Appraisal of anti-smoking advertising by youth at risk for regular smoking: a comparative study in the United States, Australia, and Britain M Wakefield, R Durrant, Y Terry-McElrath, E Ruel, GI Balch, S Anderson, G Szczypka, S Emery, B Flay ............................................................................................................................. Tobacco Control 2003;12(Suppl II):ii82–ii86 Objective: To compare the similarity in how youth in the United States, Australia, and Britain appraise anti-smoking advertisements with different characteristics. Design: Each participant viewed and evaluated a set of 10 anti-smoking adverts (from an overall total of 50 adverts) in a controlled experimental context using an audience response methodology. A struc- tured telephone interview was completed one week after viewing the adverts, in which recall and engagement with the adverts by participants was evaluated. Subjects: 615 youths who were experimenting with smoking or were susceptible nonsmokers. Main outcome measures: Measures of advert appraisal and engagement. Results: Youth in the United States, Australia, and Britain responded in very similar ways to the same anti-smoking advertisements. In full multivariate models, the target audience of the advert and the advert theme were not related to the main outcome measures employed in this study. However, adverts with visceral negative or personal testimonial executional characteristics were appraised more positively by youths and were more likely to be recalled, thought about, and discussed at follow up one week later. Conclusions: Youths in three different countries responded to anti-smoking advertisements in very simi- lar ways, suggesting that such adverts might be more actively shared among nations. The appraisal of, and engagement with, the anti-smoking adverts, however, varied substantially depending on executional characteristics. In the design of effective anti-smoking adverts, due attention needs to be paid to those characteristics that appear to most engage youth across different social and cultural envi- ronments. A good deal of evidence now indicates that anti-smoking advertising can be effective in reducing levels of smoking among youth. 1–5 Anti-smoking advertising has been a promi- nent component of tobacco control initiatives in the United States and has been associated with declines in smoking prevalence among both youth and adults in the States where such advertising has been employed. 167 The use of anti- smoking advertising has also been an important element of tobacco control efforts in Australia since the early 1980s. These advertisements, which have most recently depicted in graphic detail the adverse health consequences of smoking, have gen- erated high public awareness and positive responses among both youth and adults. 8–11 Tobacco control programmes in Britain have also employed anti-smoking advertising with some success. 12 However, not all anti-smoking advertisements are equal in terms of their efficacy in changing smoking related beliefs, attitudes, and behaviours. Indeed, a number of studies have failed to find a relationship between anti-smoking advertising and reductions in tobacco prevalence. 2–4 Clearly it is important to establish the characteristics of adverts and marketing strategies that are best able to advance tobacco control objec- tives. Opinions vary, however, regarding just what sorts of adverts are most likely to reduce smoking among youth. Pech- mann and Reibling 13 suggest that messages that emphasise harm to family, and the socially unacceptable nature of smok- ing, are likely to be most effective, whereas Goldman and Glantz 14 argue that adverts that portray the harms caused by secondhand smoke and the duplicitous nature of the tobacco industry will be most successful. Other research indicates that highly emotional appeals that depict, in graphic detail, the adverse consequences of smoking are likely to be most effec- tive for both youth and adults. 15–16 In comparison, advertise- ments that emphasise youth choice, or that smoking is uncool, such as those developed by Philip Morris, tend to be rated poorly by youth 17 and may have a counterproductive effect on tobacco control objectives. 18–19 More research is clearly required to establish the features of anti-smoking advertisements that are most likely to change smoking related beliefs, attitudes, and behaviours in ways that are commensurate with reducing the harm caused by tobacco in society. One important, as yet unanswered, question concerns the extent to which these findings generalise across different nations. Do youth in different countries respond in the same way to anti-smoking messages and appeals? Providing an answer to this question is important for a number of reasons. By establishing the characteristics of advertisements that are effective in a variety of different contexts, the development of new anti-smoking advertisements can be undertaken in ways that are likely to best realise tobacco control objectives. Furthermore, if youth in different countries respond in similar ways to anti-smoking advertisements, a strong prima facie case can be made for the sharing of such advertisements among nations, which could result in considerable financial savings. The present study was designed to address the way that youth at risk for regular smoking in the United States, Australia, and Britain respond to a variety of different anti-smoking advertisements. Two main research questions were posed: (a) do youth in the United States, Australia, and Britain respond in similar ways to anti-smoking advertising?; and (b) how are different anti-smoking advertisements, with different charac- teristics, appraised by youth in these three nations? METHOD Advert selection and preparation In total, 50 advertisements were selected for inclusion in this study. These adverts were produced and aired in the United See end of article for authors’ affiliations ....................... For correspondence: M Wakefield, Director, Centre for Behavioural Research in Cancer, The Cancer Council Victoria, Carlton, Victoria, Australia, 3053; Melanie.Wakefield@ cancervic.org.au ....................... ii82 www.tobaccocontrol.com