Background on the Results of Myanmar’s 2018 Smokeless Tobacco Campaign and Future Recommendations


The People’s Health Foundation Myanmar and Vital Strategies, a global public health organization with communication expertise, in close cooperation with the Ministry of Health and Sports, designed, implemented and evaluated a mass media campaign to discourage smokeless tobacco use in Myanmar in 2018.  This campaign is a continuation of the successfully implemented 2017 mass media campaign “Avoid Betel Chewing So You Don’t Regret Your Life Choices.”


The main objective of this smokeless tobacco campaign was to generate positive changes in the behavior of current smokeless tobacco users, motivating quit attempts and preventing non-tobacco users from starting. A secondary objective was to raise awareness about smokeless tobacco use in Myanmar and its health harms, in order to reduce social acceptability. The campaign aired in October and November of 2018.The campaign comprised of three testimonial ads/public service announcements (PSAs) of 30 seconds each (two TV messages and one radio message), featuring real people suffering the health effects of using smokeless tobacco. The ads which were run for six weeks on television, social media, radio and posters.


A study was designed to measure the campaign recall and effectiveness of its message. In this study, the effectiveness of the ads was based on change in knowledge, attitudes and social norms towards smokeless tobacco (betel quid tobacco products), as well as support for policies, and some specific behaviors reported by smokeless tobacco users.

The evaluation survey was conducted by Quality Research Firm Myanmar from Nov. 25 to Dec. 16, immediately after the campaign. Using a method called multistage stratified probability sampling 2,624 households were contacted across six townships in Myanmar, out of which 678 respondents were found eligible and consented and participated in face-to-face interviews. Each interview took approximately 45 minutes. Respondents were between 18 and 55 years old. The majority were men (71%) and those from rural areas (67%). A large proportion emerged as daily smokeless tobacco users (88%).


81% of respondents overall and 89% in urban areas recalled any of the PSA (either on TV, social media or radio) when prompted. Seven out of 10 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.



PSAs were effective in terms of their capacity to raise awareness about harms of smokeless tobacco:

Among those who recalled the campaign, nine out of 10 reported that the ad made them stop and think (86-93%) which is a very important indicator that watching the ad/listening to the ad caught the person’s attention and engaged them in a process of considering the message.


Similarly, nine out of every 10 reported that ad was easy to understand (97%);


92% also reported that ad made them feel concerned about the effect of smokeless tobacco use on their health.


PSAs also had a significant impact on intentions to modify behavior:

Among those who recalled the campaign,

Five out of every 10

said they discussed the ad with others.

Eight out of every 10

said the ad made them more likely to quit smokeless tobacco.

Six out of every 10

said that due to the ad they made quit attempts, which shows the effectiveness of the ads regarding the behavior change.


Among those who recalled the campaign,


said smokeless tobacco use causes serious illness.


believe that smokeless tobacco use harms every vital body organ.


Agree that quitting smokeless tobacco will improve their health.


believe that smokeless tobacco use is harmful.


said people important to them believe they shouldn’t use smokeless tobacco.


believe tobacco advertising encourages young people to start tobacco use.


agree that tobacco industry spokespeople mislead the public when they say tobacco is not addictive.


Among those who recalled the campaign,


expressed interest in participating in tobacco control activities.


interested in signing a petition that supports tobacco control laws.


interested in joining a voluntary group participating in tobacco control activities. 


interested in participating in a march or demonstration supporting tobacco control.


The Importance of Television and Radio

Television was the most often mentioned source of information for this campaign, reflecting it as a media that can be prioritized for such future media campaign needs. MRTV & MRTV-4 for television and Myanma Ah Than for radio emerged as the most preferred channels, suggesting that these should be the first choice for attaining the coverage. Although having relatively low coverage, radio should also be used considering its reach in rural areas. The campaign on television and radio combined achieved a healthy gross rating points (GRP) count of 1881. One GRP, or rating point, stands for 1% of the TV watching/radio listening audience at a given time.  


State Channels and Government Buy-In

When there are limited budgets, state channels can play a crucial role in successful tobacco control campaigns. In this campaign, both state TV (MRTV) and radio (Myanma Ah Than) channels have been generously donating free broadcasting time which almost matched the money spent on the campaign.


The government buy-in (in time, commitment and hosting the launch at the Ministry) for the 2018 campaign was considerably higher than the campaign in 2017.

Efforts should continue to engage the Ministry of Health and Sports to play its role as fully as possible  during future campaigns.

Social Media

The campaign on Facebook (#StopBetelMyanmar) scored an average engagement of 11.38 percent. This is far above the Facebook overall average of 0.16 percent. Total reach through the campaign on Facebook was 5.1 million, registering a total of 1.1 million video views, making it a very worthwhile medium for the campaign. This reach is not only an indication that the online campaign was ran well and was a success, it is also an indication that the target audiences care about the subject matter. The latter was confirmed by the online interactions campaign staff had with Facebook-users.

Media Events

The two media events around the campaign drew a total of 57 journalists (25 Nay Pay Taw launch, 32 Yangon pre-launch press briefing) generating free publicity media value of USD 33,720.



The campaign to discourage smokeless tobacco use was highly successful. A total of 22,95 million people in the 18 – 55 year age bracket were reached during the campaign period. Among those who recalled the campaign, there was almost universal concern for the health effects of smokeless tobacco and many people reported attempting to quit as a result of the ads. A strong majority was also willing to participate in advocacy against smokeless tobacco.


Based on the evaluation findings, the researchers recommend Myanmar continue implementing nationwide media campaigns using state media channels in order to change attitudes and behavior, and to increasingly build advocacy support towards efforts to reduce smokeless tobacco use in Myanmar. 


Draft 4 April 2019/PHF