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Countermarketing activities can promote smoking cessation and decrease the likelihood of initiation. In addition, countermarketing messages can have a powerful influence on public support for tobacco control interventions and can set a supportive climate for school and community efforts. Countermarketing attempts to oppose protobacco influences and increase prohealth messages and influences throughout a state, region, or community. Countermarketing consists of a wide range of efforts, including paid television, radio, billboard, and print counteradvertising at the state and local levels; media advocacy and other public relations techniques using such tactics as media releases, local events, and health promotion activities; and efforts to reduce or replace tobacco industry sponsorships and promotions.
—Best
Practices
for
Comprehensive
Tobacco
Control
Programs,
CDC
Media advocacy is the strategic use of mass media to advance a social or public policy initiative. The goal is to work with mass media to generate pressure for social change. Media advocacy does not try to get individuals to make specific decisions. Rather, it uses media to change the social environment in which individuals make those decisions. Media advocacy is one part of a comprehensive tobacco control program. Used in conjunction with community activities, mass media activities have been shown to decrease tobacco initiation and increase tobacco cessation.
Getting a story into the news is only half the battle. How the issue is covered is just as important as whether it is covered. The way reporters shape news stories influences what viewers and readers think about the issue and its possible solutions.
A. News Frames: News frames are the boundaries around a news story that draw attention to specific parts of the news picture, relegate other elements to the background, and leave other aspects out entirely. Just as decisions are made whenever a snapshot is taken—some conscious, some instinctive—so journalists decide what to include in a story.
B. Framing: Framing is the selection process a journalist goes through when deciding what issues, ideas, images, and other elements should appear in the news story. Framing can also refer to the attitude toward or perspective on the contents of the story. This is commonly considered the "angle" of the story. Understanding frames in this way means paying attention to symbols, metaphors, or visuals that evoke a particular meaning, image, or feeling.
C. Defining the Problem: How the problem is defined is crucial for supporting public health solutions. Originally, tobacco use was considered a private issue between patient and doctor. In this framework, "fault" was presumed to reside in the smoker; we "blamed the victim." In recent years, we have shifted the way we perceive smoking from an individual medical problem to a public health issue. This shift broadens the definition of the problem, encourages the development of more environmental approaches to tobacco control, and opens the door for expanded participation in tobacco control by a wider range of groups.
The public health frame may not automatically resonate with the media. The challenge is to make information as vivid and as compelling as possible. The language must always point to the broader environment in which people are making decisions. What barriers limit their options related to health? What elements of the environment could support wise decisions not to smoke? Illustrating the answers to these questions helps journalists and their audiences understand the importance of addressing solutions that go beyond providing help for individual smokers.
A. Assign primary responsibility. Remember that most news consumers, unless given additional information, will assume that the person with the problem is responsible for solving it. The key to advancing effective policy solutions is to create a story that leads people to say, "That just isn't right. Something ought to be done about that."
B. Present a solution. Journalists will always ask some version of two questions: What is the problem? What is the solution you propose, or what do you want to happen? Always have a concrete solution to offer that has top priority the one that needs to be advanced today. This means knowing what you want to say and being able to say it simply. Practice with colleagues until the answers roll off your tongue.
C. Make a practical appeal. Emphasize that public health solutions are based on science and desirable outcomes. Talk about how your solution will save money, enhance productivity, save lives, support business, and protect children. Give concrete examples of how policy will benefit the entire community not only those who suffer from the problem.
D. Develop story elements. The challenge in trying to influence a story's frame is that the journalists, not you, control what is covered and what is not covered in a story. But if you understand the business of news reporting and can anticipate journalists' needs, you can offer story elements that will make the reporter's job much easier. TV coverage typically requires compelling visual images. For a print story, use metaphors and symbols that make your story come alive in the readers' imaginations.
A. Prepare media bites. Despite the complexity and depth of your issue, you must be prepared to make it come alive for news consumers in short "bites." At most, a source can expect to be heard for 15 seconds in a TV story, and a few sentences in print. Think of media bites as the headlines you would want on your story. Practice with colleagues, trying out different ways to describe the problem and convey your solution in short, pithy statements. Try to address shared values, emphasizing universal themes such as fairness, common sense, or protection of children. Talk about what is at stake. Who is affected? What will this mean for people's lives? For families? For tax-supported medical care costs?
