A national mass media smoking cessation campaign: effects by race/ethnicity and education

A systematic review and network meta-analysis of population-level interventions to tackle smoking behaviour

This preregistered systematic review and meta-analysis (PROSPERO: CRD 42022311392) aimed to synthesize the effectiveness of all available population-level tobacco policies on smoking behaviour. Our search across 5 databases and leading organizational websites resulted in 9,925 records, with 476 studies meeting our inclusion criteria. In our narrative summary and both pairwise and network meta-analyses, we identified anti-smoking campaigns, health warnings and tax increases as the most effective tobacco policies for promoting smoking cessation. Flavour bans and free/discounted nicotine replacement therapy also showed statistically significant positive effects on quit rates. The network meta-analysis results further indicated that smoking bans, anti-tobacco campaigns and tax increases effectively reduced smoking prevalence. In addition, flavour bans significantly reduced e-cigarette consumption. Both the narrative summary and the meta-analyses revealed that smoking bans, tax increases and anti-tobacco campaigns were associated with reductions in tobacco consumption and sales. On the basis of the available evidence, anti-tobacco campaigns, smoking bans, health warnings and tax increases are probably the most effective policies for curbing smoking behaviour.

Awareness of and receptivity to FDA's point-of-sale tobacco public education campaign

The purpose of the study was to assess awareness of and receptivity to FDA's point-of-sale (POS) tobacco public education campaign for adult cigarette smokers called Every Try Counts; it was the first multi-county POS campaign in the U.S. The design was a county-level treatment-control three-wave longitudinal design. The setting was 15 treatment and 15 control counties. Subjects were smokers ages 25 to 54 (N = 3,628). 4,145 individuals screened in as eligible; 3,628 (87.5% response rate) completed the Wave 1 questionnaire (Wave 2: n = 2,812; Wave 3: n = 2,571; retention 70.9%). Measures were self-reported brand and ad awareness (saw any ad a few times or more) and receptivity (5-item perceived effectiveness scale). The analysis included descriptive analyses of receptivity; bivariate analyses of awareness by treatment group; and covariate- and time-adjusted logistic regression models to determine changes in awareness attributable to the campaign. Receptivity was moderate and differed significantly by race/ethnicity. As was the case for all waves, at wave 3, ad awareness was significantly higher in treatment (53.3%) than control counties (36.1%, p < .05). In regression models, brand (OR = 1.53, 95% CI: 1.26-1.86) and ad (OR = 1.74, 95% CI: 1.39-2.16) awareness were significantly higher in treatment than control counties. Every Try Counts generated a moderate level of receptivity and attention from cigarette smokers. Limitations include self-reports of campaign awareness and generalizability to a small number of U.S. counties.

Can High Exposure Help to Close Gaps? The Influence of COVID-19 Preventive Messages on Behavioral Intentions by Educational Attainment in Chile

The literature in the field of health communication has shown the existence of gaps between groups of different socioeconomic levels both in exposure to health campaign messages and in the influence these messages exert on individuals' health decisions. In this article, we examine the association between educational attainment and exposure to messages promoting COVID-19 preventive behaviors, namely, physical distancing, handwashing, and masks wearing in Chile. In addition, we model the association between exposure to these messages and the intentions to carry out the behaviors, as well as the differences attributable to educational attainment in the influence of exposure. A cross-sectional population survey combining online and telephone techniques was conducted among 3,592 adults in Chile. Regression analysis revealed that lower educational level and frequency of television use were positively associated with greater exposure to preventive messages. Exposure to preventive messages, in turn, was positively associated with intentions to maintain the three behaviors examined. Individuals in the lower educational attainment group had lower intentions to engage in two of the three behaviors, but those in these segments who were more exposed to preventive messages were as likely as their more educated counterparts to intend wearing masks and adhering to physical distance. The findings of this study underscore the importance of reaching the least educated segments with campaign messages in the context of public health crisis, since these messages can close gaps between the more and less educated group in their intentions to engage in preventive behaviors.

Why are anti-smoking health-information interventions less effective among low-socioeconomic status groups? A systematic scoping review

ISSUES

This paper identifies and synthesises explanations proposed in the literature for the (in)effectiveness of institutional anti-smoking health-information interventions (HII) among low-socioeconomic status (SES) adults in high-income countries.

APPROACH

We searched eight databases for relevant papers from various disciplines: Studies published in English since 2009, on the effectiveness among low-SES adults of anti-smoking HIIs, aimed at changing knowledge/behaviour, and conducted by official institutions, were included. Through a scoping review, we synthesised: study design, SES indicator, intervention type, intervention source, study population, outcomes, low-SES effects, equity effects, proposed explanations and whether these were studied empirically.

