Gains of stopping smoking: portraits of the dialogue between public health promotion, art and design.

Tobacco is a major public health issue. It is estimated that the annual deaths attributable to smoking are approximately 5 million and will double in 2025. Brazil has one of the highest smoking populations in the world (approximately 24 million adult smokers), thus representing an important public health concern. In 2008, we began a pragmatic intervention study aimed at promoting the use of a telephone counselling service for people wishing to stop smoking. The intervention used large (220 400 cm) posters placed at eye level on the central dividing columns of the boarding platforms of two subway stations in Rio de Janeiro, Brazil. We were keen to show not only the adverse effects of continuing to smoke (Photo 1), but also the gains that can be achieved by quitting smoking (Photo 2). The study specifically aimed to assess whether the profile of individuals calling the quit line differed by the two stimuli displayed at subway stations, i.e. ‘gains from quitting’ or ‘losses from continuing’ to smoke. The posters focused on ‘shortness of breath’ as a key symptom of continuing to smoke because this is something individuals are aware of and a symptom that can change over a shorttime frame. It is a symptom that affects younger and older smokers, as well as women and men, and would be potentially notable for subway users who have to ascent a lot of steps. The posters were designed with photos of real subway stairs in the background showing someone struggling to breathe on them or ascending without problems. The posters attracted the attention of our potential target audience (Photos 3 and 4). The school children were hopefully too young to be smoking and requiring a quit line (Photo 5), but these images may have informed them about the adverse consequences of starting to smoke.