Background
- Problem: The use of electronic cigarettes by adolescents.
- Topic importance: E-cigarettes’ use by teenagers is growing despite adverse effects.
- Target audience: Adolescents.
- Attitudes and behavior: Skepticism to the risk of e-cigarettes and their perception as something “cool” lead to smoking.
- Setting: A social media campaign on YouTube, Snapchat, and Instagram.
Introduction
Electronic cigarettes (e-cigarettes) appeared on the market rather recently, but their use has grown substantially over the years. These devices act similar to traditional cigarettes, cigars, and pipes, mimicking the process of smoking and, in some cases, providing a user with a dose of nicotine (Centers for Disease Control and Prevention [CDC], 2019). The debate about the benefits and drawbacks of using e-cigarettes over traditional ways of smoking is ongoing. The problem discussed in this paper concerns the popularity of e-cigarettes among the youth – many teenagers and young adults currently use these devices (Johnston, O’Malley, Miech, Bachman, & Schulenberg, 2015). Although the research on e-cigarettes is incomplete, more and more studies are showing that these devices have a severe and long-lasting negative effect on adolescent health. Some problems include respiratory symptoms, such as chronic bronchitis and toxic poisoning, since e-cigarettes may contain carcinogenic compounds (McGiney, 2018). Such health issues often go unnoticed by the public because the findings are recent.
Another harmful effect of e-cigarettes is the chance that, after using them, adolescents will switch to traditional tobacco cigarettes, which have many known life-threatening effects on one’s health. This fear is not baseless as numerous studies support it. Primack, Soneji, Stoolmiller, Fine, and Sargent (2015) and Leventhal et al. (2015) collect data and find that young people switch to cigarettes after using their electronic counterparts more often than those who did not smoke in the first place. Thus, this paper aims to shed some light on these connections and present essential information for adolescents themselves and their families to persuade them to stop or reduce the use of e-cigarettes.
The importance of this topic lies in the concern for public health and the lack of information that is currently considered by the broader public in relation to e-cigarettes. The paper can be used by policymakers, activists, and concerned individuals who want to reduce the presence of e-cigarettes. Furthermore, it may encourage one to develop and present regulations that will lower the use of e-cigarettes among adolescents. The paper will discuss the target audience of the campaign, attitudes and behaviors that lead these persons to use electronic cigarettes, and the channels through which the target audience may be reached. Finally, two theoretical models will be discussed to support the campaign and relate the persuasive content of the paper to the principles under which people can be informed and convinced.
Target Audience
The chosen target audience for this project is adolescents who engage in e-cigarette smoking. These persons are between the ages of a teenager and adult, transitioning from reliance on thein gamily or guardians to independent lives. Therefore, their growing desire for individual thinking and self-reliance makes the idea of a direct appeal more effective than a campaign targeting families or schools. While these groups also need to learn about the harmful effects of smoking e-cigarettes, adolescents’ desire to be treated as adults can be used to increase the appeal of the promoted message (Abou-Sabe & McFadden, 2018). Thus, a direct approach is chosen, with the further potential of using the information as a basis for legal and organizational change.
Attitudes and Behavior
The first attitude towards e-cigarettes is the dismissal of the idea that they are as dangerous to one’s health and traditional cigarettes. Before the research about the harms of e-cigarettes started appearing, the general perception of the public was that they do not have the same effect on health, especially if they do not contain nicotine (CDC, 2019). Therefore, all current findings of the harmful consequences of using these devices are dismissed or viewed with a high degree of skepticism. This attitude should be addressed because a critical view of a subject is often at the center of persuasion campaigns. The social judgment theory can explain this connection between attitude and behavior change –common knowledge states that e-cigarettes are not harmful, in contrast to traditional tobacco cigarettes (McGiney, 2018). Thus, in the minds of people using these devices, new information is met with doubt as it differs from the accepted ideas and the widespread access to e-cigarettes. Moreover, the probabilogical model can be utilized, providing such statements as “e-cigarettes do not have nicotine,” “nicotine is the main problem in traditional cigarettes,” and, consequently, “e-cigarettes are not dangerous.”
