Health

Communications

in Tobacco Prevention and Control
Acknowledgements

This guide was produced for the Centers for Disease Control and Prevention by the Center for Public 

Health Systems Science at the Brown School at Washington University in St. Louis. 

Primary contributors:

Stephanie Andersen, Laura Brossart, Isaiah Zoschke, Caitlin Ashby, Erin Foster, Rachel Barth, Sarah MorelandRussell, Douglas Luke

Input was provided by:

Brian Armour, Caryn Coln, Gail DeVito, Cecile Douglas, Monica Eischen, Randy Gibson, Karen Gutierrez, Robin 

Hobart, Michelle Johns, Elizabeth Kilgore, Brian King, Chris Kissler, Julie Lautsch, Sjonna Paulson, Tim Poor, Gabbi 

Promoff, Valerie Quinn, Robert Rodes, Amy Rowland, Robin Scala, Maggie Silver, Karla Sneegas, Ann Staples, 

Renee Wright

Input for the case studies was provided by:

Ann Staples, North Carolina Tobacco Prevention and Control Branch

Gregg Smith, Bureau of Tobacco Free Florida

Lacoadia Burkes, Bureau of Tobacco Free Florida 

Ian Abrams, Golin 

Naylet Aguayo, Golin

Elizabeth McCarthy, Alma DDB

Other contributions:

Photograph on page 7 courtesy of the U.S. Food & Drug Administration

Photographs on page 19 and 31 courtesy of the New York City Department of Health and Mental Hygiene

Photograph on page 20 courtesy of the Oklahoma Tobacco Settlement Endowment Trust

Photograph on page 26 courtesy of the California Department of Public Health

Photograph on page 27 courtesy of the Rhode Island Department of Health

Photograph on page 52 courtesy of Tobacco Free Florida
Table of Contents

Guide to the Reader .......................................................................................... 1

Making the Case .............................................................................................. 2

Brief History ................................................................................................... 3

How to .........................................................................................................4

What are Health Communications in Tobacco Prevention and Control? ....................4

Importance of Health Communications ................................................. 5

Types of Health Communications ........................................................6

Implementing Health Communications Strategies ..........................................13

Developing a Communications Plan ....................................................13

Researching the Intended Audience ....................................................17

Developing Effective Messages ......................................................... 19

Using a Mix of Strategies .................................................................22

Preparing to Launch a Campaign ...................................................... 24

Developing and Placing Paid Media ....................................................25

Generating Earned Media ................................................................32

Sharing Messages on Social Media......................................................37

Developing Program Communications ................................................42

Reducing Tobacco-Related Disparities .................................................45

Making Adjustments and Responding to Problems..................................47

Evaluating Health Communications ................................................... 48

Providing Support ...........................................................................................51

Case Studies ................................................................................................. 54

Case for Investment ........................................................................................ 56

Resources .................................................................................................... 58

References ....................................................................................................62
Health Communications l 1

GUIDE TO THE READER

Purpose

The Centers for Disease Control and Prevention’s 

(CDC) Office on Smoking and Health and the Center 

for Public Health Systems Science at Washington 

University in St. Louis are developing a set of user 

guides funded by the CDC (contract 200-2015-87568) 

for the Best Practices for Comprehensive Tobacco 

Control Programs—2014 (Best Practices 2014).

1

The purpose of the user guides is to help tobacco 

control staff and partners implement evidence-based 

best practices by translating research into practical 

guidance. The user guides focus on strategies (e.g., 

programs and interventions) that have shown strong or 

promising evidence of effectiveness. Recommendations 

in this guide are suggestions for programs 

implementing health communications strategies. 

Programs can follow these recommendations according 

to their needs, goals, and capacity.

Content

This user guide focuses on how comprehensive 

tobacco control programs can deliver effective health 

communications. Best Practices 2014 recommends 

mass-reach health communication interventions 

as “powerful tools for preventing the initiation of 

tobacco use, promoting and facilitating cessation, and 

shaping social norms related to tobacco use.”1

 Health 

communications help achieve tobacco control goals 

by building support for policy and program efforts, 

countering the tobacco industry’s extensive advertising 

and promotion, and reaching large audiences to shift 

social norms around tobacco use. This guide offers 

program staff and partners information on how 

to effectively develop and implement paid media, 

earned media, social media, and other program 

communications to support tobacco control efforts. 

Links to More Information

Each instance of italicized, bolded blue text in the guide 

indicates a link to an additional resource or a page 

within the guide itself with more information. Website 

addresses for all of the blue resources noted throughout 

the guide are also included in the Resources section.

Organization

8 Making the Case: A brief overview of why health 

communications are an essential part of tobacco 

control efforts

8 Brief History: How health communications have 

been used in tobacco prevention and control

8 How to: Strategies to plan and carry out health 

communications efforts

8 Providing Support: How tobacco control 

programs can support staff and partners’ health 

communications efforts

8 Case Studies: Real-world examples of health 

communications in tobacco prevention and control

8 Case for Investment: Information to gain 

support for health communications

8 Resources: Publications, toolkits, and websites to 

help in planning efforts

Best Practices for Comprehensive 

Tobacco Control Programs—20141

Best Practices 2014 is an evidencebased guide to help states plan, establish, 

and evaluate comprehensive tobacco 

control programs. The report offers 

recommendations and supporting evidence 

for five essential components of effective 

tobacco control programs: state and 

community interventions, mass-reach 

health communication interventions, 

cessation interventions, surveillance 

and evaluation, and infrastructure, 

administration, and management.
Health Communications l 2

MAKING THE CASE

Making the Case for Health Communications

Health communications in tobacco control can empower both individuals to change their behavior and 

communities to adopt policies that reduce tobacco use, prevent initiation, and limit exposure to secondhand 

smoke.2 Health communications are an essential part of a comprehensive tobacco control program because they: 

8 Reduce tobacco use and secondhand smoke 

exposure

Mass-reach communications reduce tobacco 

use among youth and adults,3,4,5,6,7,8

 increase quit 

attempts,6,8 increase use of cessation services,1,4,5,7 and 

prevent youth initiation.1,4,5

 They can also reduce the 

likelihood of relapse among people who quit.9

8 Counter the industry’s extensive advertising and 

promotion efforts

The tobacco industry spends over $1 million per 

hour to advertise and promote tobacco products.10

Health communications can counter industry 

advertising with messages about the health 

consequences of tobacco use. As the industry 

finds innovative ways to promote its products, the 

importance of effective health communications in 

tobacco control continues to increase.1

8 Support tobacco control policy and program 

efforts

Health communications build public support for 

strong tobacco control policies and programs by 

educating the public and decision makers about 

the importance of reducing tobacco-related 

disease and death.5,11

8 Shift social norms around tobacco use

Health communications efforts can reach large 

audiences through media channels like TV and 

radio.12 As a result, communications efforts can 

influence social norms around tobacco use.1,11

8 Reduce tobacco-related disparities

Health communications efforts can reduce 

tobacco-related disparities among diverse 

groups.1,2 Communications about the negative 

health consequences of tobacco can reach and be 

influential among populations of different ages, 

education levels, incomes, races, ethnicities, sexes, 

sexual orientations, or gender identities.1,7

8 Create a return on investment

Health communications efforts can save lives and 

billions of dollars in health care costs.4,13 From 2000 

to 2002, the national truth® campaign cost $324 

million and saved over $1.9 billion in health care 

costs.14 In 2012, the Tips From Former Smokers®

national tobacco education campaign cost $48 

million and prompted 100,000 smokers to quit for 

good, which is estimated to have prevented over 

17,000 premature deaths.15
Health Communications l 3

BRIEF HISTORY

Brief History 

Health communications were one of the earliest 

approaches to reduce tobacco use and secondhand 

smoke exposure. The first U.S. tobacco control 

communications campaign aired on TV in 1967 

(see Figure 1 below).3

 The campaign followed the 

Federal Communications Commission’s decision to 

apply the Fairness Doctrine to cigarette advertising, 

which required TV stations to devote free airtime to 

opposing views on topics of public interest. Cigarette 

ads were banned from TV and radio in 1971, ending 

free broadcast time for tobacco control messages.3

Cigarette consumption decreased during the time that 

the ads were on the air, but began to rise again after the 

messages concluded.16

The success of early tobacco control ads prompted more 

campaigns, including the first statewide campaign 

in Minnesota in 1986.5

 Campaigns in California, 

Massachusetts, and Florida soon followed. They focused 

on changing social norms about secondhand smoke, 

educating the public about the health consequences of 

smoking, and revealing the tobacco industry’s deceptive 

marketing tactics.3

 These campaigns successfully 

reduced smoking prevalence and served as a model for 

other campaigns.6,17 Between 1998 and 2002, at least 30 

other states began communications campaigns.8

 In 2000, 

the American Legacy Foundation (now Truth Initiative) 

expanded Florida’s truth campaign nationwide.18 The 

Foundation launched the national EX campaign in 2008, 

which focused on lower income smokers from diverse 

racial and ethnic backgrounds.19

As communications campaigns increased, evidence 

of their effectiveness began to emerge. As early as 

1994, the Surgeon General’s Report, Youth & Tobacco, 

recommended health communications to reduce youth 

tobacco use.20 In 2008, the National Cancer Institute’s 

Monograph 19 concluded that campaigns reduce adult 

tobacco use and prevent youth initiation.5

 The 2012 

Surgeon General’s Report, Preventing Tobacco Use 

Among Youth and Young Adults, added that greater 

exposure to ads further reduces youth smoking.3

 The 

2014 Surgeon General’s Report, The Health Consequences 

of Smoking—50 Years of Progress, concluded that 

campaigns with sufficient reach, frequency, and duration 

can be powerful tools to reduce tobacco use.11 Health 

communications are also included in the World Health 

Organization’s Framework Convention on Tobacco Control

and Healthy People 2020, a set of national objectives for 

health promotion and disease prevention.21,22

Health communications have expanded in recent years 

as programs increasingly use websites and social media 

to complement traditional strategies. In 2012, CDC 

launched its first national tobacco education campaign, 

Tips From Former Smokers®. The campaign features 

“tips” from adult former smokers about living with 

tobacco-related disabilities and diseases as motivation 

to help smokers quit. It integrates digital ads, social 

media, and a website with traditional channels.23

During the 2012 campaign, 200,000 people called the 

Quitline, 500,000 people visited Smokefree.gov, and 1.6 

million smokers made a quit attempt.24 Since 2014, the 

U.S. Food & Drug Administration (FDA) has launched 

several youth-focused campaigns, including The Real 

Cost and Fresh Empire.

25,26 Both campaigns use a mix of 

traditional and digital channels.

Figure 1. History of Tobacco Control Communications
HOW TO

What are Health 

Communications in 

Tobacco Prevention and 

Control?

Health communications is “the study and use of 

communications strategies to inform and influence 

individual and community decisions related to 

health.”27 In tobacco control, health communications 

empower individuals to change behaviors and 

encourage states and communities to adopt policies 

that reduce tobacco use, prevent initiation, and limit 

exposure to secondhand smoke.2 They are sometimes 

referred to as “countermarketing” because they try 

to counteract the marketing practices of the tobacco 

industry.1

 Health communications can be delivered 

through several strategies:

• Paid media strategies (paying to place ads on TV, 

radio, billboards, transit, online platforms, or in 

print media)

• Earned media strategies (generating free coverage 

in the press and through public service 

announcements)

• Social media strategies (sharing messages and 

engaging audiences on social networking sites 

like Facebook and Twitter)

• Program communications (delivering messages 

through program websites and stakeholder 

communications)

Other activities, like promoting the quitline and 

reducing or replacing tobacco industry sponsorship 

and promotions, are also important parts of a program’s 

communications effort.1

 The combination of these 

strategies to communicate about a specific issue is often 

referred to as a communications campaign. The exact 

mix of strategies varies for each campaign. If sufficient 

funds are available, mass-reach communications 

channels such as TV are important to make meaningful 

population-level changes.28

Communications campaigns may be brief or run for 

long periods of time. They may focus on reaching 

tobacco users, their families, specific populations, 

health care providers, the media, or decision makers. 

Campaigns are most effective when they are integrated 

into the larger program.1,5

 For example, campaigns may 

include the quitline number or raise awareness about a 

new tobacco control policy.

Tobacco control communications often focus on the 

following messages:1

• Motivating tobacco users to quit

• Protecting people from the harms of 

secondhand smoke exposure

• Changing social norms to prevent tobacco use 

initiation

CDC’s “Tips®” campaign ad created for paid media channels like magazines and 

newspapers Source: CDC MCRC 

Health Communications l 4
Importance of Health Communications

Health communications are a critical part of 

comprehensive tobacco control programs. Effective 

health communications can raise awareness about the 

dangers of tobacco use,29 increase community support 

for tobacco control programs and policies,11 and 

reduce tobacco use.3,4 Health communications are also 

important to counter tobacco industry advertising and 

promotion, especially as the industry increasingly uses 

new advertising tactics to market products.

Effectiveness of Health Communications

The Community Guide recommends mass-reach health 

communication interventions based on strong evidence 

of effectiveness.4 These strategies can reach large 

audiences quickly, repeatedly, and cost effectively.4,12

As a result, they can shift social norms around tobacco 

use and increase acceptance of tobacco prevention and 

control strategies.1,11 Mass-reach health communication 

interventions reduce tobacco use among youth and 

adults,3,4,5,6,7,8

 increase quit attempts,6,8 increase use of 

cessation services,1,4,5,7 prevent youth initiation,1,4,5 and 

reduce the likelihood of relapse among people who 

quit.9

 Health communications can also affect other 

important outcomes, such as changes in attitudes 

toward tobacco use and secondhand smoke and the 

adoption of tobacco control policies.4,11

Many programs have developed effective 

communications campaigns to support their efforts. 

Campaigns in California, New York, and Massachusetts 

have shown that state programs can implement health 

communications strategies that increase quit attempts 

and reduce tobacco use.6,17,31 Evidence also shows that 

when funding is cut for communications campaigns, 

progress toward lowering smoking rates is often 

reversed.32 For example, the Florida truth campaign 

began in 1998 and reduced youth smoking by 35% in 

just three years.32 By 2003, several years of funding cuts 

forced the campaign to end. Three years later, youth 

smoking had increased by 21%.32

Health Communications l 5

HOW TO

Communications Campaigns as 

Tobacco Control Interventions

Health communications campaigns are an 

important part of comprehensive tobacco 

control programs. They can:

• Change how people think about 

tobacco use and secondhand 

smoke27,29

• Counter the effects of industry 

advertising and promotion30

• Result in simple actions like calling 

the quitline or talking to a health care 

provider about tobacco use27,29

• Build support for tobacco control4,11

• Prevent youth initiation1,4

• Motivate tobacco users to quit1,4 

Tobacco Industry Promotion

Over the past several decades, federal regulations and 

court rulings have banned the tobacco industry from 

targeting youth and advertising cigarettes and smokeless 

tobacco on TV and billboards.3,5

 Unfortunately, these 

changes have not kept the industry from marketing 

its products. The industry spent over $9.4 billion on 

advertising and promotion in 2013.10,33 As Figure 2 

on page 6 shows, this spending far surpasses CDC 

and state funding combined for tobacco control 

communications nationwide ($136 million in 2013).1

New Industry Tactics

The tobacco industry has turned to new marketing 

strategies to work around advertising restrictions.3

Tobacco companies use in-store advertising, direct 

mail, and digital marketing, which are less restricted 

than other channels, to advertise their products. In 

2013, payments to retailers and wholesalers to secure 

product placement and reduce the price of cigarettes 

accounted for 93% of total industry advertising and 

promotional spending.10 Point-of-sale advertising 

encourages people to buy tobacco products and exposes 

children to tobacco marketing.3,10 Tobacco companies 

also use sophisticated audience research strategies to 

send targeted ads and coupons directly to consumers to 

use in stores and online.34
The tobacco industry uses websites and social media 

to market products, communicate with customers, 

improve corporate credibility, host smoking interest 

groups, promote smoking-friendly locations, and oppose 

evidence-based tobacco control strategies.3,5,35 The 

industry also uses social media to market electronic 

cigarettes (e-cigarettes). A study of Twitter posts from 

2012 found that 90% of tweets about e-cigarettes were 

commercial messages.36 Many linked directly to a website 

that marketed e-cigarettes.36 Social media promotion of 

these products may have contributed to their rapid rise 

in popularity, especially among youth.36,37

The lack of regulation of e-cigarette advertising has also 

allowed the tobacco industry to return to TV, radio, 

and billboards, exposing people of all ages to tobacco 

marketing.38 For instance, over 110 million viewers were 

exposed to e-cigarette TV ads during each of the 2013 

and 2014 Super Bowl games.38 E-cigarette marketing 

often mirrors previously banned tobacco industry 

tactics by featuring celebrities, rugged male imagery, and 

cartoon characters.39 As the industry continues to find 

new ways to promote its products, strong tobacco control 

communications are even more important.30

Figure 2. Communications Spending

Source: Federal Trade Commission and CDC10,33,40

Types of Health Communications 

Paid Media

Paid media strategies deliver messages through paid 

placements on mass media channels like TV or radio.27

Paid media has the potential to reach large numbers of 

people without in-person interactions. Although they 

can be expensive, paid media strategies allow programs 

to control an ad’s content and where, when, and how 

often it will run.27,41 See an example of a national 

campaign using paid media on page 7.

