Factors Affecting Youth Awareness of Anti-Tobacco Media Messages Komal Kochhar, M.B.B.S., M.H.A. Terrell W. Zollinger, Dr.P.H. Robert M. Saywell, Jr., Ph.D., M.P.H.

Background & Rationale Mass media anti-smoking campaigns are a promising and costly tool for health promotion. Their design has been guided primarily by focus groups. Scientific research is limited regarding what factors impact awareness and effectiveness of media campaigns.

The Indiana Anti-tobacco Media Campaign Indiana Tobacco Prevention and Cessation Agency began a media campaign in $8 million budgeted for the first 2 years Television, radio, print and billboard media venues Baseline data used for this study.

Message -Theme -Emotion TV Radio Print Billboards Duration Intensity Mediating Factors Confounding Factors Aware Venue Not Aware

Research Aims To identify mediating and confounding factors that are associated with youths’ awareness of anti-smoking messages in the mass media. To evaluate whether such factors vary by media venue. - Television- Print Media - Radio- Billboards

Methods Telephone survey was conducted in Representative sample of Indiana youths (n=610) Stratified by age, gender, race, and geographical region. Weighted to allow valid and reliable inferences to be made to the state’s youth population.

Methods (Continued) Analysis was conducted using SPSS To measure the association between media awareness for each media venue and numerous variables (knowledge, belief, smoking behavior, and demographic characteristics). Using the chi-square test of independence.

Methods (Continued) Instrument measured various tobacco related aspects (developed with a media expert): - Anti-smoking media awareness - Demographics - Tobacco-related knowledge - Tobacco-related attitudes / beliefs - Smoking behavior / susceptibility

Survey Approach Conducted by the IU Public Opinion Laboratory. Telephone numbers selected with high probability of having youth living at home. Interviewers first obtained permission from a parent/guardian before interviewing the adolescent. Standard instructions given to both the parent/guardian and the targeted youth.

Outcome Variable: Awareness During the past 30 days, how many commercials have you seen / heard about NOT smoking cigarettes? Asked separately for each media venue: TV radio, print media billboards Responses dichotomized to none or some.

Results: Awareness

Ad Think? Did this advertising make you think about whether or not you should smoke? Almost three-fourths of the respondents agreed that the messages did make them think about whether or not to smoke.

Results: Demographics Awareness of anti-smoking messages among the youth: Differed significantly by: Age group: years, race and, parental education No significant association seen in the Age group :12-14 years gender

Results: Demographics Youth in the years age group were less aware of the messages on billboards. White, non-Hispanic youth were more aware of messages on the print media and on billboards. Youth with one or both parents who have higher education were more aware of messages on the radio.

Results: Knowledge 14 items: 11 items were agree or disagree 9 showed no significant association Range of correct responses: 80.6%-100.0% 2 differed significantly 3 items were factual statements with no significant association Range of correct responses: 15.6%-40.6%

Results: Knowledge Those aware of messages on the TV and radio more often agreed that people are affected by the costs of tobacco-related problems. Respondents aware of messages on the TV more often agreed that tobacco is as addictive as other drugs, such as heroin and cocaine.

Results: Attitudes / Beliefs 18 items under 4 broad categories: Industry manipulation Autonomy Social norms General exposure 10 items showed no significant association Range of correct responses: 77.1 % % 8 items differed significantly

Results: Attitudes / Beliefs Industry Manipulation: Youth who were aware of messages on the TV more often believed that tobacco ads influenced youth to smoke. Youth who were aware of messages on the radio were less likely to attend events, like concerts and sporting events, even if they were sponsored by tobacco companies.

Results: Attitudes / Beliefs Autonomy: Youth who were aware of messages on the radio were more likely to say they could easily refuse cigarettes, if offered. Youth who were aware of messages on the radio were more likely to participate in community activities against tobacco use.

Results: Attitudes / Beliefs General Exposure: Youth who were aware of radio messages more often agreed that exposure to second-hand smoke is a serious problem. Youth who were aware of radio messages more often agreed that tobacco use by young people is a serious problem.

Results: Attitudes / Beliefs Youth who were aware of messages on TV were less likely to agree that smoking makes young people look cool. Youth who were aware of messages on TV were less likely to agree that smoking makes young people more popular.

Results: Smoking Behavior 8 items: 5 items showed no significant association 3 items differed significantly Non-users were more aware of anti- tobacco messages.

Results: Smoking Behavior Youth who had NEVER tried cigarette smoking were more aware of the anti- smoking messages on billboards. Youth who had NOT smoked cigars during the past 30 days, indicated they were more aware of the anti-smoking messages on billboards than those who had used tobacco products.

Results: Smoking Behavior Youth who had NOT smoked chewing tobacco in the past 30 days, indicated they were more aware of the anti- smoking messages on TV than those who had used tobacco products.

Interpretation Cautions Recalled exposure vs. actual exposure. Awareness does not always equal effectiveness.

Summary Most youth were aware of the TV media messages and two-thirds were aware of messages in other media venues. Most youth agreed that the media messages did make them think about whether or not they should smoke. Non-users were more aware of anti- smoking messages.

Summary Only a few demographic characteristics and beliefs were significantly related to the level of message awareness, depending on the media venue. The youth were generally quite knowledgeable and held strong anti- smoking / anti-tobacco beliefs.

Conclusions Media messages did not seem to have a great effect on knowledge or beliefs of youth, although the messages did make them think about whether or not they should smoke. Additional success from media campaigns to prevent tobacco use in youth may require a targeted approach towards specific sub- population groups (like race and education status of parents).