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

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Abstract

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.

Research highlights

► This study finds that socioeconomic status moderates the relationship between smoking cessation ad themes and measures of their effectiveness in the USA.► Smokers with low levels of formal education less often recalled ads that focused on how to quit than ads that focused on why to quit.► Smokers with low levels of formal education perceived ads that focused on how to quit as less effective than ads that focused on why to quit.► Stages of Change Theory does not provide a compelling explanation for observed socioeconomic differences in response to smoking cessation ads.

Introduction

There are large disparities in rates of cigarette smoking by socioeconomic status (SES; usually measured in terms of education and income) in the United States, Canada and Australia and other countries (Canadian Institute for Health Information (CIHI), 2008, Centers for Disease Control and Prevention (CDC), 2009, Scollo and Winstanley, 2008). Governmental and non-governmental organizations in these countries have implemented large-scale media campaigns aimed at reducing smoking rates by preventing smoking initiation among young people and/or increasing cessation among adults (National Cancer Institute, 2008), but there is mixed evidence about their relative effectiveness between lower and higher SES populations (Niederdeppe, Kuang, Crock, & Skelton, 2008). Tobacco control programs must choose intervention strategies that balance major public health goals of (1) reducing overall population smoking rates and (2) reducing tobacco-related disparities (USDHHS, 2000). In order to achieve both of these goals, it is critically important to identify message strategies that are remembered and perceived as effective among both high and low SES populations. While two recent studies tested the relative effectiveness of different smoking cessation message strategies in promoting quitting behaviors between SES groups (Durkin et al., 2009, Niederdeppe et al., 2008), there remains much to learn about the most efficient and effective campaign strategies for balancing these goals. This study extends this line of research by (1) examining SES variation in response to different types of cessation ads and (2) applying the Stages of Change Model (Prochaska & DiClemente, 1983) in an attempt to understand why these differences may occur.

Section snippets

Effectiveness of smoking cessation advertising by message themes and appeals

Cessation-focused media campaigns have generally utilized four broad message themes: (1) why to quit (Why) for personal health, (2) how to quit (How), (3) tobacco industry behavior (anti-industry), and (4) effects of secondhand smoke (SHS; Rhodes, Roskos-Ewoldsen, Eno, & Monahan, 2009). Messages focused on Why for personal health typically use (a) graphic images (Why-Graphic) or (b) emotional testimonials (Why-Testimonial) to portray the serious health effects of smoking. Messages focused on

Effectiveness of smoking cessation advertising themes by SES

Two recent studies examined the effectiveness of smoking cessation advertising themes by education and income. Niederdeppe, Fiore, et al. (2008) analyzed data from a panel of smokers in Wisconsin, comparing one-year rates of quit attempts as a function of education, income and recall of different anti-smoking ad themes. The authors found no differences by education or income in response to ads focused on the dangers of SHS. They did find significant differences, by education, in response to ads

Stages of change model as an explanation for differential effectiveness by SES

Stages of Change Theory (Prochaska & DiClemente, 1983) posits that efforts to change behavior occur in a series of five steps: (1) precontemplation, (2) contemplation, (3) preparation, (4) action, and (5) maintenance. By definition, current smokers fall into one of the first three categories, as those in the action and maintenance stage have already quit smoking. Among current smokers, precontemplators do not intend to quit smoking within the next 6 months, contemplators intend to quit within 6

Study objectives

This study aims to (1) examine SES variation in response to different types of cessation ads and (2) apply predictions derived from studies using the Stages of Change Model in an attempt to understand why SES differences may occur. We focus on two outcomes of importance for comparing the influence of smoking cessation media campaigns on low- and high-SES smokers: (a) aided ad recall and (b) perceived effectiveness (Niederdeppe, Kuang, et al., 2008). Aided ad recall is used as a measure of

Survey data

We used data from five waves of the New York Media Tracking Survey Online (hereafter called the “New York survey”), a self-administered web-based survey of adult smokers designed to track awareness of and response to smoking cessation ads that appeared, or were scheduled to appear, in New York. The New York survey sample included smokers who currently participate in the Harris Poll Online and reside in either New York or media markets within New Jersey where the New York Tobacco Control Program

Aided ad recall

Model 1 in Table 2 shows that participants recalled Why-Testimonial ads at higher rates than ads using the other three themes. Wald tests for equality of coefficients showed that participants had lower levels of ad recall for How ads than each of the other ad themes (each p < 0.001). Model 2 reveals a significant interaction between How ads (vs. Why-Testimonial) and income. We also observed significant interactions between both Why-Graphic and How ads (vs. Why-Testimonial) and education (Model

Discussion

This study of recall and response to different classes of smoking cessation ads reveals four main findings. First, participants recalled ads focused on Why that utilized emotive testimonials at higher rates than other types of ads. Second, respondents perceived ads focused on Why that featured graphic imagery as more effective than other types of ads. Third, smokers (particularly those with low education) recalled ads focused on How less often, and perceived them as less effective, than ads

Conclusion

Ads focused on why to quit smoking, using emotive testimonials or graphic imagery, generate more favorable responses among lower SES populations than ads that simply tell viewers how to quit smoking. Future studies should attempt to understand why patterns of ad response differ by ad theme and SES in an effort to maximize ad effectiveness among low SES smokers.

Acknowledgments

The New York State Department of Health’s Tobacco Control Program funded this study. We are grateful to Harlan Juster for his insightful comments on an earlier version of this paper.

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