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Introduction

In May 2011, Australian Government Department of Health and Ageing initiated the National Tobacco Campaign aimed for various target groups and having different purposes. For example, the target group includes pregnant women and those women planning to become pregnant in order to generate personal relevance and a higher level of salience of health impacts of smoking, in this case, to self and the baby (Australian Government Department of Health and Ageing 2011). Other groups considered as the target were the jobless, school children, employees, teachers, and every active society group prone to smoking. The campaign was named “Stop Smoking, Start Repairing Your Body”. Unlike its predecessors, the campaign does not focus on the risks of smoking, but it rather focuses on the benefits of not smoking. Campaign materials, especially the advert posters, focus on pleasant images with messages that can influence smokers to admire the benefits of not smoking. The campaign is based on two relevant behaviour change models: Theory of Planned Behaviour and Health Belief Model. The two behaviour change models show  how the campaign was able to affect smokers and at what magnitude.

Prior campaigns

Tobacco smoking costs Australian people and the government immense loss in terms of money and the number of people lost due to premature deaths and diseases related to tobacco smoking. It is estimated that tobacco smoking is to blame for more than 15,000 Australians dying each year and costing the economy $31.5 billion per year in social costs. Additional $5.7 billion per annum is lost due to absenteeism and a decrease in the workforce (Australian Government Department of Health and Ageing 2011). Over the years, smoking prevalence in Australia has been on the decline due to successive anti-tobacco campaigns. The success of campaigns can be attributed to the government's commitment to fund anti-smoking campaigns. For example, the COAG National Healthcare Agreement sets an objective of dropping the rate of smoking among Australian population to 10 per cent by 2018 (Council of Australian Governments 2010). It is due to such strategies that most tobacco anti-smoking campaigns have been successful (Australian Government Department of Health and Ageing 2011).

Over the past years, Australian government has invested heavily in tobacco campaigns with a record of $27.8 million spent over four-year period (2010-2014) with an aim to reach groups through conventional advertising. First on the list was the campaign targeted pregnant smokers with campaigns such as "Quit for good today, and give your baby a healthy start" and "When you smoke, she gets less oxygen". These campaigns targeted women who were pregnant or were planning to become pregnant. Next on the list were two principal social groups: males and females. The campaigns were deemed successful due to their specialization, illustrating and recognizing the needs of various groups. The campaigns had different perception messages for two different groups. Perhaps it is the ability of campaigns to associate with the victims of smoking that made them yield positive results (Glanz, Rimer, & Lewis 2002). Past campaigns focused on how smoking would damage person's health, and smokers were able to use the message to influence their smoking patterns. Table 1 below indicates how the targeted smokers utilized images and messages of the campaign about the dangers of smoking. 

Target audience

Target audience of most anti-tobacco campaigns was the age group of people aged 16-40. This is because it is the most active group in smoking due to its opportunistic nature and susceptibility to indulge in smoking. At the age of 16, most smokers are either introduced to smoking habit due to diverse reasons. Most often they believe that smoking makes them cool or is as a stress reliever. These campaigns targeted people who were at risk of stress. For example, students who did not perform well in school. Behavioural, social learning, and cognitive behavioural theory approach highlights that habits are created primarily through positive reinforcement. In smoking, this positive reinforcement comes from peers who smoke (Eysenck & Eaves 1980). On the other hand, smoking can be developed as a result of negative reinforcement.  For example, individuals who receive criticism from society for their smoking behaviour might continue smoking just to prove that they are in control of their life. Positive reinforcement would strengthen the habit or response and make it more likely to occur. Punishment reinforces avoidance responses or habits. Previous campaigns, therefore, focused hugely on both smokers and those that were planning to smoke. However, the message largely was aimed for those that were about to engage in the activities of smoking. Unlike its predecessors, “Stop Smoking, Start Repairing Your Body” campaign was focused on those people who already started smoking. The campaign also focused on susceptible groups in the society and groups that were not easy to reach. The targeted audience of the campaigns was divided into two basic groups: males and females. The expected results for each group are shown in the table below.

Table 2. Identified Health Benefits, Relating to Parts of the Image of Women

Body Part

Benefit

Face

In 1 week your sense of taste and smell improves

Chest

In 3 months your lung function begins to improve

Right arm

In 8 hours excess carbon monoxide is out of your blood

Hip pocket

In 1 year a pack-a-day smoker will save over $4,000

Face

In 1 month skin appearance is likely to improve

Chest

In 5 days most nicotine is out of your body

Chest

In 12 months your risk of heart disease has halved

Abdomen

Today quit before getting pregnant and your risk of having a pre-term baby is reduced to that of a non-smoker

The male group has extra benefits because after 5 years of quitting smoking the risk of a stroke dramatically decreases, which acts as a good operant conditioning. With such exciting benefits, the target group is likely to adopt and change the behaviours due to the fact that for an operant conditioning to work, the punishment components must overcome reinforcement components of the smoking habit. Punishment components of smoking can only be realized when an individual finds better alternative ways of realizing reinforcement components of smoking such as the relaxing feeling that results from smoking.

