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The Electronic Journal of Communication / La Revue Electronique de Communication


Volume 9 Numbers 2, 3, 4 1999

Anti-Smoking Messages

EXPLORATIONS IN ADOLESCENTS'
SENSE-MAKING OF ANTI-SMOKING MESSAGES
 
 

Micheline Frenette
Université de Montréal
Montreal, Quebec Canada
frenettm@com.umontreal.ca



 
 

Abstract.  In the context of information use, the implementation of Sense-Making Methodology assumes that humans only use information resources in the context of their own experience -- where they have come from, what they are struggling with, and where they are going. This article pulls together a series of qualitative studies that verified the relevance of this approach for understanding smoking habits among adolescents and for the design of related health campaigns. Teenage smokers and non-smokers were interviewed about their experiences with cigarettes and their perceptions of different anti-smoking campaigns that included radio and television public service announcements as well as posters and other print material. Their responses were analyzed using the core metaphor of the Sense-Making Methodology -- the idea that the person's progression through time-space involves step-takings across gaps and building bridges (cognitive, emotional, spiritual, physical) from past to future. In the context of health campaigns, the kinds of gap-facing and gap-bridging emphasized are the asking of questions (implicitly or explicitly), the searching for answers (purposively or capriciously), and the constructing of answers that work for each person. In closing, preliminary reflections are offered on the challenges and promises of designing media health messages in accordance with such a dialogic model of communication.
Introduction

Health campaigns are typically defined as messages of persuasion whether the goal is to inform, to educate, to modify attitudes and behavior, or to convince about the legitimacy of an opinion (Rice & Atkin, 1989). However, the expectations placed upon health campaigns to deliver convincing information are often not met. Tobacco smoking among young people is one such case. The fact that 90% of adult smokers begin smoking before the age of 17 (Elliott, 1993) makes it an important health issue for this age group, especially in view of the fact that, outwardly at least, a clear solution to the problem exists. But even though information about the health hazards of smoking is generally well disseminated, if not totally integrated, by teenagers (Hirsch, Hill, Frossard, Tassin & Pechabrier, 1988; King & Coles, 1992), health workers are often dismayed that young smokers do not seem to act upon that information. Indeed, some studies reveal that the majority of young smokers have no intention of quitting even though they are aware of the deleterious effects of tobacco smoking on their health (Dzumhur, Catovic & Dzumhur, 1986; Hamburg, Millstein, Mortimer, Nightingale & Peterson, 1993).

Media health campaigns have been criticized for oversimplifying issues and not making good use of concepts from the social sciences (Wallack, 1989). In this paper, I show how Sense-Making, as a dialogic theory of communication (Dervin 1980, 1989a, 1989b, 1998), can help us understand this discrepancy by shedding a different light on adolescent responses to anti-smoking messages. Indeed, to move beyond the limits of prior health campaigns, according to Dervin (1989b), we must reconceptualize the audience member as inherently active and mandated to search for situated personal meaning. This requires that we rethink the role of media messages in a way that merges with a person's meaning-making efforts. Therefore, a second goal of this paper is to derive some guidelines from the Sense-Making model as to how health messages might be conveyed through the media as meaningfully as possible. Drawing on some pilot work, part of which has also been discussed elsewhere (Frenette, 1998), I will provide examples of how Sense-Making is being used in an attempt to understand adolescents, their experience with tobacco and their way of understanding health messages. In many cases, remaining gaps need to be filled with future research, but this preliminary synthesis should be useful for planning subsequent studies.

Sense-Making Methodology, Adolescence and Smoking

Sense-Making Methodology

Sense-Making Methodology (Dervin 1980, 1989a, 1989b, 1998) posits humans as mandated by the human condition to strive to create meaning that connects with their personal life goals as they move through situationally and socially anchored times and places. Sense-Making's meta-theoretic premises assume that reality and life are gap-filled at least in part so that humans must navigate ever-changing conditions in which sense must be made, unmade, and remade. This is what Dervin calls the basic discontinuity of life. Questions asked, responses obtained from resources and the formation of new ideas are like successive steps helping to bridge the gap between an actual situation and the foreseen end goal. It is through communication in its various forms that a person attempts to find the answers. Hence, a successful communication is one when the person finds some resonance about where she is and, hopefully, something useful about where she wants to go.

This meaning-making process as it could apply to a health situation is outlined in Figure 1 although it is obviously oversimplified for the sake of demonstration. Let us consider a hypothetical process a smoker might undergo as a way to illustrate the various components listed under these three major headings. With regard to a specific issue, a person is first situated at a particular point in her life (where she is coming from): she may have started smoking to be accepted in a group (experiences); now she smokes one package of cigarettes a day (situation) and smoking helps her relax (need). In a second phase, certain problems arise which disrupt the current equilibrium (what she is struggling with): she has begun to worry because she coughs a lot (problem) and wonders whether it is time to quit (question); at the same time, she is aware that nicotine addiction is difficult to overcome (obstacle) and she is not sure how to go about it (gap). The third phase involves taking action to restore equilibrium and evaluating the consequences of such actions (where she is trying to go); she may turn to a doctor for counsel (resource) who could suggest a quitting program (solution) which may or may not work for her (use).

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Figure 1. A model applying Sense-Making meta-theory to the potential construction of health campaign messages.

