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Preliminary top-line quantitative findingsAnti-smoking radio and television advertisement ratings: Kenya, Nigeria and Senegal 1ObjectivesEvaluate existing anti-smoking television and radio ads in low- and middle- income African countries, including Kenya, Nigeria, and SenegalAds that have tested well in high-income countries should also perform well in low- and middle- income countries (LMICs) in AfricaIf so, LMICs may be able to adapt existing anti-smoking advertisements for mass media campaigns at a lower cost than creating new ads

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 adsWithin each country and across countries

Method: AdvertisementsFive radio ads were tested in each country. They were:

Emphysema Sufferer KeithIndustry SpokesmanCoughing ChildSuffering BronchoscopyA man describes how smoking has caused him to develop COPDTobacco industry executives discussing that they need more Africans to start smokingDescribes the harm smoking causes to childrenStates that many Africans are suffering from emphysema caused by smokingFeatures a doctor talking about late diagnosis of lung cancer in smokersMethod: AdvertisementsFive television ads were tested. They were:Cigarettes are eating your baby aliveBreak the ChainLung (Lung India in Kenya)SpongeIndustry Revealed

May wish to note that Industry Revealed was always shown last in the groups, due to negative reactions to this ad during piloting.5Method: SampleKenya 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

6Method: SampleNon-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 deviationKenyaNigeriaSenegalNumber of cigarettes smoked per dayM=10.16(SD=6.22)M=8.48(SD=7.20)M=10.52 (SD=6.29)Previously attempted to quit smoking75%53%70%Thinking about quitting within the next twelve months45%48%67%7Method: Sample: Non-smokers KenyaNigeriaSenegalTotal participants200200112Male60%61%64.3%Female40%40%35.7%18-29 years60%60%71.4%30-40 years40%41%28.6%University degree or above24%41%50.9%Parent38.5%24%13.4%Live with a smoker23%21%53.6%Smoking allowed indoors12%11%35.7%Television at home95.5%94%98.2%Radio at home98%92%98.2%Method: Sample: SmokersKenyaNigeriaSenegalTotal participants160159111Male75%75%65.8%Female25%25%34.2%18-29 years63%62%67.6%30-40 years37%38%32.4%University degree or above35%48%42.1%Parent41%28%26.1%Live with a smoker51%65%76.6%Smoking allowed indoors37%36%46.9%Television at home93%97%99.1%Radio at home97%96%95.5%Method: ProcedureParticipants 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:

= 0.697

makes me stop and thinktaught me something newis relevant to meis believableconcerned about my smoking (smokers only)concerned about other people smoking around me (non-smokers only) Three anti-industry/government support measures:

=0.804makes me feel angry at the tobacco industrymakes me think that the tobacco industry is deceitful increases my support for government actions to stop tobacco useInternal reliability tests were conducted on all scales that included more than one item (perceived effectiveness, anti-industry/government support, commitment to avoiding tobacco (non-smokers), and self-efficacy (smokers)). This is a measure of how well the items in a given scale hang together numbers closer to 1 represent better fit. The Cronbachs alpha () presented represents the internal reliability of the scales across the whole sample (all countries and smoking statuses combined). We also tested each of the scales for each country x smoking status combination to check they fit in each sub-group. The lower ends of these ranges usually represent Senegal, where we had a smaller sample and more skewed data.Perceived effectiveness: = 0.50-0.77anti-industry/government support measures: =0.71-0.84Commitment to avoiding tobacco: = 0.42-0.67Self-efficacy: =0.81-0.88

10Method: Procedure Three additional measures:I would talk to someone else about the message in this admakes me feel uncomfortable...is easy to understandNon-smokers answered three measures of Commitment to avoiding tobacco

= 0.732increases my commitment to not smokingconcerned about other people smoking around childrenmakes me think I should avoid places where people smokeSmokers answered two measures of Self-efficacy

=0.839

andOne additional measuremakes me feel motivated to quit smokingincreases my confidence to quit smoking

should not smoke around others11AnalysisThe 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-smokersAnalyses adjusted for the effects of: Order of ad presentation, location of testing, and languageAge, gender, and socioeconomic statusParental status and highest level of education attainedLiving with a smoker and whether smoking is allowed inside homeHaving a TV and/or radio at homeFor smokers: Daily cigarette consumption, intention to quit smoking in the next 12 months, previous quit attempts

AnalysisFor Kenya and Nigeria, the percentage of participants that agreed or strongly agreed with each item for each ad was analysedDue to a high positive response bias in Senegal, the percentage of participants that strongly agreed with each item for each ad was analysed

This means ads in Senegal had a tougher test than Kenya and Nigeria. You will see in the graphs that the overall %s for Senegal appear to be a little lower than Kenya and Nigeria.13Ad Rating Results: Radio Advertisements