Paid media includes ads on TV, on the radio, in print, 

and on billboards or public transit.1

 In recent years, 

digital advertising has increased as people spend 

more of their time connected to the internet through 

smartphones, tablets, and computers.42 Although TV is 

most effective at reaching broad audiences and changing 

knowledge, attitudes, and behaviors, communications 

efforts often include a variety of paid media channels.7,30

Using multiple channels makes campaigns appear more 

widespread, encouraging people to talk about campaign 

messages and to believe there is a social expectation not 

to use tobacco products.43

Paid media is a critical part of tobacco control 

communications.5,11 Adequately funded paid media 

strategies decrease adult and youth smoking prevalence, 

youth initiation, and the likelihood that youth will 

become established smokers.4,7,44 Exposure to paid 

media also increases the likelihood that a smoker 

will try to quit and decreases the chance of relapse 

among those who have quit.7,9 Statewide paid media 

strategies can also coordinate with local programs 

to support community-level efforts.31 States with the 

most dramatic changes in tobacco attitudes, beliefs, 

and behaviors have used paid media to challenge 

the legitimacy of industry advertising tactics and 

publicize the health consequences of tobacco use and 

secondhand smoke exposure.31

Although total costs to implement paid media strategies 

may seem high, they are cost effective when compared 

to the costs of tobacco use and exposure.4,15 From 2000 

to 2002, the national truth® campaign cost $324 million 

but prevented over $1.9 billion in health care costs.14

Learn more about developing and placing paid media 

ads on page 7.

Health Communications l 6

HOW TO
Health Communications l 7

HOW TO

A CLOSER LOOK: FDA’s The Real Cost campaign

Launched in 2014, the U.S. Food & Drug 

Administration’s (FDA) The Real Cost campaign 

focuses on making youth aware of the cost that 

comes with every cigarette. The campaign aims 

to prevent susceptible youth from trying tobacco 

and keep experimenters from becoming regular 

tobacco users.25 Key messages focus on the 

toxic mix of chemicals in cigarette smoke, loss 

of control as a result of addiction, and health 

consequences of tobacco use that are particularly 

relevant to youth (e.g., tooth loss and wrinkles).25

Initial campaign ads focused on reaching the 

more than 10 million youth ages 12–17 in the 

United States who are open to smoking or are 

already experimenting with cigarettes.25 These 

youth typically do not consider themselves 

smokers and do not think they will become 

addicted.45 In 2016, The Real Cost added new ads 

targeting rural male youth ages 12–17 who are at 

risk of smokeless tobacco use.25

To develop ads, FDA consulted tobacco public 

health experts, conducted an extensive literature 

review, and completed in-depth pretesting 

with at-risk youth around the country. Since 

campaign launch, The Real Cost has refreshed 

ads regularly to keep youth engaged. Ads are placed on TV, radio, web and social media, cinema, print 

publications, and billboards.45 To achieve enough exposure to change behaviors, The Real Cost ads run 

at the reach and frequency levels recommended by the CDC and have reached more than 75% of the 

target audience 15 times per quarter. 

FDA hired an independent research firm to conduct a large, multi-year evaluation to measure the 

campaign’s success in changing tobacco-related attitudes, beliefs, and behaviors among youth. Initial 

results found that 89% of youth were aware of at least one ad seven months after campaign launch, and 

The Real Cost positively influenced tobacco-related risk perceptions and beliefs after 15 months.46,47 Most 

notably, exposure to The Real Cost from 2014 to 2016 was associated with a 30% decrease in the risk 

of smoking initiation, preventing an estimated 350,000 youth ages 11–18 from smoking.47 A separate 

evaluation about smokeless tobacco use is underway.

Building on the success of The Real Cost, FDA launched the Fresh Empire campaign in 2015 to reach 

multicultural youth who identify with the hip-hop peer crowd and are at risk for smoking.26 In 2016, 

FDA launched the This Free Life campaign, which seeks to prevent and reduce smoking among lesbian, 

gay, bisexual, and transgender (LGBT) young adults ages 18–24.48 

“The Real Cost” campaign print ad emphasizing the health consequences 

of smoking Source: FDA 
Earned Media

Earned, or unpaid, media strategies generate free 

coverage of a story or issue.27 Programs get coverage 

by working with the press to generate news stories or 

creating public service announcements (PSAs) to air 

for free on paid media channels. These strategies are 

called “earned” media because the communications 

team has to get the attention of media outlets and the 

public to earn coverage.27 Earned media strategies 

are also sometimes called public relations or media 

relations.49 Earned media is an important part of any 

communications campaign, but especially when funds 

are limited.1 Although earned media coverage can be 

a useful low-cost strategy, the communications team 

has less control over the content or placement of stories 

than with paid media.49

News Coverage

Earned media coverage includes news stories, letters 

to the editor, editorials, or interviews. Coverage may 

run on a variety of channels, including TV, radio, 

newspapers, magazines, or digital news outlets (see 

Table 1 below).27,50 News coverage may be created 

by the media outlet, the communications team, or 

community members. Although the media outlet 

ultimately decides which pieces are published and how 

they are framed, the communications team can work to 

generate interest that leads to news coverage.51

Table 1. Types of News Coverage

Coverage Type Description

Created by the Communications Team or Partners

Letters to the Editor Brief opinion pieces written by community members and submitted to newspapers or magazines53

Opinion Editorials 

(Op-Eds)

Short essays written by community members and submitted to newspapers that express a point of 

view, backed by supporting facts and research27

Articles Full-length articles written by the communications team and typically featured in local publications

Created by News Outlets

Editorials Opinion articles written by newspapers or magazines and seen as representing the publication’s 

point of view27

News Stories Printed articles or broadcast segments that are developed by journalists and may cover events or 

tobacco-related issues

Interviews or 

Guest Appearances

Appearances by campaign spokespeople to share campaign messages with the community, for 

instance, answering questions developed by news outlet staff on a radio or TV show53

Strategies to earn news coverage can support tobacco 

control goals by changing knowledge, attitudes, and 

behaviors among youth and adults and influencing 

tobacco control policies.1 For example, from 1999 to 

2002, the Students Working Against Tobacco group in 

Florida used earned media strategies to generate high 

levels of media coverage. This coverage contributed to 

the enactment of laws to place tobacco products behind 

store counters.52

News coverage enhances the effectiveness of the overall 

campaign by complementing, but not replacing, paid 

media efforts.1

 The total number of news stories is 

often far greater than the number of times paid media 

is broadcast, making news coverage crucial to extend a 

campaign’s reach.1,5

 News coverage also:

• Allows a campaign to continue the conversation 

even after paid ads are off the air or out of print

Health Communications l 8

HOW TO
• Gives a campaign credibility because audiences 

tend to see news coverage as an important 

source of health information1,5

• Provides background and supporting information 

that cannot be conveyed through ads51

• Ensures decision makers and opinion leaders are 

aware of a campaign and its messages49

• Sets the public agenda by influencing what the 

public talks about1

Learn more about how to generate news coverage on 

page 32.

Public Service Announcements

PSAs are educational messages broadcast for free by 

media outlets.29 They typically air on TV and radio, but 

can be modified for print, internet, and outdoor use.29

PSAs are useful when the communications budget does 

not allow for paid media, but the program still wants to 

raise awareness of an issue with a general audience.27

Learn more about developing PSAs on page 36.

Social media image that encourages users to share or comment on the image 

Source: CDC MCRC 

Social Media

In recent years, the internet has shifted from 

information created by experts to content developed 

through audience participation and interaction. This 

change, combined with increased access to the internet 

and its global reach, has created new opportunities 

for health communications to get the attention of the 

public. Innovative tobacco control communications 

using social media and blogs have emerged to take 

advantage of these new opportunities.11,54 Social 

media platforms, such as Facebook and Twitter, are 

online communities where people gather to interact 

with family, friends, coworkers, and others with 

similar interests. Blogs are online, interactive journals 

where readers can leave comments and start new 

conversations.2 See Table 2 on page 10 for a list of 

social media channels.

Programs can use social media to gain audiences’ 

attention, join public conversations about tobacco, 

correct inaccurate information, and partner with 

influential celebrities and bloggers to promote tobacco 

control messages. Social media is a relatively low-cost 

strategy to share health communications because there 

are no fees to place messages. Programs with larger 

budgets can also pay to promote social media messages 

so that they reach people with similar interests and 

raise awareness of program efforts. Social media 

strategies are also important for communications 

campaigns because they help:55,56

• Increase the potential impact of messages

• Share information across networks of people

• Personalize health messages and tailor them for 

a particular audience

• Share health and safety information quickly

• Empower people to make healthier decisions

Social media use has increased more than tenfold 

since the Pew Research Center began measuring it in 

2005.57 As of 2016, 69% of adults used social media 

platforms.57 While young adults were still most likely 

to use social media (86%), use among those 65 and 

older quadrupled to 34% since 2010.57 Sixty percent 

of lower-income households used social media, 

though those in higher-income households still used 

social media at higher rates. Social media use also 

increased among rural populations.57 Sixty percent 

of rural residents used social media, compared 

with 71% of suburban residents and 69% of urban 

Health Communications l 9

HOW TO
residents.57 Social media use was also slightly higher 

among Hispanics (74%), followed by Whites (69%) 

and African Americans (63%).57 It is critical that 

communications staff stay up to date on these trends 

so they can reach audiences through the channels they 

are most likely to use. For the latest data on social 

media use, visit the Pew Research Center website.

Social media strategies are complements to, not 

substitutes for, traditional health communications 

strategies.1,5,11 Although social media can keep costs 

down and help engage hard-to-reach populations,58

they do not have the reach of traditional media.43

Information on the role of social media in achieving 

tobacco control goals is still emerging. It is important to 

evaluate social media efforts to determine and improve 

their effectiveness.1

Table 2. Social Media Channels Used by Tobacco Control Programs

Channel Description Tobacco Control Example

Facebook Social networking platform featuring user profiles, 

friends, and likes

http://www.facebook.com/cdctobaccofree

Twitter Online social networking platform featuring 

140-character messages called tweets

https://twitter.com/tobaccofreefla

Pinterest Web and mobile platform allowing users to upload, save, 

and sort images and hyperlinks, known as pins, into 

categories called boards

https://www.pinterest.com/cdcgov

Instagram Mobile photo-sharing, video-sharing, and social 

networking platform

https://www.instagram.com/cdcgov

LinkedIn Social networking platform for professionals https://www.linkedin.com/company/

campaign-for-tobacco-free-kids

YouTube Video-sharing platform allowing users to upload, view, 

and share videos

https://www.youtube.com/user/

cdcstreaminghealth

Tumblr Microblogging platform allowing users to post 

multimedia and other content to a short-form blog

http://knowtherealcost.tumblr.com

Google+ Social networking platform allowing users to form 

groups or circles and text and video chat in hangouts

https://plus.google.com/+cdc

Blog Discussion or informational website of posts listed with 

the most recent first and allowing users to comment

https://www.tobaccofreekids.org/media/blog

Program Communications

Communicating through websites, community 

engagement, and other stakeholder communications 

are important supporting campaign strategies. 

Programs use these strategies to share campaign 

updates, communicate successes, and extend the reach 

of campaign messages.

Websites and Other Digital Communications

The internet has become an important way to share 

health information. In 2016, 88% of adults reported 

using the internet.59 In 2013, 72% of all internet users 

reported searching online for health-related topics.60 As 

of 2011, all 50 state tobacco control programs had some 

internet presence and several hosted multiple websites.61

As key health authorities on tobacco prevention and 

control, state programs can use their websites as 

Health Communications l 10

HOW TO
complements to traditional health communications 

strategies to share cessation, prevention, and policy 

information and to promote programs and campaigns.5,61

They can also promote CDC recommendations and 

share new data and research by posting reports, articles, 

and fact sheets. Partners can use the resources to advance 

policy strategies.62

A variety of other digital media channels can be used 

to support communications efforts (see Table 3 below). 

For example, podcasts are downloadable audio files that 

are increasingly used by health organizations to deliver 

complex information in a convenient and enjoyable 

format.2

 Cell phones and tablets are becoming more 

commonly used for sharing health information because 

of their portability, affordability, and availability.55

When budgets are tight, content can be developed using 

a “responsive design” approach. It allows digital content 

to automatically adapt to the viewing environment 

of different devices, from wide-screen computers 

to mobile phones, without needing to be recreated. 

Programs have also delivered cessation interventions 

through apps and text messaging. 

Table 3. Websites and Other Digital Media Channels Used by Tobacco Control Programs

Channel Description Tobacco Control Example

Websites

Website Set of web pages hosted on a network and accessible via 

an internet address

http://www.tobaccofreekids.org

Mobile website Website optimized for viewing on mobile devices http://smokefree.gov

Web-based tool Software application that runs in a web browser http://www.cdc.gov/oshdata

Other Digital Media

Podcast Digital audio file that can be downloaded from a website 

to a computer or media player

https://www.cdc.gov/tobacco/data_

statistics/sgr/50th-anniversary

Text messaging Messages (limited to 160 characters) sent over mobile 

data service that can include text, images, audio, and 

video files

http://smokefree.gov/smokefreetxt

Mobile app Downloadable application that runs on a smartphone, 

tablet, or other mobile device

http://smokefree.gov/apps-quitstart

Community Engagement

Community engagement activities such as hosting 

speakers, giving presentations, or holding contests get 

community members involved in campaign activities 

and keep them engaged over time.27 Programs can 

also invite community groups and professional 

organizations to take part in tobacco control events or 

be recognized for their past contributions.27

Community engagement activities complement 

health communications strategies because community 

members deliver campaign messages to intended 

audiences, enhancing the reach and relevance of the 

messages.27 These activities also support a program’s 

overall tobacco control goals. Those who take part 

are more likely to be tobacco-free and encourage 

people close to them to quit.27 However, community 

engagement strategies may not be right for every 

campaign. Allowing the community to share messages 

on behalf of the program means that some control over 

the campaign’s message may be lost.27

Health Communications l 11

HOW TO
Stakeholder Communications 

Most organizations have systems in place to 

communicate with staff, partners, and the public. 

Internal communication is fundamental to how 

an organization works. It includes communication 

with staff, leadership, and other departments. Good 

internal communication helps staff work effectively, 

solve problems, and create a shared vision for efforts. 

Communicating with partners, supporters, and the 

public is also important to educate about tobacco use 

and create a consistent, authoritative voice as the “go to” 

place for health information.62

For more information on the topics covered in this 

section, visit the CDC Office on Smoking and Health’s 

State and Community Resources web page.63

A CLOSER LOOK: Health Promotion Strategies

Best Practices 2014 recommends including health promotion strategies in communications campaigns.1

Health promotion efforts encourage tobacco users to try to quit. They can take many forms, such as print 

and digital ads for quitlines and events like the American Cancer Society’s Great American Smokeout. 

Effective health promotion activities:

• Use a mix of communications channels to share health promotion messages

• Tag messages with quitline information

• Plan promotional events to engage audiences and generate news coverage

• Increase quitline capacity during health promotion activities

The goal of health promotion strategies is to reach a wide audience with the message that effective cessation 

treatments are available.51 Using multiple communications channels to share health promotion messages 

increases the chance that people will see and act on messages.27 Connecting cessation services to paid 

media can increase quitline calls and quit rates.51 One way to do this is with “tagging,” or including the 

quitline number or website in messages. Tagging TV, print, and radio ads with quitline information lets 

the audience know that help is available and cues them to act. Programs can also include hashtags that the 

audience can use to learn more about the campaign and find quitting resources.

Promotional events help create an environment that supports smoking cessation and generate news 

coverage of the campaign.5

 These events can take place at the same time each year or can be planned 

to capitalize on seasonal trends or behaviors, such as when people make New Year’s resolutions.64 They 

can also be tied to recent events, such as new smoke-free laws. Find more ideas at the American Cancer 

Society’s Great American Smokeout website.

64

New health promotion strategies are emerging, such as promoting quitlines in places where tobacco 

products are sold or working with health providers or social workers to connect people to cessation 

services. Placing ads on digital media channels can help reach specific populations at a low cost.65

It is important to balance the timing and length of promotions with quitline capacity. Too much 

promotion may overwhelm quitlines, but too little may leave them underused. Programs can coordinate 

with quitline partners to make sure they can handle increased volume.51 One technique to ensure a 

proper balance is “pulsing” ads to strategically promote the quitline at different times throughout the 

year.66 Programs can also add web links or hashtags to direct the audience to other cessation resources 

during periods of heavy call volume or after quitline hours.

Health Communications l 12

HOW TO
Implementing Health 

Communications 

Strategies 

Effective communications campaigns can be a 

powerful tool to achieve tobacco control goals,1

 but 

implementing them is not easy. Successful campaigns 

require adequate funding, careful planning, and hard 

work.12 Programs can use the strategies in the following 

sections to ensure successful campaigns:

• Developing a communications plan

• Researching the intended audience

• Developing effective messages

• Using a mix of strategies

• Preparing to launch a campaign

• Developing and placing paid media

• Generating earned media

• Sharing messages on social media

• Developing program communications

• Reducing tobacco-related disparities

• Making adjustments and responding to 

problems

• Evaluating health communications

Developing a Communications Plan

A communications plan guides how campaigns 

will be implemented to help achieve short- and 

long-term goals.27 It describes campaign audiences, 

messages, strategies, and the infrastructure needed 

to support the campaign.27 The communications 

plan complements the state’s comprehensive tobacco 

control plan, which guides the overall program. 

Developing a plan helps the communications team 

choose effective strategies, set priorities, assign 

responsibilities, create a timeline, and assess progress. 

The plan also helps secure funding and other support 

by describing the need for health communications.51

There is no one-size-fits-all approach to developing a 

communications plan. Programs with smaller budgets 

may want to plan one well-executed campaign to support 

multiple goals. For example, an adult cessation campaign 

can also prevent youth initiation.4

 Strong plans cover all 

years of funding and describe all communications efforts. 