The second attitude is the appeal of e-cigarettes as a part of being “cool.” While the definition of what is considered “cool” is not concrete, it is apparent that the use of e-cigarettes is closely tied to the perception of adulthood (Abou-Sabe & McFadden, 2018). Moreover, the absence of nicotine and a variety of fruit- and candy-flavored products make e-cigarettes appear less threatening to one’s well-being, equating them to snacks of similar foods (Pepper, Ribisl, & Brewer, 2016). Here, the probabilogical model may connect such thoughts as “adults smoke” and “I am an adult,” leading to “I should smoke to show that I am an adult.” The need to conform to societal trends is exceptionally high for adolescents in public spaces, such as high school. For example, the popularity of Juul, a brand of stylish e-cigarettes, is affecting schools and persuading adolescents to smoke (McGiney, 2018). Teenagers note that, once e-cigarettes entered the market, everyone was “Juuling” and asking each other to try new flavors (Abou-Sabe & McFadden, 2018). Here, the theory of reasoned action (TRA) explains this phenomenon as adolescents’ choice to value their community’s opinion in using e-cigarettes.
As a result of the attitudes towards e-cigarettes as not harmful and popular, the rates of adolescents using e-cigarettes continue to grow. According to Johnston et al. (2015), teenagers are more likely to smoke –cigarettes than traditional cigarettes, and twice as many young men use electronic cigarettes as young women (p. 15). The research explaining the popularity and role of e-cigarettes in adolescents’ lives is discussed above. It shows that the interest in e-cigarettes arises from several factors, including the access to e-cigarettes for all ages, its resemblance to cigarettes, the lack of knowledge about health issues, and the desire to conform to societal norms.
Setting
As the project is directed at adolescents, the channels of reaching this target group have to be approved by and authoritative to them. For this reason, social media campaigning is selected as the main setting. Adolescents are among the primary users of the internet, and their knowledge of the networks raises the chances of reaching a broader demographic in comparison to utilizing other mass media channels.
According to statistics, more than 80 percent of the youth aged between 13 and 17 years have access to the internet (Clement, 2019). Furthermore, more than 90 percent of teenagers have smartphones, which also have internet access (Clement, 2019). The presence of adolescents on social media is similarly high – around 70 percent of young people say that they have more than one account on various social media platforms (Office of Adolescent Health, 2019). The most popular platforms are YouTube, Snapchat, and Instagram – teenagers use these social media sites almost constantly (Anderson & Jiang, 2018). These settings allow campaigners to target adolescents using metadata and presenting them with advertisements. These ads can be in the form of interactive video messages or slideshows, with links to a website with further information and a call to action.
Design Features
Designing health messages and developing educative campaigns is not an easy task that requires much time and attention. Along with persuasive theories and frameworks, it is expected to choose the correct context and understand the essence of a model. The choice of design features depends on the intentions of a campaign and the urgency of the chosen topic. The problem of using e-cigarettes remains urgent, and one should have access to clear information and lessons to make correct choices and decisions. In this paper, the evaluation of five design features based on protection motivation theory, probabilogical models, cognitive dissonance theory, social judgment theory, and inoculation theory will be developed to prove the worth of a campaign.
Protection Motivation Theory (PMT)
The first proposed design feature is based on the Protection Motivation Theory (PMT). PMT is a part of appeal models posing that fear can be used to make messages persuasive (Cameron, 2009). PMT has two central mechanisms – the appraisal of threats and coping (Cameron, 2009). This means that a person is likely to make decisions that will lead to the least punishment and the most comfort. This particular approach has been used in healthcare campaigns for years, using people’s sense of self-preservation as a driver for healthy behaviors. Cessation programs for traditional cigarettes are often based on PMT, and their effectiveness is proven by research. Xu and Chen (2016) appraise the usefulness of this theory for smoking adolescents and note that it has many benefits to constructing a smoking cessation initiative. Similarly, hookah smoking in adolescents was also examined using PMT, providing positive results (Mazloomy Mahmoodabad et al., 2018). In both examples, teenagers are made aware what smoking can do to their bodies in long-term. Therefore, it is possible to assume that the use of e-cigarettes, another type of smoking, can be approached with this theory.
In this case, the main message that the campaign should disseminate is that e-cigarettes are dangerous. They have the same adverse effects as tobacco cigarettes and, additionally, the risks of consuming carcinogens (Rubinstein, Delucchi, Benowitz, & Ramo, 2018). Thus, it is crucial to highlight that e-cigarettes that do not have tobacco in them are still a significant threat to one’s health and the health of their friends and families. Studies about the harms of e-cigarettes show long-term impacts on health that can be irreversible (McConnell et al., 2017). This data has to become the foundation for the campaign, as directed by the PMT. This theory argues that people’s sense of self-preservation influences their decisions, which applies to the issue of smoking and health.
