The Arizona Department of Health Services rolled out sleek new television advertisements featuring popular sports coaches to promote its smoking cessation hotline.
They didn’t really work.
The ad campaign dubbed “Coaches on Coaching,” produced by the department, shows coaches like Earl Watson of the Phoenix Suns and Lute Olson, legendary former basketball coach at the University of Arizona, describing how they approach their jobs.
The ads segue into coaches at ASHLine, Arizona’s smoking cessation hotline, telling viewers how they can help them kick their habit.
But the positive ads just didn’t bring in the volume of calls that a previous campaign focused on negative outcomes from smoking did, said Wayne Tormala, the department’s bureau chief for tobacco and chronic disease.
Instead, after running the ads for a couple months last fall, the department switched back in January to more negative or fear-inducing ads they had used in the past.
The department found ads that are more graphic or appeal to emotions tend to bring in more calls, aligning with research and best practices that say negative ads tend to motivate behavior more effectively.
Ruthann Lariscy, a retired University of Georgia professor whose research focused on political advertising, said there are parallels to health-related messages.
She calls it the “sleeper effect.” While a person’s immediate reaction to a negative ad may be upsetting, her research shows they remember the content, for example, of a political ad and who the ad said they shouldn’t vote for.
“Everyone says they hate them. I don’t care if it’s in health or politics or products,” she said.
Positive Ads Bomb
One ad from the Department of Health Services campaign shows a man smoking a cigarette in a reclining chair. When he leans back, the chair turns into a metal medical examiner’s table, and he’s in a body bag, dead.
Another features a man lighting up in an open outdoor space. The ground below him starts to shift, turning into a grave. “How much longer will you ignore the warning signs?” the ad implores, before touting the ASHLine.
The coaching ads, which cost about $143,000 to produce and air on TV, brought in roughly 200-300 calls per week when they ran, Tormala said.
The more graphic ads, on the other hand, caused more than 1,000 people to call ASHLine, Tormala said.
“As much as we’d like to give the positive, gentle approach, if we want to get Arizonans to quit smoking in higher numbers, we’ve found that we have to put something out there that’s going to get their attention right away,” Tormala said.
And the department wants people to stop smoking. Tobacco use is still the leading cause of preventable death in the United States. The Centers for Disease Control and Prevention said 14 percent of Arizonans smoked cigarettes in 2015, and more than 8,000 people here die from smoking-related ailments annually. Plus, health care costs in Arizona related to smoking added up to more than $2.4 billion in 2009, the CDC reported.
Nearly 30,000 people called ASHLine last year, and about one-third of them enrolled in the program’s services. Of those enrolled, 41 percent said they quit smoking after seven months.
If an adult is still smoking these days, they’re addicted and entrenched in their behavior, Tormala said, meaning it often takes more drama to get their attention and motivate them to try to quit.
The department held focus groups, which included smokers, to test the “Coaches on Coaching” campaign messages, and people liked them, Tormala said.
“It just didn’t pan out for us,” he said.
What Research Says
The CDC’s national ad campaign, dubbed “tips from former smokers,” shows graphic negative effects from smoking. One ad features three former smokers who have stomas (surgically-created holes in the throat to remove the larynx) giving tips like “be very careful shaving” and “crouch, don’t bend over – you don’t want to lose the food in your stomach.”
Diane Beistle, chief of the health communication branch in the CDC’s Office on Smoking and Health, said the campaign is responsible for motivating millions of people to quit smoking.
Positive ads that tell smokers how to quit and give information on free resources to do so complement the harder-hitting ads, she said.
“But ads that elicit negative emotions prompt greater numbers of smokers to take action,” Beistle said.
A body of health-messaging research backs up the idea that negative or fear-inducing campaigns work.
A “meta-analysis” by the American Psychological Association of 50 years of research on messages that appeal to fear showed they are largely effective at influencing behaviors, particularly if they stress a severe outcome and recommend a one-time behavior.
The DHS ads showing a man in a grave and a body bag do this: They show the potential of death from smoking, then ask smokers to call ASHLine to help them quit.
The National Cancer Institute’s extensive guide on how media influences smoking habits says there’s consistent research showing negative messages about health consequences work better than funny or “emotionally neutral” ads.
The effectiveness of a TV ad means a lot for the smoking cessation hotline’s success. Ad campaigns are the biggest driver of calls to the ASHLine. The program’s 2016 annual report showed 43 percent of callers who then enrolled in coaching services said they heard about ASHLine from a media ad.
The department quickly realized the coaching ads weren’t working as well as they expected by tracking call volumes biweekly, Tormala said. While the ads didn’t work on TV, they still run online.
Will Humble, a former director of DHS who now works in public health at the University of Arizona, said it’s smart to experiment with new campaigns and see what works. He praised the department’s willingness to switch back to a more proven method quickly.
The ad campaigns are designed to change the behavior of someone who has likely been smoking for a long time, Humble said. Positive messages can be effective on health campaigns for diets or nutrition, but fall flat on smoking, he said.
He pointed to an ad campaign that ran while he was at DHS that showed people riding mountain bikes, telling them to “inhale life.” It didn’t work.
Humble chalked it up to “basic human psychology” and equated the fear-inducing ads to negative political ads, saying people just tend to be motivated more by both.
“In an ideal world, it’d be great if positive messages worked. But with tobacco, they don’t,” he said.