Digital media and tobacco control: Building the evidence base First of 2 presentations from the HSC in this session on digital media and how those of us in the tobacco control sector are starting to use it. I’m talking about an international synthesis of learnings that HSC and Global Dialogue, have worked together to produce. Because many countries are interested in using digital media in their tobacco control campaigns and some have been getting experience with such campaigns, we wanted to find out what has been learned to date, so that we could share the lesson learned with other countries as they begin their campaigns. Digital media and tobacco control: Building the evidence base Rhiannon Newcombe, Iain Potter Health Sponsorship Council Karen Gutierrez Global Dialogue

Global Dialogue for effective stop-smoking campaigns Since 2005 Work internationally to improve campaigns US-based Numerous initiative partners Iain and I would like to acknowledge Karen Gutierrez here from Global Dialogue who is the main person working on this review. Global Dialogue: Global Dialogue collaborates internationally to improve the impact of campaigns to reduce tobacco use and exposure to secondhand smoke - began in January 2005 to address an unmet need for updated and accessible international tobacco campaign lessons learned. goal is to improve the impact of tobacco control mass media campaigns by applying updated campaign lessons learned from the global tobacco control community - Partners include: World Lung Foundation, American Cancer Society, American Legacy Foundation, England Dept of Health, VicHealth, HSC We are presenting on one of their latest projects – international review of tobacco control use of digital media My involvement: review of all case studies – I haven’t reviewed all yet, so if you have questions about individual country – get in touch with me afterwards and I can answer. WORK IN PROGRESS – still being completed. Case studies reviewed by end of 2010 and available on Global Dialogue website from early 2011

Why are communication strategies important? Part of a broad, comprehensive tobacco control programme Evidence of benefit Decrease youth uptake Increase cessation Reduced prevalence Traditional channels: TV, radio, print, outdoor, billboard WHY are communication strategies important in tobacco control? Evidence of benefit – clearly an important contribution to reducing prevalence. What we traditionally think of are traditional channels

Traditional channels

How are digital media defined? For purposes of this presentation: Computerised, or networked information and communication technologies. Examples: Websites Blogs Text messaging Cell phone communications

Why are digital media important? Embraced by business sector Tobacco industry using extensively Ad bans don’t usually including digital vehicles Facebook “fan” pages have been created for brands such as Marlboro, Peter Stuyvesant and Lucky Strike Camel brand engaged online community to help design a new cigarette packet - 5 million adult smokers had been invited to give their input Our audience use in everyday lives Calls that we should be using in public health WHY should those of us working in public health and tobacco control be interested? Tobacco industry: Advertising bans internationally don’t include digital platforms Also know through Becky Freeman’s work that the industry have engaged with online platforms to help with brand engagement and development. Most importantly for those of us using social marketing, however, is that our audiences are using digital media increasingly in their everyday lives BECAUSE of these factors, there have been calls made by prominent public health advocates that we should be using this medium as well – Simon Chapman and Becky Freeman among others.

Use by audience Digital media NZ Internet 83% of NZers use the internet1 Social networking 48% NZers access social networking sites1 Online games 26% of NZers have played an online game in the last fortnight2 Email 86% of NZers who use the internet use email3 Cell phone 86% of NZers have regular access to a cell phone2 Globally: More and more people are using digital media Using as a way to get information and make choices NOT just high-income or high-educated people New Zealand Digital media – high level of use These stats show the overall use by adult Nzers But for some groups, including youth, the penetration and use of these technologies is even greater. The second presentation will show some of the stats of the youth audience in NZ 1 Smith, P., Smith, N., Sherman, K., Goodwin, I., Crothers, C., Billot, J., Bell, A. (2010). The Internet in New Zealand 2009. Auckland: Institute of Culture, Discourse and Communication, AUT University. 2 Research New Zealand (2009). New Zealanders’ Use of Broadcasting and Related Media. Wellington. 3 Stats NZ

What do we know about impact of digital media campaigns? Not enough Many countries are using some form of digital media in their campaigns, however, too few are measuring outcomes “process” measures easy to find (i.e., # visitors to site, # text message responses, time spent on site) “outcome” measures more difficult (i.e., increases in knowledge, changes in attitudes, changes in behaviors)

International Review of Lessons Learned from Digital Campaigns Not a comprehensive literature review Used international networks Gathered lessons learned Reflect 8 lessons learned to date Work in progress

International Review of Lessons Learned from Digital Campaigns Country Case Studies: Australia (2) Canada (4) China Denmark (2) England (5) European Union (2) Germany Israel Netherlands New Zealand (2) Norway Singapore United Kingdom United States (6) - So, we reached out to our networks of campaign contacts internationally To try to compile process and outcome data on the digital campaigns that have been conducted to date received campaign data from these countries. As was expected, the majority are high-income countries, which isn’t surprising because they typically have more funds to conduct and to evaluate their campaigns. Over time, we hope to compile data from more low- and middle-income countries. NOW PRESENTING 8 lessons learnt to date – even though partially through the review. Each of these lessons reflects the experience of several countries in the review, not just one or two.

