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Theses and Dissertations

Philip morris faces "the truth": a rhetorical analysis of the persuasiveness of two teen-targeted anti-smoking advertising campaigns.

Marybeth McMurray , Brigham Young University - Provo

Conclusions suggest that due to the vast impact of media the glorifies smoking and other self-injurious behaviors; infrequent appearance of pro-social media appeals; insidious coercive tactics of the tobacco industry; possible limitations in determining the effectiveness of pro-social media appeals due to adolescent self-perception (or third person effect variables); and lack of attention paid to more vulnerable or at-risk youth, the real need may not be better pro-social media campaigns, but rather media literacy campaigns. In doing so, youth may become empowered, critical thinkers able to make life choices based on personal preference and the desire for self-fulfillment, instead of being coerced into a belief system induced by the bombardment of media.

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McMurray, Marybeth, "Philip Morris Faces "the truth": A Rhetorical Analysis of the Persuasiveness of Two Teen-Targeted Anti-Smoking Advertising Campaigns" (2003). Theses and Dissertations . 41. https://scholarsarchive.byu.edu/etd/41

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http://hdl.lib.byu.edu/1877/etd150

Philip Morris, American Legacy Foundation, Kenneth Burke, rhetorical analysis, persuasive advertising, dramatism, persuasive attack, persuasive defense, at-risk adolescent, anti-smoking campaigns, media literacy

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• Am J Public Health
• v.96(5); May 2006

Antismoking Advertisements for Youths: An Independent Evaluation of Health, Counter-Industry, and Industry Approaches

Cornelia pechmann.

Cornelia Pechmann is with the Paul Merage School of Business, University of California, Irvine. Ellen T. Reibling is with the Department of Health Education, University of California, Irvine.

Ellen T. Reibling

Objectives. We used a validated copy test method to examine the effectiveness of 8 types of antismoking advertisements representing health, counterindustry, and industry approaches. We tested the hypothesis that health ads about tobacco victims can lower most adolescents’ intent to smoke if the ads elicit disgust and anti-industry feelings rather than fear. We hypothesized null effects for adolescents with conduct disorder because of their abnormally low empathy.

Methods. Ninth-grade students from 8 California public schools (n=1725) were randomly assigned to view 1 of 9 videotapes containing a TV show with ads that included either a set of antismoking ads or a set of control ads. Participants completed baseline measures assessing personality traits and postexposure measures assessing smoking intent, feelings, beliefs, and ad evaluations.

Results. Ads focusing on young victims suffering from serious tobacco-related diseases elicited disgust, enhanced anti-industry motivation, and reduced intent to smoke among all but conduct-disordered adolescents. Counterindustry and industry ads did not significantly lower smoking intention.

Conclusions. Sponsors of tobacco use prevention ad campaigns should consider using ads showing tobacco-related disease and suffering, not just counterindustry ads. Ads should be copy tested before airing.

Twenty-four US states have initiated tobacco use prevention advertising campaigns. 1 Different message themes and styles of execution are used, 2 , 3 and there is controversy over which approaches work best. 1 , 4 – 8 Past studies have asked adolescents their opinions of anti-smoking ads, and adolescents have generally preferred health-themed ads evoking strong negative emotions. 9 – 15 We conducted a randomized controlled trial or “copy test” to examine how exposure to different ad types affects adolescents’ intention to smoke relative to a control (no antismoking ad exposure) condition.

In a copy test, subjects are shown an ad and then asked to answer questions about their product-related feelings, beliefs, and intentions. These responses are statistically compared either with the same subjects’ baseline (preexposure) responses or with the responses of similar people who were randomly assigned to a no-exposure control condition. We used the latter approach. We tested 8 ad types representing common health, counter–tobacco industry, and tobacco industry approaches. We paid particular attention to health ads, which are often referred to as “fear appeals” and are especially controversial. 16 , 17

LITERATURE REVIEW AND HYPOTHESES

Fear appeals have at least 2 potential limitations. First, evoking fear among adolescents who feel unable to cope may lead to maladaptive responses such as denial of the problem. 18 , 19 Further, highlighting risks among adolescents who feel invincible may serve to increase the attractiveness of smoking as “forbidden fruit.” 17 , 20 , 21 Health appeals need not evoke fear, though; they may evoke disgust. 22 , 23 Research indicates that associating smoking with disgust is perhaps the single most effective way to make smoking socially unacceptable and encourage antismoking activism. 24 , 25 Disgust is what people feel in response to an immoral act, 26 , 27 and it motivates action. 28 Whereas fear is associated with a desire to escape or hide, disgust is associated with a desire to expel or obliterate. 29 , 30 Research also suggests how disgust-provoking ads can be created: by showing innocent victims suffering, empathy and moral indignation are elicited. 22 , 23 , 31 , 32 Hence, our first hypothesis was this: among adolescents, antismoking ads that focus on victims suffering from smoking’s serious health effects will elicit more disgust than other ad types and will increase anti-industry motivation and lower intention to smoke relative to the control (no antismoking ad exposure) condition.

Three types of ads fit this description: ads focusing on disease and suffering, ads focusing on a dying parent, and ads focusing on environmental tobacco smoke (Table 1 ▶ ). Counterindustry ads focus on the victimizers, not on the victims; they directly attack and ridicule industry executives. We could find no research regarding whether ads that directly attack tobacco executives evoke empathy for victims or disgust for tobacco executives. However, researchers have compared ads that explicitly state conclusions versus ads that do not. 33 The findings indicate that, if people are interested in and knowledgeable about an issue, it is preferable to give them the facts and let them draw their own conclusions. The implication is that indirect attacks on the tobacco industry, focusing on tobacco victims, might be preferable to direct attacks if youths are knowledgeable about and interested in the issue.

TABLE 1—

Antismoking Ad Types

Research also indicates that adolescents’ reactions to ads may be moderated by their personality traits. Past studies have focused on sensation seeking or the need for varied, novel, and complex experiences. 34 This trait both predicts drug use 35 – 37 and moderates response to antidrug ads. 38 – 41 Conduct disorder, “a repetitive and persistent pattern of behavior in which the basic rights of others and major age-appropriate social norms or rules are violated,” 42 (p1469) is even more strongly associated with adolescent smoking. 43 , 44 Conduct-disordered youths are up to 4 times as likely to smoke as youths without conduct disorder. 45 , 46 Further, conduct-disordered youths may be less responsive than others to ads that focus on victims, inasmuch as people with conduct disorder have abnormally low empathy. 47 – 49 Thus, our second hypothesis was that these antismoking ads would be expected to have null effects on conduct-disordered adolescents. However, we considered adolescents without conduct disorder, who constituted 81% of our sample, to be a meaningful target for antismoking interventions; for instance, 39% of them had tried smoking.

We obtained 150 English-language anti-smoking TV ads that had aired from 1997 to 2001 in campaigns focused on youths or on a general audience. Most were from Massachusetts (24%), the American Legacy Foundation (23%), Florida (16%), California (10%), or Philip Morris (7%). We identified 3 common message themes (social, health, and counterindustry) and 8 ad types, or unique combinations of theme(s), subtheme, and execution (speaker and tone; Table 1 ▶ ). The social message theme was the least common, and it was primarily used by the tobacco industry; for example, Philip Morris used ads showing social acceptance of nonsmokers 11 , 50 and Lorillard used ads focusing on the unattractive cosmetic effects of smoking. 1

We conducted an ad screening study to select 3 similar ads of each type for the copy test. We created 14 videotapes, each containing 10 or 11 ads. Each videotape was viewed by about 35 ninth-grade students (aged 14–15 years, total n = 466) from 2 schools in the area where the copy test would be conducted. After seeing an ad twice, the students were asked to appraise it. They were instructed to put a check mark next to each theme (social, health, counterindustry) and subtheme that the ad contained. They were also asked to judge the speaker’s age (youth or adult), and the ad’s emotional tone (they were asked, “Did the antismoking advertising make you feel angry? Sad? Disgusted? Fearful? Amused? Happy? Upbeat? Like laughing?”). For each ad type, we identified 3 ads that were judged by the majority of students to have the characteristic (intended) theme(s) and subtheme and no others and that did not differ significantly from each other in terms of emotional tone or speaker’s age. None of the ads chosen for the copy test were fear inducing, according to the vast majority of students who viewed them in the ad screening study. Sponsor identifications were removed.

Participants in the copy test were 1725 male and female ninth-grade students (aged 14–15 years; 42% White, 46% Hispanic, 12% Asian) at 8 public high schools in middle- to lower-middle-class neighborhoods in southern California. Participation was voluntary but exceeded 90%. About 191 individuals viewed each videotape. All videotapes were shown at every school.

The copy test was conducted in spring 2002. During each class period, about 40 students were released from classes and randomly assigned to 1 of 2 empty rooms. The participants completed a baseline questionnaire asking about personality traits, smoking behavior, and demographics. (Intent was not assessed at baseline because a pilot test showed that asking about intent at baseline contaminated the posttest intent measure.) They were then shown a 10-minute videotape of the TV show The Price is Right. Embedded in the commercial breaks were either 3 anti-smoking ads of a particular type or 3 control ads that were non–tobacco-related public service announcements. Each ad appeared twice, in 2 separate commercial breaks, providing 6 total exposures so cumulative ad effects could be assessed. 51 , 52 The participants also saw several non–tobacco-related commercials that had aired on The Price is Right. 53 After watching the videotape, participants completed the outcome and ad measures.

The design was a 2-factor experiment. The first factor was ad type with 9 levels, which we manipulated by randomly assigning participants to view 1 of 9 randomly selected videotapes. The second factor was conduct disorder (present vs absent). Comparisons were made between groups, that is, participants who saw antismoking ads were compared with those who saw control ads. Because participants were randomly assigned to groups and there were no demographic differences between groups, covariates did not affect the results and were dropped. 54

At baseline, in addition to measuring smoking behavior, we measured the personality traits that research indicates are most highly associated with youth smoking. 43 , 45 , 46 , 55 We used Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition 56 scales for aggression, 37 , 57 attention deficit–hyperactivity disorder, 58 , 59 and conduct disorder 57 , 60 , 61 ; the Children’s Manifest Anxiety Scale, Revised 55 , 62 – 65 ; the Center for Epidemiological Studies Depression Scale 57 , 63 , 64 , 66 – 68 ; Rosenberg’s Self-Esteem Scale 55 , 69 ; and the Brief Sensation Seeking Scale. 35 , 38 Standard diagnostic criteria were used.

