Anti-tobacco Messages Research Articles

How liberals and conservatives respond to feasibility and desirability appeals in anti-tobacco campaigns

ABSTRACTUsing two experiments, this study aims to investigate how politically liberal or conservative message recipients respond to anti-tobacco appeals. The results show that in Study 1, respondents were exposed to a message about price policy. In Study 2, they were exposed to a message about a warning policy. In both studies, liberal participants more favorably evaluated anti-tobacco messages emphasizing feasibility rather than desirability, whereas conservative participants more positively evaluated messages emphasizing desirability rather than feasibility. Implications for policymakers and marketers are discussed.

Perceptions of Alternative Tobacco Products, Anti-tobacco Media, and Tobacco Regulation among Young Adults: A Qualitative Study.

Objectives With increased alternative tobacco product (ATP) use and lagging public health action, we explored perceptions of ATPs, anti-tobacco messaging, and tobacco regulation among young adults. Methods Semi-structured interviews were conducted with 60 Georgia college students aged 18-25 using: (1) cigarettes, little cigars/cigarillos (LCCs), smokeless tobacco, or e-cigarettes ≥15 days of the past 30; or (2) hookah ≥10 of the past 30 days (due to lower frequency of use). Of 99 participants recruited, 80 consented, and 60 participated. Results Participants were on average 21.01 years old (SD = 2.07), 56.7% women, and 65.0% black; 56.7% reported current use of cigarettes, 43.3% LCCs, 26.7% smokeless tobacco, 45.0% e-cigarettes, and 41.7% hookah. Cigarettes were perceived as most harmful to health and most addictive. E-cigarettes and hookah were generally regarded as lowest risk. Many indicated that ATP risk information was limited or inaccessible and that most anti-tobacco campaigns were irrelevant to ATPs. Participants requested more research and dissemination of evidence regarding ATP risks and need for ATP regulation. Conclusions In light of low risk perceptions regarding ATPs among young adults, research, anti-tobacco campaigns, and regulation must address their known and potential risks.

Who Fights, Who Flees? An Integration of the LC4MP and Psychological Reactance Theory

ABSTRACTThis study tests the hypothesis that defensive message processing, like defensive behaviors in the real world, has two directions, fight-and-flight. The Limited Capacity Model of Motivated Mediated Message Processing (LC4MP) characterizes defensive message processing by increases in unpleasantness and arousal reports, and accelerated heart rate indicating either a focus on internal processing (internal thoughts) or the active withdrawal of cognitive resources from processing highly arousing and unpleasant media messages. However, the LC4MP has not included direct measures that allow discrimination between fight-and-flight responses. Psychological reactance theory (PRT) predicts defensive responses including anger and counterarguments (reactance) when media messages threaten viewers’ freedom and autonomy. We hypothesized that PRT provides the LC4MP with the appropriate measures (anger and counterarguments) needed to discriminate fight-or-flight responses. Results supported this prediction. Participants (N = 49 adult-smokers) high in defensive and low in appetitive reactivity (risk-avoiders) withdrew from the message (fled: characterized by low anger and counterarguments) while those high in appetitive and low in defensive reactivity (risk-takers) experienced reactance (fought: characterized by high anger and counterarguments) in response to freedom threatening antitobacco messages that are highly arousing and unpleasant. Moreover, both reactance and message withdrawal yielded the same cognitive, emotional, and physiological responses predicted by the LC4MP as indicators of defensive message processing. Theoretical and message design recommendations are discussed.

Assessment of prevalence and knowledge, attitude and practice regarding tobacco consumption among adolescents in rural field practice area of medical college in Telangana, India: a cross-sectional study

Background: Tobacco is a major cause of premature death and disease worldwide. Over five million people die each year due to tobacco related illness- a figure expected increase by 8 million a year by 2030. Adolescence is transitional phase of growth and development between childhood and adulthood. WHO defines an adolescent as any person between ages 10 and 19. Adolescents consist of 16% of world population. Not only being productive age group they are also vulnerable to habit formation during this age group. The study was conducted to assess the prevalence and KAP regarding tobacco consumption among the adolescents.Methods: It is a cross sectional study where sampling was done by multistage random sampling conducted in 5 villages in the rural practice area of RVM medical college, Laxmakkapally, Telangana state.Results: Study population consists of 149 adolescents between the age of 10-19 years. Mean age of study participants was 16.6 years. 92.6% of participants were males. 66.4% were affiliated to school or college. 94% were aware that tobacco was hazardous. Knowledge regarding passive smoking as hazardous to health was present only in 75.8% of the population. Knowledge regarding anti-tobacco messages was low as 69.1%. 65.8% knew that it was illegal to smoke in public places. 18.8% of study population was engaged in tobacco consumption.Conclusions: Study concludes that tobacco consumption is high among the adolescents and its similar in rural Telangana as found in other states. Even though knowledge regarding hazards of tobacco consumption is high, knowledge regarding passive smoking is low. Attitude and practice regarding tobacco consumption is not satisfactory and awareness for the same is needed.

