Smoking Cessation Messages Research Articles

Harm to myself or others? A qualitative study of the preferences of people who smoke for messages to be included in cigarette pack inserts.

Tobacco package inserts [TPIs] are a novel channel to transmit smoking cessation messages. Research has shown associations between inserts, intentions to quit and increased self-efficacy. In Israel, TPIs have been legislated, but not yet implemented. This study aimed to learn what kind of messages would appeal to people who smoke, for the purpose of developing effective TPIs. Semi-structured interviews with 25 people who smoke or formerly smoked, aged 18-67. An inductive and deductive thematic analysis was conducted to enable a dynamic process coding and identifying themes and categories across interviews. Two main themes identified were: harms of smoking and motivators for quitting. Many participants were averse to information about the harms of smoking but interested in specific information about the harm of smoking to others, particularly children, on comparative risks of different tobacco/nicotine products, and about how to address the challenge of addiction. There was a preference for motivational messages encouraging quitting, including how the body recovers, personal quit stories, practical quit tips, and information on cessation services. Adult who smoke were receptive to the idea of TPI, but considered some types of information superfluous. It is important to emphasize harm to others, provide information on quit services, and deliver information that is reliable, specific, and evidence-based regarding quitting, so that it can be encouraging, useful, and practical. The merits of providing information to people who smoke on relative risks of different nicotine and tobacco products should also be considered. The findings provide a basis for developing TPI content. A large proportion of adults who smoke are interested in quitting. Pack inserts with positive motivating messages, quitline details, and novel information about risks to people who smoke and particularly to others, should be developed and tested, and subsequently distributed nationally to reach all those who open a cigarette package.

The role of mood in shaping reactions to smoking cessation messages among adults who smoke: a multimodal investigation

IntroductionMood-tailored communications may help increase the effectiveness of smoking cessation messaging interventions. We used both self-report and psychophysiological measures to test the impact of mood on responses to cessation messages in adults who smoke.MethodsIn a two-part (crowdsourcing and psychophysiological studies) study, the impact of 30 smoking cessation messages comprised of five themes (i.e., financial, health, quality-of-life, challenges in quitting, motivation to quit) were tested. In a crowdsourcing study, participants (N = 600) were randomly placed into one of three mood induction tasks (i.e., positive, negative, neutral), and then viewed the smoking cessation messages. After each message, they were asked to self-report their motivation to quit, message receptivity, and the perceived relevance of the messages. In an in-lab, psychophysiological study, participants (N = 42) completed the same tasks as the crowdsourcing participants but were monitored for heart rate, skin conductance, and eye-tracking while viewing the cessation messages. Using a multi-attribute decision-making model (MADM) using outcomes from both studies, messages were ranked for each mood state.ResultsThe top messages for participants in the positive mood condition included the challenges in quitting, financial costs/rewards, and motivations to quit themes. The top messages for participants assigned to the negative mood condition included the challenges in quitting, quality-of-life, and financial costs/rewards themes. For participants in the neutral mood condition, messages in the challenges in quitting and quality of life themes performed best.ConclusionsVariations in the preferences of messages and themes by mood condition suggest that mood-tailored communication may increase the effectiveness of smoking cessation messages.

Resistance to anti-smoking messages related to the higher smoking stigma of Korean female smokers.

The degree of perceived smoking stigma can differ, based on various factors such as gender; this may influence the effect of smoking cessation interventions, including denormalization. This study investigates the gender differences in smoking stigma recognized by Korean smokers and explores the effect of these differences on the success of smoking cessation messages that aim to initiate an identity crisis among smokers. It aims to contribute to effective smoking cessation intervention strategies for female smokers. The smoker-gender Implicit Association Test (IAT) was used to measure gender-based smoking stigma; the test comprised photos of people smoking, with positive and negative descriptors. Participants were 120 smokers aged 19-35 years (60 males and 60 females). Participants' cognitive attitudes toward smoking and cessation intentions were assessed at baseline. To investigate the effect of social stigmatization on smokers, participants were asked to watch anti-smoking campaigns that stigmatized either smoking behavior or smokers' self-identity. Cognitive attitudes and cessations intention were used to show differences in gender and message conditions. The IAT D-score showed that female smokers perceived other female smokers significantly more negatively than they did male smokers, suggesting a higher level of smoking stigma. Female smokers in the socially stigmatizing condition reduced their negativity toward smoking less than those who were not stigmatized. Moreover, cessation intentions did not improve when female smokers received identity-threatening messages, indicating that female smokers tended to resist stigmatizing messages. These findings provide empirical evidence that the gender of Korean smokers is significantly related to differences in smoking stigma. The negative perception and resistance responses of female smokers shown in this study are consistent with the findings of previous studies on the stigma of substance use disorders and addiction. High smoking stigma can also be a risk factor in anti-smoking interventions, including health communication; therefore, these findings should be interpreted with caution.

