Anti-smoking Messages Research Articles

A Qualitative Evaluation of Tobacco Consumption in the Rural Context

Objectives: Understanding what rural adult tobacco users think about tobacco use, tobacco control policies and health may help create acceptable policies and interventions. Methods: We completed 8 focus groups in rural Michigan from winter 2016 through summer 2018. Interviews were transcribed and an iterative thematic analysis was completed during fall 2018. Results: Although our primary themes of Independence, Respect, Social Context, Economic Calculus, and Policy with an underlying theme of health were similar to themes that typically arise in tobacco control research, their application and social context appear to be unique in rural communities. Issues of respect for tobacco users, and well as third-party individuals affected by tobacco use, were paramount for participants. They viewed tobacco use as an individual choice and not a structural or policy-relevant issue, although they accepted restrictions on tobacco use in most settings where non-smokers are present. Conclusions: Participants understood that smoking is problematic and seem to be open to anti-smoking messaging and policies when correctly framed. Participants blame themselves for their smoking (ignoring industry responsibility) and used language that can be found in tobacco marketing. Framing tobacco control as a way to protect children while respecting smokers as people may be successful.

Incremental criterion validity of message perceptions and effects perceptions in the context of anti-smoking messages.

To select promising health messages, formative research has often relied on perceived message effectiveness (PME) scales assessing either of two related constructs, message perceptions (persuasive potential) and effects perceptions (potential for behavioral impact). We sought to examine their incremental criterion validity within a comparative framework. Participants were 703 U.S. adult smokers (ages [Formula: see text] 21) who received anti-smoking or comparable control (littering) messages on their cigarette packs for 3weeks. Structural equation models examined both PME constructs as simultaneous correlates of outcomes from the UNC Tobacco Warnings Model. Message perceptions demonstrated incremental criterion validity with attention, an early behavioral antecedent ([Formula: see text] = 0.82, p < .001). Effects perceptions demonstrated incremental criterion validity with later behavioral antecedents (range [Formula: see text] = 0.74-0.87, all p < .01) and quitting behaviors ([Formula: see text] = 0.36-0.66, all p < .001). Formative research on anti-smoking messages may benefit from focusing on effects perceptions to characterize potential for behavior change.

Effects of positive-negative antismoking messages to quit smoking among male college students: A randomized field study.

Based on the main concept of reasoned action theory, this study aimed to examine which of the attitude and subjective norms affect the intention of smoking cessation by using four types of antismoking messages: (1) positively and( 2) negatively stimulating one's attitude toward smoking cessation; and (3) positively and (4) negatively reflected subjective norms for second-hand smoking. We conducted a randomized field study in smoking areas in universities located in D city of South Korea. Two hundred and eighty-seven male students who smoke daily were recruited in the field and randomly divided into four experimental groups and one control group. The participants in each experimental group were asked to read attitude/positive, attitude/negative, norm/positive, and norm/negative message. The data of attitude, subjective norm, and intention to stop smoking were collected. There were significant differences in the intention to quit smoking in attitude/negative messages (F = 4.311, p = .015) and norm/positive messages (F = 4.353, p = .014). The effects of subjective norm were greater than those of attitude (p < .001). Emphasizing the positive subjective norm for smoking cessation among young smokers might be effective in persuading them to quit smoking.

The Effect of Temporal Frames in Anti-Smoking Messages on the Extension of Anti-Smoking Arguments to Smokers

The present study focused on how exposure to different health message characteristics can affect extension–i.e., the sharing of arguments that were not targeted by the messages but are consistent with the message theme. In the context of anti-smoking campaigns, many messages have either emphasized reasons to quit smoking (why-quit) or ways to quit smoking (how-to-quit). Therefore, guided by construal level theory, the study aimed to examine whether the message characteristic of temporal frames can increase or decrease extension when incorporated into why-quit and how-to-quit anti-smoking messages. Results from a randomized experiment showed that exposure to why-quit messages with distant temporal frames increased extension (vs. no-message control) while why-quit messages with proximal temporal frames did not. Findings further illustrated a potential mechanism, where why-quit messages with proximal frames significantly reduced extension compared to why-quit messages with no temporal frames. Temporal frames did not have a significant effect on extension for how-to-quit messages. Results indicate that emphasizing the present in anti-smoking messages could be detrimental for the extension of why-quit arguments. Implications for applying construal level theory to health message effects research are also discussed.