B. Practice creative epidemiology. Numbers can help substantiate claims about the importance of tobacco as a public health problem. But too often, public health spokespersons use huge numbers and statistics that are overwhelming and hard to comprehend. Creative epidemiology is the practice of making large numbers interesting and compelling by placing them in a social context that provides meaning. For example, in the few minutes that it took you to read this information, seven people died from smoking-related illness.
C. Use spokespersons. Put journalists in touch with people who have had direct experience with tobacco-related problems. Work with your spokespersons in advance. Discuss the key points they should make and the media bites they should use so that they will feel prepared and comfortable talking to journalists.
D. Tailor the message to your audience. One of the most important rules for success in using all forms of media is to understand your audience. When you take account of the audience's background, experience, and the context in which your message will be received, people will pay attention. Discuss the issues in ways that will resonate with your audience's existing values and beliefs. Use creative ways to cut through the media clutter.
E. Make use of local media. National media get a lot of attention because they are produced on a grand scale and they reach from coast to coast. But for these same reasons, it is very difficult to access the national media. Local newspapers and radio and television stations have a much greater investment in communities, and are more open to local health stories. In addition, local media may have many hours of airtime and column inches of print space to fill. Give national or international events a local spin that humanizes and personalizes the story. For state and local tobacco control data, including access to CDC's STATE system, visit www.cdc.gov/tobacco and click on "state information."
F. Know why you are doing what you are doing. Always keep the specific goal in mind. Constantly ask yourself whom you are trying to reach and what you want as a result. Let the answers to these questions guide your media plan.
G. Be flexible. Successful media advocacy requires that you be flexible and persistent. If your initial media contacts don't succeed, keep trying. Change approaches, change targets, or change spokespersons.
A media strategy is a plan for using the media to accomplish a specific goal. To be successful, your media strategy must be carefully thought out and tailored to accomplish its goal. In particular, the strategist must know
Pick a single central theme. Proceed as if the audience will only remember one line from everything that is said. Decide ahead of time what that one line should be, and lead with it. Make your total message revolve around it. Keep the theme simple and appealing.
Listed below are different ways in which you can initiate contact with the media:
When you make initial contact by E-mail, fax, or regular mail, follow-up with phone calls. Ask if the reporter has received the information you sent and if the reporter has any questions you may answer. Keep good records of contacts with reporters and track actual coverage. Develop different interview opportunities and story angles to offer to different media outlets.
Reporters are people too, so you should form relationships with them that will be mutually beneficial. You need them, but they need you too.
Take the time to introduce yourself, your organization, and your cause to members of your local media. Let them know that you are an expert on your issue and become a continuing resource for them. Build the mutual trust and respect that are essential to all successful relationships.
Keep track of the reporters on your "beat." Learn all you can about who makes the decisions in each media outlet and how. Newspapers have reporters, but they also have section editors, city editors, national editors, feature editors, managing editors, and publishers. Broadcast personnel include assignment editors and executive producers. The key people in each outlet are worth meeting in person. After a professional relationship with an assignment editor has been developed, it is acceptable to sound out ideas for news conferences or other media events to determine if the editor would send reporters to attend a particular event.
Reporters' interests will not always converge with yours. They are after stories, not necessarily social goals. Therefore, it is your responsibility to package the information that you give them in a way that serves both your needs and theirs.
Always tell the truth and do not mislead a reporter. Information is the commodity you are brokering, but credibility is what you must use to sell it. Exaggeration is not necessary in public health, because the bare facts are sufficiently sensational, like this statistic: lung cancer deaths among women have risen 600% over the past 50 years.
Learn as much as you can about the audience you will reach. If the opportunity arises, assist the reporter in developing the questions to be asked. Provide background information, including useful facts and figures. Strategies to keep in mind include the following:
A. Keep language simple and direct. Don't fall into the use of jargon or acronyms that might confuse your audience.
B. Speak in short, clear, and quotable sentences. Pretaped interviews will be edited, so points that are made in long paragraphs will be lost. Remember that media bites the 9-second quotes that encapsulate main points are essential in communicating through the media.