Planning is equally important for paid media strategies, 

earned media strategies, social media strategies, and 

other program communications.49

Strong plans also describe how the program will 

leverage national campaigns and new evidence, build 

local communications capacity, and reduce tobaccorelated disparities. Along with the broad strategies in 

the communications plan, communications efforts 

require detailed annual workplans. For example, the 

communications plan may describe how social media 

will support program goals and the workplan may 

include a month-by-month social media calendar.

Steps of Communications Planning

It can be tempting to skip communications planning 

and start sharing materials as soon as possible, but 

taking the time to plan ensures that messages are 

coordinated and strategic to achieve the greatest 

impact. Completing each of the following steps and 

developing a written plan builds a solid foundation for 

communications efforts:

• Describe the problem that health 

communications will address.

• Identify intended audiences. 

• Draft communications objectives.

• Describe health communications strategies and 

channels. 

• Develop a strategy to engage partners.

• Develop a plan to evaluate health 

communications.

• Staff the communications campaign.

• Develop a budget.

• Create a timeline.

• Review and revise the completed plan.

Health Communications l 13

HOW TO
Describe the Problem

The first section of the plan describes the severity 

of the issue, populations affected, possible causes, 

and how health communications can help solve the 

problem.27 Although many tobacco control issues 

can be addressed with communications campaigns, 

focusing on one or two problems helps ensure that 

efforts are successful.67

To develop this section, the communications team can 

start by reviewing the state tobacco control plan to 

ensure that health communications support the goals 

of the program.27 In some cases, a communications 

campaign may not be the best way to address the 

problem. For example, it may be necessary to improve 

access to cessation treatments by removing cost barriers 

or increasing quitline capacity before planning a 

cessation campaign.2

Identify Intended Audiences

The next section of the plan describes the intended 

audiences of the program’s health communications. 

The audience may be different for each campaign. 

Concentrating on one or two audiences helps focus the 

rest of the planning decisions.27 The communications 

team can gather information about the audience’s 

demographic characteristics, media preferences, and 

readiness to change. Learn more about researching the 

intended audience on page 17.

Draft Communications Objectives

Communications objectives are short, simple 

statements of the intended results of a communications 

campaign.67 Strong objectives use the SMART approach 

(Specific, Measurable, Achievable, Relevant, and Time 

bound).68

To develop realistic communications objectives, it 

can help to consider how much change is necessary 

to be successful, what has been achieved by similar 

campaigns, and what is possible with the program’s 

resources. It is also important to keep in mind how 

objectives will be measured and any barriers that may 

limit the desired change.67

Writing SMART Objectives

SMART objectives are Specific, Measurable, 

Achievable, Relevant, and Time bound.68

The following are examples of SMART 

communications objectives:69

• By May 2017, increase the number 

of news stories about the dangers of 

secondhand smoke by 50%.

• By June 2017, reach at least 75% of 

the intended audience at least five 

times through paid TV ads. 

• By July 2017, increase the percentage 

of adults who agree that there is 

no safe level of secondhand smoke 

exposure from 55% to 65%. 

Describe Health Communications Strategies and 

Channels 

Next, the plan describes the strategies that will be 

used to achieve communications objectives. This 

information will guide all future campaign materials 

and activities, so it is important to select strategies 

and media channels with the overall communications 

budget in mind.27 Learn more about choosing the right 

mix of strategies and channels on page 22. 

This section of the plan describes:27,69

• The action the program wants the audience to take

• A list of obstacles to taking the action

• The benefit to the audience of taking the action

• The channels and activities the communications 

team will use to reach the intended audience 

• The campaign message(s)

• The look and tone of materials 

Develop a Budget

Developing a realistic budget ensures that enough 

funding is in place for all communications 

activities.67 Best Practices 2014 includes state-specific 

Health Communications l 14

HOW TO
recommendations for paid media strategies, but 

it is also important for programs to plan for other 

campaign costs.1

 A comprehensive budget outlines 

the cost to staff the campaign and implement all 

strategies, including developing and placing paid ads, 

creating earned media materials, communicating on 

social media, and evaluating the campaign.27,70

To estimate costs, the communications team can seek 

advice from staff of other agencies in their state who 

have run similar campaigns.27 They can also ask other 

state programs and coalitions about their experiences.27

Variables that affect the budget include:27

• Number of overall goals and audiences

• Length of campaign

• Number and choice of media channels 

• Cost of media placements in the state

• Number and complexity of ads used

• Use of existing ads or new materials

• Use of internal staff or external contractors

• Creation of materials in other languages

Even programs with limited funding can benefit 

from creating a budget to make sure that every dollar 

goes as far as possible. Budgets can also help the 

communications team make plans to scale up or down 

activities if funding changes. Learn about ways to 

reduce costs on page 47.

Staff the Communications Campaign

Carrying out communications campaigns takes a 

capable, dedicated team. Depending on the program, 

the communications team may be a single person or 

include several members. Ideally, the communications 

team will include:27

• Program staff to oversee each part of the 

campaign 

• Communications specialists to plan and 

implement strategies

• Evaluation experts to measure results

• Community members to review messages and 

materials

Selecting Communications Specialists

Communications specialists fill gaps in the skills and expertise of the communications team. They 

create new materials, plan media placements, arrange earned media opportunities, organize community 

events, and recommend strategies to reach specific audiences.27,51 A good communications specialist can 

produce effective, memorable ads. They have diverse media buying experience (e.g., TV, radio, outdoor, 

print, and digital media) in all of the state’s counties, not just major media markets.27,71 Experience 

with multistrategy campaigns is also important, such as a history of successful earned media coverage 

and knowledge of social media tools.27 To select communications specialists, programs can look for 

contractors who have:

• Strong strategic thinking skills to make key choices about campaign direction27

• Experience implementing health campaigns and, ideally, tobacco control campaigns27

• Experience working with government agencies27

• Staff and infrastructure to support the campaign’s size and complexity71

• Knowledge of tobacco control history, national tobacco control progress, and local issues71

• No connections to the tobacco industry27,71

• A willingness to listen to and incorporate program staff ’s tobacco control expertise27 

Health Communications l 15

HOW TO
Program staff with a background in communications, 

marketing, journalism, or a related field, and, if possible, 

health communications experience, are a good fit for 

the communications team.27 Although contracting 

with media and evaluation experts requires an initial 

investment, their skills and experience can save time 

and money. Even if staff have these skills, they may not 

have the time to devote to a comprehensive evaluation or 

development of a new campaign.67 The communications 

team may also want to work with public relations experts 

who can build relationships with the news media.

Create a Timeline

A timeline breaks down health communications 

strategies into manageable steps and coordinates the 

timing of activities.72 It includes start and end dates 

and identifies who will carry out each step. The more 

information the timeline includes, the more likely 

it is that an important step will not be missed and 

communications efforts will stay on schedule.29 It is 

helpful to include time for pretesting, ad development 

(if creating new ads), and any approvals required by the 

state health department or other key stakeholders.72

Develop a Strategy to Engage Partners

Partners can provide access to intended audiences, 

expertise, credibility, and other resources.27 Thinking 

carefully about potential partnerships during planning 

helps ensure success once the campaign is underway. 

To narrow down the list of potential partners, the 

communications team can look for partners who:

• Are committed to tobacco control69

• Bring something to the partnership, such as free 

media placements69

• Are seen as trustworthy and credible by 

intended audiences27

• Work on other public health or community issues 

and can share messages with a wider audience1

• Require fewer program resources to contribute 

to communications efforts27

• Have communications experience69

Once partners are identified, the communications 

team can reach out to organizations where they 

have contacts. Making connections before the 

start of a campaign gives partners time to schedule 

campaign activities.29 Partners can make the strongest 

contributions when they are given the campaign’s key 

messages and assigned to short-term tasks that fit their 

strengths and interests.27,29 For example, well-known 

opinion leaders may be able to generate news coverage 

and organizations with strong ties to the intended 

audience can share messages on social media.69

Plan for Evaluation 

A well-developed communications plan includes 

information about evaluating communications efforts. 

Planning for evaluation ensures that funding and staff 

are in place to carry out evaluation activities.29 At this 

stage, the evaluation plan describes the most important 

evaluation questions, what information will be needed, 

and how data will be collected. Learn more about 

developing an evaluation plan in the CDC resource, 

Developing an Effective Evaluation Plan.

73

Planning is also an important time to collect initial 

evaluation data. This information can be helpful later to 

determine effectiveness. For example, finding out what 

the audience knows about smoking before the campaign 

begins can help determine what changes result from 

viewing campaign ads. Learn more about evaluating 

health communications campaigns on page 48.

Review and Revise the Completed Plan

The communications plan is typically updated at least 

once a year. Regular updates allow the plan to be 

adapted as new scientific evidence emerges and changes 

occur in the program’s priorities, funding levels, or the 

external environment (e.g., public support for tobacco 

control and new industry tactics).1

For more information on the topics covered in this 

section, visit the CDC Office on Smoking and Health’s 

State and Community Resources web page.63

Health Communications l 16

HOW TO
A CLOSER LOOK: Illinois Uses Market Research Data to Focus Health 

Communications75,76

In September 2011, the Illinois Department of Public Health applied for a grant from the Directors 

of Health Promotion and Education to access data collected by the Nielsen market research company. 

They hoped the data would help the 94 local health departments funded by Illinois Tobacco-Free 

Communities to focus their efforts, especially their health communications, on specific communities. 

Instead of having to rely only on national and county-level data, they would have access to 

information about their local communities. 

The department was awarded access to data through Nielsen’s PrimeLocation and ConsumerPoint 

software tools. The data sets projected national data to smaller Illinois geographic groups based on 

shared characteristics. The department decided to focus on segments likely to include heavy smokers and 

was able to identify the ZIP codes and census tracts of those segments. Next, they created community 

profiles that described the demographics of heavy smokers in that community, where they liked to shop, 

and what media channels they used most often. Local health departments used the profiles to decide 

where to place ads to encourage smokers to quit. 

As of September 2014, 40 local health departments had received personalized community profiles. 

According to the Kane County Health Department, “The tobacco report has definitely influenced our 

program directions. Instead of targeting the whole county in our outreach, we will be targeting the 

identified communities.” Other programs within the Illinois Department of Public Health also used the 

data. They identified communities that lacked access to healthy foods, selected priority areas at high risk 

for chronic disease, and worked with the business community to develop wellness activities. 

Researching the Intended Audience

The process of gathering information about the 

audience’s beliefs, motivations, and media use is 

often called audience research.27 Doing this research 

before starting a campaign helps the communications 

team identify influential messages and select effective 

communications channels (see an example from Illinois 

below).1 Spending some time and resources on audience 

research before the campaign begins guards against 

wasting program funds on ineffective strategies.29 Even 

the most experienced communications staff can benefit 

from audience research to stay up to date on changes in 

media preferences or social norms about tobacco use. 

Audience research is most useful when the 

communications team gathers as much information as 

possible about the audience. For example, programs 

may want to know about:

• Demographic information, such as age, race, 

ethnicity, education, and income27,74

• Current and past cigarette smoking and other 

tobacco product use74

• Knowledge and attitudes toward tobacco use 

and tobacco control1

• Hobbies, interests, and other lifestyle 

preferences27

• Preferred media channels (e.g., TV, newspapers, 

radio, or internet)27

• Media use patterns (e.g., frequency or time of 

day)74

• Literacy level and language preferences74

Much of this information is available at little or 

no cost. Large-scale surveys like the Census or the 

Behavioral Risk Factor Surveillance System report 

Health Communications l 17

HOW TO
data on population demographics and tobacco-related 

behaviors.72 State and local health departments and 

coalitions often collect detailed information about 

the populations they serve through community 

assessments.72 The team can also talk with TV, radio, 

and print representatives.77 Learning about the people 

who view and listen to their content can help select 

channels that will reach audience members.

Market research firms also maintain databases with 

information about audience media use and lifestyle 

preferences.72 Although firms charge for access to 

this information, it is generally more cost effective 

for programs to use this data than to collect the data 

themselves.29 Nonprofit and government reports and 

newspaper coverage of tobacco use among the intended 

audience can also have useful information.72 CDC staff 

and communications staff in other states can often offer 

advice from their experiences with campaigns focused 

on similar audiences.72

Social media monitoring complements more traditional 

forms of audience research. It can reveal individuals’ 

current feelings and any misunderstandings about 

tobacco control issues.55 Many social media sites offer 

their own free monitoring tools (e.g., Twitter Analytics 

and Facebook Insights). Paid monitoring services are 

also available and may offer additional features.

Narrowing the Intended Audience

Communications campaigns can be jeopardized if they 

try to reach too many people at once.72 Focusing on a 

smaller, more specific audience increases the chance 

of delivering a message that actually reaches and 

resonates with the audience. Dividing a large audience 

into smaller groups is sometimes called audience 

segmentation (see Figure 3 on the right).77 A single 

audience may be broken into many different segments, 

but focusing on at most one or two priority segments 

will keep from straining existing resources.69

To choose priority segments, the communications team 

can focus on groups that are:

• Most affected by the problem27,78

• Most likely to change their behavior78

• Easiest to reach with available campaign 

resources27,78

• Large enough to justify a campaign27

• Not already reached by existing campaigns

Communications team members can use the 

information collected to create a detailed profile for 

each priority segment.2

 One strategy is to imagine 

a single member of the audience and describe that 

person in detail. This method uses a story of a day in 

the life of the audience member, describing the person’s 

family life, community, routines, and media habits.67 By 

telling this story, the communications team can begin 

to understand what will work to change the audience’s 

behavior. Once the audience profile is complete, the 

team can use it to refine strategies. 

For more information on the topics covered in this 

section, visit the CDC Office on Smoking and Health’s 

State and Community Resources web page.63

Figure 3. Narrowing the Audience for a 

Communications Campaign 

Source: Plowshare Group Inc.79

Health Communications l 18

HOW TO
Developing Effective Messages

Hard-hitting messages that depict the negative health 

consequences of tobacco use through graphic images 

or personal testimonials increase recall and prompt 

changes in attitudes and behaviors.1,3,7,80 These kinds of 

messages emphasize the risk of death from tobacco use, 

the effects of living with tobacco-related illnesses, or 

the impact of tobacco use on loved ones.1 Hard-hitting 

messages can be even more effective when they include 

information about how to quit.4 For example, messages 

can include the quitline number or inform smokers that 

quitting is easier with help. 

Hard-hitting messages can also reduce campaign costs. 

They resonate with many different groups, including 

both youth and adults.1,5

 They are effective among 

populations experiencing tobacco-related disparities, 

reducing the need to tailor materials to specific 

audiences.1,80,81 These kinds of ads may also need to 

be viewed less often than other ads to be effective.3

Testimonials that depict real-life stories of community 

members may get covered by local media, extending the 

reach of the original message.49 Messages that connect 

tobacco use to other issues important to the community, 

such as cancer or diabetes, can encourage partners to 

share messages with their audiences.

Although messages about the serious health 

consequences of using tobacco are sometimes 

criticized for being too graphic and upsetting, they 

have been rated as more effective than messages that 

use humor or focus only on how to quit.7,83,84 Positive 

messages are best when used to supplement hardhitting messages (either as part of the same message or 

as part of the campaign). 

Elements of Effective Messages51

Effective messages:

• State the issue (e.g., secondhand 

smoke exposure is dangerous to 

nonsmokers)

• Include credible supporting facts (e.g., 

secondhand smoke contains nearly 70 

chemicals that cause cancer82)

• Evoke a shared value (e.g., everyone 

has the right to breathe clean air)

• Include a call to action (e.g., protect 

loved ones from secondhand smoke)

Outdoor ad from the New York City Department of Mental Health and Hygiene’s “Secondhand Smoke Kids” campaign Source: CDC MCRC

Educating about Secondhand Smoke Exposure 

Communications campaigns to raise awareness about 

the dangers of secondhand smoke exposure also play 

an important role in program efforts. These campaigns 

share powerful messages about the harmful effects of 

smoking on loved ones that are difficult for smokers 

Health Communications l 19

HOW TO
to ignore. By making smoking less acceptable and 

less convenient, they can encourage people to quit.43

Secondhand smoke campaigns increase quitline calls 

and encourage nonsmokers to help someone quit.41,85,86

See an example from Oklahoma below.

A CLOSER LOOK: Oklahoma Raises Awareness about the Dangers of 

Secondhand Smoke

In 2008, Oklahoma had one of the highest smoking rates in 

the nation at 24.7%.89 To raise awareness about the dangers 

of secondhand smoke exposure and encourage cessation, 

the Oklahoma Tobacco Settlement Endowment Trust and 

the Oklahoma State Department of Health collaboratively 

developed the Tobacco Stops with Me campaign. Campaign 

messages focus on the negative consequences of tobacco 

use for users and non-users and emphasize every person’s 

responsibility to make “tobacco stop with me.”87,90 To widely 

share messages with the public, the communications team 

uses a combination of paid and earned media strategies. 

Paid ads run on TV and radio, in print, online, and on 

billboards.90 Campaign staff also create news releases and 

give interviews to generate earned media coverage.90 The 

campaign has a Facebook page, Twitter account, YouTube 

channel, and a dedicated website, stopswithme.com.