The outcome measures consisted of intent to smoke and smoking-related beliefs. After participants viewed the videotape, we asked them to indicate their smoking intent 20 , 70 , 71 by agreeing or disagreeing with the following statements: “In the future, I might smoke one puff or more of a cigarette,” “I might try out cigarette smoking for a while” and “If one of my best friends were to offer me a cigarette, I would smoke it.” (A scale of 1 [strongly disagree] to 5 [strongly agree] was used throughout unless otherwise indicated). We calculated the mean intent-to-smoke score, which was 1.66. We then classified each participant whose responses were above the mean as having a smoking intent and computed the percentage of participants who had a smoking intent; however, the mean score was more precise because it used the full response range.

We also measured beliefs that previous research suggested might be affected by anti-smoking ads and might correspondingly affect smoking intent. 20 , 72 A key measure was anti-industry motivation: “I think we can stop cigarette companies from trying to get people to smoke,” “If we all try to stop cigarette companies, we can make a difference,” and “If I try to stop cigarette advertising, fewer people would smoke.”

The antismoking ad measures consisted of ad recall, recall of the number of ad spots seen, message theme and subtheme, ad tone, speaker age, and judged ad efficacy and ad sensation value. Participants were asked, “In the commercial breaks of the TV show you just saw, did you see any antismoking ad(s)?” and “How many antismoking ads did you see?” If participants reported seeing antismoking ads, they were asked, “In your opinion, was this advertising effective at stopping young people from smoking?” (0 = not effective, 1 = moderately effective, 2 = highly effective)? 10 , 20 Regarding sensation value, they were asked, “Was the advertising emotional? Unusual or unique? Exciting? Dramatic in that it tells a strong story? Powerful, forceful, or impactful? Intense or extreme?” (Reliability, or consistency of participants’ answers to 2 or more similar questions, was measured with the statistic α; for sensation value, α = .82. 38 – 40 ) Regarding emotional tone (negative or positive), they were asked, “Did the antismoking advertising make you feel angry? Sad? Disgusted? Amused? Happy? Upbeat? Like laughing?” 73 (for negative tone [first 3 items], α = .76; for positive tone, α = .79). They were also queried about theme, sub-theme, and speaker age.

Finally, all participants were asked what they thought the study was about (responses were coded by 2 judges with 90% agreement). Nine percent guessed the study might be about antismoking ads, but removing these participants’ responses from the analyses did not affect the results, so they were retained.

For the statistical analyses, we used SPSS (SPSS Inc, Chicago, Ill), setting type I error to 5%. To analyze outcome measures, we used 2-factor (ad type, conduct disorder) analyses of variance (ANOVAs). Then we conducted 1-factor (ad type) ANOVAs within each conduct-disorder subgroup. Next we conducted pairwise comparisons of each ad type versus the control, using the Dunn-Sidak critical t value (8 comparisons, 2-tailed). 74 For anti-smoking ad measures (e.g., judged ad efficacy), we compared each antismoking ad type with all others, using the Tukey-Kramer critical t value, 74 and ranked ad types from highest (1) to lowest. If 2 ad types showed an identical pattern of similarity/dissimilarity to all others, they received the same rank. (This approach is similar to using unique superscripts to designate dissimilar means.) To examine whether an ad type had a relatively negative or positive tone, we used repeated measures. To compare proportions, we used χ 2 . To compute odds ratios for intent, we used binary logistic regression with ad category as a categorical covariate (simple contrasts vs control). We used multivariate linear regression to relate beliefs and personality traits to smoking intent, and univariate linear regression to compare participants’ ad efficacy judgments with the ads’ actual effectiveness at changing smoking intent (change in intent = control mean –ad type mean).

About 93% of the participants exposed to antismoking advertising recalled seeing such ads. They recalled seeing, on average, 3.4 spots, slightly more than the 3 they actually saw, probably because of ad repetition. (Conduct-disordered participants and current smokers were less likely to report having seen the antismoking ads. When we dropped participants who failed to report seeing the antismoking ads, the ad effects discussed below became stronger. We have reported the findings for the full sample because they are more generalizable.) Table 2 ▶ shows the percentages of participants who recalled seeing each message theme. The vast majority of participants said they saw the message theme(s) each ad type was intended to convey; significantly fewer thought another message was conveyed.

TABLE 2—

Percentages of Participants Who Recalled Seeing the Antismoking Ads and Message Themes, Mean Number of Ads Recalled, and Mean Ratings of Ad Tone

Note . Subscripts indicate differences in ad rank within column, P < .05. Standard interval scales (1–5) were used.

The beliefs we measured were associated with smoking intent, but not always in the expected negative direction (Table 3 ▶ ). Beliefs about the severity of the health risks of smoking and vulnerability to social and marketing pressures were positively associated with intent. Most of the personality traits we measured were associated with smoking intent, but conduct disorder was more strongly associated with intent than were the other traits. Further analyses showed that conduct-disordered participants were substantially more likely than participants without conduct disorder to have smoked in their lifetime (68% vs 39%; χ 2 = 89.16, P < .01) and in the previous month (36% vs 13%; χ 2 = 93.59, P < .01).

TABLE 3—

Beliefs and Personality Traits as Predictors of Smoking Intent

Note . Multiple regression results for beliefs showed an adjusted R 2 = .17, P < .01 ( df for t tests = 1625). Multiple regression results for personality traits showed an adjusted R 2 = .12, P < .01 ( df for t tests = 1561).

a Standard interval scales (1–5) were used. For intent: α = .87, mean = 1.66.

b Diagnostic criteria for trait cutoffs were as follows: aggression, 4 of 8 symptoms; anxiety, 7 of 28 symptoms; attention-deficit/hyperactivity disorder, 6 of 18 symptoms; conduct disorder, 3 of 7 symptoms; depression, weighted score exceeding 23; low self-esteem, median split of 10 items; sensation seeking, median split of 4 items.

* P < .05; ** P < .01.

The 2-factor ANOVA on smoking intent revealed an ad type main effect (F[8,1707] = 2.16, P < .05), a conduct disorder main effect (F[1,1707] = 154.41, P < .01), and an ad type × conduct disorder 2-way interaction (F[8,1707] = 2.28, P < .05). Among all participants, no antismoking ad type lowered smoking intent (vs control condition). Among participants without conduct disorder, ads portraying disease and suffering significantly lowered mean smoking intent (vs control condition) and also reduced the proportion of participants who indicated intent to smoke by 42% (from 38% to 22%); no other ad type did so (Table 4 ▶ ). Among conduct-disordered participants, ad type did not significantly affect intent. In post hoc analyses, we verified that no other personality trait interacted with ad type to influence intent or any other outcome.

TABLE 4—

Antismoking Ad Effects on Outcome and Ad Measures

Note . NA = not applicable. Subscripts indicate differences in ad rank within column for each panel (overall, participants without conduct disorder, participants with conduct disorder), P < .05. Standard interval scales (1–5) were used except for judged ad efficacy (0–2).

* P < .05; ** P < .01 in comparisons between indicated antismoking ad type and control.

A 2-factor ANOVA on disgust revealed an antismoking ad main effect (F[7,1418] = 4.72, P < .01), a conduct disorder main effect (F[1,1418] = 6.93, P < .01), and a 2-way interaction (F[7,1418] = 3.39, P < .01). Among participants without conduct disorder, ad type influenced disgust (F[7,1163] = 18.10, P < .01), and ads depicting disease and suffering induced more disgust than any other ad type. Among conduct-disordered participants, ad type did not affect disgust (F[7255] = 1.10, P = .36).

A 2-factor ANOVA on anti-industry motivation showed main effects for ad type (F[8,1674]=3.27, P <.01) and for conduct disorder (F[1,1674]=47.86, P <.01) but no interaction (F[8,1674]=1.42, P =.18). However, follow-up analyses showed that ads portraying disease and suffering (vs control ads) significantly enhanced anti-industry motivation only among participants without conduct disorder (Table 4 ▶ ). Ad type did not affect other beliefs.

To summarize, for participants without conduct disorder, ads depicting disease and suffering engendered disgust and anti-industry motivation, lowering smoking intent. Thus, we conducted standard regression-based tests 75 to verify that disgust and anti-industry motivation mediated the ad effects on intent. Disgust was predictive of anti-industry motivation (B=.13, SE=.02, t [1136]=6.30, P <.01, adjusted R 2 =.03) and anti-industry motivation was predictive of intent (B=–.12, SE=.02, t [1365]=–5.23, P <.01, adjusted R 2 =.02). The ad type effect on anti-industry motivation (B=–.04, SE=.01, t [1202]=–3.10, P =.002, adjusted R 2 =.01) became nonsignificant (B=–.02, SE=.01, t [1135]=–1.86, P =.06) when disgust was included as a covariate (B=.12, SE=.02, t [1135]=5.85, P <.001, adjusted R 2 =.04), indicating that disgust was a prime cause of anti-industry motivation. The effect of ad type on intent (B=.02, SE=.01, t [1229]=2.23, P =.03, adjusted R 2 =.003) became nonsignificant (B=.01, SE=.01, t [1194]=1.46, P =.15) when anti-industry motivation was included as a covariate (B= –.11, SE=.02, t [1194]=–4.56, P <.001, adjusted R 2 =.02), indicating that anti-industry motivation was a prime cause of lowered intent.

Judged ad efficacy was influenced by ad type (F[7,1404]=6.41, P <.01) and conduct disorder (F[1,1404]=11.35, P <.01); the interaction was nonsignificant (F[7,1404]=1.66, P =.11). In the total sample, ads depicting disease and suffering had a significantly higher mean efficacy rating than any other ad type. The percentages who judged disease-and-suffering ads to be at least moderately effective were as follows: total sample, 89%; participants without conduct disorder, 90%; conduct-disordered participants, 84%. Judged ad sensation value was also influenced by ad type (F[7,1410]=4.61, P <.05) and conduct disorder (F[1,1410]=11.27, P <.01); there was no interaction (F[7,1410]=1.60, P =.13). Ads showing a dying parent consistently received the highest sensation value rating.

The higher the judged efficacy of the ads, the more the ads lowered mean smoking intent (vs the control condition) in the total sample ( r = 0.71, B = .47, SE = .19, t [6] = 2.48, P < .05) and among those without conduct disorder ( r = 0.92, B = .68, SE = .12, t [6] = 5.80, P < .01), but not among those with conduct disorder ( r = 0.13, B = .18, SE = .54, t [6] = 0.33, P = .75). Ad sensation value did not predict actual ad efficacy at lowering intent.

