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This study explores how and why young people engage with MTV Shuga, a popular mass media campaign in South Africa, to understand what makes effective HIV edutainment. Young MTV Shuga viewers from the Eastern Cape, South Africa and their parents participated in remote individual interviews and focus groups in 2020. Qualitative data were transcribed and analysed using a thematic iterative approach. Young participants engaged with MTV Shuga for relatable, tolerant and complex stories about young people navigating HIV and relationships. These stories, which made viewers aware of sexual health services, inspired young people to reflect on how they might engage with different sexual health scenarios. MTV Shuga initiated conversations among peers, partners and some families about HIV that made them feel supported and equipped to tackle problems in their own lives. Complex, relatable, non-judgemental and youth-centred storylines can make HIV edutainment engaging to youth audiences. This approach allows space for reflection and inspires discussion and debate, turning young people from passive recipients of HIV messaging to active decision-makers. Television-based interventions can disseminate resources and knowledge into communities, however, watching them with parents can expose young people to judgement. HIV edutainment should therefore be available through different mediums so young people can engage in tolerant environments [ABSTRACT FROM AUTHOR]

Cui Zhihai's book, "The United States and Late Qing China, 1894-1911," reevaluates the history of China-US relations during this period. Cui highlights the Boxer Protocol of 1901 as a turning point, leading to significant changes in the Qing government's foreign policy and internal power structure. The book explores the US government's support for modernization reforms in the late Qing, as well as its role in major events such as the anti-smoking campaign and the Wuchang Uprising. Cui's research sheds new light on the complex and special nature of Sino-US relations during this time, providing valuable insights for scholars of modern Chinese history. [Extracted from the article]

The anti-tobacco advertisements, also known as Anti-Tobacco Health Spots (ATHS), are commonly used mass-media to promote tobacco prevention and control. This study was conducted to assess perceived effectiveness of ATHS used in Indian Cinema. The study also aims to identify factors associated with effectiveness of ATHS. A cross-sectional survey of 454 men aged ≥20 years selected through multi-stage stratified random sampling was conducted. Perceived effectiveness of ATHS was assessed using a six-item scale with 7-point Likert type items. Data were quantitatively analyzed using descriptive statistics and binary logistic regression. Over half of participants (51.54%, n=234) perceived ATHS to be "less effective." The health spots were likely to be more effective when participants perceived them as powerful (OR=4.11; 95% CI=2.47–6.83) and emotional (OR=3.32; 95% CI=1.90–5.79). Among tobacco users, those with better readiness (OR=2.42, 95% CI=1.26–4.65) and higher motivation to quit tobacco (OR=4.08, 95% CI=1.25–13.31) perceived ATHS as more effective. The study findings emphasize the need to improve the Indian anti-tobacco health spots. Specific attributes such as ATHS being emotional, fear evoking and sadness inducing could be explored to make ATHS more effective. [ABSTRACT FROM AUTHOR]

In many domains of health risk prevention and management, tailoring messages specifically for different stages of change is critical. In the context of smoking cessation, this research represents an initial attempt to discover stage-specific affective profiles in terms of guilt versus shame. It then examines whether stage-congruent emotional appeals increase the persuasiveness of antismoking campaigns. Study 1 found that participants felt more negative self-conscious emotions as they entered the later stages of smoking cessation, showing more salient emotional states of guilt rather than shame. Study 2 found that stage-emotion compatibility, such as that exhibited by participants in the early stages of change, was not altered by emotional appeals regardless of the emotional type. In contrast, those in the later stages of change perceived guilt rather than shame appeals to be more effective and displayed greater smoking cessation intention. Through this, current research takes an important step toward theoretically identifying the affective states associated with different stages of change for smoking cessation and helps practitioners use emotional appeals effectively and appropriately in public health campaigns. [ABSTRACT FROM AUTHOR]

Perceived effectiveness (PE) is a validated tool for predicting the potential impact of anti-tobacco public service announcements (PSAs). We set out to evaluate the added predictive value of facial expression analysis when combined with PE in a remote (online) survey. Each of 302 tobacco users watched 3 PSAs and allowed transmission of webcam videos from which metrics for "attention" (head position) and "facial action units" (FAU) were computed. The participants completed scales for their subjective emotions, willingness to share on social media, and intention to quit smoking using the Tobacco Free Florida website. Based on PE, both ready to quit (RTQ) and not ready (NR) respondents favored the same PSAs but RTQs assigned higher PE scores. Negative PSAs ("sad" or "frightening") were more compelling overall but RTQs also favored surprising ads and were more willing to share them on social media. Logistic regression showed that the combination of Attention + FAU+ PE (AUC = .816, p < .0001) outperformed single factors or factor combinations in distinguishing RTQ from NR. This study demonstrates that on-line assessment of facial expressions enhances the predictive value of PE and can be deployed on large remote samples. [ABSTRACT FROM AUTHOR]

