ANTITOBACCO CAMPAIGN

OVERVIEW
For decades tobacco manufacturers had glamorized smoking through widespread marketing campaigns and promotions, but as the negative health effects of such behavior grew increasingly clear toward the end of the twentieth century, health officials in the United States sought to educate the public about the ills of tobacco. California was the first to organize a statewide advertising and education effort, one that was funded by smokers themselves through a state-legislated cigarette tax. Between 1989, when the campaign first began, and 1997, California spent almost $116 million on antitobacco advertising. Although this was a significant amount, it paled in comparison to the ad budgets of leading tobacco makers, which spent several billion dollars a year on advertising.
In 1997 the California Department of Health Services (CDHS) stepped up its efforts in the antitobacco battle by launching an estimated $67 million, three-year advertising campaign designed to reduce and prevent smoking among youths and adults. The aggressive campaign, developed by Asher & Partners (Asher/Gould Advertising, Inc., until late 1997) of Los Angeles, consisted of television, radio, and print advertising, including billboard ads. Ads geared toward minorities and specific ethnic groups were also included in the campaign. These were created by specialty agencies Imada Wong Communications Group Inc., Valdes Zacky and Associates Inc., and Carol H. Williams Advertising. The following year, in June 1998, the second phase of the three-year effort was launched. The approximately $22 million campaign again consisted of an extensive series of print, television, and radio ads that focused on bringing to light the manipulative marketing practices of the tobacco industry, the dangers of secondhand smoke, and the link between smoking and impotency. This last topic was the focus of one of the best-known television spots of the campaign, ‘‘Gala Event,’’ which suggested to the male audience that smoking could adversely affect their sex lives. The campaign also focused on the increasing popularity of cigars and on the smoke-free bar and restaurant policy that was implemented in the state at the beginning of 1998. Kim Belsh, the director of California’s DHS, explained the overall goal of the campaign in an interview with Daniel Zwerdling of National Public Radio, stating that ‘‘the whole focus of our media campaign is really to de-normalize tobacco use. And de-normalizing tobacco use means changing the perception of tobacco from something that is viewed as acceptable and even glamorous to a more realistic perception of tobacco as dangerous, addictive, and socially unacceptable.’’

HISTORICAL CONTEXT
In 1988 California voters passed Proposition 99, an initiative that increased the tax on tobacco by 25 cents per pack of cigarettes, with the revenue to be used to fund antitobacco programs and healthcare services for underprivileged residents. In that year about 26.7 percent of Californians were smokers. The percentage declined rapidly as the tax-funded media effort began churning out aggressive advertising, and by 1995 only 16.7 percent of Californians smoked. The rate began to rise, however, when the administration of California governor Pete Wilson diverted $67 million in antitobacco funds in 1994 to pay for failing healthcare projects. In addition, television spots with an anti-industry tone, including one that featured tobacco industry executives testifying before the U.S. Congress that nicotine was not addictive, were discontinued because of pressure from the tobacco industry. Although antitobacco efforts continued, they were toned down both in character and in number, and in 1996, 18.6 percent of California adults smoked. The change in advertising, reported a research team from the University of California at San Francisco, led to an increase in tobacco sales between 1994 and 1998 of more than $1 billion, or an additional 840 million packs of cigarettes. Also alarming were statistics for young smokers. In 1992, according to the DHS, 8.7 percent of Californians aged 12 to 17 smoked. In 1995 the percentage was up to 11.9 percent. A survey conducted by the tobacco research center at the University of California at San Diego found that the percentage of youths aged 17 who were addicted to cigarettes had risen from 9.9 percent in 1993 to 12 percent three years later.
The increase in the number of California smokers, though considerably less than the national population of adult smokers, which hovered around 25 percent, was still cause for alarm among antitobacco activists, and many criticized the Wilson administration. Alan C. Henderson of the American Cancer Society of California said in the Los Angeles Times, ‘‘The Legislature and the governor need to wake up and smell the secondhand smoke. This is an embarrassment to the state that has been the leader in fighting tobacco.’’ In response, the Wilson administration established a three-year contract with Asher & Partners to produce a major media campaign. In 1997, after some delays, the CDHS launched its first new advertising campaign since 1995 as a part of plans to reinvigorate the fight against tobacco. Sandra Smoley, secretary of California’s Health and Welfare Agency, announced in a press release, ‘‘This advertising is some of the most aggressive, hardhitting material that California’s tobacco education media campaign has ever produced . . . These ads prove, once and for all, that this Administration is wholly committed to the anti-tobacco cause.’’

