Interpersonal communication as an indirect pathway for the effect of antismoking media content on smoking cessation

In the context of health campaigns, interpersonal communication can serve at least 2 functions: (a) to stimulate change through social interaction and (b) in a secondary diffusion process, to further disseminate message content. In a 3-wave prospective study of 1,079 smokers, the authors demonstrate that mass media messages (antismoking campaigns and news coverage relevant to smoking cessation) have an indirect effect on smoking cessation intention and behavior via interpersonal communication. Exposure to campaigns and news coverage prompts discussion about the campaigns, and, in turn, about smoking cessation. Interpersonal communication regarding smoking cessation then influences intention to quit smoking and attempts to quit smoking. The study finds evidence not only for the social interaction function of interpersonal communication, but also for the secondary diffusion function. A substantial number of smokers who are not directly exposed to the antismoking campaigns are nevertheless indirectly exposed via communication with people who have seen these campaigns. These results imply that encouragement of interpersonal communication can be an important campaign objective.     

Antismoking Ads at the Point of Sale: The Influence of Ad Type and Context on Ad Reactions

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.     

Talking About Antismoking Campaigns: What Do Smokers Talk About,and How Does Talk Influence Campaign Effectiveness?

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 Exposure^SM methodology, 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.     

The Unintended Target: Assessing Nonsmokers' Reactions to Gain- and Loss-Framed Antismoking Public Service Announcements

This study examined nonsmokers' emotional responses and intentions to promote smoking cessation after exposure to a gain- or loss-framed antismoking public service announcement (PSA). Participants were 183 nonsmokers, and results reveal that gain- and loss-framed antismoking PSAs elicited different types and levels of affect as a function of the message theme for the antismoking PSA. Although secondhand smoke PSAs elicited higher levels of anger toward smokers and fear of secondhand smoke, smoking addiction PSAs tended to elicit more guilt among nonsmokers. Elicited emotions were significant predictors of intentions, and overall, loss-framed appeals worked better than gain-framed appeals at increasing nonsmokers' intentions to talk to friends who smoke about quitting.     

Communication,Reasoning, and Planned Behaviors: Unveiling the Effect of Interactive Communication in an Anti-Smoking Social Media Campaign

This study examines direct and indirect effects of interactive communication in an antismoking social media campaign. To that end, we pose a multitheoretical framework that integrates communication mediation models and the Theory of Planned Behavior. To test the theorized model, we conducted an experiment using a two-group pretest–posttest design. Participants (N = 201) were randomly assigned into two experimental conditions: “campaign message reception only” as a control group and “message reception and social interaction” as a treatment group, in which the participants contributed to the antismoking campaign by posting their own campaign ideas and information they found through mediated and interpersonal communication. The findings show that interactive communication catalyzes the participants’ information searching behaviors through diverse communication channels. In turn, increased media use plays a crucial role in changing their attitudes and perceived social norms about smoking behaviors, and eventually reducing smoking intention. This study affirms that the theory of planned behavior is effective in predicting behavioral intention and demonstrates the usefulness of a multitheoretical approach in interactive campaign research on social media.     

Socioeconomic variation in recall and perceived effectiveness of campaign advertisements to promote smoking cessation

There are large disparities in cigarette smoking rates by socioeconomic status (SES) in many countries. There is mixed evidence about the relative effectiveness of smoking cessation media campaigns in promoting quitting between lower and higher SES populations, and studies suggest that some types of ad content may have differential effects by SES. We analyzed data from five waves of the New York Media Tracking Survey Online (MTSO), a web survey involving over 7000 adult smokers conducted between 2007 and 2009, to assess SES variation in response to smoking cessation ads. Smokers with low levels of education and income less often recalled ads focused on how to quit, and perceived them as less effective, than ads using graphic imagery or personal testimonials to convey why to quit. Contrary to predictions offered by the Stages of Change Model, we found no evidence that variation in readiness to quit smoking explained patterns of response by education. Results offer guidance for theorists and campaign planners in developing campaigns that are likely to promote cessation among less educated populations.     

