'It's about the smoke, not the smoker': messages that motivate rural communities to support smoke-free policies

Abstract

Rural residents are exposed to sophisticated tobacco advertising and tobacco growing represents an economic mainstay in many rural communities. There is a need for effective health messages to counter the pro-tobacco culture in these communities. To determine relevant cultural themes and key message features that affect receptivity to pro-health advertisements among rural residents, 11 exploratory focus groups and surveys with community advocates (N = 82) in three rural Kentucky counties were conducted. Participants reviewed and rated a collection of print media advertisements and branding materials used by rural communities to promote smoke-free policies. Findings reveal that negative emotional tone, loss framing, appeals to religiosity, and shifting focus away from smokers are effective strategies with rural audiences. Potential pitfalls were identified. Attacks on smokers may not be a useful strategy. Health risk messages reinforced beliefs of secondhand smoke harm but some argued that the messages needed to appeal to smokers and emphasize health hazards to smokers, rather than to non-smokers only. Messages describing ineffectiveness of smoking sections were understood but participants felt they were only relevant for restaurants and not all public spaces. Emphasis on religiosity and social norms shows promise as a culturally sensitive approach to promoting smoke-free environments in rural communities.

Identifying Community Perspectives for a Lung Cancer Screening Awareness Campaign in Appalachia Kentucky: The Terminate Lung Cancer (TLC) Study

“…For example, evidence from a large national online survey found that the graphic and emotionally charged Tips smoking cessation campaign led to significant changes in beliefs about smoking-related risks, increased worries about health, and consequent changes in intention to quit [23]. Prior research on attitudes toward smoking cessation campaigns from the Eastern Kentucky region have also found an advantage of negative emotional advertising [24]. On the other hand, advertising that is seen as an “attack” on smokers (in that it concentrates its message toward the smoker, rather than the smoke) may be seen as placing blame, and is not well received in rural communities with high smoking prevalence and historical and economic ties to tobacco farming [24].…”

“…Prior research on attitudes toward smoking cessation campaigns from the Eastern Kentucky region have also found an advantage of negative emotional advertising [24]. On the other hand, advertising that is seen as an “attack” on smokers (in that it concentrates its message toward the smoker, rather than the smoke) may be seen as placing blame, and is not well received in rural communities with high smoking prevalence and historical and economic ties to tobacco farming [24]. …”

Smoking prevalence in urban and rural populations: findings from California between 2001 and 2012

“…Higher education level generally indicates higher socioeconomic status, different social norms, and more knowledge about health risk behaviors, which are consistently associated with lower rates of smoking (3,10). Factors associated with higher smoking prevalence in rural populations include disparities in tobacco control programs and resources, adoption of smoke-free policies, sociodemographic characteristics such as lower income and educational attainment, lower health insurance coverage and reduced access to treatment services, and targeted marketing by the tobacco industry (3,10,(21)(22)(23)(24). Higher smoking rates in urban areas have been attributed to higher levels of stress from living in urban areas (4,5,7,20).…”

“…Tobacco control efforts have been focused on urban and metropolitan areas, and there are clear disparities in tobacco control resources as well as in the success of such tobacco control programs in rural and low population density areas (22)(23)(24). Rural areas also have different social norms and behaviors which need to be taken into consideration by tobacco control programs (3,10).…”

30+ years of media analysis of relevance to chronic disease: a scoping review

“…gain-versus loss-framing) on healthrelated attitudes and behaviours such as seeking smoking cessation support [280], visiting the dentist [281], healthy snack choice [282], and chronic disease risk perception [283]. Eleven studies used focus groups, interviews and/or surveys to explore public perceptions of social marketing strategies (e.g., awareness, recall, liking, and perceived effectiveness of health promotion campaigns) [76,[284][285][286].…”