Overall, our findings suggest that it is difficult to create effective antismoking ads for adolescents. Seven of the 8 ad types failed to significantly lower adolescents’ intent to smoke (vs the control condition). The 1 ad type that significantly lowered most youths’ intent to smoke, the disease-and-suffering ad type, focused on young victims suffering from devastating tobacco-related diseases. However, even this ad type did not lower smoking intent among adolescents with conduct disorder, who constituted 19% of the sample.

One of the effective disease-and-suffering ads featured a young woman with severe emphysema who showed all the pills she must take to stay alive. Her doctor displayed a diseased lung and stated that emphysema is incurable. Another effective ad depicted a young man, a smoker, with a bad cough and the onset of heart disease. The ad demonstrated the dangerous fatty deposits accumulating in his arteries and stated, “Every cigarette is doing you damage.” Although these ads were clearly heath-related, they did not affect health risk beliefs or elicit fear about health risks. Instead, most youths apparently empathized with the victims and felt disgust and anti-industry motivation, which lowered their smoking intent (vs the control condition). Other research likewise indicates that showing innocent victims is an effective way to elicit empathy 31 , 32 and disgust, 22 , 23 and that disgust, not fear, motivates societal prohibitions and social activism. 24 – 27

We expected dying-parent and environmental-tobacco-smoke ads to perform similarly to disease-and-suffering ads. They did not. These 2 ad types elicited less disgust than disease-and-suffering ads, and they did not significantly increase anti-industry motivation or decrease smoking intent (vs the control condition). These ads emphasized that parents who smoke may harm their children by dying prematurely or by filling the air with toxins. Among adolescents, the parent-oriented messages may have lacked relevance. A previous copy test study 20 indicated that environmental tobacco smoke ads can lower adolescents’ smoking intent if the ads convey that adolescent smokers risk peer disapproval. The social-message ads we tested—the type of ad often used by the tobacco industry—did not significantly lower smoking intent, perhaps because they did not credibly portray peer disapproval. 20

The counter-industry ads elicited less disgust than the disease-and-suffering ads, and they did not significantly enhance anti-industry motivation or reduce smoking intent (vs the control condition). Previous studies indicate that counter-industry ads can, however, increase adolescents’ knowledge about the tobacco industry’s manipulative and deceptive tactics. 20 , 76 Hence, the counterindustry ads may have set the stage for the disease-and-suffering ads. The disease-and-suffering ads increased anti-industry motivation without even mentioning the tobacco industry. It seems that our California participants already knew whom to blame for the tobacco victims’ suffering because of the state’s counterindustry campaign.

Of the 24 US states conducting tobacco use prevention media campaigns, 15 (63%) employ counterindustry ads. 1 The decision to employ such ads may have been based on the reported successes of the Florida and American Legacy Foundation “truth” campaigns. 50 , 76 – 80 However, earlier studies examined the “truth” campaign while it was still novel. Our participants had seen counter-industry ads since 1990. 2 , 81 Consistent with our own findings, Thrasher et al. 82 found that the national “truth” campaign had no effects in California, Massachusetts, or Florida, where well-funded counterindustry campaigns had already aired. Those researchers concluded that “anti-industry ad campaigns may have diminishing returns” and that “other prevention strategies may be needed.” 82 (p287) Our findings support this conclusion and suggest that disease-and-suffering ads may be useful as a supplemental approach. Massachusetts supplemented its counterindustry ads with disease-and-suffering ads, apparently with much success. 2 , 83 From 1996 through 1999, adolescent smoking declined significantly more in Massachusetts than regionally or nationally. 84

Limitations

We did not study the ads’ effects on smoking behavior. When major marketing firms conduct this type of copy test, they generally assess behavioral effects by offering participants free product samples immediately after ad exposure and seeing which products are chosen. 85 This simulated choice behavior has been shown to predict in-market sales. 86 – 89 For ethical and other reasons, though, we could not offer adolescents cigarettes. Thus, our outcome measure was smoking intent. However, prospective studies have found that adolescents who do express intent to smoke are approximately 3 times as likely as those who do not to start smoking. 70 , 90 – 94

Another limitation is that when we classified ads into types, we considered only 2 executional factors: emotional tone and spokesperson age. Recent research indicates that testimonials may be especially effective, 13 and we did not consider this factor. Thus, there is unexplained heterogeneity in the ad stimuli that likely affected the results. In other words, the results are partially a function of the specific ad exemplars used. There is no guarantee that other disease-and-suffering ads will work among adolescents, or that other ad types will necessarily fail. Health messages that elicit fear may do more harm than good among youths who feel unable to cope 18 , 19 or who feel invincible and view smoking as forbidden fruit. 17 , 20 , 21

Recommendations to Practitioners

We make the following recommendations regarding tobacco control mass media campaigns for adolescents. (1) Consider using health ads that depict young adult victims suffering from devastating tobacco-related diseases; (2) try to evoke empathy for the victims, disgust, and anti-industry motivation in executing these ads rather than evoking fear; (3) copy test each ad before airing 95 ; (4) consider excluding highly troubled youths with conduct disorders, because their responses may be atypical, when screening copy test participants; (5) do not use an ad if it fails to produce statistically significant effects relative to the control or baseline condition, or produces adverse effects—try to improve it and then retest it.

In this study, participants’ judgments of ad efficacy were significantly correlated with the ads’ actual effectiveness at reducing smoking intent. However, research indicates that copy testing is the most reliable and valid method of ascertaining an ad’s behavioral effects before airing. 86 , 87 Copy testing is widely used by both marketing academics and practitioners, including the US government. 86 – 89 , 95 Copy testing is more costly than focus group ad testing, primarily because larger samples are required 95 ; however, the costs are low compared with the costs of airing weak or even counterproductive ads.

Acknowledgments

This research was funded by the California Tobacco-Related Disease Research Program.

The authors thank the participating schools, UCI Health Education, Linda Levine, Carol Whalen, and Guangzhi (Terry) Zhao for their assistance with the research, and Craig Andrews, Stanton Glantz, Pamela Ling, Michael Slater, Laura Solomon, and the Journal reviewers and Editor for their very helpful comments.

Peer Reviewed

Contributors C. Pechmann originated the study and led the writing and analyses. E. Reibling supervised the study’s implementation and assisted in the writing and analyses.

Human Participant Protection This study was approved by the University of California, Irvine, institutional review board.

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Ch Rehman Nasir Thesis (Impact of Anti-Smoking Media Campaigns on Students of IIUI)

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What makes an effective antismoking campaign - insights from the trenches

Affiliations.

• 1 Cancer Council Western Australia, Perth; [email protected].
• 2 Gatecrasher Advertising, Perth, WA, Australia.
• 3 MMResearch, Melbourne, VIC, Australia.
• 4 Customedia, Sydney, NSW, Australia.
• 5 Carroll Communications, Sydney, NSW, Australia; School of Public Health, University of Sydney, NSW, Australia.
• PMID: 36823798
• DOI: 10.17061/phrp3032021

Objectives: This paper describes traditionally effective approaches for anti-smoking mass media advertising and explores challenges and future directions for campaign planning. The changing characteristics of the current smoking population and media landscape are examined. Type of program or service: Anti-smoking mass media advertising campaigns.

Methods: We present a commentary on the established creative and media strategies proven to be effective in prompting quit attempts among smokers, discuss new challenges facing anti-smoking campaign managers today and propose considerations for the future.

Results: Although evidence of effective approaches for tobacco control messaging and execution remains clear, the media landscape in Australia has changed dramatically in recent years with some audiences moving away from frequent and heavy television consumption towards online platforms and digital media channels. In addition, as smoking rates continue to fall, characteristics of current smokers are becoming increasingly relevant considerations for anti-smoking messaging and placement within a media environment that is becoming more expensive and fragmented. Funding anti-smoking advertising at the levels required to effectively prompt and maintain smoking cessation remains a high priority considering the extensive social and economic costs of smoking.

Lessons learnt: Although it is known that hard-hitting, emotional and/or testimonial anti-smoking advertisements can be effective in prompting quit attempts, optimal media channel selection and media mix for reaching and engaging audience segments is dynamic in an ever-changing media landscape. Targeting media channels popular with lower socio-economic status (SES) smokers can efficiently achieve wide population exposure as well as effectively reaching population groups with higher smoking prevalence. A collaborative approach between health professionals, researchers, creative directors and media buyers is required to ensure advertising materials are communicating the right message for the audience, and that it is being delivered effectively.

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Article Contents

Introduction, conflict of interest statement.

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Anti-tobacco television advertising and indicators of smoking cessation in adults: a cohort study

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A Hyland, M Wakefield, Cheryl Higbee, G Szczypka, KM Cummings, Anti-tobacco television advertising and indicators of smoking cessation in adults: a cohort study, Health Education Research , Volume 21, Issue 3, July 2006, Pages 348–354, https://doi.org/10.1093/her/cyl048

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The objective of this study was to assess the relationship between exposure to state-sponsored anti-tobacco advertising and smoking cessation. Cessation rates in 2001 among a cohort of 2061 smokers who participated in the Community Intervention Trial for Smoking Cessation between 1988 and 1993 and completed a follow-up survey in 2001 were merged with 2000–01 television advertising exposure data from Nielsen Media Research. The relative risk for quitting was estimated to be 10% higher for every 5000 units of exposure to state anti-tobacco television advertising over the 2-year period, although this did not quite achieve statistical significance. The association was even larger among those who reported that the level of information in the media about the dangers of smoking had increased ‘a lot’ between 1993 and 2001 (RR = 1.19, 95% CI = 1.03–1.38). These data are consistent with the finding that increased exposure to state anti-tobacco media increases smoking cessation rates.

Televised anti-smoking advertisements are an important component of comprehensive tobacco control programs. They are designed to counter pro-tobacco influences and increase pro-health messages throughout a state, region or community. These advertisements may promote smoking cessation as well as decrease the likelihood of initiation. They also can have a strong influence on public support for tobacco control interventions [ 1 ].

Evidence suggests that state-sponsored anti-smoking media campaigns may play a potentially effective role in reducing smoking among those exposed to the message [ 2–7 ]. In the United States, electronic anti-tobacco advertising has been used as part of comprehensive tobacco control programs in several states and communities. McAlister et al. [ 8 ] found that significant reductions in adult tobacco use can be achieved through a combination of intensive media and community campaigns. In California, the tobacco control program was associated with a 10–13% decline in cigarette consumption, 21% of which was estimated to be due to the media campaign [ 9, 10 ].