Project phoenix: Pilot randomized controlled trial of a smartphone-delivered intervention for people who are not ready to quit smoking

BackgroundMost people who smoke cigarettes report they want to quit in the future, but only 20 % are ready to quit within the next 30 days. This 3-arm pilot randomized controlled trial examined the feasibility and initial efficacy of a novel smartphone-based intervention that aimed to induce smoking cessation attempts among adults not initially ready to quit. MethodsParticipants randomized into the two intervention groups (Group 1: Phoenix App Only; Group 2: Phoenix App + Nicotine Replacement Therapy) received daily smoking cessation messages via smartphone application that were tailored to their current readiness to quit, while the attention control group (i.e., Factoid) received messages not related to smoking cessation. All participants completed a weekly survey for 26 weeks and used the app to set quit dates when/if desired. ResultsParticipants (N=152) were female (67.8 %), White (75.7 %), 50.0 years old (SD=12.5), and smoked 20.4 cigarettes per day (SD=10.5). Results indicated that the Phoenix interventions were feasible (e.g., participants viewed ~185 messages over 26 weeks; 74.8 % of weekly surveys were completed; 85.5 % completed the 26-week follow-up assessment). Phoenix participants set more quit dates, set quit dates sooner, were abstinent for more days, and used smoking cessation medications on more days than those assigned to the Factoid group. ConclusionsThis low-burden, smartphone-based smoking cessation induction intervention may increase smoking cessation attempts, and may reduce barriers that are encountered with traditional in-person or call-based interventions.Trial Registration: Clinicaltrials.gov number: NCT03405129; https://clinicaltrials.gov/ct2/show/NCT03405129

Towards AI-Driven Healthcare: Systematic Optimization, Linguistic Analysis, and Clinicians' Evaluation of Large Language Models for Smoking Cessation Interventions.

Creating intervention messages for smoking cessation is a labor-intensive process. Advances in Large Language Models (LLMs) offer a promising alternative for automated message generation. Two critical questions remain: 1) How to optimize LLMs to mimic human expert writing, and 2) Do LLM-generated messages meet clinical standards? We systematically examined the message generation and evaluation processes through three studies investigating prompt engineering (Study 1), decoding optimization (Study 2), and expert review (Study 3). We employed computational linguistic analysis in LLM assessment and established a comprehensive evaluation framework, incorporating automated metrics, linguistic attributes, and expert evaluations. Certified tobacco treatment specialists assessed the quality, accuracy, credibility, and persuasiveness of LLM-generated messages, using expert-written messages as the benchmark. Results indicate that larger LLMs, including ChatGPT, OPT-13B, and OPT-30B, can effectively emulate expert writing to generate well-written, accurate, and persuasive messages, thereby demonstrating the capability of LLMs in augmenting clinical practices of smoking cessation interventions.

Developing Mood-Based Computer-Tailored Health Communication for Smoking Cessation: Feasibility Randomized Controlled Trial.

