The picture of smoking in my mind: a need for effective anti-smoking public service announcements based on the self-construals of smokers

Abstract

This qualitative study sought to understand the behaviours of smokers with independent and interdependent self-construals to design effective anti-smoking public service announcements (PSAs). Findings from the participants’ narratives and drawings suggest that individualistic message content (focused on the individual smoker) can be effective for smokers with independent self-construal, while collectivistic message content (focused on a smoker group) can be effective for smokers with interdependent self-construal to increase their quitting intentions. This study also revealed characteristics of the smoker groups in terms of routines, meanings and symbolic values of smoking, which can be used to enrich the contents for anti-smoking PSAs. The implications of this study are discussed for public policy makers and nonprofit organizations that seek to match their message with the audience to improve public health.

Keywords

self-construal smoking anti-smoking public service announcements social marketing culture

Introduction

Anti-smoking public service announcements (PSAs) are a tool commonly used by state institutions and non-governmental organizations to change smoking attitudes and behaviours of a large target audience. Despite evidence for the effectiveness of anti-smoking media campaigns (1), there is general recognition of their insufficient success (2) and need for continual improvement. While ongoing marketing efforts of tobacco companies are one factor counteracting PSAs (3), institutions must also continually re-evaluate the possibility of ineffective anti-smoking messages.

To develop effective health messages and increase campaign success, message features and how messages are processed must be understood (4). Much research has considered matching the ideal message with the cultural factors of an intended audience (5,6). Congruence between message content and the audience is a vital part of all health communication and specifically anti-smoking PSAs (7).

There is an ongoing debate in the health communication literature about the effect of self-congruent messages on individuals. The self-congruency effect suggests that advertising appeals that are consistent with the self-concept of the individuals can be more effective (8,9). For example, Chang (7) supported the effect of self-congruent messages by showing that anti-smoking messages focusing on the self are more influential with independent self-construal Taiwanese student smokers. Other research has challenged the self-congruency effect (5,10,11). For example, Yang et al. (11) demonstrated that nonsmokers in the USA with interdependent self-construal were counter-intuitively more affected by anti-smoking messages emphasizing personal (rather than relational) consequences of smoking.

This research re-examines the discrepancy over the self-congruency effect on health messaging in three somewhat unique ways. Firstly, because most studies challenging the self-congruency effect were conducted primarily in the individualistic USA, studying the subject in a less individualist culture may provide balance. Secondly, the current study utilizes the strengths of qualitative inquiry to explore the routines, meanings and symbolic importance of smoking and their connection to self-congruency. Thirdly, this study utilizes a non-student sample to mitigate the limitations of student samples (12). The current study therefore differentiates from others in terms of using a non-US Turkish participant profile, a qualitative methodology and including 25- to 35-year-old smokers.

To understand the effect of self-congruent messaging, this study considers anti-smoking PSAs broadcast in Turkey. Although Turkey has been implementing the measures set by the World Health Organization (WHO) with great effort since 2008, smoking rates are still high (3). Turkey is the fourth highest country in terms of the percentage of daily smokers in 2017 (13). According to this data, 26.5% of the population above the age of 15 constitutes daily smokers in Turkey, trailing only Indonesia, Russia and Greece.

To decrease smoking rates in Turkey, the government uses anti-smoking PSAs as one of its main tools. The themes of PSAs in Turkey are mostly negative health effects of smoking on individuals, and the most common message strategy is creating fear and disgust towards tobacco (14,15). Moreover, the focus is the quitting attempts of an individual, not a group. Therefore, the ineffectiveness of PSAs in Turkey (15,16) and its continued high smoking rate motivates this research to better understand and communicate with Turkish smokers. Accordingly, our study aims to answer the following research question: how can anti-smoking PSAs be designed in terms of effective message contents for smokers with independent and interdependent self-construals to increase their quitting intentions?

Methodology

Participants

The sample in this study is composed of eight males and nine females who are between the ages of 25 and 35 years and currently smoking cigarettes. This age group constitutes approximately 33% of the smoker population in Turkey (17). To reach the participants for the current study, the snowball technique was used. The researcher first asked for her personal contacts to participate in the study and reached nine participants initially. Afterwards, those contacts connected with their acquaintances and informed the researcher about their participation willingness. The sample is well-educated, with variation in marital status and occupation. The demographics and smoking information for the sample are given in Table 1.

