Squeezing new life out of an old Sponge: how to modernise an anti-smoking media campaign to capture...

2011 vol. 35 no. 1 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 75© 2011 The Authors. ANZJPH © 2010 Public Health Association of Australia

Mass media campaigns have evolved

as a key component of tobacco

control efforts to reduce smoking

prevalence.1-4 In Australia, well-funded media

campaigns targeting the general population

have been associated with reduced smoking

rates in both youth and adults.5-7 There is

also accumulating evidence that media-led

campaigns are a cost-effective mechanism

for promoting smoking cessation.8 However,

media campaigns are expensive to produce

and broadcast, and effective campaigns

need both medical and marketing expertise

to ensure that their content is scientifically

accurate and their presentation effective.9

Given the resources required to create

effective anti-smoking advertisements, the

practice of sharing and adapting anti-tobacco

mass media campaigns has increased, both

in Australia and internationally. Adaptations

can be made at differing levels. High-level

adaptation might entail using a campaign

concept and completely re-shooting the

advertisement to better represent the target

population. Mid-level adaptation might

involve adding or removing visual elements

of the campaign to address local issues.

Low-level adaptation is easiest and most

cost effective, and may include modifying

an end-frame to represent local sponsors or

changing a voice-over.

Adapting existing effective material offers

many benefits, including confidence that

effectiveness may transfer to the new market,

as well as significant savings in both time and

money. However, little has been published

on the outcomes of successful adaptation

in different markets. To date, research has

focused on pre-testing advertising material,

indicating that advertisements that perform

well in one market tend to do well among

other population sub-groups, at least in more

developed countries.1

In this paper, we present a case study

of adaptability by examining the process

involved in recycling Australia’s most iconic

anti-smoking television advertisement,

Sponge. The original Sponge advertisement

was aired in Sydney in the early 1980s as part

of the ‘Quit. For Life’ campaign. The original

ad featured a cardboard cut-out of a male

figure with a sponge placed on the chest area

to represent human lungs. The ad portrays

lungs as sponges designed to soak up air and

show how, for smokers, they soak up smoke.

The ad ends with the memorable image of

cancer-producing tar being squeezed from

a discoloured sponge into a rapidly filling

beaker, illustrating how much tar is absorbed

in a year by the lungs of a 20-cigarette-per-

day smoker. Sponge proved to be a highly

successful campaign; the recall rate was

Squeezing new life out of an old Sponge:

how to modernise an anti-smoking media

campaign to capture a new market

Trish Cotter, Wai Tak Hung, Donna PerezCancer Institute New South Wales

Sally DunlopCancer Institute New South Wales and University of Sydney, New South Wales

James BishopCancer Institute New South Wales

Submitted: September 2009 Revision requested: December 2009 Accepted: July 2010Correspondence to: Ms Trish Cotter, PO Box 41, Alexandria, NSW 1435;e-mail: [email protected]

Abstract

Objectives: The iconic Sponge anti-

smoking television advertisement was

first made in Sydney, Australia, in 1979. In

2007, it was re-made for a new generation

of smokers. This paper examines

the impact of the re-made Sponge

advertisement.

Methods: Qualitative evaluation of the

original Sponge ad by younger and older

smokers (n=51) was followed by an online

pre-test survey of the modernised version

(n=301). A continuous tracking telephone

survey of smokers and recent quitters

(quit in past 12 months) over 18 years

monitored performance of the modernised

version while on air in late 2007 (total

n=453; seen ad n=380).

Results: Qualitative research found that

the concept of the original Sponge ad

may motivate younger smokers – who

had not previously seen the ad – to quit.

Online pre-testing demonstrated that

the modernised version provided new

information to 54% of 18–24 year olds

(compared to 31% of older smokers).

Tracking survey results indicated that

believability of the modernised version was

highest among 18–24 year olds (92%), that

the ad was ‘attention-grabbing’ (86%), and

that it was effective at influencing quitting

intentions. Effects were amplified by the

generation of pressure from family and

friends.