Computer-tailored health communication (CTHC), a widely used strategy to increase the effectiveness of smoking cessation interventions, is focused on selecting the best messages for an individual. More recently, CTHC interventions have been tested using contextual information such as participants' current stress or location to adapt message selection. However, mood has not yet been used in CTCH interventions and may increase their effectiveness. This study aims to examine the association of mood and smoking cessation message effectiveness among adults who currently smoke cigarettes. In January 2022, we recruited a web-based convenience sample of adults who smoke cigarettes (N=615; mean age 41.13 y). Participants were randomized to 1 of 3 mood conditions (positive, negative, or neutral) and viewed pictures selected from the International Affective Picture System to induce an emotional state within the assigned condition. Participants then viewed smoking cessation messages with topics covering five themes: (1) financial costs or rewards, (2) health, (3) quality of life, (4) challenges of quitting, and (5) motivation or reasons to quit. Following each message, participants completed questions on 3 constructs: message receptivity, perceived relevance, and their motivation to quit. The process was repeated 30 times. We used 1-way ANOVA to estimate the association of the mood condition on these constructs, controlling for demographics, cigarettes per day, and motivation to quit measured during the pretest. We also estimated the association between mood and outcomes for each of the 5 smoking message theme categories. There was an overall statistically significant effect of the mood condition on the motivation to quit outcome (P=.02) but not on the message receptivity (P=.16) and perceived relevance (P=.86) outcomes. Participants in the positive mood condition reported significantly greater motivation to quit compared with those in the negative mood condition (P=.005). Participants in the positive mood condition reported higher motivation to quit after viewing smoking cessation messages in the financial (P=.03), health (P=.01), quality of life (P=.04), and challenges of quitting (P=.03) theme categories. We also compared each mood condition and found that participants in the positive mood condition reported significantly greater motivation to quit after seeing messages in the financial (P=.01), health (P=.003), quality of life (P=.01), and challenges of quitting (P=.01) theme categories than those in the negative mood condition. Our findings suggest that considering mood may be important for future CTHC interventions. Because those in the positive mood state at the time of message exposure were more likely to have greater quitting motivations, smoking cessation CTHC interventions may consider strategies to help improve participants' mood when delivering these messages. For those in neutral and negative mood states, focusing on certain message themes (health and motivation to quit) may be more effective than other message themes.

Communicating the benefits of quitting smoking on mental health increases motivation to quit in people with anxiety and/or depression

BackgroundAlthough smoking rates have declined over time, this decline has not been observed among those with mental health concerns. It is therefore important to develop effective messaging to support quitting in this population. MethodsWe conducted an online experiment with 419 adults who smoke cigarettes daily. Participants with, or without a lifetime history of anxiety and/or depression were randomized to view a message focused on the benefits of quitting smoking on mental or physical health. Participants then reported motivation to quit smoking, mental health concerns about quitting, and perceived effectiveness of the message. ResultsParticipants with a lifetime history of anxiety and/or depression who saw the message focused on the benefits of quitting smoking on mental health reported greater motivation to quit than when they saw a message focused on the benefits to physical health. This was not replicated when examining current symptoms instead of lifetime history. Pre-existing beliefs that smoking improves one’s mood were greater in those experiencing current symptoms and in those with a lifetime history of anxiety and/or depression. There was no main or interaction (message type X mental health status) effect of message type received on mental health related concerns about quitting. ConclusionsThis study is one of the first to evaluate a smoking cessation message with content specifically targeted to those with mental health concerns about quitting smoking. Additional work is needed to determine how to best target those with mental health concerns with messages focused on the benefits of quitting on mental health.

Promoting Smoke-Free Environments: The Impact of Thirdhand Smoke Awareness on Smoking Bans at Home.

A creating smoke-free home is a way to protect a vulnerable group from being exposed to secondhand smoke in the home, such as children, infants, and non-smokers. Studies reported an intervention for promoting a smoke-free home by using secondhand smoke messages and smoking cessation messages. However, the thirdhand smoke (THS) message has rarely been found. Therefore, this study aimed to explore the prevalence and correlations of smoking bans in homes. Secondary data from a community-based cross-sectional design survey was used for this study. Smoking ban status was defined as a smoking ban or no smoking ban. We used multiple logistic regression to test the association between factors and smoking ban status. An adjusted odd ratio and 95% confidence interval were reported. Of the 882 participants included in this analysis, 38.66% (95%CI: 35.43, 41.97) had a smoking ban at home. A multiple logistic regression analysis showed that participants who believe that secondhand or THS harms children had a greater correlation with developing a smoking ban in the home compared with those who did not believe (odd ratio: 3.94, 95% confidence interval: 2.35, 6.60 and odd ratio:4.22, 95% confidence interval:2.6, 6.86, respectively). This study found that the belief that thirdhand smoke and secondhand smoke exposure harm children. The smoke-free home message's relevance to the harms of thirdhand smoke exposure should be adapted to be promoted, especially in homes.

