ANALISIS DEL ENTORNO

The findings from Study One suggest that the Chinese government should consider development and dissemination of campaigns with graphic, emotionally evocative

message styles to address the tobacco epidemic within the sociocultural context of China. Although message contents should be developed to be country-specific, the

characteristics and general features of ads appear to work across both HICs and LMICs from a range of cultural contexts. Monitoring and evaluation of campaigns is a critical element of best-practice tobacco control mass media campaigns. Therefore, the campaigns should be accompanied by rigorous evaluations to better understand the messages and media channels that are most effective at reaching and influencing people to adopt healthy behavior.

The findings from Study Two provide preliminary evidence that personal testimonials that graphically and emotionally portray victims’ smoking-attributed diseases may have the greatest potential to motivate smokers to think about quitting smoking precisely because of the strong negative emotional arousal and perceived personal relevance. Testimonials featuring younger smoker victims may appeal to

younger smokers because youth appeared less likely to view themselves as susceptible to smoking-attributed diseases illustrated by people who are visibly older than them.

Testimonial ads should portray ordinary smoker victims to avoid viewers’

counterarguments about the unique social role (e.g., mothers), atypical lifestyle (e.g., entertainers) or other risky health behaviors (e.g., drinking and bête nut chewing).

Comprehension difficulties result from complex terminology, lack of direct, explicit linkage between smoking and the harm, and the use of some metaphors to illustrate harms, underscoring the need for pre-testing. Synergetic efforts may be generated by linking media campaign ads with other messaging, such as health warning labels, innovative websites, and social and digital media. These strategies may enhance the

comprehensibility as well as effectiveness of the tobacco control media campaigns (Brennan et al., 2011; Shannon et al., 2013).

The adaption of the tobacco industry denormalization messaging strategy for use outside of countries where this strategy has been effective should be carefully examined. The salience of the tobacco industry and public perceptions of its difference from other industries vary across societies, and this variation is likely to influence the effectiveness of these ads (Thrasher and Bentley, 2006), particularly those countries with state-owned monopoly since anti-tobacco industry could be interpreted as an act “against the

government” (Yuxi, 2012).

Taiwanese study findings have several implications for campaign development in China. First, personal testimonial style television ads that graphically and emotionally portray victims’ smoking-attributed diseases may be more effective than other ad styles if the aim is to change knowledge and attitudes about smoking-related harms and norms, as well as to prompt thoughts about quitting smoking among Chinese smokers. Tobacco

industry denormalization style ads may not be readily understood and perceived as relevant, but this ad type may also be considered offensive or even irrelevant in the socio- cultural and political-economic context of China. As a state-owned monopoly and the world’s largest manufacturer of tobacco products, the tobacco industry in China has substantial economic and political influence for derailing tobacco control policies. Therefore, tobacco industry denormalization strategies are likely to face resistance from both government and industry, as well as from people who benefit from the industry through ubiquitous jobs (e.g., retailer who sells cigarettes) and industry-sponsored charity projects (Pfau, Haigh, Sims, & Wigley, 2008). More research about public perceptions of tobacco industry and message pre-testing on this tobacco industry denormalization strategy are needed to determine whether this strategy works well in the Chinese context and whether it might be effectively adapted to the Chinese context. Third, although television has been suggested to be the most effective, powerful medium for reaching smokers (National Cancer Institute, 2008; Durkin et al., 2012), comprehension issues still rise partly due to the short duration of typical ads (30 seconds in length). One way to enhance comprehension is to invite ad viewers to visit campaign websites and call toll- free phone lines (e.g., quitlines) to seek and clarify information about campaign messages, which is often done in HICs (CDC, 2013). Linking media campaign content with other messaging, such as health warning labels, innovative websites, and social and digital media may enhance message comprehension by providing information to support

smoking cessation and prevention, as well as to increase exposure to campaign messages.

In sum, the findings from both studies have provided implications for best practices on messaging strategies and dissemination for tobacco control mass media campaigns.

Mass media campaigns with graphic, emotionally evocative messages that are conveyed in culturally or personally relevant ways appear promising for raising smokers’ awareness of smoking-related harms, change smokers’ attitudes that are favorable to smoking-

related norms, and potentially motivate smokers to quit smoking in Asian LMICs. In our studies, highly emotional, graphic ads were consistently perceived as effective in

motivating Asian smokers to quit smoking. Due to costs and expertise required for pre- testing and producing media campaign materials, LMICs with limited resources for tobacco control should consider using existing evidence-based materials produced in other countries through the translation and adaptation of ads (Wakefield et al., 2011). However, evidence has recently showed that locally-produced ads that feature

testimonials from people with typical sociodemographics can be highly effective, perhaps by optimizing the personal relevance of ad characteristics (Mullin et al., 2013). Therefore, when adequate resources are available for campaign development and formative research, it is recommended to produce ads that feature personal testimonials from the victims of smoking-related harms, graphic portrayal of tobacco-attributable harms, and identifiable socio-cultural contexts and characteristics of people portrayed to elicit emotions and relevance for maximizing the effectiveness of tobacco control messages.