Implications: The re-made Sponge

advertisement had a positive impact on

smokers, and was particularly effective

among the new market of smokers aged

less than 40 years. Adapting successful

mass media campaign material can be

an effective and economical strategy to

influence smokers.

Key words: Tobacco smoking, mass

media, advertising

Aust NZ J Public Health. 2011; 75-80

doi: 10.1111/j.1753-6405.2010.00654.x

Article Smoking Prevention

76 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2011 vol. 35 no. 1© 2011 The Authors. ANZJPH © 2011 Public Health Association of Australia

87% among smokers when it was first run in 1983,10 and it was

associated with a 3.4% decrease in smoking prevalence in Sydney

during the first six months of the campaign.11 By 2007, however,

the ad had not been run in NSW for more than 15 years.

In the current paper, we present qualitative research which

assessed the relevance of the original Sponge material for

current smokers in New South Wales (NSW) and informed the

adaptation of the advertisement. We outline the changes that

were made to create the modernised Sponge advertisement and

present the results from an online pre-testing study that assessed

smokers’ responses to the updated advertisement. Finally, we

present quantitative research which tracked smokers’ and recent

quitters’ responses to the ad when it was broadcast, as well as the

influence of the re-made advertisement on smokers’ cognitions

and behavioural intentions.

Study 1: Qualitative study of responses to original Sponge

Qualitative pre-testing was used to assess the relevance of

the original Sponge concept to current smokers in 2006 and to

understand the issues that may influence the production of the

re-made advertisement.

MethodA series of seven group discussions with about seven smokers in

each group was conducted in November and December 2006 (total

n=51). Participants were recruited from a professional recruitment

agency, and groups were stratified by age and location. The age

groups were 18-24 years (two groups), 25-34 years (two groups),

35-49 years (two groups) and 50 years and over (one group). The

research was conducted in an outer Sydney metropolitan area

(Parramatta) and a medium-sized regional town (Wagga Wagga)

in an attempt to provide a cross-section of middle and lower SES

smokers. Reactions to the original Sponge advertisement were

elicited in the course of a structured discussion led by a trained

facilitator. Conversations were recorded and analysed for previous

familiarity with the advertisement, new knowledge generated by

the ad, and the influence of the ad on smoking-related intentions.

Participants were paid an incentive according to current market

rates to complete the research.

ResultsFamiliarity with the advertisement was age-dependent. The

majority of participants who were over 30 years of age recalled

having seen the ad previously; very few of those who were under

30 years of age could recall it.

Overall, the advertisement prompted smokers to think about the

cumulative effects of smoking in terms of the build up of tar in their

lungs. There was a tendency for smokers who had not previously

seen the original ad to report that they had not thought about

their smoking in this way before. The advertisement appeared

to have some capacity to add to their knowledge about smoking

and contribute to thoughts about quitting. In particular, it was a

prompt to think of the long-term effects of smoking and provided

a motivator to quit eventually, though not necessarily immediately.

Smokers in the older age group who had previously seen Sponge

reported that they were unlikely to be prompted by the message or

the imagery to think about their smoking in any new ways. Thus,

the qualitative research suggested that a revised Sponge concept

would have some value for relatively new smokers, especially

those who had not been exposed to this particular health effects

message about the long-term effects of smoking, and those less

than 30 years of age.

The qualitative research informed the adaptation of the Sponge

advertisement, which involved reviewing and revising the script

and call to action, as well updating the presentation of the material.

Graphically, the cardboard cut-out was replaced with a real person,

and modern graphics techniques in post-production were used to

super-impose the sponges shaped like lungs and an x-ray image

on the silhouette. The sponge’s transition from a yellow colour to

a tar-blackened colour, and the wringing out of the tar from the

sponge lung into a beaker was also re-created for a pack-a-day

smoker. This was changed from the original ad which showed

the tar from the lungs of a ‘20-cigarette-a-day’ smoker, as the

original ad was made many years before packs greater than 25

cigarettes existed.

