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1
Sydney School of Public
Health, University of Sydney,
Sydney, New South Wales,
Australia
2
Cancer Prevention Division,
Cancer Institute NSW, Sydney,
New South Wales, Australia
3
Victorian Comprehensive
Cancer Centre, Melbourne,
Victoria, Australia
Correspondence to
Dr Sally Dunlop, Sydney School
of Public Health, University of
Sydney; Research Associate,
Prevention Division, Cancer
Institute NSW, Level 9, 8
Central Ave, Australian
Technology Park, Eveleigh NSW
2015, Australia; sally.dunlop@
cancerinstitute.org.au
Received 3 October 2011
Accepted 10 October 2012
Published Online First
10 November 2012
To cite: Dunlop SM,
Perez D, Cotter T. Tob
Control 2014;23:215–222.
Dunlop SM, et al. Tob Control 2014;23:215–222. doi:10.1136/tobaccocontrol-2011-050256
The natural history of antismoking advertising recall:
the influence of broadcasting parameters, emotional
intensity and executional features
Sally M Dunlop,1,2 Donna Perez,2 Trish Cotter3
ABSTRACT
Background The necessary first steps for televised
media campaign effects are population exposure and
recall. To maximise the impact of campaign funding, it is
critical to identify modifiable factors that increase the
efficiency of an advertisement reaching the target
audience and of their recalling that advertisement.
Methods Data come from a serial cross-sectional
telephone survey with weekly interviews of adult
smokers and recent quitters from the state of New South
Wales, Australia, collected between April 2005 and
December 2010 (total n=13 301). Survey data were
merged with commercial TV ratings data (Gross Rating
Points (GRPs)) to estimate individuals’ exposure to
antismoking campaigns.
Results Multivariable logistic regression analyses
indicated that GRPs and broadcasting recency were
positively associated with advertisement recall, such that
advertisements broadcast more at higher levels or in
more recent weeks were more likely to be recalled.
Advertisements were more likely to be recalled in their
launch phase than in following periods. Controlling for
broadcasting parameters, advertisements higher in
emotional intensity were more likely to be recalled than
those low in emotion; and emotionally intense
advertisements required fewer GRPs to achieve high
levels of recall than lower emotion advertisements. There
was some evidence for a diminishing effect of increased
GRPs on recall.
Conclusions In order to achieve sufficient levels of
population recall of antismoking campaigns,
advertisements need to be broadcast at adequate levels
in relatively frequent cycles. Advertisements with highly
emotional content may offer the most efficient means by
which to increase population recall.
Recent reviews conclude that there is strong evi-
dence that televised antismoking campaigns can
contribute to reductions in adult smoking.1 2
Higher levels of exposure to public health media
campaigns designed to encourage smoking cessation
have been associated with increased quitting activity
3–5
and decreased smoking prevalence.6 While there
is growing interest in identifying the types of mes-
sages4 7 8 and broadcasting parameters5 9 that might
optimise campaign effects, there is a limited amount
of population-level evidence showing how varia-
tions in advertisement features and media strategies
affect campaign impact. In advertising research, the
‘hierarchy of effects’ model postulates that advertis-
ing works by first being perceived and retained;10
and health communication scholars recognise that
exposure to and recall of a campaign are necessary
Research paper
first steps in the process of campaign effects.11 12 In
order to maximise the impact of scarce public health
funding, it is critical to identify modifiable factors
that increase the efficiency of an advertisement
reaching the campaign’s target audience and of their
recalling that advertisement. The primary objective
of the current study was to explore modifiable
factors related to recall of antismoking advertising,
focusing on broadcasting parameters and advertise-
ment characteristics.
Determining the impact of broadcasting para-
meters on advertisement recall is a difficult task
due to the need for population-level data relating
to real-world campaigns. Previous research has
demonstrated that recall of antismoking advertise-
ments is related to the reach and frequency of an
advertisement in a population (measured using
commercial TV ratings data providing Gross Rating
Points or GRPs), showing that more frequently
broadcast advertisements are more likely to be