90

Exposure to the campaign has changed attitudes and 

behaviors about secondhand smoke. More Oklahomans 

now believe that secondhand smoke exposure causes heart 

disease, is very harmful, and causes Sudden Infant Death 

Syndrome (SIDS).90 The campaign has also prompted tobacco users and nonusers to take part in making 

Oklahoma tobacco-free. After exposure to the campaign, daily tobacco users were more likely to make a 

quit attempt and Oklahomans who do not use tobacco were more likely to try to help someone quit.86 In 

2016, Oklahoma’s smoking rate fell to 19.6%, a new low since the campaign began.91 While still higher than 

the national average, Oklahoma no longer ranks among the 10 states with the highest smoking rates.92 

Print ad from Oklahoma’s “Tobacco Stops with Me” campaign 

Source: CDC MCRC 

Avoiding Ineffective Messages

It is important that programs are sensitive to how other 

public health issues (e.g., substance use) and populations 

(e.g., persons with disabilities) are portrayed in tobacco 

control messages. Communications efforts can also avoid 

using messages that:

• Blame individuals for their tobacco use49

• Deliver complicated or multiple messages87

• Compare risks49

• Include images of tobacco products, use, or 

other related items (e.g., ashtrays or matches)88

• Restate the tobacco industry’s messages

• Lack a call to action87

Programs may also want to carefully plan 

communications on new and emerging tobacco 

products. For example, learn more about 

communicating about e-cigarettes on page 21. 

Health Communications l 20

HOW TO
Even when programs use messages that are proven 

to be effective, pretesting messages is important to 

ensure that they will be relevant and meaningful to the 

intended audience. Campaigns also need enough reach 

and duration have an impact. Even the most effective 

messages will not change attitudes and behaviors if they 

do not reach the intended audience.7

For more information on the topics covered in this 

section, visit the CDC Office on Smoking and Health’s 

State and Community Resources web page.63

A CLOSER LOOK: Communicating about Electronic Cigarettes

Current electronic cigarette (e-cigarette) use 

increased among U.S. high school students by 

more than 900% from 2011 to 2015.93 As of 2016, 

e-cigarettes were the most commonly used tobacco 

product among both middle and high school 

students.94 Young people are widely exposed to 

advertising for e-cigarettes in retail stores, on the 

internet, on TV, in the movies, and in newspapers 

and magazines. Exposure to e-cigarette advertising 

is associated with e-cigarette use among youth, 

and in 2014, an estimated 18 million U.S. youth 

were exposed to e-cigarette advertising through 

these channels.95,96 Youth also report experimenting 

with e-cigarettes out of curiosity, because of 

these products’ appealing flavors, and because 

they consider e-cigarettes to be less harmful than 

conventional cigarettes.93

Research on e-cigarettes continues to emerge, and there are still several unanswered questions about 

the long-term impact of e-cigarettes on individual and population-level health. However, many 

effective tobacco prevention and control strategies can be applied to e-cigarettes to minimize the 

potential harms of these products among young people. For example, the U.S. Surgeon General has 

underscored the importance of providing information about the dangers of e-cigarette use among 

youth and young adults.93

Tobacco control programs can help educate youth and their families about e-cigarettes by clearly and 

consistently communicating what is known about these products, including the risks associated with use 

among young people. Specifically, programs can develop messages that include the following facts:

• E-cigarette aerosol is not harmless water vapor, although it generally contains fewer toxicants 

than combustible tobacco products.93

• E-cigarettes typically contain nicotine. Nicotine exposure during adolescence can cause addiction 

and can harm the developing adolescent brain.93

• E-cigarette use is strongly associated with use of other tobacco products among youth and young 

adults, including smoked products such as cigarettes.93

• Youth use of products containing nicotine in any form, including in e-cigarettes, is unsafe. 

Diversity of e-cigarette products Source: U.S. Department of Health 

and Human Services11 

Health Communications l 21

HOW TO
Using a Mix of Strategies

As the number of ways to communicate with audiences 

continues to grow, programs often have to make strategic 

choices about how to share messages. Questions around 

which channels to use and how much to spend can be 

overwhelming. Each option has different strengths and 

weaknesses, and communications efforts will likely use 

more than one strategy to achieve campaign goals. Using 

multiple strategies increases the likelihood that messages 

reach the intended audience, increases the number of 

times people see or hear messages, and can enhance 

message credibility. 29,51 The job of the communications 

team is to choose the best mix of strategies based on the 

campaign’s goals, the audience’s preferences, and the 

communications budget.

Building the Right Mix for a Campaign

Although the exact mix will be different for each 

campaign, programs can try to include at least some 

paid and some earned media strategies in every 

campaign. Adequately funded paid media channels, 

like TV, are important to make meaningful, large-scale 

changes in attitudes, knowledge, and behaviors.1,5

Although TV airtime can be costly, incorporating 

other lower-cost paid media channels like radio, print, 

or billboards helps campaigns get enough exposure. 

Complementing paid media strategies with other 

strategies can extend the reach of campaign messages.27

Social media channels can also support, but not replace, 

more traditional channels.1

Coordinating campaign efforts with local coalitions 

can also help extend the reach of strategies. Programs 

can share materials like sample social media content or 

news releases with coalition and community partners to 

make it easy for them to promote the campaign.

Selecting Communications Channels

The best channels for a campaign are those that reach 

audience members where they spend their time 

(e.g., in the car, at the doctor’s office, or at home).29

Using channels that reach individuals where they will 

be most attentive helps them act on the message.29

Audience members may also view some channels 

as more credible than others.29 For example, people 

may read certain newspapers or be more receptive to 

a brochure from their doctor. To select channels, the 

communications team can start by reviewing audience 

research. Local organizations that work closely with the 

audience can also recommend how best to reach them.

Sometimes, finding the right strategy takes a little 

creative thinking. For instance, programs in Alaska 

displayed messages in places people go to socialize, 

like fishing hubs, post offices, and grocery stores. 

Understanding the pros and cons of different channels 

can help build the best mix to achieve campaign goals 

(see Table 4 on page 23).

For instance, TV may be more expensive than other 

channels but can reach many more people. To make a 

fair comparison, the communications team can divide 

the cost of the channel by the size of the audience 

reached.67 Including as much information as possible 

about the cost of using the channel in this calculation 

is important, such as the cost of developing and placing 

ads. Programs with smaller budgets can learn more 

about how to reduce costs on page 47.

Channel Selection Checklist

Answering the following questions can help 

select communications channels: 

• Does the channel reach members of 

the intended audience?97

• Will the channel reach audience 

members when they are most likely 

to pay attention to messages?27,97

• Will the channel reach audience 

members where they can act?27

• Do audience members trust the 

channel?29

• Is the channel best for conveying 

complex or simple information?29

• Does the program have the budget, 

time, and resources to use the 

channel effectively?27

• Will the channel reinforce messages 

shared through other channels?29 

Health Communications l 22

HOW TO
Table 4. Pros and Cons of Select Communications Channels

Channel Pros Cons

 

Digital

• Can be inexpensive49

• Can be accessed from anywhere in the world 

with an internet connection49

• Can change content quickly49

• Can reach populations that often use digital 

media (e.g., LGBT and Hispanic/Latino 

audiences)98,99

• Limited message space27

• Requires audience to have access to the internet49

• Some viewers consider them annoying or 

distracting27

News Outlets

• No placement costs49

• Can reach broad audiences quickly29

• Can reach decision makers and other influential 

people27

• Audience can reread, think about, and share 

information29

• Less control over how message is conveyed49

• Less control over whether articles are published 

and how prominently they are placed49

• Must be newsworthy to get coverage29

Outdoor

• Helps build awareness of the campaign67

• Reinforces messages on other channels51

• Can be inexpensive51

• Can be placed near hard-to-reach populations51

• Limited to short messages because roadside 

exposure is often only 3–4 seconds49

• Can be damaged by weather and graffiti51

• May not be possible in preferred locations49

Print

• Can focus on audiences with different lifestyle 

preferences (e.g., families or athletes)67

• Opportunity for articles to complement print ads

• Long lead time67

• Competes in cluttered advertising environment51

• Misses audiences with low literacy levels51

Radio

• Production and placement is cheaper than TV29

• Ads can be produced quickly49

• Can control content and execution of ads29

• Can target audiences with different listening 

preferences (e.g., country or talk radio)29

• Can reach populations that often listen to radio 

(e.g., Hispanic/Latino audiences)100

• Can communicate complex information27

• Smaller reach than TV29

• Lacks the visual impact of TV49

• Can be hard for audience to remember or share 

information29

Social Media

• Low cost to develop54

• Can quickly update and share information29

• Can be accessed from anywhere in the world 

with an internet connection49

• Requires audience to have access to the internet29

• Requires audience to have social media accounts29

• Requires staff time to maintain and monitor29

• May result in negative response from opposition29

TV

• Can reach large audiences29

• Combines audio and images for greater impact29

• Can control content and execution of ads29

• Can reach audience when they are most attentive29

• Can reach low-income audiences29

• Can be expensive to place ads29

• Can be expensive to produce new ads29

• Hard to communicate complex information49

• Large number of TV channels can result in small 

audiences29

Websites

• Can quickly update and share information29

• Can be interactive29

• Can control information provided29

• Can be accessed from anywhere in the world 

with an internet connection49

• Requires audience to have access to the internet29

• Requires audience to search for or visit the 

website to access content29

• Requires maintenance29

Health Communications l 23

HOW TO
Selecting strategies that are different from those used 

by other campaigns can prevent duplicate efforts. 

For instance, campaigns by the CDC and others may 

coincide with the campaign. The communications 

team can design strategies to reinforce these efforts, 

such as promoting CDC’s Tips® ads on Facebook when 

the national campaign airs on TV. It is important, 

however, to be careful about relying too much 

on other campaigns or partners to communicate 

messages.29 Funding for national campaigns is not 

guaranteed, and state and local campaigns are still 

very important.1

For programs that need more help developing their 

strategies, the Health Communications Branch of the 

CDC’s Office on Smoking and Health offers customized 

technical assistance to design a mix of strategies that fits 

the program’s funding level.

For more information on the topics covered in this 

section, visit the CDC Office on Smoking and Health’s 

State and Community Resources web page.63

Elements of a Successful 

Campaign

Successful tobacco control communications 

campaigns have:

• Multiple strategies that work together 

to achieve objectives27

• Adequate funding1

• Sufficient reach and frequency1,3,4,7

• Messages that are consistently 

communicated over time1,3

• Coordination with overall program 

goals1,12

• Strategies tailored to intended 

audiences2,12,27

• Connections to cessation services12

• Culturally competent messages and 

strategies1,27

• Pre- and post-campaign evaluations49

Preparing to Launch a Campaign

Beginning a communications campaign is an exciting 

time for a program. Taking the following steps before 

launching a campaign can help ensure that it is a success:

• Review the communications plan and annual 

workplan and make adjustments to account for 

staff changes or new priorities.2

• Update the timeline with information about 

current events or opportunities.2

• Make sure that staff and partners understand 

their roles.2

• Choose a spokesperson who can answer 

questions about the campaign.

• Brainstorm what might go wrong and how to 

solve potential problems.72

• Prepare talking points and a plan for responding 

to opposition in advance.101

An important step in a new campaign is approving 

and distributing materials. How materials are 

approved varies by program. Staff can prepare by 

researching their approvals process and assigning one 

person to handle approvals. This person can also help 

to estimate how many materials will be needed, and by 

when, to avoid costly reprints.87 Before materials are 

shared, staff will want to thoroughly review them for 

technical errors, cultural competence, and fit with the 

campaign’s overall message.27

The final step before beginning a campaign is to plan 

the launch. Having an official kick-off event can raise 

awareness, generate news coverage, and extend the 

reach of campaign messages.29,72 Linking the kick-off 

to a new study or a timely event can boost interest.29

To maximize coverage, the communications team 

can invite journalists who worked with the program 

before, represent local media outlets, or work for 

health publications.29 Team members can also 

distribute background information to help attendees 

write accurate, informative stories.29 The launch 

signals the start of all other campaign activities. 

The following sections describe how to implement 

paid media, earned media, social media, and other 

program communications.

Health Communications l 24

HOW TO
Developing and Placing Paid Media

Paid media strategies are one of the best ways to reach 

and educate audiences. Paid media ads can be placed 

on channels such as TV, radio, billboards, transit, 

newspapers, magazines, and online.

Reusing Existing Ads

The communications team does not need to develop 

new ads for each campaign.1 Effective ads on similar 

topics have likely already been developed and can 

be reused at a much lower cost than creating new 

ads.1

 Adapting ads also reduces the risk that ads will 

be ineffective. Materials effective in one context are 

likely to be effective in others when adapted based on 

audience research.41,102

Ads can be obtained from health departments, 

voluntary organizations, or clearinghouses such as 

CDC’s Media Campaign Resource Center and Vital 

Strategies’ Media Beacon.

103,104 Ads with these features 

are easiest to reuse:

• Relate to the campaign’s goals29

• Have been evaluated for effectiveness30

• Include simple and accurate messages29

• Match the demographics, values, lifestyle, and 

media use habits of the intended audience29

• Have free print ads or other supplemental 

materials available for use

Once team members have selected an ad, they can ask 

the creator for permission to use or adapt it and request 

original files, if available.72 While many ads created by 

the federal government are not copyrighted and are 

free to use, there may be placement or actor fees to 

use them.29,72 The communications team may decide 

to re-shoot an ad with actors who better represent 

the intended audience or add or remove elements to 

address local issues.102 They may also change voiceovers 

to use a different language or accent or simply add or 

change the logo and quitline information.102 See an 

example of how California and others adapted an ad 

created by North Dakota on page 26.

Developing New Ads

If a program has enough funding and no existing ads 

meet its goals and objectives, the communications team 

may consider creating its own ads.1 Before deciding 

to create new ads, it is important to check that the 

program has enough money in the budget for audience 

research, ad production, and pretesting new materials.1

See an example of creating ads for a unique audience in 

New York City on page 31.

Ads that are not tied to a particular location or time 

can be reused more easily in the future. For example, 

programs may want to avoid showing items like cell 

phones that may quickly become outdated. Using 

voiceovers instead of people speaking in TV or radio 

ads makes it easy to replace the original audio track 

with updated information in an appropriate language 

or accent.43

Pretesting Ads

Pretesting ads helps protect a program’s investment 

by ensuring ads will effectively meet communications 

goals. New and adapted ads can be pretested. Ads that 

pretest well communicate key messages more effectively 

and are more likely to change the audience’s attitudes, 

beliefs, and behaviors about tobacco use.1,105,106

Pretesting cannot guarantee a campaign’s success, but 

results can help guide decisions about what changes to 

make or which ads to air.105

To determine which ads will work best with the 

intended audience, programs can ask the following 

pretesting questions:

• Were the key concepts clear and easily 

understood?27,29

• What message did participants take away?27,29,49

• Did participants believe the ad?27,29,49

• Did anything about the ad make participants 

feel uncomfortable?29

• Were any parts of the ad were confusing?29,49

• Did the information in the ad apply to 

participants’ lives?27,29,49

• Did the ad cause any negative or unintended 

consequences (e.g., smoking triggers)?107

Health Communications l 25

HOW TO
A CLOSER LOOK: California and Minnesota Reuse North Dakota Ad

In 2014, the California Department 

of Public Health began its “Healthy 

Stores for a Healthy Community” 

initiative. It aimed to improve health by 

making changes in stores and educating 

people about how in-store marketing 

affects their consumption of unhealthy 

products like tobacco, alcohol, and 

junk food.108 As part of the initiative, 

the Department sought to develop a 

campaign to highlight tobacco product 

marketing in stores and its impact on 

youth.109

Program staff began by searching 

CDC’s Media Campaign Resource Center (MCRC) and found the “Tobacco and Kids” ad developed by 

the North Dakota Center for Tobacco Prevention and Control Policy.109 The unscripted, documentarystyle ad featured children playing with flavored tobacco products in colorful packaging, illustrating the 

appeal of these products to kids.110 Flavored tobacco product packaging that resembles candy has been 

found to appeal to youth and encourage tobacco use experimentation, progression to regular use, and 

addiction.111 The California team liked the ad, but wanted it to better represent their state’s population. 

They asked for North Dakota’s permission to re-shoot the ad with children from diverse racial and ethnic 

backgrounds. California’s adapted ad received positive feedback during pretesting and was incorporated 

into “Healthy Stores for a Healthy Community.”110 California also uploaded its version of the ad to the 

MCRC as a resource for other programs. 

Since then, North Dakota’s original ad concept has been reused in at least three states, including 

Minnesota. ClearWay Minnesota wanted to highlight how flavored tobacco products are still a problem 

for the state’s youth.112 During planning for the “Still a Problem” campaign, staff searched the MCRC 

for flavored tobacco product ads and found several options that could meet their campaign goals.109

California’s ad tested strongest with audience members in raising awareness of the issue and was reused 

in Minnesota without any changes.109 

Screenshot from the California Department of Public Health’s “Kids and the 

Tobacco Predator” TV ad Source: California Tobacco Control Program 

The communications team can also compare potential 

ads against those that have already been proven 

effective at changing attitudes and behaviors, such 

as hard-hitting ads that depict the negative health 

consequences of tobacco use.

Selecting Pretesting Methods

Pretesting can be done using focus groups, individual 

interviews, or surveys. The right pretesting method 

will depend on the intended audience and the goals 

of pretesting.27,107 For example, focus groups can help 

identify promising messages, while interviews can 

reveal controversial elements of an ad that participants 

might not feel comfortable sharing in a group.27 Learn 

more about how to conduct pretesting in the resource, 

Pre-Testing Anti-Smoking Commercials: Process for 

the Conduct of Market Research.