This study examined the effects of gender-specific pictorial health warning labels contingent on their intended gender and threat levels (for females) in forming anti-smoking intentions. We conducted a within-subject design experiment with smokers and nonsmokers in Singapore (N = 100, 50% men). Each participant viewed 10 warning labels–four female-specific (high and low threat), four gender-neutral (high and low threat), and two male-specific (only low threat)–in a random order, evaluating each label on personal relevance, attention, cognitive elaboration, reactance, and intentions to purchase or avoid smoking. The findings showed that females reported greater relevance, attention, elaboration, and intentions to avoid smoking for low threat female-specific warning labels than male-specific or gender-neutral counterparts. Males reported less attention, elaboration, and relevance for low threat male-specific warning labels than female-specific or gender-neutral counterparts. Under high threat conditions, female-specific and gender-neutral warning labels were equally effective for both genders. No differences were observed by smoking status. Overall, gender-specific warning labels are potentially more effective than gender-neutral ones for deterring smoking in women contingent on low threat levels. By providing a deeper understanding of persuasive mechanisms and boundary conditions for the effects of gender specificity, findings can aid health policymakers in developing better gender-responsive interventions. [ABSTRACT FROM AUTHOR]

By the late 1980s, 'healthy eating' had largely failed as a public health discourse in Britain. Rather than providing consumers with a clear set of behavioural guidelines, it had fragmented into a confusing and ill-defined set of messages. In direct contrast to the anti-smoking campaign, which had succeeded in convincing large swathes of the British population to quit an unhealthy habit, the injunction to eat healthily failed to counteract rising levels of obesity in the 1990s, 2000s, and beyond. This article explores the emergence of a 'healthy eating' discourse in mid-to-late twentieth century Britain. It draws on a wide range of historical sources to consider how knowledge about food was re-fashioned across this period—by the state, by commercial actors, and by consumers themselves. While it is common to assert that the food and drink industry manipulated 'ordinary people' in this period, I argue that consumers were complicit in the shift towards unhealthy modes of consumption. They worked processed food products and 'healthy eating' messages into their everyday lives in contradictory ways. In turn, this article makes a strong case for histories of the everyday, arguing that 'small' histories of consumption can help to illuminate macro-level trends. [ABSTRACT FROM AUTHOR]

This study investigates the psychological mechanism by which source interactivity influences health message evaluations. Combining health communication and interactivity literature, two theoretical routes to persuasion were proposed: enhanced sense of community and reduced psychological reactance. A 2 × 2 (source interactivity: absence vs. presence X smoking status: nonsmoker vs. current smoker) factorial-design experiment (N = 343) was conducted on an anti-smoking website. Result revealed that the endorsing and sharing features that resembled the Like button on Facebook enhanced self-as-source perceptions and sense of community, which exerted significant effects on message credibility for smokers and message enjoyment for nonsmokers. Among smokers, self-as-source perceptions reduced psychological reactance, which promoted greater message credibility and more negative attitudes toward smoking behavior. [ABSTRACT FROM AUTHOR]

The present study focused on how exposure to different health message characteristics can affect extension-i.e., the sharing of arguments that were not targeted by the messages but are consistent with the message theme. In the context of anti-smoking campaigns, many messages have either emphasized reasons to quit smoking (why-quit) or ways to quit smoking (how-to-quit). Therefore, guided by construal level theory, the study aimed to examine whether the message characteristic of temporal frames can increase or decrease extension when incorporated into why-quit and how-to-quit anti-smoking messages. Results from a randomized experiment showed that exposure to why-quit messages with distant temporal frames increased extension (vs. no-message control) while why-quit messages with proximal temporal frames did not. Findings further illustrated a potential mechanism, where why-quit messages with proximal frames significantly reduced extension compared to why-quit messages with no temporal frames. Temporal frames did not have a significant effect on extension for how-to-quit messages. Results indicate that emphasizing the present in anti-smoking messages could be detrimental for the extension of why-quit arguments. Implications for applying construal level theory to health message effects research are also discussed. [ABSTRACT FROM AUTHOR]

Interactive media provide a physically active experience for users to click, slide, mouseover, and zoom-in/out, but how this increased amount of on-screen interaction is associated with cognitive and attitudinal outcomes has remained unexplored. We tackled this issue by conducting an online study where we recorded the amount of on-screen interaction on a targeted interactive feature, sliders, and correlated it with user engagement, attitudes toward anti-smoking messages, and smoking outcome beliefs, while controlling their baseline smoking outcome beliefs (N = 149). We found that the number of clicks and drags on sliders was positively associated with their attitudes toward anti-smoking messages and smoking outcome belief, but only among nonsmokers who are power users of technology. An increase in perceptual bandwidth influenced by interacting with the slider was significantly correlated with greater user engagement among these users. In contrast, for smokers who are not power users, greater on-screen interaction showed a negative correlation with their user engagement mediated by an increase in defensive processing. [ABSTRACT FROM AUTHOR]

Mass media campaigns are one of the most effective population-level interventions for the prevention of tobacco use. However, accurately evaluating the effectiveness of these campaigns presents several challenges, particularly as campaign delivery becomes increasingly fractured across media platforms. There are a number of weaknesses associated with traditional, individual-level measures of campaign exposure in an increasingly socially networked, digital media ecosystem. This study evaluated the national truth® campaign using a novel method to measure campaign exposure through an aggregate weekly exogenous measure of awareness. We generated this exogenous measure from a continuous, cross-sectional tracking survey to predict intentions to smoke and current tobacco use among youth in the United States. Results from multi-level models indicated that weeks with aggregate campaign awareness greater than 65% were associated with lower odds of current tobacco use. We conclude with a discussion of implications and practical considerations for using this method for media campaign evaluation. [ABSTRACT FROM AUTHOR]

