1. ®® Effects of Print Media on Attitudes Toward Smoking: Results From the Indiana Media Tracking Survey and Newspaper Tracking Systems Alec Ulasevich, PhD Clarese C. Astrin, PhD Steve Blahut, PhD Miranda Spitznagle, MPH Michelle Jones, MA American Institutes For Research Indiana Tobacco Prevention and Cessation Agency Alec Ulasevich, PhD Clarese C. Astrin, PhD Steve Blahut, PhD Miranda Spitznagle, MPH Michelle Jones, MA American Institutes For Research Indiana Tobacco Prevention and Cessation Agency

2. ®® Background Media Advocacy is an important component of tobacco use prevention programs News Media is an important source of health information Little is known on the effect of media coverage on attitudes toward tobacco control

3. ®® Research Question How does the amount of media coverage of specific tobacco control issues affect individual attitudes toward tobacco use and tobacco control?

4. ®® Data Sources ITPC News Media Tracking System (NMTS)  Comprehensive collection of all newspaper articles published in Indiana’s daily and weekly papers ITPC Media Tracking Survey (MTS)  A random sample survey of 1000 Hoosier adults measuring awareness of Indiana’s counter marketing campaign and attitudes toward tobacco use and tobacco control

5. ®® Methodology Hierarchical Linear Modeling (HLM)  Aggregate number of articles published on various tobacco control topics in each Indiana region one year prior to administration of MTS  Effect of media coverage on individual’s attitudes toward tobacco control and tobacco use clustered within each Indiana region.  Control for exposure to Indiana’s anti-tobacco media campaign

6. ®® Key Measures: Media Coverage Topics Clean indoor air Youth access Advertising restrictions Economic disincentives (e.g., taxes) Secondhand smoke Health consequences of smoking Healthcare cost Prevalence/Cessation Coalition/partner activities Media/outreach campaigns

7. ®® Key Measures: Attitudes and Beliefs Do you believe tobacco use by young people is a serious problem? Three measures related to perceived importance of youth smoking  People are being used by tobacco companies and tobacco companies put profits over people  I feel comfortable telling other people my age not to smoke  My family does not want me to smoke All questions were rated on a 4 point agreement scale

8. ®® Results: Youth Smoking is An Important Issue Individuals in regions with greater exposure to newspaper articles about tobacco taxes were significantly more likely to indicate that youth smoking is an important issue (t = 2.286, p <.05) compared to those individuals in regions exposed to fewer newspaper articles about tobacco taxes. Individuals in regions with greater exposure to newspaper articles about secondhand smoke were significantly more likely to indicate that youth smoking is an important issue (t = 3.261, p <.05) compared to those individuals in regions exposed to fewer newspaper articles about secondhand smoke. Individuals in regions with greater exposure to newspaper articles about the impact of smoking on healthcare costs were significantly more likely to indicate that youth smoking is an important issue (t = 2.078, p <.05) compared to individuals in regions exposed to fewer newspaper articles about the impact of smoking on healthcare costs.

9. ®® Findings: Effects on other attitudes Individuals in regions with greater exposure to newspaper articles about health consequences of smoking were significantly more likely to indicate the belief that tobacco companies put profits over people (t = 2.890, p <.05) compared to those individuals in regions exposed to fewer newspaper articles about health consequences of smoking. Individuals in regions with greater exposure to newspaper articles about health consequences of smoking were significantly more likely to indicate that they would feel comfortable telling someone their age not to smoke (t = 2.314, p <.05) compared to individuals in regions exposed to fewer newspaper articles about health consequences of smoking. Individuals in regions where newspapers carried a greater overall number of tobacco-related articles were more likely to indicate that their families would prefer for them not to smoke (t=2.799, p <.05) compared to individuals in regions where newspapers carried fewer overall tobacco-related articles.

10. ®® Conclusion Amount of coverage on taxes, second hand smoke and health care costs were significantly related to perceived importance of youth smoking as a social issue The issue of youth access is salient in coverage of cigarette taxes. However, issues of second hand smoke and health care costs are only tangentially related to youth smoking. The effect of media coverage of these issues could be the overall increase in the awareness of smoking as an important issue that generalized to youth smoking. Overall amount of coverage was significantly related to a belief that one’s family does not want one to smoke. This finding suggests that the media attention given to the overall topic of tobacco control may contribute to the normative beliefs that smoking is not acceptable. The belief that one’s family is opposed to one’s smoking may be a reflection of this overall negative social attitude toward smoking.

11. ®® Conclusions Amount of coverage of health consequences of smoking was significantly related to negative attitudes toward tobacco industry and willingness to tell others not to smoke The observed relationship between the amount of media coverage of health consequences of smoking and negative attitudes toward the tobacco industry suggests that health information may be a factor in moving individuals from viewing smoking as a private issue to viewing it more as a public health concern. As such, the attribution of the behavior may have changed from personal choice to that of manipulation by the industry. The relationship between coverage of health consequences of smoking and respondents stating willingness to tell others not to smoke suggests that media coverage may socially empower individuals to advise others not to smoke. Thus, the news media may not only reinforce already held beliefs about the dangers of smoking, but may also allow individuals to cite “outside” credible sources in telling others not to smoke.