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In other words, communication in the Sense-Making perspective is not seen as a transmission process but rather as an opportunity for dialogue. Therefore, a person can never receive information, she can only conceive information by creating her own meaning from any proposed message. How, then, can health messages relayed through the mass media be viewed within this framework? Sense-Making suggests that a successful communication will be anchored in young smokers' lived context and relate to what they are struggling with and to what they are attempting to achieve. To understand where young smokers are coming from, we first need to know about their experiences with tobacco preceding the encounter with the message and about their current situation (i.e., Are they smoking on a regular basis?  If so, to what degree?  Are they thinking about quitting?  Have they ever tried to stop?  What personal needs are served by cigarettes? etc.). Their experiences with the media and with prior health messages as well as the context in which they encounter the message are also of importance. For example, staring at a poster in a doctor's waiting room may be a far different experience from catching a glimpse of it on a passing bus. A corresponding health message could then be viewed as supporting or hindering the various components of a person's meaning-making process with regard to tobacco smoking. Before providing some examples of how messages may merge with or be at odds with where young smokers are coming from, what they are struggling with and where they are attempting to go, I will summarize data that depict the situation of adolescents with regard to tobacco smoking.

Adolescent Development

To first establish some general guidelines, adolescence is the period from 12 to 18 years of age when individuals develop their intellectual and social skills to their full capacity in order to establish the foundations of a personal identity and to become a fully autonomous adult in society (Cloutier, 1996; Crockett & Peterson, 1993). On first thought, adolescence would seem to be an ideal time in the life cycle for health promotion since abstract reasoning is at its peak and the person's thinking is more relative, more reflexive and less anchored in the immediate. Teenagers are thus increasingly capable of envisioning long-term consequences, and they can also consider multiple factors in decision-making. However, these emerging intellectual abilities are not necessarily applied in the personal sphere. Indeed, since this sophisticated cognitive development takes place alongside other significant personal events, long-range considerations about their health may be quite secondary in comparison with the more pressing needs of day-to-day living (i.e., to feel good and secure about one's self, to be appreciated and accepted by peers of both sexes, to have financial means).

Since the peer group takes on immense importance during adolescence, compliance with parents' opinion and prescriptions tends to be replaced by compliance with expectations of the peer group (especially in early adolescence). Typically, teenagers become absorbed in a compelling group life centered on shared preoccupations like musical trends, fashion, ways of looking and talking, and social interactions. Friends, therefore, become credible sources of information as well as behavior models for all areas of life. Nonetheless, even though adolescents are outwardly critical of parents and teachers, these significant adults still have a measure of influence in reinforcing values and behaviors conducive to good health. Finally, media in general convey particular discourses, values, and models drawn from society at large which necessarily impinge on adolescents' attention and serve as background, constraint and fodder for their identity-making and their perspective on health issues.

Adolescents and Tobacco Smoking

The purpose of this section is to flesh out the categories in Figure 1 based on the available literature on adolescence and tobacco smoking (Burton, 1989; Cloutier, Champoux & Jacques, 1994; Crockett & Peterson, 1993; Darbyshire, 1989; Dzumhur et al., 1986; Flay & Conrad, 1989; Haire-Joshu, Morgan & Fischer, 1991; Hamburg et al., 1993; Hirsch et al., 1988; U. S. Department of Health and Human Services, 1994).

Where Adolescents are Coming From. Factors related to the experience of tobacco smoking during adolescence are quite complex because they are in relation with both the micro- and macrosocial entourage on the one hand and psychological variables pertaining to each individual on the other. With regard to the first set of factors, it is generally acknowledged that the influence of peers is the most important factor that determines whether a teenager will begin smoking; subsequently, smoking remains largely a social activity for this age group. Other circumstances which increase the probability that an adolescent will take up smoking on a regular basis are the accessibility of cigarettes at home, unoccupied leisure time (weekends, vacation,...) and periods of stress (exams, parents' divorce,...). Teenagers who smoke also have a significantly larger number of smokers in their family entourage. Finally, once it is initiated, smoking becomes a strongly conditioned behavior reinforced by numerous stimuli encountered throughout the day.

The second set of factors conducive to tobacco smoking are no less complex and involve a host of personality variables. Among these are social precocity, a rebellious spirit, a risk-taking tendency, low self-esteem, an incapacity to say no as well as the desire to give oneself style or poise. In addition, teenagers start smoking out of curiosity, to fight boredom, to relax, or because they feel insecure about their future. According to some surveys, girls smoke more than boys because they are more precocious biologically and thus exposed at an earlier age to social influences and also because they are more concerned about their self-image. It can also be said that tobacco smoking is part of those new experiences which adolescents are simply yearning to discover. Finally, on a more abstract level, smoking cigarettes may be a symbolic means of self-assertion in a society where there are insufficient outlets for public expression of youth concerns.

What Adolescents are Struggling With. Quitting smoking is a complex and dynamic process that begins with the decision to smoke and ends with a long period of abstinence. The difficulty of the task lies with the fact that adolescent smokers develop a pharmacological addiction as well as an emotional dependence on tobacco. Those who do attempt to quit usually encounter relapses and withdrawal symptoms, as adults do. Motivations for wanting to quit are either intrinsic (the will to free one's self from a bad habit, current and future health problems) or extrinsic (the cost of cigarettes, environmental constraints). Girls are especially concerned about their appearance and often fear a weight gain if they were to stop smoking. In general, females prefer gradual methods while males appear more confident that they can quit in a radical manner. An important obstacle to breaking the tobacco habit is that people around them continue smoking; therefore, the help and support of family and friends is an important asset for those who wish to stop. In fact, one of the enticing factors for quitting is apparently the presence of opinion leaders in youth groups.