Probabilogical Models
Examining the attitudes of adolescents to e-cigarettes, one can see that a significant argument for using them is their popularity. A young person may look at their peers and see that everyone or many of them are “vaping” or “juuling,” which affects their thinking about e-cigarettes. The probabilogical model explains these mechanisms and helps to deconstruct them and create new connections that emphasize smoking cessation or negative view of electronic cigarettes. The current thought process is “everybody is using e-cigarettes,” “I want to be respected by my peers,” “I should smoke e-cigarettes.” This direction has to be challenged and changed to “smoking e-cigarettes is dangerous,” “my friends are at risk,” and “I should stop smoking and spread the message to my friends.”
The previous research on persuasion campaigns shows that probabilogical models can be effectively used in creating positive messages about food and other products. Package claims, for instance, can create specific social cues and influence thinking (Skubisz, 2017). Therefore, the use of this theory to create a new image for e-cigarettes also has the same potential. The campaign should focus on removing the message of e-cigarette advertising as safe and fashionable and develop a view that shows the dangers of e-cigarettes to one’s health.
Cognitive Dissonance Theory
Using social media as one of the sources of information has already become a significant part of human life, and people cannot ignore an opportunity to learn something from such sources as YouTube or Instagram. Different platforms can be easily accessed, and young adults may not only read or listen but also share their feedback and develop their own discussions about e-cigarettes. Cognitive dissonance theory is one of the theories to develop a comprehensive design of a campaign to persuade the audience to think about e-cigarettes usage. In the middle of the 1900s, Leon Festinger offered this theory as the necessity to study “the extreme discomfort of holding two antithetical thoughts at the same time” (Jeong, Zo, Lee, & Ceran, 2019, p. 232). The main idea of this approach is to focus on different cognitions like beliefs or opinions and the relationships that consumers tend to develop (Cameron, 2009). As soon as some understanding is achieved, it is possible to deal with existing conflicts and make one rational decision about the influence of e-cigarettes.
This theory is frequently applied in different studies, including advertising and campaigns’ creation. Two concepts, magnitude and dissonance, cannot be ignored because they influence smokers’ attitudes and determine their steps. For example, Liang (2016) used cognitive dissonance theory to examine online services and post-decision dynamics. The chosen approach helped clarify the way of how people read online information and review services to reduce dissonance among their cognitions. In this case, when the influence of e-cigarettes is evaluated through the prism of public health and fashion, cognitive dissonance theory plays an integral role. It may contribute to two decisions, either to change behaviors and stop smoking or change beliefs about the chosen behavior. Mayorga, Garey, and Zvolensky (2019) used the same theory and design to prove that the frequency of e-cigarettes use depends on public beliefs. Now, it is time to think about cognitive mechanisms that can be applied to change (improve) beliefs and underline health-related issues.
Social Judgment Theory
The goal of advertising is to increase demand and influence people to change their behaviors and motifs. It is extremely important to understand what kind of persuasion is effective and how e-smokers accept the offered services. Social judgment theory was introduced in the 1930s and developed in the 1960s as “an understanding of person’s attitude on subjects” to “provide a clue… to approaching persuasive effort” (Asemah & Nwammu, 2017, p. 75). The core of this design feature in the chosen context is the evaluation of interests and judgments of e-cigarettes’ impact. There are many personal reasons to accept or reject any idea of e-smoking, and this theory underlines the necessity to consider the power of these possibilities, existing anchors, and followed decisions.
E-cigarettes become a frequent topic for modern campaigns and discussions. In the study, it is expected to learn how people determine and combine their beliefs along with current options and change their attitudes due to existing persuasion and content (Ma, Atkin, Snyder, & van Lear, 2018; Matthews, 2019). In e-smoking campaigns, social judgment helps realize if the change of customers’ attitudes is possible in regards to their agreements and disagreements. Besides, it indicates the worth of assimilation of e-smoking knowledge by the representatives of the modern culture. E-cigarettes campaigns may fail because of the impossibility to understand what determines people’s choice. This theory enhances the classification of potential e-smokers and shows what directions are effective. At the same time, e-smoking is an example of misperceived health behaviors, and the goal of this theory is to identify and reduce the gap between wrapped perceptions about e-smoking and actual practices and consequences.
Inoculation Theory
Another approach to understanding how to succeed in developing a campaign and prevent young adults from using e-cigarettes is based on inoculation theory. According to Cameron (2009), resistance to persuasive attempts is its distinctive feature. It was firstly introduced in the middle of the 20th century by McGuire as an attempt to follow changes of attitudes and beliefs and control factors that may influence these changes. This theory fits the topic of e-smoking because it helps gather enough arguments to persuade a person and gain loyalty in health behaviors and e-cigarettes avoidance. Inoculation theory is not only a chance to work directly with e-smokers but to think about the steps that can be taken by opponents who promote this activity. Today, it is easy to find approval for bad habits, relying on personal freedoms, and this theory determines the negative aspects of e-cigarettes to be mentioned not at the expense of human rights.