recalled.11 13–16 A decay in recall has also been
observed when advertisements cease to be broad-
cast.13 Additionally, it is posited that advertisements
can ‘wear out’ over time and with repeat airings,17
with some evidence showing that newly created
antismoking advertisements may drive more change
than familiar advertisements.18
The current study utilises a continuous tracking
methodology to collect weekly population-level
data on adult smokers’ and recent quitters’ recall of
antismoking advertisements broadcast in the
Australian state of New South Wales (NSW) over a
period of 5 years. This methodology extends previ-
ous research by tracking recall of specific advertise-
ments when they are on air as well as in the weeks
and months following by assessing both ‘prompted’
and ‘unprompted’ recall, and by including a large
and varied set of advertisements. We consider the
impact of three broadcasting parameters—frequency
(measured by GRPs), recency and novelty—on
recall, expecting that advertisements achieving
higher GRPs will be more likely to be recalled (fre-
quency; H1), that the more time that has passed
since the last broadcast the less likely an advertise-
ment will be recalled (recency; H2) and that adver-
tisements are most likely to be recalled when in
their launch phase (novelty; H3).
A growing body of literature suggests that specific
advertisement characteristics can have implications
for how an advertisement is processed by the
viewer. Antismoking advertisements can be cate-
gorised along a number of dimensions, including
message theme or topic, emotional intensity, and
executional characteristics of the advertisement
215
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Research paper
such as the use of a testimonial or narrative structure or the
presence of graphic imagery.4 7 8 13 19–22 In both experimental
and population-based survey studies, antismoking advertise-
ments that use graphic imagery or personal stories to depict the
negative consequences of smoking have been associated with
greater recall and impact than other types of advertise-
ments.4 8 9 13 20–24 This advantage is typically theorised to be
due to the emotional content of such advertisements. Research
conducted by Lang and colleagues suggests that television
content that elicits negative emotion is more likely to be
attended to and remembered than that without emotional
content,25 and that discrete emotional responses increase the
viewer’s memory and the likelihood of their recalling the adver-
tisement.26 One study to date has shown a difference in recall
for highly emotive advertisements with different executional
characteristics, demonstrating the highest recall rates for adver-
tisements with testimonial formats, followed by advertisements
with graphic imagery.7 The current study extends previous
research on emotionality and other advertisement characteristics
in two main ways. The first is methodological: the population-
level dataset measures recall (both prompted and unprompted)
of a large and varied set of advertisements as they are on air and
in the months following, rather than in experimental exposures
or one-off campaigns. Consistent with previous research, we
expect that more emotionally arousing advertisements will be
more likely to be recalled than less emotional advertisements
(H4). Given the lack of evidence as to how executional
characteristics are related to recall, we pose a research question
as to whether emotionally-evocative advertisements with graphic
imagery will be recalled more frequently than
emotionally-evocative advertisements with a narrative format
(RQ1). The second way we extend previous research is by
exploring whether emotional intensity and executional
characteristics moderate the impact of broadcasting parameters
(RQ2).
METHOD
Survey data
The Cancer Institute NSW’s Tobacco Tracking Survey (CITTS)
is a serial cross-sectional telephone survey monitoring
smoking-related cognitions and behaviours, along with recall of
and responses to antismoking mass media campaigns, in adult
smokers and recent quitters (quit in the last 12 months) from
NSW. Households are recruited using random digit dialling of
landline telephone numbers and a random selection procedure
is used to select participants (selecting the nth oldest eligible
adult in the household). As a continuous tracking survey, 50
interviews per week are conducted across most weeks of the
year; analyses were limited to respondents interviewed between
April 2005 and December 2010 (n=13 301), in which an
overall response rate of 40% (using the American Association