Where Adoloscents are Going To. Most adolescent smokers believe they will eventually quit for health reasons and because of the desire to be free from a constraining habit although they seldom have a precise idea about the best time to stop. Girls however have a convenient biological timeclock and many of them say they will quit when they become pregnant. Teenagers also wonder about the most appropriate quitting method for them, what they will go through and whether they will succeed. Solutions for stopping that they are aware of include surrounding oneself with non-smokers, avoiding smoking areas and choosing an appropriate time like summer vacation; other concrete aids include turning to alternate sources of distraction and relaxation (movies, sports, music,...). Girls who smoke express more concern about the health of others and are more sensitive to the needs of children than male smokers. They also try to act as resource persons for those around them who want to quit, more than boys do.

In summary, then, the literature reviewed above suggests that tobacco smoking takes on special significance at adolescence because teenagers are at a critical point in their lives when they are constructing their personal identity and their social niche. If smoking cigarettes entails a physiological dependence, is closely linked to one's self-image, is socially sanctioned and tightly intertwined in the fabric of one's daily life, then it is no wonder that appeals to reason or fright tactics to entice adolescents to stop are not very likely to be successful.

Data Collection

The aim of using qualitative methods is to collect rich and detailed descriptions of individual experiences in order to come to a better grasp of phenomena from a subjective point of view (Hamburg et al., 1993; Millstein, 1993). To that end, interview instruments were designed in accordance with Sense-Making's meta-theoretical premises (Dervin, 1980; 1989b; 1998; 1999a) with the goal of understanding how adolescents construct meaning from smoking-related health messages. First, their experience with tobacco smoking was explored in terms of the circumstances and motivations surrounding their first cigarette, the perceived advantages and inconveniences related to both smoking and not smoking, the relationships with their friends and family in relation to smoking as well as the motivations and obstacles related to quitting. The participants then viewed some anti-smoking television advertisements or listened to some radio messages and examined some posters and other print material. They were then asked what questions came to their minds upon encountering these messages and what, if anything, about these messages was relevant for them, and how they could have been made more meaningful. The discussion also engaged them about other public service announcements (PSAs) that they could recollect. The interview concluded with a synthesis of their responses and their suggestions for future health campaigns. Initially designed for individual data collection, the interview was subsequently modified for a group situation.

The data reported here have been combined from different exploratory studies conducted over the past few years with French-speaking youth in Quebec (Canada). Altogether, a little over one hundred adolescents were interviewed with regard to different campaign materials. The age of the subjects ranged from 12 to 19 with the average age being close to sixteen. The majority of these interviews (60%) took place in the school setting while 25% were conducted in their homes and the remaining 15% in a community youth club. About half were interviewed individually while the other half participated in small group discussions of from four to six members. Among the 50 individual interviews, 24 were smokers (16 girls and 8 boys) and 26 were non-smokers (15 girls and 11 boys). Among the 52 subjects in the group interviews, 23 were smokers (13 girls and 10 boys) and 29 were non-smokers (16 girls and 13 boys). Not surprisingly, it was somewhat more difficult to recruit smokers for the interviews, especially male smokers. Boys, whatever their smoking status or age, were usually more reluctant to participate in the study, especially for individual interviews, and as a general rule, were less talkative when they did volunteer.

Although smokers and non-smokers were always interviewed separately, it is reasonable to think that the contrived small group setting may have been conducive to the expression of highly critical statements with regard to the public service announcements (PSAs) under scrutiny. However, the relatively high convergence of responses from one group to the next and among subjects in general, in combination with participants' enthusiasm in providing positive examples when they could, suggested that they responded honestly. Yet the fact remains that teenagers who volunteered for such interviews, whether individual or group, were possibly more fluent, more reflexive and more self-confident than their peers.

The interview transcripts were analyzed for the presence of elements of the sense-making process with regard to smoking as outlined earlier. This was accomplished through a cyclical inductive process involving at least two judges. The data were then summarized and compared according to the smoking status and the gender of the interviewees. The detailed results reported below describe how the adolescents perceived the messages to relate to their personal experience as well as to their current life situations and needs with respect to smoking. The messages were also examined in terms of whether they were relevant to the problems adolescents encountered with regard to smoking, whether they answered questions they might have, whether they addressed specific obstacles and gaps that they faced when trying to quit or attempting to remain a non-smoker. Finally, the data were examined to explain whether or not the messages made any connections to possible resources or solutions that might have been useful for young smokers and non-smokers. During the interviews, it became apparent that adolescents' experiences with and expectations of media in general and with public service announcements (PSAs) in particular also played a part in the way they constructed meaning from such health messages.

Findings: How Adolescents Make Sense of Anti-smoking Messages

In organizing and presenting the findings, I have extracted major themes regarding the adolescents' assessments of and intersections with campaign ads and with smoking. I have organized these themes within the category scheme presented in Table 1, again anchoring my discussion in how I see the Sense-Making Methodology serving as a framework for health campaign message construction. Indeed, the goal of this article is not to make an exhaustive presentation of a set of findings but rather to use some findings to build an interpretive framework, which eventually could direct another reading of the data. To this end, within each category, I selected at least one example of how adolescents drew support from some messages in making sense of their smoking behavior, at least one example where their sense-making was neither aided nor blocked through a message and, finally, at least one example where sense-making about their tobacco consumption seemed hindered by interacting with the message. The examples collected here come partly from adolescents' responses to direct queries about their sense-making, for example when they answered the question "In what ways does this message help your thinking about smoking or not?" But they were also deduced from what they said about the messages in a global manner during the various interviews. The linear presentation may give the false impression that adolescents reacted piecemeal to the messages. It is of course an unavoidable reconstruction of their reactions in an attempt to get at a deeper understanding of what the messages meant for them and to find out whether sense-making about the messages connects with sense-making about their own smoking.

