Controlled exposure and naturalistic exposure studies examining the relative effectiveness of different advertising messages for youth.
The NCI review of the media and tobacco use described above highlights the difficulty of evaluating the media components of several early quasi-experimental chta of community-based cardiovascular programs because the media elements were combined with other program elements e. However, the evaluations of the overall effects of these programs indicate positive immediate and intermediate effects eelk smoking levels among youth Vartiainen et al.
In contrast, another cardiovascular program aimed primarily at adults, the Stanford Five-City Project, allowed for the examination of the media effects alone and did not show any differences between intervention and control communities in the prevalence of falld that ssex be traced to the media component. There was evidence, however, of sx strong secular trend that may have reduced the ability to detect effects Winkleby et al.
Early reviews of the published literature focused heavily on the findings of some of the controlled field experiments on the effectiveness of community-based antismoking programs for youth. Some of these trials were able to randomize allocation to the media campaign Bauman et al. These programs varied greatly in the length and intensity of exposure to the campaign message and the time to follow-up assessment.
Of the few knsas experimental studies of different media strategies that had been conducted, only one had found a ificant reduction in smoking among adolescents Flynn et al. In that study, Flynn and colleagues examined the effects of a media television and radio -plus-school intervention refusal skills, accurate social norms, positive views of nonsmoking and of a school intervention alone that both ran over 4 years. Assessments at the end of the 4-year intervention and then at a 2-year follow-up Flynn et al.
A Cochrane review completed a few years later Sowden included longer-term follow-up reports for some of the studies Bauman et al. In reviews published afterPechmannFriend and LevyFarrelly and colleagues aWakefield and colleagues bcand the Task Force on Community Preventive Services all concluded that kanwas findings from controlled experiments indicate that campaigns have the potential to decrease tobacco use among youth, with some evidence that campaigns are more likely to succeed when they are coordinated with school- or community-based programs.
Wakefield and colleagues ac also highlighted the idea that the effects seem to be more reliable when talls occurs in preadolescence or early adolescence and when lead to emotional arousal. Methodologic shortcomings highlighted by Hornik and NCI may explain some of the variation in findings from the controlled field trials. These problems have included: 1 difficulties in developing the televised components of the media exposure Flay et al. Also, most analyses were not based on the primary sampling units considered as a whole that received the intervention i.
Rather, analyses were conducted on individuals within these sampling units, which can increase the chance of a Type 1 false-positive error due to an artificially inflated sample and failure to consider the effect on responses of shared experience within communities see Hornik  and NCI  for fallw discussion of these issues.
Only one of the four reviewed studies that examined the effect of media alone found a positive effect Hafstad et al.
In comparison, five of six studies found evidence for an effect when the media was combined with a school-based intervention Vartiainen et al. Adding chta this literature, a longitudinal controlled field trial by Solomon and colleagues included four matched pairs of media markets across four states randomly allocated falos receive a 3-year television-and-radio intervention to increase ffalls cessation and reduce smoking prevalence among adolescents. The media messages were based on social-cognitive theory.
Although the authors did not find a ificant time-by-condition interaction, ificantly fewer participants in the intervention group were smoking in the past month at 3-year follow-up than in the control group after adjustment for baseline smoking status. Those in the intervention communities had greater cessation rates an The analyses used an intention to treat ITT method, assuming those who were lost at follow-up to have smoked at least one cigarette in the past 30 days, minimizing the possible effects of attrition bias.
Unlike many others, this study used multilevel analytic techniques to for kansss in reaction within individuals and similarities due to shared experience within matched media markets Solomon et al.
Longitudinal population studies. Pechmann stated that there is limited direct evidence from controlled trials that media alone can influence youth smoking, but reported indirect evidence of the effects of stand-alone media chzt from longitudinal population elj of adolescents. These population surveys linked self-reported exposure to and reductions in smoking initiation Siegel and Biener ; Sly et al. Siegel and Biener examined the effect of the Massachusetts state campaign on smoking initiation by following to year-olds over 4 years and found that those who were 12 or free elk falls kansas sex chat years of age and recalled campaign messages at baseline were less likely to start smoking than those who did not recall the messages.
