- Title
- An exploration of socioeconomically disadvantaged smokers’ responses to three tobacco control strategies
- Creator
- Guillaumier, Ashleigh
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2014
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Although coordinated tobacco control approaches have been successful in reducing population prevalence rates of smoking, tobacco continues to account for significant morbidity and mortality. There also persists an inverse relationship between socioeconomic status and smoking prevalence that is evident both within and between countries. In Australia smoking rates are disproportionately high among groups who experience multiple levels of social and economic disadvantage such as those with low-income, indigenous populations, the long-term unemployed, individuals who are homeless and those with a mental illness. Limited research has assessed the impact of tobacco control interventions among highly socioeconomically disadvantaged groups with high smoking rates. The aim of this thesis was to explore how socioeconomically disadvantaged smokers in Australia respond to and engage with three tobacco control measures (mass media campaigns, plain packaging and health warning labels, and price). Participants were clients accessing non-government social and community service organisations for the provision of crisis aid and social and financial welfare assistance. Paper one “Anti-tobacco mass media and socially disadvantaged groups: a systematic and methodological review” presents the results of a literature review examining evidence of the differential effectiveness of mainstream and targeted mass media campaigns according to socio-demographic group. Findings varied across studies and outcome measures. While socioeconomically disadvantaged smokers may be less likely to recall general population campaigns compared to more advantaged groups, they may be equally likely to perceive these campaigns as effective and to quit in response. Overall, there is a lack of methodologically rigorous research investigating the effectiveness of anti-tobacco mass media campaigns, particularly among highly socioeconomically disadvantaged groups. It appears that some mainstream campaigns have the potential to be effective among socioeconomically disadvantaged smokers, however more research is needed. Paper two “What type of anti-smoking advertisement is perceived as more effective? An experimental study with a sample of Australian socially disadvantaged welfare recipients” evaluated responses to key anti-smoking message types (‘why-to-quit’ and ‘how-to-quit’ messages) among highly socioeconomically disadvantaged smokers (n = 354). The influence of nicotine dependence and cessation cognitions on ratings of message effectiveness was also assessed. To effectively promote cessation among socioeconomically disadvantaged smokers, mass media campaigns should include a high rotation of ‘why-to-quit’ television advertisements featuring negative emotive content and graphic imagery. Socioeconomically disadvantaged smokers reported high interest in quitting, but had limited quit success. Research on ways to improve the ‘how-to-quit’ message to capitalise on quit interest, motivate quit attempts and support cessation among socioeconomically disadvantaged groups with high smoking rates is needed. Paper three “Tobacco health warning messages on plain cigarette packs and in television campaigns: A qualitative study with Australian socioeconomically disadvantaged smokers” describes a qualitative study using six focus groups to explore how socioeconomically disadvantaged smokers engage with health-risk and cessation-benefit messages communicated via mass media campaigns and cigarette pack health warning labels. Some tobacco warning messages may not be resonating with disadvantaged smokers. Participants reported message avoidance behaviours, self-exempting beliefs towards warning message content and considered themselves to be desensitised to tobacco-related health warnings. Warning messaging should continue to use emotive content and address false beliefs about tobacco health-effects, but might also explore featuring more immediately relatable health concerns and providing more practical cessation advice. Discussions also indicated cigarette plain packaging negatively impacted on product perceptions and experience. Paper four “Socioeconomically disadvantaged smokers’ ratings of plain and branded cigarette packaging: an experimental study” tested the potential impact of cigarette plain packaging among socioeconomically disadvantaged smokers (n=354) prior to policy implementation in Australia. The experimental quantitative study used computer touchscreen survey methodology. Plain cigarette packs stripped of branding elements and featuring larger health warning labels were associated with reduced positive brand appeal and purchase intentions. This is the first study of its type providing evidence of the potential effectiveness of cigarette plain packaging policy among disadvantaged smokers. Paper five “Paying the price: A cross-sectional survey of Australian socioeconomically disadvantaged smokers’ responses to hypothetical cigarette price rises” assessed the use of strategies to minimise the impact of cigarette price rises across two hypothetical price rise scenarios, and measured the possible influence of financial stress. Consistent intended use of price-minimisation strategies to manage smoking costs was reported, and financial stress appeared to have little effect. Larger cigarette price increases (i.e. 20%) are significantly more likely to motivate smokers to consider quitting compared with smaller price rises (i.e. 10%). Smokers who indicated they would not change their smoking behaviour in response to price rises had heavy nicotine dependence, large weekly tobacco expenditures, and made fewer quit attempts in the past year indicating they may require additional cessation support. Paper six ““Cigarettes are priority”: A qualitative study of how Australian socioeconomically disadvantaged smokers respond to rising cigarette prices” used qualitative interviews with socioeconomically disadvantaged smokers (n=20) to further examine the wider social and economic impacts of increasing cigarette taxes. To maintain smoking despite rising prices, socioeconomically disadvantaged smokers reduced household spending, consequently leading to further social and economic deprivation. Participants reported going without meals, substituting meal choices and not paying bills. The provision of additional assistance to smokers who may find it difficult to quit unaided, particularly during times of tobacco taxation increases, should be considered. In conclusion, the research contained within this thesis is the first in Australia to recruit highly socioeconomically disadvantaged smokers to examine responses to population-level tobacco control measures. The findings highlight ways current tobacco control interventions might be improved to increase effectiveness among socioeconomically disadvantaged smokers. Increasing the effectiveness of tobacco control strategies and adequately monitoring the impact of these interventions among highly disadvantaged groups with the highest smoking rates and documented poor quit success is pivotal to addressing the social gradient in smoking rates.
- Subject
- tobacco; smoking; social disadvantage; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1055855
- Identifier
- uon:15948
- Rights
- Copyright 2014 Ashleigh Guillaumier
- Language
- eng
- Full Text
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