Evaluation of Mass Media Campaigns to Change Smokers\u27 Knowledge, Attitudes, and Behaviors In China and Taiwan

Research in high income countries (HICs) suggest that anti-smoking television advertisements are most effective if they contain emotionally evocative graphic messages or personal testimonials that depict serious consequences from smoking. The ability to effectively translate these messaging strategies to low- and middle-income (LMICs) countries outside of Western cultures remains understudied. It is critical to determine which smoking cessation messages work best in LMICs because they increasingly bear the global burden of tobacco-related disease. To date there is limited evidence on the efficacy of tobacco control mass media campaigns and the relative effectiveness of different tobacco control messaging strategies in China and Taiwan. This dissertation includes two studies that aim to provide such evidence. Study One evaluated the impact of a mass media campaign on Chinese smokers\u27 knowledge of smoking harms and attitudes toward cigarettes as gifts. This study involved a quasi-experimental design using a population-based, longitudinal cohort of adult smokers (n=3079) to evaluate one of China\u27s first-ever anti-smoking mass media campaigns, the Giving Cigarette is Giving Harm campaign (GCGH), which graphically portrayed tobacco-attributed diseases and attempted to change social norms around the time-honored cigarette gifting practice. The results suggest the GCGH campaign helped denormalize the socially engrained cigarette gifting behavior among Chinese urban smokers despite the relatively low recall and short campaign duration. Study Two explored how Taiwanese male smokers understood and responded to anti-smoking television advertisements with different message content and executional styles. This study used a mixed methods approach involving qualitative and quantitative data collection with focus group methodology to evaluate a set of anti-smoking television advertisements with differing messaging strategies among a purposive sample of Taiwanese male smokers (n=54). The results suggest that anti-smoking television advertisements using personal testimonials that graphically and emotionally portray victims\u27 smoking-attributed diseases may have the greatest potential to motivate Taiwanese smokers to think about quitting smoking. In conclusion, the study findings strengthen the evidence that mass media campaigns with graphic, emotionally evocative messages that are conveyed in culturally or personally relevant ways can raise awareness of smoking harms, change smokers\u27 attitudes that are favorable to smoking-related norms, and potentially motivate smokers to quit smoking in Asian LMICs