C. Make your most important point first. If you try leading up to it with background information, you may not get it in at all, or you may lose your audience in the meantime. Emphasize your major points by "flagging" or listing them. For example, "The most important thing to remember is. . . ", "The three crucial conclusions are. . . ."
D. Maintain control throughout the interview. Do not feel compelled to answer a question if you don't like it. Rather, use it as the opportunity to get your point across. Be ready to "reframe" questions that are off the mark. Turn negatives into positives.
E. Don't be a know-it-all. If you don't have the answer to a particular question, don't fake it. Instead, use the opportunity to make one of your main points. If a question is asked to which you do not know the answer in an interview for print, offer to get the information for the reporter. Be patient, not belligerent; kind, not nasty; helpful, not argumentative. Let your expertise come across, but do not be arrogant.
F. Dress appropriately for TV. Wear clothes that look professional but not too formal. Solid colors are better than prints. Bright colors are fine as long as they are not overwhelming. Keep jewelry simple. Let nothing dangle that could distract from what you are saying.
G. Don't count on anything you say being truly off the record. If you never want to see it in print, don't say it.
Hold a news conference when you have something to say that can be enhanced visually, through charismatic spokespersons, and with timely information. (A news release may be sufficient for disseminating information to the media.) Use good audiovisual materials.
A. Announcements: Announce the conference with a media advisory or a news release, but hold the important information for the event itself.
B. Place and Time: Make sure the location you choose will accommodate the media (e.g., has a sufficient number of electrical outlets, good lighting, and enough space). The news conference should be held early in the day to give the media time to develop and edit their stories. Monday through Thursday are often the optimal days for hard news coverage. If TV and radio reporters attend the conference, plan on the camera and sound crews arriving well ahead of starting time to set up. They may want to tape some brief interviews with your speakers before the news conference begins. Allow extra time with your spokespersons before and after the conference.
C. Spokespersons: Feature good speakers who are issue experts or community leaders. Always ask, is this person interesting enough to watch on TV or listen to on the radio? Before the news conference, discuss the agenda with your speakers, detail the questions they might anticipate, and go over the answers they should give. Develop speaking points that communicate your main messages.
D. Materials: At the event, distribute media kits that include background information, biographies, and other useful materials.
Sample
News
Conference
Agenda
When
you
plan
a
news
conference,
remember
that
speakers
with
different
areas
of
expertise
have
different
perspectives
and
therefore
bring
unique
contributions
to
your
media
event.
For
example,
The right speaker can attract media coverage and strengthen the impact and reach of an important message.
This sample news conference agenda may give you ideas for how to structure your own media events.
| Time | Content | Spokesperson |
|---|---|---|
| 9:00–9:05 a.m. | Welcoming and introductory remarks | Tobacco Control Coalition Chairwoman |
| 9:05–9:10 | The problem (discuss facts about women and tobacco use based on localized data and statistics) | Physician |
| 9:10–9:15 | The effect (put a human face on the problem through a personal story) | Tobacco-use sufferer |
| 9:15–9:25 | The solution (announce local efforts to reduce tobacco use among girls and women) Youth
peer education Secondhand smoke initiatives Tobacco cessation programs |
Youth advocate Smoke-free business leader cessation facilitator |
| 9:25–9:30 | Conclusion (including wrap-up and Q&A) | Coalition chairwoman |
You can prepare bulleted talking points for your speakers. Work with your presenters ahead of time to ensure that they cover the important points you want to communicate. Below is a list of talking points that emerged from Women and Smoking: A Report of the Surgeon General. Tailor talking points according to the target audience, the specific messages, and the selected messengers.
Physician:
FOR IMMEDIATE RELEASE
Photo Opportunity
Contact:
Phone:
Date:
(Coalition name) will put a human face and a local focus on the toll tobacco takes takes on women in (town, city, or state name). At (name activity or event here), (name of featured speaker or group) will call on the community to prevent and reduce smoking among girls and women at (time) at (location address).
Women now account for 39% of all smoking-related deaths each year in the United States, a proportion that has more than doubled since 1965, according to Women and Smoking: A Report of the Surgeon General. The report concludes that the increased likelihood of lung cancer, cardiovascular disease, and reproductive health problems among female smokers makes tobacco use a serious women's health issue.