The role of social norms in the relationship between anti-smoking advertising campaigns and smoking cessation: a scoping review.

A systematic scoping review of anti-smoking mass media campaign literature provided opportunity to explore how social normative theories and constructs are used to influence smoking cessation. Synthesis of findings was constrained by significant heterogeneity. Nevertheless, the results indicate that a broader conceptualization of social norm is worthy of further exploration. Perceptions of what others think and do contributed in multiple ways to the relationship between anti-smoking messaging and quitting outcomes. Furthermore, integrating research on social norms, social identity and communication may improve understanding of why quitting intentions are enhanced in some circumstances but reactance and counter-arguing responses corresponding to lower quitting intentions occur in others. Integrating a broader theoretical understanding of normative influences into campaign development and evaluation may prove useful in demonstrating the effectiveness of this approach in behaviour change campaigns.

An assessment of factors associated with shisha smoking among students at Evelyn Hone College, Lusaka, Zambia

Background: Shisha smoking in Zambia, referring to the way of smoking tobacco in which the vapor passes through water before inhalation, is seen as a new practice, especially among youths of 18 to 25 age group. Factors associated with this practice have not yet been established. This study aimed at assessing the factors associated with shisha smoking among students at Evelyn Hone College.Methods: A cross-sectional study was conducted on 347 Evelyn Hone College students selected using convenience sampling method. Data collection was by pre-tested semi-structured questionnaires. Chi-squared statistical tests were used to determine the association between the independent variables, which were demographic, social, environmental, cultural and personal factors, and the dependent variable being shisha smoking using SPSS version 18.Results: The study revealed that shisha smoking was significantly associated with age of the smoker, level of income, peer pressure and knowledge levels of the smokers on adverse effects associated with shisha smoking. These relationships were determined by the logistical regression output which showed that age [OR=1.802 (1.152-2.818), p&lt;0.05)], friends smoke cigarette/shisha [(OR=4.417 (1.760-11.086), p&lt;0.05)], monthly allowance/income [(OR=0.663 (0.456-0.965), p&lt;0.05)] and perceived risk [(OR=0.084 (0.046-0.154), p&lt;0.05)] which all showed significant association with shisha smoking.Conclusions: Interventions to reduce or quit shisha smoking among students need to have extended policies that apply to cigarette smoking. Additionally, health education campaigns against shisha smoking should as well be packaged in the anti-smoking messages targeting the youths.

Networked collective intelligence improves dissemination of scientific information regarding smoking risks.

Despite substantial investments in public health campaigns, misunderstanding of health-related scientific information is pervasive. This is especially true in the case of tobacco use, where smokers have been found to systematically misperceive scientific information about the negative health effects of smoking, in some cases leading smokers to increase their pro-smoking bias. Here, we extend recent work on ‘networked collective intelligence’ by testing the hypothesis that allowing smokers and nonsmokers to collaboratively evaluate anti-smoking advertisements in online social networks can improve their ability to accurately assess the negative health effects of tobacco use. Using Amazon’s Mechanical Turk, we conducted an online experiment where smokers and nonsmokers (N = 1600) were exposed to anti-smoking advertisements and asked to estimate the negative health effects of tobacco use, either on their own or in the presence of peer influence in a social network. Contrary to popular predictions, we find that both smokers and nonsmokers were surprisingly inaccurate at interpreting anti-smoking messages, and their errors persisted if they continued to interpret these messages on their own. However, smokers and nonsmokers significantly improved in their ability to accurately interpret anti-smoking messages by sharing their opinions in structured online social networks. Specifically, subjects in social networks reduced the error of their risk estimates by over 10 times more than subjects who revised solely based on individual reflection (p < 0.001, 10 experimental trials in total). These results suggest that social media networks may be used to activate social learning that improves the public’s ability to accurately interpret vital public health information.

Deliberation and Valence as Dissociable Components of Counterarguing among Smokers: Evidence from Neuroimaging and Quantitative Linguistic Analysis

ABSTRACT Counterarguing is a key obstacle to successful persuasion. However, the difficulty of directly measuring counterarguing during message exposure limits knowledge of the underlying mechanisms. The current study combines neuroimaging and linguistic measures to unpack neurocognitive and psychological mechanisms associated with counterarguing among a sample of established smokers in response to anti-smoking messaging. We capture participants’ neural activity in brain regions associated with effortful deliberation and negative argumentation during message exposure, and link it with their subsequent language patterns to further understanding of counterarguing in the brain. Greater brain activity within key regions of interest associated with deliberation and negative argumentation is associated with greater cognitive depth and less positivity in the post-scan message descriptions, respectively, among those who have lower intention to change their smoking behavior. We connect these neural representations of counterarguing with psychological theories and discuss implications that may increase the impact of persuasive communications.

