Smoking-related Interventions Research Articles

Why Audiences’ Voice on Developing Anti-Smoking Messages Matters

messages about the danger of addictive substances. For example, smoking is framed as harmful and unfavourable. Anti-smoking Public Service Advertising (PSA) depicts the severe adverse effect of smoking on health, sometimes resulting in people resisting the message. In contrast, pro-smoking through tobacco advertisements is associated with fun and enjoyable behaviour, encouraging people to smoke or start smoking. Besides quality, anti-smoking PSAs in the country cannot compete with accessible cigarette advertising in terms of quantity. As a result, intervention to prevent tobacco use remains lacking. The effectiveness of anti-smoking PSA is usually assessed by looking at and counting the significant impact of the messages on people’s intention to change their behaviour. This top-down approach is missing from understanding why people perceive the messages as meaningful and how they are likely to accept or reject them, particularly where smoking remains socially and culturally normalised, like in Indonesia. By reviewing the relevant literature on audience research, this paper aims to propose the cultural media audience as a valuable approach and framework in health communication and provide an analysis of some mediated smoking campaigns in Indonesia. The existing PSA tends to underscore people’s perceptions and expectations of the messages. It is argued that a cultural-media audience approach allows for staging people’s voices about persuasive health messages and helps to develop meaningful smoking-related interventions or campaigns. Keywords: Anti-smoking, health communication, media audience, message, Indonesia.

Revisiting Precipitation-Induced Smoking: The Role of Hedonic Versus Utilitarian Advertising Message on Smoking-Related Intervention

Background: Smoking-related intervention remains an important social marketing challenge. This article investigates the role of precipitation in driving smoking initiation and, by extension, examines how the nature of the persuasive appeal of anti-smoking messages can mitigate this effect. Focus of the Article: Research and Evaluation, Insights on Social Marketing-Mix (i.e., 4Ps). Research Question: This article aimed to investigate the role of precipitation in driving smoking initiation as well as to examine how the nature of the persuasive appeal of anti-smoking messages might moderate this effect. Importance to the Social Marketing Field: This research extends prior literature exploring how external factors might impact cigarette consumption. Also, this study brings a new understanding regarding the role of affect in everyday consumption and enriches the literature studying downstream consequences of negative affect and emotion regulation. Moreover, this research contributes to the theory of consumption motive and yields managerial implications into the social marketing domain regarding curbing precipitation-induced smoking. Methods: This research utilizes a survey (Study 1) and a controlled laboratory experiment (Study 2). Results: The results provide converging evidence that precipitation tends to induce one’s negative mood, which in turn triggers urges to smoke (Study 1—marginally significant main effect of weather: p = .058). Furthermore, the hedonic (vs. utilitarian) anti-smoking message is more likely to mitigate the precipitation-induced cigarette smoking (Study 2—significant interaction between weather and persuasion type: p = .04). Recommendations for Research or Practice: This research deepens the understanding of how natural environment, and precipitation, in particular, is linked to cigarette-smoking behavior and contributes to the literature on cigarette consumption and affect regulation. For social marketers and policy makers, the findings offer actionable insights into leveraging social marketing-mix (i.e., 4Ps) in the context of smoking-related interventions. Limitations: Conceptualization of negative mood was broad. Future research should investigate the specific types of negative moods (e.g., anger, depression, sadness) for a more nuanced understanding of the precipitation effect.

Psychological Health and Smoking in Young Adulthood

Introduction: Young adulthood is a critical time for the emergence of risk behaviors including smoking. Psychological health is associated with smoking, but studies rarely track both over time. We used longitudinal data to assess whether average patterns of psychological health influenced average patterns of smoking and whether short-term fluctuations in psychological health influenced fluctuations in smoking. Method: Young adults aged 18–30 from the Panel Study of Income Dynamics were followed from 2007 to 2013, and mean trajectories of smoking were modeled. Psychological health variables included ever having a mental health diagnosis and time-varying distress. Results: In regression models, individuals with poorer psychological health (higher distress or a diagnosis) were more likely to be smokers and to smoke greater number of cigarettes. The association of diagnosis with number of cigarettes smoked increased with age. Conclusions: Smoking-related interventions should target individuals with poorer psychological health, even if they have no formal mental health diagnosis.

