of educational objectives focused on disadvantages of smoking, refusal skills, and understanding that most kids don't smoke. Groups of messages were tailored to the specific interests of six high-risk audience' segments. The 36 television and 17 radio spots were delivered to their targeted audiences using purchased broadcast time. An average of 190 television broadcasts, 350 cable broadcasts, and 350 radio broadcasts were purchased in each of four intervention years in each media market. Purchased broadcasts were supplemented through time donated by media outlets, increasing broadcast numbers by about 50%.

The effects of these media messages were tested in a large-scale community education program. Four widely separated media markets were selected because of their matching demographic characteristics. Young people in two of these markets received the media messages over four years, plus a school smoking prevention program. Young people in two other markets received only the school program for four years. These programs began when the target groups were in grades 5-7 and continued through grades 8-10. Effects were compared between young people in the two sets of communities using school surveys throughout this period and two years later.

Results during this four-year period showed that the immediate program objectives were achieved, with the group receiving media interventions reporting attitudes and norms that were much less favorable to cigarette smoking and reporting significantly reduced prevalence of smoking. Two years after the program ended, when the target groups were in grades 10-12, the prevalence of cigarette smoking was 30% less among those receiving the media messages. Cost analyses have shown that this type of intervention compares very favorably to other forms of health interventions.

The promising results of this program have influenced smoking prevention media campaigns implemented by a variety of government agencies in this country and elsewhere. The strategies used here also are being explored for application to other health behavior problems among young people.

Narrative Description of Program

Our goal was to reduce cigarette smoking prevalence among young people using community-wide mass media messages that would support school-based smoking prevention programs. Target populations were public school students in lower-income areas of two metropolitan areas. Media and school interventions based on social learning theory and previous research began when students were in grades 5-7 and continued for four years until they reached grades 8-10. These programs changed each year to match students' developmental needs. Intensive focus group research with high-risk youths was used to tailor media messages to their needs and interests. Messages were broadcast in television and radio shows reaching high-risk youth with both purchased and contributed time.

These programs were developed and implemented by a university-based team with backgrounds in communication, health education, psychology, and medicine; this group worked directly with schools, media producers, and local broadcast and cable TV outlets. School programs were delivered by classroom teachers with curricula and training from the project. Strategies from this successful program have affected plans for smoking prevention programs in Minnesota, California, and Massachusetts; these methods are being studied by several national planning groups. Program material are now being used in other regions. Funding was provided by the National Cancer Institute.

Narrative Description of Evaluation Results

Students in two communities received media-school interventions, and students in two matched communities received only school interventions from grades 5-7 through grades 8-10. A long-term follow-up was conducted in grades 10-12, two years after interventions were completed. Substantial and significant reductions in smoking prevalence were achieved. Further analyses demonstrated that these interventions were highly cost-effective.

Smoking prevalence in 1991 was 20.5% (95% CI 18.9-22.1) in the media-school communities and 26.2 (95% CI 24.6-27.8) in the school-only communities, a difference of 5.7% (95% CI 3.5-8.0). Mediating variables measured annually during program implementation indicated that the programs had achieved their educational objectives. Long-term reductions in smoking prevalence were especially strong for high risk youths and girls, groups that were emphasized in the design of the media messages.

The number of smokers averted, among approximately 18,600 students potentially exposed to the media program would be 1064, for cost per smoker averted of $711 (95% CI $511-$1,173). Assuming nonsmokers live 5 years longer than smokers, the cost per life-year gained, discounted at 3%, would be $472 (95% CI $338-$778). Using published data for the direct and indirect costs attributable to smoking, converted to 1996 dollars, for every dollar invested in the development, production and broadcasting of the mass media program, $11 would be saved in avoiding heart disease, $37 in avoiding chronic pulmonary disease, and $8 in avoiding lung cancer.

• University of Vermont - Smoking Prevention Program

The following assessment of program strengths and weaknesses has been abstracted from reviews by the Task Force on Program Selection of The Health Project. Where weaknesses are postulated, it must be taken into account that the review Task Force is very critical, that no programs are perfect, that the Award Winning programs have been selected from over 300 candidate programs and represent the very best, that the materials reviewed may have been incomplete, that suggested deficiencies may have resulted from incomplete understanding of the program by the reviewers or that any problems may have been corrected since the time of review.

Evaluation

The University of Vermont's Smoking Prevention Through Mass Media & School Programs effort targets public school students in lower-income areas with community-wide mass media messages supported with a National Cancer Institute grant and with 50 percent matching pro bono time by local radio stations. The program changes each year to match students developmental needs and includes long term follow-up. Substantial reductions in smoking versus community norms have been realized with related savings in heart disease, chronic pulmonary disease and lung cancer based on published forecasts. Several states are now considering similar programs.

Excellent longitudinal study to evaluate the impact of community-wide mass media messages to support school-based smoking prevention programs. The study design with comparison groups, including focus group research to tailor high-risk specific messages and follow-up two years after intervention, was excellent. Study showed results of 5 percent difference in smoking prevalence between the two groups, with 1,064 fewer smokers if the same proportional reduction in smoking onset occurred. Cost-benefit and cost-effectiveness analyses show significant impact. Program cost at $28 per participant is low. This is one of the finest community programs evaluated by the Health Project. The program has been operating since 1985. Cost saved for every dollar invested were $11 in avoiding heart disease, $37 in avoiding pulmonary disease and $8 in avoiding lung cancer as imputed by the reduced number of smokers.

There is limited description of the actual multi-media materials used. Issues of smokeless tobacco were not addressed. Cost-savings were noted to be projections. Program evaluation is based upon self report and there is no evidence that the two communities (Montana/New York State) are comparable. Long-term impact not assessed. Several reviewers did not note any weaknesses.