Table 1: Sample characteristics of the online pre-test and continuous tracking survey.

Online pre-test (n=301)

%

Continuous trackinga (seen the ad, n=380)

%

GenderMale 48.6 49.4

Female 51.4 50.6

TV marketMetropolitan 63.3 53.5

Rural/regional 36.7 46.5

Smoking status

Daily 88.5 75.7

Weekly 6.5 4.4

Occasional 5.0 3.1

Recent quitter n/a 16.7

Age group

1 12.0 10.1

2 17.9 28.0

3 37.5 29.8

4 32.6 32.2

Notes:All data was post-weighted using the current ABS population data (2006) for

NSW population.a) Continuous tracking sample shown for those who recognised Sponge;

for online pre-test, Age Group (1=18-24 years; 2=25-34 years, 3=35-54 years; 4=>54 years); for continuous tracking, Age Group (1=18-24 years; 2=25-39 years, 3=40-54 years; 4=>54 years).

Cotter et al. Article


Study 2: Online Pre-Testing of Revised Sponge

An online pre-testing study was conducted in August 2007

in order to gain a preliminary understanding of adult smokers’

responses to the modernised Sponge advertisement.

MethodThe sample was drawn from an online panel (EmailCash

database), targeting smokers aged 18 years and over from NSW.

The ‘completion rate’ (CR) for the online pre-test was 29.7%. The

CR is reported as ‘it appears to be the single most informative

metric to report for a volunteer opt-in panel’ according to Callegaro

and DiSogra.12 The CR represents the proportion of those who

completed the survey among all eligible panel members who were

invited to take the survey.12

The sample was stratified by gender (50% male and 50% female)

and location (60% metropolitan NSW, i.e. greater Sydney, and 40%

rural/regional). Online surveys were completed by 301 smokers

(see Table 1 for sample characteristics). The data was weighted to

the NSW population in alignment with the 2006 Australian Bureau

of Statistics (ABS).13 Respondents were shown the revised Sponge

advertisement and were asked to rate the effectiveness of the ad in

encouraging smokers to quit on a scale from 0 to 10 (scores 7-10

categorised as ‘effective’). Additionally, new knowledge generated

by the ad was assessed by agreement with the statement ‘the ad

taught me something new’.

ResultsMore than one-third of the smokers surveyed reported that the

revised Sponge advertisement taught them something new. There

was some indication from the qualitative research that Sponge

would add to younger smokers’ knowledge about smoking to a

greater extent than to older smokers’ knowledge. This proposition

was supported by the results from the online pre-test, as the new

knowledge differed significantly across age groups (Table 2).

Younger smokers were more likely to report that the ad provided

them with new information, with up to half of those smokers

reporting that it had taught them something new. The ad was rated

as relatively effective, with almost two-thirds of smokers giving it

a rating of 7 or more out of 10. Effectiveness ratings did not differ

by age, indicating that, though the ad may not have presented new

facts to as many older smokers (compared to younger), it was still

well received by those smokers.

Study 3: Continuous tracking telephone survey

The re-made Sponge campaign commenced with a publicity

launch on 19 October 2007. The campaign included television

advertising (which ran for seven weeks), radio and print messages

for culturally and linguistically diverse communities, and outdoor

advertising (Figure 1).

Over the seven weeks, the advertisement achieved a total of 989

Target Audience Rating Points. Target Audience Rating Points

(TARPs) are an estimate based on OzTAM Australian Television

Audience Measurement and they indicate the percentage of the

target audience reached by the campaign and the average number

of times a target audience member is exposed to the advertising.

One TARP represents 1% of the target audience who have had

the opportunity to see a campaign advertisement on television

once.14,15 Continuous tracking research was used to examine the

impact and effectiveness of the revised Sponge among smokers

and recent quitters in NSW while it was on air.