Where One is Coming From

Messages and Experience

Supportive with Regard to Experience. As a general rule, the interviews showed that a health message which was anchored in a subject's experience was more likely to support sense-making about smoking. One such message was a radio ad humorously depicting smokers standing outside during winter in order to smoke during breaks.

I laughed because that is really the way it is. I could see myself hanging out with my friends during recess to grab a smoke. Like you're freezing your . . . you know, because we do it anyway. . (Male, 15, Smoker)
Another was a television message that portrayed the typical social context of tobacco use among young people, that is, non-smokers mixing with their smoking peers without overt conflict.
After a party at X's place, my sweater smelled like . . . but then I washed it. I don't really mind because they always smoke at parties and I go anyway because everyone is going. (Female, 13, Non-smoker)
Neutral with Regard to Experience. On the other hand, many adolescent experiences with smoking were overlooked in some messages when it would have been appropriate to acknowledge them. For instance, a message designed for non-smokers to show self-assertion when refusing cigarettes showed a girl saying no to her friend but disregarded the more common experience of being offered a cigarette by a stranger or a simple acquaintance.
My regular friends know I don't smoke so they don't bother me that much but my friend's cousin offered me a cigarette and I took it because I wanted to talk with him. (Female, 14, Non-smoker)
Hindering with Regard to Experience. In cases where a message went directly against adolescent experience in a way they found offensive, it seemed to actually hinder sense-making about their smoking behavior. For instance, the portrayal of a disheveled boyfriend who smokes as naive and disrespectful in one television message made adolescents, both smokers and non-smokers, react to the unfair negative representation.
I mean my boyfriend would never do that and he's talking like this (in the ad), all crooked, and it makes teenagers look bad. (Female, 15, Non-smoker)

It's the stereotype of the stupid smoker but it's not a fair representation. Anyway, I have a right to smoke if I want to. (Male, 17, Smoker)

Messages and Situation

Supportive with Regard to Situation. When the situation the individuals were currently experiencing was depicted in a message, it also increased the probability of engaging sense-making about cigarette intake. A common way of supporting this was for messages to address a specific group of youngsters in terms of their situation relative to smoking, such as asking, "Are you thinking about quitting?"

I saw this poster in the bus and I said to myself, well that's me they're talking to because quitting has been on my mind all summer. (Male, 17, Smoker)
Neutral with Regard to Situation. However, adolescents' lived situations relative to tobacco consumption were frequently overlooked in messages about smoking. For instance, a global message stating that smoking was detrimental to your health did not provide an anchorage point for a teenager to begin making sense with respect to her own situation.
Sure, they tell you smoking's not good for you. Hell, everyone knows that! So what else is new? (Female, 15, Smoker).
Hindering with Regard to Situation. On the other hand, when teenagers felt their situation was not depicted accurately, sense-making about their tobacco usage seemed to be actually hindered. In one television PSA (public service announcement), a confident female non-smoker asserted her right to remain so; however, the perceived arrogance of the young girl was not, in their view, a widespread attitude and adolescents were reluctant to identify with her. This girl was also featured on a poster which echoed the television message.
There she is with her jewelry, you know, she thinks she is so cool. Hey look at me, I'm on this poster! (Female, 14, Smoker)
Messages and Needs

Supportive with Regard to Needs. Messages that acknowledged the needs met by cigarettes such as relaxation and socialization seemed more likely to support a sense-making process that could eventually be conducive to quitting. A flyer listed reasons why smokers find it difficult to quit, among which the loss of pleasure was mentioned.

It's rare that you see any admission that smoking is enjoyable. They usually hit on us instead as though we are out of our minds for smoking. (Female, 16, Smoker)
Neutral with Regard to Needs. In contrast, when the needs satisfied by smoking were simply overlooked, it tended to make the person feel that tobacco consumption was simply not well understood by those who condemn it.
It is pleasant and I like it, especially when I am studying. After all, it's not as if I am doing something wrong! (Female, 15, Smoker)
Hindering with Regard to Needs. However, there were cases when a message appeared likely to actually hinder sense-making when it failed to meet certain expectations. For example, one television message making use of special effects inadvertently condoned a magic solution for quitting, thereby disregarding adolescents' need for recognition of their insights. Some subjects said they actually lighted a cigarette out of spite when they saw this particular message.
I mean really, do they think we are idiots or what? The girl turns into a cigarette, I've never seen anything so stupid. (Female, 15, Smoker)
Likewise, when a message suggested that smokers were arrogant (when in fact they were seen as helpful by their non-smoking peers) or naive (when in fact they were aware of the problems associated with smoking), teenagers did not feel respected and tended to react defensively.

What One is Struggling With

Messages and Problems

Supportive with Regard to Problems. In one campaign, radio messages were each dedicated in a humorous fashion to a specific problem associated with smoking (cost, odor, yellow teeth, coughing, shortness of breath, etc.). In such a case, each person had the opportunity to recognize one or more of their own problems.