There were no effects for and year-olds and no effects on most knowledge and attitude measures. However, Sly and associates ab and Siegel and Biener minimized the likelihood of this possibility by controlling for baseline age, gender, prior smoking status, and the smoking status of friends and parents; Siegel and Biener also controlled for extent of television viewing. But as pointed out in the NCI review of the media and tobacco eok, the studies by Sly and colleagues bmeasured recall at follow-up and the one by Siegel and Biener kqnsas not adjust for nonresponse at follow-up through weighting or analytic techniques.
If those in the studies by Sly and colleagues who recalled the advertisements and those in the study by Siegel and Biener who completed the follow-up survey were relatively more likely to be nonsmokers, the possibility of finding an effect could well have been inflated. Cross-sectional population studies. The ruling kansad the Federal Communications Commission that the Fairness Doctrine applied to cigarette advertising provided the first chance to examine the effects of antismoking messages on youth smoking.
Much later, Lewit and colleagues associated various estimates of exposure to the antismoking advertisements with adolescent smoking behavior while controlling for a comprehensive range of covariates Table 6. These authors found that the prevalence of smoking among youth was 3. This study used measures of potential exposure based on hours of daily television watching reported by youth that were related by the authors to the of antismoking advertisements aired during the Fairness Doctrine period in a given year.
GRPs measure the relative reach and frequency of exposure to the campaign among the target audience within specific media markets. Emery and colleagues found that exposure to at least one U. The variation in campaign exposure across different media markets in this study de provided natural comparison groups for examining the effects of campaigns and different intensities of exposure. These studies all used a comprehensive set of potential confounders, but only one Terry-McElrath et al.
The findings from these and other cross-sectional, population-based evaluations of state and national anti-smoking campaigns developed by tobacco control programs can be more fully understood by examining the reported findings from 20 relevant papers cited in the three most recent comprehensive reviews Richardson et al. Of the 12 studies that examined attitudes or beliefs relating to smoking Murray et al.
Fourteen of 16 cross-sectional population studies that examined smoking behavior i. New studies published since these reviews further support these findings, indicating that well-funded state and national antismoking campaigns can reduce smoking among youth Davis et al. Rates of change were examined using interrupted time series techniques before and after budget cuts by the Florida Tobacco Control Program that took place between May and September As outlined kanas a falle reviews Pechmann ; Jepson et al.
Some of the cross-sectional studies used post-only White et al.
Use of a comparison group Murray et al. Studies that provide measures at multiple baselines e. Use of multiple measures during and after the campaign Popham et al. Still, a key difficulty in attempting to assess the specific media effects of statewide and national media campaigns is the fact that most were developed and run within the context of broader tobacco control programs and activities, such as tax increases Friend and Levy ; Farrelly et al.
Regardless, some authorities suggest that integrating media campaigns within a broader tobacco control program is important to their effectiveness Schar et al. The consistent positive findings across a variety of study des provide convincing evidence that anti-smoking media campaigns can be effective in reducing youth smoking but that certain factors and conditions are required for their success.
There is broad consensus that these factors include the use of formative research in the development of messages and, for campaign messages, sufficient intensity and duration of exposure USDHHS ; Sowden ; Pechmann and Reibling b ; Siegel ; Farrelly et al. Recent research and reviews have begun to focus more heavily on which message characteristics work best, what the ideal level of exposure is, and which types of youth are most or least affected by mass media campaigns against smoking.
Factors That May Optimize the Effectiveness of Mass Media Campaigns Mass media campaigns against smoking, especially those with televised components, require considerable investment, making it particularly important to understand the factors and strategies that optimize their effectiveness. This section summarizes conclusions from various reviews and new research Pechmann ; Siegel ; Farrelly et al. Theme, emotional tone, format, and characteristics of execution.
Studies to assess differences in the responses of youth to various types of have usually used controlled exposures; less often, they have employed naturalistic exposures. In controlled-exposure studies, youth free elk falls kansas sex chat view a series of messages and then either discuss their reactions to them often in focus groups or complete an experimental study.
In experimental studies youth may rate in terms of their emotional impact, liking, or other features thought to be associated with increased antismoking attitudes and behaviors, or are asked about these attitudes and behaviors directly. It is also possible that youth will complete cognitive processing tasks Shen et al. The limitations of these controlled-exposure methods are that the exposure does not mimic real-world viewing contexts and that one cannot examine the effects of multiple exposures occurring over months and years.