Prevalence and characteristics of young adult smokers in the U.S. in the precontemplation stage of smoking cessation

IntroductionThe precontemplation stage of smoking cessation refers to having no intention to quit smoking in the next six months. We aimed to estimate the prevalence of and characteristics associated with the precontemplation stage of smoking cessation among U.S. young adult smokers to inform the development of targeted interventions. MethodsWe analyzed data in 2017 from the 2013–2014 National Adult Tobacco Survey. Young adult (18–29 years old) daily and non-daily smokers were included (n = 1809). We applied weighted multiple logistic regression models to examine the associations between demographics, tobacco use behaviors, exposure to pro- and anti-tobacco messages, and the precontemplation stage of smoking cessation. Results59.0% of U.S. young adult smokers are in the precontemplation stage of smoking cessation. Unemployment was positively associated with being in the precontemplation stage of smoking cessation (AOR = 1.42 95% CI = 1.05, 1.91). Smoking every day (vs. some days), more cigarettes smoked per day, using roll-your-own cigarettes (vs. manufactured cigarettes only), currently smoking cigars, and signing up for promotional offers were positively associated with being in the precontemplation stage of smoking cessation (p < 0.05). Non-Hispanic Black was negatively associated with precontemplation stage (AOR = 0.40, 95% CI = 0.27, 0.59). Not smoking after viewing a health warning on a cigarette pack was negatively associated with the precontemplation stage of smoking cessation (AOR = 0.36, 95% CI = 0.25, 0.51). ConclusionsMany U.S. young adult smokers classify as being in the precontemplation stage of smoking cessation. Interventions to motivate these smokers to quit smoking with considerations of their specific characteristics (e.g., being unemployed) are warranted.

Willingness of tobacco retailers in Oyo State to participate in tobacco control programmes.

INTRODUCTIONTobacco control strategies have not incorporated retailers, despite being the focus by the tobacco industry to promote its products. Few studies exist on their possible roles in tobacco control. This study, therefore, assessed retailer awareness of tobacco control laws and willingness to be involved in control activities.METHODSA cross sectional study was carried out on all 218 tobacco retailers in Ibarapa Central and Ibarapa East Local Government Areas of Oyo State. The willingness of tobacco retailers to participate in tobacco-use control was evaluated using a questionnaire.RESULTSThe majority of the respondents were females (95%), and 30-39 years old with respect to age. Almost two-thirds (65%) of the respondents reported the sale of tobacco as a profitable business, and a third reported that their income would decrease if they stopped tobacco sales. Up to 35% of retailers were aware of laws restricting smoking in public places and 45% aware of a ban on the sale of tobacco products to minors. Retailers were willing to: support anti-tobacco legislations (84%), counsel smokers to quit smoking (84%), and display anti-tobacco messages in their shops (77%).CONCLUSIONSThe sale of tobacco products is a profitable venture for retailers. Willingness to participate in tobacco control was high among the retailers. There is a need to raise awareness and co-opt tobacco retailers as change agents in tobacco control efforts.

A Profile of Individuals with Anti-tobacco Message Fatigue.

Message fatigue, a phenomenon of being tired of repeated exposure to messages promoting the same health behavior, may reduce the effectiveness of anti-tobacco messages, such as warning labels. As an initial step towards understanding the phenomenon, we examined predictors of anti-tobacco message fatigue. An online study (N = 1838) involving a non-probability sample of nonsmokers and smokers in the United States assessed anti-tobacco message fatigue and individual-level factors including demographic variables and smoking status. General linear models were used to analyze the data. The multivariable results show that individuals who were younger, male, and had higher income and education reported higher levels of anti-tobacco message fatigue. African Americans reported significantly lower levels of message fatigue than other racial groups. Current smokers reported greater message fatigue than transitioning smokers and nonsmokers. Among current smokers, those with greater nicotine dependence reported higher levels of anti-tobacco message fatigue. These findings underscore the importance of segmenting the audience based on their levels of message fatigue and using more novel message strategies and delivery methods to influence populations with relatively higher levels of anti-tobacco message fatigue.