The Effects of Self-Stigma in Anti-Smoking Message Among South Korean Smokers

The Effects of Self-Stigma in Anti-Smoking Message Among South Korean Smokers

Message-Elicited Brain Response Moderates the Relationship Between Opportunities for Exposure to Anti-Smoking Messages and Message Recall

Campaign success is contingent on adequate exposure; however, exposure opportunities (e.g., ad reach/frequency) are imperfect predictors of message recall. We hypothesized that the exposure-recall relationship would be contingent on message processing. We tested moderation hypotheses using 3 data sets pertinent to "The Real Cost" anti-smoking campaign: past 30-day ad recall from a rolling national survey of adolescents aged 13-17 (n = 5,110); ad-specific target rating points (TRPs), measuring ad reach and frequency; and ad-elicited response in brain regions implicated in social processing and memory encoding, from a separate adolescent sample aged 14-17 (n = 40). Average ad-level brain activation in these regions moderates the relationship between national TRPs and large-scale recall (p < .001), such that the positive exposure-recall relationship is more strongly observed for ads that elicit high levels of social processing and memory encoding in the brain. Findings advance communication theory by demonstrating conditional exposure effects, contingent on social and memory processes in the brain.

The influence and interaction of exposure to pro-smoking and anti-smoking messaging on youth smoking behaviour and susceptibility.

INTRODUCTIONExposure to tobacco-related information is an important factor in youth smoking initiation. This study aims to explore the relationship between exposure to pro-smoking and anti-smoking media and adolescents’ current smoking status and susceptibility to smoking, as well as the interaction between exposure to pro-smoking and anti-smoking media information.METHODSThis cross-sectional study was conducted in 2017. We recruited 12278 students from junior, senior and vocational high schools located in Shanghai, China. The exposure of participants to tobacco promotional and control messages over the past 30 days was examined, as well as current smoking and susceptibility to never smokers’ initiation. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using complex samples procedure logistic regression, adjusting for related covariables.RESULTSThere were 89.3% and 91.5% of adolescents exposed to tobacco pro-smoking and anti-smoking messages. Exposure was more prevalent among males, suburb school and vocational school students. Exposure to pro-tobacco and antitobacco messages, separately, increased and decreased the risk of current smoking and susceptibility to never-smokers’ smoking, respectively, especially among males and junior high school students. Risk was associated with the exposure level (p-trend<0.001). Tobacco control messaging was found to mitigate the influences of tobacco promotion on the risk of both current smoking (AOR=0.64; 95% CI: 0.41–0.99) and susceptibility to smoking (AOR=0.65; 95% CI: 0.46–0.93).CONCLUSIONSExposure to tobacco-related messages was highly prevalent and associated with youth smoking and susceptibility to smoking. It is therefore important to enhance the comprehensiveness and enforcement of promotion bans. Given that tobacco control information can counter the impact of tobacco promotion information on smoking risk, the publicity and dissemination of tobacco control information should be consistently strengthened.

Smoker identity and resistance to antismoking campaigns: The role of group entitativity

Past works have shown that identification with smokers predicts increased resistance to antismoking campaigns. In this research, we hypothesized that group entitativity, because it affects the extent to which people feel committed to act for their group, can mitigate this link. We conducted two studies with convenient samples of smokers that both included a measure of identification and measured (Study 1) or manipulated (Study 2) entitativity. Then, participants read an antismoking message and, finally, reported their attitude toward smoking (Studies 1 and 2), as well as their urge to smoke and intention to quit (Study 2). Consistently, both studies revealed more resistance among high (vs. low) identifiers, but only when they perceived smokers as a highly entitative group. These findings emphasized the importance of group processes and social identity factors for accounting for responses to antismoking information.