#1: Digital media can reach diverse audiences Examples: New Zealand: Maori England: Routine and Manual workers (“blue collar”) Singapore: Parents of young children Many countries: teenagers, young adult smokers, all smokers So, we’d like to go through 8 key lessons learned from the digital campaign review. LESSON ONE: confirmation that diverse audiences can be reached and influenced to think differently about tobacco-related topics through digital media. Here are some examples Maori: txt2quit – a text-based cessation service for young people. Maori engaged with this service and represented 1/3 of participants.

Singapore “Kids Watch. Kids Learn.” http://www.oureverydaythings.com/2009/08/smoking-kids-watch-kids-learn/ Here’s an example of one of many digital marketing interventions that the Singapore “Kids Watch. Kids Learn” campaign employed to reach parents of young children and motivate them to try to quit smoking so that their children would not take up smoking. Campaign staff engaged bloggers who were influential among parents of young children, and many of these bloggers began writing about the influence of smoking parents on their children’s behaviors. http://www.babyandpapa.com/forums/forum113/thread1470.html Influential Blogger Engagement

#2: People want to be engaged The second lesson learned is that people really want to be engaged. Here’s an example of the England Smokefree site. They were seeking to reduce smoking among blue collar, and in their digital campaign, they addressed the obstacles to quitting that they heard from this audience during qualitative research. Smokers in the lower socio-economic group were less likely to seek help, so they enlisted celebrities popular among this audience (such as this Actor from the Bill and Footballers vwes) to chronicle their quitting attempts. They showed skeptical quitters that “people like them” could quit by profiling real individuals in the community who had been successful quitting. And they connected smokers with call centre advisors via MSN messenger so they could communicate using technology that was being used every day by this audience. They also used digital mapping to link smokers with local cessation services. not only do these interventions address barriers to quitting but they also actively involve smokers in the program and in the various offerings.

Here’s another example from England – the Quit AllTogether campaign Here’s another example from England – the Quit AllTogether campaign. This campaign was built off the insight that people wanted to feel part of something, so it encouraged smokers to join a team to try to quit together. users can look at an individual’s progress and read a personal comment on why someone potentially just like them is quitting alongside them. Individuals are represented in clusters around Britain with mapping navigation, allowing users the take a closer look. Concept only

#3: Participants like digital interacting because it’s anonymous and personal Denmark Personal weight calculations Personal online advice (based on individual’s input) Discussion forum Diary Lesson number 3 is that participants seem to like interacting via digital media because it’s anonymous and yet very personal at the same time. Sounds like it could be contradictory, but in fact makes sense if you explore it more. 2. A smoker may be able to receive support without making it public that they are attempting to quit (such as a young person whose parents don’t know that they smoke) 3. Many programmes can use digital platforms to tailor tools to help the individual quit 4. Denmark – Xhale programme. Tailored and personalised feedback – based on individual input

Switzerland “Feelok” home page This youth stop-smoking program in Switzerland puts participants into one of several cessation programs based on a questionnaire they fill out about their smoking behaviors, interests, needs and attitudes.

New Zealand web banners And finally, NZ too offers a variety of tools tailored to smokers’ unique situations, such as how much money a smoker might save if they quit, based on their current tobacco consumption. SUMMARY: Digital media can reach diverse audiences People want to be engaged Participants like digital interacting because it’s both anonymous and personal

#4: Variety of digital vehicles can increase participants’ involvement The fourth lesson learned is that using a whole range of digital vehicles can increase the number of individuals reached and their level of involvement. In a campaign conducted by Cancer Research UK they sought to motivate youth and young adults to reject smoking, so they engaged youth by holding a competition to create the best tobacco control video. Once several finalists were selected, their videos were placed on video sharing sites and through viral seeding, greatly increasing exposure to the videos versus what would have been achievable by placing them on the CRUK website or the program website alone. United Kingdom: Viral seeding and video sharing

US (Minnesota) “QuitCash” Recruitment Email Blast In the United States, ClearWay Minnesota used a variety of digital technologies together to get smokers involved in the QuitCash challenge. They sent email messages to people with high likelihood of being smokers, encouraging them to sign up online for the QuitCash Challenge.

Quitcash.com Sign Up for Text Messages Mobile Welcome Text Message is sent immediately after user provides cell phone number and hits submit. Once a user agreed to provide their mobile phone number, a welcome message was sent to his phone.