TARGET MARKET
The CDHS aimed its antitobacco advertising toward a number of audiences, but the agency primarily hoped to sway youths, including those who smoked and those who were susceptible to starting. More than 100,000 youths, a study at the University of California at San Diego discovered, took up smoking each year, and one-third of them would die from smoking-related diseases such as heart disease, cancer, or emphysema. Other studies indicated that it would take most of the addicted youths 16 to 20 years to quit smoking, and that almost 90 percent of smokers picked up the habit before reaching the age of 18. If youths made it past 18 without smoking, chances were high that they would not start. The studies made it glaringly clear to the CDHS that it was necessary to try to prevent teen smoking.
To effectively address youths, who often felt invincible and were not easily persuaded by advertising, it was important, researchers found, to inform them that the tobacco industry was trying to control them. One 1997 ad, ‘‘Voicebox Smoker,’’ featured Debi Austin, a woman who began smoking at the age of 13. The spot, shot when she was 46, showed a hole in her throat where her larynx had been cut out because of her smoking habit. Still, Austin had not quit smoking; she smoked through the hole. She explained in the commercial, ‘‘When I found out how bad smoking was, I tried to stop. Believe me. I wish I could. But I can’t.’’ Belsh, discussed the strategy behind the ad in USA Today, saying, ‘‘You need to push emotional buttons . . . You need to give kids real evidence that they’re being manipulated by the tobacco industry.’’
The CDHS targeted adult smokers with its media campaign as well, with ads focusing not only on the harm inflicted upon the smoker but also on the damage caused to loved ones and others through secondhand smoke. For the 1998 campaign the CDHS tackled two new issues. Because all California bars and taverns became smokefree at the beginning of 1998, ads were deemed necessary to convince disgruntled smokers that this was a positive policy. Another issue the CDHS hoped to spotlight was the link between smoking and impotence. This time the focus was on men between 18 and 30, an age group that had traditionally been resistant to altering smoking habits. As Belsh, explained in the Toronto Globe and Mail, ‘‘Our experience has demonstrated that warning these guys that smoking will affect their health later in life has not been a very effective inducement to quit . . . Maybe warning them about the effects on their sex lives will be more powerful.’’ The problem was not one to be taken lightly, for numerous studies, including the Massachusetts Male Aging Study, had indicated a significant link between smoking and impotence.

COMPETITION
The most powerful adversary of the CDHS was the tobacco industry, which consisted of the biggest advertisers in the United States. Philip Morris Companies Inc., the parent company of number one tobacco maker Philip Morris U.S.A., was the third leading U.S. advertiser in 1996 and also in 1997, despite a 5 percent reduction in ad spending. Philip Morris U.S.A., which produced such brands as the top-selling Marlboro, Benson & Hedges, Virginia Slims, and Merit, supplied about half of all the nation’s cigarette shipments. Others included R.J. Reynolds Tobacco Company and Brown & Williamson Tobacco Corp. These powerful companies boasted immense advertising coffers and held the advantage of history. Tobacco companies had advertised and marketed their products for decades before the 1970 ban on radio and television cigarette advertising, making a strong and lasting impression among the public. Antitobacco awareness, on the other hand, was still in its infancy.

STARS AND SMOKES
Not only did the California Department of Health Services and other antitobacco forces have to contend with competition from tobacco manufacturers, but they also battled Hollywood. Many blockbuster movies, including Reality Bites and My Best Friend’s Wedding, featured chain-smoking characters, portrayed by Winona Ryder and Julia Roberts, respectively. First lady Hillary Rodham Clinton criticized the movie industry for its focus on smoking, with the Los Angeles Daily News quoted her as commenting on Roberts’s character: ‘‘This portrayal of a modern woman so reliant on cigarettes is particularly troubling given that more young women are taking up the deadly habit.’’