for Public Opinion Research Response Rate #4) was achieved.27
Measures
Recall and recognition of antismoking advertisements
A key feature of the CITTS is the ability to track recall of anti-
smoking advertisements as they are currently on air and in the
weeks following. Prompted or aided recall (henceforth labelled
‘recognition’) is often used as a self-reported measure of cam-
paign exposure,7 9 11 15 while unprompted recall can also be
used as a measure of advertisement ‘cut-through’ or the adver-
tisement’s ability to be readily recalled from memory.28
All respondents were asked ‘Have you seen any television
advertising recently about tobacco smoking?’ Respondents who
216 Dunlop SM, et al. Tob Control 2014;23:215–222. doi:10.1136/tobaccocontrol-2011-050256
answered ‘yes’ (n=9453, 71% of total sample) were asked to
describe the advertisement, with descriptions recorded verbatim
and matched to a list of television advertisements that appeared
during the study period (unprompted recall). If the response did
not match one of the listed advertisements (eg, an advertisement
for NRT), it was excluded. Following this, interviewers probed
for recall of any other antismoking advertisements, with
responses again matched to the list of available advertisements
(unprompted recall, n=7190, 54% of total sample).
Recognition of specific advertisements currently or recently
on air was then measured by describing advertisements and
asking respondents whether they remembered seeing the adver-
tisement on TV recently. The brief descriptions gave respon-
dents enough information to recognise the advertisement, but
not enough for them to falsely indicate awareness. On average,
participants were asked about four different advertisements
(range 2–7). The number of weeks that recognition was tracked
for an advertisement after it had ceased being broadcast varied
across the different advertisements (M=4, SD=6).
Covariates
Demographic items measuring age, gender, income and level of
education were included in the survey. The income and educa-
tion variables were combined into dummy variables indicating
low, middle or high socioeconomic status (SES). Postcodes were
used with the Socio-Economic Indices for Areas29 to indicate
neighbourhood SES (quintiles 4–5=low SES, quintiles 1–
3=moderate–high SES). A dummy variable was used to indicate
media market (Metropolitan, Northern NSW or Southern
NSW). For smokers, cigarette consumption was measured with
a three-level categorical variable (<10, 11–20, >21 per day).
Some of the advertisements were targeted at parents of young
children (focusing on the potential impact of their
smoking-related disease on their children). For this reason, par-
ental status (whether there were any children younger than
17 years living in their household) was controlled for in all ana-
lyses. A linear time variable was included as a covariate to
account for any secular trends in the data (numbered consecu-
tively with 1 as the first survey week).
Person-advertisement data structure
Two person-advertisement-level datasets were created (Recall
and Recognition), with the data structured so that each observa-
tion corresponded to an individual’s responses to one advertise-
ment. In the Recall dataset, each observation corresponded to
an individual’s recall score for a specific advertisement
(1=recall, 0=no recall). Given that individuals could not recall
advertisements that had not yet been broadcast, for each adver-
tisement the dataset was limited to respondents interviewed
after the date of the first broadcast. Inspection of the Recall
dataset showed that recall for advertisements that had not been
on air for more than 12 months was rare (3% of advertisements
recalled). This fact, coupled with the fact that the recall measure
referred to seeing advertisements recently, led to a restriction of
the dataset to include advertisement-specific recall scores only
for respondents interviewed within 12 months of the last broad-
cast. We note, however, that the pattern of results was the same
using the full dataset. The resulting Recall dataset consisted of
106 733 person-advertisement observations corresponding to
one respondent’s recall of an advertisement broadcast within
the previous 12 months. The Recognition dataset consisted of
38 026 person-advertisement observations corresponding to one
respondent’s recognition of a recently broadcast advertisement.
In each dataset, because individuals reported on more than one
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Research paper

