Unexpected persuasion: The influence of a youth-targeted anti-smoking campaign on adults’ attitude toward smoking cessation

Abstract

Objective

This study aimed to examine the impact of exposure to a youth-targeted anti-smoking campaign on adults’ attitude toward smoking cessation, considering their smoking status.

Study design

Exposure to the anti-smoking campaign was treated as the independent variable, while attitude toward smoking cessation served as the dependent variable. Smoking status (non-smokers vs. smokers) and target group (youth vs. adults) were included as binary moderators in the analysis.

Methods

A stratified random sampling approach was employed to select a total of 4758 respondents (2560 adults and 2198 youth) who completed structured questionnaires. These questionnaires assessed respondents’ exposure to the anti-smoking campaign, their attitude toward smoking cessation, smoking status, and demographic information.

Results

The findings indicated that exposure to the campaign was positively associated with more favorable attitude toward smoking cessation. Non-smokers exhibited stronger attitude toward smoking cessation compared to smokers. Additionally, exposure to the campaign led to an increase in smoking cessation attitude across all groups, with adults showing more pronounced changes in attitude relative to youth.

Conclusion

Unintended persuasive effects were observed among non-target groups, highlighting the need for further investigation into the relationship between targeted messages and their impact on non-target audiences. Such research could enhance the development of more effective and efficient public health campaigns.

1. Introduction

Globally, approximately 1.3 billion individuals continue to use tobacco [1]. Tobacco-related mortality exceeds 7 million annually, including approximately 1.6 million deaths attributable to secondhand smoke [1]. Furthermore, the economic burden of smoking is estimated to reach approximately $1.85 trillion USD, accounting for about 1.8 % of global GDP [2]. In light of these significant negative impacts, various countries have implemented strategies to reduce tobacco consumption, including smoking cessation programs, tobacco taxation, and the use of health warning labels [1].

Among these strategies, anti-smoking campaigns are commonly employed to raise awareness of the risks that smoking poses to health and encourage cessation. A substantial body of literature has demonstrated that exposure to these campaigns is generally effective in promoting smoking cessation intentions, enhancing beliefs about the dangers of smoking, and encouraging discourse regarding anti-smoking messages [3]. However, the effectiveness of these campaigns is not uniformly observed across all population groups. Various factors influence the impact of anti-smoking campaign exposure, with smoking status being a significant determinant. For instance, individuals who identify as non-smokers typically exhibit more favorable responses to campaign messages than those who identify as smokers [4]. Smokers, in particular, tend to demonstrate resistance to such messages [5].

Recent trends suggest that anti-smoking campaigns are increasingly tailored to specific target groups, such as youth, based on their perceived vulnerability. A notable example is the “Real Cost” campaign, launched in the United States in 2014, which has reported favorable outcomes over the past decade, including the prevention of approximately 587,000 youth from initiating smoking and the prevention of about 293,500 youth from becoming established smokers [6]. However, additional research has uncovered unexpected results regarding the effectiveness of youth-oriented campaigns on adults [7], as well as adult-targeted campaigns on adolescents [8]. Specifically, youth-targeted campaigns have been found to have limited influence on adults’ smoking intention, despite the awareness of anti-smoking messages [7], and may even result in unintended negative effects such as reduced effectiveness in smoking cessation [9]. Conversely, adult-targeted campaigns have been shown to influence youth behavior such as increasing the likelihood of attempting to quit or achieving actual quitting, while also contributing to the development of less desirable perceptions of smoking [8]. These inconsistent findings, particularly concerning untargeted groups (the impact of youth-focused campaigns on adults or vice versa), and the limited number of relevant studies, highlight the need for further investigation to clarify unintended consequences and optimize the effectiveness of anti-smoking campaigns.

In 2020, South Korea launched the “NoDam Members” anti-smoking campaign, which targeted youth [10]. In this campaign, youth storytellers present themselves as proud non-smokers who resist peer pressure to smoke [10]. The characters, situations, and language used in the campaign are specifically designed for this target group. However, given the nationwide dissemination of the campaign, non-target audiences, including adults, are also exposed to its messages. This raises the question: to what extent does a youth-targeted campaign influence non-targeted adult groups? Based on these contexts, this study aimed to explore how exposure to a youth-targeted anti-smoking campaign influences the adult responses to the campaign messages.

2. Methods

2.1. Sample

The data analyzed in this study was collected as part of the 2020 anti-smoking campaign effectiveness evaluation project, conducted in collaboration with EMBRAIN, a research firm. For the 23 days between January 26th and February 18th, 2021, the company gathered responses from its pre-existing respondent pool using a stratified random sampling method to ensure the representativeness of the sample.

2.2. Procedure

Two distinct sets of online questionnaires were developed for adults and youth. Individuals who voluntarily agreed with the consent at the beginning of the online survey were asked to complete a set of structured questionnaires. These questionnaires assessed their exposure to the anti-smoking campaign, their attitude toward smoking cessation, their smoking status, and demographic information.

2.2.1. Measurement

Smoking status was categorized into two groups: non-smokers (never smoked) and smokers (ever smoked). The measurement items employed to assess attitude toward smoking cessation were adapted from previous research [11], including “smoking cessation is a beneficial behavior for health,” “smoking cessation is a wise behavior for health,” “smoking cessation is a necessary behavior for health,” “smoking cessation is a desirable behavior for health.” The reliability of the items was acceptable (α = .97). Exposure to the anti-smoking campaign was measured through a self-reported item, where respondents rated their exposure on a 5-point scale, ranging from “not at all” (1) to “a lot” (5).