Frequency and duration of smoking scenes in Turkish movies

BACKGROUND: Comprehensive tobacco control law in Turkey bans advertisement, promotion of tobacco products and sponsorship by the tobacco industry. Advertisement of tobacco products was banned on television, billboards and press media, but not on movie films. METHODS: To evaluate the frequency and duration of smoking in the movies, 60 most watched Turkish films which were on the vision during the second half of 2016 were determined for this descriptive study. Two young males having a university degree were trained on the aim and methodology of the study. Then the two observers viewed the films independently and recorded smoking scenes or direct appearance of tobacco products on a standard form. RESULTS: There were tobacco products or smoking views in 36 (60%) out of total 60 movies. In these movies there were 4.75 times tobacco occurrences as an average (median 3). Average duration of smoking occurrences was almost 3.5 min (198 s). Smokers were mostly main characters and smoking occurrences were mostly in exciting or romantic atmosphere, which are attractive for young people. DISCUSSION: In the light of Framework Convention on Tobacco Control (Article 13), smoking scenes in movies are considered as kind of tobacco advertisement and promotion, which influences smoking behavior particularly the young people. Therefore, control and prevention of smoking occurrences in movies are important for the protection of children and young people to start smoking. Some health warnings and anti-tobacco messages may be placed in the movies, to reduce tobacco views in the movies.

Willingness to quit tobacco smoking and its correlates among Indian smokers - Findings from Global Adult Tobacco Survey India, 2009-2010.

Background:In the stages of change model for smoking cessation, “willingness to quit” forms the starting point.Objective:To determine the prevalence and correlates of willingness to quit among smokers in India from Global Adult Tobacco Survey (GATS), 2009–2010.Methods:Secondary data analysis of GATS, 2009–10, was done to find the correlates of willingness to quit among smokers. All the sociodemographic variables, smoking-related factors such as frequency, previous attempt to quit, and also effect of antitobacco messages delivered to various media were tested for association using multivariable analysis.Results:Of 9627 current smokers analyzed, 50.9% [95% confidence interval (CI): 49.9–51.9] were willing to quit smoking. Multivariable analysis showed that younger age groups [prevalence ratio (PR): 1.31, 95% CI: 1.05–1.65], individuals who have their first smoke after 60 min of wakeup (PR: 1.19, 95% CI: 1.05–1.36), those living in a house with smoking restriction (PR: 1.29, 95% CI: 1.17–1.42), those who received advice to quit from doctor, those who attempted to quit in the past 12 months (PR: 1.28, 95% CI: 1.03–1.60), having knowledge about illness caused due to smoking, and those who have noticed antismoking messages in billboards/hoardings were willing to quit smoking compared to their counterparts (PR: 1.13, 95% CI: 1.04–1.23).Conclusion:Enforcing social restrictions like smoking restriction at house and also brief advice by doctors to quit smoking during any contact with the tobacco user could improve quit rate especially in young tobacco users and those who have attempted to quit before.

The Reach of Media to Smokers and Smokeless Tobacco Users in India: Evidence from the Global Adult Tobacco Survey (GATS)

This study focuses on the impact of mass media in creating awareness and enhancing efficacy of tobacco control interventions by disseminating knowledge to the public about the harmful effects of tobacco. It examines variations in awareness of tobacco’s health hazards and anti-tobacco campaigns among 69,296 adults aged 15 and above based on gender and tobacco use (smoked or smokeless) and the role of the media in cessation attempts by tobacco users using data from the Global Adult Tobacco Survey (GATS). The GATS is a household survey which was conducted in India during 2009-10. The study found that a higher proportion of adults was exposed to anti-smoking information across different media compared with anti-smokeless tobacco information. Tobacco users are also less likely to be aware of the health hazards of tobacco compared with non-users. Noticing anti-tobacco messages and knowing the health hazards of smokeless tobacco use are significantly associated with cessation attempts among tobacco users in India. Males are more likely to notice anti-smoking and anti-smokeless tobacco information through any media compared with females.