these advertisements also present advice and information about

Table 1 Sample characteristics of recall and recognition datasets
cessation support services available to smokers. The advertise-
Recall dataset Recognition dataset ments were classified according to two dimensions: emotional
(n=13 200 unique (n=13 137 unique intensity and executional characteristics. The advertisements
respondents) respondents)
were first rated by 16 independent adults on three items measur-
Percentage N Percentage N ing emotional intensity:4 9 emotional, intense and powerful
(each scale 1–10; α=0.91). The emotional intensity scale was an
Sex: %
average of these three items (M=5.99, SD=2.15) and was used
Female 49 6811 49 6783
to classify advertisements into low and high emotion categories
Male 51 6389 51 6354
(low emotion=less than 5, high emotion=5–10). Following this,
Age: %
advertisements were then further classified by two trained
18–29 years 23 2307 23 2305
coders according to two executional characteristics: the presence
30–55 years 50 7265 50 7223
of graphic imagery or the use of a narrative format (see table 2).
55+ years 27 3560 27 3529
Discrepancies between coders were discussed until consensus
SES (education–income): %
was achieved. From this coding, it was apparent that none of
Low 42 5735 42 5701
the advertisements in the low emotion category had graphic
Moderate 25 3193 25 3184
imagery or narrative formats. Therefore, there were three cat-
High 33 4162 33 4143
egories of advertisements: low emotion, high emotion graphic
Neighbourhood SES: %
imagery and high emotion narrative.
Low 42 5691 42 5656
We ascertained GRPs for each of the advertisements based on
Moderate–high 58 7065 58 7037
OzTAM (Australian Television Audience Measurement) for
Media market: %
adults aged 18 years and older including both free-to-air and
Sydney 57 6440 57 6420
cable TV. GRPs are a product of the percentage of the target audi-
Northern NSW 23 3370 23 3348
ence exposed to an advertisement (reach) and the average
Southern NSW 20 3390 20 3369
number of times a target audience member would be exposed
Household children: %
(frequency). Hence, 200 GRPs might represent 100% of the
No 46 5820 46 5820
target audience receiving the message an average of two times
Yes 54 7317 54 7254
over a specified period or 50% reached four times. The advertise-
Current smoker: %
ments differed in length from 15 to 60 s; we took these different
No 12 1494 12 1494
lengths into account by calculating GRPs equivalent to a 30 s
Yes 88 11 706 88 11 643
spot for each advertisement.30 Emerging evidence suggests that
Cigarette consumption: (smokers, %)
the effects of antismoking advertising occur in a relatively short
Low 42 4628 42 4613
time-frame of between 2 and 3 months.5 6 31 For this reason, and
Moderate 36 4318 36 4299
the fact that the recall and recognition measures in the CITTS
High 22 2693 22 2664
referred to ‘recent’ advertising, we computed a cumulative
Recent quit attempt: %
3-month GRPs variable as a measure of media weight. We chose
No 13 13 021 14 10 268
not to include GRPs from the week of interview, given that
Yes 86 1625 86 1615
Salient quitting thoughts (smokers, %)
No 64 7322 64 7280
Yes 36 4299 36 4278 Table 2 Antismoking advertisements broadcast in New South
Launch phase*: % Wales, 2005–2010
No 96 89
Advertisement Examples of
Yes 4 11
categories advertisements Advertisements
3-month GRPs*: (M, SD) 166 (270) 378 (300)
Broadcast recency*: (M, SD) 18 (15) 4 (6) Low emotion Advertisements highlighting Quitline Services Series; Get
support services for off Cigarettes; Which
Note. n values are unweighted, percentages are weighted; some n values do not add
to total due to missing data or exclusions from coded variables. smokers; advertisements Disease?; Stairway to
*Variable measured at level of person-advertisement observation (rather than for depicting negative health Emphysema; Emphysema
unique respondents); broadcast recency, number of weeks since the advertisement effects of smoking using TV; Bubblewrap
was last broadcast. simulations of body parts
GRP: gross rating point; NSW, New South Wales; SES, socioeconomic status. or processes
High emotion with Advertisements depicting Mouth Cancer; Amputation
graphic imagery negative health effects of (Gangrene); Bronchoscopy;
smoking using graphic Everybody Knows;
advertisement, it was possible that an individual’s responses images of real body parts Cigarettes are Eating you
might be correlated across advertisements. To adjust for possible and processes Alive; Cigarettes are Eating
inter-correlations, we adjusted all estimated SEs by using the your Kids Alive; Artery;
individual as a cluster variable in all regression analyses. Sample Carotid; Sponge
characteristics of each dataset are shown in table 1. High emotion with Advertisements conveying Parents; Voice Within; Best
narrative format the negative consequences Intentions; Anthony; Zita;
of smoking using stories Excuses (Echo); If Smoking
Advertisement-level data and testimonials from was a Friend; What’s Worse
A total of 32 cessation-focused antismoking advertisements smokers or their family or
friends
were broadcast in NSW during the study period. The vast
majority of antismoking messages in NSW are aimed at adult All advertisements can be viewed at http://www.cancerinstitute.org.au/cancer_inst/
campaigns/antismoke.html
smokers and provide a strong health effects message. Some of

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Research paper

respondents are interviewed throughout the week and may there-
fore be interviewed either before or after potential exposures for
that week. To aid in interpretation, this variable was divided by
1200 so that a 1-unit increase represented an average of one add-
itional potential exposure per week for 100% of the target audi-
ence. To test for diminishing returns at increasing levels of
advertising exposure, we included a quadratic term (squared
GRPs) in our analyses.
A variable indicating the number of weeks since an advertise-
ment had last been on air was used to indicate recency of broad-
casting (coded 0 if the advertisement was presently on air). A
dummy variable was also included that identified respondents
interviewed during the launch phase of an advertisement’s
broadcasting life, the first 4 weeks that it was on air (1=launch
phase, 0=any other time).
Statistical analyses
Univariate logistic regression was used to explore associations
between the dependent variables and the advertisement-level
variables and covariates. From the univariate analyses,
advertisement-level variables and covariates associated with the
dependent variable at p<0.25 were selected to enter into multi-
variable logistic regression models predicting recall and recogni-
tion.32 The independent variables in these models included:
GRPs and GRPs-squared (testing H1), broadcasting recency
(H2), the launch phase of the advertisement (H3) and advertise-
ment type (H4 and RQ1).
In order to ascertain if the effects of broadcasting parameters
on recall were moderated by advertisement type (RQ2), the
multivariate models were also run with interaction terms
between advertisement type and these broadcasting parameters

Table 3 Unprompted recall of advertisements broadcast in last 12 months

Multivariable model with
Univariate associations Multivariable model interactions