Fear appeals are frequently used in anti-smoking advertising. The evidence on the effectiveness of fear appeals is mixed, and in some studies strong fear appeals have been found to reinforce the undesirable behaviour. Individual self-efficacy may play a role in moderating the effects of fear appeals. In advertising contexts where the intention was to encourage socially desirable behaviours, it has been shown that greater self-efficacy is associated with a more positive response to fear appeals. Similarly, in such contexts, the perceived ethicality of a fear-appeal advertisement appears to be positively related to self-efficacy. The purpose of this article is to examine the relationship between self-efficacy, perceived ethicality, and the impact of advertising on behavioural intentions in a context where the aim is to discourage undesirable behaviour, namely anti-smoking advertising. Questionnaire data were gathered from 434 respondents in London, England. Respondents with higher reported self-efficacy were found to have more favourable views of the ethicality of fear-appeal advertising, more positive attitudes towards the advertising, and stronger intentions to quit smoking. It is recommended that when using fear appeals in advertising to discourage undesirable behaviour, advertisers should incorporate messages designed to enhance self-efficacy. [ABSTRACT FROM PUBLISHER]

This study examines the moderating role of message framing in narrative persuasion in the context of promoting smoking cessation. A controlled experiment involving 101 college smokers revealed a significant interaction effect between message framing (gain-framing vs. loss-framing) and evidence type (narrative vs. nonnarrative) on smoking-related risk perceptions. For the gain-framed message, the nonnarrative version produced significantly greater perceived susceptibility to smoking-related diseases than did the narrative version. For the loss-framed message, evidence type did not make a difference in perceived susceptibility. On perceived severity of smoking-related diseases, the interaction was such that for the loss-framed message, the narrative version resulted in significantly greater perceived severity than did the nonnarrative version. In contrast, for the gain-framed message, evidence type did not make a difference in perceived severity. In addition, our results revealed that the interaction between message framing and evidence type had an indirect effect on attitudes toward quitting smoking through perceived severity of smoking-related diseases. Theoretical and practical implications are discussed. [ABSTRACT FROM AUTHOR]

Though previous evaluations of "The Real Cost" anti-smoking campaign demonstrate effects on anti-smoking beliefs and behaviors, results rely on self-reported recall as a measure of exposure and are thus open to reverse causation concerns. Exogenous measures of exposure, assessed independently of outcomes, support stronger causal inferences. In this study, we examined the relationship between Target Rating Points (TRPs) for specific ads available over four-week periods and anti-smoking beliefs in a national sample of adolescent nonsmokers and experimenters (n = 4,780). Results demonstrate positive relationships between TRPs for ads targeting two of four belief categories tested (Control and Chemical; p < .05) and targeted-belief endorsement. Furthermore, moderation models indicate that ad-specific TRPs affected targeted beliefs more than non-targeted beliefs for those Control- and Chemical-targeted ads (p < .01). Findings support a claim of campaign effects while reducing concerns about reverse causal direction and the influence of unmeasured confounders. [ABSTRACT FROM AUTHOR]

As smoking has emerged as a health-risk behavior, communication scholars and practitioners have put many efforts into finding out ways to achieve smoking cessation. In this research, participants (N = 57) were randomly assigned to a spatial augmented reality (SAR) condition (3D projection mapping) and 2D flat screen to be exposed to an anti-smoking message. This research provides insightful evidence that the effects of SAR on people's behavioral intention to spread anti-smoking messages online could be explained by spatial presence and negative emotions. Implications for research on the potential of SAR in terms of emotions and online viral behavioral intentions are discussed. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, and transgender (LGBT) individuals are at increased risk for tobacco use compared to those who are not LGBT. The Food and Drug Administration's Center for Tobacco Products launched the first U.S. large-scale tobacco public education campaign for LGBT young adults aged 18-24, This Free Life. The current study, using data from the evaluation of the This Free Life campaign, investigated the role of LGBT Identity Affirmation (i.e., the development of positive feelings or attachment to being LGBT), LGBT Identity Centrality (i.e., the degree to which an aspect of a person's identity shapes their overall identity), and Identification with the LGBT Community (i.e., an individual's relationship with the LGBT community) on perceived effectiveness of four This Free Life advertisements. The current study sample included 2,788 LGBT young adults. For the "Our Story" and "Flawless" advertisements, all three identity constructs were statistically significant positive predictors of perceived advertisement effectiveness. For female-centric and male-centric "Tip the Scale" advertisements, LGBT Identity Centrality and Identification with the LGBT Community were significant positive predictors. An additional secondary analysis found differences in identity constructs between sexual and gender minority subgroups. These results support that identity constructs may be leveraged in health interventions. [ABSTRACT FROM AUTHOR]

