No Tobacco Month: Using Social Marketing in Tobacco Control

In October 2016, the first edition of Mois sans tabac was launched, a campaign that invites French smokers to take up the challenge of quitting smoking during the entire month of November. This campaign is inspired by the British Stoptober campaign and uses a new approach in France to promote smoking cessation: social marketing (a technique that encourages behavior change). The first evaluation elements of the campaign suggest that Mois sans tabac has a positive impact on smokers' attempts to quit and that they are more likely to seek outside help to quit.

What is social marketing?

Social marketing is designed to create social change, and unlike traditional marketing, does not only benefit a brand. It raises awareness of a given problem or cause and aims to convince an audience to change their behavior for the benefit of their well-being and that of the community (Philip Kotler and Gerald Zaltman, 1971). It is particularly suitable for deploying prevention programs on health issues.

Social marketing uses consumer-oriented strategies and seeks to better identify the profile of each target audience (needs, expectations, perceptions, reluctance, living environment, etc.) in order to understand their needs and thus provide them with the support necessary to change their behavior.

The product, its placement/positioning, the price and the promotion represent the fundamental elements of marketing interventions (the "4Ps") but in the field of social marketing, we speak of the "5Cs" (behavior, communication, cost, accessibility and collaborators)

  

As part of No Tobacco Month:

- Behavior : The behavior that No Tobacco Month seeks to promote is the attempt to quit smoking for at least 30 days, in the month of November;

- Communication : the use of numerous channels for the dissemination of the campaign (website, application, TV spot, posters, etc.) and the design of relevant messages adapted to the targets;

- Cost : Which in the context of social marketing is the brake or barrier to the adoption of the desired behavior. It is therefore necessary to minimize the costs of adoption. In the context of No Tobacco Month, having a set quit period of 30 days makes weaning seem more acceptable and financially accessible.

- Access capacity : Make the various tools accessible to smokers (here through the large number of partners and distribution channels); The aids made available to smokers are free (or at very low cost for the quitline) and emphasize the benefits of quitting smoking for smokers;

- Collaborators: the many partners such as regional health agencies, health professionals, Health Insurance, networks of ambassador structures present in each region, etc.

What is No Tobacco Month?

The No Tobacco Month campaign, launched by Public Health France (SPF), is part of the first national tobacco reduction program (PNRT)- became National Tobacco Control Program (PNLT) in 2018 - proposed by the French government to reduce tobacco consumption in France. This system is part of an overall strategy aimed at preventing people from starting to smoke, helping smokers quit and including the economic dimension of the industrial tobacco epidemic.

The goal of No Tobacco Month is to encourage smokers to quit smoking for 30 days. In fact, studies show that withdrawal symptoms associated with quitting smoking decrease significantly during this period, leading to a five-times greater chance of quitting smoking for good.[1]The campaign specifically targets smokers aged 18 to 64, as this is the sub-population with the highest prevalence of smoking in France. Similarly, the program is specifically aimed at smokers with low socio-economic status, as social inequalities in health related to smoking are particularly present in the country.

No Tobacco Month is organized in three stages:

• October is the main time for communication about the scheme. The objective during this period is to recruit both smokers who will participate in the challenge and partners who will support them. This preparation phase before quitting also allows smokers to find out more, define their profile, test their dependence and choose their quitting strategy.
• November is the month of quitting itself. It is also the time for local actions, both individual and collective, to support and sustain the motivation of committed smokers and ex-smokers.
• December concludes the scheme. While the challenge is officially over, Santé publique France is committed to encouraging participants to continue their weaning, to continue using the Tabac info service tools which remain available all year round.

The importance of social marketing in the fight against smoking

In France, in 2020, more than 3 out of 10 people aged 18-75 reported smoking (31.8%) and a quarter of them reported smoking daily (25.5%)[2]. Tobacco consumption causes 75,000 deaths each year in the country, making tobacco the leading cause of preventable premature death. Around 60% of smokers want to quit smoking, but only a minority succeed without outside help. It is therefore essential to offer them effective and proven cessation aids, including support from a health professional who significantly increases the chances of quitting.

