Health education for reducing tobacco consumption in Shanghai based on the health versus financial framing effect: A randomized field study

INTRODUCTION: In China, the regular use of tobacco by much of the population has brought great losses in both health and economy. This study used the framing-effect theory to explore people’s preferences regarding message-framing for education about financial and health-related gains associated with smoking cessation in different areas of Shanghai, China. In particular, it attempts first to identify any influencing factors and offers some suggestions to improve the efficiency of education efforts regarding tobacco control. METHODS: A message-framing field study was conducted in three districts in Shanghai that represent low-income, middle-income and high-income areas between June and August 2015, respectively. This study examines leaflets with a different message-framing (Health-Financial Framework) to ascertain the preferences of participants at the different locations. A total of 4650 participants were recruited and asked to complete a questionnaire. The z-test, chi-squared test and logistic regression analysis were used for statistical analysis. RESULTS: In low-income areas, participants were more inclined towards financial rather than health message-framing, especially in financial and health oriented locations. In the middle-income areas, participants preferred health message-framing, especially at hospital locations. In the high-income areas, health message-framing was preferred in health and neutral locations in comparison with financial locations. The type of area, location and household monthly income have an impact on participants’ preference for message-framing. CONCLUSIONS: Three suggestions are proposed for tobacco control health education in China: 1) Combine health education information design with the framing-effect theory to improve the effectiveness of information content, 2) Considering the impact of different types of area and location, different tobacco control health education strategies should be adopted to improve the efficiency of publicity, and 3) Targeted and personalized tobacco control health education strategies should be implemented among different audiences.