107

Health Communications l 26

HOW TO
Recruiting Participants

Pretesting participants typically have backgrounds, 

beliefs, values, and preferences similar to the intended 

audience. Pretesting ads with audience members 

helps assesses whether the ad fits the audience’s media 

preferences, education level, culture, and lifestyle.72

Programs may want to exclude some groups from 

pretesting, such as advertising and tobacco control 

experts or people working in the tobacco industry.107

Organizations who serve the intended audience may 

be able to help recruit participants.51 For example, 

language instructors may be able to recruit recent 

immigrants and health care providers could reach 

out to pregnant women.27 Local publications can 

also be used to recruit community participants with 

specific interests.51 A short survey can help the team 

screen potential participants to determine if they fit 

pretesting needs.

Understanding the Results

Pretesting results help programs improve ads so 

that they are more likely to change attitudes and 

behaviors. The communications team can look for 

trends in comments and agreement or disagreement 

in responses.27 Even the opinions of a few participants 

could be useful to assess the ad’s effectiveness.107 Ads 

that cause negative reactions can still be effective, and 

ads that are well liked might not be effective.107 Cultural 

insensitivity or difficulty understanding the message are 

also important to note.

Reducing Pretesting Costs

In some cases, other programs may have already tested 

the ads with a similar audience.51 If not, the team 

may want to conduct its own pretesting. To reduce 

pretesting costs, they can use or modify existing ad 

rating questionnaires and use a small, representative 

sample of the audience.113 Partner organizations and 

local coalitions can help locate participants and donate 

space, refreshments, and participant incentives.51 These 

simple strategies can help make pretesting possible 

with a limited budget. However, it is still important 

to conduct enough pretesting to get conclusive, 

meaningful results.51

Paid Media Planning

Planning helps ensure that paid media strategies are 

cost effective and reach the intended audience often 

enough to change behaviors. The plan also guides 

a campaign’s media buy, or purchase of paid media 

placements.1 Planning a successful media buy starts 

with a clear understanding of the intended audience 

and their media preferences. To ensure successful 

media buys, the communications team can also:

• Include details about the media buy size, timing, 

and channels in the annual workplan

• Place ads where they will reach most of the 

intended audience, supplementing with targeted 

media buys to reach specific groups

• Choose a few key ads to place at a time 

• Buy ads on multiple channels, but use TV as the 

primary channel if it fits within the 

communications budget27,114

Print ad produced for the Rhode Island Department of Health “Be an Original” 

campaign Source: CDC MCRC 

Health Communications l 27

HOW TO
• Coordinate media buys with other ads that will 

air, such as CDC’s Tips® campaign114

• Partner with organizations that can offer free 

media placement or reduced development costs

Working with Communications 

Specialists 

Paid media strategies often require technical 

skills beyond the capacity of program 

staff. Communications specialists use their 

knowledge and experience to support 

communications campaigns by:27

• Analyzing what can be accomplished 

with a program’s resources

• Determining the exposure necessary 

to achieve paid media goals

• Designing and producing effective, 

powerful paid media ads

• Recruiting participants, conducting 

pretesting, and analyzing results

• Selecting the best media placements 

to reach the intended audience

• Getting better deals for media buys

Determining the Size of Media Buys

The size of a media buy depends on the 

communications budget, what channels will be used, 

and the amount of exposure to an ad that is needed 

to achieve the intended attitude or behavior change. 

Exposure to paid media ads is measured by gross rating 

points (GRPs). Campaigns with high GRPs reduce adult 

smoking prevalence, increase the likelihood of quitting, 

and increase quit attempts.7,115 GRPs are calculated by 

multiplying the percentage of the audience potentially 

reached by the number of times the audience will 

potentially see an ad.27 For example, 1,000 rating points 

means 100% of the audience will potentially be exposed 

to 10 ads or 50% will potentially be exposed to 20 

ads.7 Best Practices 2014 suggests that ads have enough 

GRPs to reach between 75% and 85% of the intended 

audience each quarter.1

The stage of a campaign also affects the size of media 

buys.27 For instance, campaigns may need greater 

exposure early on to increase awareness and less 

exposure during later stages. New campaigns often start 

with a large media buy of at least 1,200 GRPs per quarter 

to grab people’s attention.1,7

 Ongoing campaigns can 

be effective with 800 GRPs per quarter.1

 In general, it is 

best to buy as much exposure as the budget allows.27,49

If a program cannot buy at least 800 GRPs, other health 

communications strategies may be more appropriate. 

Deciding Campaign Length 

Paid media strategies that are sustained over long 

periods of time maintain awareness, change attitudes, 

and prompt action.1,51 Paid media campaigns generally 

take 3 to 6 months to raise awareness, 6 to 12 months 

to influence attitudes, and 12 to 18 months to change 

behavior.1 These effects can diminish quickly after 

broadcasting ends, typically within a few months.1,116

Ads sustain behavior change when they are broadcast 

in repeated cycles throughout the year.115,116

Communications teams often choose to buy media in 

“pulses,” a pattern where ads are aired during strategic 

intervals throughout the year. For example, ads may 

be on air for 3 to 6 weeks and then off air for 2 to 

6 weeks.27 These cycles maintain a baseline level of 

awareness and help control costs.27,117

Choosing Where to Place Ads

Some audiences listen to the radio, some watch cable 

news, and others notice signs on the buses they use to 

get to work. Digital ads are also becoming a popular 

strategy as people spend more time on computers, cell 

phones, and tablets.118 Outdoor ads are often used to 

supplement TV and radio ads. Ads are most effective 

when placed where the intended audience will be 

likely to see and hear the messages.1 The pros and 

cons of different paid media channels are described in 

Table 4 on page 23.

Health Communications l 28

HOW TO
A CLOSER LOOK: Placing Ads on Digital Media 

Although TV remains 

an important paid media 

channel, digital media use on 

mobile phones, computers, 

tablets, and gaming platforms 

is growing quickly.42,118

Digital media ads differ from 

traditional paid ads because 

they often require users to 

take some action to see the 

ad, such as visiting a website 

or clicking on a video.7

However, placement costs 

are often lower than other 

channels. Digital channels 

can also be used to reach 

specific audiences, such as 

those interested in certain 

topics.79 The communications 

team can use digital ads to 

complement traditional paid 

media, increase campaign 

awareness, and cost-effectively increase traffic to the program’s website or other digital content.58 The 

options for placing digital media ads continue to increase. Programs can:79

• Create banner ads for websites

• Pay for ads to pop up during internet searches

• Promote ads on social media platforms

• Air ads before or during online videos and radio programs

• Place ads in online gaming

For example, CDC created banner ads for the Tips® campaign and placed them on video, mobile, and 

streaming radio, and in paid searches. To select digital channels, the communications team can start 

by thinking about how to best reach the audience and what they want to achieve. For instance, ads 

on websites or social media can be closely targeted to reach specific audiences but may result in less 

engagement than ads that display during internet searches.79 

Web banner ad from CDC’s “Tips®” Campaign Source: CDC MCRC 

Health Communications l 29

HOW TO
Programs often have limited funding for paid media, 

so it is important to set realistic expectations. If a 

program’s communications budget is only large enough 

to air a TV ad one time, it may not have enough reach, 

frequency, and duration to be effective. A less expensive 

channel like newspaper or radio where ads can run 

more often may be a better choice.70

To choose paid media channels, the communications 

team can seek input from local coalitions and partners 

who work closely with the audience. Information 

gathered about the audience’s media preferences can 

also help select channels. Learn more about audience 

research on page 17. 

Selecting When Ads Will Run

Awareness of a campaign also depends on the time 

of year, day of the week, time of day, and type of 

programming during which an ad runs.49 For example, 

smokers may be more motivated to quit during 

certain times of the year, such as when setting New 

Year’s resolutions.114 People change their media use 

during the week and throughout the day, as Figure 

4 below shows. For instance, radio use is highest 

between 6:00 a.m. and 6:00 p.m., and TV use peaks 

at 9:00 p.m.119 Airing ads during certain programs 

can also help engage audiences. Tobacco control ads 

tend to have greater impact when placed during light 

entertainment (e.g., home and garden, cooking, game 

shows, or reality TV shows) than during comedies, 

soap operas, and dramas.120,121 The communications 

team can use these trends to strategically place ads 

and increase their reach. 

For more information on the topics covered in this 

section, visit the CDC Office on Smoking and Health’s 

State and Community Resources web page.63

Figure 4. Media Usage among U.S. Adults (May 2015) 

Source: Nielsen119 * Note: TV Connected Devices include game consoles and devices like Roku or Apple TV

Health Communications l 30

HOW TO
A CLOSER LOOK: New York City Educates about the Health Risks of Light and 

Non-daily Smoking

Despite overall reductions in smoking prevalence 

in recent years, the percentage of smokers who 

smoke fewer than 10 cigarettes per day has 

increased.122 Although smokers often perceive light 

smoking to be less risky, light smokers still have a 

greater risk of heart disease, lung cancer, and death 

than nonsmokers.123,124,125

In 2011, the New York City Department of Health 

and Mental Hygiene noticed that light and nondaily smoking was on the rise among smokers in 

the city. By 2010, nearly 75% of smokers in New 

York City were light or non-daily smokers.125 To 

reach them, Department staff developed the One 

Cigarette is One Too Many campaign to emphasize 

the dangers of light and non-daily smoking. They 

placed ads on TV, in print, and online that featured 

common statements of light smokers and powerful 

facts about the health risks of light smoking. To 

encourage cessation, the ads were paired with a 

free nicotine replacement therapy (NRT) giveaway 

for contacting the quitline during the three weeks 

that the campaign aired.125 Quitline contacts 

increased more than 400% compared to the 

previous year and light and non-daily smokers’ use 

of NRTs increased by more than 50%.125

Despite this success, the Department also wanted to make sure that heavy smokers found the ads 

effective.125 The Department tested an ad from the campaign with light, non-daily, and heavy smokers 

through an online survey to assess its effectiveness. The results showed that although light and non-daily 

smokers were more likely to express increased concern about the risks of smoking after viewing the 

ad, all participants found the ad equally effective.125 With these promising results, the Department felt 

confident that using these kinds of ads would not mean sacrificing effectiveness among heavy smokers.125

They launched another campaign in 2014 aimed at light and non-daily smokers, Cancer Doesn’t Care. 

The campaign included TV, radio, and bus ads that challenged the reasons light and non-daily smokers 

think they are exempt from the health consequences of smoking.103

Print ad from New York City’s “One Cigarette is One Too Many” 

campaign Source: CDC MCRC

Health Communications l 31

HOW TO
Generating Earned Media 

Earned media strategies are an important part of 

every communications campaign.27 Although earned 

media does not cost money, getting news coverage 

takes significant work. Successful earned media efforts 

begin with a well-developed plan and include a mix of 

news coverage strategies.

Planning a News Coverage Strategy

The first step in a successful news coverage strategy 

is identifying news outlets that are popular with the 

intended audience. To create a list, the communications 

team can review information gathered about the 

media outlets most watched, listened to, or read by the 

intended audience and ask partners for suggestions.27

The next step is to identify contacts at each media 

outlet. It is helpful to carefully track communications 

with journalists, keeping a record of the dates and 

results of these interactions.27

A news coverage strategy also includes choosing 

spokespeople and training them on key campaign 

messages to ensure they are ready when journalists 

need a quote or an interview. The best spokespeople 

represent the image of the campaign, are available to 

speak on a moment’s notice, and speak with a clear 

and credible voice.27 They may be members of the 

communications team or partners. Strong spokespeople 

are also able to answer questions on a range of tobacco 

control topics. The communications team can give 

spokespeople prepared answers that align with 

campaign messages and goals. It is also important 

that spokespeople understand the unique culture of 

the intended audience. For instance, spokespeople 

for campaigns focused on tribal populations can be 

educated on the difference between ceremonial and 

commercial tobacco use. 

Preparing spokespeople in advance can help influence 

how the news story is framed.51 Message maps that 

outline the question or concern, key messages, and 

supporting information are one tool to prepare 

spokespeople. See a template for creating message 

maps on page 40 of the resource, Effective Media 

Communication during Public Health Emergencies: A 

WHO Handbook.

126

The communications team can also prepare materials 

for journalists to reference, increasing the likelihood of 

getting coverage and the accuracy of coverage.27 This 

information could be placed in a media kit or posted 

on the campaign’s website. A media kit is a packet that 

includes news releases, fact sheets, contact information, 

or anything else that helps create a complete picture of 

the campaign and its messages.27

Getting News Coverage

News coverage can set the public agenda, extend a 

campaign’s reach, and add to a campaign’s credibility.43

The communications team and partners can use 

multiple strategies to earn news coverage, such as 

writing Opinion-Editorials (Op-Eds) or letters to 

the editor, pitching stories to the media, or hosting 

newsworthy events.

Building Relationships with 

Journalists

Good relationships with journalists increase 

the chances of media coverage.27,29 To build 

strong relationships with the media, the 

communications team can:27

• Introduce themselves to journalists 

who cover health or related issues

• Respect journalists’ time, deadlines, 

and preferred contact methods

• Give supporting information like 

recent data or background on the 

program

• Connect journalists with tobacco 

control and public health experts 

• Read journalists’ articles to 

understand the stories they cover and 

their stances on related issues

• Establish the tobacco control 

program as a resource

Health Communications l 32

HOW TO
Writing Opinions and Letters to the Editor

Communications team members and partners can 

publish messages without help from journalists via 

letters to the editor and Op-Eds. Letters to the editor 

inform decision makers of community interests. They 

are usually short and express an opinion or respond 

directly to a recent news item.27

Op-Eds are longer, stand-alone pieces of writing 

(typically 600–750 words) that express strong opinions. 

Effective Op-Eds are timely and use local statistics 

and stories to support arguments.27 Op-Eds will often 

include the signature of a strategically chosen partner 

or local decision maker.27 Publications are very selective 

in choosing Op-Eds, so chances of getting letters to 

the editor published are much greater. However, OpEds can be very influential with an audience once in 

print.53 Learn more about writing Op-Eds and letters 

to the editor on the Community Tool Box web page, 

Preparing Guest Columns and Editorials.

127

Pitching Stories to the Media

Communications team members can also pitch story 

ideas to journalists and editors for publication. One 

common way publications show support for issues 

is through editorials. Editorials show a publication’s 

support for the issue and can help reach decision 

makers, gain credibility for campaigns, and earn 

community support.27,53 The communications team can 

arrange a meeting with an editorial board to educate 

them about an issue, try to persuade them to cover a 

campaign, and take a stance supporting a campaign. 

The team can use the meeting to show why the issue is 

important to the news outlet’s audience.53

Pitch letters are another way to reach out to editors or 

journalists. These short, informal letters give enough 

information to spark interest in the campaign and 

encourage them to publish news stories or feature 

articles.27 To maximize news coverage, the focus of 

a pitched story can be adjusted so that it is relevant 

to the media outlet’s audience. Newsworthy stories 

include information of interest to a broad audience, 

are timely and locally relevant, or reveal injustice, 

irony, or conflict.128

A news release (sometimes called a press release) gives 

details about the campaign, a specific event, or other 

newsworthy item to create the foundation for a story 

or interview.27 News releases are widely distributed to 

multiple news outlets. They start with an attentiongrabbing headline, followed by the most important 

information in the first paragraph to draw in journalists 

and share the major points quickly.27 Supporting 

information follows, including the who, what, when, 

where, and why. A news release closes by concisely 

restating the key message. News releases usually follow 

a standard format, depicted in Figure 5 on page 34. 

They can also be submitted in video form to include 

sound bites and background footage.27 Learn more 

about writing a news release on the Community Tool 

Box web page, Preparing Press Releases.

129

Checklist to Pitch Newsworthy 

Stories27

• Offer new data or information.

• Highlight something unusual, 

unexpected, or new to the public.

• Indicate a trend.

• Relate the campaign to other 

breaking news.

• Convey something people want or 

need to know.

• Localize a national story by adding 

local statistics, spokespeople, or 

experts.

• Include quotes from a public health 

leader.

• Make an emotional appeal or add a 

personal story.

• Highlight injustices around tobaccorelated disparities.51

• Include compelling visuals.

• Connect the story with a national or 

local celebrity.

Health Communications l 33

HOW TO
Figure 5. Anatomy of a News Release 

FOR IMMEDIATE RELEASE (Indicates that the news can be published right now)

 

 Organization Name

HEADLINE: The headline grabs the audience’s attention and draws them in for more. Style the 

headline in bold type.

SUBHEADLINE: While not always necessary, this is the opportunity to build on the headline by 

adding secondary detail. Style the subheadline in bold, italic type.

DATELINE (city of origin & date of release): CITY, Month, Day, Year—LEAD PARAGRAPH: This is the single most 

important paragraph in the release. This is the author’s chance to draw in the reader and set up 

the story in a sentence or two.

BODY: The body section can be one or more paragraphs. This is where the author goes into more 

detail, setting up the story for the readers and giving more background or context. It explains the 

“who, what, when, where, and why” of the story and gives readers supporting facts, statistics, or 

testimonials. KEYWORD: Using strategically placed keywords throughout the release makes it easier 

for the audience to find the release when searching the web for information. QUOTE: “Incorporating 

relevant quotes in the body of the release is an effective way to get the author’s message out 

by having a person or voice validate the importance of the story. Keep quotes easy for readers 

to understand and make sure to include the speaker’s name,” said Speaker Name, Title or 

Organization Role, Organization Name.

BOILERPLATE or ABOUT:

About Organization Name. Style the heading in bold type.

This section includes a brief description of the organization—who the organization is and what it 

does. A clickable link to the organization website can provide more details.

