Graphic Ads Motivate Smokers to Quit

ANAHAD O’CONNOR
The New York Times
September 10, 2013

For almost two decades, Lisha Hancock smoked between one and two packs of cigarettes a day.

Her husband often urged her to quit, but neither his pleading nor the fact that several of her relatives died from smoking-related complications could persuade Ms. Hancock to stop.

The smoke she inhaled constantly bothered her throat and clogged her sinuses. Rather than give up smoking, though, Ms. Hancock started taking an antihistamine so she could ease the irritation in her throat and continue lighting up.

Then she saw a graphic television commercial featuring a former smoker, Terri Hall, who developed head and neck cancer. The widely seen advertisement shows Ms. Hall inserting a set of false teeth and placing a small speaker inside a hole in her neck.

“It scared me because I had always had problems with my throat,” said Ms. Hancock, 38, who lives in Kentucky. “When I saw that, it made me realize that there are other types of cancer besides lung cancer, and that really hit home for me.”

The ad prompted her to give up smoking about eight months ago, using a combination of an exercise and healthful eating regimen along with nicotine lozenges, and she has not had a cigarette since. But Ms. Hancock may be just one of thousands of Americans who quit smoking after seeing the commercial featuring Ms. Hall, which was part of a series of antismoking ads put out by the federal government last year. The campaign, called Tips From Former Smokers, was notable both for its raw images and because it marked the first time that the government directly attacked the tobacco industry in paid, nationwide advertisements.

According to a new study published on Monday in The Lancet, the ads may have prompted more than 100,000 Americans to give up smoking for good.

The study, led by a team at the Centers for Disease Control and Prevention, surveyed 5,300 Americans before and after the campaign, including 3,000 smokers. The paid ads ran for three months beginning in March, just after the New Year resolution season, when the percentage of smokers trying to quit is typically on the decline.

The researchers found that over all, four of five of smokers had seen the commercials, and the percentage who reported trying to quit rose by 12 percent. Of those who tried to quit, about 13 percent remained abstinent after the campaign had ended.

Using census data, the researchers estimated that as many as 1.6 million smokers nationwide attempted to quit as a result of the ad campaign. Most smokers require several attempts before they give up cigarettes for good, so only a fraction of those who were motivated by the campaign would have succeeded. The ads were expected to spur about 50,000 smokers to quit permanently, but the Lancet study estimated that twice that number were successful.

“We had very ambitious goals for this program,” said Dr. Thomas Frieden, the director of the C.D.C., “and it succeeded beyond our highest hopes.”

Historically, about half of the nation’s 45 million smokers try to quit every year, and yet cessation rates hover around 5 percent annually. Public health officials have long been telling smokers that cigarettes shave years off your life, contributing to more than 400,000 deaths every year.

The new campaign went in a different direction, focusing not on death but on quality of life. The creators of the campaign used focus groups and feedback from smokers to develop sobering ads showing real smokers with amputations, paralysis and disfigurement from heart and lung surgeries.

“I think the fact that you may die is not highly motivating to people,” Dr. Frieden said. “The fact that the remainder of your life may be very unpleasant is, and that’s what the data shows. Not only do smokers die about ten years younger than most people, but they feel about ten years older than their age.”

The campaign last year cost about $54 million and was paid for by the Affordable Care Act. Another series of ads ran earlier this year at a cost of roughly $48 million, and according to the C.D.C., the ads will be returning next year as well. Dr. Frieden said the money, which is only a fraction of the $8 billion the tobacco industry spends on marketing and promotion every year, was well spent.

“This is a campaign that has literally saved tens of thousands of lives,” he said. “We would like to be able to have hard-hitting campaigns like this on the air year round. The tobacco industry spends what we spent on this campaign in three days.”

In an interview with The New York Times in March, Ms. Hall said she is often approached by former smokers who recognize her from the commercials and thank her for prompting them to quit. One more person who would like to shake her hand is Ms. Hancock.

“I would say to her, thank you for putting yourself out there and being so brave when I know she’s so vulnerable, because it changed my life,” she said. “When I saw her commercial, I could see the regret and disappointment in her eyes. As a smoker I could feel it, because that’s exactly how I felt every time I picked up a pack of cigarettes.”