The content of cigarette counter-advertising: are perceived functions of smoking addressed?

A Content Analysis of Online Messages about Sugar-Sweetened Beverages

Media campaigns can reduce or promote the consumption of sugar-sweetened beverages (SSBs). Brief, US-based English-language online messages were gathered from searchable media platforms, a process that yielded 112 anti-SSB videos and 29 pro-SSB commercials. Using a combination of inductive and deductive methods, a content analysis of those messages was conducted to identify their properties. They were coded for the direction (pro vs. anti), target of the advocacy (e.g., consumption vs. policy), actor demographics (gender, age, and ethnicity), persuasive theme (e.g., excessive sugar, nurturing), and message sensation value. Anti-SSB appeals primarily targeted individual-level consumption behavior. They utilized six persuasive themes and often included more than one theme in a single message. Pro-SSB messages used feel-good themes and utilized only one theme per message. The proportions of adults, adolescents, and children differed by the direction of the advocacy. Black, Hispanic, and Asian actors were under-represented in the anti-SSB sample relative to Whites. Pro-SSB appeals were slightly higher than anti-SSB appeals in message sensation value (p = 0.09). The findings illuminate the message features that characterize the universe of brief anti-SSB appeals available online, highlight messaging disparities, and reveal the absence of certain common, effective persuasive themes.

Cigarette smoking dose-response and suicidal ideation among young people in Nepal: a cross-sectional study

BACKGROUND

Worldwide, tobacco smoking is a major risk factor for morbidity and early mortality among adult population. The present study aimed to find out the association between current smoking and suicidal ideation among young people in Nepal.

MATERIALS AND METHODS

A cross-sectional questionnaire-based survey was carried out among 452 youths from Pokhara, Nepal. The present study included both genders (age 18-24 years) who were smokers as well as non-smokers.

RESULTS

Across the study period, 452 participants were identified after matching for age, and sex (226 in the smoking group and 226 in the non-smoking group). The mean age of participants was 21.6±1.2 years and 58.8% were males. The overall rate of suicidal ideation in our cohort was 8.9%. Smokers were slightly more likely to report suicidal ideation than non-smokers (aOR 1.12). The risk of developing suicidal ideation was 3.56 (95% CI 1.26-10.09) times more in individuals who smoked greater than 3.5 cigarettes per week (p=0.01).

CONCLUSION

The rate of suicidal ideation was slightly higher among smokers and a dose-response relationship was identified with the number of cigarettes smoked per week. Being aware of the link between smoking and suicidal ideation may help health care professionals working with young people to address more effectively the issues of mental well-being and thoughts about suicide.

Relationships Between Social Support, Loneliness, and Internet Addiction in Chinese Postsecondary Students: A Longitudinal Cross-Lagged Analysis

Using the Internet has become one of the most popular leisure activities among postsecondary students in China. Concern about the large number of students using the Internet has led to an increase in research on the influencing factors of Internet addiction and the negative consequences caused by it. This short-term longitudinal study examined the associations among three dimensions of social support [objective support (OS), subjective support (SS), and support utilization (SU)], loneliness, and the four dimensions of Internet addiction (compulsive Internet use [CIU] & withdrawal from Internet addiction [WIA], tolerance of Internet addiction [TIA], time-management problems [TMPs], and interpersonal and health problems [IHPs]) in a Chinese sample. A total of 169 postsecondary first-year students (88 girls and 81 boys; mean age = 18.31 years) participated in the study. The questionnaire measurements were taken at the beginning of the school year (T1), 6 months later (T2), and 1 year later (T3). Cross-lagged and structural equation modeling analyses indicated that (a) OS (T1) and SU (T1) negatively predicted loneliness (T2); and loneliness (T2) negatively predicted OS (T3) and SU(T3); (b) CIU & WIA (T1) and TMPs (T1) positively predicted loneliness (T2); and loneliness (T2) positively predicted CIU & WIA (T3), TIA (T3), TMP (T3), and IHP (T3); (c) SS (T1) directly affected TIA (T3) and TMP (T3); and (d) loneliness (T2) played a mediating role in the relationships between OS (T1) and CIU (T3), OS (T1) and TMP (T3), OS (T1) and IHP (T3), and SU (T1) and IHP (T3). Finally, interventions for Internet addiction and implications for future studies were discussed.

A Profile of Individuals with Anti-tobacco Message Fatigue

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Reactance and Coping Responses to Tobacco Counter-Advertisements

Tobacco prevention messages generally take one of three tactics: They can be educational, attack the tobacco industry, or attack particular brands. Being a smoker and smoking a particular brand may form an essential part of a person's self-identity. As such, reactance theory suggests that attack messages can unintentionally attack smokers' self-image. A 2 × 2 × 2 × 2 experiment using six different messages and 260 respondents tested whether smokers have different reactions to tobacco counter-advertisements than nonsmokers. It also examined whether attacking a smoker's brand leads to greater reactance and other maladaptive responses compared to attacking other brands. Consistent with predictions, smokers reported more maladaptive coping responses and fewer adaptive coping responses to tobacco counter-ads than nonsmokers. The study also reveals differences attributable to brand identification. These findings suggest that interventions should consider different counter-advertising tactics for smokers and nonsmokers. Similar admonitions may apply to counter-advertising strategies on other health issues.