CONTACT INFORMATION (for the person who will handle inquiries):

Contact: 

Contact First and Last Name

Contact Title or Role

Contact Phone Number

Contact Email Address 

Adapted from: PR Newswire130

Health Communications l 34

HOW TO
Hosting Newsworthy 

Events

Press conferences inform 

the community and the 

media about breaking 

news or an upcoming 

initiative.131 Effective 

press conferences have a 

clearly defined message 

and include speakers 

who can share diverse 

perspectives.27,131 Speakers 

can be community 

members, decision 

makers, local tobacco 

control coalition members, 

or members of other 

partner organizations. 

The press may be more 

likely to attend if wellknown public figures 

will be present. For 

instance, the Wisconsin 

Tobacco Prevention and Control Program gained 

media coverage by hosting press conferences in the 

state’s major media markets featuring a local mom who 

shared her story as part of CDC’s Tips® campaign.132,133

The press conferences resulted in free coverage by 60 

media outlets, including TV news stations and local 

and regional newspapers.132

A week before a press conference, the communications 

team can send an announcement inviting the press and 

providing key details.27 Team members can also remind 

the press and media contacts of the event one to two 

days before.27 Visuals, such as posters with photos or 

data, and media kits provided the day of the event make 

it easy for journalists to develop stories.27 Learn more 

about writing a news release on the Community Tool 

Box web page, Arranging a Press Conference.131

Responding to Opposition in the Media

Information shared by tobacco control critics 

can generate news coverage, even if inaccurate.27

Opposition can come in many forms and from many 

different people. For instance, campaigns may be the 

target of negative news stories or interviews, especially 

when they tackle controversial issues.49 Opposition 

may come directly from the tobacco industry, other 

industries, or the public (sometimes prompted by 

information from the tobacco industry). 

Programs can take steps to prepare for potential 

opposition so that they can respond quickly and 

consistently, minimizing the impact on the campaign. 

Before launching a campaign, the communications 

team can:

• Create standards that cover how the issue will 

be framed in all communications, from press 

coverage to informal conversations with friends

• Form partnerships with influential 

spokespeople who can speak on the program’s 

behalf if needed

• Develop talking points for spokespeople, 

particularly for issues likely to attract opposition

• Create multiple sets of talking points to 

communicate with different audiences (e.g., 

business owners, youth, and decision makers) 

using words that they understand

Health Communications l 35

HOW TO
• Include strategies in the communications plan to 

deal with potential opposition, such as who will 

help craft a response and which stakeholders 

will be contacted101

• Train grantees on similar practices

The best way to respond to opposition depends on 

what kind of opposition the campaign experiences. 

Opposition news stories offer an opportunity to 

educate the media or to establish the program as a 

resource, which helps to strengthen relationships with 

journalists.27 They also provide a great opportunity 

to write a letter to the editor, generating more earned 

media coverage for the campaign.27 Existing partners 

and local coalition members can be a vital source of 

support to help craft responses and speak on behalf of 

the program if opposition occurs.27

On rare occasions, more serious unexpected events 

or circumstances can occur, for example, those that 

might put the organization’s credibility or reputation 

at risk. Although programs cannot always prepare in 

advance for these kinds of problems, having a plan in 

place can help minimize the impact of even the most 

difficult communications challenges. Learn more 

about dealing with communications problems in the 

Community Tool Box resource, Handling Crises in 

Communication.

101

For more information on all of the topics covered in 

this section, visit the CDC Office on Smoking and 

Health’s State and Community Resources web page.63

A CLOSER LOOK: Public Service Announcements

High-quality PSAs have a short and 

simple message conveyed using 

clear, straightforward language.134

The most important information 

is presented at the beginning of 

a PSA in a way that captures the 

audience’s attention, followed by 

the who, what, where, and why of 

the tobacco control issue.134 Strong 

PSAs end with a call to action, such 

as a prompt to call the quitline or 

visit the program’s website. 

Broadcasting PSAs is similar to 

gaining news coverage.51 Programs 

persuade media outlets to share 

their PSAs by working with their media contacts, hosting newsworthy events, and tying PSAs to current 

events. Programs can also work directly with state broadcasters associations, the national Ad Council, 

and local TV stations.27 To approach media outlets, programs can develop a proposal that explains why 

the issue is important and how the PSA helps address it.51 It is important that the PSA’s content is also 

relevant to the media outlet’s audience. Unfortunately, since media outlets donate airtime and print space 

for PSAs, programs have little control over when, where, and how often PSAs are aired or printed.27 As a 

result, the impact of a PSA may be unreliable. 

The PSA “5.6 Million Children” highlights the fact that if current tobacco use prevalence 

does not decline, 5.6 million children will die early from smoking Source: CDC MCRC 

Health Communications l 36

HOW TO
Sharing Messages on Social Media

A program’s social media strategies complement its 

traditional communications efforts and are an essential 

part of its health communications strategy.1,5,11 These 

strategies work best when they align with campaign 

goals and fit within the limits of a program’s resources.

Creating a Social Media Plan

Research suggests that developing a social media plan 

could help programs better reach and engage their 

audiences.135 Social media efforts will be easier to 

manage if programs have a social media plan in place 

that aligns with the broader communications plan and 

includes prepared messages and materials. 

A strong social media plan includes start and end 

dates and a clear goal that is pursued through frequent, 

targeted posts on multiple channels. Creating a content 

calendar can also be useful. Some experts recommend 

that Twitter and Facebook posts be planned two 

months in advance to allow time for approval of 

images and language. Posts are generally scheduled 

for when most of the audience is expected to be online 

and planned around major events, holidays, or health 

observances that relate to communications goals.136

To keep audiences engaged, it is also important for 

programs to post regularly. Posts could be daily, weekly, 

or somewhere in between, based on the audience.136

Social media plans can also include 

strategies to extend the reach of 

campaign messages. One way to do this 

is to coordinate posts with partners. 

Partners can post campaign content 

on their social media channels, and 

programs can tag partners in posts 

or share complementary partner 

content on campaign pages. The 

communications team can also work 

to get “influencers” who reach a large 

audience, such as leading bloggers 

or celebrities, to post messages. 

Monitoring other social media 

accounts for tobacco control topics 

can be a way for programs to join the 

conversation to correct misinformation 

or give links to more information. 

Staffing Social Media Efforts

Engaging audience members on social media takes 

staff time and dedication. Tobacco control staff have 

the expertise to create, review, and approve posts and 

images. They also monitor discussions, forums, and 

blogs (including checking for inappropriate or negative 

comments) and respond to audience questions.58 It is 

helpful to have people on the communications team 

who are familiar with different social media platforms. 

Often, organizations will use a mix of existing staff and 

consultants from other branches of an organization, a 

volunteer pool, or media agencies. 

Getting buy-in from leadership for social media 

efforts is also important, particularly when staff and 

financial resources are needed.137 See more tips for 

gaining leadership support for social media at Amplify 

Advocacy’s resource, Tactics for Gaining Hierarchical 

Support.

138

Selecting Social Media Channels

The best social media channels for a campaign are 

those used by the intended audience. Team members 

can talk with partners who work closely with the 

audience and use market research, social media 

metrics, and other data to determine social media 

usage. Different channels can be used to reach 

different audiences. Facebook is used by most adults 

ages 18 to 64 and is increasingly popular among older 

Health Communications l 37

HOW TO
adults.139 Pinterest is used primarily by women ages 18 

to 49, while LinkedIn is used by working-age adults 

and college graduates.139 Instagram is popular with 

young adults, and Twitter is popular among young 

adults and college graduates.139 Recent social media 

trends are depicted in Figure 6 on the right and 

Figure 7 on page 39. For the latest data on social 

media use, visit the Pew Research Center website.

Figure 6. Percentage of Online Adults Using 

Popular Social Media Platforms in 2016 

Source: Pew Research Center, 2016139 

As of 2016, Facebook was the most widely used social 

media site.139 It is used by organizations to post updates, 

links, conversations, photos, videos, and petitions 

to groups of “fans” or “potential fans.” Facebook can 

help drive traffic to program websites, increase event 

attendees, and help programs build an email list.140 It 

is important to plan a campaign’s Facebook strategy 

to ensure it is reaching intended audiences and not 

just other public health organizations. If funding is 

available, the communications team can also consider 

boosting engagement through paid Facebook ads.

Organizations can set up a Twitter account and profile 

and use it to send bursts of short, 140-character 

messages called “tweets.” Tweets give updates on 

activities or events, start conversations, request help, or 

link users to interesting resources. The communications 

team and partners can use Twitter to promote events, 

“listen” to what the community is saying about a certain 

topic, and respond with real-time messages about 

campaigns and cessation resources.137 Twitter is also 

used by event attendees to “live tweet” messages to 

others following remotely.140

As of 2016, nearly half of U.S. adults used YouTube, 

second only to Facebook.141 Videos posted to YouTube 

can be shared across multiple platforms and spread 

campaign messages very quickly.137 As video cameras 

and editing software become more affordable, it is 

becoming more common for smaller organizations 

to produce their own videos. Video engagement can 

be measured in the numbers of “comments,” “likes,” 

“dislikes,” and “shares” a video receives and in changes 

in the number of channel “subscribers.”

Sharing photos and videos can engage the audience in 

campaigns.142 It can also generate “viral” dissemination 

when viewers forward the photos or videos many times 

in a short period. It is important not to rely on photo or 

video shares to spread virally, as it is difficult to predict 

how widely materials will be shared. The widespread 

use of mobile phones has made it easier than ever to 

take photos and videos. Setting up an account with 

Instagram, Flickr, Picasa, or another photo-sharing 

site is as simple as creating a login, uploading photos, 

adding captions or tags, and distributing the links. 

Communications team members can also use images 

from CDC’s Public Health Image Library.

142

A blog can be a useful tool for discussing a topic 

that may be too complex for other channels, while 

allowing readers to leave comments and engage in the 

discussion.55 Blogs may have a team of regular authors 

or only one, but most share a similar format where 

new entries are viewed first. Programs considering 

setting up a blog can start by reviewing other tobacco 

control blogs to learn what works well and who are the 

influential bloggers.55

Several other social media channels are available to 

programs. Programs can experiment with different 

channels at a relatively low cost and decide what is 

right for their communications goals and audiences. 

As programs select social media channels, it important 

to consider which channels best fit their needs in four 

key areas: 

• Personalization—content can be tailored for 

specific audiences55

• Presentation—content is timely, relevant, and 

accessible in multiple formats and contexts55

Health Communications l 38

HOW TO
• Participation—partners and the intended 

audience contribute in meaningful ways55

• Placement—messages can be placed to reach 

specific audiences

Because each channel has different capabilities, some 

may be a better fit than others. Using a combination of 

platforms, some that tell the full story and others that 

summarize key points, can be an effective way to reach 

a broad audience.143

Figure 7. Frequency of Social Media Channel Use

% of users who visit the social media site daily, weekly, or less often

Source: Pew Research Center, 2016139 

Developing Social Media Content

Continuously creating new content for social media can 

be a challenging and time-consuming task. Programs 

can begin by exploring existing CDC Tobacco Free 

social media channels.144 The communications team 

and partners can share or repurpose CDC posts on 

their own pages “as is,” or they can download social 

media images from the CDC’s Media Campaign 

Resource Center for free and add their own logos.103 

Repurposing content from a program’s website (e.g., 

news articles, fact sheets, research reports, and event 

descriptions) can save time and resources. Web content 

is usually ready to use because it has already been edited 

and approved.56 It is best to rewrite elements for social 

media channels, rather than use web content verbatim.56

Effective content is also tailored, or optimized, for each 

social media platform. For example, a call to action 

may look very different in a Twitter message than in a 

Facebook post. See Table 5 on page 40 for posting 

tips and CDC’s Guide to Writing for Social Media for 

specific guidance on developing social media content 

for different platforms.56

When editing content to fit length constraints of 

social media channels (e.g., Twitter or Facebook), it is 

important to ensure that the content remains accurate 

and scientifically defensible. If a particular message 

cannot be communicated in a short, easy-to-read 

format and still maintain scientific integrity, it should 

not be shared via social media. 

Health Communications l 39

HOW TO
Table 5. Posting Tips for Select Social Media Channels

Channel Posting Tips

Facebook • Use a casual but professional tone.56

• Keep posts under 250 characters (420 is the limit) so they can be viewed completely in the News Feed.56

• Use consumer-friendly, action-oriented messages.56

• Include one link, photo, or captioned video per post.56

• Tag organizational partners using the @ symbol.

• Respond quickly to comments.136

• Link to the program or campaign Facebook page from your website, blog, and other social media pages.

Twitter • Use hashtags for specific events and topics.137

• Write tweets of 120 characters or less (140 is the limit) so they can be retweeted.55

• Include a hyperlink and use a link-shortening service like bitly.com or tinyurl.com to make the links 

smaller.137

• When avoiding abbreviations is not possible, only use standard abbreviations that are easily 

understood.56

• Ask a question, highlight a key statistic, or give a specific call to action.56

• Link to the program or campaign Twitter profile from your website, blog, and other social media pages.

YouTube • Use personal and real stories from your community.137

• Get signed releases before posting images or videos of people.137

• Include descriptive titles (or captions) with your videos and photos.137

• Keep video content simple (with a single message), short (under 3 minutes), and engaging.145

• Embed campaign YouTube videos on your website, blog, and other social media pages.

Flickr • Add photos after each event or activity.

• Tag photos with descriptive keywords so your photos will be easily found in Flickr search.134

• Link to Flickr photos from your website, blog, and other social media pages.

Instagram • Post high-quality photos and videos.

• Use hashtags to tie posts to specific topics. 

• Be consistent with style and design of posts.146

• Direct people to other sites where they can get more information.146

• Follow other organizations and influencers.

Blog • Keep posts as short as possible (under two paragraphs). 

• Use attention-grabbing headlines.55

• Include links that support or give context to your post.

• Edit posts carefully and keep a consistent style.55

• Promote the program’s blog on your website and other social media sites.

Health Communications l 40

HOW TO
Avoiding Pitfalls of Social Media

Creating a social media presence is not without risks. 

The interactive nature of social media means that 

programs will not always be able to control all sides 

of a conversation. Programs may receive negative or 

inappropriate comments from the public or opposition 

groups, and knowing how to respond in a way that will 

not escalate a negative interaction is important. 

Twitter bombing is a strategy used by opponents of 

a particular issue to fill Twitter feeds with a specific 

message, making the message a trending Twitter 

topic.147 The goal of a Twitter bomb is to “establish 

a false sense of group consensus about a particular 

idea.”148 In 2014, the Chicago Department of Public 

Health was the target of a Twitter bomb.147,148 A few 

days before a scheduled vote on local e-cigarette 

regulation, the Department tweeted a series of messages 

about e-cigarettes. In response, Twitter users sent over 

600 anti-policy tweets.148 Despite the social media 

opposition, the Chicago city council voted 45–4 to 

regulate e-cigarettes. 

In the summer of 2015, the California Department 

of Public Health was the target of a similar campaign 

to “bomb” the Department’s Facebook profile.149 The 

opposition was a response to a Department campaign 

on the dangers of e-cigarette use. The opposition 

group’s negativity eventually began to erode support for 

the program’s social media channels. Sensing that their 

followers were looking for a more positive tone, the 

Department responded with the #trulyfree campaign. 

The campaign shared stories of Californians who were 

completely free of all tobacco products. Evaluation of 

the campaign showed that it reenergized the program’s 

social media community by empowering followers with 

positive messages.149

Closely monitoring social media channels and hashtags 

can help anticipate, recognize, and respond to grassroots 

opposition. The communications team can also develop 

and publish a social media policy. This can go a long way 

toward protecting the organization from risk and guiding 

staff in how to respond to issues that arise. Learn more 

about developing a social media policy below.

For more information on all of the topics covered in 

this section, visit the CDC Office on Smoking and 

Health’s State and Community Resources web page.63

What is a Social Media Policy?

As tobacco control programs increasingly use social media, the need for policies that govern their use 

and guide daily activities has become more important.137 An organization’s social media policy can help 

ensure open, honest, friendly, and consistent communication by including guidelines for:140

• Developing and approving messages

• Responding to public comments

• What can and cannot be shared on social media sites

• The language and tone of social media communications

• Protecting the privacy of staff and clients when using photos or quotes

For an example of social media guidelines, see the Oklahoma Tobacco Endowment Settlement Trust’s 

Facebook Policy.

150 More information on developing a social media policy is also available in Idealware’s 

web page, Creating a Social Media Policy.

151 

Health Communications l 41

HOW TO
Developing Program Communications 

Program communications include the many other 

ways that tobacco control programs communicate 

with stakeholders. These strategies support campaigns 

and help build a strong network of supporters. 

Programs can share messages through program 

websites, other digital channels, community 

engagement, and stakeholder communications. 

Creating Websites 

Websites are an important channel for communicating 

with the public about the health effects of tobacco and 

available cessation resources. Effective websites are easy 

to access, interactive, and relevant for the audience.61

While most state programs and partners have at least one 

website, many feature only links to social media pages 

and limited interactive content.61 For example, many 

state websites include web-based cessation tools,152 but 

other interactivity is limited. By making websites more 

interactive, state programs could improve their reach and 

relevance for the populations they serve.61

Website features that can improve usefulness include: 

• A newsletter sign-up button

• Links to Facebook, Twitter, YouTube, and other 

social media channels

• Site compatibility on mobile devices

• Interactive data tools

• Web-based cessation programs

• Infographics (i.e., visual representations of 

information that are sometimes interactive)

• Separate pages for different audiences

Smokefree Oregon’s website smokefreeoregon.com uses 

these features and others to educate Oregonians about 

the health effects of tobacco.153 The site incorporates 

infographics, interactive maps, navigation for different 

types of users, links for connecting on social media, and 

links to cessation resources.