The Longitudinal Relationships between Depression and Smoking in Hardcore Smokers Using Autoregressive Cross-Lagged Modeling.

This study aimed to identify the directionality of the causal relationship and interaction between depression and amount of smoking over time in hardcore smokers using longitudinal descriptive analysis. Secondary data from the Korean Welfare Panel Study were analyzed using autoregressive cross-lagged modeling. Participants included 342 hardcore smokers who participated in the 8th to 11th waves of the panel study. Analyses revealed that change(s) in depression levels according to time had a significant positive relationship with the total amount of smoking per day (β=.29, β=.19, β=.17, p<.001), while change(s) in total amount of smoking per day according to time had a significant positive relationship with depression (β=.43, β=.50, β=.38, p<.001). Analysis of the cross-lagged effect between depression and total amount of smoking per day showed that depression at one time point had a significantly positive relationship with the total amount of smoking per day at the next time point (β=.14, β=.13, β=.13, p=.021), and that the total amount of smoking per day at one time point had a significant positive relationship with depression at the next time point (β=.04, β=.04, β=.03, p=.044). The findings in the present study confirmed a cross-interaction between depression and total amount of smoking per day in hardcore smokers. The present findings could be used to develop appropriate smoking-related interventions.

Interventions for improving modifiable risk factor control in the secondary prevention of stroke.

People with stroke or transient ischaemic attack (TIA) are at increased risk of future stroke and other cardiovascular events. Stroke services need to be configured to maximise the adoption of evidence-based strategies for secondary stroke prevention. Smoking-related interventions were examined in a separate review so were not considered in this review. This is an update of our 2014 review. To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control, including patient adherence to prescribed medications, and the occurrence of secondary cardiovascular events. We searched the Cochrane Stroke Group Trials Register (April 2017), the Cochrane Effective Practice and Organisation of Care Group Trials Register (April 2017), CENTRAL (the Cochrane Library 2017, issue 3), MEDLINE (1950 to April 2017), Embase (1981 to April 2017) and 10 additional databases including clinical trials registers. We located further studies by searching reference lists of articles and contacting authors of included studies. We included randomised controlled trials (RCTs) that evaluated the effects of organisational or educational and behavioural interventions (compared with usual care) on modifiable risk factor control for secondary stroke prevention. Four review authors selected studies for inclusion and independently extracted data. The quality of the evidence as 'high', 'moderate', 'low' or 'very low' according to the GRADE approach (GRADEpro GDT).Three review authors assessed the risk of bias for the included studies. We sought missing data from trialists.The results are presented in 'Summary of findings' tables. The updated review included 16 new studies involving 25,819 participants, resulting in a total of 42 studies including 33,840 participants. We used the Cochrane risk of bias tool and assessed three studies at high risk of bias; the remainder were considered to have a low risk of bias. We included 26 studies that predominantly evaluated organisational interventions and 16 that evaluated educational and behavioural interventions for participants. We pooled results where appropriate, although some clinical and methodological heterogeneity was present.Educational and behavioural interventions showed no clear differences on any of the review outcomes, which include mean systolic and diastolic blood pressure, mean body mass index, achievement of HbA1c target, lipid profile, mean HbA1c level, medication adherence, or recurrent cardiovascular events. There was moderate-quality evidence that organisational interventions resulted in improved blood pressure control, in particular an improvement in achieving target blood pressure (odds ratio (OR) 1.44, 95% confidence interval (CI) 1.09 to1.90; 13 studies; 23,631 participants). However, there were no significant changes in mean systolic blood pressure (mean difference (MD), -1.58 mmHg 95% CI -4.66 to 1.51; 16 studies; 17,490 participants) and mean diastolic blood pressure (MD -0.91 mmHg 95% CI -2.75 to 0.93; 14 studies; 17,178 participants). There were no significant changes in the remaining review outcomes. We found that organisational interventions may be associated with an improvement in achieving blood pressure target but we did not find any clear evidence that these interventions improve other modifiable risk factors (lipid profile, HbA1c, medication adherence) or reduce the incidence of recurrent cardiovascular events. Interventions, including patient education alone, did not lead to improvements in modifiable risk factor control or the prevention of recurrent cardiovascular events.

