Associations between tobacco control mass media campaign expenditure and smoking prevalence and quitting in England: a time series analysis

It has been established that mass media campaigns can increase smoking cessation rates, but there is little direct evidence estimating associations between government expenditure on tobacco control mass media campaigns and smoking cessation. This study assessed the association over 8 years between mass media expenditure in England and quit attempts, smoking cessation and smoking prevalence. Autoregressive integrated moving average modelling with exogenous variables (ARIMAX) was applied to monthly estimates from the Smoking Toolkit Study between June 2008 and February 2016. We assessed the association between the trends in mass media expenditure and (1) quit attempts in the last two months, (2) quit success among those who attempted to quit and (3) smoking prevalence. Analyses were adjusted for trends in weekly spending on tobacco by smokers, tobacco control policies and the use of established aids to cessation. Monthly spending on mass media campaigns ranged from nothing to £2.4 million, with a mean of £465 054. An increase in mass media expenditure of 10% of the monthly average was associated with a 0.51% increase (of the average) in success rates of quit attempts (95% CI 0.10% to 0.91%, p=0.014). No clear association was detected between changes in mass media expenditure and changes in quit attempt prevalence (β=-0.03, 95% CI -2.05% to 2.00%, p=0.979) or smoking prevalence (β=-0.03, 95% CI -0.09% to 0.03%, p=0.299). Between 2008 and 2016, higher monthly expenditure on tobacco control mass media campaigns in England was associated with higher quit success rates