95% CI 95% CI 95% CI

OR Low High p Value OR Low High p Value OR Low High p Value

Advertisement type
Low emotion 1 <0.001* 1 <0.001* 1 <0.001*
High emotion narrative 1.59 1.48 to 1.71 1.65 1.54 to 1.79 <0.001 1.79 1.41 to 2.25 <0.001
High emotion graphic 2.84 2.65 to 3.05 3.77 3.52 to 4.07 <0.001 2.96 2.39 to 3.68 <0.001
GRPs† 6.92 6.38 to 7.51 <0.001 4.46 3.08 to 6.47 <0.001 2.49 1.22 to 5.11 0.013
Advertisement type × GRPs
High emotion narrative × GRPs – 1.37 0.53 to 3.52 0.516
High emotion graphic × GRPs – 6.91 2.71 to 17.67 <0.001
GRPs-squared 6.25 5.64 to 6.29 <0.001 0.70 0.46 to 1.07 0.102 2.05 1.03 to 4.09 0.041
Advertisement type × GRPs-squared
High emotion narrative × GRPs-squared – 0.38 0.14 to 1.00 0.051
High emotion graphic × GRPs-squared – 0.03 0.01 to 0.10 <0.001
Launch of advertisement (yes) 3.93 3.61 to 4.29 <0.001 2.30 2.08 to 2.53 <0.001 1.46 1.086 to 1.96 0.012
Advertisement type × launch period
High emotion narrative × launch – 0.65 0.52 to 0.82 0.001
High emotion graphic × launch – 0.80 0.64 to 0.99 0.45
Broadcast recency 0.95 0.94 to 0.95 <0.001 0.96 0.96 to 0.97 <0.001 0.95 0.94 to 0.96 <0.001
Advertisement type × broadcast recency
High emotion narrative × recency – 1.01 0.99 to 1.02 0.108
High emotion graphic × recency – 1.03 1.02 to 1.04 <0.001
Gender (male) 0.76 0.73 to 0.81 <0.001 0.74 0.70 to 0.78 <0.001 0.73 0.70 to 0.78 <0.001
Age
18–29 years 1 <0.001* 1 0.001* 1 <0.001*
30–55 years 0.93 0.88 to 0.99 0.91 0.85 to 0.98 0.008 0.91 0.85 to 0.97 0.007
55+ years 0.58 0.54 to 0.63 0.63 0.58 to 0.69 <0.001 0.63 0.58 to 0.69 <0.001
SES
Low 1 <0.001* 1 0.003* 1 0.002*
Moderate 1.08 1.02 to 1.16 1.02 0.95 to 1.09 0.549 1.02 0.95 to 1.09 0.562
High 1.15 1.08 to 1.22 1.11 1.04 to 1.19 0.001 1.11 1.04 to 1.18 0.001
Neighbourhood SES (moderate–high) 1.00 0.95 to 1.05 0.983 – –
Children at home (yes) 1.52 1.45 to 1.60 <0.001 1.20 1.13 to 1.27 <0.001 1.19 1.12 to 1.26 <0.001
Smoking status (smoker) 0.99 0.92 to 1.07 0.798 – –
Smoking consumption
<10 1 0.077* – –
11–20 1.06 0.99 to 1.13 – –
21+ 0.99 0.92 to 1.07 – –
OR, CI; variables selected for entry into multivariate models if p<0.25 in initial models.
*Wald test of joint significance.
†In units of an average of 100 GRPs per week, excluding week of interview; multivariable analyses include variables indicating time (week of interview) and media market as covariates;
– denotes variable not entered into multivariable model.
GRPs, Gross Rating Points; SES, socioeconomic status.

