Anti-smoking advertisement: which message themes are effective among young Kazakhstani?

Table of contents: The Kazakh-American Free University Academic Journal №6 - 2014

Author: Kim-Choy Chung, KIMEP University, Kazakhstan

Introduction

Kazakhstan has a large smoker population among its youth and is one of the first Commonwealth of Independent State countries to accede to Article 6 of the Framework Convention of the World Health Organization on tobacco control. To reduce the number of smokers among its youth, the government of Kazakhstan initiated anti-smoking campaign on the public health agenda in the past three years and plans to increase excise tax on tobacco products by 25% in 2011. Several laws, including “On advertising” and “On public health and the health care system,” have brought Kazakhstan to international norms. This includes protecting against second-hand smoke, restriction of tobacco sales to minors, and regulation of cigarette advertising, promotion and sponsorship. The anti-smoking campaign in Kazakhstan includes stickers, posters and emblems containing slogan like “We do not sell tobacco products to people under 18″ and other themes which are displayed in shops around the country. However, not everyone perceives the impact of the excise (tax) increase and anti-smoking campaign positively. Politicians and businesses argue that the increase in excise taxes will have no significant impact on a decrease of Kazakhstani smokers as smokers could easily access the illegal market (contraband cigarettes) or would opt for cheap ‘makhorka’. In literature, there is argument that anti-smoking campaign should start young as consumption experiences at early years affect patterns of adult consumer behavior (Stipek, Sota & Weishaupt 1999); and that relevant and effective anti-smoking theme or message appeal are important to influence cigarette consumption behavior (Andrews et al. 2004).

Despite the numerous studies that explored the efficacy of anti-smoking advertisements (eg. Flay, Ditecco & Schlegel 1980; Harris, Connolly & Davis 1996; Goldman & Glantz 1998), the results on the impact of its message theme on anti-smoking habits remained variables. For example, studies by Flay et al. (1980) and Goldman and Glantz (1998) found anti-smoking advertisements are effective in reducing cigarette consumption. However, evidence from Wallack and Corbett (1987) and Harris et al. (1996) suggested anti-smoking advertisement messages are not an effective mean to decrease smoking.

In Kazakhstan, there is a gap of knowledge on the effectiveness of message theme in anti-smoking advertisement, a gap addressed in this study. In particular, this study examines:

i) The perceived effectiveness of fear-related (disease and death) and social disapproval themes in reducing smoking behavior among non-smoking youth in Kazakhstan;

ii) The perceived effectiveness of fear-related (disease and death) and social disapproval theme in reducing smoking behavior among smoking youth in Kazakhstan.

Relevant literature and hypothesis development

Teenagers learn about consumption stereotypes mostly from peers, media, family, and schools (John 1999). This is similar with regards to smoking habit. Youth initiate smoking because of influence by peers, marketing activities (advertisement, celebrity endorsement) and hedonic usage or out of curiosity. A study by Chassin et al. (1990) indicates that the younger the age of smoking trial, the greater the likelihood of regular smoking as adults. Despite development in cultural and social norms that smoking is an unacceptable behavior in public and private places, leading to negative stereotypes of smokers (Kim & Shanahan 2003), the numbers of smokers among the youth has increased worldwide. Existing demand for cigarettes increases is a result of advertising and other promotional activities like product placement in movies, retail display advertising, free product sampling, sports sponsorship, packaging graphics, filter design and product attributes (Pechmann & Knight 2002; Andrews et al. 2004; Netemeyer, Andrews, Burton 2005). Pechmann and Shin (1999) argue that smoking scenes positively aroused young viewers, enhanced their perceptions of smokers’ stature, and increased their intent to smoke.