All I can say is it's true! My girlfriend is always complaining about my bad breath. I wonder sometimes how she can stand it! (Laugh) (Male, 18, Smoker)
Neutral with Regard to Problems. On the other hand, when the immediate problems faced by smokers were simply overlooked, the message was not drawing attention to what could be a starting point for thinking about one's tobacco consumption. Non-smokers also struggled with problems of their own such as how to be self-assertive without alienating potential friends; thus, a message that took for granted that refusing a cigarette is easy in all circumstances was not as supportive as it could have been. Yet adolescents confided that it takes more sophisticated social skills to be self-assertive in this kind of situation as compared to dealing with people you already know.
Sure, the girl in the (anti-smoking) ad is so pretty, the guys will talk to her anyway but I remember when you're 14, some girls are so shy they'll do anything if a boy gives them some attention. (Female, 17, Non-smoker)
Hindering with Regard to Problems. Sense-making with regard to one's smoking habits could in fact be hindered when a message actually created another problem in adolescents' minds. In one instance, young female smokers felt offended by a catch-phrase that suggested that girls who smoke are less natural and less likeable.
Girls who smoke can be just like us. When you're not natural, it's when you have too much make-up or when you pretend to be someone else. It makes you wonder who makes these ads anyhow. (Female, 16, Non-smoker)
Another slogan, "To get rid of smoke is a choice for life," also inadvertently created a problem for non-smokers who had not made a fully conscious, long-term commitment to abstinence and felt pressured by such an admonition.
Yeah, I don't smoke now but I don't know that I can say I will never ever smoke. (Male, 14 Non-smoker)
They also aptly remarked that such a categorical statement could hinder smokers as well, since it did not allow room for mistakes and negated the fact that many smokers do not succeed in breaking the habit on their first trial.

Messages and Questions

Supportive with Regard to Questions. Sense-making was likely to be supported when messages were responsive to adolescents' concerns about smoking. For example, some print materials provided detailed answers to questions about efficient methods for quitting.

This is really a good flyer because it tells you what to do when the going gets rough. (Male, 13, Smoker).
A message could also be conducive to sense-making when it attempted to spark a fruitful question in a smoker's mind, whether directly or through his or her entourage.
My mom had seen this poster in the subway that said 'Do you know what you should know or what you want to know?' (about smoking) and she used to kid me when I lit a cigarette. (Male, 18, Non-smoker)
Neutral with Regard to Questions. On the other hand, messages that did not answer any questions adolescents might have had about cigarettes nor provoke any fruitful questions in their minds did not appear supportive of sense-making. For instance, non-smokers' questions, such as how they could be helpful to their smoking friends or parents, were often overlooked.
It's OK to tell us to tell others not to smoke but I wish they (the ads) would give us a new line because they (their entourage) get tired of the same old tune, and so do I. (Female, 14, Non-smoker)
Hindering with Regard to Questions. Unfortunately, some messages answered questions in a manner that was not conducive to sense-making. One such message answered an implicit question smokers may have had about their chances for quitting negatively by implying they were hooked. Finally, ambiguous messages raised irrelevant questions in the viewers' minds about what was going on and thereby sidetracked their thinking. The following reaction was in response to a television message where a girl resists pressure to smoke from a male peer.
Is she going out with him or what, if he's so stupid? How come all this smoke doesn't seem to bother her anyway? (Female, 14, Non-smoker)
Messages and Obstacles

Supportive with Regard to Obstacles. A message that acknowledged any obstacle young smokers faced in breaking their habit and, ideally, suggested how to overcome them had the potential to be highly conducive to sense-making.

This kit is pretty good because they talk about how hard it is to quit and everything you go through... like I would bet a hundred bucks it was written by an ex-smoker. (Male, 16, Smoker).
One radio message addressed an obstacle faced by non-smokers and suggested what to say in a friendly way to people whose smoke bothers you .
That's the hard thing really, even if the smoke is disgusting. You don't want to be rude or anything because they might say 'Who does she think she is anyway?' (Female, 14, Non-smoker).
Neutral with Regard to Obstacles. Messages that totally ignored the obstacles young smokers or non-smokers had to deal with were less likely to engage them in sense-making about tobacco. For example, even self-confident teenagers said they had some doubts about resisting invitations to smoke when they were vulnerable but messages rarely spoke to this specific obstacle.
Let's say I'm really stressed out with exams and everything, I'm not so sure I could say no. This friend of mine was depressed when she broke up with her boyfriend and said 'Heck, I'm going to smoke anyway.' (Female, 16, Non-smoker)
Hindering with Regard to Obstacles. Finally, sense-making about one's health even appeared to be hindered when messages negated the very real obstacles adolescents face when attempting to quit, such as overcoming physical addiction and resisting the temptation to enjoy a cigarette when around smokers. One such television message that made quitting appear deceptively easy when, in fact, adolescents were well aware of the difficulties involved led to this cynical comment.
No kidding, the girl throws away her cigarette just like that, I mean really! Hell, I'll do it right now. Youpee! it's magic, I'm a non-smoker! (Male, 14, Non-smoker)
Messages and Gaps

Supportive with Regard to Gaps. One way in which messages seemed to favor sense-making about their smoking habits was to help adolescents bridge the gaps they were experiencing with regard to their tobacco intake. For example, one clever message made a startling statement that cigarettes contain a few thousand toxic ingredients thus making teenagers aware of a gap in their knowledge.

