The Impact of Messaging on the Relationship Between COVID-19 and Perceptions of Tobacco Smoking

Background:The COVID-19 pandemic had a major impact on public health, especially for smokers, who faced higher infection risks and more severe disease progression.This study aimed to investigate how public health messages influence smokers' perceptions of tobacco use.Methods: This randomized controlled trial involved 1,303 adult smokers allocated to one of the following three groups: (1) a control group receiving a general smoking risk message, (2) a treatment group receiving a loss-framed message emphasizing smoking risks during COVID-19, or (3) a treatment group receiving a gain-framed message highlighting the health benefits of quitting during COVID-19.Immediately after reading the message, participants completed an Implicit Association Test to measure their unconscious attitudes toward tobacco by focusing on positive and negative perceptions.Results: COVID-19-related messages had a greater impact on smokers' perceptions than general messages about smoking risks, with differences depending on age and level of nicotine dependence.The gain-framed message was particularly successful in reinforcing negative views of tobacco among older smokers.Both gain-and loss-framed messages proved especially effective for individuals with high nicotine dependence.Conclusion: Message framing plays a crucial role in shaping smokers' perceptions during respiratory disease outbreaks, such as COVID-19.For effective smoking cessation policies, messaging strategies should be tailored to individual characteristics such as age and nicotine dependence.This study provides empirical evidence supporting effective public health communication strategies, particularly in the context of a pandemic.