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Findings


Study 1: Teens’ Perception of Smoking

Background:

Current research suggests that stress and other negative emotional state are predictors of smoking behavior and impediments to successful smoking cessation.  While most smokers begin smoking in early adolescence, we have little data demonstrating how adolescents themselves perceive the relationship between emotional states and smoking.  Moreover, we have little evidence suggesting how adolescents learn that smoking reduces stress. Eight focus groups were conducted with predominately low-income, White and African American teens in both rural and urban communities to examine how 14-16 year olds perceive and understand the relationship between negative emotional states and cigarette smoking.

Research Design:

Eighty adolescents (ages 14-16) participated in focus groups. A total of 8 focus groups were conducted.  Because we wanted to know whether models of smoking are distinct for racial and gender subgroups, the groups were homogeneous with respect to these characteristics.  Four groups were run in each of the two target locations, thus we have evidence from adolescents who live in poverty in a rural area and a large city.  Thus, the 8 groups broken down by the following characteristics:  rural/urban, African American/European American, male/female. 

All focus group sessions were audio taped and immediately transcribed. The transcriptions entered into the qualitative analysis package Transana 2.05.  Qualitative analyses were conducted with the aim of identifying major themes in the discussions, but more specifically to identify propositional statements about smoking and stress (Kempton, et al. 1995).

What We Have Learned:

Results indicated that reasons for smoking were similar across ethnic and gender groups.  Participants reported image concerns (looking cool, weight loss), coping mechanisms (calm nerves), and social acceptance (to fit in) as reasons teens smoke.  Smoking as part of their daily environment (e.g. peers or family members smoking) was also a frequently cited reason for smoking. 

Teenage family pressures, boy/girl friend problems, and school were listed as common stressors that may encourage smoking among teens.  While participants in all groups cited that smoking was used to reduce stress, a few participants believed that cigarettes did not reduce stress in actuality. 

Teens were asked about where they saw smoking in the media and their daily lives. Males did not believe that media influenced their decisions to smoke while females did cite media examples with regard to smoking initiation.  When asked about specific media examples, all participants easily cited real-life or media examples of people smoking, indeed, most examples they generated were stress reduction related.

Teens most frequently recalled smoking scenes from movies and TV shows (e.g. Friends). However, they also noticed celebrities (e.g. Denzel Washington, Snoop Dogg) and video games.

Results suggest that media images of smoking were associated with either (a) reducing stress and anxiety or (b) looking or being cool, whereas family/peer images recalled more associated with reducing stress or addiction.



Study 2: Ethnic Differences in Teens’ Knowledge about Smoking

Background:

White adolescents smoke at higher rates than African American adolescents. Yet, African American adults have higher smoking rates than White adults. This study explored the differences in African American and White adolescent’s implicit theories about smoking to try to understand these discrepancies.

Research Design:

In the first stage of this research, 40 White and 40 African American adolescents (ages 14-16) listed their beliefs about smoking.  The set of beliefs yielded 79 unique beliefs (e.g. lung cancer, smelly). 

A second set of 37 White adolescents and 80 African-American adolescents sorted the beliefs into piles based on the perceived similarity of the items. 

The pile sort data were converted to dissimilarity data and then analyzed using hierarchical cluster analysis.

What We Have Learned:

There were 5 unique clusters of beliefs for White adolescents (health concerns, negative affective reactions, social sanctions, social identity, and positive reasons for smoking). There were 9 unique clusters for African American adolescents (health concerns, addiction, negative affective reactions, negative images of smokers, social aspects of smoking, positive affect and smoking, stress/negative affect, commitment to not smoke, and social sanctions). 

African American adolescents’ had more complex implicit negative theories regarding smoking. White adolescents’ structure reflected primarily positive versus negative reactions to smoking.

Specific types of affect seem to play a more important role for African American adolescents’ implicit theories about smoking.  For example, there is a very salient link between negative affect (e.g. stress) as reasons to smoke for African American adolescents.

Understanding these implicit theories can assist in targeting messages to prevent smoking in these populations.  For example, White adolescents have simpler attitudes about smoking (i.e., it’s bad, but they don’t know why) and can be more easily changed then the complex attitudes of African American adolescents.  Therefore, schools should make more of an effort to create complex attitudes among all adolescents.  This can be done by providing several reasons and examples of why smoking is bad and/or the negative effects of smoking.



