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Member Research and Reports

UNC Student Co-authors Two Studies on the Difficulties of Quitting Smoking

Two new publications, co-authored by a health policy and management doctoral student at UNC’s Gillings School of Global Public Health, examine aspects of the behaviors of smokers who are trying to quit or who are exposed to antismoking advertising. The studies were conducted in collaboration with researchers from the Centers for Disease Control and Prevention (CDC) and RTI International.


[Photo: Quitting smoking, especially at earlier ages, greatly reduces the risk of one’s developing smoking-related diseases. Photo by Cory Doctorow.]

Mr. Paul Shafer is co-author of “Antismoking Ads at the Point of Sale: The Influence of Ad Type and Context on Ad Reactions,” published online April 25 in the Journal of Health Communication, and “Quit Attempt Methods Used by U.S. Adult Cigarette Smokers, 2014-2016,” published online April 13 in Preventing Chronic Disease.

In the Journal of Health Communication article, Mr. Shafer and colleagues consider the impact of an anti-tobacco advertisement’s context – whether it appears alone, paired with a pro-tobacco ad or as part of a tobacco product display – upon the potential buyers’ reactions to tobacco advertising that has been placed at the point of sale.

The tobacco industry spends about 90 percent of its $9 billion marketing budget on promotional allowances and price promotions at the point of sale, the authors report. Cigarette products which are placed prominently at checkout counters expose all convenience store customers to the products and accompanying ads, including youth and adults who do not smoke or who have quit smoking. Prior studies have shown that this type of point-of-sale advertising influences relapse by stimulating cravings in people who smoke or have smoked – and trigger interest in youth and other nonsmokers, who become more likely to try smoking and to be susceptible to future use of tobacco products.

The researchers sampled 7,812 adult smokers and recent quitters. Participants viewed one of four types of anti-smoking ads – a graphic ad showing negative health consequences; a graphic ad showing negative social consequences; an informational ad showing the benefits of quitting; and a graphic ad showing the benefits of quitting – in one of the three contexts listed above. They then assessed participants’ reactions to the ads, including perceived effectiveness, negative emotion, affective dissonance and motivational reaction.

Anti-smoking ads fared best when viewed alone, and graphic ads were least influenced by the context in which they were viewed. The results suggest to those devising point-of-sale campaigns the importance of considering the pro-tobacco context in which antismoking ads will be viewed.

“Not surprisingly, pro-tobacco advertising and other cues associated with the retail environment can distract from the message content in anti-tobacco ads,” Mr. Shafer said. “To the extent that FDA and state or local public health departments may introduce anti-tobacco advertising at the point of sale, understanding how the real-world retailer environment impacts processing of these messages is very important.”

Quitting smoking, especially at earlier ages, greatly reduces the risk of one’s developing smoking-related diseases. Especially in light of the dramatic rise in e-cigarette use over the last few years, researchers in the second study aimed to assess which methods were used most often to try to quit smoking.

Mr. Shafer and colleagues used a sample of 15,943 adult smokers in the U.S. between 2014 and 2016 who reported making a recent quit attempt. About 75 percent of the smokers reported using multiple quit methods in their last attempt to quit. Giving up cigarettes all at once, or “cold turkey,” (65.3 percent) and reducing the number of cigarettes smoked (62 percent) were most common. Substituting some cigarettes with e-cigarettes (35.3 percent) was a method used more often than using a nicotine patch or gum (25.4 percent) or other Food and Drug Administration-approved medications (12.2 percent). About 15 percent of study participants had sought help from a doctor or other health professional; 7 percent sought help on a website; and 5.4 percent used a telephone quitline.

Given that so many people trying to quit smoking rely on e-cigarettes as a means of “trailing off” smoking, and given that the FDA does not approve e-cigarette smoking as a cessation aid, Mr. Shafer and colleagues call for further research into the effectiveness of e-cigarettes as a means of stopping smoking.

“Though e-cigarettes cannot be marketed as a cessation aid, they nonetheless have overtaken virtually every other evidence-based intervention recommended to support smokers in quitting,” Mr. Shafer said. “The uncertainty about the harms of e-cigarette constituents and long-term use must be weighed carefully against strong arguments for harm reduction associated with reductions in the use of traditional cigarettes.”

Co-authors of the Preventing Chronic Disease article, from the Centers for Disease Control and Prevention (CDC) are Drs. Ralph S. Caraballo and Timothy A. McAfee, of the National Center for Chronic Disease Prevention and Health Promotion, in the CDC’s Office on Smoking and Health; and Ms. Deesha Patel, from the National Center for HIV-AIDS, Viral Hepatitis, STD and TB Prevention in the CDC’s Division of HIV-AIDS Prevention Intervention Research and Support. Co-author Mr. Kevin C. Davis is from the Center for Health Policy Science and Tobacco Research, at RTI International, in Research Triangle Park, N.C.

Co-authors of the Journal of Health Communication article are from RTI International and include Drs. Annice Kim, Jamie Guillory, James Nonnemaker, Sarah Parvanta and Matthew Farrelly and Mr. John Hollway.

Read more: https://sph.unc.edu/sph-news/doctoral-student-co-authors-two-studies-on-the-difficulties-of-quitting-smoking/