Responses to Tobacco Public Education Messages Among Young Adults: How Previous Quit Attempts and Quit Intentions Affect Message Perceptions

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RESPONSES TO TOBACCO PUBLIC EDUCATION MESSAGES AMONG YOUNG ADULTS: HOW PREVIOUS QUIT ATTEMPTS AND QUIT INTENTIONS AFFECT MESSAGE PERCEPTIONS 

 

Emma Jankowski, BSPH 

Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH 

 

Joanne G. Patterson, PhD, MPH, MSW 

Division of Health Behavior and Health Promotion, Ohio State University, Columbus, OH 

 

Introduction:

  • A large proportion of young adults are using nicotine vapes and although the rate of cigarette smoking in the young adult population has decreased over time, there is still prevalent combustible use, specifically in minoritized populations (1-2).
  • Cigarette initiation is commonly in young adulthood, so interventions must address avoidance of cigarettes as well as quitting in this group (3-5).
  • Public education campaigns can effectively prevent smoking and vaping initiation among youth and encourage cessation in adults, but their effect among young adults (YA) is understudied (6-16).
  • We tested the effectiveness of messages describing the absolute and comparative risks of smoking cigarettes and vaping nicotine and assessed how quit interest/attempts shaped post-exposure perceptions among YA living in the United States. 

 

Methods:

  • Participants were recruited and prescreened via Prolific and eligible participants were directed to Qualtrics for a survey
    • Eligibility criteria were: participants had to be ages 18-35 and reside in the U.S.
  • Participants were asked a series of pre-screening questions about their demographics, as well as their smoking/vaping and cessation history.
  • Participants were categorized by current smoking and vaping status for analysis.
  • Exposures were analyzed by having a quit attempt in the last 12 months versus not, as well as intention to quit within 6 months, compared to those intending to quit, but not within 6 months and those not intending to quit at all.
  • YA aged 18–35 years viewed 8 messages in one of three experimental conditions (control, absolute risk, comparative risk).
  • After viewing these messages, participants rated their message and effects perceptions in matrix-style questions, as well as rated their feelings about smoking and vaping, harm perceptions, and behavioral intentions with regards to smoking and vaping in the near future.
  • We fit unadjusted, post-exposure regression models to assess main effects of self-reported past 12-month quit attempts and quit interest on outcomes (impact perceptions; intentions to refrain from smoking/vaping in the next 3 months) among current smokers (N=750) and vapers (N=1015). 

 

Results:

Figure 1: Visual Presentation of Main Results

 

Table 1: Sociodemographic characteristics of analytic samples 

   Current cigarette use 

(N = 750) 

 Current e-cigarette use 

(N = 1,015) 
  N(%)  X2  P-value  N(%)  X2  P-value 
Race             
     BIPOC+  286 (38.60)  1.3004  0.254  372 (37.20)  6.4311  0.011 
     Non-Hispanic White  455 (61.40)  628 (62.80) 
Age             
     18-24  172 (23.21)  42.5967  0.000  369 (36.90)  11.3156  0.001 
     25-35  569 (76.79)  631 (63.10) 
Gender             
Cisgender male  353 (47.64)  14.9129  0.001  448 (44.84)  8.5379  0.014 
Cisgender female  339 (45.75)  479 (47.95) 
Transgender/NB+  49 (6.61)  72 (7.21) 
Sexual Orientation             
Heterosexual  421 (56.82)  5.7116  0.017  532 (53.25)  0.0247  0.875 
LGBQ+/Asexual  320 (43.18)  467 (46.75) 
Education             
Below a Bachelor’s Degree  471 (63.56)  14.1782  0.000  629 (62.96)  17.5895  0.000 
Bachelor’s Degree and Above   270 (36.44)  370 (37.04) 
Marital Status             
Single  321 (43.32)  19.0539  0.000  425 (42.59)  42.4531  0.000 
Partnered  256 (34.55)  388 (38.88) 
Married/Divorced  164 (22.13)  185 (18.54) 
Income             
50,000+  222 (29.96)  32.8118  0.000  283 (28.36)  19.1458  0.000 
20,000-49,999  305 (41.16)  393 (39.38) 
<20,000  214 (28.88)  322 (32.26) 
Cigarette Quit Variables             
Quit Interest (3-level)              
Yes, within the next 6 months  287 (38.27)  N/A  N/A       
Yes, but not within 6 months  262 (34.93)   
No/Don’t know  201 (26.80)   
Quit Interest (2-level)             
     Interested  549 (73.20)  N/A  N/A       
     Not Interested  201 (26.80)   
Past 12-month Quit Attempt             
     No  321 (42.80)  360.8720  0.000       
     Yes  429 (57.20)   
E-Cigarette Quit Variables             
Quit Interest (3-level)              
Yes, within the next 6 months        280 (27.59)  N/A  N/A 
Yes, but not within 6 months    320 (31.53) 
No/Don’t know    415 (40.89) 
Quit Interest (2-level)             
     Interested        600 (59.11)  N/A  N/A 
     Not Interested    415 (40.89) 
Past 12-month Quit Attempt             
     No        546 (53.85)  222.430  0.000 
     Yes    468 (46.15) 

