Testing Different Anti-smoking Messages Among Chinese Young Adult Smokers and Nonsmokers

Young adults are particularly vulnerable to psychological distress during the transition from adolescence to adulthood, making them more susceptible to developing persistent substance use. The tobacco industry capitalizes on this vulnerability by using marketing tactics to promote tobacco initiation and facilitate the progression from experimental tobacco use to long-term use. In China, where the average age of starting daily smoking is 21.1 years old, the number of current young adult smokers exceeds 29 million. It is crucial to develop effective communication messages to counter the tobacco industry's marketing strategies and protect the health of young adults in China. This project aims to test the effects of different anti-smoking message themes among Chinese young adults. In this online randomized clinical trial, participants will be randomly assigned to one of five antismoking message conditions. The investigators will compare the effects of these themes with each other and with the control condition.

Study Overview

• Status: Completed
• Conditions: Smoking Prevention
• Intervention / Treatment: Behavioral: Health effects; Behavioral: Tobacco industry manipulation; Behavioral: Secondhand smoke; Behavioral: Mentral health; Behavioral: Social acceptability; Behavioral: Control

Detailed Description

In this study, the investigators will examine the effectiveness of different anti-smoking themes in reducing intention to smoke among Chines young adults. The study will recruit 1500 adults aged 18-25 years old, including 750 current smokers and 750 non-smokers, evenly split between male and female.

The study will be conducted through a self-administered, web-assisted online survey software. Participants will be asked to consent to participate in this study via a consent form presented at the beginning of the survey. Consented participants will be randomized to one of six conditions (each represents a level of the independent variable: anti-smoking message theme): 1) Health effects 2) Tobacco industry manipulation 3) Mental health 4) Secondhand smoke 5) Social acceptability 6) Control messages with no cigarette-related content.

The study has two sessions. In session 1, participants will complete a 20-minute survey. The survey will begin with questions assessing demographic characteristics. Then participants will be shown intervention or control messages (watch three 30-second video in each condition), and beliefs and future intention to smoke cigarettes will be assessed.

Two weeks after session 1, participants will be asked to complete a 5-minute survey in session 2 of the study. The survey will measure participants' recall of the messages and smoking behaviors in the past two weeks after message exposure.

• Study Type: Interventional
• Enrollment (Actual): 1541
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Shanghai Municipality
    • Shanghai, Shanghai Municipality, China, 200433
      • Online
• United States
  • Georgia
    • Atlanta, Georgia, United States, 30303
      • Georgia State University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• • Aged between 18-25 years old

  • Current residency in China
  • Current smokers - having smoked at least 100 cigarettes in a lifetime and currently smoking every day or some days
  • Nonsmokers - having not smoked 100 cigarettes in a lifetime and do not currently smoke cigarettes
  • Can to read, speak, and understand Mandarin Chinese

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

6

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Control; Participants will receive messages about bottled water which should have no impact on the outcomes of interest.	Behavioral: Control; Participants in this arm will watch 3 short videos about drinking bottled water during the survey data collection. These messages display specific water products and describe hydration as a healthy activity.
Experimental: Health effects; Participants will receive messages with information about smoking-related diseases.	Behavioral: Health effects; Participants in this arm will watch 3 short videos about the smoking-related diseases during the survey data collection.
Experimental: Tobacco industry manipulation; Participants will receive messages with information about how the tobacco industry uses targeted marketing and manipulative tactics aimed at youth and young adults.	Behavioral: Tobacco industry manipulation; Participants in this arm will watch 3 short videos about how the tobacco industry uses targeted marketing and manipulative tactics aimed at youth and young adults during the survey data collection.
Experimental: Secondhand smoke; Participants will receive messages with information about secondhand smoke exposure.	Behavioral: Secondhand smoke; Participants in this arm will watch 3 short videos about the risks of secondhand smoke exposure during the survey data collection.
Experimental: Mental Health; Participants will receive messages with information about the effects of smoking on mental health.	Behavioral: Mentral health; Participants in this arm will watch 3 short videos about the effects of smoking on mental health during the survey data collection.
Experimental: Social acceptability; Participants will receive messages that portray smoking as socially unacceptable in China.	Behavioral: Social acceptability; Participants in this arm will watch 3 short videos about how smoking is socially unacceptable in China during the survey data collection.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intention to use tobacco	A five-item scale measuring future intentions to smoke cigarettes and other forms of tobacco over the next year. Response options: from 1 (very unlikely) to 5 (very likely). Higher scores represent stronger intention to use tobacco.	Immediately after message exposure

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceived harm of smoking	Measured with a single item, assesses participant's perception of own risk of overall harm to health under conditions of smoking every day. Response options range from 1 (Not at all likely) to 5 (Extremely likely), with higher scores representing a better outcome.	Immediately after message exposure
Perceived Message Effectiveness	A three-item scale measuring to what extent participants think the messages they saw discourage them from wanting to smoke, make smoking seem unpleasant, and make them concerned about health risks of smoking. Response options: from 1 (Disagree) to 4 (Neither Disagree nor Agree) to 7 (Strongly Agree). Higher scores represent a better outcome. The final perceived message effectiveness score is the mean of the response to the three items.	Immediately after message exposure
Quit intention	Only measured among smokers. A two-item scale measuring to what extent participants are interested in quitting in the next 6 month. Response options are from 1 (Not at all likely) to 5 (Extremely likely), with higher scores representing a better outcome. The final quit intention score is the mean of the response to the two items.	Immediately after message exposure
Smoking behavior	Single item measuring the average number of cigarettes smoked per day in the past two weeks.	Two weeks after message exposure
Intention to use tobacco in follow-up test	A five-item scale measuring future intentions to smoke cigarettes and other forms of tobacco over the next year. Response options: from 1 (very unlikely) to 5 (very likely). Higher scores represent stronger intention to use tobacco.	Two weeks after message exposure

Collaborators and Investigators

• Sponsor: Georgia State University

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2025
• Primary Completion (Actual): October 1, 2025
• Study Completion (Actual): October 1, 2025

Study Registration Dates

• First Submitted: December 8, 2024
• First Submitted That Met QC Criteria: December 11, 2024
• First Posted (Actual): December 12, 2024

Study Record Updates

• Last Update Posted (Estimated): October 14, 2025
• Last Update Submitted That Met QC Criteria: October 9, 2025
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: health communication; smoking behavior; anti-smoking
• Additional Relevant MeSH Terms: Behavior; Smoking; Public Health; Environment and Public Health; Complex Mixtures; Particulate Matter; Environmental Pollution; Smoke; Air Pollution; Tobacco Smoke Pollution
• Other Study ID Numbers: H24245

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No