Pediatrician-Delivered Smoking-Cessation Messages for Parents: An Update.

Clinicians who care for children and adolescents are well positioned to help parents quit smoking – the leading preventable cause of disease and death in the US. Understanding parents’ preferences for smoking-cessation messages may help clinicians tailor interventions to increase the likelihood of quitting. A concept from behavioral economics, called message framing, can be leveraged to motivate adult smokers to quit and may help motivate parents to quit. 1 Jenssen B.P. Kelly M.K. Faerber J. et al. Pediatrician Delivered Smoking Cessation Messages for Parents: A Latent Class Approach to Behavioral Phenotyping. Acad Pediatr. 2021; 21: 129-138https://doi.org/10.1016/j.acap.2020.07.018 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar In our study, “Pediatrician Delivered Smoking Cessation Messages for Parents: A Latent Class Approach to Behavioral Phenotyping,” using a discrete choice experiment and latent class analysis, we identified subgroups of parents who smoke with preferences for certain types of motivational messages: messages focused on the impact of smoking on the child, messages that were gain-framed rather than loss-framed messages (emphasizing benefits of engaging over costs of failing to engage in treatment), and messages focused on the financial impact of smoking. 1 Jenssen B.P. Kelly M.K. Faerber J. et al. Pediatrician Delivered Smoking Cessation Messages for Parents: A Latent Class Approach to Behavioral Phenotyping. Acad Pediatr. 2021; 21: 129-138https://doi.org/10.1016/j.acap.2020.07.018 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar We proposed that future work should explore how to best incorporate these messages into clinical practice as well as examine the relationship between tailored messages and subsequent behavior change. Since the publication of our study, others have expanded work in this field. In this progress report, we consider our study’s findings within the context of other studies published since January 2021, when we submitted our manuscript for publication, and discuss: 1) tailored content to help individuals who smoke quit, 2) methods to create a new system for smoking cessation for parents of pediatric patients, and 3) preliminarily evaluation of this new system in clinical practice.

Using Smartphone Survey and GPS Data to Inform Smoking Cessation Intervention Delivery: Case Study.

Interest in quitting smoking is common among young adults who smoke, but it can prove challenging. Although evidence-based smoking cessation interventions exist and are effective, a lack of access to these interventions specifically designed for young adults remains a major barrier for this population to successfully quit smoking. Therefore, researchers have begun to develop modern, smartphone-based interventions to deliver smoking cessation messages at the appropriate place and time for an individual. A promising approach is the delivery of interventions using geofences-spatial buffers around high-risk locations for smoking that trigger intervention messages when an individual's phone enters the perimeter. Despite growth in personalized and ubiquitous smoking cessation interventions, few studies have incorporated spatial methods to optimize intervention delivery using place and time information. This study demonstrates an exploratory method of generating person-specific geofences around high-risk areas for smoking by presenting 4 case studies using a combination of self-reported smartphone-based surveys and passively tracked location data. The study also examines which geofence construction method could inform a subsequent study design that will automate the process of deploying coping messages when young adults enter geofence boundaries. Data came from an ecological momentary assessment study with young adult smokers conducted from 2016 to 2017 in the San Francisco Bay area. Participants reported smoking and nonsmoking events through a smartphone app for 30 days, and GPS data was recorded by the app. We sampled 4 cases along ecological momentary assessment compliance quartiles and constructed person-specific geofences around locations with self-reported smoking events for each 3-hour time interval using zones with normalized mean kernel density estimates exceeding 0.7. We assessed the percentage of smoking events captured within geofences constructed for 3 types of zones (census blocks, 500 ft2 fishnet grids, and 1000 ft2 fishnet grids). Descriptive comparisons were made across the 4 cases to better understand the strengths and limitations of each geofence construction method. The number of reported past 30-day smoking events ranged from 12 to 177 for the 4 cases. Each 3-hour geofence for 3 of the 4 cases captured over 50% of smoking events. The 1000 ft2 fishnet grid captured the highest percentage of smoking events compared to census blocks across the 4 cases. Across 3-hour periods except for 3:00 AM-5:59 AM for 1 case, geofences contained an average of 36.4%-100% of smoking events. Findings showed that fishnet grid geofences may capture more smoking events compared to census blocks. Our findings suggest that this geofence construction method can identify high-risk smoking situations by time and place and has potential for generating individually tailored geofences for smoking cessation intervention delivery. In a subsequent smartphone-based smoking cessation intervention study, we plan to use fishnet grid geofences to inform the delivery of intervention messages.

