摘要：Objectives. We assessed which types of mass media messages might reduce disparities in smoking prevalence among disadvantaged population subgroups. Methods. We followed 1491 adult smokers over 24 months and related quitting status at follow-up to exposure to antismoking ads in the 2 years prior to the baseline assessment. Results. On average, smokers were exposed to more than 200 antismoking ads during the 2-year period, as estimated by televised gross ratings points (GRPs). The odds of having quit at follow-up increased by 11% with each 10 additional potential ad exposures (per 1000 points, odds ratio [OR] = 1.11; 95% confidence interval [CI] = 1.00, 1.23; P < .05). Greater exposure to ads that contained highly emotional elements or personal stories drove this effect (OR = 1.14; 95% CI 1.02, 1.29; P < .05), which was greater among respondents with low and mid-socioeconomic status than among high–socioeconomic status groups. Conclusions. Emotionally evocative ads and ads that contain personalized stories about the effects of smoking and quitting hold promise for efforts to promote smoking cessation and reduce socioeconomic disparities in smoking. Tobacco use inflicts the greatest burden of illness on those least able to afford it. 1 , 2 An enormous challenge for tobacco control is how to tackle the consistently higher levels of smoking prevalence found among disadvantaged groups, 3 – 5 especially because these gaps may be widening. 6 , 7 Televised antismoking campaigns provide an effective population-wide method of preventing smoking uptake, 8 , 9 promoting adult smoking cessation, 10 and reducing adult smoking prevalence, 11 and research indicates that some types of ads may be more effective than others. Antismoking messages that produce strong emotional arousal, particularly personal stories or graphic portrayals of the health effects of smoking, tend to perform well 12 ; they are perceived to be more effective than others, are more memorable, and generate more thought and discussion. 13 – 16 However, it is unclear whether different types of messages might maintain, increase, or mitigate the disparities in smoking prevalence across population subgroups. Research on subgroup differences in responses to a range of anti-tobacco ads has not found systematic differences by gender, race/ethnicity, or nationality. 13 , 17 – 19 A review of the literature on the use of mass media concluded that in comparison with their effects on other populations, campaigns have often been less effective, sometimes equally effective, but rarely more effective in promoting cessation among socioeconomically disadvantaged populations. 20 However, many of the less effective general-audience campaigns were hampered by minimal reach to smokers of low socioeconomic status (SES) because they were low-cost campaigns unable to afford extensive media exposure. 20 Most research examining longer-term quit rates in the context of large-scale, well-funded antismoking campaigns found comparable quit rates or reductions in smoking prevalence in low- and high-SES groups. 21 – 28 However, to our knowledge, no population-based research has examined the relationship between the degree of exposure to different types of antismoking messages and quit rates between low- and high-SES groups. A variety of theories 29 – 38 provide guidance about which styles of ads may best encourage quitting, especially among members of lower socioeconomic groups. Consistent with these theories, reviews of the effects of antismoking advertising have concluded that advertisements that evoke strong emotional responses through negative visceral imagery or personal stories about the health effects of smoking can increase attention, generate greater recall and appeal, and influence smoking beliefs and intentions. 12 , 39 , 40 Recent research indicates that self-relevant emotional reactions (i.e., emotional reflections about one's life, body, or behavior that are triggered by the ad 41 ) may be especially persuasive, because they affect perceptions of future risk of becoming ill, 42 which in turn have been linked with reduced cigarette consumption, increased intentions to quit, and quit attempts. 43 Antismoking ads that use strong graphic imagery of the health effects of smoking are likely to be predominately associated with high negative emotional arousal, but personal stories of the consequences of smoking may evoke high or low levels of emotion depending on the particular story and the degree to which smokers relate to the characters. 38 However, less emotional personal testimonials may still be more effective than other types of less emotional ads because there is no explicit persuasive intent against which smokers may react 38 , 44 and because health information is presented in a story-based format, which people learn to process naturally from an early age. 45 Because lower-SES groups tend to have a greater degree of resistance to messages from the health care sector, 46 lower health literacy levels, 47 , 48 greater likelihood of belief in myths about cancer risks and prevention, 49 and less perception that smoking increases a person's chance of getting cancer, 48 we proposed that emotional messages and personal stories might be especially influential. Presenting antismoking messages in an emotional or personal testimonial format may convey health information to these smokers in a way that is difficult to discount, natural and easy to process, and likely to arouse emotions that lead to increased perceptions of susceptibility to smoking-related diseases and motivation to quit. 38 , 42 , 44 Drawing on the only previous study to examine the effect on adult quitting of the degree of exposure to antismoking ads, 10 we first hypothesized that when all types of advertisements were considered together, greater exposure to these antismoking ads would be associated with greater likelihood of quitting by follow-up. Our second hypothesis was that particular types of antismoking ads (those containing highly emotional elements or personal testimonials about the effects of smoking) would be associated with a greater chance of successful quitting by follow-up than would exposure to ads without these elements. Finally, we hypothesized that highly emotional or personal testimonial ads would be especially effective among lower-SES groups.
