Adolescent reactance and anti-smoking campaigns: a theoretical approach

Children between the ages of 9 and 15 are a high-risk group for tobacco use. The Centers for Disease Control estimates that first use of cigarettes among adolescents has risen 30% over the past decade, and that more than 1.2 million people age < 18 became daily smokers in 1996 alone. Moreover, research indicating that awareness and liking of cigarette advertisements is higher among adolescents than adults underscores the need to devote more effort to understanding reactions to tobacco-related messages. Adding to this problem is the fact that the early gains of some successful anti-tobacco interventions disappear as adolescents age. Drawing on the theory of psychological reactance, a number of hypotheses were tested that addressed the impact of pro- and anti-smoking messages on a variety of outcomes, including participants' intended behaviors, evaluation of message sources, and seeking of disconfirming information. All the messages were created and delivered to 4th-, 7th-, and 10th-grade students via personal computers. The pattern of results supports the theoretically derived hypotheses, indicating that grade level and message type had a significant impact on the processing of tobacco-related messages. Implications and suggestions for future tobacco prevention campaigns are discussed.     

Paternalism and Finnish anti-smoking policy

Paternalism is one of the most problematic ethical issues in public health promotion. In the article an attempt is made to elucidate the matter by examining the theoretical characteristics of paternalistic attitudes and action on the one hand, and actual Finnish anti-smoking policies on the other. The attitudes adopted by Finnish health authorities toward smoking are strongly paternalistic, i.e. based on the idea that the general public is not to be relied on in assessing the health risks of tobacco use. Surprisingly, however, the actual governmental anti-smoking measures in Finland cannot be truthfully described as overtly constraining. Since paternalism implies restrictions on personal freedom for the individual's own good, many branches of smoking control fall outside its proper scope: for instance, restrictions on smoking in public premises can almost always be justified by referring to the harm inflicted by smokers on the other people. But most of the Finnish governmental anti-smoking measures which can be classified as paternalistic are also justifiable. Some of them concern minors only or mainly minors, and thus can be defended as instances of authorities' parental concern for our children. Some are freedom-restricting but only in a weak sense and are based on the idea of informing people about the dangers of smoking, while leaving the final decision up to them. In the last analysis, there is but one regulation that meets the criteria of wrongful paternalism, and that one, the ban on strong tobacco brands, may not be important enough, in practice, to raise major ethical controversies.     

Academicians' attitudes and beliefs towards anti-smoking measures

Academic staff of Lucknow University (India) and its various faculties were questioned to know their attitudesand beliefs regarding various anti-smoking measures, using a questionnaire based on WHO guidelines. Of the male teachers 21.4% were current smokers and 12.3% were ex-smokers. Non-smokers were in greater agreement with various anti-smoking measures than current and ex-smokers, while more females — all of whom were non-smokers — than their male counterparts supported these measures. Endorsement of various anti smoking measures differed from group to group, however, academicians agreed most with the notion that ‘Everybody has a right to breath air free of tobacco smoke’. ‘Sale of tobacco completely banned’ was the measure opposed by most of the academicians. ‘Preventing diseases’ and ‘Religious reasons’ were, respectively, the most and least important motives for not smoking.     

General parenting, anti-smoking socialization and smoking onset

A theoretical model was tested in which general parenting and parental smoking predicted anti-smoking socialization, which in turn predicted adolescent smoking onset. Participants were 4351 Dutch adolescents between 13 and 15 years of age. In the model, strictness and psychological autonomy granting were related to lower likelihood of smoking onset, and parental smoking was positively related to smoking onset. Involvement and strictness were positively related to anti-smoking socialization, whereas parents who smoke where less likely to be engaged in anti-smoking socialization. In turn, anti-smoking socialization was negatively related to adolescent smoking. To test mediation, an asymptotic resampling method was used (bootstrapping); anti-smoking socialization appeared to mediate the links between involvement and smoking onset, strictness and smoking onset and parental smoking and smoking onset. In addition, parental smoking appeared to moderate the link between anti-smoking socialization and smoking onset. Implications for prevention were addressed.     