Social marketing is based on the premise that people come from different backgrounds and have different ideas and beliefs at different times in their lives. They do not react to information in the same way and do not all behave in the same way when faced with a social issue. Most anti-smoking efforts warn of the risks of tobacco use and continually remind individuals not to start smoking, to quit smoking and not to start smoking again. This involves implementing proven measures (tax increases, smoking bans, etc.) and prevention campaigns (Smoking kills, smoking causes cancer, etc.).

These information campaigns have their limits, however; it is possible that the individual does not feel directly concerned, puts the messages at a distance or that they go unnoticed. Even if an individual is aware of the health risks of some of his actions (alcohol, smoking, junk food) he will not necessarily change his behavior. For example, among smokers, some minimize the risks for them (I don't smoke much), do not feel concerned (I'm young, I'll stop later), others can understand the risks without worrying about them (you have to die of something), still others want to stop but cannot (need outside help)[3]A social marketing campaign emphasizes the importance of social and psychological factors and considers all these beliefs (and their related actions) as part of a continuum and tailors strategies accordingly.

Rather than focusing solely on providing information on the risks of smoking, Tobacco Free Month seeks to create the opportunity and positive environment for smokers who wish to quit. The approach is incentive-based and voluntary. The campaign adopts a positive and inclusive approach in its messages and seeks to make quitting a mass collective behavior, thus hoping to normalize it and turn it into a social movement. This approach is achieved through mobilizing slogans such as “In November, we’ll stop together!” “You too can join the challenge” etc. The program involves well-known/appreciated personalities, who can act as role models, helping to make it a popular success. The use of social networks allows participants to feel socially supported by other smokers and not to feel alone in their efforts to quit smoking. Non-smokers are also invited to participate in the campaign by supporting their loved ones.

  

Tobacco-Free Month relies on various channels: television, radio, billboards, internet, social networks, free smoking cessation support services (via the '39 89' telephone line, a dedicated website tabac-info-service.fr, an e-coaching application, a quitting kit that includes a lot of information and tools to help you quit as best you can). In addition, local awareness-raising and smoking cessation support actions (supervised by regional health agencies) are deployed in healthcare establishments, pharmacies, workplaces and other sites. These systems are particularly effective because They encourage patients to engage in dialogue with healthcare professionals. However, the help of a health professional increases the chances of stopping by 70%. The plurality of channels used and the regional deployment thus make it possible to reach all the intended targets.

The impact of No Tobacco Month on smoking cessation in France

The final step is to evaluate the impact of the campaign to see if the objectives set at the beginning have been achieved.[4]The evaluation of the Tobacco-Free Month scheme is based on the Public Health France Barometers, which are repeated surveys carried out by telephone among random samples of the population of people aged 18 to 75 and residing in France.

In France, between 2014 and 2019, smoking prevalence decreased by almost 4 points (-11%), from 34.3% to 30.4%. Daily smoking decreased by 4.5 points (-16%) during this period, from 28.5% to 24%.[5]This decline has been attributed to an arsenal of measures implemented in the country in recent years: the introduction of plain packaging, the banning of flavourings, price increases, the reimbursement of nicotine substitutes, etc.

To date, no study has specifically evaluated the impact of the Mois sans tabac program on this drop in smoking in France, but initial results attest to its effectiveness in quitting attempts. A recent study, published on October 26, 2021, indicates that Mois sans tabac has triggered 1.8 million quit attempts between 2016 and 2019.^[6]. This represents more than double the number of registered people. For Public Health France, "This means that the impact of the operation goes beyond those registered online and that it is useful to have a tool to monitor its effects on attempts to quit made by smokers in the general population."