Beliefs about smoking-related lung cancer risk among low socioeconomic individuals: the role of smoking experience and interpersonal communication.

Previous research has documented that smoking prevalence is generally high among low socioeconomic groups and that tobacco industries continue to target these population groups. However, little research has investigated the beliefs of individuals with low socioeconomic position (SEP) about the association between smoking and cancer risks. In this study, we examined beliefs about smoking-related lung cancer risk and the role of smoking experience, mass media exposure and health-related interpersonal communication among a sample of low SEP population. Data were gathered from 324 urban poor recruited from adult education centers in the greater Boston area, Massachusetts, USA as part of a larger project called Click to Connect. While we collected a variety of data at baseline and follow-up, the data for this study come from the baseline survey alone. We found that individuals with smoking experience tend to be better than those without in perceiving the lung cancer risks of smoking. Moreover, we found that health-related interpersonal communication with friends and family members is positively associated with beliefs about the link between smoking and lung cancer. Our findings suggest that low SEP individuals with smoking experience might be more exposed to anti-tobacco messages than are low SEP individuals without smoking experience. This could suggest that anti-tobacco interventions thus far may have done very little in raising the awareness of low SEP nonsmokers about the dangers of smoking and that they may have little potential to avert the initiation of smoking in this population.

Deceived, Disgusted, and Defensive: Motivated Processing of Anti-Tobacco Advertisements

ABSTRACTA 2 × 2 experiment was conducted, where participants watched anti-tobacco messages that varied in deception (content portraying tobacco companies as dishonest) and disgust (negative graphic images) content. Psychophysiological measures, self-report, and a recognition test were used to test hypotheses generated from the motivated cognition framework. The results of this study indicate that messages containing both deception and disgust push viewers into a cascade of defensive responses reflected by increased self-reported unpleasantness, reduced resources allocated to encoding, worsened recognition memory, and dampened emotional responses compared to messages depicting one attribute or neither. Findings from this study demonstrate the value of applying a motivated cognition theoretical framework in research on responses to emotional content in health messages and support previous research on defensive processing and message design of anti-tobacco messages.

Exploring anti-tobacco messages from an experiential arts activity with Aboriginal youth in an Australian high-school setting

Abstract High Aboriginal smoking prevalence exposes youth to passive smoking and encourages initiation. Using an educational arts-in-health project, we engaged youth in exploring the meaning of smoking for the Aboriginal community. An interactive classroom session educated N=20 Aboriginal high-school students about smoking and mass media literacy, followed by a poster-making session. The students could choose a threat-appeal, a positive benefit appeal or an advocacy message, targeted at youth, families or Elders. The visual and textual content of the posters underwent framework analysis to explore the range of messages and images. Students created innovative posters depicting issues facing Aboriginal people from smoking, including the potential loss of parents to ill-health. The majority of messages were fear-based (59 per cent), and targeted family (63 per cent). Over half of the students included Aboriginal arts styles or symbols. Aboriginal students exhibited insight into the effects of tobacco on their community.

Countering Craving with Disgust Images: Examining Nicotine Withdrawn Smokers’ Motivated Message Processing of Anti-Tobacco Public Service Announcements

There is a lack of research examining whether smoking cues in anti-tobacco advertisements elicit cravings, or whether this effect is moderated by countervailing message attributes, such as disgusting images. Furthermore, no research has examined how these types of messages influence nicotine withdrawn smokers’ cognitive processing and associated behavioral intentions. At a laboratory session, participants (N = 50 nicotine-deprived adults) were tested for cognitive processing and recognition memory of 12 anti-tobacco advertisements varying in depictions of smoking cues and disgust content. Self-report smoking urges and intentions to quit smoking were measured after each message. The results from this experiment indicated that smoking cue messages activated appetitive/approach motivation resulting in enhanced attention and memory, but increased craving and reduced quit intentions. Disgust messages also enhanced attention and memory, but activated aversive/avoid motivation resulting in reduced craving and increased quit intentions. The combination of smoking cues and disgust content resulted in moderate amounts of craving and quit intentions, but also led to heart rate acceleration (indicating defensive processing) and poorer recognition of message content. These data suggest that in order to counter nicotine-deprived smokers’ craving and prolong abstinence, anti-tobacco messages should omit smoking cues but include disgust. Theoretical implications are also discussed.

Do Emotions Spark Interest in Alternative Tobacco Products?