  

Table 4b. Main effects of quit interest and quit attempts on outcomes among SMOKERS 

  PAST 12-MONTH SMOKING QUIT ATTEMPT  SMOKING QUIT INTEREST 
  No quit attempt (Ref)  Yes, made quit attempt    No quit interest (Ref)  Interested, but not within 6 months    Interested,  within 6 months     
  Mean  95% CI  Mean  95% CI  p-value (vs ref)  Mean  95% CI  Mean  95% CI  p-value (vs ref) 

 

 Mean  95% CI  p-value (vs ref)  p-value (6 mos vs. 6+ month) 
Message and Effects Perceptions  
Message perceptions  3.04  (2.92, 3.17)  3.39  (3.28, 3.50)  <.001  2.92  (2.77, 3.08)  3.19  (3.05, 3.32)  .011  3.51  (3.39, 3.64)  <.001  .001 
Motivate people to quit ALL smoking and vaping  2.39  (2.25, 2.53)  2.71  (2.59, 2.83)  <0.001  2.32  (2.14, 2.49)  2.50  (2.35, 2.65)  0.126  2.82  (2.68, 2.97)  <.001  0.003 
Motivate cigarette smokers to quit  2.75  (2.62, 2.89)  3.22  (3.10, 3.34)  <0.001  2.71  (2.53, 2.88)  2.99   (2.84, 3.14)  0.017  3.27  (3.12, 3.41)  <0.001  0.009 
Motivate cigarette smokers to switch to vaping  2.74  (2.59, 2.88)  3.00  (2.88, 3.13)  0.007  2.77  (2.58, 2.95)  2.88  (2.72, 3.04)  0.372  2.98  (2.82, 3.13)  0.086  0.385 
Motivate vapers to quit   2.27  (2.13, 2.41)  2.52  (2.40, 2.64)  0.007  2.20  (2.03, 2.37)  2.34  (2.19, 2.49)  0.232  2.62  (2.48, 2.77)  <0.001  0.008 
Motivate non-users to start vaping  1.65  (1.53, 1.77)  1.89  (1.79, 2.00)  0.003  1.83  (1.67, 1.99)  1.75  (1.61, 1.89)  0.453  1.80  (1.67, 1.93)  0.792  0.588 
Motivate non-users to start smoking   1.30  (1.21, 1.38)  1.44  (1.36, 1.51)  0.020  1.46  (1.35, 1.57)  1.34  (1.24, 1.44)  0.118  1.35  (1.26, 1.44)  0.139  0.901 
Feelings about Smoking/Vaping 
Feelings toward smoking cigarettes  3.26  (3.12, 3.39)  2.96  (2.85, 3.08)  0.001  3.41  (3.24, 3.57)  3.25  (3.11, 3.40)  0.162  2.72  (2.58, 2.85)  <0.001  <0.001 
Feelings toward vaping nicotine  3.31  (2.87, 3.75)  3.50  (3.12, 3.88)  0.532  3.28  (2.72, 3.83)  3.58  (3.09, 4.07)  0.419  3.37  (2.91, 3.83)  0.798  0.539 
Harm perceptions 
Perceived harm of cigarettes to health  8.50  (8.32, 8.69)  8.65  (8.50, 8.81)  0.219  8.12  (7.89, 8.35)  8.58  (8.38, 8.78)  0.003  8.92  (8.73, 9.11)  <0.001  0.014 
Perceived harm of nicotine vapes to health  6.83  (6.57, 7.09)  6.88  (6.66, 7.11)  0.766  6.52  (6.19, 6.85)  6.73  (6.44, 7.02)  0.351  7.21  (6.94, 7.49)  0.002  0.017 
Perceived harm of vaping nicotine to health (vs smoking cigarettes)  4.85  (4.52, 5.17)  5.08  (4.79, 5.36)  0.301  5.07  (4.66, 5.48)  4.80  (4.44, 5.16)  0.329  5.08  (4.73, 5.42)  0.982  0.272 
Behavioral Intentions 
Intent to smoke cigarettes within next 3 months   1.99  (1.90, 2.08)  2.61  (2.53, 2.69)  <0.001  1.95  (1.84, 2.06)  2.13  (2.04, 2.23)  0.016  2.81  (2.72, 2.90)  <0.001  <0.001 
Intent to vape nicotine within next 3 months   2.46  (2.35, 2.57)  2.73  (2.63, 2.83)  <0.001  2.33  (2.20, 2.47)  2.50  (2.38, 2.62)  0.075  2.91  (2.80, 3.03)  <0.001  <0.001 

 

Table 4c. Main effects of quit interest and quit attempts on outcomes among VAPERS 

