Tobacco Control in a Rapidly Changing Media Environment

Project Title: Tobacco Control in a Rapidly Changing Media Environment

Organization: University of Illinois at Chicago

Grant Number: 1U01CA154254

Principal Investigator: Sherry Emery

Note: The descriptions in this section were provided by the principal investigator and are not maintained or updated by NCI.

Co-Investigators:
Joseph Capella, University of Pennsylvania
Kurt Ribisl, University of North Carolina at Chapel Hill
Jidong Huang, Georgia State University
Yoonsang Kim, National Opinion Research Center
Frank Chaloupka, University of Illinois at Chicago

Project Website: https://www.norc.org/About/Departments/Pages/social-data-collaboratory.aspx

Study Summary
Dr. Emery and her research team conducted two waves of a longitudinal Internet-based survey with a large nationally representative sample of adult smokers and nonsmokers. This survey assessed population media use and exposure to tobacco, searching and sharing of tobacco-related information across both traditional and new media platforms; and attitudes, beliefs, and behaviors related to use of various tobacco products. In addition, the team collected rich and varied sets of tobacco-related data from online social media sources including Twitter, Facebook, YouTube, and Instagram, developing and documenting innovative, rigorous methodologies for such data collection and analysis in the process. The team combined these new data with existing data on smoking behavior, exposure to tobacco-related advertising, and state-level data on tobacco control policies to analyze the relationships between that information and attitudes, beliefs, and smoking behavior. This project represents the first large-scale survey of new media consumption in the context of tobacco control.

Research Aims and Methods

• Describe media consumption patterns, exposure to smoking-related advertising, and information seeking and exchange related to smoking and quitting, across media platforms.
• Assess potential relationships between the amounts of pro- and anti-tobacco information to which individuals are exposed, search for, and share via traditional and new media platforms.
• Analyze the relationships between the amount of tobacco-related information across media platforms and attitudes, beliefs, and tobacco use behaviors among adults.
• Disseminate findings widely to policymakers, tobacco control advocates, public health professionals, the general public, and other academic and scientific professionals.

Target Population: Media consumption and exposure

Key Findings

• The graphic messaging strategies employed by CDC’s “Tips from Former Smokers” televised anti-tobacco campaign were highly accepted by viewers; further, the campaign successfully extended its reach on social media (Twitter) and by obtaining “earned media” through online news and blog coverage. [1,6,14]
• U.S. adults are widely exposed to e-cigarette marketing on the Internet and in social media networks, and there is evidence that such marketing differentially targets specific demographics, including priority populations. Related, e-cigarette promotional spending in the U.S. has rapidly increased since 2010, with the second quarter of 2013 representing more than double the expenditures for the year 2012. Print was found to be the dominant media channel followed by television. [2,3,7]
• U.S. adults across demographic groups viewed e-cigarette use as less likely to cause lung cancer, oral cancer, or heart disease compared to smoking regular cigarettes, and viewed non-cigarette tobacco products (snus, dissolvable tobacco and smokeless tobacco) as more likely to cause oral cancer and less likely to cause lung cancer compared to smoking regular cigarettes. [5]
• Social media platforms such as Twitter and YouTube are major information-sharing platforms for tobacco products. In our analysis of e-cigarette content on YouTube, we found staggering number of promotional videos, with high user engagement (unique accounts, millions of views, hundreds of thousands of ratings and comments); in an analysis of little cigar and cigarillo (LCC) content on Twitter, we found over 4 mil relevant tweets posted by individuals, influencers, and commercial accounts, with 83% of messages referencing co-use of tobacco and marijuana; in an analysis of menthol flavored cigarettes on Twitter, we found nearly 100,000 relevant tweets, with a more than half of posts expressing positive sentiment towards the product. [9,10,15]
• A conceptual framework for social media data collection and quality assessment was developed, tested, and validated. Further, the team proposed reporting standards that researchers and reviewers may use to evaluate and compare the quality of social data across studies. [8]
• Analysis of Twitter messages surrounding California’s 2012 ballot initiative Proposition 29 to increase state cigarette tax, shed some light as to why the policy failed on election day, despite strong early public support. The general health message of ‘Yes on 29’ was insufficient to withstand aggressive counterarguments of the ‘No on 29’ industry and advocate campaign. [11]
• Analyses of the use of various tobacco products across adult lesbian, gay, bisexual and transgendered (LGBT) subpopulations confirm the elevated risk of tobacco use among LGBT and provide evidence that tobacco-related LGBT health inequities, particularly among bisexual and lesbian women and transgendered, may be greater than previously indicated. [4,13]

