In 2016, the Centers for Disease Control and Prevention launched an anti-smoking mass media campaign that included ads featuring Rebecca, a real person who agreed to speak on camera about her use of tobacco and her struggles with depression.
About 32 percent of people with mental health conditions smoke compared to 23 percent of smokers without mental illness. The CDC’s 2016 Tips from Former Smokers or "Tips" campaign, in which Rebecca appeared, was one of the first to deliberately feature someone who had a mental health condition and successfully quit smoking.
At its core, Rebecca's message was this: I had depression and quit smoking, and you can too.
Judith Prochaska, PhD, an associate professor of medicine at Stanford who consulted on the CDC’s development of the Rebecca ad series, sought to evaluate the impact of the Rebecca ads on individuals with mental health concerns.
Now, after conducting survey analysis (based on data collected before and after the Tips campaign aired), Prochaska and her colleagues found that greater exposure to Rebecca's commercials among individuals with mental health conditions was associated with greater intention to quit and higher rates of quit attempts.
The findings were published online this week in Nicotine and Tobacco Research. Prochaska is the lead author of the study.
Prochaska says that there are myths surrounding individuals who have mental health conditions and smoke tobacco — such as, quitting could be too stressful or could compromise the person's mental health recovery.
"Tobacco use has been normalized for people with mental health conditions, and their efforts to quit are sometimes discouraged," Prochaska said. "The data from the Rebecca ads show that its message — quitting successfully with depression is possible and should be encouraged — is salient and successful in engaging individuals with mental health conditions. Population-level interventions like these are needed to address the high smoking prevalence in this group."
Early on, Prochaska was involved in guiding the direction of the Rebecca ads for the 2016 Tips campaign. "Overall, our goal was to be more inclusive," she explained. "These types of anti-smoking campaigns have existed for a number of years, and they try to have a diversity of spokespeople. It was time to include someone with a mental health concern, given the high prevalence of smoking in this group."
Before the campaign aired, a random-sample survey was conducted with thousands of people across the United States, asking whether or not they smoked or had a mental health condition. In the months that followed the campaign (which aired on television, over the radio, on the internet and in print) the team conducted a follow-up survey with those who said that they smoked, asking whether or not they had seen the Rebecca ad, and if they intended to quit smoking or had made attempts to quit smoking since viewing the ad.
In thinking about future directions, Prochaska points out that substance users may use multiple substances such as tobacco and alcohol or marijuana and opiates.
“Tobacco remains the leading preventable cause of death globally, and yet it’s often viewed as a lesser evil relative to problems such as alcoholism or opioid addiction,” she said. Prochaska says that her research shows that quitting smoking does not harm recovery from other drugs of abuse — something she thinks is ripe for publicizing in a future mass-media campaign.
Photo by Sara Kurfeß