1. Preliminary top-line quantitative findings Preliminary top-line quantitative findings Anti-smoking radio and television advertisement ratings: Kenya, Nigeria and Senegal

2. Objectives Evaluate existing anti-smoking television and radio ads in low- and middle- income African countries, including Kenya, Nigeria, and Senegal Ads that have tested well in high-income countries should also perform well in low- and middle- income countries (LMICs) in Africa  If so, LMICs may be able to adapt existing anti-smoking advertisements for mass media campaigns at a lower cost than creating new ads

3. Aims The primary aim of the study is to assess the comprehension, acceptability, and potential effectiveness of existing anti-smoking television and radio advertisements in two locations in Kenya, Nigeria, and Senegal Also aim to examine whether non-smokers and smokers respond similarly to these ads  Within each country and across countries

4. Method: Advertisements Five radio ads were tested in each country. They were: Emphysema Sufferer Keith Industry SpokesmanCoughing ChildSufferingBronchoscopy A man describes how smoking has caused him to develop COPD Tobacco industry executives discussing that they need more Africans to start smoking Describes the harm smoking causes to children States that many Africans are suffering from emphysema caused by smoking Features a doctor talking about late diagnosis of lung cancer in smokers

5. Method: Advertisements Five television ads were tested. They were: Cigarettes are eating your baby alive Break the Chain Lung (Lung India in Kenya) SpongeIndustry Revealed

6. Method: Sample Kenya and Nigeria: 20 groups of approximately 10 adult non-smokers 16 groups of approximately 10 adult smokers 2 locations: Nairobi and Eldorat (Kenya), Lagos and Abuja (Nigeria) Senegal: 12 groups of approximately 10 adult non-smokers 12 groups of approximately 10 adult smokers 1 Location: Dakar Results from a second location (Saint Louis) will be available at a later date All materials were translated and presented in appropriate local language/s for each country

7. Method: Sample Non-smokers: those who do not currently smoke and have smoked fewer than 100 cigarettes in their lifetime Smokers: daily smokers who have smoked for at least 1 year Note: M=Mean, SD=Standard deviation KenyaNigeriaSenegal Number of cigarettes smoked per day M=10.16 (SD=6.22) M=8.48 (SD=7.20) M=10.52 (SD=6.29) Previously attempted to quit smoking 75%53%70% Thinking about quitting within the next twelve months 45%48%67%

8. Method: Sample: Non-smokers KenyaNigeriaSenegal Total participants 200 112 Male 60%61% 64.3% Female 40% 35.7% 18-29 years 60% 71.4% 30-40 years 40%41% 28.6% University degree or above 24%41% 50.9% Parent 38.5%24% 13.4% Live with a smoker 23%21% 53.6% Smoking allowed indoors 12%11% 35.7% Television at home 95.5%94% 98.2% Radio at home 98%92% 98.2%

9. Method: Sample: Smokers KenyaNigeriaSenegal Total participants 160159111 Male 75% 65.8% Female 25% 34.2% 18-29 years 63%62% 67.6% 30-40 years 37%38% 32.4% University degree or above 35%48% 42.1% Parent 41%28% 26.1% Live with a smoker 51%65% 76.6% Smoking allowed indoors 37%36% 46.9% Television at home 93%97% 99.1% Radio at home 97%96% 95.5%

10. Method: Procedure Participants were presented with each ad twice They then gave ratings about the extent to which they agreed or disagreed with 14 statements about the ads: Measured on a 5-point scale: 1 ‘strongly disagree’ 5 ‘strongly agree’ All participants answered: Five measures of perceived effectiveness: α = 0.697 …makes me stop and think …taught me something new …is relevant to me …is believable …concerned about my smoking (smokers only) …concerned about other people smoking around me (non-smokers only) Three anti- industry/government support measures: α =0.804 …makes me feel angry at the tobacco industry …makes me think that the tobacco industry is deceitful …increases my support for government actions to stop tobacco use

11. Method: Procedure Three additional measures: …I would talk to someone else about the message in this ad …makes me feel uncomfortable...is easy to understand Non-smokers answered three measures of Commitment to avoiding tobacco α = 0.732 …increases my commitment to not smoking …concerned about other people smoking around children …makes me think I should avoid places where people smoke Smokers answered two measures of Self-efficacy α =0.839 and One additional measure …makes me feel motivated to quit smoking …increases my confidence to quit smoking …should not smoke around others

12. Analysis The adjusted proportion of participants that gave a positive response on each of the outcomes was calculated separately for each country, and separately for smokers and non-smokers Analyses adjusted for the effects of: Order of ad presentation, location of testing, and language Age, gender, and socioeconomic status Parental status and highest level of education attained Living with a smoker and whether smoking is allowed inside home Having a TV and/or radio at home For smokers: Daily cigarette consumption, intention to quit smoking in the next 12 months, previous quit attempts