Keepers of the Secret: Desires to Conceal a Family Member's HIV-Positive Status in Namibia,Africa

In this research, we examine the influence of liking for antismoking public service announcements (PSAs), relative to that of PSAs' perceived argument strength, on adolescents' smoking-related behavioral intentions. Data from the first Legacy Media Tracking Survey (LMTS–I) suggest that the relative persuasive impact of PSA liking and perceived argument strength varies as a function of message recipients' smoking status. PSA liking appears to be an important predictor of smoking intentions for never smokers, whereas perceived argument strength strongly predicts quitting intentions for current smokers. For former smokers, both perceived argument strength and PSA liking have significant effects on smoking intentions, with perceived argument strength exerting a stronger impact. Theoretical and practical implications of the findings are discussed.     

Tobacco denormalization and industry beliefs among smokers from four countries

BACKGROUND: Tobacco denormalization is an important concept for understanding smoking behavior. The present study sought to assess beliefs about the tobacco industry and the social acceptability of smoking among nationally representative samples of adult smokers from four countries, and to assess the relationship of these measures to cessation behavior and tobacco-control policy. DESIGN: A longitudinal survey of 9058 adult smokers from Canada (n = 2214), the United States (n = 2138), the United Kingdom (n = 2401), and Australia (n = 2305), was conducted in October-December 2002 and again in June and August 2003 (75% follow-up rate). The analyses were conducted in 2005. RESULTS: The findings indicate that few smokers perceive approval for their smoking, and most hold relatively antagonistic beliefs toward the tobacco industry. For example, 80% of smokers reported that society disapproves of smoking, and more than three quarters reported that tobacco companies cannot be trusted to tell the truth. Social and industry denormalization were independently associated with intentions to quit smoking. Baseline levels of social denormalization were associated with abstinence at the 8-month follow-up, as were changes in industry denormalization beliefs between baseline and follow-up. Anti-industry beliefs at baseline did not predict abstinence at follow-up. A similar pattern of findings was observed across all four countries. In addition, social denormalization and anti-industry beliefs were significantly associated with tobacco-control policies, such as noticing health warnings on packages and greater workplace smoking restrictions. CONCLUSIONS: Tobacco denormalization constructs were independently linked to cessation-related outcomes among adults from four countries. Tobacco-industry denormalization themes in mass media campaigns may help to reduce tobacco use above and beyond more traditional communications that target social norms.     

Adolescent smoking behavior: measures of social norms

BACKGROUND: Relatively little research has focused on the social norms of teen smoking. This study examined social norms regarding adolescent smoking and their relationship with smoking behavior. METHODS: Data were collected in 1998 as part of the follow-up for a randomized trial in 14 rural Minnesota communities. Four aspects of perceived social norms of smoking were measured, and students were classified as nonsmokers, daily smokers, past-week smokers, or past-month smokers. Social norms were compared across four levels of smoking behavior, and multivariate models controlled for personal characteristics and family and peer smoking. RESULTS: The sample comprised a total of 3128 girls and 3146 boys in grades 8 to 10. For all four measures, nonsmokers had the most antismoking perceptions of social norms around smoking (p <0.001). In multivariate models, noticing other teens smoking and the perception that adults care about and disapprove of teen smoking remained significantly related to past-month smoking. Using more frequent smoking as the dependent variable, noticing smoking remained significantly associated with smoking in the anticipated direction. Perceived prevalence of smoking did not perform consistently across models. CONCLUSIONS: Noticing teens smoking is associated with smoking behavior across three different levels of smoking frequency. The perception that adults care about and disapprove of teen smoking was associated with past-month and past-week smoking. Although perceived prevalence is often used to measure social norms of teen smoking, this measure may have limited utility. Strategies for health promotion and intervention on the issue of youth smoking are discussed.     