KEY FINDINGS

Thirty-eight studies were included in this scoping review. Seventeen suggested explanations for the (in)effectiveness of the HIIs in low-SES adults, but only nine assessed them empirically. Thematic analysis yielded six themes: message engagement, material conditions, cognition, risk perception, social environment and self-efficacy.

IMPLICATIONS

Explanations for intervention results are not always present, and empirical evidence for explanations is often not provided. Including such explanations and testing their empirical merits in future research can provide the crucial information needed for developing more effective anti-smoking HIIs for low-SES adults.

CONCLUSIONS

To our knowledge, this is the first review to explore the explanations proposed for why anti-smoking HIIs are (in)effective among low-SES adults. It contains insights for future studies aiming to provide empirical evidence on the causes of this (in)effectiveness, and concludes that such research is yet largely missing, but crucial to the quest for more effective and equitable anti-smoking interventions.

Anti-Smoking Media Campaigns and Disparities in Smoking Cessation in the United States, 2001-2015

PURPOSE

To evaluate sociodemographic differences in the relationship between state and national anti-smoking media campaigns and cessation behaviors among adult smokers in the U.S.

DESIGN

Repeated cross-sectional analysis.

SETTING

U.S. nationally representative survey of adults ages 18 and older, 2001-2015.

SUBJECTS

76,278 year-ago smokers from the 2001-2015 Tobacco Use Supplement to the Current Population Survey.

MEASURES

Area-level exposure to State-sponsored and "Tips from former smokers" anti-tobacco media campaigns was the primary predictor of this study. Outcome variables included: quit attempt in the past 12 months, past 30-day smoking cessation, and past 90-day smoking cessation among year-ago smokers.

ANALYSIS

We conducted modified Poisson regression models to examine the association between media campaign exposure and cessation behaviors. We also examined effect modification on the additive scale by sex, race/ethnicity, income, and education using average marginal effects.

RESULTS

Year-ago smokers with greater exposure to media campaigns were more likely to report 30-day (Prevalence Ratio [PR]: 1.18, CI: 1.03, 1.36) and 90-day cessation (PR: 1.18, CI: 1.00, 1.41) compared to respondents with less campaign exposure. We found no evidence of effect modification by sociodemographic variables.

CONCLUSION

Exposure to anti-smoking media campaigns were associated with year-ago smokers' cessation behaviors. However, there were no differences in the association by sex, race/ethnicity, income, or education, indicating that broadly focused media campaigns may be insufficient to reduce smoking cessation among priority populations, and thus health disparities generally.

LGBT young adults' awareness of and receptivity to the This Free Life tobacco public education campaign

PURPOSE

This study measures awareness of and receptivity to the Food and Drug Administration's This Free Life campaign seeking to change tobacco-related attitudes and beliefs among lesbian, gay, bisexual and/or transgender (LGBT) young adults.

METHODS

Participants were young adults who self-identify as LGBT. The evaluation uses a treatment-control design. This study includes data from four survey rounds with participants from each round invited to participate in subsequent rounds and new participants invited to account for attrition. Bivariate analyses assess treatment-control differences in campaign awareness by round. We used multivariable logistic regression models with a time×treatment interaction and covariates to assess whether increases in awareness were greater in treatment than control from follow-ups 1 to 4. Descriptive statistics describe perceived effectiveness and models explore covariates of perceived effectiveness.

RESULTS

At each round, an increasing number of participants in treatment were brand aware (25%-67%) and reported high (16%-34%) and medium (16%-25%) video awareness compared with control (all p<0.001). Regressions revealed interactions in brand and video awareness, wherein the effect of treatment on awareness increased more over time, with significant treatment-control differences in change from follow-up 1 to 4 (all p<0.05). Reactions to all but one ad were positive (one neutral) with mean perceived effectiveness scores from 3.21 to 3.92 ('neither disagree nor agree' to 'agree' on 5-point scale). Perceived effectiveness differed by LGBT identity (all p<0.05).

CONCLUSIONS

At follow-up 4, This Free Life reached most of the campaign audience in treatment markets and has achieved higher awareness in treatment than control markets, at individual survey rounds and over time.

Broadcast reach and self-reported exposure to court-ordered corrective statements on cigarette harms

In August 2006, U.S. District Court Judge Gladys Kessler ordered four tobacco companies to disseminate court-approved corrective statements on five topics pertaining to health hazards of cigarette smoking. Based on the 2018 Health Information National Trends Survey (HINTS), approximately 50% of U.S. smokers viewed at least one corrective statement via television or newspaper during the first six months of the airings/publications (November 2017-April 2018). Using televised gross rating points (GRPs) and cross-sectional data from the 2018 HINTS (n = 3484) and 2019 HINTS (n = 3331), the current study extends previous ones by estimating broadcast reach/frequency and the moderating effect of survey year on smokers' exposure to a corrective statement. The weighted percentage of participants who viewed a corrective statement was significantly greater in the 2019 versus 2018 HINTS for smokers (64.3% vs. 50.5%, χ² _1df = 5.85, p = .01), but not for non-smokers (39% in 2018/2019, χ² _1df = 0.02; p = .88); this differential effect was evidenced by a significant interaction term (OR = 2.0(1.2, 3.2), p < .001). This study also revealed that the televised reach of the corrective statements to the U.S. population (43.5 GRPs/43.5%) was comparable to the published estimate from the 2018 HINTS (40.6%). The frequency of exposure to any corrective statement in the first six months of televised airings was only 0.68 exposures/month, an estimate that does not meet CDC Best Practices. Yet, as evidenced by the significant interaction with survey year, it is likely that the addition of messages to tobacco company websites and cigarette package onserts may have contributed to smokers' greater exposure to a corrective statement.

