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Congrats to our team member, Emma Jankowski, on helping to write this paper on the sustainability of social needs resolution interventions! The full text is linked in our bio!

Happy International Women’s Day! Let’s celebrate the social, economic, cultural, and political achievements of women and continue to advocate for women’s equality.

Presenter: Joanne G. Patterson (1,2) 

Co Authors: Alysha C. Ennis (1), Emma Jankowski (1), Grace Turk (1), Ashley Meadows (1), Caitlin Miller (1), Hayley Curran (2), Sydney Galusha (1)

1. The Ohio State University College of Public Health
2. Center for Tobacco Research, The Ohio State University James-Comprehensive Cancer Center

Introduction:

• Lesbian, gay, bisexual, transgender, and queer young adults (LGBTQ+ YA) report high rates of cigarette smoking and nicotine vaping (1-6).
• Mass-reach anti-tobacco communications can increase public knowledge of tobacco harms and decrease use, yet they may not engage LGBTQ+ YA (7-17).
• No studies describe effective anti-tobacco message framing for SGM and non-SGM YA engaged in dual use, though understanding these nuances is important for developing inclusive anti-tobacco communications.
• We conducted a formative evaluation to inform culturally targeted (CT) anti-tobacco communications. 

Methods:

• We reviewed existing CT anti-tobacco campaigns before conducting in-depth focus groups of N=22 LGBTQ+ YA (18-35) ever dual users to assess best practices for message design (visuals, semantics).
• We applied findings to develop 9 CT and 9 non-targeted (NT) messages, which an expert panel (N=7) of LGBTQ+ community partners, scientists, and LGBTQ+ YA reviewed.
• Messages are being experimentally tested in a remote eye tracking study with LGBTQ+ YA.

Results:

• LGBTQ+ YA were skeptical of CT anti-tobacco campaigns featuring stereotypical representation of LGBTQ+ individuals and questioned the motive of cultural targeting,
  • “Are you genuinely […] advertising to me, or are you advertising to some, like, monolithic LGBT group that you think exists?” (FG34, Queer, he/him).
• Communications featuring naturally posed models and a diversity of LGBTQ+ people engaged participants more than overly posed models and oversaturated colors:
  • “If I was scrolling, [the natural ad] would actually make me stop… but the second I see those saturated blue, purple looks, I’m like “That’s an ad”, and I just scroll right past it.” (FG23, Bisexual, he/him/she/her).
• Personal stories were well received:
  • “I also like the quotes, and that it has the people’s name there. It makes it feel more personal…they’re reaching out to you with their story.” (FG21, Bisexual, they/them).
• Unclear visuals and slogans were negatively received.
• We applied findings to develop CT anti-tobacco communications featuring naturalistic LGBTQ+ models of diverse races, ethnicities, and genders. We paired harms messaging with personal stories and subtle cultural cues (e.g., “our health”, pronouns). These are shown at the bottom of this post.
• The expert panel confirmed that messages were culturally and scientifically relevant.  

Conclusions:

• LGBTQ+ YA were distrustful of CT communications that leveraged “stereotyped” LGBTQ+ imagery.
• As authenticity is important to LGBTQ+ YA, co-creating CT anti-tobacco communications may enhance acceptability, engagement, and effectiveness.
• Eye-tracking research will objectively assess the effect of CT (vs NT control) communications on engagement. 

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. 

References:

1. Ridner S, Ma J, Walker K, et al. Cigarette smoking, ENDS use and dual use among a nationalsample of lesbians, gays and bisexuals. Tob Prev Cessat. 2019;5(December). doi:10.18332/tpc/114229
2. Delahanty J, Ganz O, Hoffman L, Guillory J, Crankshaw E, Farrelly M. Tobacco use among lesbian, gay, bisexual and transgender young adults varies by sexual and gender identity. Drug Alcohol Depend. 2019;201:161-170. doi:10.1016/j.drugalcdep.2019.04.013
3. Fallin-Bennett A, Lisha NE, Ling PM. Other Tobacco Product Use Among Sexual Minority Young Adult Bar Patrons. Am J Prev Med. 2017;53(3):327-334. doi:10.1016/j.amepre.2017.03.006
4. Nayak P, Salazar LF, Kota KK, Pechacek TF. Prevalence of use and perceptions of risk of novel and other alternative tobacco products among sexual minority adults: Results from an online national survey, 2014–2015. Prev Med. 2017;104:71-78. doi:10.1016/j.ypmed.2017.05.024
5. Osibogun O, Taleb ZB, Bahelah R, Salloum RG, Maziak W. Correlates of poly-tobacco use among youth and young adults: Findings from the Population Assessment of Tobacco and Health study, 2013–2014. Drug Alcohol Depend. 2018;187:160-164. doi:10.1016/j.drugalcdep.2018.02.024
6. Stanton CA, Bansal-Travers M, Johnson AL, et al. Longitudinal e-Cigarette and Cigarette Use Among US Youth in the PATH Study (2013–2015). JNCI J Natl Cancer Inst. 2019;111(10):1088-1096. doi:10.1093/jnci/djz006
7. Farrelly MC, Nonnemaker J, Davis KC, Hussin A. The Influence of the National truth® Campaign on Smoking Initiation. Am J Prev Med. 2009;36(5):379-384. doi:10.1016/j.amepre.2009.01.019
8. Farrelly MC, Duke JC, Nonnemaker J, et al. Association Between The Real Cost Media Campaign and Smoking Initiation Among Youths — United States, 2014–2016. MMWR Morb Mortal Wkly Rep. 2017;66(02):47-50. doi:10.15585/mmwr.mm6602a2
9. Sly D, Hopkins R, Trapido E, Ray S. Influence of a counteradvertising media campaign on initiation of smoking: the Florida “truth” campaign. Am J Public Health. 2001;91(2):233-238. doi:10.2105/AJPH.91.2.233
10. Weiss JW, Cen S, Schuster D, et al. Longitudinal effects of pro‐tobacco and anti‐tobacco messages on adolescent smoking susceptibility. Nicotine Tob Res. 2006;8(3):455-465. doi:10.1080/14622200600670454
11. Siegel M. What the FDA Gets Wrong About E-Cigarettes. Bloomberg. https://www.bloomberg.com/view/articles/2017-03-16/what-the-fda-gets-wrong-about-e-cigarettes?in_source=embedded-checkout-banner. Published March 16, 2017. Accessed July 25, 2023.
12. Calabro KS, Khalil GE, Chen M, Perry CL, Prokhorov AV. Pilot study to inform young adults about the risks of electronic cigarettes through text messaging. Addict Behav Rep. 2019;10:100224. doi:10.1016/j.abrep.2019.100224
13. U.S National Cancer Institute. A Socioecological Approach to Addressing Tobacco-Related Health Disparities | Division of Cancer Control and Population Sciences (DCCPS). A Socioecological Approach to Addressing Tobacco-Related Health Disparities; 2017. Accessed July 25, 2023. https://cancercontrol.cancer.gov/brp/tcrb/monographs/monograph-22
14. Duke JC, Farrelly MC, Alexander TN, et al. Effect of a National Tobacco Public Education Campaign on Youth’s Risk Perceptions and Beliefs About Smoking. Am J Health Promot. 2018;32(5):1248-1256. doi:10.1177/0890117117720745
15. Kranzler EC, Hornik RC. The Relationship Between Exogenous Exposure to “The Real Cost” Anti-Smoking Campaign and Campaign-Targeted Beliefs. J Health Commun. 2019;24(10):780-790. doi:10.1080/10810730.2019.1668887
16. The Real Cost E-Cigarette Prevention Campaign. Published online July 21, 2023. Accessed July 31, 2023. https://www.fda.gov/tobacco-products/real-cost-campaign/real-cost-e-cigarette-prevention-campaign#:~:text=Our%20Goal%3A%20Educate%20youth%20about,addiction%20from%20using%20e%2Dcigarettes
17. This Free Life Campaign. Published online March 11, 2022. Accessed July 31, 2023. https://www.fda.gov/tobacco-products/public-health-education-campaigns/free-life-campaign

Images Presented in Focus Groups:

Culturally Targeted Imagery for Eye-Tracking

Control Imagery for Eye-Tracking

** At this point, we are pre-publication. If you would like to see more images, please reach out to the Principal Investigator, Joanne Patterson (patterson.1191@osu.edu).