Table 1.

Demographic characteristics of the sample.

Name ^a	Gender	Age	Education	Occupation	Marital status	Years smoked
Smokers with independent self-construal (independent smoker group)
Mert	Male	26	Bachelor’s	Masters student	Single	10
Ufuk	Male	27	Graduate	Research assistant	Single	4
Veli	Male	27	Bachelor’s	Engineer	Single	10
Deniz	Male	27	Bachelor’s	Engineer	Single	11
Onur	Male	28	Graduate	Doctor	Single	9
Sibel	Female	28	Bachelor’s	Consultant	Married	12
Burcu	Female	29	Graduate	Research assistant	Married	12
Yasin	Male	31	Bachelor’s	Engineer	Single	13
Meltem	Female	35	Bachelor’s	Nurse	Married	17
Smokers with interdependent self-construal (interdependent smoker group)
Merve	Female	25	Bachelor’s	Pharmaceutical representative	Single	6
Pelin	Female	27	Bachelor’s	Engineer	Single	2
Mustafa	Male	29	Bachelor’s	Gov’t official	Single	13
Ceren	Female	29	Bachelor’s	Engineer	Single	10
Buket	Female	29	Graduate	Engineer	Married	4
Alper	Male	30	Graduate	Engineer	Married	11
Sevgi	Female	32	Graduate	Academician	Married	8
Elif	Female	35	Bachelor’s	Teacher	Single	11

Names changed to protect the privacy of the participants.

Data collection

In this study, two different qualitative methods were used to gain an in-depth understanding about the smoking behaviour and self-construals of the participants: semi-structured interviews and art-based method in the form of personal drawings. The interview guide was prepared to explore individuals’ beliefs, experiences, perceptions and motivations (18). To determine the independent and interdependent self-construals of the participants, questions were prepared based on the INDCOL (Individualism-Collectivism) scale (19) as well as descriptive measures in the broader literature. The main questions in the interview guide are provided in Table 2.

Table 2.

Interview guide.

Interview questions
Warming-up questions:
When and how did you start smoking?
What do you like about smoking? Do you have any smoking routines?
If you ever stopped smoking, what do you think will be missing in your life?
What can you say about the positive and negative consequences of smoking on you?
Questions about self-construals:
How do you make your decisions regarding life?
How does it feel to you to have a disagreement with your family and friends about a subject? And what do you do when you have a disagreement?
What does it mean for you to become successful in life? And how do you feel when people around you become more successful than you on a particular subject?
Do you think that you are different from people around you? How do you feel about this?
Does anyone in your life express any concerns about your smoking? How do you feel about this?
Drawing section:
Now, I request you to draw a picture that represents you. In what kind of scene do you draw yourself while smoking?
Questions about anti-smoking public service announcements (PSAs):
What do you think generally about anti-smoking PSAs that are broadcasted on TV?
Can you exemplify the catchiest parts from the anti-smoking PSAs that you have watched? And what is your reaction to those parts generally?
If you were to prepare anti-smoking PSAs, what kind of contents would you consider encouraging yourself to quit smoking?
Based on your answer, do you prefer that the content is intended only for the person who smokes so that the message you give will be more effective? Or do you prefer that family and friends of the smoker are also involved in the content?
Why do you think that this kind of content you create will be more effective?
Ending question:
When you consider this conversation, what kind of conclusion do you make for yourself?

The interviews were conducted by the first author who is a native Turkish speaker. A consent form was taken from each participant before starting. The interviews were done in Ankara, the capital of Turkey, from January to March 2019. Because the researcher aimed to get as close to the participants’ natural settings as possible while maintaining a professional distance, the interviews took place in cafes or homes considering each participant’s preference. The researcher recorded each interview for a total of over 11 hours (average of 40 minutes per interview), which yielded over 128 pages of single-spaced transcripts.