"The millions of women who die prematurely from smoking aren't strangers," (local leader) said. "They are our mothers and grandmothers, our friends and neighbors. Smoking cessation can save their lives."
"Increased marketing by tobacco companies has stalled progress in smoking cessation by women, and recent increases in smoking among teenage girls threaten to wipe out any progress in tobacco prevention that has been made in the last few decades," said (expert).
Quitting results in immediate health benefits for both light and heavy smokers, including improvements in breathing and circulation. The increased risk for coronary heart disease and stroke is substantially reduced after 1 or 2 years of not smoking.
When smokers quit, their lungs begin to heal and their risk of lung disease drops. Smoking cessation also improves quality of life and physical functioning. Science-based smoking cessation interventions are much more cost effective than many common medical interventions.
"I think that it's important to emphasize that it's never too soon or too late to quit smoking," (expert) said.
For more information, call (contact name and phone number).
Most major newspapers include an op-ed section on the page opposite the editorial page. Although op-eds are often written by regular columnists (national and local), there are always opportunities for guest writers. Many papers solicit articles from individuals knowledgeable in particular fields or from local writers if they are seeking a local point of view.
Letters to the editor offer important opportunities for readers to share their opinions through the newspaper to a broad audience. Letters to the editor are among the best-read sections of the paper. After reading the editorials, most policy makers turn next to letters to the editor.
Find out how your local newspaper wants to receive op-eds and letters to the editor (i.e., in electronic or hard-copy format), what the maximum length should be, and how much lead time they need. This information is often available on the editorial page of the newspaper or from the local newspaper office. Be prepared to make your submissions on short notice when national or local news provides an opportunity.
Below are two sample letters to the editor that illustrate how you can use this media outlet.
Dear Editor:
Recently, the Surgeon General released his latest report on women and smoking, and the numbers are grim. Since the last report on women
and tobacco in 1980, over 3 million women have lost their lives to cigarettes. These women are our mothers, our sisters, our grandmothers, our aunts, and
our friends.
According to the new report, the consequences of tobacco use are especially devastating to pregnancy outcomes. Not only are women who smoke more susceptible to fertility problems, but the impact on the babies they carry can be deadly. Smoking during pregnancy has been associated with increased risk or spontaneous abortion, low birth weight, stillbirths, and sudden infant death syndrome (SIDS). Not only does this create a huge human tragedy, but the additional health care costs are enormous. According to the report, reducing the national prevalence of smoking during the first 3 months of pregnancy by only 1 percentage point every year would prevent 1,300 babies from being born at low birth weight and save $21 million in direct medical costs during the first year alone.
(State's) numbers for smoking during pregnancy and neonatal outcomes can definitely be improved. (Insert state-specific dollar amounts and smoking during pregnancy rates, if available.) We can save health care dollars, but more importantly, we can save lives if we encourage young girls to never start smoking and help women who want to quit.
Sincerely,
(Your name and affiliation)
Dear Editor:
Recently, the Surgeon General released an important report on women
and smoking. Not only does it show that lung
cancer
–
NOT breast
cancer
is
now the leading cause of cancer death in women, but since the last
Surgeon General's report on women and smoking in 1980, over 3 million women in
the United States have died from tobacco use. Here in
(State),
(number of women who have
died) have died in this 21-year period.
It is not by accident that tobacco use has increased to the point of creating an epidemic among American women. The tobacco companies have developed slick advertising campaigns that glamorize smoking. A recent Federal Trade Commission report on tobacco advertising revealed that advertising expenditures have increased by more than $2 billion since 1998, for a grand total annual expenditure of $8.24 billion. In our state, tobacco companies spend (get number from www.tobaccofreekids.org* Web site) to advertise their deadly and addictive products.
The Centers for Disease Control and Prevention is now providing a community toolkit to help combat the problem of tobacco use among young girls and women. This is good news because tobacco use among young girls in (state) has been on the increase. We must fight back.
We may not have the money that the tobacco companies have, but we have hearts that react to the pain and suffering caused by tobacco use. All of us must work together to keep children safe from tobacco use and to help those who want to quit their deadly addiction.