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 

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

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

**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. 

References

1. Pierce JP, Luo M, McMenamin SB, et al. Declines in cigarette smoking among US adolescents and young adults: indications of independence from e-cigarette vaping surge. Tobacco Control Published Online First: 08 November 2023. doi: 10.1136/tc-2022-057907
2. Sanford BT, Brownstein NC, Baker NL, et al. Shift From Smoking Cigarettes to Vaping Nicotine in Young Adults. JAMA Intern Med. 2024;184(1):106–108. doi:10.1001/jamainternmed.2023.5239
3. Pérez A, Bluestein MA, Kuk AE, Chen B. Age of e-cigarette initiation in USA young adults: Findings from the Population Assessment of Tobacco and Health (PATH) study (2013-2017). PLoS One. 2021 Dec 13;16(12):e0261243. doi: 10.1371/journal.pone.0261243. PMID: 34898629; PMCID: PMC8668126.
4. Barrington-Trimis JL, Braymiller JL, Unger JB, McConnell R, Stokes A, Leventhal AM, Sargent JD, Samet JM, Goodwin RD. Trends in the Age of Cigarette Smoking Initiation Among Young Adults in the US From 2002 to 2018. JAMA Netw Open. 2020 Oct 1;3(10):e2019022. doi: 10.1001/jamanetworkopen.2020.19022. PMID: 33021650; PMCID: PMC7539122.
5. Kelsh S, Ottney A, Young M, Kelly M, Larson R, Sohn M. Young Adults’ Electronic Cigarette Use and Perceptions of Risk. Tob Use Insights. 2023 Mar 7;16:1179173X231161313. doi: 10.1177/1179173X231161313. PMID: 36911177; PMCID: PMC9996725.
6. Farrelly MC, Nonnemaker J, Davis KC, Hussin A. The Influence of the National truth® Campaign on Smoking Initiation. Am J Prev Med. 2009;36(5):379-384. doi:10.1016/j.amepre.2009.01.019
7. Farrelly MC, Duke JC, Nonnemaker J, et al. Association Between The Real Cost Media Campaign and Smoking Initiation Among Youths — United States, 2014–2016. MMWR Morb Mortal Wkly Rep. 2017;66(02):47-50. doi:10.15585/mmwr.mm6602a2
8. Sly D, Hopkins R, Trapido E, Ray S. Influence of a counteradvertising media campaign on initiation of smoking: the Florida “truth” campaign. Am J Public Health. 2001;91(2):233-238. doi:10.2105/AJPH.91.2.233
9. Weiss JW, Cen S, Schuster D, et al. Longitudinal effects of pro‐tobacco and anti‐tobacco messages on adolescent smoking susceptibility. Nicotine Tob Res. 2006;8(3):455-465. doi:10.1080/14622200600670454
10. Siegel M. What the FDA Gets Wrong About E-Cigarettes. Bloomberg. https://www.bloomberg.com/view/articles/2017-03-16/what-the-fda-gets-wrong-about-e-cigarettes?in_source=embedded-checkout-banner. Published March 16, 2017. Accessed July 25, 2023.
11. Calabro KS, Khalil GE, Chen M, Perry CL, Prokhorov AV. Pilot study to inform young adults about the risks of electronic cigarettes through text messaging. Addict Behav Rep. 2019;10:100224. doi:10.1016/j.abrep.2019.100224
12. U.S National Cancer Institute. A Socioecological Approach to Addressing Tobacco-Related Health Disparities | Division of Cancer Control and Population Sciences (DCCPS). A Socioecological Approach to Addressing Tobacco-Related Health Disparities; 2017. Accessed July 25, 2023. https://cancercontrol.cancer.gov/brp/tcrb/monographs/monograph-22
13. Duke JC, Farrelly MC, Alexander TN, et al. Effect of a National Tobacco Public Education Campaign on Youth’s Risk Perceptions and Beliefs About Smoking. Am J Health Promot. 2018;32(5):1248-1256. doi:10.1177/0890117117720745
14. Kranzler EC, Hornik RC. The Relationship Between Exogenous Exposure to “The Real Cost” Anti-Smoking Campaign and Campaign-Targeted Beliefs. J Health Commun. 2019;24(10):780-790. doi:10.1080/10810730.2019.1668887
15. The Real Cost E-Cigarette Prevention Campaign. Published online July 21, 2023. Accessed July 31, 2023. https://www.fda.gov/tobacco-products/real-cost-campaign/real-cost-e-cigarette-prevention-campaign#:~:text=Our%20Goal%3A%20Educate%20youth%20about,addiction%20from%20using%20e%2Dcigarettes
16. This Free Life Campaign. Published online March 11, 2022. Accessed July 31, 2023. https://www.fda.gov/tobacco-products/public-health-education-campaigns/free-life-campaign