中国控烟健康教育现状及研究进展

烟草危害是当今世界最严重的公共卫生问题之一,是人类健康所面临的最大的可以防御的危险因素。烟草中的尼古丁是一种神经毒性物质,有成瘾性,长期使用会中毒,还会引发冠心病、心肌梗塞、中风、动脉硬化等疾病,加速肿瘤组织的生长,烟雾中的焦油等有害物质对他人尤其是妇女、儿童造成极大的危害。国际社会在《烟草控制框架公约》的指导之下,目前正展开一场大规模的全球性的控烟运动。     

Adolescent substance abuse, the importance of family, school and peers: data from the health behaviour in school children

Summary. Objectives: To determine the possible factors associated with adolescent substance use in a country having recently experienced war.Methods: The survey applied the World Health Organization research protocol for cross-national survey – HBSC: a cross-sectional study among 1540 15-year old adolescents in Belgrade was conducted. The research instrument was a self-administered questionnaire.Results: Substance abuse is associated with living in a single parent family, living in a family without support, having a poor commitment to school, displaying aggressive behaviour, and spending a lot of time with friends.Conclusions: Factors associated with adolescent substance use include social background, family, school and peers. Such associations could help to focus on better measures to eliminate or reduce the risk of substance use.

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Zusammenfassung. Missbrauch von Substanzen bei Jugendlichen, Bedeutung von Familie, Schule und peers: Angaben aus BelgradFragestellung: Ziel der Forschung ist, Faktoren zu bestimmen, die für den Substanzmissbrauch bei Jugendlichen mitverantwortlich sind.Methoden: Die Forschung ist ein Teil des Projektes Gesundheitliches Verhalten bei Schulkindern, das gemäss dem Protokoll der WHO für internationale komparative Studien, bei 1540 Jugendlichen in Belgrad durchgeführt wurde. Es wurde ein Fragebogen benutzt, der von den Befragten selbst ausgefüllt wurde. Die Ergebnisse sind mit Methoden der deskriptiven Statistik analysiert worden, d.h. mittels Chi2-Tests sowie der logistischen Regression.Ergebnisse: Die Ergebnisse deuten darauf hin, dass der Substanzmissbrauch mit folgenden Faktoren in Zusammenhang steht: Leben in einer Familie mit nur einem Elternteil, Leben in einer Familie ohne Unterstützung, einem sehr niedrigen Engagement für die Schule, leichter Kommunikation mit Freunden des anderen Geschlechts, mit agressivem Verhalten sowie dem Verbringen eines grossen Teils seiner Freizeit mit den Gleichaltrigen.Schlussfolgerung: Es besteht ein Zusammenhang zwischen dem Substanzenmissbrauch bei Jugendlichen und den verschiedenen sozialen Verhältnissen wie Familie, Schule und Gleichaltrige. Die Erkennung dieses Zusammenhangs wird uns die Fokussierung auf die Massnahmen ermöglichen, die den Expositionseffekt zum Risiko beseitigen, reduzieren oder auf irgendeine Weise schwächer machen können.

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Résumé. Labus de substances chez les adolescents limportance de la famille, de lécole et des pairs (Health Behaviour in School Children – Belgrade)Objectifs: Déterminer les facteurs pouvant provoquer un abus de substances chez les adolescents dans un pays ayant souffert récemment de la guerre.Méthodes: Le projet Health Behaviour in School Children a été réalisé parmi 1540 adolescents à Belgrade selon le protocole de lOMS, avec un questionnaire auto-administré.Résultats: Labus de substances est en lien avec la présence dune structure familiale monoparentale ou avec labsence de soutien familial, avec un comportement agressif, avec un investissement scolaire limité de même quavec le temps passé auprès des pairs.Conclusions: Les facteurs en lien avec labus de substances chez les adolescents à Belgrade sont dorigine sociale comme par exemple la famille, lécole, les pairs. La mise en évidence de ces facteurs pourrait contribuer à améliorer les mesures prises pour éliminer ou réduire le risque dabus de substances.

     

The impact of mass media anti-smoking publicity

The rapidly rising cost of health care has brought increasingattention to the potential of preventive measures as distinctfrom curative ones. Cigarette smoking is the leading preventablecause of morbidity and mortality in the UK. It is of considerableimportance therefore that the effectiveness of the differentpolicies which seek to reduce smoking be evaluated, This paperfocuses on how effective mass-media anti-smoking publicity isin reducing smoking. The approach adopted here is to reviewthe econometric literature of the past fifteen years which bearson this question. Thirteen articles are critically assessed.Both British and American work is included, as well as a relevantarticle from Switzerland. The conclusion reached is that mass-mediaanti-smoking publicity has proved effective in reducing smoking,both initially and in the longer term.     

