Short communicationNo untoward effects of smoking cues in anti-smoking public service announcements☆
Introduction
Mass media campaigns employing anti-smoking public service announcements (PSAs) have shown promise in reducing smoking prevalence (Emery et al., 2012, Hu et al., 1995), although not all campaigns are successful (Durkin et al., 2012). Anti-smoking PSAs often include smoking-related cues in order to illustrate the negative consequences of smoking. However, visual drug cues can trigger cravings to smoke (Carter and Tiffany, 1999) and may play a role in relapse (Shiffman et al., 2002). Indeed, preliminary work suggests that smoking cues in anti-tobacco PSAs increase smoking urges if the central argument is weak (Kang et al., 2009). Furthermore, smokers display attentional biases to smoking cues (Bradley et al., 2004, Waters et al., 2003) that may affect cognitive processing of the PSA. By distracting smokers from the central message and providing a clear motivator to continue smoking (i.e., increased urge to smoke), the presence of smoking cues in anti-smoking PSAs could be counter-productive to the goal of reducing smoking prevalence.
We examined effects of smoking cues in PSAs on smoking urges, cognitive measures (e.g., attitudes, self-efficacy, intentions, and recall), and smoking behavior in a sample of 318 daily smokers. PSAs were coded by independent raters for the presence of smoking cues, including whether cues were central or peripheral to the PSA’s central argument. Based on prior research (Kang et al., 2009), we included argument strength (AS, low versus high) as a factor, resulting in six PSA conditions (all between-subject). We hypothesized that (1) PSAs containing smoking cues, particularly peripheral cues, would increase smoking urges (primary outcome), have a negative influence on cognitions about quitting smoking, recall of PSA arguments, and increase post-viewing smoking behavior (secondary outcomes); and (2) the negative effects of smoking cues on these measures would be more pronounced for PSAs with weaker arguments (cues by argument strength interaction). An exploratory analysis utilized eye-tracking to examine whether time spent viewing cues predicted primary or secondary outcomes.
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PSA selection
A selection of 99 PSAs coded for argument strength (AS; Strasser et al., 2009, Zhao et al., 2011) were evaluated by both well-trained and naïve raters for the presence of smoking cues. Argument strength was assessed for each PSA in this study following procedures detailed in Zhao et al. (2011). Argument strength is an aggregate rating averaged across independent samples of smokers. The ratings were obtained as a part of coding work on a large collection of anti-smoking PSAs (for example, see
Descriptive statistics
Three hundred eighteen participants completed the study. Of these, 160 (50.3%) were female; the majority were African American (63.8%) and reported education beyond high school (69.8%). The mean age was 32.5 years (SD 9.9, range 20–61) and mean CPD was 13.9 (SD 5.8, range 5–30). There were no significant differences in age, sex, or CPD among PSA conditions.
Primary outcome: smoking urges
Across all conditions, there was a significant increase in reported smoking urges from baseline to the post-PSA assessment; the mean QSU-B
Discussion
Anti-smoking PSAs often include smoking-related cues to illustrate the harmful effects of smoking. The results of this large experimental analysis of smoking cue effects within these PSAs provides no evidence for untoward effects of cue presence or view time on smoking urges, cognitions about quitting smoking, recall of the PSA message, or immediate post-viewing smoking behavior.
Smoking cues presented in other settings have been shown to increase smoking urges. For example, smokers presented
Role of funding source
This work was supported by the National Cancer Institute Center of Excellence in Cancer Communication Research (CECCR), P50-CA095856 and P20-CA095856-06 (Hornik). M. Falcone is supported by NIH grant T32 GM008076. The funding sources had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Contributors
M. Falcone was responsible for data analysis and manuscript writing; C. Lerman and J.N. Capella were responsible for study design, interpretation and manuscript writing; C. Jepson analyzed data and assisted in manuscript preparation; P.M. Sanborn assisted in data collection, scoring and manuscript preparation; and A.A. Strasser was responsible for study design, data analysis and manuscript writing. All authors have approved the final version of the manuscript.
Conflict of interest
Dr. Lerman has served as a consultant and has received research funding from Pfizer that is unrelated to this project. The other authors declare no conflicts of interest.
References (23)
- et al.
Do movie stars encourage adolescents to start smoking? Evidence from California
Prev. Med.
(1999) - et al.
Graphic warning labels in cigarette advertisements: recall and viewing patterns
Am. J. Prev. Med.
(2012) - et al.
Use of mass media campaigns to change health behaviour
Lancet
(2010) - et al.
Attentional and evaluative biases for smoking cues in nicotine dependence: component processes of biases in visual orienting
Behav. Pharmacol.
(2004) - et al.
Meta-analysis of cue-reactivity in addiction research
Addiction
(1999) - et al.
Evaluation of the brief questionnaire of smoking urges (QSU-brief) in laboratory and clinical settings
Nicotine Tob. Res.
(2001) - et al.
Mass media campaigns to promote smoking cessation among adults: an integrative review
Tob. Control
(2012) - et al.
The effects of smoking-related television advertising on smoking and intentions to quit among adults in the United States: 1999–2007
Am. J. Public Health
(2012) - et al.
The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire
Br. J. Addict.
(1991) - et al.
Reducing cigarette consumption in California: tobacco taxes vs an anti-smoking media campaign
Am. J. Public Health
(1995)
The effect of smoking cues in antismoking advertisements on smoking urge and psychophysiological reactions
Nicotine Tob. Res.
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Supplementary material can be found by accessing the online version of this paper. See Appendix A for more details.