MethodSmokers and recent quitters (quit in the past 12 months) 18 years

and older were interviewed as part of continuous tracking research

to evaluate the effectiveness of all anti-smoking advertising on

air in NSW. The sample was obtained using list-assisted Random

Digit Dialling (LA-RDD) and the interviews conducted using

computer assisted telephone interviewing (CATI). Approximately

50 interviews were conducted each week while Sponge was on

air and for a further two weeks post-campaign (n=453). The data

were post-weighted by age, gender and metro or regional television

market.13 The response rate for the nine weeks (22 October to 20

December 2007) of tracking analysed was 35.2%

Figure 1: Sponge outdoor advertisement.

Table 2: Results from online pre-testing by age.

New knowledge

(%)

Effectiveness rating

(%)

Total (n=301) 38.5 59.3

Age group

18 to 24 yrs (n=37) 54.1 62.2

25 to 34 yrs (n=53) 47.2 51.9

35 to 54 yrs (n=112) 35.7 54.0

> 54 yrs (n=99) 31.3 68.4

Chi-squared 7.99* 6.03

Linear age trend 7.62** 1.62

Note:New knowledge (agree/strongly agree with ‘taught me something new’);

Effectiveness rating (score >=7 out of 10); *p<.05, **p<0.01.

Smoking Prevention Squeezing new life out of an old sponge


Advertising recall was measured using both unprompted and

prompted measures. First, respondents were asked to describe

the anti-smoking advertisement they most recalled (unprompted

recall). Following this, the Sponge ad was described to all

respondents and they were asked if they remembered seeing the

ad on TV recently (prompted recognition).

Those respondents who recognised the ad (n=380) were asked

a number of questions relating to their responses to the ad. They

were asked if they found the ad ‘attention-grabbing’, ‘believable’

and ‘relevant’ (1=very, 3=not at all); if they ‘were getting tired of

seeing this ad’ (1=a lot 3=not at all,); and if they ‘didn’t want to

see the ad anymore’ (1=strongly agree to 5=strongly disagree).

They were also asked to rate the effectiveness of the ad using

the same measure as in the online pre-test (score from 0-10). In

order to assess take-out of the advertisements’ key messages, they

were asked whether the ad gave the impression that: (a) ‘smoking

causes lung cancer’; (b) ‘smoking damages your lungs’; (c) ‘tar

from cigarette smoke causes cancer’; and (d) ‘tar build up in your

lungs can make you sick’.

Smokers were asked if ‘the ad made me want to stop smoking

now or think about quitting in the future’ as a measure of quitting

intention in response to the ad. Smokers were also asked to indicate

if any of their friends and family had talked to them about their

smoking as a result of seeing Sponge. This was assessed through

the following four statements: (a) ‘family, friends or others have

talked to me about quitting’; (b) ‘family, friends or others are upset

with me about my smoking’; (c) ‘nagging from my children to

quit’; and (d) ‘nagging from my partner to quit’. Combinations

of these responses were re-coded to create an ‘interpersonal

pressure’ indicator (0= none of those situations occurred, 4= all

of the situations occurred).

Chi-squared tests were used to investigate associations between

variables. Proportions were tested for a linear age trend where

appropriate. All quantitative analyses were performed using SPSS

v14 software for Windows.16

ResultsTwenty-three per cent of the smokers and recent quitters

described the Sponge advertisement when asked to recall an ad,

and 84% of respondents recognised the ad when it was described

to them. Prompted recognition did not differ significantly across

the age groups (χ2=2.61, p=0.46).

The qualitative research had indicated that advertising cut-

through might be impacted by age. The tracking research

confirmed these age differences, with agreement that the Sponge

advertisement was ‘attention grabbing’ highest amongst smokers

aged 25-39 years (93.4%; see Table 3). Perceptions of the ad’s

believability and relevance were also highest for the younger

smokers (18-39 years), and those perceptions decreased with age.

There was some potential for advertising wear-out identified in the

qualitative research among older smokers, and, correspondingly,

older respondents in the tracking survey were more likely to agree

that they didn’t want to see the ad anymore. While there was also

a tendency for older respondents to report that they were getting

tired of the ad, the age difference was not significant.