Health communication delivered via media channels can substantially influence adolescents' choices, and the effects of messages are amplified through interpersonal sharing. However, the underlying psychological and neurocognitive mechanisms that influence message effectiveness and likelihood of sharing are not well understood, especially among adolescents. Based on research in adults, we hypothesized and preregistered that message-induced neural activation in regions associated with self-reflection, social processing, and positive valuation would be related to greater perceived ad effectiveness and intentions to share messages. We focused on brain activity in meta-analytically defined regions associated with these three processes as 40 adolescent nonsmokers viewed advertisements from "The Real Cost" antismoking campaign. Perceived message effectiveness was positively associated with brain activity in the hypothesized social processing regions and marginally associated with brain activity in self-relevance regions, but not associated with brain activity in valuation regions. By contrast, intentions to share the messages were not associated with neural response in these 3 systems. In contrast to previous neuroimaging studies with adult subjects, our findings highlight the role of social cognition in adolescent processing of persuasive messages. We discuss the possibility that the mental processes responsive to effective and shareworthy messages may reflect developmental processes pertinent to media effects. [ABSTRACT FROM AUTHOR]

Although cartoons are widely used in health communication, their effectiveness has seldom been tested. In this study, the effects of four humor-threat antismoking cartoon posters are evaluated in a sample of 12- to 15-year-olds (n = 183) in Hong Kong. The five-group comparison (including the control group) revealed that these posters did not increase antismoking attitudes in the sample but did decrease antismoking behavioral intentions. The better liked, more humorous, and more frightening posters did not produce increased antismoking attitudes or behavioral intentions. These findings warrant the development of theories to clarify the role of humor in health communication. Although cartoons are well liked by adolescents, practitioners must be aware of the possible negative effects of humor in cartoon-based messages. [ABSTRACT FROM AUTHOR]

This study examines nonsmokers’ responses to antismoking messages. Informed by construal-level theory (CLT), it investigates whether and how evidence type (narrative vs. non-narrative) and social distance might interact to influence nonsmokers’ attitudes toward others’ quitting smoking and intentions to persuade others to quit smoking. Results of a controlled experiment (N = 281) revealed an approximately significant two-way interaction pertaining to attitudes. Simple effects analyses revealed that narratives produced less-favorable attitudes toward others’ quitting smoking than nonnarratives when participants thought about their best friend. Yet, there was no difference in attitudes between narratives and nonnarratives when participants thought about socially distant others. The results also indicated that nonnarratives overpowered narratives to influence participants’ attitudes toward others’ quitting smoking. Moreover, social distance had a consistent impact on their risk beliefs, such that they perceive fewer health risks of their close friends than an average college student. Theoretical and practical implications of the results are discussed. [ABSTRACT FROM AUTHOR]

Research on health campaigns and interpersonal communication has seldom examined how campaign message exposure can influence the transmission of campaign-relevant information into interpersonal communication. Specifically, an individual exposed to a campaign message may send the message's core argument (replication) or other campaign-consistent information (extension) to additional campaign targets. Replication and extension may enhance campaign effects because they are expected to extend a campaign's reach and produce more campaign-consistent communication. Using a randomized controlled experiment, this study examined how exposure to why-quit and how-to-quit themed antismoking messages influences replication and extension. Study results showed that while both why-quit and how-to-quit messages were successful in increasing replication, only why-quit messages were successful in influencing extension. The study results demonstrate that there is variation in the degree of how messages can successfully be replicated or extended in interpersonal contexts, which can inform campaign development. [ABSTRACT FROM AUTHOR]

Stigmatization against smokers characterizes many of today’s anti-smoking campaigns in the United States. It is believed that stigmatization motivates people to quit smoking by arousing a state of emotional distress, such as shame, in viewers. However, stagnant cessation rates among socioeconomically disadvantaged smokers imply that stigmatizing campaigns might be ineffective in promoting cessation among those low in socioeconomic status. To understand the effectiveness of stigmatizing campaign messages, we proposed a moderated mediation model and experimentally tested it among current smokers (n = 136). Results show that exposure to a stigmatizing message significantly lowered smokers’ cessation intentions who have lower income and less self-efficacy. The conditional negative effect of the message was accounted for by shame experienced by smokers. [ABSTRACT FROM AUTHOR]

This study examines the roles that the media effects and persuasion ethics schemas play in people's responses to an antismoking ad in South Korea. An online experiment was conducted with 347 adults. The media effects schema was manipulated with news stories on an antismoking campaign's effectiveness, while the persuasion ethics schema was measured and median-split. Analysis of Variance (ANOVA) tests were performed for issue attitudes (Iatt), attitude toward the ad (Aad), and behavioral intention (BI). Results show significant main effects of themedia effects schema on the three dependent variables. People in the weakmedia effects condition had significantly lower Iatt, Aad, and BI than those in either the strong media effects condition or the control condition. This pattern was more pronounced among smokers. While there was no significant main effect of the persuasion ethics schema on any of the dependent variables, a significant interaction effect for persuasion ethics schema and smoking status was found on behavioral intention (BI). Nonsmokers' BI was significantly higher than smokers' in the low-persuasion ethics schema condition, but it was not significant in the highpersuasion ethics schema condition. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This study examined the effects of temporal framing used in messages about the future likelihood of developing smoking-related diseases on intention to quit smoking. Based on construal level theory (CLT), a causal model delineating the relationships among four variables—perceived temporal distance, personal relevance, perceived susceptibility, and behavioral intention—was proposed. The model was validated by an online experiment with a sample of 222 current smokers, revealing the effects of perceived temporal distance on behavioral intention via personal relevance and perceived susceptibility. Following the CLT-grounded model, the effects of different temporal frames (near future vs. distant future) on the four variables were tested. The near-future frame featured a risk perceived to be more temporally proximal (i.e., heart attack), and the distant-future frame featured a risk perceived to be more temporally distant (i.e., larynx cancer) among current smokers. Participants exposed to the near-future frame reported significantly shorter perceived temporal distance, greater personal relevance and perceived susceptibility to the risk portrayed in the message, and greater intention to quit smoking than participants exposed to the distant-future frame. Implications for antismoking communications are discussed. [ABSTRACT FROM PUBLISHER]