I couldn't believe it . . . but I thought, if the people at Health Canada say it on TV, it must be true. . (Male, 13, Smoker)
Neutral with Regard to Gaps. In contrast, many messages simply overlooked many of the gaps expressed by adolescents relative to smoking, such as the social contradictions surrounding tobacco or the interaction between physical activity or health nutrition on the one hand and smoking on the other.
I think my body can afford to smoke because I don't eat a lot of junk food like most of my friends, mostly healthy stuff. In the end, it balances out . . . ( Male, 14, Smoker)
Hindering with Regard to Gaps. On the other hand, a message could potentially interfere with sense-making on this issue when it belittled or negated gaps relative to smoking that adolescents had or mistakenly attributed gaps to them. For instance, one message falsely implied that smokers entertained a gap about the ease of quitting; instead, adolescents interviewed showed a realistic awareness of the difficulty of the task and consequently felt misunderstood.
They talk as if we didn't know anything about smoking or never knew anyone who had tried to stop. (Male, 16, Smoker)
Where One is Going To

Messages and Resources

Supportive with Regard to Resources. Messages were more conducive to sense-making about teenagers' smoking habits when they helped them identify resources in their own milieu (suggesting, for instance, how they could turn to their friends, siblings, parents, teachers or doctors) or reinforced their belief that they were their own major resource when it comes to abstaining from smoking. Another way for a message to be helpful in this regard was to point the way to useful resources (such as print material or a hot-line).

This poster is good because it gives you a toll-free number to call to get the kit so that way, you don't feel stranded. (Female, 16, Smoker)
Neutral with Regard to Resources. In contrast, messages that quite simply overlooked resources and provided no clue as to where to turn to for help offered very little leverage for action.
This poster doesn't help me at all because what can I do with it? (Male, 13, Smoker)
Hindering with Regard to Resources. On the other hand, a message could become a hindrance to sense-making when it offered false leads. One message actually denied the usual resources for quitting (willpower and peer support) by suggesting the boy in the ad lacked the necessary personal strength and that his girlfriend would not help him in this regard. Another message exploiting visual effects inadvertently condoned a magical solution for quitting, thus implying that the most important resource lies outside the individual; obviously, this was problematic for sense-making since it positioned the teenager in a passive role.
When I see this ad, it makes me mad and I feel I've had enough with this smoking thing. (Male, 15, Smoker)
Messages and Solutions

Supportive with Regard to Solutions. Messages also had the potential to encourage sense-making when they demonstrated or suggested feasible solutions. For instance, one television advertisement showed teenagers socializing more with non-smokers and turning to sports to alleviate the anxiety of withdrawal.

That's what I did when I managed to quit. For one, I did more biking, big-time, and it took my mind off cigarettes. (Male, 17, Non-smoker)
Neutral with Regard to Solutions. Sometimes, solutions offered were too vague to be of interest for many adolescents. For instance, one message intending to reinforce refusal skills for non-smokers was not very explicit for adolescents who have less self-confidence; in the script, the girl offered only passive resistance to smoking and was saved the effort of talking to her peers and possibly having to deal with negative reactions to her refusal. Surprisingly, many messages simply exhorted behavior change without providing any clue as to how to attain that goal.
It's easy to say stop when you don't smoke, but where on earth do you start? (Female, 14, Smoker)
Hindering with Regard to Solutions. More unfortunately, a message sometimes interfered with sense-making that would lead an adolescent to consider relinquishing tobacco when it inadvertently implied there were no solutions for smokers or offered only misguided solutions.
In this kit, they say when you quit cigarettes, you can save enough money to buy a stereo chain but it would take a lot of time if you don't smoke much. You're better off mowing a few lawns. (Male, 17, Smoker)
Messages and Uses

Supportive with Regard to Uses. Constructive messages lent themselves to a variety of uses conducive to sense-making about cigarettes. This sometimes involved a positive contribution to the tobacco issue over time. For instance, adolescents thought some of the messages examined were useful to remind smokers to respect non-smokers and to project a positive image of responsible adolescents to adults and children.

I don't really need that kind of reinforcement but I still think it's a good thing for the younger kids in grade school to see that on TV to make them think ahead of time. (Female, 17, Non-smoker)
Neutral with Regard to Uses. Unfortunately, some messages appeared so disconnected with adolescents' lived context as to be practically useless for adolescents' sense-making about cigarettes.
I don't know what to say about this ad. It leaves me cold . . . (Male, 15, Smoker)
Hindering with Regard to Uses. Finally, a message that was felt as offensive could hinder sense-making in the direction of a healthier life-style. One such message led a female smoker to transform a non-smoking slogan to fit her own situation.
I like smoking. It's my decision. (Female, 15, Smoker).
Discussion, Implications and Conclusions

Extracting from the findings presented above, the final section of this paper looks first at major conclusions, then at implications for campaign design, and finally presents an argument for the application of Sense-Making to issues of campaign design, both in terms of the promises it holds and the challenges it presents. In the exploratory studies reported in this paper, Sense-Making Methodology was used as a way to understand what happens when an adolescent encounters an anti-smoking message. The basic research question was how sense-making about the message connected with sense-making about one's tobacco consumption? Obviously, there is a wide range of individual differences and circumstances that guide one's sense-making of a message, but some degree of convergence did emerge from the interviews. These revealed that adolescents found anti-smoking messages to be variously supportive, neutral or hindering with respect to their sense-making about cigarette smoking.

On the positive side, an anti-smoking message could sometimes be used like a stepping-stone to sense-making about tobacco in various ways. For example, this happened when the adolescents perceived the messages to relate to their personal experience as well as to their current life situation and had no reason to be defensive about themselves or their peers. Likewise, when needs satisfied by smoking were acknowledged, smokers felt respected and were more inclined to listen to suggestions of healthy alternatives to meet those needs. Similarly, when a message offered an intriguing fact, it gave them a new angle to talk about cigarettes in a way that connects with reasoning about their health.

