Developing Anti-Smoking Media Campaign Messages: Should Messages Differ by Race or Gender?

Theoretical Background and research questions/hypothesis: Gender and racial disparities in smoking rates or smoking-related health outcomes exist. However, debate persists over the necessity of segmenting health messages in media campaigns by race or gender to reduce health disparities within these groups.  Thus, the present analysis examines whether the association between beliefs about quitting smoking and intention to quit smoking differ by race or gender, one criterion for choosing the focus of messages. 

Methods: Data came from the formative evaluation of an anti-smoking media campaign in Philadelphia, Pennsylvania; the campaign is part of the CDC Communities Putting Prevention to Work initiative. A representative sample of adult smokers (N=501) from Philadelphia answered questions about their beliefs and intentions regarding smoking cessation. Twenty-nine cessation beliefs were considered for analysis.  To test whether race (White or Black) moderated the association of these beliefs on cessation intention, we included the interaction of race and belief in multiple linear regression models predicting cessation intention. In separate models, we tested whether gender moderated the belief-intention relationships.

Results: Black smokers reported significantly higher intentions to quit smoking compared to White smokers.  Intention to quit did not differ by gender. Among the entire sample, 11 beliefs were significantly related to intentions to quit smoking. Among the race moderation models, three interactions were statistically significant (p ≤ 0.01). Beliefs corresponding to these interactions were 1) using help to quit smoking is a sign of weakness; 2) confidence to manage intense cravings; and 3) confidence to manage irritability after quitting. These interactions indicated that increasing agreement with the belief was more associated with higher intentions to quit smoking among White than Black smokers (indeed none of the three were significantly associated with intentions for Black respondents). In the gender moderation analyses, only one interaction was statistically significant; female respondents showed a stronger association between the belief that quitting smoking would increase energy to do enjoyable activities and intention to quit.   

Conclusions: The results show that almost all beliefs about quitting smoking are not differentially associated with cessation intentions by race or gender, although many showed significant overall associations.  The significant interactions in the race analysis were in the same direction and highly significant, suggesting that those detected differences are not by chance, and would suggest that messages promoting these three beliefs would be inappropriate for an audience that included Black and White smokers.  Given that only one in 29 gender interactions produced a significant finding, that result may well be due to chance, and could be ignored. 

Implications for research and/or practice: Before allocating resources to develop and disseminate anti-smoking messages, campaign planners should consider how the effects of those messages might differ across various sub-audiences, particularly groups at higher risk for poor health behaviors and outcomes.  Finding a single message that resonates with the entire audience would keep message development and advertising costs low. The present study shows there are a number of beliefs about cessation that would resonate with Blacks and Whites and men and women smokers.