The role of parents' health in their offspring's intentions to quit smoking

BACKGROUND: Motivating cessation among young smokers is an important challenge for smoking reduction programs. This research examines the role of perceived illness in smoking parents as a motivator for cessation in young smokers. METHODS: Two nationally representative samples of young U.S. smokers (ages 14 to 22 and 18 to 25 in 2002) assessed perceptions of parent health, quit intentions, risk perceptions and affective expectations for smoking to test the hypothesis that perceived illness in smoking parents motivates quitting by linking unfavorable emotional reactions to the smoking experience. RESULTS: Approximately 88% of young smokers reported that parents who smoked were in less than very good health compared to 54% of smokers whose parents did not smoke. Unlike young smokers whose parents did not smoke, the quit intentions of those whose parents smoked were directly related to the perceived ill health of their parents. Affective expectations rather than perceived risk of smoking appeared to mediate these relations. CONCLUSION: Youth smoking cessation programs could benefit from targeting smokers whose parents smoke and are likely to show the long-term effects of smoking-related illness.     

Changing smoking attitudes by strengthening weak antismoking beliefs - Taiwan as an example

I first explored the strength of Taiwanese high school students' beliefs regarding five antismoking messages. Findings of a nationwide survey showed that the students held these beliefs in the following order of decreasing strength: second-hand smoke damages health, smoking has long-term health consequences, smoking has short-term health consequences, cigarette marketers are manipulative, and smokers are perceived negatively. Experiment one further showed that antismoking ads featuring weakly held beliefs are more effective than those featuring strongly held beliefs. Experiment two demonstrated that antismoking campaigns need to be framed carefully; in general, it is more effective to positively frame messages about strongly held antismoking beliefs but negatively frame messages about weakly held antismoking beliefs.     

中国三城市男性吸烟者的社会规范与戒烟行为的关系

【目的】了解中国男性戒烟相关社会规范的现状及其与戒烟意愿、戒烟尝试等戒烟行为之间的关系。【方法】基于横断面研究,于2013年8-11月在上海、南宁、牡丹江三个地区抽取成年男性现在吸烟者进行问卷调查,收集基本信息、每日吸烟量、戒烟意愿、戒烟尝试和戒烟相关社会规范等资料。建立单因素、多因素logistic回归模型分别分析戒烟相关社会规范与戒烟意愿、戒烟尝试的关系。共获得有效问卷3621份,总有效率95.8%。【结果】吸烟者感知到的戒烟相关社会规范较低,很少能从家人、朋友及其他身边的人获得戒烟的劝谏与建议。社会规范得分每提高1分,则吸烟者的戒烟意愿可能性增加69%(OR为1.69,95%CI为1.48~1.94),吸烟者戒烟尝试的可能性增加86%(OR为1.86,95%CI为1.66~2.08)。【结论】戒烟相关社会规范是吸烟者产生戒烟意愿、戒烟尝试的独立预测因子。今后的控烟干预策略应该致力于创建鼓励戒烟的社会规范。     

The contribution of antismoking advertising to quitting: intra- and interpersonal processes

This study explored the roles of transportability-the tendency to become absorbed in a narrative-and interpersonal discussion in the use of televised antismoking advertising in attempts to quit smoking. We used data from a representative population survey of adults (n = 2,999), examining responses from current smokers (n = 594) and former smokers who had quit in the last 5 years (n = 167). Logistic regression analysis revealed that current and former smokers higher in transportability were more likely to recall an antismoking ad (OR = 1.08, p < .001), and to perceive they had been helped by antismoking advertising in their attempts to quit smoking (OR = 1.05, p < .01). Transportability also was related to the recall of narrative antismoking advertisements (OR = 1.06, p < .05). Among current smokers, those who engaged in interpersonal discussion about any antismoking advertising were more likely to have made a quit attempt (OR = 2.76, p < .001). Finally, individuals were most likely to discuss advertising containing information about the negative health consequences of smoking using graphic images or simulations of bodily processes. These results suggest that the effectiveness of antismoking advertising is dependent upon both intra- and interpersonal processes that are triggered by the advertisements.     