An Eye Tracking Study of Anti-Smoking Messages on Toxic Chemicals in Cigarettes

The US Food and Drug Administration is tasked with communicating information to the public about the harmful chemicals in cigarette smoke. Our study used eye tracking method to test the effectiveness of messages about the harmful chemicals in cigarettes smoke among adult smokers. A sample size of 211 current cigarette smokers viewed four communication messages that included: Health effects of a chemical in cigarette smoke and an image depicting the health effect. The messages focused on arsenic, formaldehyde, uranium, and general health. Eye tracking recorded the length of time participants viewed the text and the image. After each message, the participants were asked about the messages’ effectiveness in changing attitudes towards smoking. We analyzed the data using multilevel modeling, and of the 211 smokers, 59.7% were female, 36.5% were Black, and 21.3% had a high school degree or less. Compared to the general message, the messages about formaldehyde and uranium were more discouraging to smoking (p < 0.05). Messages about formaldehyde were more believable and made participants want to quit more than the general messages. Increasing message dose was significantly associated with discouraging participants from smoking and made participants want to quit (p < 0.05). Our findings suggest that anti-smoking messages, containing chemical information, can successfully increase negative attitudes toward smoking cigarettes and potentially encourage quitting.

Adolescent Attention to Disgust Visuals in Cigarette Graphic Warning Labels

PurposeAdolescents are often a target audience for disgust-eliciting antismoking messages, including graphic warning labels (GWLs) on cigarette packages. Yet, few studies have examined how adolescents attend and respond to disgust imagery frequently depicted in these messages. MethodsA within-subjects eye-tracking experiment with middle school youth (N = 436) examined attention for GWLs that feature disgust versus nondisgust images. Hypotheses were based on emotion theory and previous findings with adult participants. This study also tested whether living with a smoker moderated effects of attention on negative emotions and risk beliefs. ResultsParticipants paid similar levels of attention to warnings with disgust visuals as they did warnings with nondisgust visuals, accounting for other differences in the warnings. The presence of a disgust visual drew greater attention to the warning image and reduced attention for the warning text. These viewing patterns were similar for youth who live with a smoker and those who do not. Attention to disgust imagery was the only attentional factor to predict negative emotional reactions, and this relationship was driven by results observed among youth who live with a smoker. Attention to neither image nor text predicted risk beliefs. ConclusionsGWLs with disgust imagery do not trigger more or less attention to the overall warnings but do influence allocation of attention to images over text. Future work should confirm whether attention to disgust imagery itself is important for triggering negative emotional responses, particularly with youth for whom the message is more personally relevant.

An Efficient Message Evaluation Protocol: Two Empirical Analyses on Positional Effects and Optimal Sample Size

Reliable and valid message evaluation has a central role in effective health communication and message effects research. The authors have employed a message testing protocol to efficiently acquire valid and reliable message evaluation results: (a) use multiple messages, (b) recruit evaluators from the target population, (c) use valid and reliable effectiveness measures, (d) expose an evaluator to multiple messages, and (e) ensure enough evaluations per message. Two secondary analyses of anti-tobacco message evaluation studies provide evidence for reliability and validity regarding points (d) and (e). Seven studies where adult smokers evaluated the effectiveness of various anti-smoking campaign messages were examined. The first analysis shows that the position in which a message appears has little or no impact on its evaluation, supporting the validity of multiple-exposure design. The second analysis suggests having 25 evaluations per message can achieve a fair balance between accuracy and efficiency.

Messaging and Advocacy in U.S. Tobacco Control Policy, 2009–19

Social science and public health researchers have spent decades investigating the effectiveness of various interventions designed to lower smoking rates and educate the U.S. public about the damages of tobacco consumption. This manuscript addresses two deficiencies in the existing literature. First, it examines important changes in tobacco control policy since the passage of the 2009 Family Smoking Prevention and Tobacco Control Act, the most significant antismoking legislation in decades. Second, it analyzes the ways in which governmental and nongovernmental anti‐tobacco advocates have framed their arguments. Using a seminal article by Donley Studlar (2008) as its point of departure, this paper employs data from annual reports, press releases, and advertising campaigns to explore the similarities and differences in the antismoking strategies and messaging of two government agencies (the Food and Drug Administration and the Centers for Disease Control and Prevention) and two advocacy groups (the Truth Initiative and the Campaign for Tobacco‐Free Kids) from 2009 to 2019. The analysis reveals an ongoing tension between themes of industry denormalization (which generates arguments grounded in morality) and harm reduction (which generates a more regulatory approach to policymaking) in modern tobacco control policy.