Sponge strongly communicated its key take-out messages, with

more than 80% of the smokers and recent quitters recognising that

the ad communicated the risks associated with tar in the lungs.

There were no age differences in message take-out. Similarly,

there were no differences between the age groups on the ratings

of advertisement effectiveness.

Table 3: Responses of smokers and recent quitters to revised Sponge from the continuous tracking survey by age.

Overall (n=380)

18-24 yrs (n=38)

25-39 yrs (n=106)

40-54 yrs (n=113)

55+ yrs (n=123)

χ2 Linear trend

The ad was...

attention-grabbinga 86% 79% 93% 88% 81% 9.14* 1.54

believablea 83% 92% 91% 85% 73% 15.81** 14.13***

relevant to mea 72% 76% 81% 76% 60% 14.32** 10.00**

I ...

don’t want to see ad anymoreb 33% 13% 31% 42% 31% 10.94* 2.57

am getting tired of this adc 18% 11% 16% 25% 16% 5.92 0.42

Key message take-out 81% 79% 87% 78% 79% 3.46 3.66

Effectiveness rating 55% 55% 58% 52% 56% 0.68 0.02

Smokers only (n=316)

Quit intention 60% 64% 72% 63% 47% 13.10** 8.88**

Interpersonal pressure 59% 67% 64% 63% 51% 5.02 3.99*

Note. χ2 = chi=squared statistic; a) Percentages represent the proportion of each sample who responded ‘very’ or ‘somewhat’ (compared to ‘not at all’) to each statement.b) Agreed (strongly or somewhat) that they don’t want to see the ad anymore.c) Getting tired of seeing the ad ‘a lot’ (compared to ‘somewhat’ or ‘not at all’); Key message take-out (agreed that ad gave the impression that: ‘smoking causes

lung cancer’, ‘smoking damages your lungs’, ‘tar from cigarette smoke causes cancer’, and ‘tar build up in your lungs can make you sick’); Effectiveness rating (rated the ad >= 7 out of 10); Quitting intention (agree with ‘this ad makes me want to quit smoking now or think about quitting in the future’); Interpersonal pressure (at least one instance of pressure); *p<0.05, **p<0.01, ***p<0.001.



There was some indication from the qualitative research that

Sponge would contribute to quitting intention, particularly for

younger smokers. In the tracking survey, agreement that the ad

made me ‘want to stop smoking now’ or ‘think about quitting in the

future’ was highest among younger smokers (18-39 years; 68%).

Finally, the tracking survey included a measure of interpersonal

pressure stimulated by the Sponge campaign. More than half of the

smokers indicated that someone had been upset with them, talked

to them, or ‘nagged’ them, about their smoking. There was a small

but significant tendency for younger smokers to be more likely to

report this type of interpersonal pressure. Notably, interpersonal

pressure in response to Sponge was associated with an increased

likelihood of the ad motivating quitting intentions Forty-three per

cent of the respondents who had not experienced any discussion

from others about Sponge reported that the ad made them want

to quit, compared to 78% of those who had experienced all four

of the discussion situations (x2 = 32.03, p<0.001; linear trend =

26.31, p<0.001).

DiscussionThis paper provides some new insights into ways in which

existing anti-smoking advertising material can be recycled to

influence smokers and move them towards quitting. The qualitative

research highlighted the potential performance of the Sponge ad in

a new market, and informed some of the changes that would need

to be made to make the ad up-to-date. The online pre-testing and

tracking research confirmed the modernised version had a strong

impact, particularly on younger smokers who had not seen the

original version. Given that 40% of smokers in NSW are aged

between 16 and 34 years17 the re-made advertisement had the

potential to influence a large number of smokers.