How neuroticism affects responses to anti-smoking messages

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

Targeting the smoker in an anti-smoking campaign

Between May and September 1983, 1,661 smokers from a random sample of the populations of Sydney and Melbourne were interviewed in their homes. Of the first group, 219 were followed up 12 months later, representing a 75% response rate. Intention, measured by perceived likelihood to quit, was validated as a predictor of a later attempt to quit smoking in the cohort study. Males reported likelihood to quit more often than females. Perceived importance of smoking as a community health problem was also important in predicting attempts to change smoking status, indicating the possible importance of an agenda-setting role for the mass media in promoting change. The key finding was the interaction between health beliefs and social influence in predicting level of intention. On their own, health beliefs showed no relationship to perceived likelihood to quit, and social influence could be counterproductive. However, taken together, these two variables were strongly predictive of change. This suggests that a combination of these two messages should be used in anti-smoking campaigns.     

Youth smoking, cigarette prices, and anti-smoking sentiment

In this paper, we develop a new direct measure of state anti-smoking sentiment and merge it with micro-data on youth smoking in 1992 and 2000. The empirical results from the cross-sectional models show two consistent patterns: after controlling for differences in state anti-smoking sentiment, the price of cigarettes has a weak and statistically, insignificant influence on smoking participation, and state anti-smoking sentiment appears to have a potentially important influence on youth smoking participation. The cross-sectional results are corroborated by results from the discrete time hazard models of smoking initiation that include state-fixed effects. However, there is evidence of price-responsiveness in the conditional cigarette demand by youth and young adult smokers.     

Original: anti-smoking media campaign messages: theory and practice

This study examined televised anti-smoking advertisements that were designed to discourage adult and teen smoking. A content analysis of 399 television advertisements catalogued in the Media Campaign Resource Center (MCRC) database were evaluated to determine (a) whether the advertising content reflected core health communication theories used in the design of health campaign messages to change behavior and (b) the affective presentation of tobacco-control advertisements aimed to decrease smoking. The results revealed that anti-smoking advertising relied overwhelmingly on appeals to attitudes. Although the benefits of not smoking were mentioned in 61% of advertisements, barriers were mentioned in only 17% of advertisements. Advertisements emphasized the consequences of smoking more than the viewer's self-efficacy. Finally, advertisements were more likely to use informational and humor appeals, rather than sadness, fear, or anger appeals. The research identifies the types of advertisements that are most likely to be utilized and underutilized in national and statewide anti-smoking advertising campaigns catalogued in the MCRC database.     

Extent of law compliance and anti-smoking teaching at Spanish schools

OBJECTIVE: Knowing the degree of fulfillment of the anti tobacco legislation in Spanish schools and the influence that this has on the percentage of smoking pupils. MATERIAL AND METHODS: A survey was carried out among 3050 headmasters of Spanish schools, who were asked about different aspects of the fulfillment of the antitobacco laws in their schools and about the main characteristics of tobacco consumption in their centers. RESULTS: A 80.9% of the headmasters claim that the fulfillment of the legislation is demanded in their centers, and only a 64.9% of them have posters in theirs schools that warn people about smoking ban. Anti tobacco teachings are imparted in a 82.2% of the schools where laws is demanded and only in a 64.8% where is not demanded. The percentage of teachers who, smoke in the presence of the pupils is of a 5.9% in the schools where anti tobacco legislation is demanded and a 12.9% where is not demanded. In the schools where anti tobacco teachings are imparted, a 29% of the pupils have tried tobacco, opposite a 31% who have tried in the schools where these teachings are not imparted. CONCLUSIONS: The, headmasters of the schools, as people in charge of watching over the fulfillment of the anti tobacco legislation in theirs schools, must demand the fulfillment of this one, because this measure is effective in order to improve the global functioning of the schools and to reduce the percentages of smoking pupils and teachers.     

社区人群控烟方法及其效果评价

为探索人群控烟的有效措施 ,在北京、上海和长沙三城市社区人群中开展以宣传材料为主大众媒介宣教 ,结合学校健康教育 ,随访和管理社区吸烟者等多种形式的干预活动。按类试验设计评价人群吸烟行为的变化。结果显示在干预社区 ,男、女和男女合计吸烟率干预后较干预前分别降低 5 5 4 %、2 6 1%和2 94 % ,均有统计学差异。参照对照社区 ,男、女和男女合计吸烟率分别净下降 4 90 %、3 37%和 3 5 1% ,而男、女和男女合计戒烟率分别净提高 4 35 %、17 19%和 6 30 %。女性以及男女合计吸烟率和戒烟率净变化均有统计学差异。表明以健康教育为主的社区干预对人群控烟具有一定的效果 ,今后的社区控烟工作应争取健康教育的政策和社区支持环境和引进行为激励机制     

Chinese physicians' cigarette smoking habits and their anti-smoking counselling practices