Study 3: What is not the “Truth”? Teens’ Perceptions and Recall of Anti-Smoking PSAs

Background:

This paper presents the second set of findings from the focus groups. We asked low-income young adolescents to tell us about any anti-smoking messages they have seen.

Research Design:

A total of 8 focus groups were conducted with 78 low-income teens between ages 14-16. Teens participated in same sex/same ethnicity groups (e.g. white girl, black girls, rural/ urban within each group)

Sessions were semi-structured. The first set of questions focused on why the teens felt people (in general) and teens (in specific) smoked cigarettes.  Later parts of the discussion addressed peer and family influences on smoking behavior.  Each session concluded with participants writing down smoking ads they had seen. Then the moderator led them in a discussion of where they had seen these messages, where they had seen smoking portrayed in the media, and their impressions of media-based anti-smoking messages.

What We Have Learned:

Findings indicated that teens were strongly aware of the American Legacy Foundation’s “Truth” brand, to the point where they over-generalized the brand to encompass many non-“Truth” PSAs, including anti-marijuana PSAs. Females were more favorable toward the “Truth” campaign than were males, who generally dismissed the campaign. Teens’ recommendations for future campaigns include using more empathy appeals and including more health-related information.



Study 4: The Content of Cigarette Counter-Advertising

Background:

Media campaigns can be an effective tool in reducing adolescent smoking, especially when combined with community and school based interventions.  The effectiveness of individual PSAs is less well established and may require a match of message strategy with the functions that teens perceive served by cigarette smoking.

Research Design:

A content analysis was conducted of all ads (N=487) available at the CDC Media Campaign Resource Center (Waves 1 through 7).  PSAs were coded for target audience, primary theme, emotions, and sensation value (e.g. production techniques that attracted attention and increase arousal). 

What We Have Learned:

Messages focused on industry attack, health consequences of smoking, secondhand smoke, quitting, or social image of smokers. A majority of ads were rated as having moderate sensation value, and PSAs targeted at teens and children were, on the average, higher in sensation value than were those targeting general audiences. 

In spite of research showing that the functions of stress relief, mood regulation and weight loss are strong reasons for teens to initiate and continue smoking cigarettes, none of thePSAs in the set addressed these functional themes. Implications for developing campaigns that more closely relate to the functions of smoking for teens are discussed.



Study 5:  Using Social Norms to Predict Risky Adolescent Health Behavior

Background.
The goal of Study 5 was to understand how an adolescent’s primary social group can affect their likelihood of engaging in risky behaviors such as smoking.  Study 5 uses Self Categorization Theory (SCT) to test the influence of in-group members’ influence on four risky health behaviors (cigarettes, alcohol, marijuana and sex). SCT is not a model of peer pressure; rather, it’s a model of how teens strive to be similar to their social group.  An important predictor of risk behaviors for adolescents is the extent to which they identify with their most important social group.  SCT argues that the more an adolescent identifies with his or her primary social group, the more they strive to be similar to that group, which, in turn, predicts their risky behaviors. 

Research Design.  A 2 (Race of participant:  African American vs. White) x 2 (Gender of participant) x 2 (Teen’s home:  urban vs. rural location) was used to test the model of social group identification.  Low income high school freshmen (N = 325, average age 14.92) were selected such that half were from urban homes and the others were from rural homes.  Within each geographic location, approximately half the teens were African American and, within, race, half were female.  We assessed identification with a primary social group, perceived similarity to the social group prototype, race and gender. Outcome measures were self-reported behavior and behavior intent for cigarettes, alcohol, marijuana and sex. 

What We Have Learned.
Level of identifying with a social group predicted how similar a teen saw his or herself as being with the prototype of that social group.  Prototype similarity, in turn, predicted behavior intent for 3 of 4 behaviors and successfully predicted all four risk behaviors assessed.

For behavior intent, White teens were more likely than African American teens to self report intent to drink and to smoke cigarettes.  For behavior, males were more likely than females to report having engaged in sexual activity.  These data for race and gender are similar to data collected with large representative samples. While race and gender predicted behavior/intent, neither variable predicted or interacted with any concepts in the SCT model suggesting that the model worked well across subgroups.