This study examined the effects of an anti-smoking campaign that employs a crowdsourcing method with a social networking service. Drawing upon social capital scholarship and the expression effect research paradigm in eHealth systems, the study also investigated the roles of social trust and community life satisfaction in the social media campaign that has a specific geographical boundary. To that end, we conducted an experiment using a two-group pretest–posttest design. We randomly assigned 201 participants to two conditions: “campaign message reception only” as a control group and “message reception and expression” as a treatment group in which participants fully engaged in the campaign process by sharing their own campaign ideas with other participants. Findings revealed that social trust and community life satisfaction interacted with the treatment condition to positively affect persuasive intentions, but in distinct ways. Social trust moderated the effect of the message reception and interaction condition on participants’ willingness to encourage community members to stop smoking. In contrast, community life satisfaction moderated the effect of the treatment condition on encouraging others to comply with the community’s anti-smoking policy. These results provide theoretical and practical implications related to the roles of social capital in geographically defined social media campaigns. [ABSTRACT FROM PUBLISHER]

Smokers often talk about antismoking campaigns, and these conversations can contribute to campaign effectiveness. However, little is known about the predictors and content of naturally occurring campaigngenerated conversations. In two studies (Study 1, N = 480; Study 2, N = 232), we systematically examined whether the occurrence and content of smokers' conversations after exposure to one of eight antismoking television advertisements were predicted by characteristics of (a) the message, (b) intrapersonal responses to the message, (c) the individual, and (d) the social context in which exposure occurred. In multivariable models, we found that conversations were more likely to occurwhen advertisement exposure occurred in the presence of others, and as the amount of anxiety elicited by the advertisement increased. Conversationsweremore likely to contain a favorable appraisal of the advertisement when the message elicited higher levels of sadness, and less likely to contain favorable appraisals when the respondent had finished secondary education (vs. lower levels of education). Stronger feelings of guilt reduced the likelihood that conversations contained unfavorable appraisals, and increased the likelihood that they contained quitting talk. These findings suggest several promising avenues for future investigations into why smokers talk and talk in particular ways. [ABSTRACT FROM AUTHOR]

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

Though previous research suggests the FDA’s “The Real Cost” anti-smoking campaign has reduced smoking initiation, the theorized pathway of effects (through targeted beliefs) has not been evaluated. This study assesses the relationship between recall of campaign television advertisements and ad-specific anti-smoking beliefs. Respondents in a nationally representative survey of nonsmoking youths age 13–17 (n = 4,831) reported exposure to four The Real Cost advertisements and a fake ad, smoking-relevant beliefs, and nonsmoking intentions. Analyses separately predicted each targeted belief from specific ad recall, adjusting for potential confounders and survey weights. Parallel analyses with non-targeted beliefs showed smaller effects, strengthening claims of campaign effects. Recall of four campaign ads (but not the fake ad) significantly predicted endorsement of the ad-targeted belief (Meanβ = .13). Two-sided sign tests indicated stronger ad recall associations with the targeted belief relative to the non-targeted belief (p < .05). Logistic regression analyses indicated that respondents who endorsed campaign-targeted beliefs were more likely to have no intention to smoke (p < .01). This study is the first to demonstrate a relationship between recall of ads from The Real Cost campaign and the theorized pathway of effects (through targeted beliefs). These analyses also provide a methodological template for showing campaign effects despite limitations of available data. [ABSTRACT FROM PUBLISHER]

Background. Measures of perceived effectiveness (PE) of ads have been validated to predict changes in cognitive precursors of quit attempts, but a relationship between PE and actual quit attempts has not been shown in population-based studies. We analyzed smokers’ PE ratings of ads from the nationalTips From Former Smokers(Tips) campaign to (1) establish the validity of PE in predicting quit attempts in a large, nationally representative sample of smokers; (2) identify behavioral and demographic correlates of PE among respondents; and (3) examine whether PE is influenced by matching the race/ethnicity of ad participants with that of the ad viewer.Methods. We used survey data from two waves (baseline and follow-up) of a longitudinal online cohort of adult U.S. cigarette smokers. Respondents were shown one or more of 14Tipscampaign ads and were asked to assess each ad in terms of PE. We used multivariate models to estimate the association between baseline PE and prospective quit attempts; cross-sectional associations between PE and various respondent characteristics, including race/ethnicity, desire to quit, and health conditions; and the association between race/ethnicity of respondents andTipsad participants.Results. Higher PE at baseline was associated with increased odds of a quit attempt at follow-up. Higher PE scores were associated with non-Hispanic black race, Hispanic ethnicity, higher desire to quit, presence of a chronic health condition, and presence of a mental health condition. There was no relationship between PE scores and matched race/ethnicity of the respondent andTipsad participants.Conclusions. This is the first study to demonstrate an association between PE scores for antismoking ads and prospective quit attempts in a large, nationally representative sample of smokers. Our findings also provide strong evidence that racial/ethnic minority subpopulations, including non-Hispanic blacks and Hispanics, react more favorably to Tips campaign ads irrespective of race/ethnicity of the ad participant. This suggests that message characteristics (e.g., graphic visuals and emotional content) may play a more important role in PE than race/ethnicity of ad participants. [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM AUTHOR]