Anti-smoking message themes

Stipek et al. (1999) emphasize the value of early intervention and everyday classroom activities to prevent high-risk behaviors, such as smoking. However, most interventions to reduce smoking are directed toward reducing demand for tobacco (Lemieux 2001). Andrews et al. (2004) suggests that adolescents’ antismoking beliefs are affected by advertising attitudes, prior trial behavior, and social influence affect; and concludes that well-designed anti-smoking advertisement can decrease smoking-related behaviors among adolescents. In general, message themes in anti-smoking campaigns or advertisements can be classified as either fear-related (disease and death) or social disapproval-related (Uusitalo & Niemela-Nyrhinen 2008). Thus, most anti-smoking campaigns portray smokers as people at risk, either physically or socially (i.e. how they influence not only the smoker but those around them).

Fear appeal has been a popular approach in anti-smoking campaigns in most developed countries, especially those related to health messages such disease and death (Beaudoin 2002). Disease and death themes describe how smokers suffer from diseases caused by smoking. The intent is to raise the perceived health risk severity ranging from serious diseases to eventual death as a result of smoking. This approach conformed to Witte’s (1994) Extended Parallel Process Model which suggest that when individual is exposed to fear, he/she is highly motivated to control the danger by lessening their at-risk behavior or control the fear through denial when they feel that the threat is severe (that smoking leads to disease or death); feel vulnerable to the threat (the consequences of smoking will affect them personally); feel capable of changing their at-risk behavior (quit smoking); and perceive the behavior change is effective in averting the threat (quitting smoking effectively eliminates the risk). However there are mixed findings about the effectiveness of the health-related messages (disease ad death) for adolescents in anti-smoking campaign. It is argued that youths exposed to anti-smoking health messages generated by tobacco companies were more likely to be open to smoking (Farrelly et al. 2002), thus, immune them to the anti-smoking health related (disease and death) theme. Further, young people do not appreciate the risk from smoking, as they believe that they can quit any time and are over-optimistic about health-related consequences of smoking (Weinstein 1998). Rogers’s (1983) revised Theory of Protection Motivation explains the lack of effectiveness in fear-aroused messages by relating rewards to perceived severity and susceptibility when analyzing a particular course of action. For instance, if the reward (e.g. pleasure, social pleasure or hedonic effect) of an action is greater than the perceived consequences, susceptibility and severity of the danger of the action (e.g. smoking cause cancer), individuals will continue to practice maladaptive behavior (eg. continue to smoke). Nevertheless, fear-related themes continued to found favor among anti-smoking proponents in the last few decades (Prevention First 2008). Consequently, this study proposed:

H1: Messages related to fear-related (disease and death) theme is effective in reducing smoking behavior among the non-smoking youth in Kazakhstan.

H2: Messages related to fear-related (death) theme is effective in reducing smoking behavior among the smoking youth in Kazakhstan.

Netemeyer et al. (2005) indicate that advertisements that target specific anti-smoking beliefs, such as addictiveness of smoking, dangers of environmental tobacco smoke to children, and tobacco industry’s use of unethical or deceptive advertising practices enhance consideration of quitting among adult smokers, especially if they live with their children at home. Several other studies (Pechmann et al 2003; Pechmann & Ratneshwar 1994; Uusitalo, Niemela-Nyrhinen 2008) also argue that social disapproval theme is more effective in anti-smoking campaign. Pechmann and Knight (2002) reveal that cigarette advertising shown in conjunction with anti-smoking advertising evoked unfavorable impressions about smoking. Similarly, Pechmann and Ratneshwar (1994) indicate anti-smoking campaigns affect non-smoking teenagers’ perceptions of peers who smoke, reinforcing preexisting beliefs that smokers foolishly endanger their health and are relatively immature or unglamorous, a perception absent among smokers. As such, this study proposed:

H3: Messages related to social disapproval theme is effective in reducing smoking behavior among the non-smoking youth in Kazakhstan.

H4: Messages related to social disapproval theme is effective in reducing smoking behavior among the smoking youth in Kazakhstan.

