[MUSIC UP AND UNDER] If you've been in New York recently, there’s a good chance you've seen or heard Marie from the Bronx. She’s on billboards, buses and TV commercials, showing where the fingers were amputated from her hand, as part of an anti-smoking campaign.

[CLIPS]:

MARIE: I've gotten this disease from smoking and I've had about, I'd say, between 17 and 20 amputations.

MARIE: I used to paint my own house.

MARIE: I can't hang up pictures.

MARIE: The light in my kitchen blew out and I can't change it.

MARIE: Because I have no fingertips, everything I do now I have to stop, and think, because just me banging my hand or something could cause me to lose my finger. That’s not living.

[END CLIPS]

BOB GARFIELD: It’s been a commonly-held belief among anti-smoking campaigners that ads must be tailored to specific cultural sensibilities, so it’s no surprise that the gruesome Marie ads were produced for hardened New Yorkers. It’s also a conventional wisdom that ads should, above all, emphasize the notion that smoking kills. But after tracking the response from a recent global ad campaign, Sandra Mullin, senior vice president for Communications for the World Lung Foundation, came to a slightly different conclusion. Mullin says her organization found that across cultures around the world, the most effective ads don't simply highlight death, but rather the pain and suffering that comes from smoking.

SANDRA MULLIN: Ads that include some of the awful consequences of smoking, including showing people dying slow and painful deaths from emphysema or lung cancer, or ads showing diseased body parts, such as the ones that have been shown in New York City, are the ones that have the most impact. And the gorier and harder hitting and more graphic, the better; they work on everybody.

BOB GARFIELD: I don't know what the incidence is of tobacco disease-related amputations, but my guess is that it’s quite small. I certainly have never encountered anyone in my 53 years who had been through that, which makes me think of, you know, hype in a good cause, overstatement that could have the effect of diminishing the credibility of the campaign. Got any thoughts on that?

SANDRA MULLIN: Indeed, this is using a particular individual with a particular consequence to really illuminate what the consequences were for her. The interesting thing is Marie is a real person, this is her real story. And it’s not easy to find people who want to step forward and tell their story. So even though some people might be turned off and might think it’s not credible enough, it certainly did the job.

BOB GARFIELD: Smoking is way down in the United States, compared to 20, and especially 40 years ago. I suppose the drop-off has been substantially less stark in the developing world. What is the landscape in Africa, China, India, Eastern Europe?

SANDRA MULLIN: Well, in China, about 70 percent of men smoke. That’s compared to a rate of less than 20 percent in New York City. And when you think about a population of over a billion people, that’s a tremendous, tremendous number. It’s one-third of the world’s smokers. Similarly, in India, about 30 percent of men smoke. And men really are the people that we're most concerned about. They are the ones who are going to be dying of these diseases or already dying of smoking-related diseases. So it’s rather grim. I think in Africa, in general the rates are lower, but climbing rapidly, given the direction of marketing by tobacco companies in Africa and other parts of the world where they're really ramping up their efforts to get people hooked.

BOB GARFIELD: Are there any results that have surprised you, ads that you wouldn't have expected to do well in a different context that, in fact, scored very highly, or vice versa, ads that you thought would have been powerful that just didn't seem to move the needle?

SANDRA MULLIN: Yeah, there are a couple of examples. There’s an ad called Artery that models an artery that a surgeon with gloves is sort of squeezing the innards out of, and it’s this gooky, yellowish, disgusting-looking stuff that’s coming out. And essentially the idea is that this is how your arteries are getting blocked when you smoke. That ad performed extremely well in China, where I think our belief before that was that in China people are more interested in metaphorical kinds of ads that take a much more softer approach to the anti-smoking message. In India, we message-tested Ronaldo which is an ad that worked very well in New York City - it’s also performed well in Mexico and the Philippines - and the ad is of a gentleman of Latino descent who speaks out of a hole in his throat because he developed throat cancer. And, for some reason, he didn't work as well in India. We thought he would. But I think people thought, well, he’s still alive, so maybe it’s not so bad. [LAUGHS]

BOB GARFIELD: You know, the most successful advertising campaign in the history of commerce is the Marlboro Cowboy. Maybe the second most successful advertising campaign [LAUGHS] is for De Beers Diamonds, “Diamonds Are Forever,” when 80 or 90 years ago the diamond cartel got the notion to tell the world that culturally the diamond is the proper way to celebrate an engagement or a wedding. I mention that because you’re doing something in China that is kind of the reverse of the “Diamonds Are Forever” campaign. Can you tell me about it?

SANDRA MULLIN: We tried to take on the whole cultural concept of giving cartons of fancy cigarettes as gifts during holiday seasons, whether spring festival or birthdays or weddings. And we, working with various partners on the ground, came up with a campaign that was called something like “Giving the Gifts of Cigarettes is Giving the Gift of Death.” And we did some visuals that showed people in body bags and people giving cartons of cigarettes, but then showing a disease impact on the person to whom the carton was given to. And I have to say that this was a trial balloon kind of campaign, and I didn't know what to expect, and the results were certainly better than we expected.

BOB GARFIELD: Sandy, thank you very much.

SANDRA MULLIN: Thank you.

BOB GARFIELD: Sandra Mullin is senior vice president of Communications for the World Lung Foundation.