Perceived effectiveness of text-based tobacco control messages among Chinese young people: A mixed-methods study

INTRODUCTION: Tobacco use remains a significant public health challenge among young people in China. This study evaluated the perceived effectiveness of 10 text-based tobacco control messages among Chinese young people and identified key characteristics of effective messages. METHODS: We recruited 147 young people aged 11-23 years from public schools and universities in Beijing and Kunming during March 2021. Participants completed a structured questionnaire evaluating ten tobacco control messages by selecting the single most and least effective message for preventing smoking initiation. An effectiveness index (EI) was calculated as the percentage rating each message is most effective minus the percentage rating it is least effective. Follow-up focus group interviews explored reasons for effectiveness perceptions. Quantitative data were analyzed using chi-squared tests and binary logistic regression, while qualitative data underwent thematic analysis. RESULTS: Participants had a mean age of 14.6 years (SD=2.7), with 49.0% female and 98.6% never smokers. Messages providing specific information about severe health consequences were associated with the highest perceived effectiveness. The top-ranked message detailed multiple cancer types (EI=0.285), followed by severe lung disease and COPD (EI=0.232). Three commonly used messages showed limited effectiveness: 'No smoking, I'm healthy, I'm fashionable' (EI= -0.470), 'Smoking causes periodontitis' (EI= -0.204), and 'Refuse the first cigarette' (EI= -0.008). Binary logistic regression confirmed that gender was significantly associated with the least effective message selection after adjusting for covariates (adjusted odds ratio, AOR=3.85; 95% CI: 1.97-7.52, p<0.001 for females selecting the 'fashionable' message). Qualitative analysis identified that young people valued specificity, severity, and factual information, while vague language, directive tones, and unfamiliar conditions were associated with lower perceived effectiveness. CONCLUSIONS: Tobacco prevention campaigns targeting Chinese young people may benefit from prioritizing messages providing specific, factual information about severe health risks. Messages using abstract or directive language were associated with lower perceived effectiveness, offering preliminary guidance for more effective campaigns in China.