Public acceptability of government intervention to change health-related behaviours: a systematic review and narrative synthesis.

BackgroundGovernments can intervene to change health-related behaviours using various measures but are sensitive to public attitudes towards such interventions. This review describes public attitudes towards a range of policy interventions aimed at changing tobacco and alcohol use, diet, and physical activity, and the extent to which these attitudes vary with characteristics of (a) the targeted behaviour (b) the intervention and (c) the respondents.MethodsWe searched electronic databases and conducted a narrative synthesis of empirical studies that reported public attitudes in Europe, North America, Australia and New Zealand towards interventions relating to tobacco, alcohol, diet and physical activity. Two hundred studies met the inclusion criteria.ResultsOver half the studies (105/200, 53%) were conducted in North America, with the most common interventions relating to tobacco control (110/200, 55%), followed by alcohol (42/200, 21%), diet-related interventions (18/200, 9%), interventions targeting both diet and physical activity (18/200, 9%), and physical activity alone (3/200, 2%). Most studies used survey-based methods (160/200, 80%), and only ten used experimental designs.Acceptability varied as a function of: (a) the targeted behaviour, with more support observed for smoking-related interventions; (b) the type of intervention, with less intrusive interventions, those already implemented, and those targeting children and young people attracting most support; and (c) the characteristics of respondents, with support being highest in those not engaging in the targeted behaviour, and with women and older respondents being more likely to endorse more restrictive measures.ConclusionsPublic acceptability of government interventions to change behaviour is greatest for the least intrusive interventions, which are often the least effective, and for interventions targeting the behaviour of others, rather than the respondent him or herself. Experimental studies are needed to assess how the presentation of the problem and the benefits of intervention might increase acceptability for those interventions which are more effective but currently less acceptable.

(338) Pain and motivation to smoke tobacco: Experimental findings and a theoretical conceptualization

The prevalence of smoking among chronic pain patients is twice that of the general population. Despite evidence that smokers are at risk for developing and exacerbating painful conditions, yet consistent with evidence of smoking-related analgesia, most patients report a need to smoke when in pain, and correlations between pain intensity and cigarettes smoked have been reported. The purpose of this study was to determine whether cold-pressor pain would enhance motivation to smoke tobacco. Smokers were randomly assigned to either pain or no pain conditions. Results indicated that pain increased urge ratings (p < .001) and produced shorter latencies to smoke (p = .03), with increased urge ratings partially mediated by negative affect (p < .001). This study provides the first experimental evidence that situational pain is a potent motivator of smoking. Comprising the literature to date, we conceptualize a potentially reciprocal relationship between pain and smoking that acts as a positive feedback loop, with the end result being increases in both pain and smoking. We propose that smokers who are motivated to use tobacco to cope with or assuage pain may unwittingly aggravate their painful condition by increasing their cigarette consumption, thus engendering a vicious cycle that could lead to greater nicotine dependence. We are currently testing the causal relationship between pain and smoking motivation by manipulating potential mediating (use of pain-related coping behaviors) and moderating variables (smoking-related outcome expectancies), as influenced by social learning theory-based conceptualizations of pain coping and addiction motivation. This 2X2 crossed-factorial design will also provide an analogue test of variables that may influence interventions for individuals with comorbid pain and addiction disorders. PURPOSE: The ultimate goals of this line of research are to better understand the relationship between smoking and chronic pain, and to develop smoking-related interventions for individuals in pain.