SCT suggests teens participate in creating their social group’s norms and, norms are best understood as shared expectations about the behavior and attitudes of group member.  Our results support a shift in understanding social norms away from a peer pressure perspective to one where adolescents’ behaviors are affected by their social groups because adolescents strive to be similar to members of their groups.



Study 6: The Impact of Decision Style on Perceptions of Anti-Smoking PSAs

Background:

Despite intense health promotion campaigns, many youth living in poverty have been seemingly immune to interventions designed to reduce their risk behaviors such as smoking. Study 6 & 7 examine how young teens perceive PSAs used in anti-smoking campaigns to better understand how such PSAs may be useful in campaigns and interventions. More specifically Study 6 examines how differences in teens affect how they see anti-smoking PSAs as biased.  The more reactant they are to a message, the more manipulative and biased they believe the message is. We measure their reactance to messages by assessing their perceptions of message bias. Attitude accessibility and decision-makings styles were also examined.

Research Design:

A 2 (gender: Male vs. Female) x 2 (race: White vs. African American) x 2 (Teen’s home: urban vs. rural) mixed design with message type as a within-subjects factor was utilized.  325 teens (average age 14.97) were evenly distributed across urban or rural locations. Within each location, about half of the teens were African American (the other half were White) and half of the kids within racial group were female. Teens completed individual difference measures (attitude accessibility, rational thinking, experiential thinking, and items assessing their smoking behaviors. They then were exposed to 4 PSAs (3 of them were anti-smoking messages and 1 was an alcohol message).

What We Have Learned:

When attitudes were not accessible, then attitudes towards smoking (ether pro smoking or anti smoking) did not affect how teens view the anti-smoking PSAs. However, when attitudes towards smoking were accessible, then attitude predicts perceptions of message bias. Teens with accessible positive smoking attitudes viewed the messages as more biased.

Teens high in experiential thinking saw the PSAs as less biased and more effective.

Teens high in rational processors viewed PSAs as more biased only when the teens felt positive about smoking. In other words, teens that enjoy processing messages rationally were affected by the messages when the message was inconsistent with their own smoking attitudes and behaviors. In such cases they saw these messages as more biased and less effective.

Race and gender were also significant predictors of perceived message bias. Whites perceive more bias than blacks and males perceive more bias than females.



Study 7.  Selecting Messages to Use with Young Adolescents

Background:
Young teens are reactant to being told what to do or what not to do. Anti-smoking PSAs are “do not do” messages and, thus, teens naturally are reactant to them.  One way to assess teen’s reactance to PSAs is to measure their perceptions of how biased and manipulative they think the PSAs are.  We measure how biased and manipulative teens viewed each message using a message bias scale.

Study 7’s goal was to select a set of messages that teens view as having little bias.  Our hope is to use those messages in studies 8 & 9 as part of an effective smoking prevention effort. 

Research Design:
To understand how poor southern teens view anti-smoking PSAs, we used a 2 (race of teen:  African American or White) by 2 (gender: male or female) by 2 (Teen’s home:  urban or rural) design.  A total of 325 adolescents ages 14-17 (average age 14.97) participated.  Those 325 teens were evenly distributed across urban and rural locations.  Within each location, approximately half of the teens were African American (the other half were White) and half of the kids within racial group were female. 

Nine anti-smoking PSAs (3 personal testimony PSAs, 3 secondhand smoke and 3 informative ones) were used.  Each teen was randomly assigned to watch 1 ad from each message type (e.g., each student saw 1 personal testimony, 1 secondhand smoke and 1 informative ad).  Teens evaluate each PSA for message bias (e.g., the ad was overblown, manipulative) and for effectiveness (this ad made me not want to start/quit smoking).

What We Have Learned:
Females viewed all messages as less biased and more effective than did males.
Whites viewed messages as less biased and more effective than did African Americans.

In general, young adolescents view personal testimony ads as significantly less biased and more effective than informative messages or secondhand smoke messages.  However, young smokers and those who intend to start smoking viewed informative messages as somewhat less biased than other message types.

Smokers, kids who have family or friend who smoke and kids who intend to smoke perceive secondhand smoke PSAs as especially biased and ineffective.

