Problem/Objective: Massachusetts Tobacco Control Program (MTCP) aired no paid advertising for five years. Before doing so, MTCP decided to assess the attitudes of smokers and non-smokers with regard to quitting smoking, public health, and insurance costs. The results of this study helped shape subsequent communications messages.

Methods: Respondents to a random digit dialed telephone survey were asked to compare attitudes about smoking with other chronic conditions. There were three broad categories of questions.

- effort required to stop a behavior

- impact of that behavior on insurance costs

- importance to one's health of quitting a specified behavior.

Respondents made direct comparisons between smoking and the following chronic conditions: obesity, heart disease, HIV/AIDS, alcohol abuse, diabetes, drug abuse, stress, and depression. For example, some respondents were asked to state whether it took more or less effort to quit smoking than to overcome a drug addiction.

Results: A principal components analysis was conducted yielding a two-dimensional component space for each category of question. More importantly, data were analyzed separately for smokers and non-smokers. The differences between the component spaces of smokers and non-smokers were striking. For example, smokers saw smoking as a uniquely difficult challenge. All other conditions paled in comparison to the problems posed by nicotine addiction. For non-smokers, smoking was one among many difficult challenges faced throughout one's life.

Conclusions: These results highlight the need to create very different communications messages for smokers and non-smokers. They may also require us to rethink the recommendation of seeking “social supports” to aid in quitting.