Abstract
Objectives
Roughly 10% of pregnant women are current smokers. Improving smoking cessation in this population before and during pregnancy is essential to prevent adverse fetal outcomes. This study aimed to examine cessation messages targeting American women.
Methods
An obstetrics–gynecological clinic-based sample of female, current smokers of reproductive age (18–44 years old) was recruited (n = 135) from January to May 2019; half (51.2%) were currently pregnant. Participants completed a within-subjects study with a randomized set of gain- and loss-framed text-only pregnancy-related cessation messages (5 each). Each individual message was rated on a validated, 10-point scale for perceived effectiveness; responses to the seven items were averaged. Regression analyses examined differences in effectiveness ratings by message framing.
Results
Study participants (female smokers) rated the gain-framed messages as slightly more effective than loss-framed messages (7.9 versus 7.7, p < 0.01). After adjusting for quit intention and pregnancy, the relationship between gain- and loss-framing and effectiveness ratings was modified by both self-efficacy and risk perceptions. Women who perceived high risks of smoking during pregnancy had higher effectiveness ratings of both gain- and loss-framed cessation messages, compared to women who perceived low risks. Lower cessation self-efficacy was significantly associated with lower effectiveness ratings for gain- and loss-framed messages (1.53 and 1.92, respectively; p < 0.05).
Conclusions for Practice
Women with lower self-efficacy and low risk perception of smoking risks had the lowered effectiveness ratings for both frames of cessation messages. Enhancing self-efficacy and risk perceptions through clinical interventions may improve the effectiveness of targeted messages to promote quitting smoking before or during pregnancy.
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References
Amos, A., Greaves, L., Nichter, M., & Bloch, M. (2012). Women and tobacco: A call for including gender in tobacco control research, policy and practice. Tobacco Control, 21(2), 236–243. https://doi.org/10.1136/tobaccocontrol-2011-050280.
Campbell, B. K., Le, T., Yip, D., Griffin, K. B., Gubner, N. R., & Guydish, J. R. (2019). Sex differences in graphic warning label ratings by addictions clients. Tobacco Regulatory Science, 5(1), 3–14. https://doi.org/10.18001/trs.5.1.1.
Centers for Disease Control. (2020). The Brief Tobacco Intervention Pocket Card. Retrieved February 18, 2020, from https://www.cdc.gov/tobacco/basic_information/for-health-care-providers/clinical-tools/index.html.
Centers for Disease Control and Prevention. (2020). Percent of adults (18+) who now smoke every day or some days. Retrieved February 18, 2020, from https://www.cdc.gov/STATESystem/.
Curry, S. J., Grothaus, L., McBride, C., Lando, H., & Pirie, P. (2001). Motivation for smoking cessation among pregnant women. Psychology of Addictive Behaviors, 15(2), 126–132. https://doi.org/10.1037/0893-164X.15.2.126.
Francis, D. B., Hall, M. G., Noar, S. M., Ribisl, K. M., & Brewer, N. T. (2017). Systematic review of measures used in pictorial cigarette pack warning experiments. Nicotine and Tobacco Research, 19(10), 1127–1137. https://doi.org/10.1093/ntr/ntx082.
Gwaltney, C. J., Metrik, J., Kahler, C. W., & Shiffman, S. (2009). Self-efficacy and smoking cessation: a meta-analysis. Psychology of Addictive Behaviors, 23(1), 56.
Hammond, D. (2011). Health warning messages on tobacco products: A review. Tobacco Control, 20(5), 327–337. https://doi.org/10.1136/tc.2010.037630.
Haukkala, A., Uutela, A., Vartiainen, E., McAlister, A., & Knekt, P. (2000). Depression and smoking cessation: The role of motivation and self-efficacy. Addictive Behaviors, 25(2), 311–316. https://doi.org/10.1016/S0306-4603(98)00125-7.
Holbrook, B. D. (2016). The effects of nicotine on human fetal development. Birth Defects Research Part C: Embryo Today: Reviews, 108(2), 181–192. https://doi.org/10.1002/bdrc.21128.
Kollath-Cattano, C., Osman, A., & Thrasher, J. F. (2017). Evaluating the perceived effectiveness of pregnancy-related cigarette package health warning labels among different gender/age groups. Addictive Behaviors, 66, 33–40. https://doi.org/10.1016/j.addbeh.2016.11.007.
Lange, S., Probst, C., Rehm, J., & Popova, S. (2018). National, regional, and global prevalence of smoking during pregnancy in the general population: A systematic review and meta-analysis. The Lancet Global Health, 6(7), e769–e776. https://doi.org/10.1016/S2214-109X(18)30223-7.
Levis, D. M., Stone-Wiggins, B., O’Hegarty, M., Tong, V. T., Polen, K. N. D., Cassell, C. H., & M Council (2014). Women’s perspectives on smoking and pregnancy and graphic warning labels. American Journal of Health Behavior, 38(5), 755–764. https://doi.org/10.5993/AJHB.38.5.13.
McKee, S. A., Smith, P. H., Kaufman, M., Mazure, C. M., & Weinberger, A. H. (2016). Sex differences in varenicline efficacy for smoking cessation: A meta-analysis. Nicotine and Tobacco Research, 18(5), 1002–1011.
Melvin, C. L., Dolan-Mullen, P., Windsor, R. A., Whiteside, H. P., & Goldenberg, R. L. (2000). Recommended cessation counselling for pregnant women who smoke: A review of the evidence. Tobacco Control, 9(SUPPL 3), iii80–iii84. https://doi.org/10.1136/tc.9.suppl_3.iii80.