Sincerely,
(Your name and affiliation)
Christy Turlington, cover model and entrepreneur, is working with the Centers for Disease Control and Prevention (CDC) to communicate the smoke-free message to teens and young women. Watch her video-stream on Women and Tobacco: Seven Deadly Myths at www.thriveonline.com (click on "stop smoking").
The following example is an actual op-ed written by Christy Turlington that was printed in local newspapers across the country. Additional timely examples of op-eds are posted on the Web site of the Campaign for Tobacco-Free Kids at www.tobaccofreekids.org*.
In my family, there are two people who have quit smoking my Dad and me. For me, it took 7 years. When I finally did quit for good, I knew it was one of the biggest accomplishments of my life.
It was different for my father. He stopped smoking in December 1996, just 6 months before he died of lung cancer. He was only 64. So much has happened in our family since then that my father would have enjoyed. There have been many things I wanted to tell him, many questions I wanted to ask him. Now there's a great deal that he and I will never share. It's comforting to know that when you're gone, you live on in the hearts of those who loved you. But it's infuriating to realize that his and so many other premature deaths were completely preventable! Tobacco use remains the leading preventable cause of death in the United States, killing more than 430,000 Americans each year more than all who die of AIDS, alcohol or drug abuse, car crashes, murders, and suicides combined!
For women, particularly young women and the children they care for, the health consequences of smoking grow increasingly grave. We may have come a long way in some ways, but when it comes to tobacco, women have taken many steps back.
The number one cause of cancer deaths in women is lung cancer. The rate of lung cancer in women has increased by 600% in the last 50 years.
Women who smoke have more miscarriages, are more likely to be infertile, and enter menopause earlier than nonsmokers.
Mothers who smoke have smaller and sicker babies, more stillbirths, and more neonatal deaths than mothers who do not smoke. Secondhand smoke causes 35,000 to 62,000 deaths a year from heart disease in nonsmokers. Secondhand smoke also causes asthma, lung infections, and even sudden infant death syndrome (SIDS).
More than 5 million children living today will die prematurely because of a decision they made as adolescents the decision to smoke cigarettes.
We were warned long ago that when women started to smoke like men, they would die like men. The reality is even worse. Not only do women smokers suffer like men smokers from the increased risk of cancer, heart disease, and lung disease, but they also experience the health problems unique to menstrual and reproductive functions. Why, after all that we know, has this happened? There are two important reasons.
The first is sheer marketing power. Women started smoking in great numbers when tobacco companies targeted them to do so. "Reach for a Lucky instead of a sweet" remains one of the most successful advertising themes of all times because it made women believe that if they smoked, they would be slim and beautiful. Virginia Slims' incredibly successful "You've come a long way Baby" morphed into the 1990s as "It's a woman thing," and recently into the most cynical multiethnic advertising campaign, "Find your voice."
The commercial coupling of smoking with women's freedom, emancipation, and empowerment camouflages the second reason why so many women are suffering from tobacco use the terrible reality of tobacco addiction. Like the large majority of smokers, I was just a kid when I started smoking only 13. And, like almost every smoker, I started out believing that I wouldn't get hooked. But addiction is a fact one that the tobacco companies have long known and used to their advantage.
There is good news. Quitting is hard, but everyone can quit. More than 50 million Americans have! That's more than those who still smoke. And, according to the new Surgeon General's Report on women and smoking, quitting smoking begins immediately to reduce the risk of dying prematurely, no matter when that step is taken. As Dr. Virginia Ernster, Senior Scientific Editor of the report emphasizes, it's never too late to quit smoking.
Now I know that the best contribution I can make is to help girls and women to become and to stay smoke free. That's why I'm helping Secretary of Health and Human Services Tommy Thompson and U.S. Surgeon General David Satcher to deliver this important message about women and smoking: Don't start and if you already do smoke, please stop. Trust me, I know this is hard. Don't give up giving up.