Mobile Sign Up Scroll WAP Signup Page Same entry fields as online signup page. Intro Text Includes: “click to call” to the QUITPLAN Services Scroll Choice of weekly tips sent to email or mobile phone. Click to call QUITPLAN & link to website. The mobile message included an option to “click to call” the QuitPlan services, an option to go to the QuitPlan website and an option to be sent weekly email tips on quitting The tailoring to individual needs/preferences is a key feature of the digital platform. WAP Signup Page

Quit Tips Email and Videos Here’s an example of the quit tips that were sent via email. This one included a link to an entertaining video about quitting. MAIN MESSAGE HERE: That a variety of different offerings through different digital platforms can increase participant’s involvement

#5: Digital campaigns inexpensive, but reach limited and measurement critical UK Youth Anti-Smoking Video Competition: 108,000 views of winning videos across video sharing sites and seeding network ($1.63 per view) England: Yahoo Forum 300,000+ visitors (39,000+ visits of 5+ minutes) Almost 4000 smokers pledged to quit smoking (each cost NHS 1/3 of what normal TV campaign costs to achieve) England: MSN partnership 160,000 unique visitors over 6 weeks Cost per active response of approx. $7.50 (the lowest of all media responses, including TV) The fifth lesson is that while digital campaigns are typically much less expensive than broadcast campaigns, their reach is also typically much more limited. That makes it very important to measure the outcomes of these campaigns, so you know what impact, if any, you are making on the audience’s attitudes and behaviors. Many campaigns are not being evaluated at all, beyond number of site visits, time on the site, pages viewed, etc. Here are some examples of campaigns that went further in evaluating what they got for their spending. 1. CRUK intervention - mentioned earlier, they achieved 108,000 views of the winning videos at a cost of $1.63 per view. While this is very helpful information, they did not go further and measure whether anyone changed their attitudes or behaviors as a result of seeing the videos. 2. England’s Yahoo Forum campaign measured not only the number of visitors and the interaction between Forum members but also the number of smokers who pledged to quit smoking. Importantly, they also measured the cost of getting each smoker to pledge to quit in the Forum versus through normal TV campaigns Found that the digital campaign was much more cost-efficient. ONE-THIRD 3. England’s MSN partnership campaign - they measured not just number of visitors and number of videos viewed but also contacts between quitting advisors and participants and cost per active response—versus other mass media—again finding digital to be more cost-efficient than TV, radio and print.

“Smoke-free Ride” Results Canada: Campaign for a Smoke-free Ride Campaign to influence parents not to smoke in cars and increase support for legislation Measured awareness, main message communication, attitudes & claimed behaviors Findings 86% awareness among parents ‘Smoking in cars with children is illegal’ most commonly recalled message Those who recalled Campaign in greater disagreement with statement ‘Smoking in cars with children won’t harm them as long as you leave the windows open’ than those who didn’t recall campaign Those who recalled Campaign messages less likely to report smoking in cars with children. For Canada’s “Campaign for a Smoke-Free Ride AIM: sought to influence parents not to smoke in cars and build support for legislation prohibiting smoking in cars where children are present. In addition to conventional media vehicles, campaign elements included Website and web buttons WHAT DID THE EVALUATION DO? Measured outcomes the way that regular broadcast campaigns are measured—through awareness of the campaign, main message communication, and changes in attitudes and claimed behaviors. Could compare the progress this campaign made versus traditional media campaigns. WHAT DID THEY FIND? By using traditional and digital media, they achieved very high awareness of the campaign among all parents, not just those who had visited the site. People recalled campaign message People who recalled the campaign had more pro-campaign attitudes and behaviour change

Smoking cessation support 12-month follow-up study Xhale Results Smoking cessation support 12-month follow-up study Intervention > control to be Smokefree at 1 year follow-up Positive feedback on content and form Attracted target audience (15- to 25-year-olds) XHALE as already mentioned – smoking cessation support for young people aged 15 to 25 USED a website, and text-messages and e-mail programs WHAT DID THEY DO? - A 12-month follow-up study was conducted - telephone interviews of both intervention and control groups. - Control groups came from national survey baseline who indicated they were current smokers FINDINGS: Xhale.dk participants were more likely than the control group to be smoke-free one year after the baseline measurement (3x more quit) Overall, xhale.dk was perceived positively by participants – they are willing to recommend it to others. Both the content and form of communication of xhale.dk attracted the 15- to 25-year-old target audience

#6: Digital campaigns can benefit from saliency of traditional media Nielsen (2010) TV has far greater reach Web advertising helps TV campaigns work ‘harder’ The sixth lesson learned is that digital campaigns can really benefit from combining digital with conventional media—the saliency, or presence of your campaign on traditional channels such as TV, radio, print, etc. and their high levels of exposure can help the digital campaign get the high awareness needed to cause population-level changes. Relates to some recent research conducted by Nielsen TV still has far greater reach web advertising helps TV campaign work harder. Double the impact of an exposure if on TV+online versus online only