Another factor pointing to the importance of anti-tobacco advertising in reducing population smoking behavior is the length to which the tobacco industry will go in seeking to divert funding away from such advertising into strategies with lower levels of population impact. Extensive lobbying of legislators by the tobacco industry and groups associated with the industry has been documented in many of the states with comprehensive programs involving media campaigns [ 11, 12 ].

Traditionally, precise measurement of the impact of media exposure on behavior has been methodologically difficult. Most studies have focused on evaluation of campaigns in a single jurisdiction, with the resulting difficulty of lack of a good control group. Additional problems include misspecification of exposure due to differential recall and the lack prospective data that pinpoints the exposure before the behavior change takes place. Using a large cohort of smokers with detailed smoking data collected prospectively, in addition to independently assessing advertising exposure data from a range of communities with wide variation in levels of exposure to state-run media campaigns, we aimed to test the hypotheses that adults exposed to more state-sponsored anti-tobacco advertising will be more likely to successfully stop smoking.

The original Community Intervention Trial for Smoking Cessation study—1988–93

Details of the Community Intervention Trial for Smoking Cessation (COMMIT) intervention are published elsewhere [ 13 ]. Briefly, the COMMIT cohort was identified by a telephone survey in 1988. Participants were current smokers aged 25–64 years who lived in communities that were located in California, Iowa, Massachusetts, New Mexico, New Jersey, New York, North Carolina, Oregon, Washington and Ontario, Canada. An extended interview that included questions about current and past smoking behaviors, brand and type of cigarette usually smoked, interest in quitting smoking and other smoking-related attitudes and behaviors was completed in 1988.

2001 Follow-up survey of original COMMIT cohort participants

In the summer of 2001, we re-interviewed US cohort participants who had completed the 1993 interview, with the aim of measuring long-term changes in smoking behavior. Among the 12 435 baseline smokers who resided in the United States, were interviewed in 1993 and agreed to be re-contacted in the future, 6603 (53%) were successfully re-interviewed in 2001. Data for this paper are restricted to participants who resided in the same community in 1988 and 2001, lived in one of the top 75 media markets, and were smokers in 1999 ( n = 2061).

Exposure to tobacco control television media

Data from the 2001 follow-up survey were merged with television ratings data acquired from Nielsen Media Research (NMR). NMR collects data on occurrences of all tobacco-related television advertisements appearing on network and cable television across the largest 75 media markets in the United States for the years 1999–2000. A media market or designated market area is defined by a group of non-overlapping counties, which comprise a major metropolitan area. Fifteen of the 20 US COMMIT communities were located in one of these largest media markets.

Using a combination of diary measurement and television set devices that monitor television channel and time, NMR obtains rating estimates for television programs in a given media market. Advertisements appearing in a given program are assigned the audience ratings for that program. As explained by Szczypka et al. [ 14 ], ratings provide an estimate of the percentage of households with televisions watching a program or advertisement in a given media market. For example, if 20 000 households out of a total of all 100 000 households in a media market were tuned into the same program, the program would receive a 20 rating, meaning that it was seen by 20% of households in the media market.

Rating points for a program are summed over a specified time interval and are called gross rating points (GRPs), which provide estimates of audience size for all households [ 14 ]. GRPs are often expressed in exposures where 100 GRPs is equal to an average of one exposure per person in the target population. For example, if an advertisement were to receive 200 GRPs over a monthly interval in a given media market, this means that the average household within the media market viewed that advertisement twice during the month. The actual exposure in any given household may be more or less than two exposures during that month; however, these aggregate estimates are useful for comparing average relative exposures between advertisers and geographic regions and over time [ 14 ]. The GRP exposure measures presented in this paper are per 5000 GRPs exposed in 1999 and 2000 combined, which translates into 50 additional exposures per person during this 2-year period or about two exposures per month.

We focused on only one type of advertisement for the purposes of this paper. We examined state tobacco control advertisements, which were anti-tobacco advertisements sponsored by state health departments. The content and type of advertisement are derived from the NMR database of television programming and advertisements. State tobacco control advertisements were not consistently coded and reported prior to 1999; therefore, only GRP data from 1999 and 2000 are used in this paper. All COMMIT participants residing in a given media market are assigned the total GRP level for state tobacco control advertisements for 1999 and 2000 combined.

Because aggregate GRP data assigned at the media market level may not reflect actual exposure for a given individual, we further stratified all analyses based on responses to the following question obtained in the 2001 follow-up survey, ‘How much increase has there been in the amount of information in the media on the dangers of smoking? (no increase or a decrease, it increased a little, it increased moderately, it increased a lot)’, in an effort to better isolate those participants who may have been more exposed to television media messages.

Table I shows descriptive data on relevant GRP exposure and cessation for the 15 COMMIT communities included in this analysis.

State tobacco control GRP level and smoking cessation rate by community, 1999–2000

A participant was defined as a former smoker if he/she reported having smoked 100 cigarettes in his/her lifetime and also reported he/she had not smoked any cigarettes in the 6 months prior to the 2001 interview. All former smokers were asked the year in which they quit smoking, and they are defined as former smokers in that and subsequent years and current smokers in previous years. Additional baseline variables used as control variables included gender (male or female), age in 2001 (35–44, 45–54, 55–64, ≥65 years), race/ethnicity (white, non-Hispanic; black, non-Hispanic; Hispanic; other) and cigarettes smoked per day in 1993 (<15, 15–24, 25+).

Percentages of smokers who reported successfully quitting by 2001 were reported overall and by community and the Spearman rank correlation coefficient was used to compare the agreement between community-level anti-tobacco GRPs and cessation. Logistic regression analysis was performed to assess the association between level of state anti-tobacco media exposure with smoking cessation for the entire sample, as well as stratified by those who reported ‘a lot of increase’ in anti-tobacco media and those who did not, adjusting for the covariates enumerated above. To account for possible response bias due to differential rates of attrition, the 2001 survey data were weighted to the age, sex, race/ethnicity and community distributions of the baseline 1988 survey population smokers who agreed to be re-contacted in the future. Weighted data are presented, although the weighted and unweighted results were very similar.

Human participant protection

Institutional ethics review was obtained for all aspects of the data collection.

Among 2061 smokers in 1999 and 2000, 12.0% ( n = 247) had quit by the time of the 2001 survey. Combined GRPs for 1999 and 2000 for state tobacco control media ranged from 41 (Greensboro-High Point, NC, USA) to 17 481 (Boston, MA, USA). The quit rate for those in communities above the median for state anti-tobacco GRPs was 12.9% compared with 11.0% for those below the median (Spearman rank correlation statistic = 0.52, P = 0.047). The median is 1218 GRPs (see Table I ).

After controlling for other factors related to cessation, the relative risk for quitting was estimated to be 10% higher (95% CI = 0.98–1.24) for every 5000 GRPs of exposure to state anti-tobacco advertising between 1999 and 2000, which translates into about two additional exposures per person per month. When restricted to those who were more exposed to these media (those who felt the level of anti-tobacco information in the media has increased ‘a lot’ in their community), the association was larger and statistically significant (RR = 1.19, 95% CI = 1.03–1.38) with no association among those who reported lower levels of increasing anti-tobacco information in the media ( Table II ).

Relative risk for smoking cessation from a logistic regression model controlling for demographic and smoker characteristics

Sample sizes for the two stratified samples are not equal to the overall sample size of 2061 because of missing data for stratification variable. * P = 0.017.

Results from this paper are consistent with the finding that increased exposure to state anti-tobacco media increases smoking cessation rates, even after controlling for other factors that are related to smoking cessation.

The increased cessation rates in those communities exposed to higher levels of state-sponsored anti-tobacco television advertising are consistent with reports that show comprehensive state tobacco control programs, which include a well-funded anti-tobacco advertising campaign, are effective in reducing smoking rates in the population [ 1–7, 15, 16 ]. The amount of anti-smoking advertising varied widely across states. A simple comparison of cessation rates in states above and below the median for advertising GRPs revealed a higher quit rate in states above the median. Using GRPs as a continuous variable in a logistic regression model revealed an overall positive relationship between the level of advertising and cessation rates which, while not statistically significant at the <0.05 level, is in the predicted direction. Support for the causal nature of this relationship is found in the observation that the relationship between advertising exposure was stronger among those who reported seeing a lot of increase in the dangers of smoking in the media.

These results help to quantify the relationship between the amount of anti-tobacco media exposure and cessation rates in adult smokers. These data suggest that for every 5000 GRPs spent by states on anti-tobacco advertising over a 2-year period, or about two anti-tobacco advertisements per month, the quit rate among adult smokers increased by ∼10%. The estimated magnitude of effect from this study is similar to the estimated prevalence rate reduction estimated by Friend and Levy [ 17 ] in a recent meta-analysis of anti-tobacco campaigns. However, the 10% boost in quit rates we estimate is less than the 40% boost for cessation-oriented media campaigns estimated by Levy et al. [ 18 ] in a recent review of the impact of mass media on cessation rates.

While it is often difficult to separate out the effect of specific program components, anti-tobacco advertising is one of the main elements of comprehensive tobacco control programs recommended by the Centers for Disease Control and Prevention [ 1 ]. Further, tobacco control media can indirectly promote policy changes such as increase in cigarette excise taxes or passage of clean indoor air law by changing societal norms [ 19 ].

The primary advantage the present study has over previous studies is that prospective data on smoking cessation are examined in a large sample with diverse exposures to anti-tobacco advertising. The finding of higher cessation rates as the level of GRP exposure increased in this study lends further evidence that the observed relationship is causal. The finding that this effect was greater among those who reported a lot of increase in the amount of media on the dangers of smoking, which we hypothesize are people who are more likely to be watching television and be exposed to anti-tobacco advertisements, is expected if the underlying hypothesis is correct.

While there are several unique strengths of this study, the following key limitation should be noted, which is that we did not have individual level media exposure but used aggregate data for the entire media market and applied it to individuals. This should lead to an underestimate of effects in the general population of smokers. We have stratified our findings based on each individual's self-report of how much increase there has been in the media on the dangers of smoking under the assumption that those who report a lot are more likely to be exposed to television media. This could be problematic because those who are thinking about quitting or attempting to quit may have more of a reason to remember this type of advertising, and report it as being prominent. While this method is imperfect, it does allow us to separate those who may not have seen any of these advertisements from the rest of our sample.

