Powerful Anti-Smoking Ad Campaigns Work

Hard-hitting anti-smoking media campaigns effectively raise awareness about the serious toll that tobacco use takes on one’s health and the many lives it affects.

In the United States, tobacco use is responsible for about 480,000 deaths each year.1 For every person who dies, about 30 more people suffer with at least one serious illness from smoking.2 Smoking also affects the numerous nonsmokers exposed to hundreds of toxic chemicals in secondhand smoke. Since 1964, 2.5 million nonsmokers have died from exposure to secondhand smoke.3

Can a graphic and emotional ad on TV really make a difference? The Florida Department of Health’s (FDOH) Tobacco Free Florida campaign uses aggressive ads that show the human impact of smoking as part of a comprehensive program. FDOH and the Bureau of Tobacco Free Florida (BTFF) select ads that have run in other states and countries and that have had a demonstrated positive effect on inspiring people to seek help in quitting smoking.

Tobacco Free Florida has seen encouraging results in reducing tobacco use in the state. The adult cigarette smoking rate in Florida was at 16.8 percent in 2013. That was below the 2013 national average of 19 percent.4 Florida’s adult cigarette smoking rate decreased by 13 percent – from 19.3 percent in 2011 to 16.8 percent in 2013.

Another positive sign is the increased number of people served by Tobacco Free Florida’s 3 Ways to Quit, which are free and evidence-based resources that include the Florida Quitline, Web Coach and in-person classes via the Florida Area Health Education Centers (AHEC). For example, from July 2013 through June 2014, more than 93,100 Floridians used one of the 3 Ways to Quit.5

Furthermore, Florida has seen great progress in reducing cigarette use among youth. Since Tobacco Free Florida began airing hard-hitting ads in 2010, the state’s youth cigarette smoking rate has been cut by about half – from 8.3 percent in 2010 to 4.3 percent in 2014 among Floridians ages 13-17.6 The state had one of the lowest high school cigarette smoking rates in the country at 7.5 percent in 2014. That was below the national average of 9.2 percent in the equivalent 2014 national survey.7 The decrease in smoking among young people in Florida is an encouraging indication of the effectiveness of our tobacco control program.

Strong evidence proves that graphic, hard-hitting anti-tobacco ads work, and those that arouse strong negative emotions perform better than those that do not. Hard-hitting media campaigns are not only effective at promoting quit attempts, they also reduce youth initiation.8

The Evidence

  • According to a report published in The Lancet medical journal in September 2013, the Centers for Disease Control and Prevention’s (CDC) 2012 Tips From Former Smokers (Tips) campaign motivated 1.6 million smokers to make a quit attempt. More than 100,000 U.S. smokers will remain quit as a result of the 2012 campaign. An estimated 6 million nonsmokers talked with friends and family about the dangers of smoking.9 Several Tips ads were chosen by FDOH and BTFF to run in Florida.
  • During March 4–June 23, 2013, CDC conducted its second annual Tips campaign. During the campaign, the average weekly numbers of calls and website visitors increased by 75 percent and almost 38-fold, respectively, compared with the 4 weeks before the campaign, and quickly decreased almost to pre-campaign levels once the campaign ended. This suggests that the campaign led to 151,536 additional quitline calls and nearly 2.8 million additional unique Tips website visitors above pre-campaign levels.10 Several of these Tips ads were also chosen by FDOH and BTFF to run in Florida.
  • Studies show that emotionally evocative media campaigns featuring graphic images of smoking-related diseases are effective in motivating smokers to quit.11,12,13,14
  • According to a study published in June 2010, ads that utilize a why-to-quit strategy with graphic images of the physical consequences of smoking and ads that use testimonials of personal loss from smoking were perceived as more effective among smokers than other ad categories.15
  • Campaigns that show the serious health consequences linked to smoking to motivate adults to quit have also been associated with prevention of smoking uptake among youth.16
  • Studies indicate that sad or frightening ads that are highly emotional and feature the serious health consequences of tobacco use score significantly higher among adults on perceived effectiveness compared to ads that are funny or neutral.17
  • In one study, smokers who reported being exposed to more highly emotional and personal testimonial ads were more likely to quit smoking at follow-up.18
  • Meta-analyses on the use of fear appeals in health campaigns conclude that fear appeals are most effective when accompanied by equally strong efficacy messages, such as information to call a quitline for help and support to quit.19
  • In New York, researchers found that graphic television ads were strongly associated with higher call volume to a quitline from 2001 to 2009.20 Two of those ads, Reverse the Damage – Heart Attack and Reverse the Damage – Lung Cancer were chosen by FDOH and BTFF to run in Florida.
  • The Australia National Tobacco Campaign, which featured graphic hard-hitting ads depicting the negative health consequences of smoking, found that the campaign achieved high rates of recall and recognition, was appraised favorably by smokers, contributed to new learning about smoking and health, and increased agreement with campaign-related attitudes.21,22 Furthermore, even though the campaign was not targeted at teenagers, the vast majority of adolescents were aware of the campaign and thought it was relevant to them.23 These ads, Artery and Sponge were chosen by FDOH and BTFF to run in Florida.