Depending on a campaign’s goal, personal testimony messages are more effective at a prevention population (e.g., non-smokers) whereas informative ads may be more effective for young smokers and those who plan to try smoking.   Interestingly, secondhand smoke messages were seen as least effective and most biased by all subgroups.



Study 8: Smoking Behavior and Perceptions of Messages

Background:

Teenagers are reactant.  This natural tendency to be resistant to things they are told to do affects how they view anti-smoking PSAs. We measure their reactance to messages by assessing their perceptions of message bias.

Many factors predict smoking behavior in teens.  It is unknown, however, if those same things also predict message bias of anti-smoking messages.  It is also unknown if the amount of effort a teenager puts into thinking about a message is predicted by the same factors that predict smoking behavior.

This project had three main goals: 1) to see if factors that predict smoking in other studies predict smoking in our sample of young adolescents; 2) to see if those same factors predict young adolescents’ processing of anti-smoking PSAs as biased; and 3) to see if those same factors predict young adolescents’ cognitive responses to anti-smoking PSAs.

Research Design:

The project was a 2 (gender) X 2 (race: African American and White) design with 367 high school freshman participants from 6 rural Georgia schools.  Students completed a 30-45 minute survey on laptop computers.  They first answered questions about smoking and other risks, then watched 3 anti-smoking PSAs, and finally answered questions after each PSA about message bias, and their cognitive responses to the PSAs. 

This study measured 8 predictors of smoking behavior: sensation seeking, perceived riskiness of smoking, willingness to smoke, tobacco receptivity, parental monitoring, peer and family smoking behavior, race and gender.  Adolescent smoking behavior was also measured.

What We Have Learned:

Kids who smoke saw messages are more biased and were less thoughtful about the messages.

Factors that reflect adolescents’ assessments about smoking (i.e., how risky/harmful smoking is and how willing a teen is to smoke) predict thoughtfulness (e.g. their cognitive responses to PSAs). 

Other individual differences (e.g. sensation seeking and parental monitoring) were significant predictors of teen’s perceptions of PSAs as being biased. Thus, while attitudes towards smoking predicted thoughtful reactions to messages, messages were perceived as more biased by kids high in sensation seeking and kids who self-report having little monitoring by their parents. Interestingly, cognitive responses to messages and perceived message bias were not related.



Study 9: Mini-Prevention Effort & Message Recall

Background:

Young teens are reactant to being told what to do or what not to do. Anti-smoking PSAs are “do not do” messages and, thus, teens naturally are reactant to them.  One way to assess teen’s reactance to PSAs is to measure their perceptions of how biased and manipulative they think the PSAs are.  We measure how biased and manipulative teens viewed each message using a message bias scale.

This project split participants into one of two groups. One group saw three anti-smoking PSAs that were rated by other teens as low in perceived message bias. That means that teens were not reactant against these messages. The second group was the control group. They also saw three anti-smoking PSAs but these PSAs were the kind that kids saw as being more biased, thus, they reacted stronger against these messages. We want to compare how exposure to low bias messages affects kids’ attitudes and smoking behavior 12 weeks later as compared to the kids in the control group.

The first goal of the project was to find out if smoking behavior and attitudes were different for the two message bias groups.  It was predicted that students who saw the low message bias PSAs would have more negative attitudes about smoking and have a lower level of smoking behavior.
The second goal of the project was to find out how well teenagers remembered the PSAs they saw.

Research Design:

This project was a 2(gender) X 2(race: African American and White) X 2(what messages they saw: low biased PSAs or control PSAs) design.  Students were 367 high school freshmen from 6 rural Georgia schools. 

For the first part of the study, each student completed a 30-45 minute survey on laptop computers.  They first answered questions about smoking and other risks, then watched 3 anti-smoking PSAs, and finally answered questions after each PSA about message bias, and their cognitive responses to the PSAs. 

The second part of the study was a 12-week follow-up phone survey to the same 367 students.  Students were asked questions about smoking behavior and attitudes and then asked to discuss anything they could remember about the PSAs they had seen 12 weeks earlier.  It is thought that adolescents who saw the low bias PSAs would have more negative attitudes about smoking and be less likely to smoke.  PSAs low in bias should also be easier for the teens to recall 12 weeks later.

What We Are Learning:

Data collection in process.

 

 

 

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