Exposure to advertisements for tobacco products and tobacco warning labels evokes emotions. This study evaluated the association of discrete positive and negative emotions with interest in alternative tobacco products. In 2013, 1,226 U.S. adult nonsmokers and current smokers viewed advertisements for moist snuff, snus, and electronic cigarettes (e-cigarettes) with various warning labels and then indicated their emotional responses in terms of anger, anxiety, sadness, guilt, disgust, discouragement, hope, and contentment. Outcomes were openness to using moist snuff, snus, and e-cigarettes in the future and interest in a free sample of each product. Data were analyzed in 2016. Hope was positively associated with openness and interest across all alternative tobacco products as was contentment for moist snuff and snus. Anger was negatively associated with openness to moist snuff and e-cigarettes, disgust negatively to moist snuff and snus, and anxiety negatively to e-cigarettes. Being a current smoker, ever trying a corresponding product, being male, and younger age were associated with greater openness to and interest in moist snuff and snus. For e-cigarettes, being a current smoker, ever trying e-cigarettes, and being female were associated with greater openness, and being a current smoker was associated with greater odds of selecting a free sample. Positive emotions, particularly hope, were consistently positively associated with interest in alternative tobacco products. Hope is widely used by tobacco and e-cigarette companies to advertise their products. Antitobacco messages should aim to lower hope associated with tobacco products but increase hope for cessation or life without tobacco.

Quitting smoking during substance use disorders treatment: Patient and treatment-related variables

Although individuals in substance use disorders (SUD) treatment continue to smoke at high rates, regulatory, policy and programming changes promoting tobacco cessation are being implemented and some patients quit successfully. We examined associations of smoking patterns, tobacco advertising receptivity, anti-tobacco message awareness, health risk perception, attitudes towards addressing smoking and availability of smoking cessation services with quitting smoking during SUD treatment. Surveys were completed by 1127 patients in 24 programs chosen randomly, stratified by program type (residential, methadone maintenance, outpatient), from among publicly funded, adult treatment programs within the National Drug Abuse Treatment Clinical Trials Network. Among respondents who had been in SUD treatment for at least one month, there were 631 current smokers and 52 former smokers who reported quitting smoking during treatment for at least one month prior to survey completion; these respondents comprised our sample (N=683). Results showed that participants who reported health concerns as a reason for quitting were 1.27 times more likely to have quit during treatment (p=0.015) than those reporting health concerns affected quitting a little or not at all. Additionally, participants who reported that smoking cessation was part of their personal treatment plan during SUD treatment were 1.08 times more likely to have quit during treatment (p<0.001). Participants in methadone treatment were 49% less likely to report successfully quitting during treatment than those in outpatient treatment (95%CI: 0. 35–0.75, p<0.001). Leveraging health concerns about smoking and including smoking cessation in an individualized treatment plan may help increase smoking cessation during SUD treatment.

Discard the Smoking Cues—Keep the Disgust: An Investigation of Tobacco Smokers’ Motivated Processing of Anti-tobacco Commercials

ABSTRACTThis study experimentally examines the effect of smoking cues and disgust images commonly found in anti-tobacco advertisements on tobacco smokers’ message processing. In a 2 (smoking cues) × 2 (disgust) within-subjects experiment, smokers watched anti-tobacco advertisements selected to vary in presence/absence of smoking cues and high/low ratings of disgust. The results of the experiment suggest that smoking cues and disgust images each have effects on resource allocation, recognition memory, emotional responses, smoking urges, and intentions to quit smoking. However, the most notable finding in this study was how the combination of smoking cues and disgust images in a single anti-tobacco message resulted in defensive message processing. Theoretical and applied implications of these findings are discussed along with future research directions.

Cultural challenges when developing anti-tobacco messages for Indigenous Australians.