ANOTHER EXAMPLE OF AN ILLICIT CIGARETTE MARKET: A STUDY OF PSYCHIATRIC PATIENTS IN TORONTO, ONTARIO

Tobacco taxation is a key mechanism for reducing smoking consumption and prevalence in the general population. Few studies, however, have acknowledged the disproportionately heavy tobacco tax burden placed upon some groups—usually poor, marginalized populations—in the drive for population-based public health goals.1 Shelley et al.2 recently examined the relations between a large tax increase in New York State and the development of a pervasive, illicit cigarette market in a low-income minority community and described the financial burden of smoking among the poor who had not quit. Our letter extends these qualitative findings in 2 ways: by examining similar issues in a different marginalized, low-income population—psychiatric patients in one of Canada’s largest psychiatric hospitals—and by quantifying the relative magnitude of illicit cigarette consumption in this population. Approximately 60% to 80% of people with schizophrenia and other severe mental illnesses smoke cigarettes3,4—a rate of roughly 4 times higher than that of the general population in Canada.5 Smoking plays an important role in the significantly higher rates of coronary heart disease morbidity and mortality found among people with severe mental illnesses, and coronary heart disease screening and smoking-cessation programs are much needed for this population.6 Our study involved the collection of cigarette butts from 3 sites in Toronto, Ontario: a 436-bed inpatient psychiatric hospital (where 70–75% of the patients have a primary diagnosis of schizophrenia), an addiction and mental health research and outpatient facility, and a large general hospital. In addition, a garbage audit was performed at the inpatient psychiatric facility to extract cigarette packages from 1 week’s worth of garbage. The collected cigarette butts were then sorted according to their filter-tip logos. In Ontario, an unbranded cigarette filter almost always indicates an illicit brand. The inpatient psychiatric hospital had a dramatically higher rate of “unbranded” cigarette butts: 54% versus 16% at the research facility and 6% at the general hospital site (Figure 1 ▶). The garbage audit resulted in the extraction of 320 cigarette packages. Approximately 80% of the packages were from illicit tobacco brands—a rate dramatically higher than that found in a recent, city-wide garbage audit in Toronto.7 FIGURE 1— Patterns of branding on cigarette butts collected at an inpatient psychiatric hospital (n = 1288 butts), an addiction and mental health research and outpatient treatment facility (n = 1271 butts), and a general hospital (n = 1784 butts). Similar to the findings of Shelley et al., our study demonstrated that cigarette taxation policies appear to place a disproportionate burden on some marginalized groups. As a result, it is important to assess and ensure principles of taxation equity for such populations,8 especially given that higher cigarette prices may paradoxically increase the availability of cheap (but illicit) cigarettes and undermine smoking-related interventions.

Adolescents Discriminate between Types of Smokers and Related Risks

Many studies concerning cigarette smoking and smoking-related outcomes among adolescents use categories such as “casual” or “regular” smoker to define different types of smokers. It is not clear whether adolescents themselves differentiate between different types of smokers. The present study sought to examine whether and how adolescents discriminate between categories of smokers and how these discriminations engender different perceptions of risk attributable to smoking. Five hundred and fifty ninth graders (mean age 14) who reported never smoking tobacco completed a self-administered survey concerning smoking attitudes and beliefs. Adolescents discriminated significantly between nonsmokers, casual smokers, smokers, and addicted smokers, based on both frequency of smoking and the number of cigarettes smoked. Addicted smokers were perceived as having the greatest chance of experiencing negative outcomes, followed by the smoker, the casual smoker, and last, the nonsmoker. Finally, adolescents ascribed a far greater chance of quitting smoking to casual smokers than they did to either regular or addicted smokers. Understanding how adolescents define and discriminate between types of smokers has important implications for smoking-related interventions, especially concerning how we communicate about risks of smoking.