There are many important aspects of inoculation theory that influence the effectiveness of e-cigarette campaigns. In their study, Sharpe and Hanson (2018) used the theory to discuss how explanatory knowledge about advertising can predict the negative effects of corporate social responsibility. In the chosen context, one should say that modern young adults are exposed to various sources of information and lose the right way due to the lack of knowledge about e-cigarettes. There is a burning need to prove the effects e-cigarette smoking may have on people, and counterarguments developed within the frames of this theory may be significant. Gesualdo and Yanovitzky (2019) investigate the relationship between advertising and preferences for the consumption of specific food. The use of this theory proves the importance of resisting to advertising effects and enhances the attention to counterarguments that strengthen the chosen position. Similar approaches seem to be effecting in discussing the effects of e-cigarette smoking and achieving the established goals, which are the promotion of public health and prevention of smoking among young adults.
Next Steps
The idea of the campaign identified in this paper is to explain the effects of e-cigarette smoking, contribute to positive outcomes in public health, and prevent the development of negative habits in young adults. There are five possible design features that can be applied to this project, focusing on protection, positive messages, consumer beliefs, persuasion, and counterargument. Each has its particular strengths and benefits and is used in different advertising campaigns. One of the critical steps of the campaign is to make a choice and follow the offered directions. It is recommended to check if inoculation theory can be effective enough for preventing smoking activities in the defined audience.
On the one hand, one should gather enough material about all aspects of e-cigarette smoking and discuss what positive and negative attitudes exist at the moment. It was mentioned that young people could prefer smoking e-cigarettes because they consider it as a cool activity. Some youths believe that e-cigarettes may be compared to the decision of to eat a dessert or drink an alcohol cocktail (Lewak, 2017). Comparing a cigarette to a glass of wine provides people with an opportunity to reduce the number of the negative effects on health. Such trends exist, and it is important to respect them. Therefore, a campaign should not be based on negative aspects of smoking only. When people see that their choices are recognized and respected, they are eager to watch or learn other alternatives and weight their chances. Inoculation theory will be a vaccine for young adults to indicate all potential benefits and threats of smoking and strengthen the arguments to quit this habit as soon as possible (with respect to their beliefs and attitudes).
Regarding such an analysis, the recommendations are as follows:
- To gather enough information about why people choose e-cigarettes;
- To learn what people feel when they smoke;
- To describe life with and without e-cigarettes;
- To introduce strong statistics and real-life examples;
- To tell why this campaign aims at preventing smoking e-cigarettes among young adults.
These steps will help strengthen the campaign and be prepared for a variety of attitudes toward what is given there. Many smokers do not find it necessary to listen to commonly encouraging speeches about the harm of smoking and its negative outcomes on the environment, children, families, and even working qualities. The purpose of this campaign is to attract the attention of all young adults, either smokers or non-smokers, and share the data to prevent e-cigarette brand. There are many other alternatives to stay cool and be healthy at the same moment, and people should learn about their opportunities. Inoculation theory promotes design where e-cigarette smoking is not considered as a purely bad or negative but as something that has better alternatives.
The choice of the content and the tone plays a crucial role in the creation of the campaign. Multiple anti-smoking advertisements can be found within several seconds online. In this case, the strength of the project lies in respect, options, and the best decision. The history of relationships between young adults and e-cigarette smoking is rich and long. Longitudinal studies published in peer-reviewed articles prove the possibility to replace cigarette smoking with the less harmful e-cigarette activities (Soneji et al., 2017). Still, fashion is hard to control, and YouTube, Instagram, or Snapchat campaigns must not only teach but entertain and fascinate.
In general, the idea of using a social media campaign to predict e-cigarette smoking is not new. Therefore, competition and history can prevent its successful recognition within a short period. To make a unique offer, the developers of this campaign should combine educative material, personal interests, fashion choices, and opposite beliefs within the same message. Inoculation theory contributes to the choice of the correct design feature and the evaluation of supportive ideas and counterarguments. Sometimes, people are not ready to quit their smoking habits just because it is said in a campaign. Young adults are also exposed to a variety of external factors, brands, and social changes. Therefore, to predict the use of e-cigarette smoking and improve public health, a campaign should include different opinions, options, and background knowledge to help a person make the best and right choice.
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