Pro-tobacco marketing and anti-tobacco campaigns aimed at vulnerable populations: A review of the literature

INTRODUCTION

We reviewed research literature on pro-tobacco marketing and anti-tobacco campaigns targeting eight vulnerable populations to determine key findings and research gaps. Results can inform tobacco policy and control efforts and the design of public education campaigns for these groups.

METHODS

Five journal databases in medicine, communication, and science, were used to identify 8875 peer-reviewed, original articles in English, published in the period 2004-2018. There were 144 articles that met inclusion criteria on pro-tobacco marketing or anti-tobacco campaigns aimed at eight US groups: women of reproductive age, racial/ethnic minority groups (African American, Hispanic/Latino, Asian/Pacific Islander and American Indian/Alaska Native), Lesbian/Gay/Bisexual/Transgender (LGBT) populations, groups with low socioeconomic status, rural/inner city residents, military/veterans, and people with mental health or medical co-morbidities. We summarized the number of articles for each population, type of tobacco, and pro-tobacco or anti-tobacco focus. Narrative summaries were organized by population and by pro-tobacco or anti-tobacco focus, with key strategies and gaps by group.

RESULTS

There were more studies on pro-tobacco marketing rather than anti-tobacco campaigns, and on cigarettes rather than other tobacco products. Major gaps included studies on Asian Americans, American Indian/Alaska Natives, pregnant women, LGBT populations, and those with mental health or medical co-morbidities. Gaps related to tobacco products were found for hookah, snus, and pipe/roll-your-own tobacco in the pro-tobacco studies, and for all products except cigarettes in anti-tobacco studies. Common tobacco industry methods used were tailoring of product and package design and messages that were used to reach and appeal to different sociodemographic groups. Studies varied by research design making it difficult to compare results.

CONCLUSIONS

We found major research gaps for specific groups and tobacco products. Public education campaigns need a stronger foundation in empirical studies focused on these populations. Research and practice would benefit from studies that permit comparisons across studies.

Strategies to customize responsible gambling messages: a review and focus group study

BACKGROUND

Responsible gambling messages are widely used as a tool to enable informed choice and encourage appropriate gambling behavior. It is generally accepted that gamblers have different levels of risk of developing gambling problems and require various harm minimization tools and resources. Therefore, it is reasonable to expect that responsible gambling messages should be customized and target specific groups of gamblers. This project aimed to understand hypothesized differences between cohorts of gamblers and receive qualitative feedback on archetypal targeted messages used to increase use of responsible gambling tools.

METHODS

Focus groups were held to test messages for specific cohorts: young adults (18-24 years), seniors (60+ years), frequent gamblers (weekly), and gamblers of skill-based games (poker, sports betting).

RESULTS

Cohorts exhibited different preferences and responses to message archetypes. Seniors preferred messages about limit setting, whilst young adults and frequent gamblers responded to messages about their own play and expertise. Skill game gamblers were interested in the odds of winning and their own outcomes over time. However, all groups agreed that using positive, non-judgmental language in messaging is important.

CONCLUSIONS

This research makes an important contribution to the field by demonstrating that the wording of message content will likely influence the effectiveness of such messages differentially across various groups of gamblers for engaging gamblers in harm reduction tools. Guidance is provided on themes that can be used by public health marketers.

Fear, Sadness and Hope: Which Emotions Maximize Impact of Anti-Tobacco Mass Media Advertisements among Lower and Higher SES Groups?

Emotive anti-tobacco advertisements can increase quitting. Discrete emotion theories suggest evoking fear may be more effective than sadness; less research has focused on hope. A weekly cross-sectional survey of smokers and recent quitters (N = 7683) measured past-month quit attempts. The main predictor was level of exposure to four different types of anti-tobacco advertisements broadcast in the two months prior to quit attempts: advertisements predominantly evoking fear, sadness, hope, or evoking multiple negative emotions (i.e., fear, guilt, and/or sadness). Greater exposure to fear-evoking advertisements (OR = 2.16, p < .01) increased odds of making a quit attempt and showed similar effectiveness among those in lower and higher SES areas. Greater exposure to advertisements evoking multiple negative emotions increased quit attempts (OR = 1.70, p < .01), but interactions indicated this was driven by those in lower SES, but not higher SES areas. Greater exposure to hope-evoking advertisements enhanced effects of fear-evoking advertisements among those in higher SES, but not lower SES areas. Findings suggest to be maximally effective across the whole population avoid messages evoking sadness and use messages eliciting fear. If the aim is to specifically motivate those living in lower SES areas where smoking rates are higher, multiple negative emotion messages, but not hope-evoking messages, may also be effective.

