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标题：Smoking-Cessation Media Campaigns and Their Effectiveness Among Socioeconomically Advantaged and Disadvantaged Populations
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作者：Jeff Niederdeppe ; Michael C. Fiore ; Timothy B. Baker 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2008
卷号：98
期号：5
页码：916-924
DOI：10.2105/AJPH.2007.117499
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined whether the impact of televised smoking cessation ads differed by a population’s education and income. Methods. We used longitudinal data from the Wisconsin Behavioral Health Survey, a statewide sample of 452 adult smokers who were interviewed in 2003 to 2004 and followed up 1 year later. Logistic regression was used to assess whether baseline recall of secondhand smoke ads and “keep trying to quit” ads was associated with quit attempts and smoking abstinence at 1 year. Interaction terms were used to assess whether these associations differed by the smokers’ education and income levels. Results. Overall, neither keep-trying-to-quit nor secondhand smoke ad recall was associated with quit attempts or smoking abstinence. Keep-trying-to-quit ads were significantly more effective in promoting quit attempts among higher-versus lower-educated populations. No differences were observed for secondhand smoke ads by the smokers’ education or income levels. Conclusions. Some media campaign messages appear less effective in promoting quit attempts among less-educated populations compared with those who have more education. There is a need to develop media campaigns that are more effective with less-educated smokers. Large antitobacco media campaigns, combined with other tobacco-control activities, have been associated with decreased smoking prevalence and reduced cigarette consumption. 1 ^, 2 However, populations with higher socioeconomic status (SES) may benefit from media campaigns more than populations with lower SES, leading to increased disparities over time. 3 ^– 6 Smoking-cessation media campaigns have led to increased quit rates in several countries 7 ^– 9 and several states within the United States. 10 ^– 12 One third of former smokers cite campaign ads as factors in helping them quit. 13 ^, 14 A variety of message strategies have been used by smoking-cessation media campaigns. 14 ^– 16 Ads with evocative testimonials about the health effects of smoking have been cited by former smokers as influential in their efforts to quit. 17 Ads emphasizing that quitting is difficult but that smokers should keep trying to quit (KTQ) have been associated with increases in telephone quit line call volume 18 ^, 19 and higher quit rates. 20 California’s tobacco-control program produced declines in cigarette consumption in part by using ads to convince smokers that secondhand smoke (SHS) harms others. 11 ^, 15 No published studies have assessed the relative effectiveness of the various approaches between low- and high-SES populations. Low-SES populations are a critical target for smoking-cessation campaigns. There are large disparities in smoking rates by SES in the United States. 21 Disparities in smoking by SES have increased dramatically since 1966, 6 ^, 22 concurrent with the first surgeon general’s reports on the health consequences of smoking 23 ^, 24 and the first national anti-smoking media campaign. 25 Smoking rates are higher among lower-SES than among higher-SES populations in part because they are less likely to quit successfully. 26 ^, 27 Combined, these findings suggest that cessation media campaigns may have greater impact among higher-SES versus lower-SES populations. 3 ^– 6 Zhu et al. and others have found lower-SES populations to be less likely than higher-SES populations to call telephone quit lines in the context of cessation media campaigns. 28 At the same time, Macaskill et al. and Siahpush et al. have found few differences in media campaign effects by SES 29 ^, 30 or a greater volume of calls to telephone quit lines from low-SES populations during media campaign activities. 31 ^, 32 Most published evaluations have not included examinations of cessation campaign effects by SES. A relative ineffectiveness of media campaigns among low-SES populations could be caused by several factors, including differences in (1) exposure and attention to campaign messages, (2) motivational impact of campaign messages, and (3) capacity to make sustained behavioral changes in response to media messages. 5 This framework suggests that lower-SES populations may be less likely than higher-SES populations to recall messages, attempt to quit, or quit successfully in response to a smoking-cessation media campaign. Cessation campaigns could increase SES disparities in smoking if any of these 3 scenarios occurred. The Wisconsin Tobacco Prevention and Control Program broadcast televised smoking-cessation media campaign messages between May 2002 and December 2003 to increase the volume of calls to the Wisconsin Tobacco Quit Line, raise awareness of the effects of SHS, and promote quit attempts among Wisconsin smokers. The campaign used 2 message approaches: KTQ and SHS ads. A series of televised KTQ ads were broadcast between November 2002 and June 2003. These ads emphasized that quitting is difficult but that practice and assistance from the telephone quit line makes quitting easier. The KTQ ads aired most weeks at 40 to 60 gross ratings points per week between November 2002 and June 2003. Forty gross ratings points represent an average of 0.40 exposures per Wisconsin television viewer in a given week. A subset of KTQ ads was targeted to lower-SES and specific racial/ethnic populations by placing these ads in programs with high proportions of low-SES and minority viewers. After 3 hiatus months, KTQ ads were broadcast in October to December 2003 through donated air time. The campaign also aired a series of televised SHS ads to raise awareness of the health consequences of SHS exposure and, as a secondary goal, to promote quit attempts. Most SHS ads featured short vignettes from individuals affected by SHS. The SHS ads aired at 100 or 150 weekly gross ratings points most weeks between May 2002 and October 2003. A few SHS ads included the quit line number but the majority did not. A subset of SHS ads were targeted to lower-SES and racial/ethnic minority populations. The Wisconsin Tobacco Prevention and Control Program’s use of 2 smoking cessation message approaches (KTQ and SHS ads), combined with longitudinal data from a sample of Wisconsin smokers, allowed us to assess whether these approaches had different impacts on low- and high-SES populations. We did not expect differences in KTQ and SHS ad recall between high- and low-SES populations because the campaign targeted a subset of ads to lower-SES smokers. As a result, any SES differences in recall that might have been expected in the absence of targeting should have been offset by the increased likelihood of exposure to the targeted ad placements by low-SES smokers. Nevertheless, KTQ ads could be less effective for lower- versus higher-SES populations. Lower-SES populations may reject messages promoting quit attempts because they face greater difficulty in quitting. 26 ^, 27 SHS ads may not produce differences in quitting by SES because quit attempts are often a secondary goal of these messages. We tested for SES differences in KTQ and SHS ad impact on quit attempts (hypothesis 1) and smoking abstinence (hypothesis 2).