Screenshot of Smokefree Oregon’s program website 

Communicating through Other Digital Channels

Podcasting, text messaging, and mobile applications 

work best when chosen carefully and integrated with 

Health Communications l 42

HOW TO
a program’s overall communications strategy. These 

activities have different resource needs in terms of cost 

and staff time. Some, like creating a podcast, are best 

suited for sharing information, while others, like text 

messaging, engage audience members in conversation. 

Figure 8 on the right describes the resources needed for 

different digital and social media activities. 

Podcasting is an effective way to share audio 

recordings of speeches, interviews, or news updates 

with a broad audience.154 See CDC’s Smoking & 

Tobacco Use Podcasts for an extensive library of 

podcasts that are available for download, posting, and 

sharing by partners.155

Over 90% of American adults own a mobile phone 

and almost all cell phones are able to send and receive 

text messages.156 Text messaging can be a simple and 

effective way to reach many people with important 

health messages. Emerging evidence indicates that quitsmoking text-messaging programs on smartphones can 

improve cessation rates.157,158,159 Effective text messages 

are relevant to the audience and include a way for them 

to respond, such as a phone number or website link.56

The adoption of smartphones has led to an increase 

in users who access the internet mostly on their 

mobile devices.59 Teams can also consider working 

with web developers to create apps that deliver health 

information. Smoking cessation apps, in particular, 

are becoming widely available. A search for “Quit 

Smoking” on Apple’s iTunes or Google’s Play site 

returns hundreds of apps, though quality and features 

vary greatly. Many of these apps lack elements that are 

normally recommended for cessation and could be 

improved to better reflect evidence-based practices.160

Figure 8. Resources Needed for Digital and 

Social Media Activities 

Adapted from: CDC, The Health Communicator’s Social Media Toolkit55

Communicating with Stakeholders

Communicating with staff, partners, and decision 

makers is important to keep stakeholders up to 

date on campaign progress and grow support for 

the program. To maintain frequent, informative 

communication with these important groups, 

programs can use the following materials:

• Monthly updates to administration leadership 

on campaign goals and results69

• Internal employee newsletters, distributed 

quarterly

• Externally distributed fact sheets sharing data 

about important issues161

• Printed educational brochures about the 

program’s current initiatives

• Email newsletters to partners and supporters 

to share new scientific evidence, give campaign 

updates, and build momentum154

As with all materials created by a tobacco control 

program, it is important that these communications 

align with the overall communications strategy 

and present a strong organizational voice that 

communicates authority, value, and professionalism.162

Decision makers are given lots of information 

and have limited time to review, so it is important 

that messages for this audience are as concise as 

Health Communications l 43

HOW TO
possible.163 They can share 

information about a new 

campaign, updates about 

program outcomes, or new 

scientific evidence.163 Featuring 

economic data and personal, 

local stories can improve the 

chances that decision makers 

will pay attention to this 

information.163 Making the 

connection between program 

goals and decision makers’ 

interests can also encourage 

them to support a program’s 

efforts. Reusing existing media, 

such as news articles, Op-Eds, 

and letters to the editor, is a 

great way to reach decision 

makers without having to generate new content.

When tobacco control programs communicate with 

decision makers, it is critical that they understand 

special restrictions on programs that receive 

federal funding. While educating and raising public 

awareness about issues are important activities 

of a tobacco control program, lobbying efforts 

are not permitted.164 Lobbying includes directly 

communicating with decision makers about pending 

legislation or encouraging their constituents to 

ask them to support a specific bill.164 For more 

information about which activities are allowed, read 

the CDC resource, Anti-Lobbying Restrictions for 

CDC Grantees.

164

For more information on all of the topics covered in 

this section, visit the CDC Office on Smoking and 

Health’s State and Community Resources web page.63

Coordinating with Partners and Coalitions

Coordinating strategies with local coalitions and other partners can extend the reach of messages and 

increase visibility of tobacco control issues. Programs can:

• Develop messages that emphasize the connections between tobacco use and other health issues 

• Train partners on news coverage strategies, such as writing letters to the editor

• Give partners sample news releases and other templates

• Invite partners to be spokespeople and give them talking points

• Promote the campaign at partners’ events

• Create an information-sharing network with partners to share new scientific evidence and 

opportunities to promote campaign messages

• Provide sample social media posts and shareable content for use on partners’ social media 

channels

• Tag partners in social media posts and share partners’ content 

Health Communications l 44

HOW TO
Reducing Tobacco-Related 

Disparities

Despite recent progress, tobacco use 

is still higher among certain racial 

and ethnic minority groups, low 

socioeconomic status individuals, 

LGBT populations, people with mental 

health and substance abuse conditions, 

and people living in certain geographic 

areas.165 Communications campaigns 

that have focused on groups affected 

by tobacco-related disparities have 

increased quitline calls and quit 

attempts among these populations.7

To implement campaigns that reduce 

tobacco-related disparities, the 

communications team can:

• Recruit staff that represent the intended 

audience

• Develop cultural competence

• Identify and describe populations most affected 

by tobacco use

• Seek input from the intended audience 

throughout the campaign

• Use messages and materials that resonate with 

the intended audience

• Place materials where the audience is most likely 

to see and hear them

The Maryland Department of Health’s Center for Tobacco Prevention and Control aired “Jessica’s 

Asthma Tip” from CDC’s “Tips®” campaign in Spanish on the jumbotron at Verano Zol, an annual 

music festival with a large Spanish-speaking audience167 Source: CDC

Recruiting Staff that Represent the Intended 

Audience

Including audience members or people who have 

worked with them on the communications team can 

bring awareness and understanding of the audience to 

communications efforts.166 The skills and knowledge of 

these team members help the program communicate 

in ways that are culturally appropriate and relevant to 

the community. To recruit diverse staff, the program 

can circulate job announcements throughout the 

community and prioritize applicants who have 

experience working with groups affected by tobaccorelated disparities.166

Developing Cultural Competence

Cultural competence is an important skill for 

tobacco control staff, especially those who work 

on health communications. Culturally competent 

health communications respect individuals’ cultures 

and language preferences.168 For example, the 

communications team may develop materials in the 

audience’s native language. They can also adapt materials 

to fit the audience’s reading level or numeracy skills. For 

tips on developing culturally competent materials, see 

the CDC’s resources on Culture & Health Literacy.

169

To strengthen cultural competency skills, programs can 

have staff complete a self-assessment of their values, 

attitudes, and communications styles. It also makes 

them aware of others’ communications styles, histories, 

preferred languages, and literacy levels.165,170 The 

Community Tool Box section, Building Relationships 

with People from Different Cultures, can help staff 

get started by becoming aware of their own cultural 

backgrounds and biases.171

Identifying and Describing Populations Most 

Affected by Tobacco Use

Community assessments help programs identify 

the groups in their communities that are most 

affected by tobacco use and describe the impact of 

tobacco use on these groups.165 The communications 

Health Communications l 45

HOW TO
team can use community assessments to plan and 

implement campaigns. It is important to pay attention 

to differences among subgroups when conducting 

assessments. There may be important language or 

cultural differences even within a smaller group.27 Learn 

more about conducting a community assessment in 

the CDC resource, Best Practices User Guide: Health 

Equity in Tobacco Prevention and Control.

165

Involving the Intended Audience

Involving audience members helps ensure that 

campaigns reflect the population’s values, beliefs, and 

attitudes.51 It can also help overcome a community’s 

negative experiences with targeted advertising or 

positive experiences with the tobacco industry.51

It is especially important to include underserved 

populations. One way to encourage involvement is to 

educate people on how tobacco harms their community 

and how they can help.27 Organizations working with 

specific populations can also be an important resource 

during campaigns.27

Using Messages that Resonate with the Audience

There are universally strong tobacco control messages 

that are effective among diverse audiences, such as 

testimonials or ads with graphic imagery that depict the 

negative health effects of tobacco use.1

 Many of these 

ads feature people from groups with higher rates of 

tobacco use or are available in other languages.172

Existing ads can often be used to effectively reach 

these groups. When developing new materials, it is 

best to use the audience’s native language whenever 

possible.27 Having native speakers review and edit 

materials can help make sure they share the same 

message as the English version. It is also critical to 

pretest materials with audience members to gauge 

whether messages resonate with them before spending 

time and money on a full campaign. Local coalitions 

and other partners who work closely with the 

population can help connect the program with native 

speakers or participants for pretesting. 

Chinese-language print ad from Asian Smokers’ Quitline campaign Source: 

CDC MCRC 

Tailoring Message Placement

Placing hard-hitting ads where the intended 

audience will be likely to see and hear them is a 

way to effectively reach specific populations with 

these messages. For instance, ads can be placed with 

minority-focused media outlets or other channels 

that are popular among the audience.1,165 Radio and 

internet ads are also effective at reaching specific 

populations.58,65 Today, technology allows programs 

to tailor placement of digital ads to precise groups, 

such as people interested in LGBT topics or fans of 

NASCAR. Coalition members and other partners who 

have experience working with a population can be 

helpful resources for selecting the best channels for 

media placements.

Health Communications l 46

HOW TO
Making Adjustments and Responding 

to Problems

Closely monitoring activities throughout the campaign 

helps the communications team quickly respond to 

unexpected problems or new opportunities. Team 

members can check activities against the annual 

workplan, assessing if they are being completed on 

time and whether some are more successful than 

others.29 Timelines may need to be adjusted and 

unsuccessful activities changed or eliminated.29 Paying 

close attention to what stakeholders are saying about 

campaigns can also help keep strategies on track 

to meet communications goals.2

 Learn more about 

evaluating campaign progress on page 48.

A CLOSER LOOK: Reducing Costs of Health Communications

Communications campaigns require time and resources, but programs with limited resources can still 

create effective campaigns by finding ways to strategically reduce costs. Paid media can take up a large 

portion of the communications budget. To reduce paid media costs, teams can search CDC’s Media 

Campaign Resource Center (MCRC) for ads that can be reused or adapted at a much lower cost than 

creating new ads. The MCRC also includes a list of “Ads in Cycle,” which are currently on air and can 

be circulated without additional cost. Other paid media channels may be less expensive than TV, such 

as radio, print, and outdoors.5 Supplementing with other low-cost strategies, such as getting free news 

coverage and sharing campaign messages on social media helps extend the reach of paid media.1

To keep costs down, the communications team can also try the following strategies:

• Reduce pretesting costs by using existing tools and a small, representative sample of the 

intended audience.113

• Identify a smaller, well-defined audience and strategically place ads where audience members will 

see them.

• Ask for bonus ad placements when buying from TV and radio stations, magazines, or billboard 

companies.27

• Ask for nonprofit rates from media agencies.27

• Coordinate health communications with partners and local coalitions to extend the reach of 

campaign messages.

• Engage community partners (e.g., faith-based organizations and health care providers) who are 

connected to the intended audience.

• Work with partners to get needed expertise and resources, such as pretesting and evaluation tools, 

media buyer referrals, and lessons learned from their experiences with similar campaigns.27Reduce 

the number of goals, campaigns, or intended audiences to fit a program’s funding situation.1 

Taking Advantage of New Opportunities 

Capitalizing on new opportunities is important to 

keep campaigns fresh and new, but it can also prompt 

programs to take on activities that do not support 

communications objectives. Turning down these 

opportunities can be hard, especially when a partner 

offers to do much of the work or provide some of the 

resources. To decide if a new opportunity fits with 

campaign activities, the communications team can 

answer the following questions:67

• Does the new opportunity help solve the 

problem the campaign is trying to address?

• Does it help achieve communications objectives?

Health Communications l 47

HOW TO
• Does it help deliver campaign messages?

• Are enough resources available to implement it?

• Can it be implemented by current 

communications staff or partners?

• Can it be measured as part of the campaign 

evaluation?

Dealing with Unexpected Challenges 

Sometimes communications campaigns may 

experience unexpected problems. For instance, ads 

may not reach the intended audience, or audience 

members may not understand campaign messages.101

The communications team can start by talking with 

audience members to figure out exactly what the 

problem is and how to fix it.101 Other programs 

or coalitions that have experienced similar issues 

can also offer helpful advice. The Tobacco Control 

Network’s Help Your Peers discussion board can 

connect staff with other state programs.173

When a campaign encounters unexpected 

challenges or opposition, existing partners can 

be the communications team’s strongest allies. 

Communicating often with partners during campaigns 

will make sure they are aware of potential problems 

and are ready to help. Even when things are going 

smoothly, the communications team can keep partners 

engaged by sending them materials to share with 

their audiences, updating them regularly about the 

campaign, crediting their work in news releases, and 

involving them in campaign events.29

For more information on the topics covered in this 

section, visit the CDC Office on Smoking and Health’s 

State and Community Resources web page.63

Evaluating Health Communications

Evaluating health communications tells programs 

and partners if campaigns are going as planned and 

achieving goals.27 Evaluating campaign progress by 

tracking activities helps determine if messages are 

reaching the intended audience and how to improve 

the campaign. This is sometimes called process 

evaluation. It can salvage an ineffective campaign by 

allowing the communications team to quickly respond 

to failing strategies. Evaluating campaign outcomes 

helps programs determine if objectives were met.27

Communications staff can measure outcomes at different 

times throughout a campaign and look for changes in 

tobacco use knowledge, attitudes, and behaviors. 

To evaluate health communications, the communications 

team will collect different data about each media 

strategy. For instance, team members evaluate social 

media strategies by tracking followers and retweets. To 

evaluate the success of news coverage, they monitor the 

number of news stories about the campaign. Table 6 on 

page 50 includes sample measures for evaluating each 

health communications strategy. 

Planning for Evaluation

There is seldom enough funding to answer all possible 

questions about a communications campaign. The 

communications team can develop an evaluation plan 

that matches the size and budget of the campaign by 

focusing on key activities and information necessary to 

inform future campaigns. Partners, funders, decision 

makers, and community members can also help 

programs decide how to use evaluation resources. To 

help decide what questions to answer, it is important 

that stakeholders understand what results can be 

expected.73 Tobacco industry marketing, slow-tochange social norms, and the addictive nature of 

nicotine can limit the results of even the most wellplanned, comprehensive campaign.1,12 Learn more 

about evaluation planning in the CDC resource, 

Developing an Effective Evaluation Plan.

73

Health Communications l 48

HOW TO
Evaluating Paid Media

Evaluating paid media strategies helps protect a 

program’s investment. The communications team 

can assess the effectiveness of paid media strategies 

by tracking exposure to ads and changes in audience 

awareness and behavior. Exposure to paid media ads 

is measured by gross rating points (GRPs). Learn how 

to calculate GRPs on page 28. Questions about how 

well the audience remembers an ad or how closely 

they paid attention to an ad also measure exposure.174

Behavior change is measured by asking questions about 

actions such as calls to the quitline or encouraging a 

loved one to quit. 

Evaluating Earned Media

Earned media evaluation gathers information about how 

a campaign is reported in the news media. One way to 

track news coverage of the campaign is by creating a 

media activity record. It outlines which media channels 

and news outlets covered the campaign or tobacco 

control issue.175 It can also track the accuracy, slant, 

or bias of news stories.176 For example, the Wisconsin 

Tobacco Prevention and Control Program’s partners 

use an online activity tracker to report news coverage.132

They record which media outlets covered their activities, 

the earned media strategies used (e.g., letter to the 

editor), and when the stories were published.132 For an 

example media activity record, see the Tobacco Control 

Evaluation Center’s resources on Reviewing Media 

Activity & Policy Records.

176

Evaluating Social Media

Social media evaluation gathers information about 

how programs use social media platforms to engage 

audiences. The communications team can review 

demographic data, location, language, login frequency, 

and device profiles to learn about the audience they are 

reaching through social media and adjust strategies. 

Many measures can be observed in real time, allowing 

for adjustments during a campaign. Many social media 

platforms have their own tools and metrics for tracking 

use (e.g., Twitter Analytics and Facebook Insights). 

Tools like Google Analytics also help measure increased 

traffic to websites from social media channels.

Evaluating Program Communications

Evaluating program communications helps ensure 

that information reaches and is used by stakeholders. 

For example, programs can track the frequency of 

opened email messages and clicks on links to further 

action to assess stakeholder support. Programs can also 

monitor how visitors typically access their website and 

what content is most viewed through data collected 

by the website service provider or tools like Google 

Analytics.137,154 Tools such as ForeSee measure user 

experience through a survey on the website. This 

information can help tailor communications to be most 

useful to partners.

Sample Evaluation Questions

Health communications evaluation can 

answer questions about the progress and 

outcomes of campaign strategies:

Evaluating Progress

• Is the campaign reaching enough 

people?72

• How is the audience responding to 

messages?

• Are activities being executed as 

planned and on schedule?72

• Should any adjustments be made 

because of political, social, cultural, 

or scientific developments? 