Recently, many programs have been funded to tackle Indigenous Australian smoking. This study assessed what challenges and unexpected responses could occur when developing anti-tobacco messages for Indigenous communities. A cross-sectional telephone survey of organizations involved in making anti-tobacco messages for the target population was conducted in 2012-2013. Open-ended questions explored cultural challenges to message development and unexpected outcomes. Responses were noted and these qualitative data were independently coded by two researchers using an inductive analysis. Non-parametric tests explored associations between organization orientation, whether target group feedback about messages was sought (pre-tests) and the presence of the above factors. The 47 organizations represented included: 22 Aboriginal Medical Services (AMS), 13 government organizations (GO), eight non-government organizations (NGO) and four universities. The response rate was 83%. Cultural challenges were reported equally by organizations oriented towards Aboriginal communities and those oriented towards the general population. Organizations conducting target group pre-tests of the messages were more likely to report cultural challenges (p = 0.002). Four main themes were revealed: the diversity of Aboriginal and Torres Strait Islander cultures; the selection of role models; conflicts and delays; and unexpected outcomes. Nearly 60% of organizations reported better-than-expected outcomes e.g. community appreciation and pride. A further 40% reported negative responses, e.g. messages being misunderstood or confronting. Cultural challenges and unexpected outcomes are reported by Australian organizations when developing anti-tobacco messages for Indigenous Australians warranting attention to improve the salience of anti-tobacco messages for Indigenous peoples.NB. In this paper, Indigenous Australians is a term used to refer to Aboriginal and Torres Strait Islander peoples, the first inhabitants of Australia. No offence is intended. The authors acknowledge and respect that Aboriginal and Torres Strait Islander people are diverse populations with different language and cultural groups.

Smoking among patients in substance use disorders treatment: associations with tobacco advertising, anti-tobacco messages, and perceived health risks

ABSTRACTBackground: Although tobacco control efforts have contributed to an overall decline in smoking, individuals with substance use disorders (SUDs) continue to smoke at high rates and remain targets of advertising to vulnerable groups, including those with mental health disorders and SUDs. Objectives: We examined associations of tobacco advertising exposure and receptivity, anti-tobacco message awareness, and health-risk perception with smoking status and cigarettes-per-day (CPD) in a national sample of SUD treatment patients. Methods: The patients (N = 1,113) in 24 programs chosen randomly, stratified by program type, from among publicly funded adult treatment programs within the National Drug Abuse Treatment Clinical Trials Network completed surveys of smoking, advertising exposure and receptivity, anti-tobacco message awareness, and perceived health risks. Results: Current smokers (77.9% of the sample) smoked a daily median of 10 cigarettes (IQR = 13). The participants reporting daily advertising exposure were 1.41 times more likely to be smokers (p = 0.019) than others. Those highly receptive to advertising were 2.34 times more likely to be smokers (p < 0.001) than those with low/moderate receptivity. Higher perceived health risk was associated with lower odds of smoking (OR = 0.99, 95% CI: 0.98–0.99, p < 0.001). CPD for smokers highly receptive to advertising was 11.1% (95% CI: 2.8%–20.0%) higher than for smokers with low/moderate advertising receptivity. Anti-tobacco message awareness was not associated with smoking status or CPD. Conclusion: The high rate of smoking among SUD treatment patients is associated with daily exposure and high receptivity to tobacco advertisements and lower perception of health-related smoking risks. Tobacco control efforts should target this vulnerable population.

A Tobacco Cessation Intervention with Rural, Medically Underserved, Blue-collar Employees: A Quasiexperimental Study.

BackgroundThe aim of this study was to increase knowledge regarding the dangers associated with tobacco use, and decrease secondhand smoke exposure and tobacco use behaviors with an antitobacco messaging campaign among rural, medically underserved, blue-collar workers.MethodsA quasiexperimental study was conducted with employees at two worksites. One worksite received the intervention, which consisted of nine different antitobacco messages. Baseline and follow-up surveys were conducted at each worksite to assess change in knowledge and behavior; the data were compared across the two worksites.ResultsTwo hundred twenty-two and 243 participants completed baseline and follow-up surveys at the intervention and comparison sites, respectively. A statistically significant difference was seen over time between the worksites on knowledge of the dangers of tobacco (p < 0.0001); the mean knowledge score increased at the intervention site, but remained unchanged at the comparison site. In general, nonsmokers at both worksites appeared to try to decrease exposure to secondhand smoke over the follow-up period. Repeated measures analysis indicated that there were no differences in motivation to quit (p = 0.81), interest in quitting (p = 0.40), thinking about quitting (p = 0.53), or several tobacco-use behaviors over time among smokers at the intervention and comparison worksites. There were slight increases over time in the proportion of smokers who do not allow smoking in their homes/vehicles at the intervention worksite, although not statistically significant.ConclusionParticipants at the intervention worksite increased their knowledge regarding the dangers of tobacco use and secondhand smoke exposure. Among current tobacco users, the intervention appeared to increase family rules regarding secondhand smoke exposure in their homes and vehicles.