The 2018 and 2019 editions were a great success with more than 440,000 cumulative registrations. The rate of quit attempts directly attributable to the operation increased from 2.9% in 2016 and 2017 to 4.8% in 2018, before stabilizing in 2019 (4.3%). Santé publique France explains the success and the significant increase in the number of quit attempts observed between 2017 and 2018 by a major overhaul of communication media, in particular the design of new advertising spots broadcast on television and a renewed digital strategy, associated with a substantial increase in the budget for purchasing advertising space.[7]These two factors were able to restore visibility and interest in participating in the operation for smokers.

The six editions of No Tobacco Month have recorded more than a million registrations in total, including nearly 113,000 in 2021. A study by Public Health France [8], based on data from the 2017 Public Health Barometer France, evaluated the first year of the scheme. One year after the operation, approximately 6% to 10% of former smokers were still abstinent, compared to rates reported in the literature usually reaching 3 to 5% for attempts to quit without external help. The smokers interviewed (who had attempted to quit in connection with Tobacco-Free Month) also more often mentioned having used help (mainly electronic cigarettes (27 %) and nicotine substitutes (18 %)) to quit smoking (67 % compared to 43 % for quits not related to STDs).

Data from future editions of the Health Barometer will help to complete the monitoring of the evaluation indicators for the Tobacco-Free Month system.

To go further: Gallopel-Morvan K. (EHESP), Nguyen Thanh V. and Arwidson P. (Public Health France), G. Hastings (University of Stirling) "Social Marketing. From Understanding Audiences to Changing Behavior" (2019). Presses de l'Ecole des Hautes Etudes en Santé Publique, 194 pages"The No Tobacco Month websitePublic Health France©Tobacco Free Generation

AE

(Thanks to Justine Avenel-Roux, Romain Guignard and Viet Nguyen-Thanh of Public Health France for their proofreading)

 

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[1] West R, Stapleton J. Clinical and public health significance of treatments to aid smoking cessation. European Respiratory Review. 2008;17(110):199-204[2] Pasquereau A, Andler R, Guignard R, Soullier N, Gautier A, Richard JB, Nguyen-Thanh V. Tobacco consumption among adults in 2020: results from the Public Health France Barometer. Bull Epidémiol Hebd. 2021;(8):132-9. http://beh.santepubliquefrance.fr/beh/2021/8/2021_8_1.html[3] Gallopel-Morvan K. (EHESP), Nguyen Thanh V. and Arwidson P. (Public Health France), G. Hastings (University of Stirling) "Social Marketing. From Understanding Audiences to Changing Behavior" (2019). Presses de l'Ecole des Hautes Etudes en Santé Publique, 194 pages"[4] Gallopel-Morvan, Karine, et al. “Evaluating a social marketing campaign: the example of No Tobacco Month”, , Social Marketing. From Understanding Audiences to Changing Behavior, under the direction of Gallopel-Morvan Karine, et al. Presses de l'EHESP, 2019, pp. 151-168.[5] Pasquereau A, Andler R, Arwidson P, Guignard R, NguyenThanh V. Tobacco consumption among adults: a five-year assessment of the national tobacco control program, 2014–2019. Bull Epidémiol Hebd. 2020;(14):273–81[6] Guignard R, Gautier A, Andler R, Soullier N, Nguyen-Thanh V. Attempts to quit smoking during the Tobacco-Free Month operation (2016-2019): results from the Health Barometers of Public Health France. Bull Epidémiol Hebd. 2021[7] Guignard R, Gautier A, Andler R, Soullier N, Nguyen-Thanh V. Attempts to quit smoking during the Tobacco-Free Month operation (2016-2019): results from the Health Barometers of Public Health France. Bull Epidémiol Hebd. 2021;(16):284-9. http:// beh.santepubliquefrance.fr/beh/2021/16/2021_16_1.html[8] Guignard R, Andler R, Richard JB, Pasquereau A, Quatremère G, Nguyen-Thanh V. Effectiveness of Tobacco-Free Month 2016 and 1-year follow-up of individuals who attempted to quit, based on the 2017 Public Health France Barometer. Saint-Maurice: Public Health France; October 2019. Summary 19 p.National Committee Against Smoking |