Mass media interventions for smoking cessation in adults

BACKGROUND

Mass media tobacco control campaigns can reach large numbers of people. Much of the literature is focused on the effects of tobacco control advertising on young people, but there are also a number of evaluations of campaigns targeting adult smokers, which show mixed results. Campaigns may be local, regional or national, and may be combined with other components of a comprehensive tobacco control policy.

OBJECTIVES

To assess the effectiveness of mass media interventions in reducing smoking among adults.

SEARCH METHODS

The Cochrane Tobacco Addiction Group search strategy was combined with additional searches for any studies that referred to tobacco/smoking cessation, mass media and adults. We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) and a number of electronic databases. The last search was carried out in November 2016.

SELECTION CRITERIA

Controlled trials allocating communities, regions or states to intervention or control conditions; interrupted time series.Adults, 25 years or older, who regularly smoke cigarettes. Studies which cover all adults as defined in studies were included.Mass media are defined here as channels of communication such as television, radio, newspapers, billboards, posters, leaflets or booklets intended to reach large numbers of people, and which are not dependent on person-to-person contact. The purpose of the mass media campaign must be primarily to encourage smokers to quit. They could be carried out alone or in conjunction with tobacco control programmes.The primary outcome was change in smoking behaviour. This could be reported as changes in prevalence, changes in cigarette consumption, quit rates, or odds of being a smoker.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed all studies for inclusion criteria and for study quality (MB, LS, RTM). One author (MB) extracted data, and a second author (LS) checked them.Results were not pooled due to heterogeneity of the included studies and are presented narratively and in table form.

MAIN RESULTS

Eleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow-up, methods of evaluation and also in definitions and measures of smoking behaviour used. Among seven campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large-scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. Among the eight studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex-smokers combined.

AUTHORS' CONCLUSIONS

There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality. One state-wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign. Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme. Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney). The intensity and duration of mass media campaigns may influence effectiveness, but length of follow-up and concurrent secular trends and events can make this difficult to quantify. No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender.

Targeted mass media interventions promoting healthy behaviours to reduce risk of non-communicable diseases in adult, ethnic minorities

BACKGROUND

Physical activity, a balanced diet, avoidance of tobacco exposure, and limited alcohol consumption may reduce morbidity and mortality from non-communicable diseases (NCDs). Mass media interventions are commonly used to encourage healthier behaviours in population groups. It is unclear whether targeted mass media interventions for ethnic minority groups are more or less effective in changing behaviours than those developed for the general population.

OBJECTIVES

To determine the effects of mass media interventions targeting adult ethnic minorities with messages about physical activity, dietary patterns, tobacco use or alcohol consumption to reduce the risk of NCDs.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, ERIC, SweMed+, and ISI Web of Science until August 2016. We also searched for grey literature in OpenGrey, Grey Literature Report, Eldis, and two relevant websites until October 2016. The searches were not restricted by language.

SELECTION CRITERIA

We searched for individual and cluster-randomised controlled trials, controlled before-and-after studies (CBA) and interrupted time series studies (ITS). Relevant interventions promoted healthier behaviours related to physical activity, dietary patterns, tobacco use or alcohol consumption; were disseminated via mass media channels; and targeted ethnic minority groups. The population of interest comprised adults (≥ 18 years) from ethnic minority groups in the focal countries. Primary outcomes included indicators of behavioural change, self-reported behavioural change and knowledge and attitudes towards change. Secondary outcomes were the use of health promotion services and costs related to the project.

DATA COLLECTION AND ANALYSIS

Two authors independently reviewed the references to identify studies for inclusion. We extracted data and assessed the risk of bias in all included studies. We did not pool the results due to heterogeneity in comparisons made, outcomes, and study designs. We describe the results narratively and present them in 'Summary of findings' tables. We judged the quality of the evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology.