The national youth and young adult tobacco prevention mass media campaign, truth®, relaunched in 2014 with the goal of creating "the generation that ends smoking." The objective of this study was to assess whether the strategy of airing truth ads during popular, culturally relevant televised events was associated with higher ad and brand awareness and increases in social media engagement. Awareness of six truth advertisements that aired during popular television events and self-reported social media engagement were assessed via cross-sectional online surveys of youth and young adults aged 15-21 years. Social engagement was also measured using separate Twitter and YouTube metrics. Logistic regression models predicted self-reported social engagement and any ad awareness, and a negative binomial regression predicted the total social media engagement across digital platforms. The study found that viewing a popular televised event was associated with higher odds of ad awareness and social engagement. The results also indicate that levels of social media engagement for an event period are greater than for a nonevent period. The findings demonstrate that premiering advertisements during a popular, culturally relevant televised event is associated with higher awareness of truth ads and increased social engagement related to the campaign, controlling for variables that might also influence the response to campaign messages. [ABSTRACT FROM AUTHOR]

Efforts are underway to educate consumers about the dangers of smoking at the point of sale (POS). Research is limited about the efficacy of POS antismoking ads to guide campaign development. This study experimentally tests whether the type of antismoking ad and the context in which ads are viewed influence people’s reactions to the ads. A national convenience sample of 7,812 adult current smokers and recent quitters was randomized to 1 of 39 conditions. Participants viewed one of the four types of antismoking ads (negative health consequences—graphic, negative social consequences—intended emotive, benefits of quitting—informational, benefits of quitting—graphic) in one of the three contexts (alone, next to a cigarette ad, POS tobacco display). We assessed participants’ reactions to the ads, including perceived effectiveness, negative emotion, affective dissonance, and motivational reaction. Graphic ads elicited more negative emotion and affective dissonance than benefits of quitting ads. Graphic ads elicited higher perceived effectiveness and more affective dissonance than intended emotive ads. Antismoking ads fared best when viewed alone, and graphic ads were least influenced by the context in which they were viewed. These results suggest that in developing POS campaigns, it is important to consider the competitive pro-tobacco context in which antismoking ads will be viewed. [ABSTRACT FROM PUBLISHER]

Based on the critical approach in health communication, along with Habermas’s theory of legitimation and Ellul’s theory of propaganda, this qualitative study analyzes the political and ideological dimensions of the video advertisements used in the 2012 anti-smoking and 2014 anti-drinking campaigns in the Republic of Moldova. This analysis shows that these health videos support male domination and exclusion of the poor and legitimate the current political leadership with its declared pro-European orientation. This study uniquely contributes to the critical approach in health communication by focusing on the post-Soviet context in which statehood and national identity are unstable and societies are torn between the Russian and (post-)Soviet influences on one hand and European aspirations on the other. Drawing on critical scholarship in global health communication, this article calls for greater respect and recognition of Moldova’s local culture and definition of health. [ABSTRACT FROM PUBLISHER]

This article considers co-creation as a new persuasive strategy in health campaigns. Co-creation enables target audience members to become active campaign producers. A recent Dutch anti-smoking campaign applied co-creation, inviting the target audience to complete the slogan "smoking is sóóó . . . " with something outdated on social networking sites (SNSs) like Facebook and Twitter to stress nonsmoking as the new social norm. From a corpus-linguistic perspective, we investigated how the slogans from the target audience resonated with or deviated from the campaign's original message. In general, the target audience slogans followed the campaign's approach, but on the SNSs, differences were found regarding the valence, type of utterance, and domain to which smoking was compared. The target audience frequently compared smoking with other (inter)personal social norms. Co-creation thus provides the target audience with an opportunity to disseminate campaign messages from their own perspective, but at the same time a co-creation strategy risks diluting the intended campaign message. [ABSTRACT FROM AUTHOR]

This study investigates the indirect effect of source information on attitudes toward antismoking campaigns through perceived bias and psychological reactance by employing a survey experiment (N = 416). Findings demonstrate that an editorial advocating antismoking campaigns from ideologically congruent media is perceived as less biased than the same editorial from hostile media. The perceived bias is linked to perceived threat to freedom, which, in turn, is linked to psychological reactance against the editorial, resulting in less favorable attitudes toward antismoking campaigns. Smokers are more likely to show the linkages than nonsmokers. Implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

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

This article empirically assesses the role of new health information in the decision to quit smoking. Using individual level data from the Swiss Household Panel, health information is proxied by three different types of health events: physical health problems, mental disorders, and accidents. Exploiting retrospectively reported information on smoking behaviour, smoking cessation is modelled using a discrete time hazard model that also accounts for estimation problems arising from almost quasi-complete separation in the data. The empirical results yield robust evidence that general health problems increase the probability of instantaneous smoking cessation. Differentiating between the type of health event reveals that the overall effect is mainly driven by physical health events. [ABSTRACT FROM PUBLISHER]