Methodology

A total of 239 university students from two major cities (Almaty = 189, Astana = 150) in Kazakhstan were interviewed to study the effectiveness of message theme in anti-smoking advertisement. The respondents comprised of 54.8% female and 45.2% male with age ranging from 17 to 24 years old. Each respondent was presented with two anti-smoking advertisements (posters), namely: disease and death theme with graphic depicting the formation of tumors in the lung airways and arteriolosclerosis in the aorta; and social disapproval theme with picture of lighted cigarette and coughing children in the playground (to emphasize that other people may suffers from second-hand smoke), before being asked to response to a semi-structured questionnaire which comprised of 6 sets of scales: The first two scales asked respondent about the perceived effectiveness of the respective presented anti-smoking advertisements in reducing smoking behavior, namely: i) “I think the ‘disease and death’ anti-smoking advertisement (poster A) is effective in reducing smoking behavior” (1- strongly disagree to 5 – strongly agree); ii) “I think the ‘social disapproval’ anti-smoking advertisement (poster B) is effective in reducing smoking behavior” (1- strongly disagree to 5 – strongly agree). The third asked respondent to indicate whether they are smokers or non-smokers while fourth and fifth question asked their reasons for smoking and non-smoking respectively. The sixth scale relates to demographic variable (age, gender, number of cigarette smoked per day).

Findings

The study found that 43.9% (n=105) of the samples identified themselves as smokers (more than three cigarettes daily), 41.0% (n=98) identified themselves as non-smokers while 15% (n=36) are not sure of their status (Table 1). The main reasons for smoking were habit (23.8%), for relieving stress (21.9%), peer influence (17.1%) and inability to quit smoking (15.2%). The main reasons for non-smoking include: dislike cigarette smell (24.5% of respondents), thinks that smoking is bad for health (34.7%), does not think it is cool to smoke (13.2%) and are dissuaded by parents (9.2%). The Analysis of Variance indicated significant within group difference in terms of the perceived effectiveness of fear-related (F=21.31, sig=0.0) and social-disapproval themes (F=11.25, sig=0.0) in reducing smoking behavior among the respondents in Kazakhstan at the 5% significant level. The Post-Hoc test (Bonferroni) revealed significant difference between smokers and non-smokers; and between smokers and ‘not sure’ status with regards to both anti-smoking message themes (Table 2).

Table 1: Main reasons for smoking and non-smoking

Table 2: Post-Hoc statistics

Compared to smokers (mean=2.49 out of max 5), non-smokers are more likely to find disease and death theme (mean= 3.99) effective in reducing smoking behavior (Table 3). Similarly, the social-disapproval theme are perceived more effective in reducing smoking behaviour among the non-smokers (mean=3.95) than smokers (mean=2.30). Thus, both hypotheses H1: Messages related to fear-related (disease and death) theme is effective in reducing smoking behavior among the non-smoking youth in Kazakhstan, and H3: Messages related to social disapproval theme is effective in reducing smoking behavior among the non-smoking youth in Kazakhstan were supported in this study. This also implied that there is insufficient evidence to support both hypotheses H2: Messages related to fear-related (death) theme is effective in reducing smoking behavior among the smoking youth in Kazakhstan, and H4: Messages related to social disapproval theme is effective in reducing smoking behavior among the smoking youth in Kazakhstan. In other words, there is inconclusive evidence to indicate both fear-related (disease and death) and social-disapproval themes are perceived effective in reducing smoking behavior among the smoking youth in Kazakhstan. A possible explanation for this observation may be the denial effect as indicated in Witte’s (1994) Extended Parallel Process Model which suggested that when individual is exposed to fear, he/she is highly motivated to control the danger by lessening their at-risk behavior (not observed in this study) or control the fear through denial.

Table 3: Descriptive statistics

Conclusions and limitations of study

This study revealed fear-related (disease and death) and social-disapproval themes are perceived effective in reducing smoking behavior among the non-smoking youth in Kazakhstan, but insufficient evidence to suggest similar conclusion among the smoking youth. Given that this study’s samples are collected only at two cities in Kazakhstan, further research is needed to revalidate this research finding. Future research should examines the boomerang or denial effects of anti-smoking advertising (including promotion of nicotine replacements as quit smoking tool) and other social marketing campaigns (asking people not to smoke in public areas) among smokers in Kazakhstan.

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Table of contents: The Kazakh-American Free University Academic Journal №6 - 2014

  
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