Nudging smokers away from lighting up: A meta-analysis of framing effect in current smokers

Should smoking cessation messages be framed in terms of gains or losses? While the risk-framing hypothesis suggests a persuasive advantage for gain-framed messages, empirical evidence so far has been mixed. In defense of the risk-framing hypothesis, researchers have suggested that the diversity of results in this literature stream can be attributed to differences in issue involvement. The present study examined these predictions by employing a meta-analysis (14 studies) comprising of a Correlated and Hierarchical Effects model with Robust Variance Estimation. There was a small persuasive advantage in favour of gain-framed messages (g = 0.104, SE = 0.049), but this contrast was not statistically significant (p = 0.070, CI95 = -0.011, 0.218). This finding is robust to the values of correlation between sampling errors of the effect sizes, influential outliers, and publication bias. Moreover, issue involvement proxied through nicotine dependence did not moderate the relative persuasiveness of gain and loss-framed messages in encouraging smoking cessation. The conclusion remains unchanged regardless of how nicotine dependence is measured and before and after controlling for study and participant characteristics. These results strongly cast doubt on the applicability of the risk-framing hypothesis that continues to guide research and public-health campaigns.

Interplay between benefit appeal and valence framing in reducing smoking behavior: Evidence from a field experience

AbstractSmoking is one of the leading causes of preventable death globally, yet it remains a common behavior. Interventions that increase the concreteness of future smoking outcomes have been suggested to be effective, but little research has examined what type of future outcomes should be highlighted, and in what way. The present study therefore explores the efficacy of two types of framings of smoking cessation consequences: Benefit appeal (time vs. money) and valence (gain vs. loss). A randomized controlled field experiment with 2935 participants conducted via a digital therapeutics app found an interplay between appeal type and valence such that messages focusing on money were most likely to lead to immediate reduced smoking behavior when framed as a gain, rather than loss. Effects on motivation or long‐term smoking cessation were not detected. The results shed light on psychological differences between money and time, between attitudes and behaviors, and between short‐term and long‐term behavior change. This study highlights the importance of considering both benefit appeal and valence framing when designing smoking cessation messages.

Developing the Message Assessment Scale for Tobacco Prevention Campaigns: Cross-sectional Validation Study.