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*Consist with the non-smoker results, Coughing Child was also rated as the most understandable ad in all three countries by smokersAgain 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: UnderstandThe pattern of responses was very similar across the three countriesCoughing Child was the highest rated ad on measures of perceived effectiveness in all three countriesLikewise, the same ad Industry Spokesman, was rated lowest in all three countries Non-smokers: Perceived effectiveness*Smokers responses were very consistent with non-smokersCoughing Child highest rated ad on measures of perceived effectiveness in all countries for smokersAgain consistent with the non-smoker results, Industry Spokesman was the lowest rated ad three countries for smokersSmokers: Perceived effectiveness* = Highest rated ad for that country; ~ = Lowest rated ad in that countryFor both Kenya and Nigeria the highest rated ad was Coughing Child, in contrast to Industry Spokesman in SenegalFor both Nigeria and Senegal the lowest rated ad was Bronchoscopy, in contrast to Industry Spokesman in KenyaNon-smokers: Uncomfortable*The highest rated ad in Nigeria was Suffering and the highest rated ad in Senegal was Coughing ChildIn Kenya, three ads (Suffering, Coughing Child, and Bronchoscopy) received equally strong ratingsThe lowest rated ad overall was Industry Spokesman, however, in Senegal four ads received equally poor ratingsSmokers: UncomfortableFor 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 highestEmphysema Sufferer Keith and Bronchoscopy tended to be rated lowest across all three countries Non-smokers: Anti-Industry and Support for government actions*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 NigeriaEmphysema Sufferer Keith was the lowest rated ad on the anti-industry/government support measures in all three countriesSmokers: Anti-Industry and Support for government actionsCoughing Child was the highest rated ad in all three countries on measures of commitment to avoid tobaccoIndustry Spokesman was the lowest rated ad in all three countriesAcross all countries, all ads were rated strongly above 75%Non-smokers: Commitment to avoid tobacco*There was some differentiation in ad performance between countriesOverall, the highest rated ad in Nigeria and Senegal was Coughing Child, in contrast to Suffering in KenyaThe lowest rated ad in Kenya and Nigeria was Industry Spokesman (equal with Bronchoscopy in Kenya) and the lowest rated ad in Senegal was SufferingSmokers: Self-efficacyThe 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 SpokesmanSmokers: Should not smoke around othersIn all three countries, Coughing Child was the highest rated ad on DiscussThere was differentiation in the lowest rated ad between countries: Emphysema Sufferer Keith in Kenya, Industry Spokesman in Senegal, and Bronchoscopy in NigeriaAcross all countries, all ads were rated strongly on Discuss above 80%Non-smokers: Discuss*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 countriesSmokers: DiscussAd Rating Results: Television Advertisements

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 countriesNon-smokers: Understand~~~~For smokers, there was slightly more differentiation between ad ratings within each countryBaby Alive was the highest rated ad in Nigeria and SenegalIndustry Revealed was highest rated ad in Kenya but lowest rated in Nigeria and SenegalSponge was the lowest rated ad in Kenya and SenegalSmokers: Understand~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 ChainIn Kenya and Nigeria, all five ads were rated above 80%Non-smokers: Perceived effectivenessThe highest rated ad in Kenya and Senegal was Sponge (equal with Lung in Kenya) in contrast to Baby Alive in NigeriaThe lowest rated ad in all countries was Break the Chain (equal with Industry Revealed in Nigeria)Smokers: Perceived effectiveness~~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 ChainAll ads except Break the Chain were rated similarly in KenyaNon-smokers: UncomfortableSponge was the highest rated ad in Kenya and Nigeria, in contrast to Industry Revealed in SenegalConsistent with the non-smoker results, the lowest rated ad on Uncomfortable in all three countries was Break the ChainSmokers: Uncomfortable~For the anti-industry/government support measures, there was no meaningful differentiation in ad ratings in NigeriaIn 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 actionsThe 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 ChainSmokers: Anti-industry and Support for government actions~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 NigeriaAll five ads were rated above 80%Non-smokers: Commitment to avoid tobaccoIn Kenya the highest rated ad was Lung and the lowest were Break the Chain and Industry RevealedIn 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~The highest rated ad in all three countries was Baby AliveSponge and Industry Revealed were rated lowest overall for all three countriesSmokers: Should not smoke around others~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 LungNon-smokers: DiscussOn the item Discuss, there was no meaningful differentiation in ad ratings in SenegalIn 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~~ConclusionsWithin each country, the ads that performed best among non-smokers also showed strong performance in smokersIn all three countries, the most successful radio ad was Coughing Child consistently highest overall for both smokers and non-smokersOverall, the most successful television ad in all three countries was Baby Alive however, it was not always highest for smokersLung performed slightly better than Baby Alive for smokers in NigeriaIndustry Revealed performed slightly better than Baby Alive for smokers in SenegalConclusionsIn Kenya and Nigeria, the poorest performing radio ad was Industry SpokesmanLikewise, 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 othersConclusionsNo important pattern of differences between demographic sub-groups were found (i.e. gender, age, socio-economic status) in any countryAds focusing on negative health effects of smoking on children and on the individual, tend to perform most successfully in Kenya, Nigeria, and SenegalQualitative 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 definitionsBoth the anti-industry ads in particular showed these comprehension and acceptance issues

Research TeamThe Cancer Council Victoria: Melanie Wakefield, Megan Bayly, Jessica ChircopWorld Lung Foundation: Sandra Mullin, Rebecca Perl, Nandita Murukutla, Mego Lien, Roshan Dauharry Millward Brown Firefly, KenyaInfotrak Research and Consulting, NigeriaTNS RMS, SenegalFunded by the Bloomberg Initiative