Objective: Tobacco-free policies are being rapidly adopted nationwide, yet compliance with these policies remains a challenge. This study explored college campus key informants' experiences with tobacco policies, and their perceived benefits, drawbacks, and outcomes. Participants: The sample for this study was 68 key informants representing 16 different California universities with varying tobacco policies (no smoking indoors and within 20 feet of entrances, designated smoking areas, 100% smoke-free, and 100% tobacco-free). Methods: Qualitative, descriptive study. Semistructured interviews were transcribed verbatim and analyzed using content analysis. Results: Strategies to improve compliance ranged from a social approach to a heavy focus on punitive enforcement. Key informants from campuses using a social approach alone reported barriers to improving compliance, including a perceived lack of efficacy of the approach. However, these campuses found it challenging to incorporate enforcement through campus police or security. Conclusions: College campus decision makers should explore using a combined approach (social approach as well as formal enforcement), with enforcement primarily the responsibility of nonpolice university channels (eg, Student Affairs, employee supervisors). [ABSTRACT FROM AUTHOR]

Lesbian, gay, and bisexual (LGB) adults in the United States have a higher prevalence of smoking than their heterosexual counterparts. In 2013, the Los Angeles County Department of Public Health launched a social marketing and outreach campaign called Break Up to reduce the prevalence of smoking in LGB communities. Break Up was evaluated using cross-sectional, street-intercept surveys before and near the end of campaign. Surveys measured demographics, campaign awareness, and self-reported smoking-related outcomes. Bivariate statistics and logistic regression models were used to identify whether campaign awareness was associated with smoking-related outcomes. Calls by LGB persons to a smokers' helpline were also measured. Among those interviewed at endline, 32.7% reported Break Up awareness. Awareness was associated with thinking of quitting smoking and ever taking steps to quit but not with smoking cessation (defined as not smoking in the past 30 days among those who had smoked in the past 6 months). There was a 0.7% increase in the percentage of weekly calls by LGB persons to the helpline in the year after the campaign. Break Up reached about a third of its intended audience. The campaign was associated with smoking cessation precursors and may have led to an increase in helpline utilization, but there is no evidence it affected quit attempts. This study adds to the limited literature on tobacco programs for LGB persons and, as far as we know, is one of the first to evaluate tobacco-free social marketing in this important yet understudied population. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

Current warning labels on cigarette packages are generally focused on long-term losses that can be incurred if one continues smoking. This study compares the effects of these labels against warning labels that stress short-term losses of smoking as well as labels that stress short- and long-term benefits that can be obtained when one quits smoking. A 2 (message frame: gain vs. loss) × 2 (temporal context: short vs. long term) between-subjects experiment was conducted among 132 smokers, with attitude toward quitting smoking and intention to quit smoking, as well as information-seeking behavior and message recall, as the dependent variables. Findings were in line with theory regarding message framing and temporal discounting, showing enhanced effects of gain over loss frames and short-term over long-term consequences on warning labels for attitudes and intentions. In addition, an interaction between message frame and temporal context was found. Especially, gain-framed messages showed stronger effects on intentions to quit smoking than loss-framed messages when warning labels concerned short-term outcomes. Findings suggest that current warning labels, with an emphasis on long-term negative health outcomes, should be reconsidered. [ABSTRACT FROM AUTHOR]

In February 2014, the Food and Drug Administration launchedThe Real Cost, a national youth tobacco prevention campaign. This article examines youth receptivity to potential campaign ads using data from 3 message pretesting studies featuring the same design and consistent instrumentation. A total of 3,258 adolescents ages 13–17 were randomized to either an ad-viewing condition or a no-exposure control condition. Perceived ad effectiveness, smoking-related beliefs, and attitudes were measured as outcome variables. The sample consisted of both experimental smokers (58%) and current nonsmokers at risk for cigarette initiation (42%). A total of 14 ads were tested across the three studies. Participants who viewed the ads generally considered them to be effective (with a mean perceived ad effectiveness score of 3.66 on a scale from 1 to 5). Compared to those in the control condition, participants in the ad-viewing condition reported stronger beliefs about the health risks of smoking (p < .001), a greater likelihood that smoking would lead to loss of control in life (p < .001), and more negative attitudes toward smoking (p < .001). Responses to campaign ads were largely consistent between experimenters and at-risk nonsmokers. Implications of the findings for the campaign are discussed. [ABSTRACT FROM PUBLISHER]

The originaltruthcampaign was a branded, national smoking prevention mass media effort focused on at-risk youth ages 12–17. Today thetruthbrand focuses on the goal of finishing tobacco (truth FinishIt). There have been significant changes in the tobacco control landscape, leadingFinishItto focus on 15- to 21-year-olds. The present article reports on formative research and media monitoring data collected to pilot test a newtruth FinishItbrand equity scale. The goals of this study were to (a) content analyzetruth FinishItmass media ads, (b) assesstruth’s social media and followers’ perceptions oftruth’s digital brand identity, and (c) develop and feasibility test a new version of thetruth FinishItbrand equity scale using data from an existing Truth Initiative media monitoring study. Through factor analysis, we identified a brand equity scale, as in previous research, consisting of 4 main constructs: brand loyalty, leadership/satisfaction, personality, and awareness. Targetedtruthattitudes and beliefs about social perceptions, acceptability, and industry-related beliefs were regressed on the higher order factor and each of the 4 individual brand equity factors. Ordinary least squares regression models generally showed associations in the expected directions (positive for anti-tobacco and negative for pro-tobacco) between targeted attitudes/beliefs andtruth FinishItbrand equity. This study succeeded in developing and validating a newtruth FinishItbrand equity scale. The scale may be a valuable metric for future campaign evaluation. Future studies should examine the effects oftruth FinishItbrand equity on tobacco use behavioral outcomes over time. [ABSTRACT FROM PUBLISHER]