Televised Antismoking Advertising: Effects of Level and Duration of Exposure

Objectives. We assessed the effects of levels and duration of exposure to televised antismoking advertising on cognitive and behavioral changes.Methods. We used data from a serial cross-sectional telephone survey with weekly interviews of adult smokers and recent quitters in New South Wales, Australia (n = 13 301), between April 2005 and December 2010. We merged survey data with commercial TV ratings data to estimate individuals’ exposure to antismoking advertising.Results. Logistic regression analyses indicated that after adjustment for a wide range of potential confounders, exposure to antismoking advertising at levels between 100 and 200 gross rating points per week on average over 6 to 9 weeks was associated with an increased likelihood of having (1) salient quitting thoughts and (2) recent quit attempts. Associations between exposure for shorter periods and these outcomes were not significant.Conclusions. Broadcasting schedules may affect the success of antismoking ads. Campaign planners should ensure advertising exposure at adequate frequency over relatively sustained periods to maximize impact.In the Australian state of New South Wales, adult smoking prevalence declined from 20.1% in 2005 to 15.8% in 2010,1 during a period of implementation of tax increases on tobacco products, graphic health warnings on packs, clean indoor air legislation, and point-of-sale display bans. In addition, the government has made significant investments in televised antismoking mass media campaigns. Studies that merge commercial TV ratings data at the market level with individual-level data have demonstrated that increases in an individual’s potential exposure to televised antismoking campaigns are associated with improved youth smoking-related attitudes, beliefs, and behaviors2–6; increased calls to quitlines7–13; increased quitting behaviors among adults14–16; and decreased adult smoking prevalence.17 It is increasingly recognized that the response of smokers to mass media campaigns is likely to be influenced by the kinds of messages broadcast.11,13,15 The extent of population exposure to those messages is also an important factor in determining the impact of media campaigns.16 Identifying the level and duration of campaign media placement to achieve optimum population response is a critical question of efficiency for campaign planners and funders.Despite a consensus that advertising must reach the audience a sufficient number of times to be effective,18–20 attempts to quantify the advertising intensity that can most efficiently influence behavior have not yet resulted in firm conclusions. Among adult smokers, one estimate suggested that for every 2 exposures to anti-tobacco advertisements per month, the quit rate increased by approximately 10%.14 A more recent study showed that the likelihood of quitting within a 2-year period increased 49% with an additional 2 exposures per month.15Less attention has been paid to how population response to antismoking advertising builds and decays. Although some advertisements may be recalled long after the end of a campaign, campaign effects on the most critical outcome of behavioral response are detectable only while they are being broadcast or for a short time after.17,21,22 Although public health researchers have started to address the issue of advertising decay, studies to date have not addressed questions relating to the “build” or “wear in” of advertising effects on smoking-related behaviors. Studies exploring the impact of different levels of advertising on smoking behaviors have typically examined associations between advertising exposure and behavior changes over differing periods, ranging from 3 months to 2 years. For this reason, it is not clear whether the effect of increased antismoking advertising on population smoking behavior occurs within a few weeks or requires longer durations of exposure.We investigated the effect of differing levels and durations of exposure to antismoking advertising on quitting outcomes, focusing on proximal indicators of behavior change expected to vary contemporaneously with advertising.22 Public health media campaigns have been theorized to affect audiences in 1 of 2 ways: by providing new information that changes existing beliefs or by increasing the salience or accessibility of an existing belief.23 In countries with long-running tobacco control programs, such as Australia, many smokers already possess favorable beliefs about quitting.24 Therefore, we expected that the effects of antismoking advertising would be evident in increased salience of quitting-related thoughts. We also examined the relationship between advertising exposure and quit attempts, because it has been shown that increasing the rate of quit attempts in a population has been shown to be critical for reducing overall smoking prevalence.25     

Does Stigmatization Motivate People to Quit Smoking? Examining the Effect of Stigmatizing Anti-Smoking Campaigns on Cessation Intention

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.     