13. Analysis For Kenya and Nigeria, the percentage of participants that agreed or strongly agreed with each item for each ad was analysed Due to a high positive response bias in Senegal, the percentage of participants that strongly agreed with each item for each ad was analysed

14. Ad Rating Results: Radio Advertisements

15. Overall, Coughing Child was rated as the most understandable ad in all three countries (equal with Suffering in Kenya) The ads that were rated lowest on Understand were Industry Spokesman (Nigeria and Senegal) and Emphysema Sufferer Keith (Kenya) Non-smokers: Understand *

16. Consist with the non-smoker results, Coughing Child was also rated as the most understandable ad in all three countries by smokers Again consistent with the non-smoker results, the ads that were rated lowest on Understand were Industry Spokesman (Nigeria and Senegal) and Emphysema Sufferer Keith (Kenya) Smokers: Understand

17. The pattern of responses was very similar across the three countries Coughing Child was the highest rated ad on measures of perceived effectiveness in all three countries Likewise, the same ad Industry Spokesman, was rated lowest in all three countries Non-smokers: Perceived effectiveness *

18. Smokers responses were very consistent with non-smokers Coughing Child highest rated ad on measures of perceived effectiveness in all countries for smokers Again consistent with the non-smoker results, Industry Spokesman was the lowest rated ad three countries for smokers Smokers: Perceived effectiveness

19. * = Highest rated ad for that country; ~ = Lowest rated ad in that country For both Kenya and Nigeria the highest rated ad was Coughing Child, in contrast to Industry Spokesman in Senegal For both Nigeria and Senegal the lowest rated ad was Bronchoscopy, in contrast to Industry Spokesman in Kenya Non-smokers: Uncomfortable *

20. The highest rated ad in Nigeria was Suffering and the highest rated ad in Senegal was Coughing Child In Kenya, three ads (Suffering, Coughing Child, and Bronchoscopy) received equally strong ratings The lowest rated ad overall was Industry Spokesman, however, in Senegal four ads received equally poor ratings Smokers: Uncomfortable

21. For both Kenya and Senegal, Industry Spokesman was the highest rated ad on the anti-industry/government support measures, in contrast to Nigeria where Coughing Child was highest Emphysema Sufferer Keith and Bronchoscopy tended to be rated lowest across all three countries Non-smokers: Anti-Industry and Support for government actions *

22. In Kenya and Senegal, consistent with the non-smoker results, the highest rated ad was Industry Spokesman In contrast, Suffering was the highest rated ad in Nigeria Emphysema Sufferer Keith was the lowest rated ad on the anti- industry/government support measures in all three countries Smokers: Anti-Industry and Support for government actions

23. Coughing Child was the highest rated ad in all three countries on measures of commitment to avoid tobacco Industry Spokesman was the lowest rated ad in all three countries Across all countries, all ads were rated strongly – above 75% Non-smokers: Commitment to avoid tobacco *

24. There was some differentiation in ad performance between countries Overall, the highest rated ad in Nigeria and Senegal was Coughing Child, in contrast to Suffering in Kenya The lowest rated ad in Kenya and Nigeria was Industry Spokesman (equal with Bronchoscopy in Kenya) and the lowest rated ad in Senegal was Suffering Smokers: Self-efficacy

25. The pattern of responses to the ads was similar across countries By far, the highest rated ad on the measure Should not smoke around others was Coughing Child in all three countries The lowest rated ad in all three countries was Industry Spokesman Smokers: Should not smoke around others

26. In all three countries, Coughing Child was the highest rated ad on Discuss There was differentiation in the lowest rated ad between countries: Emphysema Sufferer Keith in Kenya, Industry Spokesman in Senegal, and Bronchoscopy in Nigeria Across all countries, all ads were rated strongly on Discuss – above 80% Non-smokers: Discuss *

27. Consistent with the non-smoker results, Coughing Child was the highest rated ad on Discuss in all three countries (equal with Suffering in Kenya) Emphysema Sufferer Keith, Industry Spokesman, and Bronchoscopy showed lower ratings overall across all three countries Smokers: Discuss

28. Ad Rating Results: Television Advertisements

29. For non-smokers, there was very little variation within each country as all ads were rated very strongly on Understand – all above 80% The pattern of responses was similar across countries Non-smokers: Understand ~ ~ ~ ~

30. For smokers, there was slightly more differentiation between ad ratings within each country Baby Alive was the highest rated ad in Nigeria and Senegal Industry Revealed was highest rated ad in Kenya but lowest rated in Nigeria and Senegal Sponge was the lowest rated ad in Kenya and Senegal Smokers: Understand ~

