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Authors: Ashley Meadows, Emma Jankowski, Hayley Curran, Alysha C. Ennis, Sydney Galusha, Caitlin Miller, Grace Turk, and Joanne G. Patterson

 

Poster presented at the 2023 CASEL Tobacco Regulatory Science Conference

INTRODUCTION

• LGBTQ+ young adults report higher rates of smoking and vaping compared to non-LGBTQ+ young adults.
• Mass-reach tobacco public education campaigns are an effective strategy for preventing tobacco initiation and decreasing use in the general population.
• Few published studies have examined the content and features that LGBTQ+ young adults prefer when viewing culturally-targeted tobacco public education campaigns.
• This study qualitatively assessed LGBTQ+ young adults’ perceptions and reactions to culturally targeted tobacco education campaign materials.

METHODS 

• Focus groups (N=6 groups; n=22 participants) of young adults aged 18-35 (76% non-Hispanic white, 52% bisexual, 86% assigned female at birth) were recruited from December 2022 – January 2023.
• Participants viewed a randomly ordered set of culturally targeted tobacco public education advertisements. Semi-structured interviews assessed perceptions of images and language on each culturally targeted tobacco education ad.
• We used template analysis to thematically analyze data. A priori deductive and inductive coding were applied to qualitatively understand LGBTQ+ young adults’ perceptions of visuals and semantics used in the FDA’s “This Free Life” and “Every Try Counts” tobacco public education campaigns.

RESULTS 

Qualitative Codebook for Focus Groups with Young Adults

Theme	Code	Definition
Ad Design
	Font	Participants discuss liking or disliking font choices/typography
	Layout	Participants discuss liking or disliking spacing, layout, or white space.
	Colors	Participants discuss liking or disliking colors
	Graphic type	Participants discuss liking or disliking the type of graphic (e.g. photograph vs. illustration/cartoon)
	Brand Identity	Discusses that the ad design matches or does not match the product being sold given what is known/presumed about a brand (e.g., of “not matching” brand identity:  Kandy Pens ad image of women/men being intimate and product not featured; “I like that they used their brand name as kind of like a play on words”).   “This ad tells me nothing about what this company is or does, or anything.”
	Creativity	Participants discuss whether an ad does or does not feel creative or clever with respect to its design (e.g., Bud Light ad where “L G B T” were highlighted).
	Aesthetically pleasing	Participants discuss whether  an ad is overall aesthetically pleasing or not
Ad Content: Imagery
	Imagery – Representative	Participants discuss feeling though the images in ad represent them/people they know (i.e., looks like me, acts like me) or feature real representation of LGBTQ people generally.
	Imagery – Liking	General like code for imagery
	Imagery – Disliking	General dislike code for imagery
	Imagery – Subtle/Overt	Participants discuss the subtlety or overtness of the LGBTQ elements within an ad
	Imagery – Pride Flags and rainbows	Discusses the liking or disliking of LGBTQ flags and colors within ads
	Imagery – Who	Participants describe liking or disliking having posed (“fake”)   vs. more natural looking (“real”) models in the ad.
Ad Content: Language
	Language – Word choice	Participants discuss liking or disliking word choice
	Language – Efficacy of absolute risk vs. self-efficacy messaging	Participants discuss liking or disliking absolute risk messages as compared to self-efficacy messages
	Language – Slang use	Participants discuss liking or disliking the use of slang in an ad (e.g. words like “slay”, “queen”)
	Language- Humor	Participants discuss liking or disliking the use of humor in advertisements
	Language- slogans or taglines	Participants discuss liking or disliking the use of slogans, taglines, or catch phrases in an advertisement (e.g., “Quitting isn’t a perfect process” or “Made with Pride”)
Ad Content: Representativeness
	Inclusivity	Participants discuss whether or not the ad is representative of LGBTQ identities (L – G – B – T  – Q – NB)
	Stereotyping	Participants discuss feeling as though the ads represent stereotypes of the LGBTQ community, in imagery, language, content, etc.
	Intersectionality	Participants discuss whether or not ads are intersectional in terms of identities that are not within the LGBTQ umbrella such as racial identity or class status
	Authenticity	Participants discuss feeling as though ads are inauthentic/authentic; (e.g., feeling like ads have been created by those not within the LGBTQ community/ feeling as though ads have been created by those within the LGBTQ community   (authentic ads may take into consideration the feelings, wishes and traditions towards the LGBTQ community)
	Fetishization of LGBTQ community	Participants discuss ads sexualizing or fetishizing the LGBTQ community
	Target Audience	Discusses whom they believe an ad was targeted towards
	Normalization/Visibility	Participants discuss ads being used to normalize or make visible LGBTQ people and relationships. Word “representative” might be used by participants.
Context
	Brand partnerships	Participants discuss liking or disliking the inclusion of brand partnerships with LGBTQ organizations (e.g. GLADD, Rainbow Railroad)
	Ad placement	Participants discuss where they see culturally-targeted ads (e.g. social media, malls, TV)
	Outdated/Current	Discusses whether the language, content, and/or design of ad feels outdated or current (e.g., compared to the current time period/context).
	Rainbow capitalism	Participants discuss only seeing culturally-targeted ads during Pride Month, or being performative/used just to make money
	Pandering	Participants discuss feeling as though companies are trying to please the LGBTQ community by acting in a way they believe the LGBTQ community would want them to act
	Corny/Trite	Participants discuss advertisements feeling “corny” or trying too hard. (e.g. describing things as “tumblr-core,” “white woman’s instagram,” “millennial”, “mom”)
	Necessity	Participants discuss whether or not they view LGBTQ+ advertising as necessary/needed for LGBTQ community
	General feelings	Participants discuss how they feel about LGBTQ culturally targeted advertising generally; whether like, dislike, or neutral
	Personal Experience	Discusses how their personal experience influences their perception of an ad
	Favorite	Participant discusses an ad as their favorite
	Purchasing	Discusses buying and purchasing product advertised in the ad shown

