Information on imminent versus long term health consequences: impact on children's smoking behavior, intentions, and knowledge

This study is concerned with the design and evaluation of persuasive conununications that can affectively intervene on the smoking behavior of children. Smoking behavior is influenced by psycho-social factors such as peer, parent, and media pressure. These social pressure sources are influential enough to offset the knowledge that smoking may lead to severe consequences such as lung cancer and heart disease. Nevertheless, many school anti-smoking programs stress the long term dangers of cigarette smoking. A number of studies which have evaluated traditional anti-smoking programs show that even elaborate programs usually do not result in significant reductions in adolescent smoking rates. The present investigation is based on a model of persuasive communications (Hovland, Janis, and Kelley, 1953) that focuses on the content stimuli of fear appeal messages which operate to arouse motives to accept opinions which are recommended. The model suggests that audience responsiveness should be assessed in terms of the degree to which the message elicits attention to the verbal content and acceptance of the conclusions advocated by the message. The degree to which this process occurs is hypothesized to be dependent on the meaningfulness of the message to the audience. Three factors are identified as affecting the meaningfulness of message. Threat may be minimized if the consequence communicated is perceived to be improbable, temporally remote, and/or is discounted as unimportant or inapplicable to one's self. With regard to children, the factor limiting the meaningfulness of traditional anti-smoking messages may be time perspective. Substantial research evidence indicates that children have limited future time orientation so that their perceptions of the future beyond childhood are unclouded by reality. Evidence also suggests that the perceived immediacy, probability, and severity of a consequence may be heuristically related. Consequences which children judge to be imminent are also judged to be highly probable while consequences judged to be temporally remote are perceived as being of concern only in the distant future. It may be that the efficacy of health-related messages directed at children can be increased if such messages are focused on immediate consequences which are highly probable. To test this hypothesis, a sample of 220 6th grade students was drawn from three public elementary schools in Houston, Texas. Four experimental groups were formed using a quasi-experimental design. One group was exposed to an anti-smoking program that stressed cancer as a consequence of smoking. A second group received information on carbon monoxide ingestion. Both groups were pretested, posttested immediately after exposure to the program, and posttested again ten weeks after the pretest. A testing only control group and a pretest/final posttest control group were also included. The cancer group viewed two cancer films, viewed preserved lung displays taken from the cadavers of persons who had lung disease, and engaged in focused discussions concerning these displays. The carbon monoxide group viewed two short films on carbon monoxide measurement in automobile exhaust, in cigarette smoke, and in the breath. A demonstration of the measurement procedure and discussion of the demonstration were also included. For both groups, posters reflecting the messages were placed in the classrooms. The dependent measures were concerned with smoking behavior, intentions to start smoking, information gained, and perceived salience of information about carbon monoxide. In order to increase the validity of self reports of smoking behavior, a three-step procedure was used. All subjects viewed a film which showed how a mass spectrometer could analyze salvia for nicotine content, then produced salvia specimens, and finally answered a 20-item dependent measure instrument. It was hypothesized that; 1) the smoking onset rate of the Co group would be lower than that of the Cancer group and that the smoking cessation rate of the Co group would be greater than that of the Cancer group; 2) no group would demonstrate changes in knowledge about cancer but that the Co group would demonstrate significant increases in knowledge about carbon monoxide; 3) initially, all subjects would perceive that all consequences of smoking are likely to happen sooner to others as compared to when the same consequences would occur to them personally if they started smoking. By the end of the study, the Co message group was predicted to continue to report differential perceived onset time for short term consequences; 4) non-smokers in the Co group, as compared to non-smokers in the cancer group, would report that they intended to start smoking later in life by the time of the final posttest; 5) subjects in the Co group would come to view short term health consequences as more salient to the health considerations of young people than long term consequences while the Cancer group would continue to view long term consequences as most salient. The results were generally supportive of the notion that persuasive appeals which communicate short term consequences of smoking will be more affective in intervention programs aimed at school children than are programs which describe severe long term consequences of smoking. Subjects in the Co group displayed a significant increase in cessation rate, learned to recognize carbon monoxide as a short term consequence of smoking, and came to judge short term consequences as being more salient to the health considerations of young people than long term consequences. The hypothesis concerning differences in perceptions for the onset of consequences in others as compared to personal estimates was not confirmed. The hypothesis regarding intentions-to-smoke-in-the-future also was not confirmed. It is concluded that if subsequent investigation results in a replication of the results obtained in the present study, then school systems may be advised to institute new programs emphasizing short term consequences of smoking in place of traditional programs which stress long term dangers such as cancer.