MAIN RESULTS

Six studies met the inclusion criteria, including three RCTs, two cluster-RCTs and one ITS. All were conducted in the USA and comprised targeted mass media interventions for people of African descent (four studies), Spanish-language dominant Latino immigrants (one study), and Chinese immigrants (one study). The two latter studies offered the intervention in the participants' first language (Spanish, Cantonese, or Mandarin). Three interventions targeted towards women only, one pregnant women specifically. We judged all studies as being at unclear risk of bias in at least one domain and three studies as being at high risk of bias in at least one domain.We categorised the findings into three comparisons. The first comparison examined mass media interventions targeted at ethnic minorities versus an equivalent mass media intervention intended for the general population. The one study in this category (255 participants of African decent) found little or no difference in effect on self-reported behavioural change for smoking and only small differences in attitudes to change between participants who were given a culturally specific smoking cessation booklet versus a booklet intended for the general population. We are uncertain about the effect estimates, as assessed by the GRADE methodology (very low quality evidence of effect). No study provided data for indicators of behavioural change or adverse effects.The second comparison assessed targeted mass media interventions versus no intervention. One study (154 participants of African decent) reported effects for our primary outcomes. Participants in the intervention group had access to 12 one-hour live programmes on cable TV and received print material over three months regarding nutrition and physical activity to improve health and weight control. Change in body mass index (BMI) was comparable between groups 12 months after the baseline (low quality evidence). Scores on a food habits (fat behaviours) and total leisure activity scores changed favourably for the intervention group (very low quality evidence). Two other studies exposed entire populations in geographical areas to radio advertisements targeted towards African American communities. Authors presented effects on two of our secondary outcomes, use of health promotion services and project costs. The campaign message was to call smoking quit lines. The outcome was the number of calls received. After one year, one study reported 18 calls per estimated 10,000 targeted smokers from the intervention communities (estimated target population 310,500 persons), compared to 0.2 calls per estimated 10,000 targeted smokers from the control communities (estimated target population 331,400 persons) (moderate quality evidence). The ITS study also reported an increase in the number of calls from the target population during campaigns (low quality evidence). The proportion of African American callers increased in both studies (low to very low quality evidence). No study provided data on knowledge and attitudes for change and adverse effects. Information on costs were sparse.The third comparison assessed targeted mass media interventions versus a mass media intervention plus personalised content. Findings are based on three studies (1361 participants). Participants in these comparison groups received personal feedback. Two of the studies recorded weight changes over time. Neither found significant differences between the groups (low quality evidence). Evidence on behavioural changes, and knowledge and attitudes typically found some effects in favour of receiving personalised content or no significant differences between groups (very low quality evidence). No study provided data on adverse effects. Information on costs were sparse.

AUTHORS' CONCLUSIONS

The available evidence is inadequate for understanding whether mass media interventions targeted toward ethnic minority populations are more effective in changing health behaviours than mass media interventions intended for the population at large. When compared to no intervention, a targeted mass media intervention may increase the number of calls to smoking quit line, but the effect on health behaviours is unclear. These studies could not distinguish the impact of different components, for instance the effect of hearing a message regarding behavioural change, the cultural adaptation to the ethnic minority group, or increase reach to the target group through more appropriate mass media channels. New studies should explore targeted interventions for ethnic minorities with a first language other than the dominant language in their resident country, as well as directly compare targeted versus general population mass media interventions.

Smoking cessation among U.S. Hispanic/Latino adults: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

This paper examines patterns of smoking cessation among Hispanics/Latinos with particular attention to gender, acculturation, and national background. Data are from the Hispanic Community Health Study/Study of Latinos, a population-based study of 16,415 non-institutionalized Hispanics/Latinos ages 18-74 from a stratified random sample of households in Chicago, Miami, the Bronx, and San Diego. Face-to-face interviews, in English or Spanish, were conducted from 2008 to 2011. Findings are based on 6398 participants who reported smoking at least 100 cigarettes in their lifetime. Associations with smoking cessation outcomes were assessed in bivariate and multivariable analyses. Findings indicate that approximately equal proportions of men and women were former smokers. There was little difference by gender in socioeconomic characteristics associated with smoking cessation. Both men and women who lived in households with smokers were less likely to be abstinent. Multivariable analysis indicated that the likelihood of quitting varied by national background primarily among men, however, Puerto Rican and Cuban smokers of both genders were the least likely to successfully quit smoking. Among women, but not men, younger and more socially acculturated individuals had lower odds of sustaining cessation. Over 90% of female and male former smokers reported quitting on their own without cessation aids or therapy. The results suggest that many Hispanics/Latinos are self-motivated to quit and are able to do so without clinical assistance. Heterogeneity in smoking behaviors among Hispanics/Latinos should be taken into account when developing and delivering smoking cessation interventions and public health campaigns.

A preliminary evaluation of a community-based campaign to increase awareness of concurrency and HIV transmission in African American and African-Born communities

We evaluate an innovative grassroots community-based campaign in Seattle, WA focused on educating African American and African-born communities about concurrent partnerships and HIV transmission. Respondents completed a short self-administered questionnaire on a handheld personal digital assistant to evaluate the reach, acceptability and preliminary efficacy of the campaign. Of those who remembered seeing the campaign materials (82 %), social networks were the most common source of exposure (80 %). Respondents rated campaign materials very visually attractive (86 %), very interesting (91 %), and very important for themselves (90 %) and their community (93 %). Respondents reported that the campaign increased their knowledge about concurrency (84 %), changed their attitudes about it (77 %), and 65 % said it was likely or very likely that they would change their behavior as a result. This inexpensive grassroots campaign demonstrated extensive reach in the local black community and was able to move beyond individual exposure and into social networks.