Another potential limitation is that other factors may account for the observed findings. For example, state-level tobacco control policies often accompany state tobacco control media campaigns. In this study, state cigarette excise taxes increased in California and New York during the study period, but they remained constant in the other states. To assess whether the relationship between state tobacco control television media exposure and quitting was confounded by the tax increases in these states, we restricted our analysis to the communities in the states that did not experience tax increases. The results were virtually unchanged from the overall results, which suggests that the GRP and cessation association is not due to the adoption of other tobacco control policies like tax increases.

Anti-tobacco advertising should educate smokers about the risks inherent in cigarette smoking and hopefully motivate smokers to make a quit attempt. Recent studies have documented that smokers are misinformed about the risk of smoking and methods for quitting smoking [ 20–24 ], so there remains a need for public education campaigns. The positive association observed between exposure to state-sponsored anti-tobacco television advertising and increased rates of quitting among adult smokers in this study adds to the growing body of evidence that supports the need for state governments to continue investing in anti-tobacco advertising campaigns.

None declared.

This research is funded by the National Cancer Institute's State and Community Tobacco Control Interventions Research Initiative by grant number R01 CA 86225.

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Smoking and the Rhetorical Analysis of a TUPP Ad

How it works

The overall composition of an anti-smoking advertisement is designed to make addicted smokers feel ashamed of themselves. Most especially in this advertisement from the organization based in California Tobacco Use Prevention Program (TUPP). This analysis focuses on the aspects of these advertisement’s components that might persuade the target audience, which in this case would be young women in their seemingly early twenties and are adjusting into the party scene. The advertising manipulates the audience to think a certain way about themselves and, on top of that, it offers assistance with addicted smokers.

Exploring the different ways this ad tries to convince people to quit smoking and prevent tobacco use overall, there are several things taken into consideration. Such as, the logic, the feelings the audience might experience, the credibility of the organization putting this ad together, and the things that fall out of place and are not tying everything together in this piece of media.

TUPP is a government organization in Orange County, California with the objective of reducing the number of addicted smokers. TUPP made the advertisement in an attempt to get smokers, specifically young women, to quit smoking. The advertisement shows a young woman holding a cigarette with the text “A cheaper way of looking smoking hot…quit!” The advertisement convinces the viewer to quit smoking by appealing to the person’s desire to save money. It also appeals to a person’s own vanity by suggesting, through the face of the young woman, that if they smoke they will not look as beautiful as they did prior to making smoking a habit. The ad uses the following visuals: seemingly aged skin, crooked teeth, and yellow nails to show some of the effects smoking could have on someone. It uses fear tactics to those who don’t smoke by showing them the effects it has, as well as shaming those who do by subtly telling them that they are less attractive to those who don’t smoke. The advertisement primarily uses pathos to get its message across. It also uses a fair amount of logos to get readers to see the reasoning as to why someone should quit smoking. The ad also uses ethos to apply to one’s value of beauty and uses its influence as a government-funded organization to further convince anyone who happens upon this advertisement that smoking has a negative effect on them. Background information The origin of the ad was published by TUPP, a program that is part of an agency called the Orange County Public Health Care Agency where they have been around for more than three years. The program’s goal is to reduce the use of tobacco and nicotine and to avert secondhand smoke in the state of California (OCTEC).

The program offers a free hotline, where the caller will be referred to a counselor who will let them know when and where the next seminar or class will be held or the caller may simply call to schedule an appointment with a counselor. This program assists smokers to quit their addiction and helps them get back up on their feet to a better lifestyle. The services provided are free to the public; everyone is invited to attend. The program states that they provide attendants with free nicotine patches, a quit plan, tips on stress management and free individual support. TUPP does not only focus on those with a working wage; they offer their services to the homeless as well. This way, the homeless population will get the help they need in order to be back on their feet. Ethos The ad that is spoken of is approved by the County of Orange in California. This proves that the advertisement was paid for and was published by the County of Orange, a firm of authority. What stands out about Orange County is the location. Orange County has six coastal cities, totaling around forty miles of coastline. What this signifies is that people who live in Orange County areas are accustomed to going to the beach as a casual activity. Going to the beach or being blonde and beautiful is often seen as a stereotype for Californians.

Being attractive for the people in this County does come at a cost: plastic surgery. Plastic surgery is seen as a norm in this state, especially near the beach residencies. Because the people of these areas are rich, they can afford to get plastic surgeries out of thin air. Orange County is the home to many Fortune 500 companies, meaning that business and international trade are very popular. Due to the number of riches citizens hold, they believe they are able to take risks when it comes to their health because they can afford it, but are always concerned about how they are when it comes to their physical appearance and beauty. The wealthy are only the tip of the iceberg. There are those that do not have the monetary resources to afford a stable home but are addicted to a certain degree, where they will only think about when their next cigarette will be. When spoken of those that do not have enough money, it is the youth that is highlighted. Pathos        

Young women who are usually in their early 20s are pressured to feel as if they need to be beautiful, especially if they live in California where the beauty standard is drastically different from other states; As stated, in California, having plastic surgery done is the norm. Women have a sense of needing to be beautiful, so with this ad, they are being shamed for not being “pretty” because they are smokers. Smoking is more often than not seen as an unattractive quality. The advertisement shows the woman looking much older on the side where the cigarette is placed on her lip. Overall, she is not very beautiful due to things in her appearance like eyebags, crooked yellow teeth, and seemingly burnt ashy skin and lips. The ad is essentially giving off the idea that smoking does not make someone an attractive person and they should stop before their lungs fail. Logos       

The advertisement also uses logos as a method of convincing the viewer. The advertisement does this by showing several visuals to the viewer of the ad. This ad shows various ways smoking could have a detrimental impact on a person’s body. It does all this to convince any young women who may happen upon the advertisement to either quit smoking or to refrain from smoking. The advertisement shows a young woman holding a cigarette in her right hand. The side of her face that is nearest to the cigarette appears to be aged and wrinkled. A viewer of the ad can come to the logical conclusion that if they smoke they will begin to appear older than what they really are. Another thing that the advertisement shows are the woman’s teeth. On one half her teeth are straight and white, while the other half is stained and crooked. The ad uses this as further proof of what smoking can do to one’s body and as another reason as to why someone should stop smoking. The advertisement persuades the viewer by appealing to their desire to look beautiful. It also persuades the young women who see the ad to quit smoking by shaming them. A less noticeable effect that the ad shows are the woman’s fingernails. On her right hand, the two fingers holding the cigarette have yellow fingernails. This subconsciously tells the person seeing this ad that if they smoke they will get yellow fingernails. Although this advertisement is primarily targeted towards young women, this ad can still apply to anyone who cares deeply about their appearance. A viewer of the advertisement can use logic to see that if they smoke, it will start to show in their appearance.

What is odd about the slogan on the ad that reads, “A Cheaper Way to Look Smoking Hot…Quit!” is that it implies that cigarettes are expensive. Making that statement an appeal to probability fallacy, and while the statement may be truthful in a way, because of the added sin tax that is proposed and regulated by the federal government, it should be taken into account that while smoking is in fact an expensive habit, so is any other feminine hobby. For example, makeup, an art used by an overwhelmingly female population, is nothing short of being on the cheap side. Makeup can quickly become expensive habit and hobby, especially if she is a trendy follower that is up to date with all the latest collections and releases. Language The advertisement uses language to specifically target the person viewing it in a way that would make them feel ashamed of themselves, particularly younger women, who are expected to care deeply about their outward appearance and how they are viewed by society.

When the ad itself says “A Cheaper Way to Look Smoking Hot… Quit!” it opens up the discussion that women should not destroy their bodies because of their personal choice of smoking. The words “Ready to be tobacco free?” give the targeted audience a sense of encouragement. The tone of the words are used to give the viewer hope in halting their habit and “becoming hotter” after they stop smoking. Conclusion In essence, this ad demonstrates that anyone associated with TUPP would want to help a smoking addict with the assistance and resources they are able to provide. Smoking is not that easy to quit; it takes time in order to fully stop. With the information given by this specific organization in Orange County, those native to the area will know that there is assistance for smokers wishing to quit their addiction. It’s important to analyze ads because the information that is offered by any type of advertisement in helpful to determine what the consumer or person would want to do with that information. From there it would be completely up to the individual whether or not to take up on the offer, along with how the ad influenced their decision.

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• Open access
• Published: 01 February 2017

College anti-smoking policies and student smoking behavior: a review of the literature

• Brooke L. Bennett 1 ,
• Melodi Deiner 1 &
• Pallav Pokhrel 1  

Tobacco Induced Diseases volume  15 , Article number:  11 ( 2017 ) Cite this article

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Currently, most college campuses across the U.S. in some way address on-campus cigarette smoking, mainly through policies that restrict smoking on campus premises. However, it is not well understood whether college-level anti-smoking policies help reduce cigarette smoking among students. In addition, little is known about policies that may have an impact on student smoking behavior. This study attempted to address these issues through a literature review.

A systematic literature review was performed. To identify relevant studies, the following online databases were searched using specific keywords: Ovid MEDLINE, PsycINFO, PubMed, and Google Scholar. Studies that met the exclusion and inclusion criteria were selected for review. Studies were not excluded based on the type of anti-smoking policy studied.

Total 11 studies were included in the review. The majority of the studies (54.5%) were cross-sectional in design, 18% were longitudinal, and the rest involved counting cigarette butts or smokers. Most studies represented more women than men and more Whites than individuals of other ethnic/racial groups. The majority (54.5%) of the studies evaluated 100% smoke-free or tobacco-free campus policies. Other types of policies studied included the use of partial smoking restriction and integration of preventive education and/or smoking cessation programs into college-level policies. As far as the role of campus smoking policies on reducing student smoking behavior is concerned, the results of the cross-sectional studies were mixed. However, the results of the two longitudinal studies reviewed were promising in that policies were found to significantly reduce smoking behavior and pro-smoking attitudes over time.

More longitudinal studies are needed to better understand the role of college anti-smoking policies on student smoking behavior. Current data indicate that stricter, more comprehensive policies, and policies that incorporate prevention and cessation programming, produce better results in terms of reducing smoking behavior.

Tobacco use, especially cigarette smoking, continues to remain a leading preventable cause of mortality in the United States (U.S.). Across different age-groups, young adults (18–29 year olds) tend to show the highest prevalence of cigarette smoking [ 1 ]. For example, past-30-day prevalence of cigarette smoking among 18–24 year olds is 17%, whereas the prevalence is approximately 9% among high school students [ 2 ]. Although most smokers initiate cigarette smoking in adolescence, young adulthood is the period during which experimenters transition into regular use and develop nicotine dependence [ 1 ]. Young adulthood is also the period that facilitates continued intermittent or occasional smoking [ 3 ], neither of which is safe. In addition to the possibility that intermittent smokers may show escalation in nicotine dependence, intermittent smoking exposes individuals to carcinogens and induces adverse physiological consequences [ 4 ].

