In a recent study, an area of the brain that initiates behavioral changes had greater activation in smokers who watched anti-smoking ads with strong arguments than ads with clever tricks like loud sounds and unexpected twists - and those smokers had significantly less nicotine metabolites in their urine when tested a month after viewing those ads.

In a study of 71 non-treatment-seeking smokers recruited from the Philadelphia area, the team led by Daniel D. Langleben, M.D., a psychiatrist in the Center for Studies of Addiction at Penn Medicine, identified key brain regions engaged in the processing of persuasive communications using fMRI, or functional magnetic resonance imaging. They found that a part of the brain involved in future behavioral changes—known as the dorsomedial prefrontal cortex (dMPFC)—had greater activation when smokers watched an anti-smoking ad with a strong argument versus a weak one. 

One month after subjects watched the ads, the researchers sampled smokers' urine cotinine levels (metabolite of nicotine) and found that those who watched the strong ads had significantly less cotinine in their urine compared to their baseline versus those who watched weaker ads. Even ads riddled with attention-grabbing tactics, the research suggests, are not effective at reducing tobacco intake unless their arguments are strong. However, ads with flashy editing and strong arguments, for example, produced better recognition.

 This is the first time research has shown an association between cognition and brain activity in response to content and format in televised ads and behavior, they say.

Debi Austin, the star of the most famous anti-tobacco commercial ever, passed away  in February of 2013. Her ad was shocking, and clever, but did it work?  Manufacturers have always been leery of clever, award-winning ads unless they, as car executives called it, "move the iron". A new paper says shocking anti-smoking ads are not the most effective.

"We investigated the two major dimensions of any piece of media, content and format, which are both important here," said Langleben. "If you give someone an unconvincing ad, it doesn't matter what format you do on top of that. You can make it sensational. But in terms of effectiveness, content is more important. You're better off adding in more sophisticated editing and other special effects only if it is persuasive."

Does this mean the end of shock ads and a move toward appeals to reason?  Don't bet on it. Political ads - and anti-smoking campaigns are big business these days - have not changed in 200 years.  

A 2009 study looked solely at format and found people were more likely to remember low-key, anti-smoking messages versus attention-grabbing messages. This was the first research to show that low-key versus attention-grabbing ads stimulated different patterns of activity, particularly in the frontal cortex and temporal cortex. But it did not address content strength or behavioral changes.

The new study is the first longitudinal investigation of the cognitive, behavioral, and neurophysical response to the content and format of televised anti-smoking ads, according to the authors. 

"This sets the stage for science-based evaluation and design of persuasive public health advertising," said Langleben. "An ad is only as strong as its central argument, which matters more than its audiovisual presentation. Future work should consider supplementing focus groups with more technology-heavy assessments, such as brain responses to these ads, in advance of even putting the ad together in its entirety."

Published in the Journal of Neuroscience.