Apps and butts
If you're planning a visit to Kampong Glam, a shisha hot spot in Singapore's central region, don't be surprised if you receive an anti-smoking multimedia message on your phone.
From last month, people who come within a kilometre of the area, which has about 40 shisha cafes, will receive an 18-second video on their mobile phone, where a hip-looking man spells out the risk of shisha smoking.
Singapore's Health Promotion Board (HPB), which launched the programme with the city state's biggest mobile phone service provider, SingTel, is among a number of anti-tobacco groups to parlay the rise in phone connectivity and social media use into hard-hitting anti-smoking campaigns.
Such groups say they must counter the influence of tobacco companies, who are aggressively promoting their brands online due to the advertising restrictions and bans in developed countries.
Douglas Bettcher, director of Tobacco Free Initiative of the World Health Organisation, says the bans have made the tobacco industry 'more desperate'. Digital marking provides an ideal platform, as it's tough to police, reaches out to a wide audience, and costs little or nothing to use. Facebook, for example, has 845 million users globally - and tobacco companies are quick to take advantage of this and other social media outlets.
British American Tobacco has 1,400 employees on Facebook, says Becky Freeman, research officer with the University of Sydney's School of Public Health. These employees join groups and post comments and images of hip youngsters smoking in pubs.
'You may think that people have freedom of speech and we shouldn't stop people from saying online which brands of cigarettes they enjoy smoking. But it's another matter when employees of the tobacco companies are doing the same online,' says Freeman. 'Such promoting of tobacco products online violates advertising bans. People take advantage of the fact that social media is just too huge for effective monitoring.'
Says Bettcher: 'The monitoring and countering of the industry's use of new media must become an essential element of tobacco control.'
Twitter, with 140 million users, is another hot spot for tobacco aficionados, says Freeman. 'Word-of-mouth marketing can be powerful, especially if you have a flair for writing and can write with panache online. In spite of its 140 word limit, tweets and retweets can make posts on tobacco-related stuff go viral.'
According to the new edition of Tobacco Atlas, which looks at key indicators of the tobacco industry such as cigarette consumption and production, 163 tobacco brand-related videos were found on YouTube in 2010, with one pro-smoking music video being viewed more than two million times.
Health advocates are fighting fire with fire. New media is ideal for not only spreading messages about health warnings, but also boosting cessation work, says Sandra Mullin, senior vice-president in policy and communications with the World Lung Foundation.
In the developing world there are 67 mobile subscriptions for every 100 people. 'SMS cessation programmes can be launched in places where subscribers get quit tips through text messages,' says Mullin.
Michele Ybarra, developer of SMS Turkey for smokers in the country's capital city, Ankara, says text messages could help strengthen the resolve to quit.
'Messages start two weeks before quit day. If a user has a relapse and has a cigarette in the last 24 hours, we send them different messages concerning relapse aimed at helping them recommit to quitting.'
Singapore, too, has recently launched a smoking cessation app which has a hotline embedded to help users deal with urges. 'The exciting part of the app is that you are in constant communication with the people you love who will give you reply and encouragement,' says HPB chief executive Ang Hak Seng.
Last year, Hong Kong's Tobacco Control Office launched an iPhone app for quitting and has had 12,000 downloads to date, says a spokesman from the office. An Android version will be available this year. The app helps smokers understand the hazards of tobacco, introduces quitting aids and offers tips to cope with withdrawal symptoms. It also keeps track of the quitting progress and issues regular reminders according to the user's smoking habit.
It's the latest move in a slew of initiatives that highlight the office's recognition of the importance of new media in communicating health issues to the public. In 2009, an Online Cessation Centre was launched to help smokers measure nicotine dependence and track daily quitting progress. That same year, a Facebook page was started by the office's partner in tobacco control, Tung Wah Group of Hospitals' Integrated Centre on Smoking Cessation, to facilitate information exchange among quitters.
Social media campaigns, however, can be hit and miss. Stephen Hamill, associate director in communications and advocacy with the World Lung Foundation, says they've learned to fine-tune their campaigns after misfires that failed to attain viral growth online.
For the 2009 World No Tobacco Day, the theme was the support of graphic health warnings on cigarette packs; for example, a Facebook app was developed where users could make personalised health pack warnings and post them on their personal or friends' walls. 'We wanted to spread messages on the harm of tobacco in an in-your-face way,' says Hamill.
Initially, the campaign was a success with more than 200 pictures created. But it flatlined after a week, with few new users and existing users falling off. Feedback showed that people felt uncomfortable about sharing gross pictures. 'You can have a conversation about tobacco harm with your spouse, but no one wants to offend their smoking friends and bosses.'
Greater success was met with a Facebook smoke-free campaign in 2010 to dovetail with the Egyptian government's move to make Alexandria the first smoke-free city in Egypt. The campaign was launched during Ramadan, when the cost of airtime on television and radio is double or triple normal rates. With a budget of only US$5,000, an online local advertising agency was hired to start a Facebook page. A moderator posted a few times each day and responded to user posts. Non-smokers were encouraged to speak up for Alexandria's smoking ban in public places to put pressure on the 'reluctant government to provide better enforcement', says Hamill.
More than 7,000 people joined the group. 'We wanted to create a perception to the media and policy makers that the smoke-free law is popular with the public.'