To enrich the interview data, an art-based method in the form of personal drawings, a projective technique practised in consumer research to encourage self-expression (20), was also used. Participant artwork ‘allows visual documentation of behaviours and contexts that are often unconscious, giving researchers access to participants’ subjective worlds (21)’. Creative methods can reveal the emotional and symbolic meanings in more detail than mainstream methods (22). For drawing, participants were given paper and coloured pencils and asked to draw a picture of themselves while smoking. Participants were asked to explain their drawing in a detailed manner, which elicited deeper reflections (20).

Data analysis

All interviews were recorded and transcribed verbatim. Afterwards, interview transcripts and artwork were first scanned for emerging themes. During the open coding, dominant themes from the interviews were gathered and then categorized and linked with each other during the axial coding (23). The combination of open and axial coding was utilized to organize the data in meaningful themes (24). To ensure the trustworthiness of the study, triangulation of different data collection methods (e.g. semi-structured interviews and personal drawings) was used for credibility, and neutrality was sustained through the second author who was not in the interviews and a coding strategy for confirmability and dependability.

The data analysis of the interviews and the participants’ drawings was based on three main objectives. Firstly, self-construal analysis was done to understand the dominant self-construal of the participants, and then the participants were categorized into independent and interdependent smoker groups. Secondly, the similarities and differences between the identified independent and interdependent smoker groups were analyzed in terms of the routines and meanings of smoking. Finally, the researchers reviewed each smoker groups’ suggestions on how PSAs could be more influential and integrated them with the main points revealed throughout the interviews and artwork. Considering the purpose of the study, two primary themes emerged of individualistic message content for the independent smoker group and collectivistic message content for the interdependent smoker group.

Findings

Self-construal findings

Based on the self-construal analysis, nine smokers were categorized as having dominant independent self-construal while eight smokers were categorized as having dominant interdependent self-construal (see Table 1). The self-construal analysis of the participants was evaluated in four main dimensions, namely decision-making styles, conflict styles, perception of uniqueness/ordinariness and perception of success, each of which shows how the two groups differ from each other. Through analyzing the individuals based on these dimensions, we saw evidence emerge of independent and interdependent smoker groups. In decision-making styles, the independent (vs. interdependent) group applies decision-making based on one’s own (vs. in-group’s) preferences. In conflict styles, the independent (vs. interdependent) group has dominating (vs. compromising) conflict style. Considering the perception of uniqueness/ordinariness, the independent (vs. interdependent) group has a perception of uniqueness (vs. ordinariness). In the perception of success, the independent (vs. interdependent) group sees success as a self-oriented (vs. group-oriented) achievement. Since individuals can have the characteristics of both independent and interdependent self-construals at the same time (25,26), the researchers looked at which of them outweighed the others. For example, a participant can have the characteristics of independent self-construal in some dimensions although he or she has a dominant interdependent self-construal.

Independent smoker group

Based on the analysis of the drawings and narratives of the smokers, the independent smoker group tended to associate their smoking behaviour with specific routines, symbols and meanings. Figure 1 shows representative drawings from both the independent and interdependent smoker groups.

Figure 1.

Representative drawings of the independent and interdependent smoker groups.

The participants from the independent smoker group associate their smoking behaviour with some routines. For example, Onur draws his smoking routine of drinking tea (see Figure 1). The participant shares,

Here is my room. I am sitting there. After I ate my dinner, I am coming to my room, drinking my tea and turning on my computer. My smoking routine is tea, there is not any other. In fact, with every cup of tea that I am drinking, I also want to smoke. (Onur)

As the informant explains, drinking tea is a kind of complement to his smoking behaviour. Owing to the positive associations between them, coffee and tea can be thought of as triggering factors that increase cigarette consumption (27). When the participant was further asked the reason for drawing such a scene, he explained,

I think I am getting tired during the day and I want to have a rest when I am at home. When I am in my room, I feel myself more peaceful. I do things that I want to do. This is a moment of pleasure. I feel happy at that moment. (Onur)

Since Onur is a doctor, he may get overwhelmed during the day at the hospital in terms of dealing with the patients who are complaining about their illnesses all day. This situation may create a kind of situation for Onur where he feels trapped. Therefore, the cigarette may give him a freedom in terms of allocating his time to his favourite activities such as smoking in his room, drinking tea and surfing on the Internet. Therefore, smoking symbolizes the freedom and peacefulness after work.