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included. Interactions were entered one by one and retained
only if significant. Finally, we visually represented the relation-
ship between advertisement type and GRPs by plotting the pre-
dicted probabilities of each outcome by GRPs and
advertisement type, holding all other variables constant.
Since cigarette consumption was only available for the
smoker sample, the analyses were run in both the smoker
sample and the full sample (of smokers and ex-smokers). In
each analysis, the same pattern of results emerged, so we
present only the results from the full sample.
All analyses were conducted using Stata V.11. Population
weights were applied to adjust for a slight over-representation of
female subjects, older respondents and regional residents com-
pared with the NSW population,33 and clustering on a unique
individual identifier was used in all models to adjust for possible
inter-correlations among observations.
RESULTS
Unprompted recall
Of the advertisements that were recalled and matched to NSW
antismoking advertisements, 17% were low emotion, 34% were
high emotion narrative advertisements and 48% were high
emotion graphic advertisements. The first multivariable model
in table 3 shows that, consistent with H1, there was a significant
association between recall and GRPs, such that, with each add-
itional 1200 exposures over the previous 3 months (equating to
approximately one exposure per week for 100% of individuals),
there was an increase of 4.46 in the odds of a respondent recal-
ling an advertisement. Both types of high emotion advertise-
ments were more likely to be recalled than the low emotion
advertisements (consistent with H4), with a comparison of the
point-estimates indicating that this difference was greater for
recall of the graphic advertisements than the narrative advertise-
ments (RQ1). Confirming H2, recency of broadcasting was also
a significant predictor, with recall decreasing as the final broad-
cast became more distant. Finally, consistent with H3, respon-
dents interviewed in the launch period of an advertisement were
more than twice as likely to recall that advertisement than those
interviewed at other times in the following 12 months.
From the model with the interaction terms, it was apparent
that broadcasting parameters had differential impact according
to advertisement type (RQ2). GRPs were more strongly asso-
ciated with recall for the high emotion graphic advertisements
than for the low emotion advertisements. However, the signifi-
cant quadratic term in which the OR is less than 1 indicates a
diminishing effect of GRPs on recall for the graphic advertise-
ments, as illustrated in figure 1. The launch phase of a campaign
was a stronger predictor of recall for the low emotion than for
the high emotion narrative advertisements, and the recency of
broadcast was a stronger predictor for the high emotion graphic
advertisements than for the low emotion advertisements.
Recognition
In all, 42% of respondents who were queried about a low
emotion advertisement recognised the advertisement, 64% of
those queried about high emotion narrative advertisements indi-
cated recognition and 54% of those who were asked about high
emotion graphic advertisements recognised them. Table 4 shows
that there was a positive association between GRPs and recogni-
tion (consistent with H1), though the significant quadratic term
(OR<1) indicated a diminishing effect of GRPs at higher levels.
Recognition was positively associated with the launch phase of
an advertisement (consistent with H3), and there was a negative
association between recognition and weeks since last broadcast
Dunlop SM, et al. Tob Control 2014;23:215–222. doi:10.1136/tobaccocontrol-2011-050256
Research paper
Figure 1 Predicted probability of unprompted recall. GRPs, Gross
Rating Points.
(consistent with H2). Both types of high emotion advertise-
ments were more likely to be recognised than the low emotion
advertisements (consistent with H4), and a comparison of the
ORs indicates that this difference was greater for the narrative
advertisements than the graphic advertisements (RQ1). From
the model which included the interaction terms, it was apparent
that GRPs were more strongly associated with recognition for
low emotion advertisements than for the high emotion adver-
tisements (shown in figure 2). Further, the positive association
between recognition and the launch phase of an advertisement
was stronger for low emotion than high emotion advertise-
ments. Similarly, the association between broadcast recency and
recognition was stronger for the low emotion advertisements
than for the high emotion advertisements.
DISCUSSION
Consistent with prior literature4 8 9 13 20−24 and our hypothesis,
emotionally arousing advertisements were more likely to be
recalled (using both unprompted and prompted measures) than
those which were less emotional. Emotional messages might be
more likely to promote higher-order cognitive processing34 or
to increase feelings of personal relevance,35 leading the audience
to generate their own persuasive messages in response to the
advertisement and increasing their memory for the content. It
might also be that they generate greater discussion after expos-
ure,36 37 reinforcing memory for the advertisement. It is pos-
sible, however, that some unmeasured factor related to
emotional intensity, such as argument strength,38 is the real
basis for improved recall, and this should be explored in future
research. Nonetheless, for practical applications, emotional
intensity is relatively easy to assess and might therefore be used
by campaign developers as a way to select advertisements likely
to generate high levels of population recall.9
Among high emotion advertisements, advertisement execu-
tion was related to recall, though the results differed according
to type of recall. High emotion advertisements with graphic
imagery were most likely to be ‘top-of-mind’ using the
unprompted recall measure. There are a number of potential
219
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Table 4 Prompted recognition of antismoking advertisements