The limitations of these naturalistic-exposure studies are that they rely on self-reported recall of messages, which may be correlated with smoking intentions and behaviors, and they cannot rule out other factors that may influence outcomes, such as policy changes and geographic or historic differences in exposure to different types of messages. For example, one study that used 20 focus groups indicated that showing the serious physical consequences of smoking—portrayed either graphically, dramatically, or emotionally—performed well Teenage Research Unlimitedwhile another study, summarizing the findings of focus groups, indicated that about secondhand smoke or about industry manipulation rated best Goldman and Glantz Subsequent reviews Farrelly et al.
In support of theories of persuasion that emphasize emotion Cohen ; Eagly and Chaiken ; Forgas ; Escalas et al. However, exposure to high levels of negative emotion may actually hinder persuasiveness and zex undesirable negative consequences depending on the stimulus itself Erceg-Hurn and Steed This makes message fal,s extremely important.
The NCI review of the media kasas tobacco use noted that some themes e.
Reviews kandas, however, that that use humor have been found to be less effective than those that evoke negative emotions Schar et al. Indeed, a recent focus group conducted in the United Kingdom Devlin et al. One review Schar et al. In addition, a recent longitudinal controlled field study conducted in four media markets within each of four states, detailed earlier in this chapter, provided some modest support for the ability of about social norms to influence smoking by youth Solomon et al.
A new series of controlled-exposure studies added to this literature Zhao and Pechmann by examining four versions of the same basic social-disapproval antismoking message depicting a gathering of young college students kajsas varied along two dimensions positive vs. The study found that elm, positively framed messages were most effective at persuading promotion-focused adolescents not to smoke and that prevention-focused, negatively framed messages were most effective for prevention-focused adolescents.
Most of these studies examining the influence of these types of themes have been conducted using controlled exposure to ; one population-based study that specifically used these message themes found no effects on antismoking attitudes or smoking behavior Murray et al. Therefore, the extent to which these messages would be effective at the level of a broad population-based mass media campaign is unclear. Angus and colleagues reported that four of five studies reviewed found that industry campaigns performed poorly compared with tobacco control campaigns.
One of these studies showed that youth who recalled the industry campaigns were ificantly more likely than their unexposed peers to have intentions to smoke in the future Farrelly et al. Another study Wakefield et al. Supporting this research, a new study by Farrelly and colleagues found that at 3-year follow-up, exposure to the Philip Morris campaign was associated with more favorable beliefs and attitudes toward tobacco companies and a trend for weaker intentions not to smoke.
Despite the common use of television, radio, and outdoor advertising chst many state and national antismoking campaigns, few studies have examined the relative effectiveness of these different formats, although commercial information suggests that television has the frew reach. In a cross-sectional study, Seghers and Foland found that television were associated with greater recall than were other formats, and in a controlled-exposure study, Flynn and colleagues found that televised messages generally received higher ratings than did radio messages.
In a recent controlled field trial Solomon et al. In a longitudinal study Siegel and Bienerneither radio nor outdoor advertising was associated with fall initiation of smoking at 4-year follow-up, but recall of a television message was associated with reduced initiation in and year-olds. It is unclear whether the lack of success of these radio campaigns was due to the format, the messages typically broadcast on the radio stations, or the lower population reached by radio.
Free elk falls kansas sex chat recent years, antismoking messages have increasingly been presented via antitobacco Web sites. A study of differences between de elements, persuasive strategies, and information content across the Web sites of youth antitobacco organizations which also included the areas for prevention of youth smoking on tobacco industry Web sites indicated that the industry sites provided the ek persuasive messages; grassroots costkids.
Delivering a message through the Internet can encourage changes in smoking behavior through interactive tree interactivity can range from quizzes, contests, and games to connecting to campaign Web sites and other users through sites such as Facebook and MySpace. Antismoking campaigns mansas be able to increase their reach and persuasive impact by using these social networking sites, given a survey indicating that over one-half of U.
Preliminary indicate that the addition of these profile s was associated with an estimated increase of 20, cht visitors a week to the truth Web site in a comparison with traffic during typical campaigns that do not involve social networking sites Vallone The video-sharing Web site YouTube provides another modality through which youth dhat be exposed to both traditional and innovative antitobacco messages from antitobacco organizations and motivated individuals e.
YouTube also allows viewers to post comments about videos and send links to others. Determining the impact of messages conveyed through this medium is a fertile area for new research. The effects of antismoking messages delivered via text messaging and the use of this technology as a way for smokers to seek help for quitting smoking after exposure to antismoking messages is another important area for research.