A female informant also shared how she experiences joy when coffee accompanies her cigarette, ‘I usually like drinking coffee while I am smoking. That cigarette will be there if I am smoking. I feel its joy that moment’ (Meltem). When we look at Meltem’s drawing (see Figure 1), we also see that the participant describes a comfortable scene with the images of couch, television, smart phone and cigarette as her smoking routine. Therefore, the participant associates her smoking behaviour with some elements that make her relaxed and comfortable. Since Meltem is working outside the home and has two children, her smoking behaviour symbolizes her leisure time after she completes the housework and takes care of her children. The participant even mentions how the cigarette may symbolize a kind of reward which is taken after accomplishing the daily tasks,

I really like smoking alone while lying on a couch, watching TV and looking at my phone at the same time. It is so comfortable and relaxing! But I cannot always do this as I don’t have too much time due to work. Still I can say that it is the best moment that I can think about smoking. (Meltem)

Other than the routines, the clearest point observed in the narratives and drawings of the independent smoker group is thinking of smoking as an ‘individual’ activity. Therefore, they mostly draw themselves alone while they are smoking. For example, Yasin drew himself alone on the top of the hill where he can see the beautiful view of Istanbul (see Figure 1).

Lighting up a cigarette across a beautiful landscape feels good. I am drawing the Bosporus here. Over there, Hagia Sophia Mosque! I am on the top of a hill and there are trees, nature, and historical places around me. I am smoking. It is very pleasurable. (Yasin)

Considering his explanations, Yasin associates smoking with pleasure and joy and he can visualize the scene where he feels good and relaxed while smoking. This may explain how independent smokers give a self-related meaning to their smoking behaviour. Each of their drawings is a picture where the smoker is concerned with his or her own pleasure in his or her own space. Therefore, smoking is usually symbolized with freedom, peacefulness, uniqueness and pleasure in those drawings.

Interdependent smoker group

The participants from the interdependent smoker group associate their smoking behaviour with different specific routines, symbols and meanings than the first independent group. The narratives and drawings of the interdependent smoker group show that they tend to connect their smoking behaviour to drinking alcohol with their friends. For example, both Buket and Alper drew themselves at a bar drinking alcohol with their friends. Buket shares, ‘Here is a bar. There is the bartender’s table at the back. Music is playing. There is a group of friends of mine and everyone is drinking beer, eating peanut and chips. We are chatting and smoking at the same time.’ Participants from the interdependent smoker group emphasize the atmosphere where both smoking and drinking alcohol play a role in strengthening the interpersonal dialogue and sustain group harmony.

Alper’s drawing also shows one of the meanings of alcohol in Turkish culture. Alper writes ‘meyhane’ (bar) above his drawing, which is associated with drinking ‘rakı’ (a special Turkish alcoholic drink). This place is usually preferred by males to socialize and have fun with their friends. Alper explains, ‘If I have one chance to smoke, I would prefer this setting. I prefer smoking with my close friends while drinking alcohol. It feels good and you can get relaxed there. I mean we are happy at that moment.’ Considering his explanation, Alper draws a picture in which smoking symbolizes a focal point for the members of the friend group by enabling warmth and comfort, also shown the inclusion of candlelight.

The drawings and narratives of interdependent smokers show smoking as a ‘social’ activity. Contrary to the first group, they mostly draw themselves with other people while smoking. One participant mentions:

I usually prefer to smoke with my friends while we are sitting together and listening to good music. I like smoking during nighttime, so I drew stars and the moon. You can see that we are also chatting and having fun together. (Pelin)

Pelin sees smoking as a way to express oneself close to others. The cigarette can become a kind of bridge from one person to another, enabling a deeper conversation and strengthening the bonds between people. As the drawings show, interdependent smokers see smoking as a way to socialize and share deep conversation with others.