31. The highest rated ad in all countries was Sponge (equal with Lung in Kenya and equal with Baby Alive in Nigeria) The lowest rated ad in all three countries was Break the Chain In Kenya and Nigeria, all five ads were rated above 80% Non-smokers: Perceived effectiveness

32. The highest rated ad in Kenya and Senegal was Sponge (equal with Lung in Kenya) in contrast to Baby Alive in Nigeria The lowest rated ad in all countries was Break the Chain (equal with Industry Revealed in Nigeria) Smokers: Perceived effectiveness ~ ~

33. The highest rated ad on Uncomfortable in all three countries was Baby Alive (equal with Sponge in Kenya) The lowest rated ad in all three countries was Break the Chain All ads except Break the Chain were rated similarly in Kenya Non-smokers: Uncomfortable

34. Sponge was the highest rated ad in Kenya and Nigeria, in contrast to Industry Revealed in Senegal Consistent with the non-smoker results, the lowest rated ad on Uncomfortable in all three countries was Break the Chain Smokers: Uncomfortable ~

35. For the anti-industry/government support measures, there was no meaningful differentiation in ad ratings in Nigeria In Kenya and Senegal, the highest rated ad was Industry Revealed The lowest rated ad in Kenya and Senegal was Break the Chain (equal with Lung in Senegal) Non-smokers: Anti-industry and Support for government actions

36. The pattern of responses for smokers was similar across all countries The highest rated ad in all countries was Industry Revealed The lowest rated ad in all countries was Break the Chain Smokers: Anti-industry and Support for government actions ~

37. The highest rated ad in all three countries was Baby Alive (equal with Lung in Kenya and Nigeria) The lowest rated ad in Kenya and Senegal was Industry Revealed, in contrast to Break the Chain in Nigeria All five ads were rated above 80% Non-smokers: Commitment to avoid tobacco

38. In Kenya the highest rated ad was Lung and the lowest were Break the Chain and Industry Revealed In Nigeria the highest rated ad was Baby Alive and the lowest was Break the Chain In Senegal the highest rated ad was Industry Revealed and the lowest were Lung and Sponge Smokers: Self-efficacy ~

39. The highest rated ad in all three countries was Baby Alive Sponge and Industry Revealed were rated lowest overall for all three countries Smokers: Should not smoke around others ~

40. On the item Discuss, there was very little differentiation in ad ratings in Nigeria – all above 85% In Kenya and Senegal, the highest rated ad was Baby Alive (equal with Industry Revealed in Kenya) The lowest rated ad in Kenya was Break the Chain and the lowest rated ad in Senegal was Lung Non-smokers: Discuss

41. On the item Discuss, there was no meaningful differentiation in ad ratings in Senegal In both Kenya and Nigeria, the highest rated ad was Baby Alive (equal with Industry Revealed in Kenya) The lowest rated ad in Kenya and Nigeria was Break the Chain Smokers: Discuss ~ ~

42. Conclusions Within each country, the ads that performed best among non-smokers also showed strong performance in smokers In all three countries, the most successful radio ad was Coughing Child – consistently highest overall for both smokers and non-smokers Overall, the most successful television ad in all three countries was Baby Alive – however, it was not always highest for smokers Lung performed slightly better than Baby Alive for smokers in Nigeria Industry Revealed performed slightly better than Baby Alive for smokers in Senegal

43. Conclusions In Kenya and Nigeria, the poorest performing radio ad was Industry Spokesman Likewise, in both Kenya and Nigeria, the poorest performing television ad was Break the Chain (with Industry Revealed in Kenya) Reviewing only the smaller sample from one location in Senegal, currently no single ad appears to be performing significantly more poorly than the others

44. Conclusions No important pattern of differences between demographic sub-groups were found (i.e. gender, age, socio-economic status) in any country Ads focusing on negative health effects of smoking on children and on the individual, tend to perform most successfully in Kenya, Nigeria, and Senegal Qualitative reports from Kenya and Nigeria indicate that the least successful ads tend to be those that have execution issues, including issues with the ad script, or those that use unfamiliar or complex terms without definitions Both the anti-industry ads in particular showed these comprehension and acceptance issues

45. Research Team The Cancer Council Victoria: Melanie Wakefield, Megan Bayly, Jessica Chircop World Lung Foundation: Sandra Mullin, Rebecca Perl, Nandita Murukutla, Mego Lien, Roshan Dauharry Millward Brown Firefly, Kenya Infotrak Research and Consulting, Nigeria TNS RMS, Senegal Funded by the Bloomberg Initiative