• LGBTQ+ young adults found the FDA’s “Every Try Counts” tobacco public education campaign effective. They responded positively to the campaign’s diverse and authentic representation of LGBTQ+ people and found subtle rainbow background color gradients aesthetically pleasing.
• Participants had fewer positive reactions when discussing the FDA’s “This Free Life” tobacco public education campaign. Young adults perceived imagery representing LGBTQ+ people as inauthentic and stereotypical. Overuse of LGBTQ+ cultural imagery (e.g., overt rainbows), neon colors, and unclear slogans were viewed as less effective.

 

CONCLUSIONS

• Participants responded positively to “personal” and strengths-based messages, subtle cultural imagery, and authentic representation of LGBTQ+ people.
• Participants responded more positively to the “Every Try Counts” campaign. 
  • “I think it’s effective…I could still believe that  a real person said this, even if it was definitely written by someone for this purpose.” (LGBTQ+ current smoker and vaper)
  • “I think with the quote and the age, it kind of ties everything together. Like, oh its that person, and they’re reaching out to you with their story…it makes it feel more personal.” (LGBTQ+ current smoker and vaper)
  • “It looks more relatable as opposed to in your face with an overproduced photoshoot.” (LGBTQ+ current smoker) 
  • “The flags are great, they are utilized very well here.” (LGBTQ+ current smoker) 
  • The composition is really nice…not stereotypically gay looking people.” (LGBTQ+ current smoker and vaper)
• Participants responded less positively to the “This Free Life” campaign.
  • “What do you mean ‘dull your glow?’ What do you mean ‘Shine?’ Like what are these attributes that you are claiming? I genuinely don’t know…if it’s a good thing or a bad thing.” (LGBTQ+ current smoker and vaper)
  • “I don’t think a lot of people identify with the very bright rainbows…it’s like rainbow washing.” (LGBTQ+ current smoker and vaper)
  • “They are making it way more flamboyant than it needs to be.  And once again, it’s alienating.” (LGBTQ+ current smoker and vaper) 
  • “It reminds me of middle school in a way…it’s hard for me to take that one seriously.” (LGBTQ+ current smoker and vaper)
  • “It’s definitely giving throw back to my emo phase.” (LGBTQ+ current smoker)

 

IMPLICATIONS

• LGBTQ+ culture is dynamic, and tobacco public education needs periodic updates to accurately represent culturally-specific semantics (slang, pronouns) and visuals (fashion, expression).
• Future research should experimentally test the effect of exposure to tobacco public education that leverages visual and semantic strategies acceptable to LGBTQ+ young adults on behavior.
• Developing best practice toolkits and modifiable LGBTQ+ culturally targeted campaign materials may support local and government public health agencies to implement LGBTQ+ specific campaigns across time and settings.

 

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

 

SUPPLEMENTAL MATERIALS

Sample of Media shown to Focus Group Participants

           

Example Questions Asked to Participants: 

• “When you see this advertisement, what do you think?”
• “Who is the target audience? Who is it missing?”
• “Would this advertisement be effective at reaching LGBTQ people, why or why not?”
• “Is this ad believable? Convincing?”
• “What imagery do you like/not like?”
• “What language do you like/not like?”