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