Examples were provided in the previous section of messages that were conducive to sense-making about tobacco smoking in other ways as well. This was the case when teenagers found the messages relevant to the problems they encountered, when they either answered questions they had or sparked a novel question, and when they addressed specific obstacles or gaps they faced when trying to quit or attempting to remain a non-smoker. Finally, adolescents also found the anti-smoking messages meaningful when connections were established with resources or solutions that might be useful for young smokers and non-smokers.

However, in numerous instances messages could be termed neutral with regard to teenagers' sense-making about their cigarette habit. This happened when the lived context of smoking was ignored, when obstacles encountered by smokers attempting to quit were not acknowledged nor gaps attended to, in short when adolescents did not perceive any suggestion as to how to move forward in their sense-making about their tobacco intake. Finally, there were circumstances where teenagers' sense-making about tobacco seemed to be actually hindered by anti-smoking messages. One example is when young smokers were unfairly portrayed as dependent and unresponsive to others' needs. Another is messages that appeared oblivious to the social dynamics surrounding cigarettes were more likely to antagonize both groups than to achieve any constructive goal. In other cases, adolescents invested more energy in understanding a message that was ambiguous than in thinking about their own health. In short, Sense-Making Methodology allowed us to become aware of different uses teenagers had for anti-smoking messages. But in what ways is Sense-Making Methodology different from other approaches to health campaigns? I will venture some preliminary ideas in response to this question with respect to how Sense-Making fosters a particular view of the "other" and of mass communication. To begin with, Sense-Making meta-theory leads to a careful consideration of the Other's subjectivity.

The Sense-Making theoretic assumptions are implemented in method via a core methodological metaphor which pictures the human moving through time-space bridging gaps and moving on. (Dervin, 1999a, in press)
Thus, Sense-Making suggests that persuasive arguments that make sense to health agents are likely to be deconstructed and reconstructed by adolescents, simply because they, too, are searching for meaningful signposts for the conduct of their own lives. Certainly, there is a general consensus in the health milieu that it is important to consider the significance of health issues from the point of view of the individual. For instance, we can assert from a logical standpoint that tobacco is detrimental to one's health, but in order to understand why such a statement is likely to simply slip by a large number of young smokers, we need to understand the meaning of tobacco smoking for adolescents. Thus, most people would agree that teenagers often smoke to fit in with their peers and that pressing obligations to define their self-identity usually make them oblivious to long-range considerations about their health. However, the fundamental difference of Sense-Making Methodology for health campaigns is to remind us that understanding the other's point of view is indeed essential, not to better win her over to our own, but rather to find out what would be meaningful for her.

Viewing the other as constantly involved in sense-making also has the beneficial consequence of relativizing the health topic under scrutiny. The person is always simultaneously dealing with a number of issues of all sorts and of all magnitudes, whereas health campaigns typically focus on a single theme. But even with regard to a specific issue, individuals find themselves at different levels of awareness and living in an infinite number of circumstances. Thus a smoker may be on the defensive about his right to smoke or be desperately looking for a way to stop; a non-smoker may be struggling to persevere or be seriously bothered by secondary smoke. In fact, it is difficult to envision that a person does not experience some form of dissatisfaction (or discontinuity) with regard to an issue because that would be tantamount to admitting the person is not constantly evolving. For example, some of the young smokers interviewed, even though they had no intention of quitting in the foreseeable future, still had questions about when would be a good time to do so, eventually. Likewise, confident non-smokers still asked themselves whether they would be tempted to smoke during periods of heightened vulnerability.

Intersecting with these numerous levels of personal sense-making are the immediate social environments people live in and the multiple discourses and actions of people around them with regard to cigarettes. Further, a wider sociological context embraces all of the above, conveying particular cultural values and discourses about tobacco, which are likely to be echoed in the mass media. Obviously, describing a dynamic and complex process such as sense-making with static and uni-dimensional concepts is bound to be less than perfect. Hence, the linear sequence in Table 1 is but an abstraction since, in fact, these steps overlap and there is frequent movement back and forth between them.

While Sense-Making relies heavily on concepts of time, space, movement, and gap, it must be emphasized that these are not set forth as if sense-making was merely a purposive, linear, problem-solving activity. (Dervin, 1999a, in press)
For instance, even a successful solution may raise some questions or other problems which in turn call for a solution, etc. In short, capturing the endless interweaving of people's multiple sense-makings is not simple even with respect to a single issue such as smoking cigarettes.

Nonetheless, the specific challenge I have faced is to understand how sense-making about one's health may be facilitated by an encounter with an anti-smoking message conveyed through the mass media, given the basic premises of Sense-Making Methodology.

Sense-Making refocuses attention from the transcendent individual or collective human unit to the verbing, focusing attention on practices rather than persons . . . Sense-Making assumes that movement is the one irreducible of the human condition... Instead of focusing on elusive, ever-changing and constantly challenged nouns, Sense-Making mandates a focus on the hows of human individual and collective sense-making and sense-unmaking . . . (Dervin, 1999b, in press)
Therefore, when applied to mass media communication, the Sense-Making approach invites us to consider the role of the message as a catalyst within the individual's personal dynamics. That is, if we accept that information is not contained within the message, but created by the adolescent, the messages must be seen not as a vehicle for a predefined content, but rather as an opportunity for the adolescent to construct his or her own "information." In this perspective, successful interaction between the health agency and the "audience" will take place to the extent that the messages are speaking to young people's need for a better grasp of reality -- in other words, if they lead to some clarification of their life situation without throwing a shadow on some other aspect.