Research [ 5 ] shows that smokers who quit smoking before the age of 30 almost eliminate the risk of mortality due to smoking-induced causes. Thus smoking prevention and cessation efforts that target young adults are of importance. Traditionally, tobacco-related primary prevention efforts have mostly focused on adolescents [ 6 ] and have utilized mass media as well as school and community settings [ 7 , 8 ]. This is only natural given that most smoking initiation occurs in adolescence. However, primary and secondary prevention efforts focusing on young adults have been less common. This is particularly of concern because tobacco industry is known to market tobacco products strategically to promote tobacco use among young adults by integrating tobacco use into activities and places that are relevant to young adults [ 9 ].

As more and more young adults attend college [ 10 ], college campuses provide a great setting for primary and secondary smoking prevention as well as smoking cessation efforts targeting young adults. According to the American College Health Association [ 11 ], approximately 29% U.S. college students report lifetime cigarette smoking and 12% report past-30-day smoking. Currently, most college campuses across the U.S. in some way address on-campus cigarette smoking, mainly through policies that restrict smoking [ 12 , 13 ]. One of the main reasons why such policies are considered important is the concern about students’ exposure to secondhand tobacco smoke [ 14 ]. Therefore, at their most rudimentary forms, such policies tend to be extensions of local- or state-level policies restricting smoking in public places [ 15 ]. However, some colleges may take a more comprehensive approach, by integrating, for example, smoke-free policies with anti-smoking campaigns and college-sponsored cessation services [ 16 ]. Further, some colleges may implement plans to enhance enforcement of and compliance to the smoke-free policies [ 17 – 19 ].

At present, there are a number of questions related to college-level anti-smoking policies that need to be examined carefully in order to scientifically inform how colleges can be better utilized to promote smoking prevention and cessation among young adults. Besides the degree of variation in anti-smoking policies, there are questions about students’ compliance with such policies and whether such policies have influence on students’ attitudes and behavior related to cigarette smoking. Past reviews of the studies on the effects of tobacco control policies in general (e.g., not specific to college populations) [ 20 – 22 ] emphasize the need for a review such as the current study. Wilson et al. [ 20 ] found that interventions involving smoke-free public places, mostly restaurants/bars and workplaces, showed a moderate to low effect in terms of reducing smoking prevalence and promoting smoking cessation. The review included three longitudinal studies, none of which showed that the policies had an effect on smoking cessation. Fichtenberg & Glanz [ 21 ] focused on smoke-free workplaces and found that the effects of such policies seemed to depend on their strength. That is, 100% smoke-free policies were found to reduce cigarette consumption and smoking prevalence twice as much as partial smoke-free policies that allowed smoking in certain areas. In a recent exhaustive review, Frazer et al. [ 22 ] found that although national restrictions on smoking in public places may improve cardiovascular health outcomes and reduce smoking-related mortality, their effects on smoking behavior appear inconsistent. There are reasons why college anti-smoking policies may be more effective than policies focused on restaurant/bars or even workplaces. For example, students tend to spend the majority of their time on campus premises. In fact, in the case of 4-year colleges, a large number of students live on or around campus premises. Strong anti-smoking policies may deter students from smoking by making, for example, smoking very inconvenient. However, the current state of research on college anti-smoking policies and student smoking behavior is not well documented.

The purpose of the current study is to systematically review quantitative studies that have investigated the impact of college-level anti-smoking policies on students’ attitudes towards tobacco smoking and smoking behavior. In the process, we intend to highlight the types of research designs used across studies, the types of college and student participants represented across studies, and the studies’ major findings. A point to note is that this review’s focus is on anti-smoking policies and cigarette smoking. Although the review does assess tobacco-free policies in general, our assumption at the outset has been that most studies in the area have had a focus on smoke-free policies and smoking behavior because of the emphasis on secondhand smoke exposure. Smoke-free and tobacco-free policies are different in that smoke-free policies have traditionally targeted smoking only whereas tobacco-free policies that have targeted tobacco use of any kind, including smokeless tobacco [ 23 ]. Both types of policy could be easily extended to incorporate new tobacco products such as the electronic nicotine delivery devices, commonly known as e-cigarettes. Given that e-cigarettes are a relatively new phenomenon in the process of being regulated, we assumed that the studies eligible for the current review might not have addressed e-cigarette use, although if addressed by the studies reviewed, we were open to addressing e-cigarettes and e-cigarette use or vaping in the current review.

Study selection

We searched Ovid MEDLINE (1990 to June, 2016), PubMed (1990 to June, 2016), PsycINFO (1990 to 2013), and Google Scholar databases to identify U.S.-based peer-reviewed studies that examined the effects of college anti-smoking policies on young adults’ smoking behavior. Searches were conducted by crossing keywords “college” and “university” separately with “policy/policies” and “smoking”, “tobacco”, “school tobacco”, “smoke-free” “smoking ban,” and “tobacco free.” Article relevance was first determined by scanning the titles and abstracts of the articles generated from the initial search. Every quantitative study that dealt with college smoking policy was selected for the next round of appraisal, during which, the first and the last authors independently read the full texts of the articles to vet them for selection. Studies were selected for inclusion in the review if they met the following criteria: studies 1) were conducted in the U.S. college campuses, including 2- and 4-year colleges and universities; 2) were focused on young adults (18–25 year olds); 3) focused on implementation of college-level smoking policies; 4) were quantitative in methodology (e.g., case studies and studies based on focus groups and interviews were excluded); and 5) directly (e.g., self-report) or indirectly (e.g., counting cigarette butts on premises) assessed the cigarette smoking behavior. References and bibliographies of the articles that met the inclusion criteria were also carefully examined to locate additional, potentially eligible studies.

Selected studies were reviewed independently by the first and the last authors in terms of study objectives, study design (i.e., cross-sectional or longitudinal), data collection methods, participant characteristics, U.S. region where the study was conducted, college type (e.g., 2- year vs. 4-year), policies examined and the main study findings. The review results independently compiled by the two authors were compared and aggregated after differences were sorted out and a consensus was reached.

Study characteristics

Figure  1 depicts the path to the final set of articles selected for review. Initial searches across databases resulted in total 71 titles and abstracts related to college smoking policies. Of these, 49 were deemed ineligible at the first phase of evaluation. The remaining 22 articles were evaluated further, of which, 11 were excluded eventually. Two studies [ 24 , 25 ] were excluded because these studies did not assess students’ tobacco use behavior. One study [ 26 ] was excluded because it was not quantitative. Five studies [ 17 – 19 , 27 , 28 ] were excluded because the studies focused on compliance to existing smoking policies and did not assess the impact of policies on behavior. One study [ 15 ] was excluded because although it studied college students, the smoking policies examined were county-wide rather than college-level. Two studies [ 29 , 30 ] were excluded because their samples consisted of college personnel rather than students. Thus, a total of 11 studies were included in the current review.

Chart depicting selection of the final set of articles reviewed

Table  1 summarizes the selected studies in terms of research purpose, study design, subjects, type of college, region, policies and findings. The majority of the studies were conducted in the Midwestern ( n  = 3; 27.3%) or Southeastern United States ( n  = 3; 27.3%). Other regions represented across studies were Southern ( n  = 2; 18.1%), Northwestern ( n  = 2; 18.1%), and Western United States ( n  = 1; 9.1%). Six studies (54.5%) included predominantly White participants (i.e., greater than 70%), and 2 studies (18%) included predominantly female participants. Nationally, women and Whites comprise 56% and 59% of the U.S. college student demographics, respectively [ 10 ]. Two studies (18.1%) assessed smoking behavior indirectly by counting cigarette butts on college premises, counting the number of individuals smoking cigarettes in campus smoking “hotspots,” or counting the number of smokers who utilized smoking cessation services. Across studies, the sample size ranged between N  = 36 and N  = 13,041. The mean and median sample sizes across studies were 3102 (SD = 4138) and 1309, respectively. Participants tended to range between 18 and 30 years in age. The majority of the studies ( n  = 6; 54.4%) were cross-sectional in design. Only 2 (18%) of the studies were longitudinal. The majority of the studies were conducted at 4-year colleges ( n  = 10; 90.9%). Only 1 study was conducted at a 2-year college ( n  = 1; 9.1%).

Three studies (27%) focused on tobacco-free policies and 3 studies (27%) on smoke-free policies. Three studies ( n  = 3; 27.3%) compared the associations of differing policies on smoking behavior. One study [ 31 ] examined the relative impacts of policies utilizing preventive education, smoking cessation programs, and designated smoking areas or partial smoking restriction. Another study [ 32 ] implemented an intervention to increase adherence to a partial smoking policy (i.e., smoking ban within 25 ft of buildings). The intervention involved increasing anti-tobacco signage, moving receptacles, marking the ground, and distributing reinforcements and reminder cards.

Anti-smoking policies and students’ smoking behavior

Table  1 lists the types of anti-smoking policies examined across studies and the corresponding findings. Major findings are as follows:

Partial smoking restriction

Borders et al. [ 31 ] compared colleges that utilized partial smoking restriction by providing “designated smoking areas” to curb smoking with college-level policies that incorporated preventive education and with those that provided smoking cessation courses only. Results indicated that the presence of preventive education was associated with lower odds of past-30-day smoking whereas the presence of designated smoking areas only or smoking cessation programs only was associated with higher odds of past-30-day smoking. Fallin et al. [ 16 ] found that college campuses with designated smoking areas tended to show higher prevalence of smoking, compared with campuses that enforced smoke-free and tobacco-free policies. Braverman et al.’s [ 33 ] findings indicate that enforcing smoke-free policies tends to reduce secondhand exposure close to college buildings but may increase smoking behavior on the campus periphery.

Smoke- and tobacco-free campuses

Fallin et al. [ 16 ] found that compared with policies that relied on partial smoking restriction, tobacco-free policies were associated with reduced self-reported exposure to secondhand smoke as well as students’ lower self-reported intentions to smoke cigarettes in the future. Studies [ 34 , 35 ] consistently observed fewer cigarette butts or smokers in campuses under smoke-free policies compared with campuses without smoke-free policies. Prevalence of cigarette butts was likely to be inversely related to policy strength [ 35 ]. A study that monitored smokers’ behavioral compliance to smoke-free policies [ 32 ] indicated that interventions to promote compliance, such as use of signage, are likely to be effective in improving compliance and reducing student smoking in areas were the policy is enforced.