England Example: of how digital campaigns can benefit from traditional media England “Smokefree United” Idea: men can ‘get more out of their game’ by going smoke free Used football as mechanism to appeal to target audience. To create a club of fans who want to quit smoking Had a digital strategy – website with quitting information – “coaching” BUT also used traditional media to promote the campaign Radio station Talksport promoted SF United for 12 weeks with advertorials, live DJ reads, live quitting clinic on morning show Radio DJs encouraged smokers to visit SF United site, pledge to quit and submit a ‘smokefree chant’—winner would chant on-air and win a prize for their community

Canada “Smoke-Free Ride” Materials We’ve already discussed some of the results from this campaign, but just to add here: Canada’s “SF Ride” campaign used several traditional vehicles to help build awareness of the online campaign, including bumper stickers and print ads. By using traditional and digital media, they achieved very high awareness of the campaign among all parents, not just those who had visited the site.

#7: Needs to be part of a broader strategy One-off approaches less successful Needs to be integrated Strategy important Campaign managers report this.

#8: Internet opens your program to everyone in the world Benefits: inexpensive way to publicise your program and key messages Also a way to help target a global problem Drawbacks: difficult to determine whom you are reaching and whether they are in the scope of your target audience(s) Your cost per participant or per visitor may include people who you aren’t interested in reaching Lastly, the seventh lesson learned is that one of the Internet’s biggest benefits is also one of its biggest drawbacks. The fact that the Internet can reach many, many people at a very low cost is great news for most of us with our limited budgets. ALSO good way to target global problem However, because of this, your Internet-based programs are also reaching many, many people who aren’t in your target audience, who don’t live in your country, and who your funds weren’t meant to cover. Thus, you need to be very careful when evaluating your cost per participant or registrant or visitor to make sure that you really know how many people in YOUR TARGETED population are being reached.

Example – viral games developed in New Zealand Kiss Off Kanvas Example – NZ shows how placement of digital campaigns can impact on who engages with your campaign. two viral games produced for a youth-focussed tobacco control mass media campaign in NZ called Smoking Not Our Future. Data showed that NZ youth were playing games on the internet often. So this mechanism was used to promote tobacco control messages to a target audience who may be resistant to traditional message delivery Kiss Off – a game looking at promoting social dissaproval and denormalisation messages of Smoking Not Our Future campaign. Kanvas – an art game which promoted smokefree imagery and messages.

Example 1: Kiss Off Example 2: Kanvas Smoking Not Our Future Application on FB, Bebo, and seeded into global viral gaming sites 450,000 visits, including 22,000 from NZ NZ visits ranked 6th Example 2: Kanvas Linked to NZ campaign website 26,500 visits, including 25,000 from NZ NZ visits ranked 1st Example here of two viral games developed in NZ with tobacco control messages. The difference in promotion of these games has led to a different profile of results in terms of reach and participation. Tobacco is a global epidemic and this example shows how some initiatives can have a global impact, whilst not reducing the impact on the country of origin’s audience. Shows also the powerful presence of audience-specific activities – Brazil youth – high users of flash gaming sites where the games were seeded.

Summary of Lessons Learned Digital media provide excellent means to reach diverse audiences, not just youth and high-income People want to be engaged—want to be heard and give advice (e.g., stories and experiences), to build relationships Participants like interacting digitally because it feels both anonymous and personal/tailored A variety of digital vehicles and relationships (Internet, mobile messaging, IVR, etc.) can increase the participants’ involvement in the program Digital campaigns can reach many people quickly and inexpensively, however numbers typically in thousands not millions, and outcomes are critical to measure Digital campaigns can benefit from the saliency of traditional vehicles Digital campaigns need to be part of a broader strategy The Internet opens your program to everyone in the world—has benefits and drawbacks

Contact Information Karen Gutierrez Global Dialogue for Effective Stop-Smoking Campaigns global@stopsmokingcampaigns.org For campaign development resources and summaries of lessons learned, visit: www.stopsmokingcampaigns.org Rhiannon Newcombe Health Sponsorship Council rhiannon@hsc.org.nz Please note that while we have compiled over 20 case studies to date and have done initial analysis on them, we still welcome campaign details and results from more countries, so if you have campaign data to share, please send it to us as soon as possible. We will be finishing analysis of the data in December. We hope to have the full digital campaign review document finalized within the first half of 2011, and as soon as it is finalized, we will upload it to the Global Dialogue website (mentioned here). We will also send an announcement to our list of Global Dialogue members, so if you haven’t already registered online to be a GD member, please take a few minutes to do so. Thanks!

US time spent on internet Source: http://blog.nielsen.com

Use of digital media is changing 40% of time by US online users spent doing three things: Social networks Online games E-mail Increase in time spent on social networking sites and online games; email decreasing