Are There Socioeconomic Differences In Responsiveness to Anti-Smoking Message Topics?

Theoretical Background and research questions/hypothesis: Sharp socioeconomic disparities in smoking behavior and smoking related health outcomes exist. There is growing contention that communication campaigns meant to improve health behavior and outcomes might in fact exacerbate some health disparities, like smoking disparities. Yet evidence suggesting if and where health communication inequalities exist or how to reduce inequalities in health communication effects is sparse. One hypothesis suggests that health messages—such as anti-smoking messages—designed for the general public might not appeal to some marginalized groups, including people who are disadvantaged socioeconomically. Such messages would have little influence on smoking behaviors in these populations, which could subsequently contribute to disparities in smoking-related outcomes. The present study stems directly from this hypothesis and tests if beliefs about cessation, which might serve as the central topics of anti-smoking messages, are differentially related to cessation intentions by socioeconomic status (SES).

Methods: Data came from a representative sample of 501 adult smokers (56% female; 46% African American; 24% without a high school degree) surveyed for the formative evaluation of the Philadelphia Anti-Smoking Campaign. The campaign is part of Get Healthy Philly, a program led by the Philadelphia Department of Public Health, and funded by the CDC Communities Putting Prevention to Work initiative to reduce chronic disease. Participants responded to questions regarding their intentions to quit smoking, as well as 25 different beliefs about the consequences of quitting, perceived normative pressure to quit, and self-efficacy to quit. Self-reported education level served as the measure of SES (less than high school to college or more). In multiple linear regression models predicting cessation intention, significant interactions between SES and beliefs about quitting indicated differential responsiveness to those beliefs by SES.

Results: Associations between three of the quitting beliefs and cessation intentions were contingent on SES level: having more energy to do enjoyable activities; having confidence to manage irritability during a quit attempt; and not believing that one would experience intense cravings for cigarettes. Each of these beliefs were related to positive intentions to quit smoking among higher SES smokers, but were not positively related to cessation intentions among low SES smokers (i.e., less than high school education). The remaining belief-intention associations did not differ by SES.

Conclusions: Anti-smoking messages promoting beliefs that are highly related to cessation intentions have strong potential to change quitting behaviors in the population. However, promoting beliefs that are related to intentions for only high SES smokers could widen the smoking-related disparities that already exist between low and high SES groups.

Implications for research and/or practice: This analysis revealed that three beliefs were differentially related to cessation intentions by SES, and could be ineffective in messages targeted to low SES smokers. Messages based on such beliefs should likely be avoided in citywide anti-smoking campaigns aiming to increase quitting among low and high SES smokers through message communications. Fortunately, a majority of other beliefs were not differentially related to intentions by SES and could be candidates for cessation promotion messages targeting low and high SES audiences.