Lechner et al. [ 36 ] conducted assessments at a single college campus before and after a tobacco-free policy went into implementation. The policy, which also involved making smoking cessation services available campus-wide, was found to reduce proportions of high- and low-frequency smokers, pro-smoking attitudes (i.e., weight loss expectancy), and exposure to second-hand tobacco smoke [ 36 ]. The study did not find an effect on smoking prevalence. Seo et al. [ 37 ] followed a similar design where a policy intervention was evaluated based on pretest and posttest surveys. However, this study [ 37 ] included a “control” campus where similar assessments as in the “treatment” campus were conducted but no intervention was implemented. The study found that compared with the control campus, the campus that implemented smoke-free policies showed an overall decrease in smoking prevalence.

Other policies

Borders et al. [ 31 ] did not find policies governing the sales and distribution of cigarettes on campus to be associated with smoking behavior. Hahn et al. [ 38 ] found that college smoking policies that integrate smoking cessation services may increase the use of such services as well as promote smoking cessation. This study kept track of students who utilized the smoking cessation service offered by a college after the policy offering such a service was enacted. Sixteen months after the policy was first implemented, smokers who utilized the service were surveyed. Based the results it was estimated that approximately 9% of them had quit smoking.

To our knowledge, this is the first study to systematically review studies examining the effects of anti-smoking policies on smoking behaviors among U.S. college students. We found that such studies are severely limited. Only 11 studies met the inclusion criteria in the present review, although the review appeared to encompass all policies aimed at smoking behavior on college campuses. Thus, this review stresses the need for increased smoking policy and smoking behavior research on college campuses.

Rigorous evaluation of existing college anti-tobacco policies are needed to refine and improve the policies so that national-level efforts to reduce tobacco use among young adults are realized. Key initiatives at the national level have recognized the importance of mobilizing college campuses in the fight against tobacco use. For example, in September 2012 several national leaders involved in tobacco control efforts, in collaboration with the ACHA, came together to launch the Tobacco-Free College Campus Initiative (TFCCI) [ 39 ]. The TFCCI aims to promote and support the use of college-level anti-tobacco policies as a means to change pro-tobacco social norms on campuses, discourage tobacco use, protect non-smokers from second-hand exposure to tobacco smoke and promote smoking cessation. The ACHA’s position statement [ 11 ] regarding college tobacco control recommends a no tobacco use policy aimed towards achieving a 100% indoor and outdoor campus-wide tobacco-free environment.

We found that the majority of studies on smoking policies were cross-sectional in nature. Researchers relied upon students to report their smoking behavior or their observations of other students’ smoking behavior after a smoke-free or tobacco-free policy had been implemented. It is difficult to draw conclusions about an anti-smoking policy’s ability to change smoking behavior without knowing the smoking behavior prior to policy implementation. This domain of research would benefit from additional longitudinal studies. Ideally, research studies should collect data before the policy is implemented, immediately after, and at follow-up time points.

We found inconsistencies in the measurement of smoking behavior across studies. Two studies [ 34 , 35 ] counted cigarette butts, one study [ 38 ] counted people seeking tobacco dependence treatment, one study [ 32 ] counted smokers violating policy, and seven studies [ 16 , 31 , 36 , 37 , 40 , 41 ] relied upon self-report of smoking behavior. Another study [ 33 ] used survey methods to obtain participants’ response on other students’ smoking behavior. Counting cigarette butts has been validated as an effective measure of smoking behavior [ 19 ], especially when validating compliance to an anti-smoking policy, and self-report measures are commonly used in public health research [ 42 ]. Despite the validity and feasibility of these measures, the lack of a consistent measurement tool makes comparing effectiveness of anti-smoking policies on smoking behaviors across campuses difficult. Research in this domain would benefit from a consistently used measurement of smoking behaviors.

Although the reviewed studies represented diverse U.S. regions, the majority of the research was set in the Southeastern and Midwestern United States; Northeastern and Southwestern regions were not represented. Only one of the reviewed studies reported a sample that contained less than 50% White participants. Across studies, the minority group most represented was Asian American; but only one of the reviewed studies [ 16 ] included 20% or more Asian Americans. Relatively few studies included or reported Hispanic participants, although Hispanics are the largest minority group in the United States [ 43 ]. None of the reviewed studies included 20% or more Black participants. Only three studies [ 33 , 36 , 37 ] included American Indian/Alaska Natives and in only one of those studies [ 32 ] was the proportion greater than one percent. Only two studies [ 33 , 37 ] included Pacific Islanders, and in both the proportion was less than one percent. Clearly, more research is needed on minority populations, specifically Black, Hispanic, Native Hawaiian/Pacific Islander, American Indian/Alaska Native students and the subgroups commonly subsumed under these ethnic/racial categories. The U.S. college student demography is ethnically/racially diverse [ 10 ], comprising 59% Whites. The remaining 44% include various minority groups. Thus, for research on U.S. college students across the nation, studies with more ethnically/racially diverse student samples are needed.

The review findings were helpful in elucidating the types of tobacco policies being implemented on college campuses and their effects on the smoking behavior of U.S. college students. Mainly, three types of smoking policies were studied: smoke-free policies, tobacco-free policies and policies that enforced partial smoking restriction, including prohibition of smoking within 20–25 ft of all buildings and providing designated smoking areas. Indeed, campus-wide indoor and outdoor tobacco-free policy is considered a gold-standard for college campus tobacco control policy [ 11 ]. But only one study [ 16 ] compared tobacco-free and smoke-free policies. Other policies such as governing the sale and distribution of tobacco products, preventive education programs, and smoking cessations programs were also studied, but to a lesser extent. In general, interventions regarding the implementation of smoking policies on college campuses were difficult to find in the existing literature.

The combined results of the studies reviewed suggest that stricter smoking policies are more successful in reducing the smoking behavior of students. Tobacco-free and smoke-free policies were linked with reduced smoking frequency [ 16 , 36 , 37 ], reduced exposure to second-hand smoke [ 16 , 36 ], and a reduction in pro-smoking attitudes [ 36 ]. Implementation of a campus-wide tobacco-free or smoke-free policy combined with access to smoking cessation services was also associated with increased quit attempts [ 38 , 40 ] and treatment seeking behaviors [ 38 ]. It appears that 100% smoke-free policies are not only successful in reducing smoking rates, but also have strong support from students and staff members alike [ 33 ]. These results remained consistent when compared to less comprehensive tobacco control policies, which was evidenced by student report and the number of cigarette butts found on campus [ 34 , 35 ].

There was one important consistent exception to the general success of anti-smoking policies: designated smoking areas. All three studies which included designated smoking areas [ 16 , 31 , 41 ] found that designated smoking areas were associated with higher rates of smoking compared with smoke-free or tobacco-free policies. Designated smoking areas were also associated with the highest rates of recent smoking [ 16 ]. Lochbihler, Miller, and Etcheverry [ 41 ] proposed that students using the designated areas were more likely to experience positive effects of social interaction while smoking. They found that social interaction while smoking on campus significantly increased the perceived rewards associated with smoking and the frequency of visits to designated smoking areas [ 41 ].

None of the studies included in this review addressed new and emerging tobacco products such as e-cigarettes. This is understandable given that the surge in e-cigarette use is relatively new and in general there have only been a few studies examining the effects of anti-smoking policies on student smoking behavior, which has been the focus of this review. However, going forward, it will be crucial for studies to examine how campus policies are going to handle e-cigarette use, including the enforcement of on-campus anti-smoking policies given the new challenges posed by e-cigarette use [ 44 ]. For example, e-cigarette use is highly visible, the smell of the e-cigarette vapor does not linger in the air for long and e-cigarette consumption does not result in something similar to cigarette butts. These characteristics are likely to make the monitoring of policy compliance more difficult. Moreover, because of the general perception among e-cigarette users that e-cigarette use is safer than cigarette smoking, compared with cigarette smokers smoking cigarettes, e-cigarette users might be more likely to use e-cigarettes in public places. The fact that the TFCCI strongly recommends the inclusion of e-cigarettes in college tobacco-free policies [ 39 ] bodes well for the future of college health.

The current study has certain limitations. It is possible that this review might have missed a very small number of eligible studies. We believe that the literature searches we completed were thorough. However, new studies are regularly being published and the possibility that a new, eligible study may have been published after we completed our searches cannot be ignored. In addition, we may not have tapped eligible studies that were in press during our searches. If indeed a few eligible studies were not included in our review, the non-inclusion may have biased our results somewhat, although it is difficult for us to speculate the nature of such a bias. Hence, we recommend that similar studies need to be conducted in the future to periodically review the literature. Second, non-peer-reviewed articles or book chapters were excluded from this review. Despite the potential relevance of non-peer-reviewed materials, the choice was made to limit the inclusion in order to maintain scientific rigor of the review. However, it is possible that some data pertinent to the review might have been overlooked because of this, thus increasing the possibility of introducing a bias to the current findings. Third, this study focused on anti-smoking policies. Although we used “tobacco free” as search terms, “smoking” dominated our search strategies. Thus our results are more pertinent to cigarette smoking than other tobacco products and may not generalize to the latter. Lastly, in order to be as inclusive as possible, we reviewed three studies [ 32 , 35 , 38 ] that focused on more on compliance to anti-smoking policy than on the effect of policy on student smoking behavior. The findings of these studies may not be comprehensive in regard to student smoking behavior, even though they are indicative of the success of the policies under examination.

Conclusions

Despite limitations, this study is significant for increasing the understanding of smoking policies on U.S. college campuses and their effects on the smoking behavior of college students. We found that research on smoking policies on U.S. college campuses is very limited and is an area in need of additional research contribution. Within existing research, the majority used samples that were primarily White females. More diverse samples are needed. Future research should also report the full racial/ethnic characteristics of their samples in order to identify where representation may be lacking. Future research would benefit from longitudinal and interventional studies of the implementation of smoking policies. The majority of current research is cross-sectional, which does not provide the needed data in order to make causal statements about anti-smoking policies. Lastly, existing research was primarily conducted at 4-year colleges or universities. Future research would benefit from broadening the target campuses to include community colleges and trade schools. Community colleges provide a rich and unique opportunity to collect data on a population that is often older and more racial diverse than a typical 4-year college sample [ 45 ]. Also, there is at present a need to understand through research how evidence-based implementation and compliance strategies can be utilized to ensure policy success. A strong policy on paper does not often translate into a strong policy in action. Thus, comparing policies on the strength of written documents alone is not enough; policies need to be compared on the extent to which they are enforced as well as the impact they have on student behavior.

