"This is your brain (an egg). This is drugs (a hot frying pan). This is your brain on drugs (one fried egg). Any questions?"
Actually, a group of researchers led by Melanie Wakefield, the director of the Center for Behavioral Research in Cancer at the Cancer Council Victoria in Australia, did have a questions. Namely, do mass media efforts such as the 1987 "Brain on Drugs" campaign launched by the Partnership for a Drug-Free America really work?
After reviewing the outcomes of hundreds of mass media campaigns worldwide aimed at a multitude of health-risk behaviors, their simple answer -- published in the medical journal Lancet in October -- was yes, they do. But some fare better than others.
The group found strong evidence that anti-smoking campaigns, which have been the most widely studied, were beneficial, especially when aired in combination with other tobacco control strategies such as tobacco taxation and smoke-free policies.
With the exception of campaigns to reduce drunken driving, however, alcohol and drug prevention efforts have had little effect, the researchers said.
"I was sobered, pardon the pun, by the fact that campaigns to improve unsafe drinking behaviors had been largely unsuccessful," said Wakefield, who chalks up the failures to lax alcohol marketing regulations that enable advertising that she says sends ambiguous messages.
"They're at once promoting alcohol use and then saying, 'Don't drink so much.' It's not a clear message."
Most media campaigns fell somewhere in between. The review found that messages aimed at improving nutrition, increasing up physical activity and voluntary cancer screening rates were moderately helpful.
Ken Wheaton, managing editor of the marketing and media analysis magazine Advertising Age, said he is skeptical of the study's results.
Wheaton doesn't deny that some ads may have an impact but said he believes their effects are tough to separate from the effects produced by economic incentives, which he says primarily explain the decrease in risky health-related behaviors over time.
"New York City has seen smoking go down but it could also be attributed to the fact that is costs 10 to 12 bucks for cigarettes and you can't smoke inside anymore," he said. "A sin tax which hits people in the pocketbook -- that's more likely to change behavior. Economics tend to nudge people along more than health issues."
The study's findings do support Wheaton's perception. The review found that the creation of policies that give people a legal or financial reason to change their unhealthy behavior provide additional motivation and discourage such behaviors. But Wakefield said that there is also an independent effect of mass media campaigns.
"The best studies in more recent periods have controlled for other policies that happened during the mass media campaign and have been able to identify the independent contribution of the campaign to reducing smoking prevalence and making people quit," she said.
The study also concluded that the likelihood a media campaign succeeds increases substantially when the target behavior is one-off -- like getting screened for breast cancer or vaccinated against disease -- rather than something that requires habitual maintenance, like diet or exercise.
Availability of products or services necessary to change behaviors, i.e. access to condoms for preventing spread of HIV, is similarly crucial to persuading people to act on the media messages.
For Robert Thompson, professor of popular culture at Syracuse University, the success of a PSA comes down to the level of sacrifice it requires of its viewers.
"A PSA campaign can be very good at making people do stuff that doesn't require that much of a sacrifice, like going and getting a colonoscopy, or a mammogram or waiting to get to your garbage can to throw away your litter," Thompson said. "It's much harder to get people to stop eating fatty foods."
One of the minds behind some of the most emotion-laden messages is Australian Paul Fishlock, whose Campaign Palace has won numerous advertising awards and produces some of the most spectacular tobacco control ads on display around the world, Wakefield says.
"These aren't commercials that people want to watch but they are commercials that smokers need to watch," said Fishlock, whose agency produced an anti-smoking ad called "Separation" that caused quite a stir when it was aired in New York.
But even Fishlock, who said he believes media health campaigns play a vital societal role, said he'd have to be arrogant to believe that they are the primary catalyst for spurring decreases in risky health behaviors. Instead, he said they operate under the radar, causing some direct and many indirect effects in their wake.
"I see some of our work in communication as providing unremitting background noise," he said. "I think if we took our foot off the accelerator a bit, if that noise wasn't out there and continually being refreshed, that the tide wouldn't be going out in quite the way that it is."
A look at the ads:
"This is Your Brain on Drugs"
This anti-drug PSA produced by the Partnership for a Drug Free America first hit airwaves in 1987. It has since become one of the most well-recognized mass media health campaign ads, evoking parodies and drawing the ire of comedians and musicians. The ad came in at No. 11 on TV Guide's 1999 Top 50 commercials.
"I've never in my life taken illegal drugs but if I would've seen that 'This is your brain on drugs' one more time, I was ready to go and score some cocaine just to spite the commercial. It was so irritatingly preachy and not effective, either. And of course, that isn't your brain when you take drugs, it doesn't fry like an egg." – Robert Thompson, professor of pop culture at Syracuse University.
"Throat Hole Guy"
In 2006, graphic ads featuring former smoker Rolando Martinez, who developed throat cancer at the age of 39, began airing in New York. In the spots, Martinez is seen poolside, in the shower and at local baseball fields, speaking through a hole in his throat with the aid of a microphone. The ads got plenty of ink on the popular advertising trade publication AdWeek's AdFreak blog, which mockingly dubbed Martinez as "Throat-Hole Guy" and bemoaned his ubiquity.
In 2008, Paul Fishlock's agency, the Campaign Palace, created an anti-smoking ad meant to illustrate the effect that smoking can have on the children of nicotine addicts. The ad depicts a young boy who is left by his mother at a busy train station. All alone and disturbed by the commotion, the boy beings to cry. The spot is meant to simulate what a child goes through when they lose a parent. When the ad aired in New York last year, it set off a firestorm of debate because some believed it went too far and asked whether the young boy had actually been traumatized by making the commercial.
Although anti-littering campaigns weren't explicitly reviewed in the Lancet study, this ad, which aired in 1971, is one of the most widely cited PSAs. It depicts a man, dressed in traditional American Indian garb, as he canoes down a river polluted with litter while dramatic music plays. As he pulls up on shore and steps up to a busy highway, a driver tosses a bag of garbage that lands at his feet and the camera zooms in on a single tear running down his cheek. The ad was shown throughout the 1970s and '80s, winning two Clio Awards and being named one of the top 100 advertising campaigns of the 20th century by Ad Age. The Crying Indian became an icon of the anti-littering, clean Earth movement and is sometimes credited with inspiring America's environmental movement.