  PAST 12-MONTH VAPING QUIT ATTEMPT   
  No quit attempt (Ref)  Made quit attempt    No quit interest (Ref)  Interested, but not within 6 months    Interested,  within 6 months     
  Mean  95% CI  Mean  95% CI  p-value  Mean  95% CI  Mean  95% CI  p-value (vs ref)  Mean  95% CI  p-value (vs ref)  p-value (6 mos vs. 6+ month) 
Message Perceptions and Motivations 
Message perceptions  2.83 (2.44, 3.23) 3.06 (2.63, 3.49) 0.442 2.95 (2.50, 3.41) 2.84 (2.32, 3.36) 0.750 3.02 (2.47, 3.58) 0.844 0.635
Motivate people to quit ALL smoking and vaping 2.35 (2.24, 2.45) 2.48 (2.36, 2.59) 0.094 2.22 (2.10, 2.34) 2.46 (2.33,2.60) 0.007 2.62 (2.48, 2.76) <0.001 0.119
Motivate cigarette smokers to quit 3.03 (2.92, 3.13) 3.16 (3.05, 3.28) 0.091 2.94 (2.82, 3.06) 3.09 (2.95, 3.22) 0.122 3.32 (3.17, 3.47) <0.001 0.026
Motivate cigarette smokers to switch to vaping 3.16 (3.05, 3.27) 3.25 (3.13, 3.37) 0.290 3.13 (3.01, 3.26) 3.22 (3.08, 3.36) 0.360 3.29 (3.14, 3.45) 0.115 0.508
Motivate vapers to quit 2.14 (2.04, 2.24) 2.47 (2.36, 2.58) <0.001 2.08 (1.97, 2.20) 2.24 (2.11, 2.37) 0.067 2.66 (2.52, 2.80) <0.001 <0.001
Motivate non-users to start vaping 1.67 (1.57, 1.76) 1.84 (1.73, 1.94) 0.017 1.72 (1.61, 1.83) 1.71 (1.59, 1.84) 0.937 1.82 (1.69, 1.96 0.227 0.224
Motivate non-users to start smoking 1.22 (1.16, 1.28) 1.36 (1.29, 1.42) 0.002 1.28 (1.21, 1.35) 1.24 (1.16, 1.32) 0.389 1.35 (1.26, 1.43) 0.256 0.064
Feelings about Smoking/Vaping
Feelings toward smoking cigarettes 3.14 (3.03, 3.24) 3.02 (2.91, 3.13) 0.134 3.26 (3.14, 3.38) 3.09 (2.95, 3.22) 0.053 2.83 (2.69, 2.98) <0.001 0.011
Feelings toward vaping nicotine 3.71 (3.42, 4.01) 3.54 (3.22, 3.86) 0.447 3.74 (3.40, 4.08) 3.76 (3.37, 4.15) 0.945 3.32 (2.91, 3.74) 0.123 0.128
Perceived Harm
Perceived harm of cigarettes to health 8.85 (8.72, 8.98) 8.81 (8.67, 8.95) 0.679 8.65 (8.50, 8.79) 8.93 (8.76, 9.10) 0.014 8.97 (8.79, 9.15) 0.007 0.731
Perceived harm of nicotine vapes to health 5.75 (5.55, 5.95) 6.84 (6.63, 7.05) <0.001 5.62 (5.40, 5.85) 6.32 (6.06, 6.57) <0.001 7.12 (6.84, 7.39) <0.001 <0.001
Perceived harm of vaping nicotine to health (vs smoking cigarettes) 3.64 (3.38, 3.89) 4.59 (4.31, 4.86) <0.001 3.64 (3.35, 3.94) 4.18 (3.85, 4.51) 0.018 4.61 (4.25, 4.97) <0.001 0.085
Refrain Scale
Intent to refrain from smoking cigarettes within next 3 months 3.01 (2.93, 3.09) 3.27 (3.18, 3.35) <0.001 2.83 (2.74, 2.92) 3.22 (3.12, 3.32) <0.001 3.46 (3.35, 3.57) <0.001 0.002
Intent to refrain from vaping nicotine within next 3 months 1.92 (1.85, 1.99) 2.45 (2.37, 2.52) <0.001 1.86 (1.79, 1.94) 2.02 (1.94, 2.10) 0.005 2.77 (2.68, 2.86) <0.001 <0.001 

**All results are Bonferroni corrected so alpha = 0.03 

 

Conclusions:

  • Tobacco public education messages describing the absolute and comparative risks of smoking cigarettes and vaping nicotine were most effective for YA who reported making a recent quit attempt, or who were interesting quitting smoking/vaping within 6 months.
  • Results suggest that YA are interested in quitting smoking/vaping and that unique message framing must be developed to engage YA across the quit continuum. 

 

Funding/Acknowledgements:

  • Thank you to all members of the Practice and Science for LGBTQ+ Health Equity Lab for their contributions.
  • This research was funded by the National Institutes of Health, National Cancer Institute and FDA Center for Tobacco Products (K99CA260718 and R00CA260718; PI: JGP), and supported by the Ohio State University Comprehensive Cancer Center and the Ohio State University College of Public Health. 

 

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