This review may be of particular interest to college or universities in the process of making their own anti-smoking policies. The combined results of the existing studies on the impact of anti-smoking policies on smoking behaviors among U.S. college students can help colleges and universities make informed decisions. The existing research suggests that stricter policies produce better results for smoking behavior reduction and with smoking continuing to remain a leading preventable cause of mortality in the U.S. across age-groups [ 1 ], college and university policy makers should take note. Young adults (18–25 year olds) show the highest prevalence of cigarette smoking [ 1 ], which places colleges and universities in the unique position to potentially intervene through restrictive anti-smoking policies on campus.

U.S. Department of Health and Human Services. Preventing tobacco use among youth and young adults: a report of the surgeon general. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2012.

Google Scholar  

Centers for Disease Control and Prevention (CDC). Smoking and tobacco use. 2016. http://www.cdc.gov/tobacco/data_statistics/ . Accessed 16 Aug 2016.

Pierce JP, White MM, Messer K. Changing age-specific patterns of cigarette consumption in the United States, 1992–2002: association with smoke-free homes and state-level tobacco control activity. Nicotine Tob Res. 2009;11:171–7.

Article   PubMed   PubMed Central   Google Scholar  

Schane RE, Ling PM, Glanz SA. Health effects of light and intermittent smoking: a review. Circulation. 2010;121:1518–22.

Peto R, Darby S, Deo H, Silcocks P, Whitley E, Doll R. Smoking, smoking cessation, and lung cancer in the U.K. since 1950: combination of national statistics with two case-control studies. BMJ. 2000;321:323–9.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Bruvold WH. A meta-analysis of adolescent smoking prevention programs. Am J Public Health. 1993;83:872–80.

Pentz MA, Dwyer JH, MacKinnon DP, Flay BR, Hansen WB, Wang EY, Johnson CA. A multicommunity trial for primary prevention of adolescent drug abuse: effects on drug use prevalence. JAMA. 1989;261:3259–66.

Article   CAS   PubMed   Google Scholar  

Tobler NS, Roona MR, Ochshom P, Marshall DG, Streke AV, Stackpole KM. School-based adolescent drug prevention programs: 1998 meta-analysis. J Prim Prev. 2000;20:275–336.

Article   Google Scholar  

Ling PM, Glantz SA. Why and how the tobacco industry sells cigarettes to young adults: evidence from industry documents. Am J Public Health. 2002;92:908–16.

National Center for Education Statistics (NCES). Fast facts. 2016. http://nces.ed.gov/fastfacts/display.asp?id=98 . Accessed 16 Aug 2016.

American College Health Association. Position statement on tobacco on college and university campuses. 2011. https://www.acha.org/documents/resources/guidelines/ACHA_Position_Statement_on_Tobacco_Nov2011.pdf . Retrieved November 20, 2016.

Wechsler H, Kelly K, Seibring M, Kuo M, Rigotti NA. College smoking policies and smoking cessation programs: results of a survey of college health center directors. J Am Coll Health. 2001;49:205–12.

Patterson F, Lerman C, Kaufmann VG, Neuner GA, Audrain-McGovern J. Cigarette smoking practices among American college students: review and future directions. J Am Coll Health. 2004;52:203–12.

Article   PubMed   Google Scholar  

Wolfson M, McCoy TP, Sutfin EL. College students’ exposure to secondhand smoke. Nicotine Tob Res. 2009;11:977–84.

Hahn EJ, Rayens MK, Ridner SL, Butler KM, Zhang M, Staten RR. Smoke-free laws and smoking and drinking among college students. J Community Health. 2010;35:503–11.

Fallin A, Roditis M, Glantz SA. Association of campus tobacco policies with secondhand smoke exposure, intention to smoke on campus, and attitudes about outdoor smoking restrictions. Am J Public Health. 2015;105:1098–100.

Fallin A, Johnson AO, Riker C, Cohen E, Rayens MK, Hahn EJ. An intervention to increase compliance with a tobacco-free university policy. Am J Health Promot. 2013;27:162–9.

Ickes MJ, Hahn EJ, McCann M, Kercmar S. Tobacco‐free take action: increasing policy adherence on a college campus. World Med Health Policy. 2013;5:47–56.

Ickes MJ, Gokun Y, Rayens MK, Hahn EJ. Comparing two observational measures to evaluate compliance with tobacco-free campus policy. Health Promot Pract. 2015;16:210–7.

Wilson LM, Tang EA, Chander G, et al. Impact of tobacco control interventions on smoking initiation, cessation, and prevalence: a systematic review. J Environ Public Health. 2012. doi: 10.1155/2012/961724 .

Fichtenberg CM, Glanz SA. Effect of smoke-free workplaces on smoking behavior: systematic review. BMJ. 2002;325:188–95.

Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption (review). Cochrane Database Syst Rev. 2016. doi: 10.1002/14651858.CD005992.pub3 .

Americans for Nonsmokers’ Rights. 2016. http://www.no-smoke.org/ . Accessed 20 Nov 2016.

Lee JG, Goldstein AO, Kramer KD, Steiner J, Ezzell MM, Shah V. Statewide diffusion of 100% tobacco-free college and university policies. Tob Control. 2010;19:311–7.

Miller KD, Yu D, Lee JG, Ranney LM, Simons DJ, Goldstein AO. Impact of the adoption of tobacco-free campus policies on student enrollment at colleges and universities, North Carolina, 2001–2010. J Am Coll Health. 2015;63:230–6.

Garg T, Fradkin N, Moskowitz JM. Adoption of an outdoor residential hall smoking policy in a California public university: a case study. J Am Coll Health. 2011;59:769–71.

Ickes MJ, Rayens MK, Wiggins AT, Hahn EJ. A tobacco-free campus ambassador program and policy compliance. J Am Coll Health. 2015;63:126–33.

Russette HC, Harris KJ, Schuldberg D, Green L. Policy compliance of smokers on a tobacco-free university campus. J Am Coll Health. 2014;62:110–6.

Gerson M, Allard JL, Towvim LG. Impact of smoke-free residence hall policies: the views of administrators at 3 state universities. J Am Coll Health. 2005;54:157–65.

Mamudu HM, Veeranki SP, He Y, Dadkar S, Boone E. University personnel’s attitudes and behaviors toward the first tobacco-free campus policy in Tennessee. J Community Health. 2012;37:855–64.

Borders TF, Xu KT, Bacchi D, Cohen L, SoRelle-Miner D. College campus smoking policies and programs and students’ smoking behaviors. BMC Public Health 2005;5: doi: 10.1186/1471-2458-5-74 .

Harris KJ, Stearns JN, Kovach RG, Harrar SW. Enforcing an outdoor smoking ban on a college campus: effects of a multicomponent approach. J Am Coll Health. 2009;58:121–6.

Braverman MT, Hoogesteger LA, Johnson JA. Predictors of support among students, faculty and staff for a smoke-free university campus. Prev Med. 2015;71:114–20.

Fallin A, Murrey M, Johnson AO, Riker CA, Rayens MK, Hahn EJ. Measuring compliance with tobacco-free campus policy. J Am Coll Health. 2012;60:496–504.

Lee JG, Ranney LM, Goldstein AO. Cigarette butts near building entrances: what is the impact of smoke-free college campus policies? Tob Control. 2011;22:107–12.

Lechner WV, Meier E, Miller MB, Wiener JL, Fils-Aime Y. Changes in smoking prevalence, attitudes, and beliefs over 4 years following a campus-wide anti-tobacco intervention. J Am Coll Health. 2012;60:505–11.

Seo DC, Macy JT, Torabi MR, Middlestadt SE. The effect of a smoke-free campus policy on college students’ smoking behaviors and attitudes. Prev Med. 2011;53:347–52.

Hahn EJ, Fallin A, Darville A, Kercsmar SE, McCann M, Record RA. The three Ts of adopting tobacco-free policies on college campuses. Nurs Clin North Am. 2012;47:109–17.

The National Tobacco Free College Campus Initiative. 2012. http://tobaccofreecampus.org/ . Retrieved November 20.

Butler KM, Rayens MK, Hahn EJ, Adkins SM, Staten RR. Smoke‐free policy and alcohol use among undergraduate college students. Public Health Nurs. 2012;29:256–65.

Lochbihler SL, Miller DA, Etcheverry PE. Extending animal models to explore social rewards associated with designated smoking areas on college campuses. J Am Coll Health. 2014;62:145–52.

Gorber SC, Tremblay MS. Self-report and direct measures of health: bias and implications. In: Shepherd RJ, Tudor-Locke C, editors. The objective monitoring of physical activity: contributions of accelerometry to epidemiology, exercise science and rehabilitation. Switzerland: Springer International Publishing; 2016. p. 369–76.

Chapter   Google Scholar  

U.S. Census Bureau. United States Census 2010. 2010. http://www.census.gov/ . Accessed 3 Jun 2013.

Pokhrel P, Herzog TA, Muranaka N, Fagan P. Young adult e-cigarette users’ reasons for liking and not liking e-cigarettes: a qualitative study. Psychol Health. 2015;30:1450–69.

Pokhrel P, Little MA, Herzog TA. Current methods in health behavior research among US community college students: a review of the literature. Eval Health Prof. 2014;37:178–202.

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Acknowledgements

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This research was supported by National Cancer Institute (NCI) grant 1R01CA202277-01.

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Data sharing not applicable to this article as no datasets were generated during the current study. All articles that contributed to the results and conclusions of the current study are included in the reference list.

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BB conducted the literature review, analyzed and interpreted results, and was a major contributor in writing the manuscript. MD assisted with the literature review. PP conceptualized the study, assisted with the literature review and manuscript preparation, and provided overall guidance. All authors read and approved the final manuscript.

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Bennett, B.L., Deiner, M. & Pokhrel, P. College anti-smoking policies and student smoking behavior: a review of the literature. Tob. Induced Dis. 15 , 11 (2017). https://doi.org/10.1186/s12971-017-0117-z

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Received : 09 September 2016

Accepted : 21 January 2017

Published : 01 February 2017

DOI : https://doi.org/10.1186/s12971-017-0117-z

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Tobacco Induced Diseases

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