The China Tobacco Control Media Campaign on Sina Weibo is novel in the context of smoking prevention and cessation in China and has not to date been evaluated. This study draws on health behavior theories and dialogic theory in public relations to analyze microblog campaign postings and their relationships with the outcome of online audience engagement. Microblog postings from May 2011 to January 2015 were content analyzed, showing that the most common persuasive content characteristic was perceived risk, followed by subjective norms and self-efficacy. Perceived risk and self-efficacy postings positively influenced online audience engagement, whereas subjective norm postings was a nonsignificant predictor. Postings were more likely to share information than aim to interact with audience members. However, both information sharing and audience interaction postings were positive predictors of online audience engagement. There was also evidence of main and interactive effects of message originality on online audience engagement. The current study has, to the best of our knowledge, broken new ground in 2 regards: (a) using health behavior theories as a basis for analyzing the content of an anti-smoking social media campaign and (b) examining the content of an anti-smoking media campaign of any type in China. [ABSTRACT FROM AUTHOR]

The current study examined the use of online social media for a health campaign. Collecting tweets (N = 1,790) about the recent smoking cessation campaign by the Centers for Disease Control and Prevention, the current study investigated the dissemination of health campaign messages on Twitter and answered questions from the process evaluation of health campaigns: who tweeted about the campaign, who played central roles in disseminating health campaign messages, and how various features of Twitter were used for sharing of campaign messages. Results showed that individuals and nonprofit organizations posted frequently about the campaign: Individuals and nonprofit organizations posted about 40% and 30% of campaign-related tweets, respectively. Although the campaign under investigation was steered by a government agency, nonprofit organizations played a vital role as mediators who disseminated campaign messages. The culture of retweeting demonstrated its particular usefulness for the dissemination of campaign messages. Despite the expectation that the use of social media would expand opportunities for engagement, actual two-way interactions were few or minimal. Drawn from the results, practical suggestions on how to strategize the use of Twitter for future health campaigns are discussed. [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM PUBLISHER]

The protection motivation model has contributed usefully to researchers’ understanding of fear appeals in advertising. However, the empirical evidence reported to date in the literature has been mixed. An overview of literature reveals that the effect of emotional response and personal difference has not been explored as often as fear in health care marketing. The present study focused on this emotion in a context of antismoking advertisements. Based on the protection motivation theory, a modified structural model was proposed including emotional response and personal difference. Model was tested using college students in United States and Korea. [ABSTRACT FROM AUTHOR]

Campaign-stimulated conversations have been shown to increase the effectiveness of antismoking campaigns. In order to explore why such effects occur, in the current study we coded the content of naturally occurring conversations. We also examined whether the short-term effects of talking, and of different types of talk, on quitting intentions were mediated through intrapersonal message responses. Using the Natural ExposureSMmethodology, we exposed 411 smokers to 1 of 6 antismoking advertisements while they were watching television at home. Responses to the advertisement—conversation participation and content, emotional responses, personalized perceived effectiveness, and changes in intentions to quit—were measured within 3 days of exposure. Conversations were coded for appraisal of the advertisement (favorable, neutral, or unfavorable) and the presence of quitting talk and emotion talk. Mediation analyses indicated that the positive effects of talking on intention change were mediated through personalized perceived effectiveness and that the positive effects were driven by conversations that contained a favorable appraisal and/or quitting talk. Conversely, conversations that contained an unfavorable appraisal of the advertisement were negatively associated with campaign effectiveness. These findings highlight the importance of measuring interpersonal communication when evaluating campaigns and the need for further research to identify the message characteristics that predict when smokers talk and when they talk only in desirable ways. [ABSTRACT FROM PUBLISHER]

This research advances and tests a normative mediation model of media effects on youth smoking. The model predicts that exposure to various types of smoking-related media messages, including anti-smoking ads, cigarette ads, and smoking scenes in movies and television shows, exerts indirect effects on youth smoking intentions through the mediation of perceived descriptive and injunctive norms. Analysis of the data from the 3rd Legacy Media Tracking Survey offers general support for the proposed model with some unexpected findings, revealing a complex picture of media influence on youth smoking via normative and non-normative mechanisms. Theoretical and practical implications of the findings are discussed. [ABSTRACT FROM PUBLISHER]

The prevalence of adolescent smoking has been increasing rapidly in China. Expanding adolescent exposure to antismoking messages may be an effective approach to prevent tobacco use among this population. Using a cross-sectional sample of 8,444 high school students in four Chinese cities, this study assessed the relation between self-reported exposure to antismoking messages from families, schools, and mass media and the rate of past 30-day smoking and smoking intention among junior and senior high school students. Results from logistic regression suggested that antismoking messages delivered via school and media inhibited both tobacco use and the intention to smoke. The effects of familial warnings about harmful effects of smoking, in contrast, were at best insignificant. [ABSTRACT FROM AUTHOR]