Proposed behaviour change and its potential impact

The proposed behaviour change is aimed at illustrating the benefits of not smoking rather than the dangers of smoking. The behaviour change has a huge impact on the society. It illustrates the benefits or what individuals would gain if they did not smoke. In such manner, the campaign approaches the social problem in an optimistic rather than a pessimistic manner. For example, when tackling a social problem, it is advisable to look at the problem on the brighter side by offering alternatives to the problem. Earlier campaigns had focused their effort on scaring smokers away from the smoking habit but did not, in most cases, provide an alternative solution or benefits of not smoking. The proposed behavioural change has to happen on a personal level, where the impact of smoking and the benefit of not smoking are explained.  The proposed behavioural change is aimed at enticing individuals to accept healthy lifestyles as it gives a S.M.A.R.T. approach to the problem.

Barriers to behaviour change and the competing alternative behaviours

Despite the potential impact of the proposed behaviour, there are multiple challenges that must be addressed before implementing the behaviour change model. One of the issues to consider is the difficulty or the ease of quitting smoking abruptly. Competing alternative should be incorporated in the campaign. The competing alternative behaviours include an introduction of a leisure activity that will substitute the relaxing component offered by smoking. Instead of smoking, one can start chewing the bubble gum. However, it is important for an individual to realize the negative effects of smoking on their health and discard all activities that harm their health without alternative behaviours. Alternative behaviours to smoking should highly focus on repetitive habits like smoking. This is because if the alternative behaviour was not repetitive, it would amount to boredom for the quitters. Nicotine replacement products and medication are known to drive out the addiction to smoking. Another major barrier in the scope of behaviour change is the cost of switching from smoking to other habits. For example, if chewing gum was more expensive than a cigarette, then it would not make sense to the smoker.

How the campaign removes barriers to behaviour change

One of the most noteworthy means by which the campaign eliminates the barriers to behaviour change is the price tag of switching from smoking. In the campaign, it is estimated that a smoker can save as much as $4,000 annually if they quit smoking. On the same note, the quitter is kept away from the expenses incurred in hospital for treating various diseases, such as heart disease, cancer, and stroke, resultant from smoking.

Health belief model

The anti-smoking campaign through the health belief behaviour change model illustrates all perceived capabilities of the campaign. The health belief model is focused on attempts to explain and predict health behaviours from a psychological approach (Glanz, Rimer, Lewis 2002). Table 3 below illustrates different concepts of health belief model and the expected capabilities of the smoker in each concept.

Table 3: Health Belief Model

Concept

Definition/Capability

1.Perceived susceptibility

The target group is able to understand that they can be exposed to the dangers of smoking such as loosing $ 4,000 a year and getting cancer.

2. Perceived severity

The target group understands that the risk and dangers of smoking are big and should be avoided.

3. Perceived benefits

The target groups believe that the recommended action of not smoking would protect them from the health risks such as heart disease, stroke and cancer (Hurley & Matthews 2007).

4. Perceived barriers

The target groups are able to identify personal barriers to quit smoking such as class and the nice feeling of smoking. After identifying the barriers, the smokers should identify and explore ways to eliminate or reduce these barriers.

5. Cues to action

The target groups receive reminder cues for action in the form of incentives, such as t-shirts, caps and pens with reminder message such as “it is time to repair what I damaged”.

6. Self-efficacy

The target group is able to illustrate what it has learnt.

 

Theory of Planned Behaviour

The theory of a planned behaviour tries to link attitudes and behaviours. In the campaign, one of the objectives was to link awareness about the benefits (to self and the baby) of quitting smoking and attitudes towards smoking and quitting (Moan & Rise 2005). The theory of planned behaviour tries to show the process that leads an individual to engage in behaviour, for example, smoking. Similarly, the theory can identify the process of quitting smoking and create an intention point. The most notable aspect is the intent to perform behaviour once the intent is discovered, then the individual's (in this case the smoker's) attitude towards the target behaviour (quitting) and subjective norms about engaging in the behaviour (class and leisure) help decide the behaviour change (Moan & Rise 2005). Table 4 below illustrates how the element of theory of planned behaviour can create intention, environmental constraints, social (normative) pressure, and self-image in the campaign.

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