Results of Myanmar’s 2018 second smokeless tobacco mass media campaign “avoid betel chewing so you don’t regret your life choices”

Introduction: In Myanmar, 18% of women and 59% of men age 15-49 chew tobacco. Its related death toll is higher than in other low-income countries. Objectives: The People’s Health Foundation Myanmar and Vital Strategies, a global public health organization, in close cooperation with the Ministry of Health and Sports, designed and implemented a mass media campaign consisting of 3 PSAs to discourage smokeless tobacco use in Myanmar. A post campaign evaluation survey was undertaken in 2018 to measure the campaign effectiveness in terms of increase in knowledge, attitudes, behavior and social norms about smokeless tobacco. Methods: Using multistage stratified probability sampling, 2,624 households were randomly contacted across six townships in Myanmar, out of which 678 respondents were found eligible (18-55 years) and consented for face-to-face interviews of approximately 45 minutes. The majority emerged as men (71%) and those from rural areas (67%). A large proportion (88%) were found as daily smokeless tobacco users. Results: Overall, 81% recalled any of the public service announcements (PSAs), either on TV, social media or radio when prompted. This proportion was higher in urban areas (89%). Around 70% correctly remembered the campaign’s message. The most impacted people were smokeless tobacco users, those who live in urban areas, men, and those in middle and older age groups. The PSAs were effective in terms of their capacity to raise awareness about harms of smokeless tobacco. Nine out of 10, who recalled the campaign, reported that the ads made them stop and think (86-93%). Similarly, 97% reported that ads were easy to understand; and 92% said that ads made them feel concerned about the effect of smokeless tobacco use on their health. Conclusion(s): As proven in Myanmar, adopting an evidence-based approach is critical to maximizing effectiveness of tobacco control mass media campaigns.