# Framing effects on smoking cessation intentions: A quasi-experimental study of gain- versus loss-framed text messages among male smokers in China

## TL;DR

This study found that messages emphasizing gains, rather than losses, increased smoking cessation intentions among male smokers in China.

## Contribution

The study demonstrates that gain-framed messages are more effective than loss-framed messages in increasing quit intentions among Chinese male smokers.

## Key findings

- 34.6% of participants in the gain-framed group showed increased quit intention compared to 30.7% in the loss-framed group.
- Gain-framed messages had stronger effects for participants with low self-efficacy and low self-exempt beliefs.
- The quasi-experimental design suggests a need for further research to confirm these findings in real-world settings.

## Abstract

China has over 300 million smokers, yet overall willingness to quit remains low. Moreover, more than 90% of Chinese smokers who attempt to quit have no professional support, underscoring the need for effective self-directed cessation interventions.

We conducted a pretest–posttest quasi-experimental study in Hangzhou, China (March–June 2023). A total of 1082 eligible adult male smokers were allocated to receive gain-framed (n=546) or loss-framed (n=536) cessation messages after baseline assessments. Quit intention was measured with a 5-point Likert scale immediately before and after exposure to the allocated message. The primary outcome was an increase in quit intention post-exposure. Logistic regression was used to compare framing effects between groups, adjusting for occupation, annual household income, baseline quit intention, self-exempt beliefs, self-efficacy, and nicotine dependence (FTND). Subgroup analyses explored effect modification by these psychological factors.

All participants received the allocated intervention and 1081 were included in the final analysis. Increased quit intention was observed in 34.6% of the gain-framed group versus 30.7% of the loss-framed group (adjusted odds ratio, AOR=0.73; 95% CI: 0.55–0.98; p=0.038). Subgroup analyses showed consistent benefits of gain-framed messages, with stronger associations among participants with low self-exempt beliefs (AOR=0.66; 95% CI: 0.45–0.96; p=0.031) and low self-efficacy (AOR=0.48; 95% CI: 0.28–0.83; p=0.008).

Gain-framed messages were associated with higher quit intentions than loss-framed messages among Chinese male smokers. Tailoring message framing to smokers’ psychological profiles may yield more favorable responses. Given the quasi-experimental design, further studies are needed to obtain sufficient evidence for culturally sensitive tobacco control strategies in China.