A possible hesitation in using Sense-Making theory to analyze media health campaigns could be that the model only applies to information sought by the person in the midst of making sense. In that case, how significant could a televised message be when its encounter is entirely circumstantial? Indeed, this is the crux of the matter with regard to health promotion via the mass media. The Sense-Making framework suggests that a person is always striving to make sense of her life, even though she may not be struggling specifically with the question of tobacco at that point in time. Her encounter with a public service announcement (PSA) is then seen as inscribing itself within the overall meaning-making process, wherever the individual happens to stand on the issue. Evoking the multiple levels and modes of Sense-Making helps us to consider how people at different levels of awareness will be making different sense of the same message or, for that matter, how the same people at diverse times and places will experience the message differently. In fact, an (indirect) benefit of the Sense-Making framework applied to communication by way of the media is to remind us that everyone "out there" is making sense of all the public service announcements (PSAs) they encounter and have encountered, whether these are still in the public space or lingering in their minds.

Situating media health messages in the context of Sense-Making leads us to view them in a different light, as partaking in adolescents' general efforts to create meaning and direction in their lives rather than imparting a meaning and direction to them. I would venture to add that Sense-Making invites us to consider media messages not as a finite product in time and space, but rather as part of an ongoing dialogue that is constructed by both parties over time. Creating a dialogue zone through the message naturally implies that we strive to make ourselves understood, but lends equal importance to what the other has to say. In other words, adolescents' critique of a health message would then be seen as a contribution to the dialogue instead of a sign of resistance. The latter interpretation would rather suggest that we are of a persuasive mind. I will easily admit that considering a public service announcements (PSA) as a dialogue zone instead of an admonition presents a particular challenge and calls for a great deal of thought and imagination.

Such an outlook might, in fact, appear mind-boggling in the context of mass communication, considering the myriad possibilities of interpretation. But conversely, these may be seen also as multiple avenues of connection with different individuals. Making the effort to think through the design of an anti-smoking message from a Sense-Making perspective involves envisioning how our message can be as meaningful as possible to as many people as possible, by connecting with questions they may have in their minds or with obstacles that stand in the way of their goals. In short, messages may be considered as different invitations to sense-making, none of them fixed in advance obviously. Ultimately, the fate of a media message escapes its creator's intent. One person may use a message to lock herself in, whereas someone else may use the same message to open a door. Consequently, a message should probably not be judged on behavioral change or on how much adolescents agree with it. For instance, it may simply confirm the adolescent's perception that the community at large cares about his health at this point in time, an attitude that may come into play later when he is struggling with a problem related to smoking. At the very least, an encounter with a PSA (public service announcement) should not contribute to the creation of obstacles in a person's mind.

During the interviews, it became apparent that adolescents' experiences with and expectations of media in general and public service announcements (PSAs) in particular also play a part in the way they construct meaning from such health messages. In other words, PSAs in and of themselves are the object of a meaning-making process, in combination with their discourse on tobacco as such. Thus, the Sense-Making interviews were also useful in showing how the stylistic elements of PSAs participate in adolescents' construction of meaning. Indeed, I have been impressed by the manner in which many adolescents, in their own way, expressed the necessity of a meaningful synergy between content and form in public service announcements (PSAs). For example, some messages made use of special effects to illustrate the deleterious consequences of smoking, but these were accepted by the teenagers only to the extent that they were semantically meaningful. Therefore, they reacted negatively to gratuitous effects that did not spark a question in their minds or make them discover some new facet of smoking (in addition to being spectacular to watch).

The importance of careful artistic crafting of PSAs (public service announcements) was also highlighted by the fact that some messages, instead of contributing to adolescents' meaning making about tobacco smoking, created gaps and obstacles in their understanding of the message itself. For example, if the behavior of the actors or the relationships among them were ambiguous, the adolescents' efforts were sidetracked into trying to grasp the context of the message. Thus, if a meaningful organization of the content of the message appears fundamental, a creative approach with regard to the stylistic features seems just as essential when considered from a Sense-Making perspective. In short, the Sense-Making interviews underscored the idea that a message about smoking should be synchronized with adolescents' sense-making experiences about cigarettes, but it should also be concordant with their conception of what a public service announcement should be. Most teenagers interviewed were receptive to the idea of health messages designed especially for them, but they did expect a frank treatment of the issue. This is a form of participation in the dialogue.

The observations reported in this paper have been offered in the hope of making a small contribution to the success of future health campaigns. Given the expense of producing television public service announcements (PSAs) and their notoriously weak impact in terms of behavior change, it is reasonable to doubt their usefulness. But interviews with a diversity of individuals reveal that such messages stand out in the programming flux, nourish conversations and are remembered for a long time. To the extent that PSAs are seen as complementary to other means of health promotion, I believe they fulfill a vital function within a campaign. When we have the privilege of exploring adolescents' reactions to these well-meaning campaigns, it is amazing to find how precious opportunities may be overlooked in some messages or how some aspects of the message inadvertently contribute to self-sabotage. Therefore, it is not sufficient for a PSA to be notorious and aesthetically pleasing. I hope to have conveyed to the reader that such messages should be as meaningful as possible and that Sense-Making Methodology can be helpful in this respect.

Simply stated, the most fundamental contribution of Sense-Making Methodology for health campaigns may be to draw attention to the communication theory underlying the design of health messages. Although the task of delineating the full theoretical and methodological implications of Sense-Making for media health campaigns is still under way, the prospect of how sense-making about PSAs (public service announcements) intersects with sense-making about smoking opens up exciting avenues for media health communication. I also believe we will be able to build upon insights acquired through research on campaigns in traditional media to envision how technologically interactive media might offer other creative opportunities for health promotion in ways that are truly significant for people.

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