Univariate associations Multivariate model Multivariate model with interactions

95% CI 95% CI 95% CI

OR Low High p Value OR Low High p Value OR Low High p Value

Advertisement type
Low emotion 1 <0.001* 1 <0.001* 1 <0.001*
High emotion narrative 2.46 2.33 to 2.60 2.78 2.64 to 2.98 <0.001 3.96 3.45 to 4.54 <0.001
High emotion graphic 1.67 1.58 to 1.77 1.97 1.85 to 2.08 <0.001 3.19 2.81 to 3.63 <0.001
GRPs† 2.36 2.15 to 2.59 <0.001 3.44 1.53 to 1.91 <0.001 6.25 4.43 to 8.80 <0.001
Advertisement type × GRPs
High emotion narrative × GRPs – 0.54 0.40 to 0.73 <0.001
High emotion graphic × GRPs – 0.34 0.26 to 0.46 <0.001
GRPs-squared 2.22 1.97 to 2.49 <0.001 0.41 0.30 to 0.58 <0.001 0.47 0.33 to 0.66 <0.001
Launch of advertisement (yes) 1.33 1.24 to 1.43 <0.001 1.18 1.09 to 1.28 <0.001 2.28 1.98 to 2.62 <0.001
Advertisement type × launch period
High emotion narrative × launch – 0.44 0.36 to 0.53 <0.001
High emotion graphic × launch – 0.44 0.37 to 0.52 <0.001
Broadcast recency 0.97 0.97 to0.97 <0.001 0.98 0.98 to 0.99 <0.001 1.00 0.99 to 1.01 0.78
Advertisement type × broadcast recency
High emotion narrative × recency – 0.98 0.97 to 0.99 <0.001
High emotion graphic × recency – 0.98 0.97 to 0.99 <0.001
Gender (male) 0.83 0.79 to 0.87 <0.001 0.82 0.77 to 0.86 <0.001 0.81 0.77 to 0.86 <0.001
Age
18–29 years 1 <0.001* 1 <0.001* 1 <0.001*
30–55 years 1.05 0.98 to 1.12 1.04 0.97 to 1.13 0.249 1.05 0.97 to 1.13 0.25
55+ years 0.78 0.72 to 0.85 0.78 0.72 to 0.86 <0.001 0.78 0.72 to 0.86 <0.001
SES
Low 1 <0.001* 1 0.002* 1 <0.001*
Moderate 0.92 0.86 to 0.99 0.89 0.83 to 0.96 0.002 0.89 0.83 to 0.96 <0.001
High 0.92 0.87 to 0.98 0.91 0.85 to 0.97 0.004 0.90 0.84 to 0.97 <0.001
Neighbourhood SES (moderate–high) 1.01 0.96 to 1.07 0.688 – –
Children at home (yes) 1.30 1.23 to 1.37 <0.001 1.06 1.00 to 1.13 0.07 1.06 0.99 to 1.13 0.08
Smoking status (smoker) 0.94 0.86 to 1.01 0.113 – –
Smoking consumption
<10 1 0.082* – –
11–20 1.05 0.99 to 1.12 – –
21+ 1.08 1.00 to 1.16 – –
OR, CI; variables selected for entry into multivariate models if p<0.25 in initial models.
*Wald test of joint significance.
†In units of an average of 100 GRPs per week, excluding week of interview; multivariable analyses include variables indicating time (week of interview) and media market as covariates;
– denotes variable not entered into multivariable model.
GRPs, Gross Rating Points; SES, socioeconomic status.

explanations for this. The first is that graphic images increase
message processing and therefore recall. An alternative explan-
ation is that graphic advertisements are more readily recalled
because they contain content most easily linked to the category
cue (of antismoking or tobacco advertisement). Additionally, a
number of the graphic images used in the advertisements were
also used as graphic health warnings on cigarette packs,39 40 and
repeated exposure to these images on packs might reinforce
memory for the advertisements.41 In contrast, and consistent
with another study using a recognition measure,7 high emotion
narrative advertisements were more frequently recognised than
graphic imagery advertisements, even when controlling for
potentially different levels of exposure. Narrative effects are
posited to arise from processes of identification and transporta-
tion into the story, so that perceptions of personal vulnerability
are heightened, leading to greater impact.35 42–44 This type of
processing might lead to a deeper memory trace for these types
of advertisements and should be a subject for further research.
Future research might also investigate the relationship between
different types of recall (prompted or unprompted) and adver-
tisement effects in order to determine if one type of recall is
more closely associated with advertisement-related cognitive and
behavioural changes.
Broadcasting parameters were closely related to both
unprompted recall and prompted recognition. Consistent with
our hypotheses, and with previous research,13 16 the likelihood
of recall increased with increasing GRPs. There was, however,
some evidence of a slowing of the effects of increasing advertis-
ing exposure on both recall and recognition. For the recognition
measure, this effect was apparent for all advertisement types.
For the unprompted recall measure, the diminishing effects
were only apparent for the high emotion graphic advertise-
ments. Since the graphic advertisements were most likely to be
recalled in this measure, a plausible explanation might be that
the other advertisement types would also show diminishing
returns once they reached a level of recall similar to that of the