江苏省媒体控烟宣传对吸烟人群戒烟意愿的影响

目的了解各种媒体控烟宣传覆盖现状,探讨媒体控烟宣传对吸烟人群戒烟意愿的影响,为今后利用媒体开展控烟宣传提供依据。方法采用多阶段整群随机抽样方法在江苏省14个疾病监测点中抽取8400名18岁及以上成人进行调查,分析人群接触各种媒体情况和各种媒体控烟宣传覆盖情况,并用非条件logistic回归模型研究控烟宣传媒体暴露数量对吸烟人群戒烟意愿的影响。结果人群中接触率较高的媒体为电视（89．4％）和报纸（54．3％）,且媒体接触率在不同性别、年龄、城乡、文化和收入水平人群中存在差异（P〈0．01）;控烟宣传覆盖较高的媒体为电视（51．8％）和报纸（22．2％）,互联网（6．7％）和电影院（3．3％）相对较低;26．7％现在吸烟者有打算戒烟的意愿;非条件logistic回归分析显示吸烟人群中暴露于控烟宣传媒体数量越多,其打算戒烟的比例也越高,暴露于2种和3种及以上控烟宣传媒体的现在吸烟者打算戒烟比例分别是未暴露者的1．45倍和1．59倍,差异有统计学意义（P〈0．01）。结论公共场所中控烟宣传覆盖比例仍相对较低,应该针对吸烟者自身和环境因素制定媒体控烟宣传策略,加强公共场所媒体控烟宣传力度,促进吸烟者戒烟。     

The Effects of Smoking-Related Television Advertising on Smoking and Intentions to Quit Among Adults in the United States: 1999–2007

