ABSTRACT
Background: Positive portrayals of tobacco use in entertainment media can normalize and perpetuate use. In 2012, the Government of India implemented the Tobacco-Free Film and Television Rules, a first-of-its-kind comprehensive regulation to restrict tobacco depiction in films and television programs. Two complementary studies were undertaken to assess the implementation of the film rules on television and in movie theaters. Methods: In the first part, movie theater observations and exit surveys were conducted from Feb. 3 to March 24, 2015. In total, 308 movie theaters were selected for the observation of films. A total of 3080 exit surveys were conducted to assess moviegoers' reactions toward the film rule. The second part comprised the systematic observation of 424 prerecorded television programs that aired from Nov. 20 to Dec. 30, 2015. Results: Compliance with the Tobacco-Free Film and Television Rules policy was lower on television than in movie theaters. While 66% of television programs with tobacco scenes implemented at least 1 of the 3 elements of the film rule, not a single program executed all required elements correctly. In movie theaters, 99% of films that contained tobacco scenes implemented at least one element of the film rule. However, all elements of the film rules were implemented correctly during 27% of the films observed. Exit surveys showed that among moviegoers who recalled viewing at least one element of the film rule, there was increased concern about tobacco's harms and intentions to quit. Conclusion: Implementation of the film rules was higher in movie theaters than on television, though there were gaps in implementation for both. Despite inconsistent application, audience reactions to the anti-tobacco messages were favorable, with increased concern about tobacco's harms and intention to quit. Overall, the film rules offer a strong tool for countering tobacco promotion, reaching hundreds of millions with anti-tobacco messaging.
ABSTRACT
The evidence on the efficacy of tobacco control messages in low and middle-income country (LMIC) settings is limited but growing. Low message salience and disengagement, in the face of tobacco control messages, are possible barriers to self-efficacy and cessation-related behaviours of tobacco users. Although adaptations of existing pretested graphic and emotional appeals have been found to impact on behaviours, more personalised, culturally relevant and compelling appeals may more fully engage message receivers to elicit optimal behavioural responses. The objective of these case studies is to use lessons learnt from high-income country tobacco control communication programmes, and adapt practical approaches to provide cost-effective, culturally nuanced, graphic and personalised messages from tobacco victims to achieve the optimal behavioural impact for population-level communication campaigns in the resource-constrained settings of LMICs. The 'raw and real' messaging approach, which emanated from message pretesting in India, outlines creative and production processes for the production of tobacco victim testimonials, given the need to source patients, facing life-threatening conditions. This cost-efficient approach uses real tobacco victims, doctors and family members in a cinéma vérité style approach to achieve more personalised and culturally resonant messages. The methodological approach, used for the development of a number of patient testimonial messages initially in India, and later adapted for tobacco cessation, smoke-free and graphic health warning communication campaigns in other countries, is outlined. Findings from campaigns evaluated to date are encouraging as a result of the simple fact that true stories of local people's suffering are simply too difficult to ignore.