3. Results

A total of 4758 respondents participated in the online survey, comprising 2560 adults and 2198 youth. The adult sample consisted of 1304 males (50.9 %) and 1256 females (49.1 %), with a mean age of 43.81 years (SD = 13.15), ranging from 20 to 69 years. The youth sample included 1122 males (51 %) and 1076 females (49 %), with a mean age of 16.27 years (SD = 1.25), ranging from 14 to 18 years.

Data were analyzed using SPSS, employing the PROCESS macro (Model 3) to address the research questions. Exposure to the anti-smoking campaign was treated as the independent variable, while attitude toward smoking cessation were treated as the dependent variable. Smoking status and target group were included as binary moderators in the analysis.

The results indicated that exposure to the anti-smoking campaign led to a significant increase in attitude toward smoking cessation (B = .29, SE = .07, t = 12.61, p < .001). In comparison to smokers, non-smokers demonstrated more favorable attitude toward smoking cessation (B = .22, SE = .02, t = 2.22, p < .05). However, no significant difference in attitude toward smoking cessation was observed between the targeted group (youth) and the non-targeted group (adults) (B = .03, SE = .14, t = .19, p > .05).

The impact of exposure on attitude toward smoking cessation was not moderated by smoking status (B = - .03, SE = .10, t = - .85, p > .05) or target group (B = .00, SE = .04, t = .03, p > .05). Nevertheless, a significant three-way interaction between smoking status, target group, and exposure was observed (B = −.12, SE = .05, t = −2.29, p < .05).

For non-smokers, both adults (B = .29, SE = .02, t = 12.61, p < .001) and youth (B = .29, SE = .04, t = 8.01, p < .001) showed an increase in attitude toward smoking cessation with increased exposure to the campaign. Notably, the effect of exposure was more pronounced among adults than youth. A similar pattern was found among smokers, where both adults (B = .27, SE = .02, t = 12.62, p < .001) and youth (B = .15, SE = .02, t = 8.31, p < .001) exhibited an increase in attitude toward smoking cessation. The effect was stronger for adults than for youth (see Table 1).

Table 1.

The influence of anti-smoking campaign exposure by smoking status and targeting group.

		B	SE	t	LLCI	ULCI
Exposure		.29	.07	12.61∗∗∗	.25	.34
Smoking status (Non-smoker vs. Smoker)		.22	.02	2.22∗	.03	.41
Targeting (Adult vs. Youth)		.03	.14	.19	−.24	.30
Exposure x Smoking status		−.03	.10	−.85	−.09	.04
Exposure x Targeting		.00	.04	.03	−.08	.09
Exposure x Smoking x Targeting		−.12	.05	−2.29∗	−.22	−.02
Conditional effect
Non-smoker	Adult	.29	.02	12.61∗∗∗	.25	.34
	Youth	.29	.04	8.01∗∗∗	.22	.37
Smoker	Adult	.27	.02	12.62∗∗∗	.22	.31
	Youth	.15	.02	8.31∗∗∗	.11	.18

Note1: ∗p < .05, ∗∗p < .01, ∗∗∗p < .001.

Note2: LLCI: Lower Limit Confidence Interval, ULCI: Upper Limit Confidence Interval.

4. Discussion

The “NoDam Members” campaign represents South Korea's first nationwide anti-smoking initiative targeted specifically at youth, promoting non-smoking as a proud behavior in the face of peer pressure. This study aimed to examine the influence of exposure to this campaign on attitude toward smoking cessation, considering smoking status and target group. The results revealed that exposure to the campaign was positively associated with more favorable attitude toward smoking cessation. Non-smokers demonstrated stronger pro-cessation attitude compared to smokers. Furthermore, the campaign produced more significant changes in cessation attitude among adults than among youth, within both smoker and non-smoker groups.

This study not only confirms the substantial influence of anti-smoking campaigns on smoking cessation attitude, but also extends previous [[7], [8], [9]] research that identified unintended consequences associated with anti-smoking campaigns. Specifically, it suggests that these unintended effects may outweigh the intended outcomes. The unintended outcomes observed in the adults and non-smokers in response to this youth-focused anti-smoking campaign can be interpreted through the Elaboration Likelihood Model (ELM) [12], which posits that attitude change is a function of a cognitive process driven by motivation. According to the model, individuals are more likely to engage with persuasive messages when the information is perceived as personally relevant, thereby influencing the strength of the persuasion. In the context of this study, two factors may motivate respondents to engage with anti-smoking messages. First, the campaign emphasized pride in maintaining a non-smoking lifestyle, which may increase non-smokers’ motivation to engage with the message. Additionally, the campaign's focus on scenarios that adults could relate to the early stage of their smoking experience likely prompted them to reflect on their smoking history, fostering empathy with the message and ultimately influencing their smoking cessation attitude.

Despite the promising nature of these findings, further studies are essential to investigate the actual impact of anti-smoking campaigns on smoking-related behaviors. Future studies should examine how non-targeted messages influence behavior change, as attitude alone may not fully predict smoking cessation.

In conclusion, this study explored the responses of non-target groups to South Korea's first nationwide anti-smoking campaign targeted at youth. The findings suggest that unintended persuasive effects can occur among non-target groups, underscoring the need for further exploration of the relationship between targeted messages and their effects on non-target audiences. Such research will contribute to the development of more effective and efficient public health campaigns.

Ethical statement

The ethical processes were evaluated by the institutional review board in Sejong University, South Korea (IRB #: SJU-2020-005).

Funding

This study was supported by the Ministry of Health and Welfare, South Korea, in 2020 (Contract #: 20200901C65 - 01).

Declaration of competing interests

There is no conflict of interest.