220 Dunlop SM, et al. Tob Control 2014;23:215–222. doi:10.1136/tobaccocontrol-2011-050256

 Downloaded from http://tobaccocontrol.bmj.com/ on June 15, 2015 - Published by group.bmj.com
Figure 2 Predicted probability of recognition. GRPs, Gross Rating
Points.
graphic advertisements. These diminishing effects might be
interpreted as meaning that advertisements will cease to reach
new viewers with increasing exposures past a particular GRP
level; nonetheless, increased frequency of exposure might still
reinforce the message effects on those that have seen it.
There was also evidence that, controlling for variations in
level of broadcasting, recall for an advertisement was the great-
est during its launch phase, possibly indicating that the novelty
of an advertisement attracts greater attention, or that accom-
panying media releases and unpaid media exposure can boost
recall. Once advertisements were removed from air, recall
decreased with time. In order to maintain high levels of popula-
tion recall, campaign planners should endeavour to ensure
adequate exposure to advertisements over relatively frequent
broadcasting cycles, and to include new or novel advertisements
in their mix of campaigns.
In general, broadcasting parameters were more closely related
to recall for the advertisements arousing lower levels of
emotion. Consistent with a series of studies focusing on youth
recall of antismoking advertising,9 13 more emotionally intense
advertisements required fewer exposures in order to achieve
comparable levels of recall to the less emotional advertisements.
This has an implication for campaign planners: if emotionally
intense advertisements generate higher levels of recall at lower
levels of broadcast, they may be best suited for making efficient
use of scarce tobacco control funding. When lower emotion
advertisements are included in the ‘media mix’ of antismoking
campaigns, they need to be broadcast at sufficient levels to
ensure adequate population recall.
The strengths of this study are the length of the study period
and resulting variation in antismoking advertising exposure,
measurement of both unprompted recall and prompted recogni-
tion, the range of advertisements included, and the ability to
track recall and recognition while advertisements were currently
or recently on air. Limitations are the use of landline-only tele-
phone numbers and the relatively low response rate, possibly
leading to some bias in sample composition. We note that both
these sampling issues were consistent across the study period,
limiting their influence on the observed pattern of results, and
that the inclusion of the linear time variable in all analyses helps
Dunlop SM, et al. Tob Control 2014;23:215–222. doi:10.1136/tobaccocontrol-2011-050256
Research paper
to account for any gradual differences over time. The rate of
mobile-only households in Australia was recently estimated at
14%, limiting concerns about excluding these individuals from
the sample.45 The response rate is similar to that of other recent
population telephone surveys in Australia 46 and the USA,47
and the overall rates of quitting in this sample are similar to that
of larger population surveys of NSW smokers,48 suggesting that
the smoker sample is somewhat representative.
This study demonstrates that both broadcasting parameters
and advertising creative execution have significant impacts on
advertising recall and recognition, with high emotion graphic
and narrative advertisements being more likely to be recalled by
smokers. Additionally, the results indicate that these types of
advertisements are likely to require less GRPs (and hence less
funds) to achieve higher levels of recall.
What this paper adds
▸ Previous research has shown that antismoking advertising
can influence population-level smoking behaviours.
Nonetheless, there is still a limited understanding of which
types of advertisements are most likely to be successful at
reaching and influencing smokers, and how broadcasting
parameters can increase the likelihood of smokers’ recall of
advertisements.
▸ This study suggests that population recall of antismoking
campaigns is related to the emotional intensity of the
advertisements, with high emotion advertisements being
more likely to be recalled than low emotion advertisements.
▸ High emotion advertisements with graphic imagery were
most likely to be ‘top-of-mind’ using an unprompted recall
measure, whereas high emotion narrative advertisements
were more frequently recognised than graphic imagery
advertisements using a prompted recognition measure.
▸ Recall was positively related to the frequency and recency of
broadcasting, and also to the novelty of the campaign.
▸ There was some evidence for a diminishing effect of
increased Gross Rating Points on advertisement recall.
▸ In general, advertisements which elicit high levels of
emotion required fewer exposures to achieve similar levels of
recall to low emotion advertisements, suggesting that they
might present the most cost-efficient means of reaching and
influencing smokers.
Contributors SD analysed the data and contributed writing for all drafts. TC
contributed to the conception of the study and all drafts. DP contributed to the
interpretation of the data and all drafts. All authors gave final approval of the paper.
Funding Sally Dunlop is employed by the University of Sydney. Donna Perez is
employed by the Cancer Institute NSW, a state government organisation. Trish Cotter
is employed by the Victorian Comprehensive Cancer Centre. She is also a technical
advisor on mass media to the World Lung Foundation.
Competing interests None.
Ethics approval The NSW Population Health Services Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Readers are encouraged to the contact the authors for
further information regarding the data.
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Dunlop SM, et al. Tob Control 2014;23:215–222. doi:10.1136/tobaccocontrol-2011-050256
 Downloaded from http://tobaccocontrol.bmj.com/ on June 15, 2015 - Published by group.bmj.com

The natural history of antismoking

advertising recall: the influence of
broadcasting parameters, emotional intensity
and executional features
Sally M Dunlop, Donna Perez and Trish Cotter

Tob Control 2014 23: 215-222 originally published online November 10,
2012
doi: 10.1136/tobaccocontrol-2011-050256

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