Self-Affirmation Moderates Self-Congruency Effect in Health Messaging

ABSTRACT Previous research found that health risk messages framed to be congruent with people’s independent or interdependent self-construal were not consistently more effective than incongruent messages. We argue that people potentially process the self-construal congruent health risk messages in a biased manner. To test this proposition, we examined the role of self-affirmation, which is expected to reduce defensive processing, in college nonsmokers’ responses to an antismoking message congruent vs. incongruent with their dominant self-construals. Results from an online experiment suggested that self-affirmation moderated the self-congruency effect. Specifically, among college nonsmokers endorsing a dominant interdependent self-construal, self-congruency effect emerged only when the group was engaged in self-affirmation. Among college nonsmokers endorsing a dominant independent self-construal, with no prior affirmation, the group reported self-incongruent messages better than the self-congruent messages. After being engaged in self-affirmation, the group reported similar effects for self-congruent and self-incongruent messages. Theoretical and practical implications of our findings are discussed.

Dimensions and validation of the print perceived message sensation value scale (PPMSV)

Two studies establish reliability and validity of the print perceived message sensation value scale (PPMSV). For study one, 397 participants responded to a single high- and a single low-sensation value anti-smoking message. In study two, 284 participants responded to a single high- and a single low-sensation value anti-crystal meth message. Results of an exploratory factor analysis and confirmatory factor analysis suggest that the PMSV of a print message can be assessed using a 12-item three-dimensional scale, making an important contribution to the literature as no similar measures existed for print messages prior to the PPMSV. The newly developed PPMSV scale remained stable across sensation seeking levels and two sets of anti-drug messages (anti-tobacco & crystal meth). Results provided support for convergent, divergent, and predictive validity of the scale and point to PMSV as an important element that contributes to perceived message effectiveness and attitude toward the print ad.

Understanding further education as a context for public health intervention: qualitative findings from a study process evaluation.

BackgroundOver 1.2 million 16–18 year-olds are enrolled in further education (FE—advanced secondary education) in England. Life course transitions provide opportunities to change, establish or reinforce health behaviours. FE presents an opportunity for public health improvement, yet few interventions target this setting. Using a smoking prevention intervention, we explore how young people were viewed in FE and how this affected intervention acceptability.MethodsEleven student and five staff focus groups were conducted in three intervention institutions (two colleges, one school sixth-form), as part of the process evaluation of a smoking prevention feasibility study. FE managers in intervention and control institutions were also interviewed (n = 5). Data were analysed using thematic analysis.ResultsIn both colleges and the sixth-form, students were viewed as emergent adults and treated differently from ‘school-children’, in practice if not in policy. Colleges permitted smoking in designated areas; in the school sixth-form smoking was unofficially tolerated but concealed from younger students. Using staff to deliver anti-smoking messages reintroduced an unwanted power dynamic which disrupted perceptions of students as young adults.ConclusionsFE is an important setting for young people’s health. Understanding the culture and context of FE is critical in designing acceptable and effective public health interventions.

Effectiveness and cost-effectiveness of repeated implementation intention formation on adolescent smoking initiation: A cluster randomized controlled trial.

Objective: Forming implementation intentions (if–then plans) about how to refuse cigarette offers plus antismoking messages was tested for reducing adolescent smoking. Method: Cluster randomized controlled trial with schools randomized (1:1) to receive implementation intention intervention and messages targeting not smoking (intervention) or completing homework (control). Adolescents (11–12 years at baseline) formed implementation intentions and read messages on 8 occasions over 4 years meaning masking treatment allocation was not possible. Outcomes were: follow-up (48 months) ever smoking, any smoking in last 30 days, regular smoking, and breath carbon monoxide levels. Analyses excluded baseline ever smokers, controlled for clustering by schools and examined effects of controlling for demographic variables. Economic evaluation (incremental cost effectiveness ratio; ICER) was conducted. Trial is registered (ISRCTN27596806). Results: Schools were randomly allocated (September–October 2012) to intervention (n = 25) or control (n = 23). At follow-up, among 6,155 baseline never smokers from 45 retained schools, ever smoking was significantly lower (RR = 0.83, 95% CI [0.71, 0.97], p = .016) in intervention (29.3%) compared with control (35.8%) and remained so controlling for demographics. Similar patterns observed for any smoking in last 30 days. Less consistent effects were observed for regular smoking and breath carbon monoxide levels. Economic analysis yielded an ICER of $134 per ever smoker avoided at age 15–16 years. Conclusions: This pragmatic trial supports the use of repeated implementation intentions about how to refuse the offer of a cigarette plus antismoking messages as an effective and cost-effective intervention to reduce smoking initiation in adolescents.