Objectives. We investigated whether state-sponsored antitobacco advertisements are associated with reduced adult smoking, and interactions between smoking-related advertising types.Methods. We measured mean exposure to smoking-related advertisements with television ratings for the top-75 US media markets from 1999 to 2007. We combined these data with individual-level Current Population Surveys Tobacco Use Supplement data and state tobacco control policy data.Results. Higher exposure to state-sponsored, Legacy, and pharmaceutical advertisements was associated with less smoking; higher exposure to tobacco industry advertisements was associated with more smoking. Higher exposure to state- and Legacy-sponsored advertisements was positively associated with intentions to quit and having made a past-year quit attempt; higher exposure to ads for pharmaceutical cessation aids was negatively associated with having made a quit attempt. There was a significant negative interaction between state- and Legacy-sponsored advertisements.Conclusions. Exposure to state-sponsored advertisements was far below Centers for Disease Control and Prevention–recommended best practices. The significant negative relationships between antismoking advertising and adult smoking provide strong evidence that tobacco-control media campaigns help reduce adult smoking. The significant negative interaction between state- and Legacy-sponsored advertising suggests that the campaigns reinforce one another.Cigarette smoking remains the leading cause of preventable death in the United States. State tobacco control programs rely heavily on paid television advertising to promote tobacco control messages, with the goals of influencing attitudes and beliefs about tobacco use, and reducing population smoking. The California Tobacco Control Program, launched in 1990, is the largest and longest-running state-sponsored antismoking media campaign in the United States.1 Massachusetts introduced a campaign in 1994, Arizona in 1997, and Oregon and Florida in 1998.2,3 Between 1998 and 2002, at least 30 other states started antismoking media campaigns. Cigarette excise taxes and earmarked funds from the 1998 Master Settlement Agreement (MSA) have financed the majority of such campaigns4; in recent years, however, many of these state campaigns have been significantly cut, or even eliminated. The American Recovery and Reinvestment Act of 2009 allocated $650 million toward the Communities Putting Prevention to Work initiatives, many of which included significant tobacco control media campaigns.5 This recent infusion of funding represents the largest expansion of state and regional tobacco control media campaigns since 1998. In addition, the US Food and Drug Administration has announced its own sizable tobacco control media campaign scheduled in 2012.6State-sponsored antitobacco advertisements are not the only smoking-related messages seen on television in the United States in recent years. Since 1996, when nicotine replacement therapies were approved for over-the-counter distribution, pharmaceutical companies have used television advertising extensively to promote smoking cessation aids.7 Also as a result of the MSA, the American Legacy Foundation (Legacy) was formed in 1999, and in 2000 introduced “truth,” its national antismoking advertising campaign. In addition, Philip Morris and Lorillard each launched media campaigns in 1998, which included television advertising with putatively antismoking messages.8Early evidence has suggested that public investments in antismoking media campaigns contributed to reductions in smoking among youths.9 Research on the relationship between antismoking advertisements and adult smoking behavior is encouraging but less conclusive.4,10 Most studies have focused on individual media campaigns within a single state or country, and have not controlled for other smoking-related advertising or other tobacco control policies, such as cigarette excise taxes or clean indoor air regulations, which also influence smoking.11 For example, a recent Australian study showed that higher levels of televised antismoking advertising was associated with reduced adult smoking, with control for important concurrent tobacco control policies.12 One multistate study of the relationship between antismoking advertisements and adult smoking in the United States showed that smokers with higher levels of awareness of antismoking media campaigns were more likely to quit, even after control for other tobacco control policies in the 9 states studied.13 However, that study did not explore the impact of other antitobacco or cessation-related advertising, such as Legacy’s truth campaign or advertisements for pharmaceutical cessation aids. Adults in the United States received substantial levels of exposure to ads for pharmaceutical cessation aids, as well as to Legacy’s predominantly youth-targeted antitobacco media campaign.7 Exposure to either or both of these smoking-related messages may therefore have had important effects on adult smoking. To date, there has been no research on the relationship between smoking among US adults and concurrent exposure to smoking-related advertisements produced by various sponsors, or potential interactions among advertising produced by various sponsors.We examined the relationships between US adults’ smoking behaviors and their exposure to smoking-related television advertisements sponsored by state health departments, the American Legacy Foundation, tobacco companies, and pharmaceutical companies promoting their cessation products. We hypothesized that higher levels of exposure to state-sponsored antitobacco advertisements would be associated with reduced smoking. Our models controlled for individual characteristics, as well as state tobacco control policies and, therefore, overcame the limitations of previous research on the effects of antismoking advertising on smoking among adults.     

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

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

The Moderating Effects of Self-Esteem and Self-Efficacy on Responses to Graphic Health Warnings on Cigarette Packages: A Comparison of Smokers and Nonsmokers

Do graphic pictorial health warnings (GPHWs) on cigarette packaging work better for some people than others? According to the Extended Parallel Process Model (EPPM), fear appeals should heighten positive change only if a person believes he or she is capable of change (i.e., self-efficacy). We exposed 242 smokers and 241 nonsmokers (aged 18–29) in the Republic of Korea to either a GPHW or a text-only warning in a between-subjects experiment. Results indicated that the GPHW increased intentions and motivations to quit smoking (for smokers) and intentions and motivations to not start smoking (for nonsmokers). However, these effects were moderated by self-efficacy related to quitting or not starting smoking. For smokers, a GPHW was especially effective in increasing desires and intentions to quit for people high in self-efficacy and high in self-esteem. However, for nonsmokers, a GPHW was effective only when self-efficacy was high, regardless of self-esteem level. For smokers and nonsmokers, results were mediated by heightened perceived health estimation. Implications for understanding the effectiveness of warning labels on cigarettes, for the introduction of GPHWs in the Republic of Korea, and for the Extended Parallel Process Model, are discussed.