BackgroundMass media campaigns are effective for influencing a broad range of health behaviors. Prior to launching a campaign, developers often conduct ad testing to help identify the strengths and weaknesses of the message executions among the campaign’s target audience. This process allows for changes to be made to ads, making them more relevant to or better received by the target audience before they are finalized. To assess the effectiveness of an ad’s message and execution, campaign ads are often rated using a single item or multiple items on a scale, and scores are calculated. Endorsement of a 6-item perceived message effectiveness (PME) scale, defined as the practice of using a target audience’s evaluative ratings to inform message selection, is one approach commonly used to select messages for antitobacco campaigns; however, the 6-item PME scale often does not produce enough specificity to make important decisions on ad optimization. In addition, the PME scale is typically used with adult populations for smoking cessation messages.ObjectiveThis study includes the development of the Message Assessment Scale, a new tobacco prevention message testing scale for youth and young adults.MethodsData were derived from numerous cross-sectional surveys designed to test the relevance and potential efficacy of antitobacco truth campaign ads. Participants aged 15-24 years (N=6108) responded to a set of 12 core attitudinal items, including relevance (both personal and cultural) as well as comprehension of the ad’s main message.ResultsAnalyses were completed in two phases. In phase I, mean scores were calculated for each of the 12 attitudinal items by ad type, with higher scores indicating more endorsement of the item. Next, all items were submitted to exploratory factor analysis. A four-factor model fit was revealed and verified with confirmatory factor analysis, resulting in the following constructs: personally relevant, culturally relevant, the strength of messaging, and negative attributes. In phase II, ads were categorized by performance (high/medium/low), and constructs identified in phase I were correlated with key campaign outcomes (ie, main fact agreement and likelihood to vape). Phase II confirmed that the four constructs identified in phase I were all significantly correlated with main fact agreement and vape intentions.ConclusionsFindings from this study advance the field by establishing an expanded set of validated items to comprehensively assess the potential effectiveness of advertising executions. This set of items expands the portfolio of ad testing measures for ads focused on tobacco use prevention. Findings can inform how best to optimize ad executions and message delivery for health behavior campaigns, particularly those focused on tobacco use prevention among youth and young adult populations.

Evaluating the use of a recommender system for selecting optimal messages for smoking cessation: patterns and effects of user-system engagement

BackgroundMotivational messaging is a frequently used digital intervention to promote positive health behavior changes, including smoking cessation. Typically, motivational messaging systems have not actively sought feedback on each message, preventing a closer examination of the user-system engagement. This study assessed the granular user-system engagement around a recommender system (a new system that actively sought user feedback on each message to improve message selection) for promoting smoking cessation and the impact of engagement on cessation outcome.MethodsWe prospectively followed a cohort of current smokers enrolled to use the recommender system for 6 months. The system sent participants motivational messages to support smoking cessation every 3 days and used machine learning to incorporate user feedback (i.e., user’s rating on the perceived influence of each message, collected on a 5-point Likert scale with 1 indicating strong disagreement and 5 indicating strong agreement on perceiving the influence on quitting smoking) to improve the selection of the following message. We assessed user-system engagement by various metrics, including user response rate (i.e., the percent of times a user rated the messages) and the perceived influence of messages. We compared retention rates across different levels of user-system engagement and assessed the association between engagement and the 7-day point prevalence abstinence (missing outcome = smoking) by using multiple logistic regression.ResultsWe analyzed data from 731 participants (13% Black; 73% women). The user response rate was 0.24 (SD = 0.34) and user-perceived influence was 3.76 (SD = 0.84). The retention rate positively increased with the user response rate (trend test P < 0.001). Compared with non-response, six-month cessation increased with the levels of response rates: low response rate (odds ratio [OR] = 1.86, 95% confidence interval [CI]: 1.07–3.23), moderate response rate (OR = 2.30, 95% CI: 1.36–3.88), high response rate (OR = 2.69, 95% CI: 1.58–4.58). The association between perceived message influence and the outcome showed a similar pattern.ConclusionsHigh user-system engagement was positively associated with both high retention rate and smoking cessation, suggesting that investigation of methods to increase engagement may be crucial to increase the impact of the recommender system for smoking cessation.Trial registrationRegistration Identifier: NCT03224520. Registration date: July 21, 2017.

Your Money or Your Life: Interplay Between Benefit Appeal and Valence Framing in Reducing Smoking Behavior

Smoking is one of the leading causes of preventable death globally, yet it remains a common behavior. Interventions that increase the concreteness of future smoking outcomes have been suggested to be effective, but little research has examined what type of future outcomes should be highlighted, and in what way. The present study therefore explores the efficacy of two types of framings of smoking cessation consequences: appeal type (time vs. money) and valence (gain vs. loss). A randomized controlled field experiment with 2,935 participants conducted via a digital therapeutics app found that messages focusing on money (time) are most likely to lead to immediate reduced smoking behavior when framed as a gain (loss). Effects on motivation or long-term smoking cessation were not detected. The results illustrate the psychological differences between money and time, between attitudes and behaviors, and between short-term and long-term behavior change. This study highlights the importance of considering both appeal type and valence framing when designing smoking cessation messages.