The modernised Sponge advertisement performed well in

comparison to the original version, screened more than 15 years

earlier, with recall of both the original and the modernised version

of the ad among smokers over 80%.2 These figures also compare

well with recall of other Australian anti-smoking advertisements

such as those aired in phase one of the 1997 National Tobacco

Campaign which achieved a rate of 87% prompted recognition.18

The ad was re-made to particularly influence the younger

audience who were not likely to have seen the original versions.

Smokers aged 18-24 years were the most likely to find the Sponge

ad believable, and to agree that it provided new information.

Encouragingly, those aged 25-39 years were the most likely to

find the Sponge ad ‘relevant’, ‘attention grabbing’ and indicate it

had made them ‘want to stop smoking now or think about quitting

in the future’. The results thereby indicate that impact was not

exclusive to younger smokers; however, the ad was less effective

among smokers older than 54 years of age.

The advertisement’s key strength appears to lie in its ability

to grab attention and simply communicate the long-term health

consequences of smoking, even amongst the older smokers

who were likely to have previously seen the original version.

The ad was effective in influencing quitting intentions, and this

effect was enhanced further by the generation of interpersonal

pressure by family and friends. Importantly, research indicates

that interpersonal discussion about anti-smoking messages may

increase the likelihood of an actual quit attempt.19,20

Limitations, conclusions and implicationsThe relatively consistent results across these three studies give

confidence to these findings; however, there are some limitations

to consider. The use of online panel sampling for the pre-test

might have led to some selection bias, as could the low response

rate of the tracking survey. The low response rate of the tracking

survey is at least partially attributable to the quotas applied to

interview at least 50 respondents per week, leading to decreased

opportunity for recontact. Despite the use of population weights

to account for differences between the samples and the NSW

population, the samples might have been more likely to include

smokers already amenable to an anti-smoking message. However,

as the purpose of these studies was to assess direct responses to

the revised ad, rather than to link ad exposure to behavioural or

attitudinal outcomes, this poses less of a problem. Nonetheless,

any associations between exposure to Sponge and behavioural

outcomes such as quit attempts would provide a more stringent

test of the ad’s impact.

Producing effective anti-smoking advertisements is a costly

and time-consuming process requiring a team of professionals

with the right balance of expertise in the medical science and

marketing fields, as well as creativity, attention to detail, and focus

on achieving objectives. In a real world setting, advertisements

cannot be judged effective if the funds dedicated to their media

placement strategy are not sufficient for the target group to notice

and act upon their messages. Therefore, adapting proven material

is a pragmatic and economical strategy with significant savings

in time, developmental research and production. In the case of

the modernised Sponge advertisement, costs were roughly a third

of the cost of producing completely new material. This allowed

precious funds to be focused on media placement, where reach of

the ad could be enhanced, ensuring that smokers see it (as reflected

in the high rates of recognition) and can act upon its messages

(as evidenced by the high levels of interpersonal pressure and

quitting intentions).

Effective anti-smoking advertisements are extremely hard to

come by, requiring significant investment in time, money and

expertise. This study reminds us that we don’t always have to

re-invent the wheel. The re-made Sponge advertisement had a

positive impact on a new smoker market and was particularly

effective amongst smokers aged less than 40 years. The trend of

most variables towards stronger responses from younger smokers

confirms its impact on this media savvy group. Modernising by

improving the production values of this effective but outdated

advertisement was a successful strategy in influencing the new,

as well as the mature, smoker market. Recycling or adapting

successful mass media campaign material should be considered

as an effective and economical strategy in influencing population-

level smoking rates.

Smoking Prevention Squeezing new life out of an old sponge


AcknowledgementsJohn Bevins, writer, and Brian Slapp, art director, of the original

Sponge advertisement. Paul Fishlock, The Campaign Palace, for

producing the re-made advertisement. Samara Lewis for reviewing

the paper and assistance with referencing and formatting. Michael

Murphy, The Social Research Centre, for the conduct of the

qualitative pre-testing. TNS Social Research for the conduct of the

online pre-testing and McNair Ingenuity Research for the conduct

of the continuous tracking research.

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