Impact of a U.S. antismoking national media campaign on beliefs, cognitions and quit intentions

In 2012, the Centers for Disease Control and Prevention launched a national tobacco education campaign, Tips From Former Smokers, that consisted of graphic, emotionally evocative, testimonial-style advertisements. This longitudinal study examines changes in beliefs, tobacco-related cognitions and intentions to quit smoking among U.S. adult smokers after a 12-week airing of the campaign (n = 4040 adult smokers pre- and post-campaign). Exposure to the campaign was associated with greater odds of intending to quit within the next 30 days [odds ratio (OR) = 1.28, P < 0.01] and within the next 6 months (OR = 1.12, P < 0.05), and quit intentions were stronger among respondents with greater campaign exposure (OR = 1.12, P < 0.01). Campaign exposure was also associated with significant changes in beliefs about smoking-related risks (ORs = 1.15-2.40) and increased worries about health (b = 0.30, P < 0.001). Based on study change rates applied to U.S. census data, an estimated 566 000 additional U.S. smokers reported their intention to quit smoking within the next 6 months as a result of viewing campaign advertisements. Campaign effects were consistent with the theory of reasoned action and an expanding body of research demonstrating that graphic, emotional advertisements are highly effective for prompting positive cessation-related cognitions and behavioral intentions.

Tobacco health warning messages on plain cigarette packs and in television campaigns: a qualitative study with Australian socioeconomically disadvantaged smokers

Television advertisements, packaging regulations and health warning labels (HWLs) are designed to communicate anti-smoking messages to large number of smokers. However, only a few studies have examined how high smoking prevalence groups respond to these warnings. This study explored how socioeconomically disadvantaged smokers engage with health risk and cessation benefit messages. Six focus groups were conducted over September 2012-April 2013 with adult clients of welfare organizations in regional New South Wales, Australia who were current smokers (n = 51). Participants discussed HWLs, plain packaging and anti-smoking television advertisements. Discussions were audio-taped, transcribed verbatim and analysed using thematic analysis. Highly emotive warnings delivering messages of negative health effects were most likely to capture the attention of the study participants; however, these warning messages did not prompt quit attempts and participants were sceptical about the effectiveness of cessation programmes such as telephone quitlines. Active avoidance of health warning messages was common, and many expressed false and self-exempting beliefs towards the harms of tobacco. Careful consideration of message content and medium is required to communicate the anti-smoking message to disadvantaged smokers who consider themselves desensitized to warnings. Health communication strategies should continue to address false beliefs about smoking and educate on cessation services that are currently underutilized.

Longitudinal evaluation of the Tobacco Stops With Me campaign

INTRODUCTION

Counter-marketing in tobacco control plays an important role in increasing smoking cessation, reducing overall tobacco use, and reducing exposure to secondhand smoke.

PURPOSE

To evaluate the Tobacco Stops With Me campaign in Oklahoma by determining awareness and impact on tobacco-related attitudes, knowledge, and behavior among tobacco users and non-users.

METHODS

A 2-year longitudinal population-based study of 4,001 Oklahomans aged 18-54 years was conducted to evaluate campaign-related changes in knowledge, attitudes, and behaviors. Baseline data were collected using landline and cellular phones in 2007 prior to the launch of the campaign, with follow-up surveys at 1 year after baseline (n=2,466) and 2 years after baseline (n=2,266). Data were analyzed in 2012 using methods appropriate for weighted longitudinal data.

RESULTS

Overall campaign awareness was 81%. Exposure to Tobacco Stops With Me doubled quit attempts among tobacco users and increased knowledge about the harm of secondhand smoke. Tobacco non-users exposed to the campaign were 1.5 times more likely to help someone quit using tobacco than those not exposed, report that tobacco is a serious problem in Oklahoma, believe that tobacco companies should not be allowed to give away free samples or advertise at public events, and believe that smoking should be banned at public outdoor places. These findings were statistically significant after controlling for potential confounding variables.

CONCLUSIONS

This study demonstrates the campaign's impact on tobacco-related attitudes, knowledge, and behaviors among both tobacco users and non-users.

The impact of the tobacco retail outlet environment on adult cessation and differences by neighborhood poverty

AIMS

This study examined the impact of tobacco retail outlets on cessation outcomes over time among non-treatment-seeking smokers and assessed differences by neighborhood poverty and individual factors.