Another idea for a news event is to issue a proclamation or resolution. A resolution is a request or demand for a specific action or the adoption of a certain policy. Generally, a resolution can be broken down into "whereas" clauses (which are basically translations of facts or data) and "resolved" clauses (that state the action or promise). "Whereas" clauses give the background and rationale for the resolution. They identify the problem or need for action and frame it as urgent or timely. "Resolved" clauses are the essential part of the resolution because they state clearly the action or policy called for. They come at the end of the document, and comprise the main motion for the organization.
Proclamations use "whereas" clauses in the same format; the final statement in the document is the official action taken on the basis of these clauses.
Sample Resolution
Whereas, tobacco use is the leading cause of preventable death and disease in the United States;
Whereas, according to a new report from the Surgeon General in March 2001, nearly 3 million U.S. women have died prematurely from smoking since the first Surgeon General's report on women and smoking in 1980;
Whereas, lung cancer is the leading cause of cancer death among women;
Whereas, in (state, city, town) (number of women who have died in the last year) women have lost their lives to smoking-related disease in the last year;
Whereas, tobacco use during and after pregnancy harms the unborn child and newborn infant;
Whereas, tobacco companies are targeting women and young girls with advertising that makes smoking look attractive;
Whereas, educational and policy initiatives can greatly reduce smoking initiatives and increase cessation rates for young girls and women; now, therefore, be it
Resolved that (name of organization) supports public health efforts to offer smoking cessation assistance to women who smoke; be it further
Resolved that we will promote tobacco-free messages to our members and to the public; be it further
Resolved that, where possible, we will support policies that reduce youth access to tobacco products and that promote community awareness of the hazards of smoking and of secondhand smoke.
| ______________________________ (Sponsoring Organization) |
_______________ (Date) |
Creating high-quality, effective tobacco counteradvertising can be time consuming and expensive. To save time and costs, CDC has licensed existing advertisements developed by a number of states and federal agencies. These include the California Department of Health Services, Massachusetts Department of Public Health, Arizona Department of Health Services, Tobacco-Free Florida Coalition, Kansas Health Foundation, Oral Health America, U.S. Environmental Protection Agency, FDA, and others. These ads are available through the Media Campaign Resource Center for Tobacco Control, which not only provides access to these ads but also offers help in developing an overall campaign that uses them effectively.
By providing access to existing advertising materials, the resource center allows states and organizations to save the high cost of producing new ads; resource center customers pay only talent fees and nominal charges for tagging, shipping, and processing. The resource center currently offers about 400 television spots, 200 radio spots, 125 print ads, and 100 outdoor ads. The materials are available in several different languages, and topics addressed include youth prevention, adult cessation, and protection from secondhand smoke. The resource center's Web site includes a comprehensive chart of advertising materials, information about how to order media campaign resource books and video catalogs, and other helpful information. The resource center also offers technical assistance to help with ad selection and other advertising campaign tasks.
Resource books: The Media Campaign's resource books catalog available ads and contain valuable information on developing tobacco prevention advertising campaigns. In addition, all of the television and radio spots are featured on the video catalog (VHS format). For a $25 subscription to the resource books and video catalogs, you will also receive future resource center updates and ideas.
Technical assistance: For those who would like an expert's advice, in-depth technical assistance is available. Assistance includes help in choosing ads for the target audience, developing a media plan, negotiating with media outlets, and publicizing campaigns to other states and organizations.
Web site—www.cdc.gov/tobacco/mcrc/: To get more information about the Media Campaign Resource Center, order the resource books, and find out about promotional packages, please visit this Web site. The electronic campaign chart in the "what's new" section of the site is a downloadable Excel spreadsheet that includes information about all of the advertising materials in the resource center. The "advertising on a tight budget" section of the Web site contains lists of spots with no talent fees and lists of "in cycle" spots that are available at reduced talent fees. Reviewing these lists can help you save money.
Contact information: To order materials or request technical assistance, contact the Media Campaign Resource Center at (770)488-5705 (press 2 at the prompt), or E-mail mcrc@cdc.gov. Other inquiries can be directed to CDC's Office on Smoking and Health at (770)488-5705.
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Privacy Policy | Accessibility TIPS Home | What's New | About Us | Site Map | Contact Us CDC Home | Search | Health Topics A-Z This page last reviewed September 10, 2003 United States
Department of Health and Human Services |
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Dispelling
the
Myths
About
Tobacco