National Institute of Health. (2018). Are there gender differences in tobacco smoking? Retrieved May 19, 2020, from https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/are-there-gender-differences-in-tobacco-smoking.
Noar, S. M., Bell, T., Kelley, D., Barker, J., & Yzer, M. (2018). Perceived message effectiveness measures in tobacco education campaigns: A systematic review. Communication Methods and Measures, 12(4), 295–313. https://doi.org/10.1080/19312458.2018.1483017.
Noar, S. M., Hall, M. G., Francis, D. B., Ribisl, K. M., Pepper, J. K., & Brewer, N. T. (2016). Pictorial cigarette pack warnings: A meta-analysis of experimental studies. Tobacco Control, 25(3), 341–354. https://doi.org/10.1136/tobaccocontrol-2014-051978.
Office on Smoking and Health. (2001). Women and Smoking: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK44302/.
Scharf, D., & Shiffman, S. (2004). Are there gender differences in smoking cessation, with and without bupropion? Pooled-and meta-analyses of clinical trials of Bupropion SR. Addiction, 99(11), 1462–1469. https://doi.org/10.1111/j.1360-0443.2004.00845.x.
Schneider, S., & Schutz, J. (2008). Who smokes during pregnancy? A systematic literature review of population-based surveys conducted in developed countries between 1997 and 2006. European Journal of Contraception and Reproductive Health Care. https://doi.org/10.1080/13625180802027993.
Smith, P. H., Bessette, A. J., Weinberger, A. H., Sheffer, C. E., & McKee, S. A. (2016). Sex/gender differences in smoking cessation: A review. Preventive Medicine, 92, 135–140. https://doi.org/10.1016/j.ypmed.2016.07.013.
Smith, P. H., Kasza, K. A., Hyland, A., Fong, G. T., Borland, R., Brady, K., et al. (2015). Gender differences in medication use and cigarette smoking cessation: Results from the International Tobacco Control Four Country Survey. Nicotine and Tobacco Research, 17(4), 463–472. https://doi.org/10.1093/ntr/ntu212.
Tan, A. S. L., Bigman, C. A., Nagler, R. H., Minsky, S., & Viswanath, K. (2017). Comparing perceived effectiveness of FDA-proposed cigarette packaging graphic health warnings between sexual and gender minorities and heterosexual adults. Cancer Causes and Control, 28(10), 1143–1155. https://doi.org/10.1007/s10552-017-0954-3.
Thrasher, J., Anshari, D., Lambert-Jessup, V., Islam, F., Mead, E., Popova, L., et al. (2018). Assessing smoking cessation messages with a discrete choice experiment. Tobacco Regulatory Science, 4(2), 73–87. https://doi.org/10.18001/TRS.4.2.7.
Thrasher, J. F., Swayampakala, K., Borland, R., Nagelhout, G., Yong, H. H., Hammond, D., et al. (2016). Influences of self-efficacy, response efficacy, and reactance on responses to cigarette health warnings: A longitudinal study of adult smokers in Australia and Canada. Health Communication, 31(12), 1517–1526. https://doi.org/10.1080/10410236.2015.1089456.
Toll, B. A., O’Malley, S. S., Katulak, N. A., Wu, R., Dubin, J. A., Latimer, A., et al. (2007). Comparing gain-and loss-framed messages for smoking cessation with sustained-release bupropion: A randomized controlled trial. Psychology of Addictive Behaviors, 21(4), 534–544. https://doi.org/10.1037/0893-164X.21.4.534.
Toll, B. A., Salovey, P., O’Malley, S. S., Mazure, C. M., Latimer, A., & McKee, S. A. (2008). Message framing for smoking cessation: The interaction of risk perceptions and gender. Nicotine and Tobacco Research, 10(1), 195–200. https://doi.org/10.1080/14622200701767803.
US Department of Health and Human Services. (2014). The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. A Report of the Surgeon General: Executive Summary.
US Surgeon General. (2001). Women and Smoking: A Report of the Surgeon General.
Wang, T. W., Asman, K., Gentzke, A. S., Cullen, K. A., Holder-Hayes, E., Reyes-Guzman, C., et al. (2018). Tobacco product use among adults—United States, 2017. Morbidity and Mortality Weekly Report, 67(44), 1225–1232.
Warnecke, R. B., Morera, O., Turner, L., Mermelstein, R., Johnson, T. P., Parsons, J., et al. (2001). Changes in self-efficacy and readiness for smoking cessation among women with high school or less education. Journal of Health and Social Behavior, 42(1), 97–110.
Acknowledgements
We appreciate Dr. Allison Lazard for her expertise on the warning message selection and evaluation metrics.
Funding
This research was funded by the Critical Difference for Women Grant from the Coca-Cola Foundation and supported by a Roessler Medical Student Research Scholarship.
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Busho, A.C., Macisco, J.M., Oslock, A.G. et al. Effectiveness of Cessation Messages Targeting Pregnant and Nonpregnant Female Smokers in the United States: A Cross-Sectional Analysis into the Impact of Pregnancy, Self-Efficacy, and Risk Perception. Matern Child Health J 24, 1515–1520 (2020). https://doi.org/10.1007/s10995-020-03001-6
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DOI: https://doi.org/10.1007/s10995-020-03001-6