DESIGN

Observational longitudinal cohort study using geospatial data. We used generalized estimating equations to examine cessation outcomes in relation to the proximity and density of tobacco retail outlets near the home.

SETTING

Eight large Designated Media Areas across the United States.

PARTICIPANTS

A total of 2377 baseline smokers followed over three waves from 2008 to 2010.

MEASUREMENTS

Outlet addresses were identified through North American Industry Classification System codes and proximity and density measures were constructed for each participant at each wave. Outcomes included past 30-day abstinence and pro-cessation attitudes.

FINDINGS

Smokers in high poverty census tracts living between 500 m and 1.9 km from an outlet were over two times more likely to be abstinent than those living fewer than 500 m from an outlet (P < 0.05). Density within 500 m of home was associated with reduced abstinence [odds ratio (OR) = 0.94; confidence interval (CI) = 0.90, 0.98) and lower pro-cessation attitudes (Coeff = -0.07, CI = -0.10, -0.03) only in high poverty areas. In low poverty areas, density within 500 m was associated with greater pro-cessation attitudes (OR = 0.06; CI = 0.01, 0.12). Gender, education and heaviness of smoking did not moderate the impact of outlet proximity and density on cessation outcomes.

CONCLUSIONS

In the United States, density of tobacco outlets within 500 m of the home residence appears to be negatively associated with smoking abstinence and pro-cessation attitudes only in poor areas.

Internet use, browsing, and the urban poor: implications for cancer control

BACKGROUND

Despite the growing penetration of the Internet, little is known about the usage and browsing patterns of those in poverty. We report on a randomized controlled trial that sheds light on the Internet use and browsing patterns among the urban poor.

METHODS

The data come from 312 participants in Boston, Massachusetts, from Click to Connect, a study that examined the impact of an intervention that provided computers, Internet, and training to people from lower socioeconomic position (SEP). Data were gathered through pre- and posttest surveys and Internet use tracking software that generated approximately 13 million network activity files and more than 5.5 million records.

RESULTS

Internet use increased among intervention participants, with most of their time spent on social and participatory media sites or Internet portals. Differential patterns of use by gender and race/ethnicity were observed. Purposive searching for health information was low among all participants. Most of the visits to health-related sites were to local hospitals' sites suggesting the influence of possible preexisting relationships and trust. Social networking sites were frequently visited, with three sites enjoying similar popularity among all groups.

CONCLUSIONS

Our data show that the availability of Internet can lead to significant increase in its use among low SEP groups. Low SEP members used the Internet for participation and engagement, but the sites visited differed by group. Harnessing the power of social networking sites and shareware sites may be a way to increase access to health information.

The influence of antismoking television advertisements on cessation by race/ethnicity, socioeconomic status, and mental health status

Disparities in tobacco use and smoking cessation by race/ethnicity, education, income, and mental health status remain despite recent successes in reducing tobacco use. It is unclear to what extent media campaigns promote cessation within these population groups. This study aims to (1) assess whether exposure to antitobacco advertising is associated with making a quit attempt within a number of population subgroups, and (2) determine whether advertisement type differentialy affects cessation behavior across subgroups. We used data from the New York Adult Tobacco Survey (NY-ATS), a cross-sectional, random-digit-dial telephone survey of adults aged 18 or older in New York State conducted quarterly from 2003 through 2011 (N = 53,706). The sample for this study consists of 9,408 current smokers from the total NY-ATS sample. Regression methods were used to examine the effect of New York State's antismoking advertising, overall and by advertisement type (graphic and/or emotional), on making a quit attempt in the past 12 months. Exposure to antismoking advertising was measured in two ways: gross rating points (a measure of potential exposure) and self-reported confirmed recall of advertisements. This study yields three important findings. First, antismoking advertising promotes quit attempts among racial/ethnic minority smokers and smokers of lower education and income. Second, advertising effectiveness is attributable in part to advertisements with strong graphic imagery or negative emotion. Third, smokers with poor mental health do not appear to benefit from exposure to antismoking advertising of any type. This study contributes to the evidence about how cessation media campaigns can be used most effectively to increase quit attempts within vulnerable subgroups. In particular, it suggests that a general campaign can promote cessation among a range of sociodemographic groups. More research is needed to understand what message strategies might work for those with poor mental health.

Equity impact of population-level interventions and policies to reduce smoking in adults: a systematic review

BACKGROUND AND AIMS

There is strong evidence about which tobacco control policies reduce smoking. However, their equity impact is uncertain. The aim was to assess the effectiveness of population-level interventions/policies to reduce socioeconomic inequalities in adult smoking.

METHODS

Systematic review of studies of population-level interventions/policies reporting smoking-related outcomes in adults of lower compared to higher socioeconomic status (SES). References were screened and independently checked. Studies were quality assessed. Results are presented in a narrative synthesis. Equity impact was assessed as: positive (reduced inequality), neutral (no difference by SES), negative (increased inequality), mixed (equity impact varied) or unclear.