Smoking Cessation Messages for Pregnant Aboriginal and Torres Strait Islander Women: A Rapid Review of Peer-Reviewed Literature and Assessment of Research Translation of Media Content.

This review summarized literature about knowledge, attitudes, and beliefs of Aboriginal and Torres Strait Islander women from Australia who smoke during pregnancy, then examined the extent that existing health promotion materials and media messages aligned with evidence on smoking cessation for pregnant Aboriginal and Torres Strait Islander women. Knowledge, attitudes, and beliefs of pregnant Aboriginal women who smoke tobacco were identified in the literature. Health promotion campaigns were retrieved from a grey literature search with keywords and social and professional networks. Key themes from peer-reviewed papers were compared against the content of health promotion campaigns using the Aboriginal Social and Emotional Wellbeing Model, the Behavior Change Wheel and thematic analysis. Eleven empirical studies and 17 campaigns were included. Empirical studies highlighted women sought holistic care that incorporated nicotine replacement therapy, engaged with their family and community and the potential for education about smoking cessation to empower a woman. Health promotion campaigns had a strong focus on ‘engagement with family and community’, ‘knowledge of risks of smoking,’ ‘giving up vs cutting down’ and ‘culture in language and arts’. There were similarities and variances in the key themes in the research evidence and promotion materials. Topics highly aligned included risks from smoking and quitting related issues.

Effects of culturally tailored smoking prevention and cessation messages on urban American Indian youth

American Indians (AI) face significant disparities in smoking-related diseases. In addition, smoking prevalence increases exponentially between ages 11 and 18. Smoking prevention and cessation efforts aimed at AI youth therefore are important. In order to strengthen understanding of evidence-based message strategies for smoking prevention and cessation among AI youth. The objective of this study was to test whether a message that was tailored to AI cultural values associated with the sacredness of traditional tobacco can change variables that behavioral theories have identified as predictors of smoking (i.e., instrumental and experiential attitudes, injunctive and descriptive norms, perceived capacity and autonomy, and intention with respect to smoking). We conducted a randomized field experiment among 300 never-smoking and ever-smoking urban AI youth in Minneapolis-Saint Paul between May 18 and July 27, 2019. We used a 3 (message condition: cultural benefits of not smoking cigarettes, health benefits of not smoking cigarettes, comparison message about benefits of healthy eating) × 2 (smoking status: ever-smoked, never-smoked) between-subjects design. Multivariate analysis of variance showed that for ever-smokers, the cultural consequences of smoking message significantly lowered instrumental attitude (partial eta2 = 0.029), experiential attitude (partial eta2 = 0.041), perceived capacity (partial eta2 = 0.051), and smoking intention (partial eta2 = 0.035) compared to the healthy eating comparison message and the health consequences of smoking message. This was not observed among never-smokers, who already had very negative smoking perceptions. We conclude that messages that tailor to AI culture may be effective tools for discouraging smoking among AI youth.

Perceptions and Patterns of Cigarette and E-Cigarette Use among Hispanics: A Heterogeneity Analysis of the 2017-2019 Health Information National Trends Survey.

There are documented disparities in smoking behaviors among Hispanic adults in the U.S., but little is known about patterns of e-cigarette use. Using data from the HINTS 5 cycle 1–3, we examined cigarette and e-cigarette history and current use, as well as perceptions of the dangers of e-cigarette use relative to cigarette use. Primary predictors were Hispanic ethnic group, gender, age, education, income, and English language proficiency. Binary outcomes were modeled using the logit link, and multinomial outcome variables were modeled using generalized logit model. Fifty-three percent of participants were Mexican, 8% Puerto Rican, 4% were Cuban, and 35% identified as other Hispanics. Of the 1618 respondents, 23% were former cigarette smokers and 10% were current cigarette smokers. Twenty percent reported history of electronic cigarettes and 4% reported current use. In multivariable models, Hispanic women were significantly less likely to report ever being smokers compared to Hispanic men (aOR = 0.61, 95% CI = 0.42, 0.88). Puerto Ricans were 2.4 times as likely to report being current smokers (95% CI = 1.11, 5.11) compared to Mexicans. Among Hispanics, significant differences in e-cigarette and cigarette use behaviors emerged by gender, age, ethnicity, and cancer history, with implications for tailoring smoking prevention and cessation messages.