Key Implications

• Findings provide strong support for the use of graphic, emotionally evocative imagery and messaging in anti-tobacco media campaigns. Use of both traditional and new media outlets can expand the reach and exposure to campaign messages. [1,6,14]
• Ongoing surveillance of the use of e-cigarettes and other novel tobacco products, particularly among priority populations, is needed to inform policy decisions about regulating these products. Continued surveillance and monitoring of e-cigarette marketing expenditures is needed to guide product marketing regulation and policy, inclusive of both traditional and new media sources. [2,3,7]
• It is important to consider whether consumer perceptions of risk or harm vary by tobacco product type, as findings could help inform future public health campaign messages and product regulation. [5]
• Social media platforms are major information-sharing platforms for traditional and novel tobacco products, and analyses into topics and content of tobacco-relevant data from each platform taught us that each media outlet is used for different purposes by different audiences. These insights should be considered when framing public counter-messaging and campaign messages, and further research and surveillance of tobacco messaging and promotion on social media calls for attention from public health professionals and policymakers. [9,10,15]
• Rigorous research on social media data should clearly delineate data sources, how data were accessed and collected, and the search filter building process; and should report levels of retrieval precision and recall and how those figures were calculated. [8]
• Policy campaign strategies should incorporate strong social media messaging and surveillance targeted at their audience of interest, and incorporate prospective analysis in campaign evaluations. [11]
• Exploring LGBT as a unified population is inadequate to accurately characterize tobacco-related LGBT health inequities. Future research should assess tobacco use differences across LGBT subpopulations, and the public health community should tailor tobacco control efforts to address these disparities. [4,13]

Original Abstract
The proposed research focuses on the role of mass media in state and community tobacco control efforts. The overarching goals of the proposed project are a) to develop an understanding of the amount and variety of tobacco-related information that both smokers and nonsmokers encounter across media platforms, and b) to analyze the relationships between that information and attitudes, beliefs and smoking behavior. This research is critically important for state and community tobacco control efforts because the mass media landscape has fundamentally transformed over the past five years, to include platforms such as increasingly sophisticated internet marketing and advertising strategies, social networking (e.g., facebook, twitter, and youtube), mobile messaging, and the growing fragmentation of traditional broadcast media. As a result, the amount and variety of pro- and anti-tobacco information available across media platforms has proliferated. Yet, there is very little detailed public information available about which new media is commonly used, or how much they are used across demographic groups. In addition, little is known about the extent to which smokers and non-smokers are exposed to pro- and anti-tobacco information, or how much tobacco-related information seeking and exchange is conducted across media platforms. The proposed research will conduct the first large-scale survey on new media consumption, exposure to smoking-related advertising and information seeking and exchange related to smoking/quitting across traditional and new media platforms. By combining existing data on exposure to smoking-related messages on TV, with new data collected as part of the proposed research, this project will provide the first comprehensive description of the amount and variety of pro- and anti-tobacco information that smokers and non-smokers encounter passively, and which they actively seek out and exchange. With these data, we will be able to explore whether, and the extent to which, smoking-related information delivered across various media platforms is associated with attitudes and smoking behaviors. Further, these data will enable us to examine whether and how the various type's tobacco-related information and media interact with each other.