The finding that campaigns can be recalled suggests appropriate media channels, targeting strategies, durations and intensities have been utilized to reach target audiences. These campaign characteristics were not always reported by studies so it is not possible to draw a link between types of campaign strategies and levels of recall or exposure. Recall of tobacco mass media campaigns has been shown to be positively associated with smoking cessation (Jepson et al., 2007) so the outcome may be an important first step towards subsequent behaviour change in populations.
Most campaigns that aimed to improve knowledge were shown to be effective. This was particularly evident in areas where knowledge was initially low, for example, knowledge of unit consumption guidelines and of the link between alcohol and cancer. Mass media can yield sustained knowledge, which may lay the groundwork for reductions in consumption that are achieved using other public health measures.
There was evidence of increases in information seeking and treatment seeking. However, alcohol campaigns have not presented the simple call to action of tobacco messages (‘quit’) or provided offers of tangible help such as ‘quitlines’. Furthermore, as alcohol support services have historically been aimed at very heavy drinkers there may be a perception that current services do not cater for those who drink less. Mass media might therefore have limited utility in promoting service uptake.
Most studies found no impact on alcohol consumption, consistent with the conclusion of a previous review that there should be modest expectations of behaviour change from such campaigns (Snyder et al., 2004). Longer term evaluations conducted following sustained and repeated exposure to campaigns might be expected to be better able to detect effects on behaviour. However, the relationship between tobacco mass media campaign duration and effectiveness has been difficult to gauge due to confounding influences and trends over time (Durkin et al., 2012). The context in which alcohol health promotion campaigns operate is particularly challenging because of the ubiquity and power of alcohol marketing (de Bruijn et al., 2016) and pro-alcohol cultural norms (Gordon et al., 2012). This is another key difference to tobacco, where health campaigns in recent years have run in a context where most tobacco marketing has been banned or strictly regulated and social norms have become increasingly anti-smoking. The current review found evidence of impact on short term intermediate outcomes, suggesting mass media can play a supportive role for other actions which are more likely to have an impact on behaviour. These might include price-based measures (Babor et al., 2010), advertising restrictions (Siegfried et al., 2014), limiting availability and access to alcohol (Anderson et al., 2009) with the targeting of high risk groups (Foxcroft et al., 2015).