A survey of Chinese physicians' cigarette smoking habits andtheir counselling of patients to quit smoking was carried outin two provincial hospitals in Wuhan, capital city of Hubeiprovince, People's Republic of China. All 559 physicians inthe two hospitals were given the questionnaire, of which 86%(480) returned their completed questionnaires. Of the 480 physicians,50.9% of the males, and 4.8% of the females were current cigarettesmokers. The majority of physicians (85.6%) had counselled theirpatients about cigarette smoking in the past year, althoughfew physicians (2.9%) felt that they were very successful inhelping patients to quit smoking. The frequency of physicians'anti-smoking counselling was significantly correlated with anumber of variables: physicians' own smoking status; whetherthey perceived themselves as the most influential people inhelping patients to quit smoking; whether physicians thoughtthat they were successful in their past counselling practices;and physicians' age.     

创建卫生城市推动控制烟草危害工作的探讨

创建卫生城市,对于提升城市品位,改善市民生活环境,促进经济社会又好又快发展,具有十分重要的意义,将有力促进城市卫生状况、市容市貌和环境质量的不断好转,改善人居环境,预防和消除疾病,提高市民的健康水平。这对于广大市民安居乐业,保持健康向上的精神风貌,提高城市的亲和力,推动社会和谐发展,都具有长久和深远的影响。     

Do anti-smoking media campaigns help smokers quit?

As part of an evaluation of the 1990-91 anti-tobacco media campaign carried out by the California Department of Health Services, a study was conducted among 417 regular smokers who had quit during the period of the media campaign. In brief telephone interviews, all respondents identified up to three events or experiences that had influenced them to quit. In response to uncued questions, 6.7 percent of those interviewed indicated that they had been influenced to quit by an advertisement they had seen or heard on radio, television, or billboards. In response to direct questions about the media campaign, 34.3 percent of the respondents indicated that the media campaign''s advertisement had played a part in their decision to quit. Applying the 6.7 percentage to the number of Californians who quit smoking in 1990-91, it can be estimated that for 33,000 former smokers, the anti-tobacco media advertisements were an important stimulus in their quit decision. Multiplying the 34.3 percent by the number of former California smokers who quit in 1990-91, the estimate of former smokers for whom the media campaign''s advertisements played at least some part in their decision to quit rises to 173,000 persons. While causal attributions from such investigations should be made with caution, the evidence suggests that the 1990-91 campaign did influence substantial number of smokers in California to quit.     

Critical evaluation of school-based anti-smoking education in Japan

OBJECTIVE: A critical evaluation was performed on school-based anti-smoking education reported over the past 25 years in Japan. METHODS: Relevant papers were retrieved by the key words of "smoking prevention" or "anti-smoking education" and those on anti-smoking education actually performed for pupils or students in Japan were collected. According to the criteria for whether they might be regarded as quasi-experimental studies regarding use of a control group, and performance of pretest and posttest assessment. Response rate, individual behavioral change, target group for evaluation, comparison methods e.g. before-after comparison, and points of evaluation were reviewed for each paper. RESULTS: Of 27 relevant papers, approximately 40% utilzed a control group and pretests were not conducted in 30%. Two kinds of posttest were performed; one was an immediate posttest 2 weeks after the anti-smoking education, and the other featured a longer interval. An immediate posttest only, a later posttest only and both posttests were performed in 10, 5, and 10 studies, respectively Eight, or 30%, were regarded as quasi-experimental for which the ranked of the quality of evidence might be II-1. Individual behavioral change was examined in only one paper. CONCLUSIONS: Three fourths of the 27 papers reviewed had some drawbacks in terms of study design. One half of the control groups were set in the same school as the education group and the remainders set in separate schools. Preferably, control groups should be set both in and out of the school of the education group. Apretest is an essential step and a posttest at the age of 20 is preferable where possible. Methodological innovation is required for individual identification and follow-up. In addition, objective indices of behavioral change should be analyzed and biases such as arising from selection bias should carefully be watched. Knowledge of epidemiological study designs is of essential importance to improve the quality of evaluations of health education programs.     

Randomised controlled trial of anti-smoking advice in pregnancy.

In a randomised controlled trial intensive individual anti-smoking advice given in parallel with hospital antenatal care did not influence the outcome of pregnancy. The belief that retardation of fetal growth caused by maternal smoking occurs in late pregnancy is not well based, and the advice may not have been given in time to be effective. Other possible interpretations of the results, that maternal smoking is merely an index of some other factor that retards growth or that those counselled did not reduce their smoking sufficiently to influence outcome, cannot be excluded.