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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. 

 

References

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Meet the Lab – Dr. Elise Stevens

| Elle Elson

Dr. Elise Stevens

Pronouns: She/Her/Hers

Title: Assistant Professor, University of Massachusetts Chan Medical School’s Department of Population and Quantitative Health Sciences- Division of Preventative and Behavioral Medicine; Director of the UMass Chan Center for Tobacco Treatment Research and Training

Dr. Stevens is a professor and health communication scientist, whose research focuses on the cognitive, affective, and behavioral responses to health messages. 

 

What was a memorable experience of your public health career?

My most memorable experiences in my public health career have been working with incredible, smart, and funny people who push science forward. 

What advice would you give to students pursuing public health?

For students pursuing a career in public health, I would advise them to anticipate numerous challenges along the way. However, cultivating resilience and nurturing a deep passion for the mission will not only lead to success but also imbue their work with greater meaning and fulfillment. 

Meet the Lab – Dr. Liz Klein, MPH

| Elle Elson

Dr. Liz Klein, MPH

Pronouns: She/Her/Hers

Title: Chair & Professor, OSU College of Public Health– Health Behavior & Health Promotion Division

Dr. Klein is a trained behavioral epidemiologist, with research focuses on the field of tobacco control, where she uses various approaches to multi-level strategies that are best to reduce or prevent tobacco use in cross-sectional, experimental, and longitudinal studies. She focuses on youth, young adults, and rural adults at high risk for tobacco use, focused on strategies to eliminate health disparities and achieve health equity.  

What was a memorable experience of your public health career?

I’m grateful to have found public health early in my career.  I’ve enjoyed working in communities, in practice, and in academia.  My favorite experiences boil down to helping reduce the burden of disease by preventing tobacco use or helping people to quit their addiction to tobacco products. 

What advice would you give to students pursuing public health?

Public health is a rewarding, challenging career.  I would advise students to explore their own strengths and find a way to apply those strengths.  There are lots of ways to do impactful public health work, no matter where you work! 

Meet the Lab – Maxwell Schoen

| Elle Elson

Maxwell Schoen (he/him) 

Research Assistant, Public Health with a specialization in Sociology, Freshman 

1/16/2024 

I am from Cincinnati, Ohio. My interest in public health stems from my passion for cancer prevention and LGBTQ+ health equity. The Public Health Sociology program provides a background on how social factors impact the health of communities. 

What drew you to a public health education?  

Public health has always interested me because of its unique blend of disciplines and the way that it impacts almost every part of life. I really appreciate how it combines my interests of health, social justice, and policy into one multifaceted education.  

What are your goals for the future? 

I hope to earn my MPH in health behavior and health promotion before I pursue a medical degree. I would like to use my public health background to contribute meaningful research to the body of knowledge around health disparities and be a more compassionate physician. 

How do you spend your time outside of academia?  

Outside of academia, I enjoy playing guitar, going to concerts, running, working out and doing outdoor activities like hiking, canoeing, and camping. I also really enjoy traveling to different countries and experiencing different cultures. 

 

NIH Tobacco Regulatory Science Meeting

| Ashley Meadows

Four team members from our lab had the opportunity to travel to the NIH Tobacco Regulatory Conference this year.  It was great hearing this year’s updates about methanol use, cigars, Nicotine Product Standards, and much more.  Our own Alysha Caine Ennis, MPH and Dr. Joanne Patterson led a symposium about our lab’s latest research on developing culturally targeted tobacco education messages.  Emma Jankowski and Ashley Meadows had the opportunity to present posters sharing their work with the broader tobacco community at NIH as well.  The team had an amazing learning experience and hope to be back next year!

Meet the Lab – Dr. Darren Mays

| Elle Elson

Dr. Darren Mays

Pronouns: He/Him/His

Titles: Associate Professor of Internal Medicine and Assistant Dean for Research & Tenure Track Faculty at the College of Medicine, and Director of Training at the Center for Tobacco Research

Dr. Darren Mays’ research focuses on addictive behaviors in the context of cancer prevention, including nicotine/tobacco use, alcohol consumption, and others.

 

What was a memorable experience of your public health career?

My most memorable experience was probably starting my first faculty position. I always had my sights set on an academic research career, but it only took a couple of weeks for me to realize at that point in my career after completing my PhD, I still had so much to learn!

 

What advice would you give to students pursuing public health?

My training is in public health but my career path wound to academic medicine. My main advice is to consider diverse opportunities where your skills and expertise can apply. You never know which door will open and will be your “forever” job!

Meet the Lab – Dr. Amy Ferketich

| Elle Elson

Dr. Amy Ferketich 

Pronouns: She/Her/Hers 

Title: Professor & Interim Chair, OSU College of Public Health, Epidemiology Division 

Dr. Ferketich is a professor of public health, with research interests in smoking cessation, tobacco control, and policies that are focused on youth and young adult tobacco initiation prevention.  

What was a memorable experience of your public health career?  

Working on Ohio State’s first Tobacco Center of Regulatory Science was memorable because I was one of the PIs of the Buckeye Teen Health Study. From that project, we learned a lot about adolescent tobacco use in Ohio. I also worked with an outstanding group of investigators who taught me a lot! 

What advice would you give to students pursuing public health?  

Public health is political and it’s easy to get frustrated by the politics, lack of funding, etc. Students should not let this get in their way of doing good work because what we do is important and impactful. 

Meet the Lab – Rithika Nidimusali

| Elle Elson

Rithika Nidimusali (She/Her/Hers)

Research Assistant, BS in Neuroscience, Minor in Global Public Health

I am currently pursuing a bachelor’s degree in neuroscience with a minor in global public health. My commitment revolves around recognizing and alleviating health disparities in diverse communities, with a specific emphasis on the LGBTQ community.

What drew you to a public health education? 

I was drawn to a public health education by my aspiration to become a physician and my desire to comprehend the interconnectedness of health and societal factors influencing patient well-being. Recognizing that health outcomes are not solely determined by medical interventions, I sought a broader understanding of the social, economic, and environmental determinants that contribute to health disparities. A public health education provides me with the knowledge and tools to address these broader factors, allowing me to approach patient care with a more holistic and informed perspective.

How do you spend your time outside of academia? 

Outside of academia, I indulge in my passions for thrifting, upcycling, and sustainability. I find joy in exploring thrift stores, discovering hidden gems, and repurposing items to give them new life.

Meet the Lab – Dr. Megan Roberts

| Elle Elson

Dr. Megan Roberts 

Pronouns: She/Her/Hers

Title: Associate Professor, OSU College of Public Health

Dr. Megan Roberts is an Associate Professor of Public Health at The Ohio State University. Her research focuses on tobacco use among populations historically targeted by the tobacco industry–particularly adolescents and young adults, racial/ethnic minorities, the LGBTQ+ community, and individuals living in rural areas.

What was a memorable experience of your public health career?

I supported the restriction on flavored tobacco products that was recently passed in our city of Columbus, OH. A lot of public health equity advocates worked very hard to make this happen: working with key community stakeholders, garnering support from the public, and providing testimony to the City Council. It was really exciting to watch the process unfold, but also nerve-racking because of the strong industry opposition!

What advice would you give to students pursuing public health? 

Public health is so incredibly broad, so take time to find an area that is the right fit for you. Working or volunteering with public health faculty or public health organizations is a great way to experience different environments.

Follow her on Instagram! @meganroberts_osu