Measuring fidelity to delivery of a new smoking cessation intervention integrated into routine tuberculosis care in Pakistan and Bangladesh: Contextual differences and opportunities.

INTRODUCTIONTobacco smoking among tuberculosis (TB) patients leads to poorer treatment outcomes. Smoking cessation support should be integrated into routine TB care. We measured healthcare providers’ fidelity to a smoking cessation intervention integrated into routine TB care, in Bangladesh and Pakistan. We aimed to understand the role of providers and settings in the implementation of behavior support (BS) messages for TB and smoking cessation.METHODSThe integrated BS intervention was implemented in TB clinics (24 public and 1 private). Cross-sectional data were collected on the fidelity of delivery of the BS intervention using a predefined fidelity index based on an existing validated method of measuring intervention fidelity. Audio-recordings of patient-provider BS sessions were coded using the fidelity index. Intervention fidelity was presented as the proportion of sessions that implemented BS messages.RESULTSA total of 96 sessions were conducted, 37 in Bangladesh and 59 in Pakistan. In public settings, TB medication advice was offered in 91.9% (95% CI: 78.7– 97.2) of sessions in Bangladesh, and in 75.5% (95% CI: 62.4–85.1) of sessions in Pakistan; whilst it was offered in 83.3% (95% CI: 43.7–97.0) of sessions in the private setting in Pakistan. Patients’ smoking status was assessed in 70.3% (95% CI: 54.2–82.5) of sessions in Bangladesh, and in 34.0% (95% CI: 22.7–47.4) of sessions in the public setting and in 66.7% (95% CI: 30.0–90.3) of sessions in the private setting in Pakistan. A quit date was set in 32.4% (95% CI: 19.6–48.5) of all sessions in Bangladesh, and in 33.3% (95% CI: 9.6–70.0) of all sessions in the public setting in Pakistan.CONCLUSIONSFidelity to the intended delivery of the intervention was found to be high for TB-related messages but not for smoking cessation messages. Clinic contexts may play a mediating role in health workers’ opportunities to deliver the intervention as planned.TRIAL REGISTRATIONInternational Standard Randomized Clinical Trial Number (ISRCTN43811467). Registered 23 March 2016, https://doi.org/10.1186/ISRCTN43811467

The Potential Effectiveness of COVID-Related Smoking Cessation Messages in Three Countries.

IntroductionHealth authorities are advising smokers to quit to reduce their COVID-related risk. The types of messages that may be effective in alerting smokers to this risk and encouraging a quit attempt are unknown. The aim of this study was to test a series of messages to identify potentially effective communication approaches.MethodsAn online survey was completed by 1509 smokers across three countries (Australia: n = 604; New Zealand: n = 304; United Kingdom: n = 601) in April–May 2020. Respondents were randomly assigned to view just one of four quit messages, two of which explicitly referred to the coronavirus, one referred to risk of chest infection, and one encouraged cessation for financial reasons. Outcome variables included quit intentions, further information seeking, message perceptions, and health and financial concerns.ResultsAll four messages were associated with significant differences in the proportions of respondents intending to quit within the following 2 wk (increase range: 11%–34%) and with substantial proportions of respondents electing to access additional information (range: 37%–50%). The differences in intentions were significantly larger for the two health-related messages that specifically mentioned the coronavirus. All messages were perceived favorably in terms of acceptability, believability, effectiveness, and personal relevance. Negligible differences in health and financial concerns were observed.ConclusionsSmokers in Australia, New Zealand, and the United Kingdom appear likely to be receptive to messages about their COVID-related risk. Such messages have the potential to increase quit intentions and prompt information-seeking behaviors.ImplicationsThe COVID-19 pandemic represents an opportunity to encourage smokers to quit to reduce both their COVID-related risks and their risks of a broad range of noncommunicable diseases.