Individualistic message content

After carefully analyzing the narratives and drawings of the participants, we saw that individualistic message content of showing the quitting attempts of a smoker can be effective for the independent smoker group. Since these smokers are more concerned with their self-related goals, showing examples from former smokers can encourage smoking cessation. Some of the participants mentioned that PSAs should first show that smoking cessation is achievable, before showing the ways to quit smoking. For instance, an informant shared:

I think quitting smoking difficult, but I also believe that it is not impossible. The PSAs can present a kind of applicable model for people to quit smoking. For example, if you do this you can quit smoking easily. The content can be related with the easiness of quitting smoking. (Sibel)

Presenting applicable methods can be an alternative way to show smokers that smoking cessation is possible. Real-life examples will increase the persuasiveness of the message. Another informant shared:

If I were the one who designs the PSA, I would try to give more information about how to quit. Sometimes they give an advertisement in three parts in terms of introduction, development and conclusion like a story. If the PSAs can be divided into three parts; the first one can be an intro, the second one can show the methods of quitting and the third one can show a man who quit smoking with method X. I mean showing the one who gets benefit instead of the dying one motivates people more. (Onur)

In summary, showing the successful quitting attempts of a smoker (rather than a fear appeal) can encourage people to quit smoking. A more personalized tone can attract the attention of smokers with independent self-construal who want to be encouraged by the applicable ways of quitting smoking.

Collectivistic message content

Showing the quitting attempts of a smoker group can be an effective collectivistic message content for the interdependent smoker group. Throughout the interviews, some participants mentioned they are motivated by acting as a group. One informant shared:

We are smoking as a friend group. Recently, there have been some quitting attempts of one of my friends. She is trying to quit smoking and she has not smoked for a week. We are thinking that smoking has lost its attraction already. We are having fun while smoking together but we can also find other things to do instead of smoking. (Pelin)

The informant gives clues about her motivation to quit smoking after one of her friends also tried it. Since smoking is usually an activity done with a group of friends for the interdependent smoker group (as discussed based on Figure 1), when one quits, it may create a chain reaction for others as well. The group of friends can find a different activity to do together. Since a group can create both motivation and disincentive towards smoking, showing the quitting attempts of a group of smokers can be effective in encouraging interdependent people to quit smoking.

Discussion

The purpose of the present study was to explore effective message contents for anti-smoking PSAs based on the independent and interdependent self-construals of smokers to increase their quitting intentions. Consistent with the self-construal literature, this study corroborates the idea that individuals with independent and interdependent self-construals will have different intentions (28) and they will be influenced by different message strategies to quit smoking (7,29). The self-congruency effect that individuals will get affected by different messages that are congruent with their self-aspects (9) was seen in this study. Although some research has not supported the self-congruency effect (5,10,11), the reason for observing the self-congruency effect in this study might be that, unlike most cultures where the research was conducted, Turkey is classified as a collectivistic culture (30). This may be part of the reason why the participants having interdependent (vs. independent) self-construal indicated favourable reactions to others-related (vs. self-related) health messages.

This research intends to contribute to the literature by proposing specific contents for PSAs. Based on the participants’ independent and interdependent self-construals, two message contents emerged (individualistic and collectivistic). The independent smoker group is more motivated to quit smoking when the anti-smoking message is self-oriented and shows the ways of quitting with examples from former smokers (e.g. the story of how a former smoker quits smoking and lives a healthy life). Considering our participant profile, males constitute the majority of smokers in the independent smoker group. This suggests males may be more often motivated by messages focusing on self-aspects rather than group-aspects (31). On the other hand, it was shown that the interdependent smoker group is more motivated to quit smoking when the message is socially oriented and shows a group of people trying to quit smoking together (e.g. a group of former smokers socializing together through a different activity like picnicking or playing sports). Females constitute the majority of smokers in the interdependent smoker sample, suggesting females may be more often motivated by acting as a group (31). These contents may offer fresh approaches to the anti-smoking PSAs in Turkey that have lacked effectiveness (15,16). However, further research is needed to explore these observations at the population level.

The analysis of participants’ drawings is another contribution to the existing literature because the drawings provide a window into the possible symbolic meanings of smoking. When given a neutral prompt to draw oneself smoking, it is striking how positive the pictures are. These drawings not only represent the participants’ self-construal characteristics, but they also show routines of smokers and positive associations of smoking.