Alcohol harm reduction advertisements: a content analysis of topic, objective, emotional tone, execution and target audience

BACKGROUND

Public health mass media campaigns may contribute to reducing the health and social burden attributed to alcohol consumption, but little is known about which advertising characteristics have been used, or have been effective, in alcohol harm reduction campaigns to date. As a first step towards encouraging further research to identify the impact of various advertising characteristics, this study aimed to systematically identify and examine the content of alcohol harm reduction advertisements (ads).

METHOD

Ads were identified through an exhaustive internet search of Google, YouTube, Vimeo, and relevant government and health agency websites. Eligible ads were: English language, produced between 2006 and 2014, not primarily focused on drink-driving or alcohol in pregnancy, and not alcohol industry funded. Systematic content analysis of all ads was performed; each ad was double-coded.

RESULTS

In total, 110 individual ads from 72 different alcohol harm reduction campaigns were identified, with the main source countries being Australia (40%) and the United Kingdom (26%). The dominant topic for 52% of ads was short-term harms, while 10% addressed long-term harms, 18% addressed underage drinking, 17% communicated a how-to-change message, and 3% advocated for policy change. The behavioural objective of most ads was to motivate audiences to reduce their alcohol consumption (38%) or to behave responsibly and/or not get drunk when drinking (33%). Only 10% of all ads mentioned low-risk drinking guidelines. Eighty-seven percent of ads used a dramatisation execution style and 74% had a negative emotional tone. Ninety percent of ads contained messages or content that appeared to target adults, and 36% specifically targeted young adults.

CONCLUSIONS

Some message attributes have been employed more frequently than others, suggesting several promising avenues for future audience or population-based research to compare the relative effectiveness of different characteristics of alcohol harm reduction ads. Given most alcohol-attributable harm is due to long-term disease, these findings suggest future campaigns may fill a potentially important gap if they were to focus on long-term harms. There is scope for such long-term harm campaigns to place greater emphasis on encouraging reduced personal consumption of alcohol, potentially through more frequent communication of low-risk drinking guidelines.

Effects of Temporal Framing on Response to Antismoking Messages: The Mediating Role of Perceived Relevance

This study tested the effect of temporal framing on young adult smokers' response to antismoking communication messages. In two studies using largely identical designs, young adult smokers recruited from a large university (n = 52) and Amazon Mechanical Turk (n = 210) were exposed to either no messages or messages featuring different temporal frames. Analysis of the combined data (N = 262) showed that framing the health consequences of smoking in a proximal (vs. distal) time frame led to greater perceived message relevance, less use of heuristic processing, greater use of systematic processing, greater positive affect, and more intense fear. Mediation analysis showed that perceived relevance was a significant mediator of the effect of temporal framing on message processing and emotional responses. In separate analysis of the Amazon Mechanical Turk data, the proximal frame also showed a consistent pattern of stronger impact on behavioral intentions compared to the distal frame, but the difference was only significant on the measure of intending to try to quit. Overall, findings of this study suggest that using proximal (vs. distal) frames may enhance receptivity to antismoking messages among young adult smokers, although the behavioral impact of this framing strategy still awaits further research.

Teens' Reactance to Anti-Smoking Public Service Announcements: How Norms Set the Stage

Data from a study of the effects of anti-smoking ads were analyzed. This study measured the accessibility of peer and parent norms for smoking, exposed teens to three anti-smoking ads that either emphasized personal narratives of the dangers of smoking or had a surprise ending, and measured reactance to the messages. Readiness to smoke was assessed via a phone survey 3 months later. The accessibility of pro-smoking peer norms increased readiness to engage in smoking behavior through reactance toward anti-smoking messages. The accessibility of parent norms was unrelated to reactance. Reactance was particularly strong when the ads included a surprise ending. Peer norms that oppose smoking, particularly if they can be brought to mind quickly, are an important protective factor in that they may reduce reactance to anti-smoking messages.

Variations in state use of antitobacco message themes predict youth smoking prevalence in the USA, 1999-2005

OBJECTIVE

This study tests relationships between the volume of advertisements (ads; public service announcements (PSAs)) employed in state antismoking campaigns, use of different themes and stylistic features in these PSAs, and state youth smoking prevalence between 1999 and 2005.

METHODS

We merged commercially available data on televised antismoking PSAs that aired between 1998 and 2004 with data on state tobacco control activity to test the relationship between the volume and content of youth-targeted and general-targeted/adult-targeted antismoking PSAs on youth smoking prevalence, controlling for other tobacco control efforts. We use content analysis and ordinary least squares (OLS) regression to assess which thematic and stylistic features employed in state antismoking PSAs are associated with reduced smoking prevalence.

