A Process-Based Evaluation of Mass Communication Channels in Anti- Smoking Behaviour: A Cross-Sectional Study

Background Tobacco use remains a major preventable public health challenge, and communication campaigns are central to tobacco-control strategies. However, many studies focus mainly on exposure while giving less attention to the psychological pathways through which communication influences quitting behaviour. This study compared the effectiveness of six anti-smoking communication channels and examined how exposure, credibility, personal relevance and action motivation shape quit intention and quit behaviour. Methods A cross-sectional survey was conducted among 418 adults with varying smoking status. Measures assessed exposure, credibility, personal relevance and action motivation for television/OTT platforms, social media, doctor advice, cigarette-pack warning labels, government posters, and family or friends. A composite Effectiveness Index (EI) was calculated for each channel. Confirmatory factor analysis, Friedman tests, logistic regression and structural equation modelling (SEM) were performed. Results Cigarette-pack warning labels recorded the highest effectiveness score (EI = 3.49), followed by doctor advice and family or friends, whereas social media and government posters ranked lowest. Significant differences were observed across channels (χ² = 108.16, p < .001). Pack warnings were the strongest predictor of quit intention (OR = 2.22, p = .011), while social media showed marginal influence. Quit intention strongly predicted quit attempts (OR = 5.86, p < .001). SEM findings indicated that credibility and personal relevance were key mediators linking communication exposure to behavioural outcomes. Conclusions Anti-smoking communication appears to work through a credibility-to-intention pathway rather than exposure alone. Strengthening warning labels and combining them with credible interpersonal communication may improve tobacco-control outcomes. Trial registration: Not applicable this study is a cross-sectional survey and did not involve a health care intervention requiring prospective registration.