MARKETING STRATEGY
The 1998 antitobacco media campaign developed by Asher & Partners consisted of several dozen television, radio, and print/billboard ads, including some borrowed from the Massachusetts Tobacco Control Program’s media campaign. Although the dangers of smoking were by then common knowledge in the United States, antitobacco messages were still a hard sell. As Bruce Dundore of Asher & Partners admitted in Adweek, ‘‘It is a very challenging account . . . It’s tough to get people not to buy stuff, especially when it’s a product equated with pleasure.’’ Ads that publicized the implementation of California’s smoke-free policy for restaurants and bars began running in late 1997, and radio and television spots addressing the increased popularity of cigars began to air in the spring of 1998 while the full campaign continued to be developed. The cigar effort centered on the theme ‘‘Cigars, the big new trend in cancer,’’ and the single television spot ‘‘How Many?’’ focused on the amount of nicotine in each cigar. A business suit-clad character named Chad relaxed with a cigar as the narrator questioned him about how many cigarettes he thought might equal the nicotine of one cigar. As he offered guesses, the corresponding number of cigarettes appeared in Chad’s mouth. The narrator finally informed Chad that he would need to smoke more than 70 cigarettes to equal the nicotine in the cigar, and 70 cigarettes were seen stuffed into Chad’s mouth. The spot ended with the narrator asking, ‘‘Need a light, Chad?’’ In June 1998 the full CDHS campaign was launched. ‘‘Gala Event,’’ the television spot that emphasized the link between smoking and impotence, was set at a festive affair. A handsome man in a tuxedo caught the eye of a beautiful woman across the bar, and the two exchanged long gazes as he suavely lit a cigarette. His cigarette suddenly went limp, and the woman was gone. The voice-over explained, ‘‘Now that medical researchers believe cigarettes are a leading cause of impotence, you’re going to be looking at smoking a little differently.’’ The spot then focused on three men smoking cigarettes. An attractive woman sauntered by, and the three men stared after her, only to find their cigarettes going limp. Embarrassed, the men covered their cigarettes or removed them from their mouths. The narrator then asked, ‘‘Cigarettes. Still think they’re sexy?’’ ‘‘For decades, the tobacco industry has tried to link its deadly products with virility and sex appeal,’’ explained Belsh, of the CDHS. ‘‘It’s ironic that medical science shows smoking to be one of the leading causes of male impotence.’’
‘‘Baby Smokers’’ focused on the problems of secondhand smoke and showed photos of young children and infants with lines such as ‘‘Nicholas Steele. Smoking since birth’’ and ‘‘Chris McDonald. Pack-aweek smoker’’ superimposed on the photos to emphasize how a parent’s or guardian’s habits could directly affect children. The tag line read, ‘‘Secondhand smoke is a firstrate killer.’’ ‘‘Waitresses’’ featured various waitresses from restaurants and bars explaining the health hazards they experienced as a result of working in smoke-filled environments. They also voiced their support of the smokefree restaurants and bars policy. ‘‘Ironic Quotes’’ showed a bedridden patient named Aaron. After quoting a tobacco industry executive, who claimed that people did not die from smoking, Aaron stated, ‘‘Let me clear things up for him. My doctor says I have less than one year to live.’’ The tag line read, ‘‘The Tobacco Industry—They can bury the victims, but they can’t bury the truth.’’ A print ad, ‘‘Truth vs. Advertising,’’ featured a circle of 20 cigarette print ads—ads that focused on the glamorous aspects of smoking and led consumers to believe that their lives would be enhanced by cigarettes—with the dates they ran. Printed alongside the ads were messages revealing what tobacco companies knew about cigarettes, for example, ‘‘The tobacco industry has known that nicotine is addictive since 1963. They denied any knowledge before Congress in 1994. Four years later they finally admitted it.’’

OUTCOME
The 1998 antitobacco campaign received considerable media attention, particularly ‘‘Gala Event,’’ which brought to light a traditionally taboo subject. The number of smokers in California appeared to be on the decline as well, with the percentage of adult smokers dropping from 18.6 percent in 1996 to 18.2 percent in 1997. Smoking among youths also dropped, from 11.2 percent in 1996 to 10.9 percent in 1997. ‘‘I’m encouraged by the decline in smoking,’’ announced Belsh, in a press release. ‘‘Smoking among youth in California has dropped for two years in a row, despite rising rates of youth smoking around the rest of the country. The adult smoking rate remains lower than any other state, with the exception of Utah.’’ Also encouraging was the reduction in illegal sales of tobacco goods to minors in California, which dropped to 13.1 percent in 1998, an impressive 40 percent in one year.
Although the CDHS continued with its aggressive antitobacco media campaign in 1999, the word about the ills of smoking began to spread beyond a few select states such as California, Massachusetts, and Arizona. Out of the $206 billion settlement reached between tobacco companies and 39 states, which were suing to recoup the healthcare costs generated by tobacco-related illnesses, about $1.45 billion was tagged to pay for a fiveyear national antitobacco educational campaign. The newly formed National Tobacco Control Foundation was thus poised to launch the largest and most unified antitobacco advertising campaign ever developed, with an estimated $150 to $225 million marketing budget for 1999.