RESULTS

A 100-ad increase in the yearly volume of youth-targeted state antismoking PSAs was associated with a 0.1 percentage point decrease in state youth smoking rates in the following year. This relationship was driven by variation in state use of PSAs emphasising health consequences to self or others and anti-industry appeals. Controlling for appearances of these themes, use of graphic imagery and personal testimonials did not predict reduced smoking prevalence. Adult-targeted/general-targeted PSAs were not associated with youth smoking prevalence.

CONCLUSIONS

Youth-targeted state antitobacco PSAs that emphasise the health consequences of smoking (to oneself and others) and contain anti-industry appeals are associated with reduced youth smoking rates. Future work should avoid typologies that do not account for the co-occurrence of thematic and stylistic content in antitobacco PSAs.

Tobacco industry marketing to low socioeconomic status women in the U.S.A

OBJECTIVES

Describe tobacco companies' marketing strategies targeting low socioeconomic status (SES) females in the U.S.A.

METHODS

Analysis of previously secret tobacco industry documents.

RESULTS

Tobacco companies focused marketing on low SES women starting in the late 1970s, including military wives, low-income inner-city minority women, 'discount-susceptible' older female smokers and less-educated young white women. Strategies included distributing discount coupons with food stamps to reach the very poor, discount offers at point-of-sale and via direct mail to keep cigarette prices low, developing new brands for low SES females and promoting luxury images to low SES African-American women. More recently, companies integrated promotional strategies targeting low-income women into marketing plans for established brands.

CONCLUSIONS

Tobacco companies used numerous marketing strategies to reach low SES females in the U.S.A. for at least four decades. Strategies to counteract marketing to low SES women could include (1) counteracting price discounts and direct mail coupons that reduce the price of tobacco products, (2) instituting restrictions on point-of-sale advertising and retail display and (3) creating counteradvertising that builds resistance to psychosocial targeting of low SES women. To achieve health equity, tobacco control efforts are needed to counteract the influence of tobacco industry marketing to low-income women.

Seeing is believing: the direct and contingent influence of pictures in health promotion advertising

Because pictures, compared with words, are more effective in triggering vivid imagery, their effects should increase in situations in which they play a crucial role in facilitating imagery. This study accordingly explored the relative effects of information presented in pictorial formats and verbal formats in health promotion advertising. Symptoms presented in pictorial formats increased perceptions of the severity of a disease, whereas prevention options presented in pictorial formats enhanced efficacy in preventing the disease. This study also examined two contingent situations: when people were oriented toward visual processing, and when imagery could not be easily triggered without the help of pictures, such as when symptoms or prevention options were difficult or unpleasant to imagine. The findings of three studies supported the offered predictions.

How neuroticism affects responses to anti-smoking messages

The effect of trait neuroticism on college students' (n=200) responses to anti-smoking public service announcements (PSAs) was examined using a 2 (neuroticism: high vs. low) × 3 (message type: personal testimony, secondhand smoke, and informative) × 3 (message: nested within message type) design. We hypothesized that those high in neuroticism would be avoidant toward anti-smoking messages, have quicker and stronger negative reactions and perceive the messages as more biased and less involving. As hypothesized, those high in neuroticism were more likely to want to avoid thinking about smoking as a function of viewing the messages and more likely to see messages as biased; however, neuroticism did not affect judgments of message involvement. Tobacco use and gender also affected message bias and avoidance. Those scoring high in neuroticism also responded quicker to negative emotion assessments to messages. Implications for the importance of neuroticism in message design and message processing research are discussed.

"Yo! This is no lie, if you smoke, you die": a content analysis of anti-smoking posters created by adolescents

INTRODUCTION

Exposure to anti-smoking messages is strongly associated with lower smoking initiation by adolescents. However, few anti-smoking efforts have involved message generation by adolescents themselves. This article presents a content analysis of anti-smoking posters created by middle school students in two northeastern schools in the United States. Understanding how smoking prevention messages should be framed from the perspective of young teens will provide us with formative information about what kinds of smoking prevention messages teens believe are effective.

METHODS

50 anti-smoking posters created by adolescents (11-14 years) were content analysed, with a focus around three broad areas: effects of smoking portrayed in posters, specific ways of message depiction in posters and use of slogans.

RESULT

Results of content analysis reveal that appearance-related factors (44%) were most commonly used to convey harmful health effects of smoking, followed by messages about death and dying (30%), before-after effects of smoking (22%), other sickness-related effects of smoking (20%) and cancer (12%). Supplemental thematic analysis revealed that in a majority of posters pictures were exaggerated and were dominant part of the posters.

DISCUSSION

These results provide information about anti-smoking messages/themes perceived as efficacious by young adolescents and have implications for developing anti-smoking messages for adolescents.