RESULTS

117 studies of 130 interventions/policies were included: smokefree (44); price/tax (27); mass media campaigns (30); advertising controls (9); cessation support (9); settings-based interventions (7); multiple policies (4). The distribution of equity effects was: 33 positive, 36 neutral, 38 negative, 6 mixed, 17 unclear. Most neutral equity studies benefited all SES groups. Fourteen price/tax studies were equity positive. Voluntary, regional and partial smokefree policies were more likely to be equity negative than national, comprehensive smokefree policies. Mass media campaigns had inconsistent equity effects. Cigarette marketing controls were equity positive or neutral. Targeted national smoking cessation services can be equity positive by achieving higher reach among low SES, compensating for lower quit rates.

CONCLUSIONS

Few studies have assessed the equity impact of tobacco control policy/interventions. Price/tax increases had the most consistent positive equity impact. More research is needed to strengthen the evidence-base for reducing smoking inequalities and to develop effective equity-orientated tobacco control strategies.

Reducing tobacco-related cancer incidence and mortality: summary of an institute of medicine workshop

Tobacco use remains a serious and persistent national problem. Recognizing that progress in combating cancer will never be fully achieved without addressing the tobacco problem, the National Cancer Policy Forum of the Institute of Medicine convened a public workshop exploring current issues in tobacco control, tobacco cessation, and implications for cancer patients. Workshop participants discussed potential policy, outreach, and treatment strategies to reduce tobacco-related cancer incidence and mortality, and highlighted a number of potential high-value action items to improve tobacco control policy, research, and advocacy.

The impact of cessation media messages on cessation-related outcomes: results from a national experiment of smokers

PURPOSE

Examine effects of exposure to two types of cessation advertisements on changes in cessation-related outcomes.

DESIGN

Experimental data from a nationally representative, longitudinal sample of smokers, collected in three waves over 4 weeks.

SETTING

National. Subjects. Three thousand and two adult U.S. smokers aged 18+ completed baseline and follow-up interviews at 2 and 4 weeks, from December 2010 to February 2011.

INTERVENTION

Six randomly assigned conditions consisting of repeated exposure to cessation advertisements: why-to-quit advertisements featuring emotional, personal testimonies (1: WTQ-T) or graphic images (2: WTQ-G); how-to-quit advertisements (3: HTQ), a combination of both (4: WTQ-T + HTQ; 5: WTQ-G + HTQ), and no-ad condition (6: control).

MEASURES

Cessation-related beliefs, attitudes, intentions, and quitting behavior.

ANALYSIS

Multivariable ordinary least squares and logistic regressions testing whether exposure to antitobacco television advertisements were associated with changes in tobacco-related outcomes.

RESULTS

Exposure to WTQ-T or WTQ-G advertisements, both alone and combined with HTQ advertisements, elicited positive change in beliefs, attitudes, and intentions as compared to controls. Smokers in three of four WTQ conditions were substantially more likely to have quit smoking at 4 weeks than controls (odds ratios range from 5.9 to 10.1, p < .05 or better). No effects were found for the HTQ-only condition.

CONCLUSION

Exposure to WTQ advertisements markedly increases the odds that a smoker will quit in the study period, suggesting positive movement toward successful, long-term cessation. HTQ advertisements did not enhance advertising effectiveness and may not be suitable as a primary message strategy.

Anti-tobacco mass media and socially disadvantaged groups: a systematic and methodological review

ISSUES

Only a limited amount of research has been conducted to explore whether there are socioeconomic status differences in responses to mass media. However, the methodological quality of this evidence has not been assessed, limiting confidence in conclusions that can be drawn regarding study outcomes. A systematic review of the effectiveness of anti-tobacco mass media campaigns with socially disadvantaged groups was conducted, and the methodological quality of included studies was assessed.

APPROACH

Medline, The Cochrane Library, PsycInfo, Embase and Web of Science were searched using MeSH and keywords for quantitative studies conducted in Western countries prior to March 2012. A methodological quality assessment and narrative analysis of included studies was undertaken.

KEY FINDINGS

Seventeen relevant studies (reported in 18 papers) were identified; however, weak study designs and selection bias were common characteristics, limiting strong conclusions about effectiveness. Using predominantly non-cessation related outcome measures reviewed papers indicated mixed results for mass media tobacco control campaign effectiveness among various social groups. Most studies assessed mass media impact on low socioeconomic status groups rather than highly socially disadvantaged groups.

IMPLICATIONS

Methodological rigour of evaluations in this field must be improved to aid understanding regarding the effectiveness of mass media campaigns in driving cessation among disadvantaged groups.

CONCLUSION

The results of this review indicate a gap in methodologically rigorous research into the effectiveness of mass media campaigns among socially disadvantaged groups, particularly the highly disadvantaged.