Evaluating Outcomes

• Did knowledge, attitudes, or behaviors 

change as a result of the campaign?27

• Were new policies enacted as a result 

of the campaign?27

• Was the campaign cost effective?2

• Did any unintended consequences 

occur as a result of the campaign?72 

Health Communications l 49

HOW TO
Table 6. Sample Measures for Evaluating Health Communications

Evaluation Type Sample Measures

Measuring campaign 

progress 

Paid media (e.g., TV, radio, print, digital, and outdoor ads)

• Average number of ads run per week on each paid media channel 

• Number of times ads aired on each channel

• Number of local radio stations, magazines, and newspapers featuring ads 

• Number of Gross Ratings Points (GRPs) per ad

• Average number of Spanish ads run per week on Spanish-language channels 

Earned media (e.g., news stories)

• Number of news stories about tobacco control or the campaign

• Quality of news stories (e.g., timeliness of the story, accuracy of the content, and influence of 

the newspaper)

• Slant of media coverage (e.g., positive, negative, or neutral)

Social media (e.g., Facebook and Twitter)

• Number of referrals (i.e., clicks to social media sites from search engines, blogs, or other sites) 

• Audience reach (e.g., number of followers, fans, or sign-ups)

• Audience engagement (e.g., number of likes, shares, or comments)

Program communications (e.g., websites, newsletters, and fact sheets)

• Number of website visitors and number of visits

• Number of referrals (i.e., clicks to websites from search engines, blogs, or other sites)

• Time spent on a website by each visitor, measured in minutes and seconds

• “Bounce” rate (i.e., rate at which someone leaves a site after only viewing one page)

• Conversion rate (i.e., percentage of people who achieved a goal, such as filling out a form or 

opening an e-newsletter)

Measuring campaign 

outcomes

• Percentage of the intended audience that can accurately recall campaign message

• Extent to which audience members believe that campaign messages were convincing, made 

them think about their actions, or prompted discussion

• Increase in visits to cessation websites or calls to quitline 

• Adoption of policy

• Percentage decline in tobacco use rates

• Return on investment calculations (e.g., cost per smoker who quit, cost per quality-adjusted 

life years saved (QALY))

Sharing Results

Sharing evaluation results shows stakeholders the value 

of health communications, improves future campaigns, 

and helps secure resources. Effective evaluation reports:

• Explain how the evaluation was carried out2

• Report progress toward communications 

objectives2

• Describe changes that can be made to improve 

future campaigns2

• Discuss social, cultural, and political influences 

on communications outcomes2

• Include program success stories67

When frequent updates are communicated to 

stakeholders, they can share campaign successes and 

adapt campaign strategies. Findings can be shared in 

written reports, presentations, online, in news releases, 

and in success stories. Learn more about sharing 

evaluation results in the CDC resource, Developing an 

Effective Evaluation Report.

177

For more information on all of the topics covered in 

this section, visit the CDC Office on Smoking and 

Health’s State and Community Resources web page.63

Health Communications l 50

HOW TO
How Can Tobacco Control Programs Support 

Health Communications?

Effective health communications require coordinated efforts by state and community partners. Although 

communications campaigns may look different in each tobacco control program, programs can help support 

communications efforts by taking the following actions:

Administrative Support

8 Create a communications plan to guide how strategies will be implemented to achieve tobacco control program 

goals. 

8 Ensure enough funding is in place to conduct all campaign activities, including hiring the communications 

team, conducting audience research, developing and pretesting materials, and implementing the campaign. 

8 Train local partners in health communications strategies, such as writing letters to the editor or speaking with 

the media.

8 Evaluate campaign progress and outcomes and share results with partners.

Coordination & Collaboration

8 Seek input from members of the intended audience when planning campaigns, developing content, and 

pretesting materials. 

8 Reach out to local coalitions and partners with similar goals to coordinate efforts. 

8 Share campaign materials with local coalitions and partners so they can give feedback and help promote a 

campaign or deflect opposition.

8 Create an information-sharing network with local partners to share new scientific evidence and opportunities 

to promote campaign messages.

8 Educate decision makers on the importance of health communications.

Health Communications l 51

PROVIDING SUPPORT
Florida Case Study

Tobacco Free Florida uses social media to engage and connect with audiences.

State program uses social media to support hard-hitting ads

In 2010, the tobacco control program of the Florida 

Department of Health, Tobacco Free Florida (TFF), 

began airing a hard-hitting campaign about the 

devastating effects of tobacco use. During planning, the 

team agreed that they needed a positive counterpoint to 

the serious tone of campaign ads. They decided to use 

social media to complement the paid ads.

TFF’s first step was to define the role that social 

media would play in achieving overall campaign 

goals. The team decided that they wanted to focus 

on the positive health outcomes of quitting, raise 

brand awareness, and drive people to the program’s 

website.136 Led by former acting Bureau Chief Gregg 

Smith, the team began a well-funded Facebook and 

Twitter messaging campaign in 2013. The campaign 

offered useful resources and a supportive community 

to help Floridians quit. It featured original content 

posted in real time, frequent interaction with 

audience members, and close monitoring of campaign 

outcomes. On average, the campaign published 61 

Facebook posts and 220 tweets per month in 2013.152

To carry out this extensive effort, the communications 

team included tobacco control program staff and 

media professionals who developed materials, made 

media buys, and managed social media engagement. 

Tobacco Free Florida focuses on creating content to boost 

audience engagement

The primary focus of TFF’s social media strategy 

was on developing unique content to bring users to 

the program’s pages and keep them interested. The 

team planned social media content well in advance 

using a detailed calendar of scheduled posts. The 

schedule ensured that they posted original and relevant 

content every day to maintain high levels of audience 

engagement. Reusing the most successful content is a 

good strategy, but the team cautions that social media 

efforts work best when they include new content. To 

keep audiences engaged, they created posts related to 

upcoming health observances, holidays, and events; 

developed mini-campaigns on specific topics; and 

shared content from tobacco control partners.178

Along with these planned posts, the TFF team 

responded to news and trends by creating social media 

content in real time. Social media communications are 

unique because audience members not only interact 

with the program, but also communicate with one 

another. The team researched what conversations were 

trending and then created posts on those topics. 

TFF Facebook post about the fall season 

Relevant content tailored for specific audiences keeps the 

audience engaged

The campaign’s social media pages attracted a wide 

variety of individuals, including passionate tobacco 

control supporters, people interested in quitting, and 

people with family members or friends who were trying 

to quit. The team focused on creating content that was 

relevant to each of its multiple audiences. Ian Abrams, 

Health Communications l 52

CASE STUDIES
TFF’s media agency contractor, said, “Your audiences 

are all looking for different kinds of content, so 

balancing your community and interacting with them 

on an issue like tobacco control is pretty complicated. It 

really does require a deep understanding of the variety 

of audiences you are talking to.”

 “ 

Tobacco Free Florida interacts with followers to manage the 

online community

Implementing their social media strategy taught TFF that 

simply creating and posting content for each audience 

is not enough to keep them engaged with the campaign 

month after month. Keeping the different communities 

engaged took daily attention. The communications team 

encouraged followers to quit smoking, congratulated 

them on their successes, and responded to those looking 

for information with helpful resources. A supportive 

online community was important so that followers felt 

welcome and kept coming back. 

According to TFF, audiences do not naturally 

communicate on tobacco control program social media 

pages. Most conversations about tobacco use happen on 

other pages and sites. It is important to find people where 

they gather online and engage them there. Exploring 

social media pages where people discuss broader public 

health issues, such as groups about smoking-related 

illnesses, helped grow the campaign’s audience.

Tobacco Free Florida uses data analytics to assess social media 

impact and refine its strategy

The communications team continuously collected 

and analyzed information about its social media 

strategies. Team members used Facebook Page Insights 

and Twitter Analytics to look at a variety of metrics, 

including Facebook likes, comments, and shares 

and Twitter tweets and retweets. The team reviewed 

social media metrics monthly and adjusted campaign 

strategies to include more relevant content and expand 

the campaign’s reach. Lacoadia Burkes, TFF’s marketing 

manager, said, “Everything we do is backed by tobacco 

control best practices and social media analytics.” 

TFF’s close monitoring of the campaign worked: 

in 2013, Florida had the highest level of audience 

engagement on social media of any state health 

department, measured by likes, comments, shares, and 

retweets.152 The team continues to build on its success 

with new social media approaches. Team members 

focus on staying up to date on social media trends and 

best practices so that they are always creating new and 

relevant content.

Health Communications l 53

CASE STUDIES

“ Everything we do is backed by 

tobacco control best practices 

and social media analytics. ”

— Lacoadia Burkes
North Carolina Case Study

The North Carolina Tobacco Prevention Control Branch fights tobacco-related disparities by 

launching a digital communications campaign.

State program uses CDC funding to reach LGBT smokers

The North Carolina Tobacco Prevention Control 

Branch is always seeking ways to reach North 

Carolinians with tobacco control messages, but its 

very limited budget often requires creative, low-cost 

approaches to health communications. When the 

Branch learned that a small amount of CDC funding 

would be available for a communications campaign, 

they realized the funds could have a greater impact if 

they focused on a smaller, high-risk group rather than 

the general population. Knowing that the state’s LGBT 

population had a high smoking prevalence, program 

staff had already begun building relationships with this 

community. They also had data that showed that their 

typical health communications were not increasing 

quitline calls from LGBT smokers. They decided to use 

the CDC funding to focus on the LGBT population. In 

January 2015, the Branch launched a communications 

campaign to reach LGBT smokers using CDC’s existing 

Tips From Former Smokers® digital campaign ads.

Campaign reuses Tips From Former Smokers® ads focused on LGBT 

population

To plan the campaign, the Branch worked with the 

state health department’s media buyer. Together, they 

focused on reaching residents of urban areas who were 

interested in LGBT issues, smoking, entertainment, 

nightlife, or alternative lifestyles. They used two Tips®

ads featuring members of the LGBT population who 

were hurt by tobacco use. One ad featured Brian, a 

former smoker with HIV. The other ad featured Ellie, 

who suffers from asthma due to secondhand smoke 

exposure. The first campaign media buy included an 

equal mix of web-based banner ads and smartphone 

ads. Each ad was tagged with the state quitline number. 

“We did not have a lot to spend, but we knew we had 

these great assets—Tips®

 ads that were LGBT-specific. 

We had been looking for an opportunity to use the 

Brian and Ellie ads,” said Ann Staples, Director of 

Public Education and Communication.

 “ 

With a relatively small investment of $8,000, the twomonth campaign resulted in 1.75 million page views 

and 2,000 ad click-throughs to QuitlineNC.com.65

QuitlineNC online activity during the campaign 

increased by over 45% compared to the previous 

year.65 During the second month of the campaign 

alone, calls to the quitline from LGBT smokers 

increased by 7%.65 The ads that generated the highest 

volume of click-throughs were on websites such as 

Pandora, Hollywood Life, OK Cupid, Answers.com, 

and OpposingViews.com.65 Staples said that for the 

investment, the reach of the digital media strategy was 

far greater than the program could have achieved by 

running ads in North Carolina’s LGBT newspaper. 

Health Communications l 54

CASE STUDIES
The Branch placed Brian’s Tip and Ellie’s Tip digital ads from CDC’s “Tips®” campaign on mobile and desktop websites Source: CDC MCRC 

Close monitoring led program to shift strategies mid-campaign

A major advantage of using digital media channels 

was that campaign progress could be monitored daily. 

Halfway through the campaign, the media buyer alerted 

program staff that smartphone ads were outperforming 

web-based ads by nearly two-to-one. The team decided 

to stop web-based ads and shift all of the campaign 

resources toward smartphone ads. Staples said, “Mobile 

ads are really powerful. People are so connected to their 

phones, and they are more likely to click through on 

mobile ads.” 

 “ 

North Carolina’s low-cost strategy serves as model for other state 

tobacco control programs

The success of North Carolina’s digital ads shows that 

even with limited funding, programs can deliver effective 

health communications campaigns. Staples reports 

that they plan to use digital ads again, potentially with 

different audiences. She also cautions that while programs 

can pay to place ads on digital channels, it is important to 

continue using traditional media channels. Many people, 

including decision makers, still read news coverage, so 

writing letters to the editor and Op-Eds are important 

activities. Viral digital content is often first published by 

traditional media outlets like newspapers and magazines.

Health Communications l 55

CASE STUDIES
Why Invest in Health Communications?

Health communications are powerful tools to prevent tobacco use initiation, promote cessation, and shape social 

norms.1

 They reach large audiences to shape population-wide patterns of tobacco use and counter the tobacco 

industry’s extensive advertising and promotion efforts. Tobacco control programs and partners can use the 

information in this section to educate decision makers and other leaders about the important role that health 

communications play in a comprehensive tobacco control program.

History and Adoption

The first U.S. tobacco control communications 

campaigns aired on TV from 1967 to 1971, after 

the Federal Communications Commission required 

stations to devote free airtime to opposing views on 

topics of public interest.3

 These early ads showed the 

first evidence that campaigns can reduce cigarette 

consumption and led to the development of more 

campaigns, including the first statewide campaign in 

1986.5

 Since then, state and national communications 

campaigns have become widely used to reduce tobacco 

use and increase cessation.3,5,31

As the evidence for tobacco control communications 

continued to build, national reports encouraged their 

use. The National Cancer Institute’s 2008 Monograph 

19 and the 2012 Surgeon General’s Report, Preventing 

Tobacco Use Among Youth and Young Adults, concluded 

that communications campaigns reduce tobacco use 

among adults and prevent youth initiation.3,5

 The 2014 

Surgeon General’s Report, The Health Consequences 

of Smoking—50 Years of Progress and CDC’s Best 

Practices 2014 added new evidence for health 

communications.1,11 Communications campaigns 

are also included in the World Health Organization’s 

Framework Convention on Tobacco Control and Healthy 

People 2020, a set of national objectives for health 

promotion and disease prevention.21,22

Health communications have expanded in recent years 

to include websites, social media, and other digital 

media. Launched in 2012, CDC’s national tobacco 

education campaign, Tips From Former Smokers®

(Tips®), integrated digital ads, social media, and a 

website with traditional channels.23

Scientific Evidence

Strong evidence indicates that mass-reach health 

communications reduce tobacco use among youth and 

adults,3,4,5,6,7,8

 increase quit attempts,6,8 increase use of 

cessation services,1,4,5,7

 and prevent youth initiation1,4,5

when part of a comprehensive tobacco control 

program. They can also reduce the likelihood of relapse 

among people who quit.9

 California, New York, and 

Massachusetts, among others, have shown that statelevel communications campaigns are effective tobacco 

control strategies.6,17,31

Communications campaigns help achieve other 

important tobacco control goals, including changing 

attitudes toward tobacco use and raising awareness 

about the dangers of secondhand smoke.4

 For example, 

CDC’s first 12-week Tips® campaign in 2012 prompted 

6 million people to start talking about the risks of 

smoking and 4.5 million people to encourage family 

and friends to quit.24

Health Communications l 56

CASE FOR INVESTMENT
Cost 

Tobacco is the leading cause of preventable death and 

disease in the United States.11 Cigarette smoking alone 

resulted in approximately $175.9 billion in health 

care costs in 2013 and approximately $150.7 billion in 

annual productivity losses.11 Health communications 

have been a key strategy to reduce the high cost of 

tobacco use. For example, from 2000 to 2002, the 

national truth® campaign cost $324 million and saved 

$1.9 billion in health care costs.14 In 2012, CDC’s Tips®

campaign cost $48 million and prompted 100,000 

smokers to quit for good, which is estimated to have 

prevented over 17,000 premature deaths.15

Communications campaigns can have even greater 

returns on investment when they are part of a wellfunded comprehensive tobacco control program. A 

combination of strategies is more effective than any 

single strategy.5

 For example, California’s program 

combines state and community interventions with 

media campaigns and technical assistance. The 

program cost $2.4 billion over 10 years but saved $134 

billion in health care costs.1 Washington combined 

program, community, and media efforts and saved $5 

for every $1 spent.179

When communications funding is cut, progress toward 

tobacco control goals can be halted and downward 

trends in smoking rates can be reversed.32,180 For 

example, the 1998 Florida truth campaign reduced 

youth smoking by 35% in just three years.32 Funding 

cuts eventually caused the campaign to end, and by 

2006 smoking among youth had increased by 21%.32

Following a funding cut to the Minnesota tobacco 

control program that ended the Target Market

campaign, youth susceptibility to smoking increased by 

nearly 10% in just a few months.181

Health Communications l 57

CASE FOR INVESTMENT

Sustainability

Health communications help create lasting public health 

improvements by preventing tobacco use initiation and 

increasing cessation.11 Communications campaigns 

can also change social norms about tobacco use and 

secondhand smoke exposure.11 Changing social norms is 

the most effective way to sustain behavior change.1,11

Communications also strengthen other efforts of 

comprehensive tobacco control programs. They can 

increase awareness of other strategies, such as smokefree housing.11 Communications materials tagged 

with a quitline number or website also increase use 

of cessation services.4 Successful campaigns can be 

replicated by other communities.2

Health communications spread messages to a broad 

audience. Campaigns educate the public and decision 

makers about the harms of tobacco use and secondhand 

smoke. Coalition partners and community leaders who 

become involved in the campaign can extend the reach 

of these messages and increase their own commitment 

to sustaining efforts. Communications strategies can 

increase public support for strong tobacco control 

policies and programs and build momentum for longterm change.5,11 Effective campaigns also help make the 

case for continued support of tobacco control.
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Schiavo R. Health Communication: From Theory to 

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Manuals, Reports, and 

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• Building Relationships with People from 

Different Cultures

http://bit.ly/ctb_relationships

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This document was produced for the Centers for Disease Control and Prevention by the 

Center for Public Health Systems Science at the Brown School at Washington University 

in St. Louis.

Suggested citation:

Centers for Disease Control and Prevention. Best Practices User Guide: Health Communications in 

Tobacco Prevention and Control. Atlanta: U.S. Department of Health and Human Services, Centers 

for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health, 2018.

Ordering information:

To download or order copies of this report, go to www.cdc.gov/tobacco or to order single copies, 

call toll-free 1-800-CDC-INFO or 1-800-232-4636.

More information:

For more information about tobacco control and prevention, visit CDC’s Smoking & Tobacco Use 

website at www.cdc.gov/tobacco.