Firstly, when we look at the dominant self-construal of the participants, we can realize the connection between the representations of the self and the dimensions of the self-construals. For instance, the drawings of the independent smoker group mostly emphasize self-related aspects of smoking, and these can be associated with the independent self-construal dimensions of decision-making based on one’s own preferences (e.g. continuing smoking as it gives pleasure), perception of uniqueness (e.g. smoking in a private, self-determined, unique environment) and success as a self-oriented achievement (e.g. smoking as a kind of reward). For the interdependent smoker group, drawings mostly emphasize the group-related aspects of smoking, and these can be associated with the interdependent self-construal dimensions of decision-making based on the in-group’s preferences (e.g. continuing smoking since close others are also smoking), perception of ordinariness (e.g. not distinguishing self among the drawing of similar stick figures around a table) and success as a group-oriented achievement (e.g. enabling group harmony/identity with smoking). Considering the drawings, participants’ representations of their smoking behaviours by linking them with their self-construal characteristics show how self-congruent messages can become effective for individuals as other research has indicated (7,9).

Secondly, the drawings also showed some of the routines of smokers and positive meanings of smoking. Other research has indicated the importance of cultural orientations on health communication literature (29). Therefore, participants’ drawings are important in terms of revealing how Turkish culture shapes the smokers’ routines and meanings of smoking. For example, the independent smoker group mostly highlights smoking with tea/coffee and smoking to get relaxed in their drawings while the interdependent smoker group emphasizes smoking with alcohol and smoking to socialize. Therefore, these drawings showed the picture of smoking in smokers’ minds in terms of combining the self-construal aspects of the smokers and their smoking behaviours. The symbolic meanings of a cigarette should be considered in understanding what smokers are being asked to give up if they quit (6). Drawing sensitively on such symbolic meanings could enrich the contents of PSAs and deal with the deeper aversions to quitting.

Strengths and limitations

The findings of this study have many implications for public policy makers who are responsible for designing anti-smoking campaigns. If they become aware of the characteristics of the independent and interdependent smoker groups, they can design the contents for anti-smoking PSAs in a way that will appeal to each group’s sensitivities. The findings of this study showed that people’s meanings and routines play an important role in their smoking behaviour. Since the self-construal literature is a reflection of culture, policy makers should consider the needs and motives of smokers with independent and interdependent self-construals separately.

We hope that this study also contributes to the broader practice and research of health communications. This study underscores the importance of exploring concepts in non-western contexts which may differ, for example, in their degree of individualism and corresponding response to different types of health messages. The qualitative approach also enabled the discovery of routines and meanings that can open up new paths for effective understanding and communication. More specifically, we hope that the innovative art-based method may be utilized by others to understand the symbolic importance of current behaviours. Health communicators should go into greater depth in understanding differences in the audience and their varying practices and underlying meanings in order to most effectively communicate with them.

The findings of this study should be considered with its limitations as well. Since this study applied a qualitative approach, a relatively small number of participants (17 smokers) constitute the research sample of this study. These smokers are situated in a particular time and cultural context. Since the aim of our qualitative methodology was to gain an in-depth understanding about the phenomenon in one culture, it will be up to future research to measure the discovered themes and extend the findings to a wider population. Moreover, the sample of this study was smokers aged 25–35 years who are well-educated and employed; therefore the findings reflect the motivations of the young adult smoking population in Turkey. Future research may extend the participant profile to show whether the findings change according to different age groups or education levels. Findings of this study showed that smoking has many strong positive associations in smokers’ minds. Future studies can explore possibilities of substitutes for smoking that could still offer some of the same positive meanings.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Mutlu Önen

References

Wakefield

Dphil

Nichter

Giovino

Effects of anti-smoking advertising on youth smoking: a review. J Health Commun. 2003; 8: 229–247.

Shen

The effect of message frame in anti-smoking public service announcements on cognitive response and attitude toward smoking. Health Commun. 2010; 25: 11–21.

Erguder

Bilir

Özcebe

Irmak

Tasti

İlter

, et al. Exposure to anti-and pro-tobacco advertising, promotions or sponsorships: Turkey, 2008. Glob Health Promot. 2013; 23: 58–67.

Fishbein

Cappella

The role of theory in developing effective health communications. J Commun. 2006; 56: 1–17.

Shen

Benefits for me or risks for others: a cross-culture investigation of the effects of message frames and cultural appeals. Health Commun. 2013; 28: 133–145.

Tane

Hefler

Thomas

DP.

Smokefree leadership among the Yolnu peoples of East Arnhem Land, Northern Territory: a qualitative study. Glob Health Promot. 2019; 27: 100–108.