To view some of Tobacco Free Florida’s ads, please visit tobaccofreeflorida.com/videos.


1 U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

2 U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

3 U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

4 Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Prevalence and Trends Data, 2013. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

5 Professional Data Analysis

6 Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2014.

7 Centers for Disease Control and Prevention (CDC). Tobacco Use Among Middle and High School Students—United States, 2011–2014. MMWR Morbidity and Mortality Weekly Report 64(14);381–385. 16 April 2015

8 National Cancer Institute, The role of the media in promoting and reducing tobacco use. Tobacco\ Control Monograph No. 19. NIH Pub. No. 07-6242, 2008, USDHHS, National Institutes of Health, National Cancer Institute: Bethesda MD.

9 McAfee T, Davis KC, Alexander Jr RL, Pechacek TF, Bunnell R. Effect of the first federally funded US antismoking national media campaign. Lancet 2013; September 9

10 Centers for Disease Control and Prevention. Impact of a national tobacco education campaign on weekly numbers of quitline calls and website visitors–United States, March 4-June 23, 2013. MMWR Morb Mortal Wkly Rep. 2013 Sep 20;62(37):763-7.

11 Community Preventive Services Task Force. Reducing tobacco use and secondhand smoke exposure: mass-reach health communication interventions. Atlanta, GA: Task Force on Community Preventive Services; 2013. Available at http://www.thecommunityguide.org/tobacco/massreach.htm

12 National Cancer Institute. The role of the media in promoting and reducing tobacco use. Tobacco control monograph no. 19. Bethesda, MD: US Department of Health and Human Services, National Cancer Institute; 2008. Available at http://www.cancercontrol.cancer.gov/tcrb/monographs/19/index.htm

13 Durkin S, Brennan E, Wakefield M. Mass media campaigns to promote smoking cessation among adults: an integrative review. Tob Control 2012;21:127–38.

14 Farrelly, M, Mann N, Watson K, Pechacek T. The influence of television advertisements on promoting calls to telephone quitlines. Health Educ Res 2013;28:15–22.

15 Davis, K. C., Nonnemaker, J. M., Farrelly, M. C., Niederdeppe, J. Exploring differences in smokers’ perceptions of the effectiveness of cessation media messages. Tob. Control 2010;0:tc.2009.035568v1-tc.2009.035568

16 Wakefield, M.A., B. Loken, and R.C. Hornik, Use of mass media campaigns to change health behaviour. Lancet, 2010. 376(9748): p. 1261-71.

17 Biener, L., Anti-tobacco advertisements by Massachusetts and Philip Morris: what teenagers think. Tob Control, 2002. 11 Suppl 2: p. ii43-6.

18 Durkin, S.J., L. Biener, and M.A. Wakefield, Effects of different types of antismoking ads on reducing disparities in smoking cessation among socioeconomic subgroups. Am J Public Health, 2009. 99(12): p. 2217-23.

19 Witte, K. and M. Allen, A meta-analysis of fear appeals: implications for effective public health campaigns. Health Educ Behav, 2000. 27(5): p. 591-615.

20 Farrelly, M.C., et al., Promoting calls to a quitline: quantifying the influence of message theme, strong negative emotions and graphic images in television advertisements. Tob Control, 2011. 20(4): p. 279-84.

21 Tan, N., M. Wakefield, and J. Freeman, Changes Associated with the National Tobacco Campaign: Results of the Second Follow-up Survey. , Canberra, Editor 1999, Commonwealth Department of Health and Aged Care.

22 Wakefield, M., J. Freeman, and J. Boulton, Changes Associated with the National Tobacco Campaign: Pre and Post Campaign Surveys Compared. , Canberra, Editor 1999, Commonwealth Department of Health and Aged Care.

23 White, V., et al., Do adult focused anti-smoking campaigns have an impact on adolescents? The case of the Australian National Tobacco Campaign. Tob Control, 2003. 12 Suppl 2: p. ii23-9.