Evaluation of a Social Marketing Campaign to Reduce the Social Acceptability of Giving Tobacco As Gifts In China

Theoretical Background and research questions/hypothesis: Gift-giving is essential to establishing and maintaining interpersonal relationships in Chinese culture and cigarettes are one of the most popular gifts.  This study aimed to evaluate the effectiveness of a television and poster campaign to raise awareness of smoking harms and reduce the social acceptability of giving cigarettes as gifts.

Methods: Population-based, representative data were analyzed from 3709 adult smokers who participated in the China administration of the International Tobacco Control Policy Evaluation Project (ITC Project) in six cities (Beijing, Shanghai, Guangzhou, Shenyang, Changsha, and Yinchuan), before and after the campaign.  Campaign exposure was assessed in two ways: comparison of the cities where the campaign was and was not aired, as well as by examining people who did and did not recall the campaign within the intervention cities.  Bivariate and multivariate logistic regression analyses were conducted to examine association between campaign exposure and disagreement with the contention that cigarettes are good gifts, which was assessed only at followup.  For measures of campaign-related content that were collected both before and after the campaign, bivariate and adjusted ordinal regression models were estimated, regressing the post-campaign assessment on campaign exposure while controlling for corresponding pre-campaign measures and other sociodemographic variables.  Sociodemographics, consumption intensity and intention to quit were treated as control variables in all adjusted models.

Results: The percentage of people who disagreed that cigarettes were good gifts was significantly higher than in the intervention compared to the control cities (73 vs. 63%, p<0.001).  Within the intervention cities, 13% of people recalled exposure in the intervention cities, and the percentage of people who disagreed that cigarettes were good gifts was significantly higher amongst those who recalled the campaign compared to those who did not (83 vs. 71%, p<0.001).  This crude and adjusted odds of disagreement was again higher amongst those who recalled the campaign (OR 1.93, 95% CI 1.36, 2.75; AOR 1.78, 95% CI 1.24, 2.56).  Furthermore, people in the intervention cities who were younger, had middle school education or above, smoked some day, and were planning to quit smoking also were more likely to disagree that cigarettes were good gifts in multivariate models.  In the intervention cities, the mean of campaign-targeted knowledge of smoking harms increased significantly from 2.76 to 3.17 among people who recalled the campaign, whereas the mean increased from 2.40 to 2.76 among people who did not recall the campaign.  Ordinal regression models indicated that recall of the campaign was significantly and positively associated with post-campaign knowledge, in both unadjusted and in models that controlled for pre-campaign knowledge level, sociodemographic variables, and intention to quit.

Conclusions:The “Giving cigarettes is giving harm” campaign appears to have increased disapproval of giving cigarettes as gifts, as well as increased campaign-targeted knowledge that could promote downstream cessation among Chinese smokers.

Implications for research and/or practice: Mass media campaigns can be used in diverse cultural contexts to shift social norms related to the acceptability of tobacco, while promoting knowledge and awareness about the harms of smoking.  Governments around the world should implement evidence-based mass media strategies to accompany other tobacco control policies that discourage smoking.