Chang

Enhancing the effectiveness of antismoking messages via self-congruent appeals. Health Commun. 2009; 24: 33–40.

Chang

Self-congruency as a cue in different advertising-processing contexts. Commun Res. 2002; 29: 503–536.

Hong

Zinkhan

GM.

Self-concept and advertising effectiveness: the influence of congruency, conspicuousness, and response mode. Psychol Mark. 1995; 12: 53–77.

10.

Kim

HS.

Message framing and defensive processing: a cultural examination. Health Commun. 2010; 25: 61–68.

11.

Yang

Nan

Zhao

Persuasiveness of anti-smoking messages: self-construal and message focus. Health Educ. 2017; 117: 1–34.

12.

Hanel

PHP

Vione

KC.

Do student samples provide an accurate estimate of the general public?

PLoS One. 2016; 11: 1–10.

13.

The Organisation for Economic Co-operation and Development (OECD). Daily Smokers [Internet]. 2019. [cited 2020 April 5]. Available from: https://data.oecd.org/healthrisk/daily-smokers.htm

14.

Özbük

Öz

Examination of public service announcements in Turkey through content analysis method. Bus Econ Res J. 2017; 8: 575–589. Turkish.

15.

Güllülü

Türk

The public service advertising effect on smoking cessation or reduce intention. Pazarlama ve Pazarlama Araştırmaları Derg. 2015; 16: 23–41. Turkish.

16.

Yaman

Göçkan

İ.

The effect of public spotlight advertising on smokers: an application in Afyonkarahisar. J KAU IIBF. 2015; 6: 53–66. Turkish.

17.

Ministry of Health of Turkey. Health Statistics Yearbook, Distribution of Individuals Using Tobacco Product by Sex and Age Groups [Internet]. 2018. [cited 2020 April 10]. Available from: https://dosyamerkez.saglik.gov.tr/Eklenti/36164,siy2018en2pdf.pdf?0

18.

Heigham

Croker

RA.

Qualitative Research in Applied Linguistics: A Practical Introduction. New York: Palgrave Macmillan; 2009.

19.

Singelis

Triandis

Bhawuk

DPS

Gelfand

MJ.

Horizontal and vertical dimensions of individualism and collectivism: a theoretical and measurement refinement. Cross Cult Res. 1995; 29: 240–275.

20.

Moisander

Valtonen

Qualitative Marketing Research: A Cultural Approach. London: SAGE; 2006.

21.

Hays

Singh

AA.

Qualitative Inquiry in Clinical and Educational Settings. New York, NY: The Guilford Press; 2012.

22.

Bragg

Consulting Young People: A Literature Review. 2nd ed. Newcastle: Creativity, Culture and Education; 2010.

23.

Neuman

WL.

Social Research Methods: Qualitative and Quantitative Approaches. 7th ed. Harlow, Essex: Pearson; 2014.

24.

Miles

Huberman

AM.

Qualitative Data Analysis: An Expanded Sourcebook. 2nd ed. Thousand Oaks, CA: SAGE Publications; 1994.

25.

Markus

Kitayama

Culture and the self: implications for cognition, emotion and motivation. Psychol Rev. 1991; 98: 224–253.

26.

Triandis

HC.

The self and social behavior in differing cultural contexts. Psychol Rev. 1989; 96: 506–520.

27.

Swanson

Lee

Hopp

JW.

Caffeine and nicotine: a review of their joint use and possible interactive effects in tobacco withdrawal. Addict Behav. 1994; 19: 229–256.

28.

Lee

Ebesu Hubbard

O’Riordan

Kim

MS.

Incorporating culture into the theory of planned behavior: predicting smoking cessation intentions among college students. Asian J Commun. 2006; 16: 315–332.

29.

Cho

Lee

Personal, social, and cultural correlates of self-efficacy beliefs among South Korean college smokers. Health Commun. 2009; 24: 337–345.

30.

Hofstede

Culture’s Consequences: International Differences in Work-Related Values. Abridged ed. Beverly Hills, CA: SAGE; 1980.

31.

Cross

Madson

Models of the self: self-construals and gender. Psychol Bull. 1997; 122: 5–37.