Five Questions with Xiaoquan Zhao

December 14, 2021

Xiaoquan Zhao is a Professor in the Department of Communication at George Mason University. Zhao researches health message design and effects, evaluation of public communication campaigns, health information seeking, health information disparities, news effects on health and risk perceptions, and the role of the self in health behavior and persuasive communication. In addition to publishing numerous articles in leading Communication journals, Zhao has also consulted on projects for the U.S. government. In 2013-2014, Zhao worked as a Tobacco Regulatory Science Fellow at the FDA's Center for Tobacco Products. Since 2014, Zhao has served in an advisory role for the Division of Research and Evaluation in the Office of Health Communication and Education at the FDA’s Center for Tobacco Products and has supported tobacco education campaigns. 

1. Much of your research has focused on tobacco use and tobacco education campaigns. One thing that you’ve looked at recently is how to prevent vaping among young people. What kinds of messages have been most effective in preventing young people from vaping? 

This is an active area of research, and we are continually learning more about the relative effectiveness of different message strategies. Vaping is a relatively new phenomenon (compared to other forms of tobacco use), but its popularity among young people, particularly youth who are otherwise unlikely to use tobacco at all, is deeply concerning. Research shows that many kids who are currently using or curious about vaping are intrigued by sleek product design, glamorous advertising, and tempting flavors. However, they are relatively unaware of the harms vaping can do to their growing minds and bodies. 

Evidence so far shows that messages conveying factual information about the negative health consequences of vaping, such as lung damage and brain impairment, and about the dangerous ingredients of vaping products, such as heavy metals and toxic chemicals, tend to resonate well with youth. Other message themes, such as those tying vaping to addiction and loss of control over life, also have potential. Messages that evoke strong emotional responses, such as fear and disgust, can work well. However, communicators must be careful to ensure that these emotional reactions do not backfire. My research shows that focusing on the negatives of vaping generally works better than focusing on the positives of abstinence. Delivering messages through trusted sources, such as personal pediatricians, and using more engaging message formats, such as stories and testimonials, can also enhance the effectiveness of vaping prevention messages.  

The pandemic has complicated the youth vaping landscape. There is evidence that many young people have quit vaping or reduced consumption of nicotine through vaping since the pandemic began. Our own data show that at-risk adolescents generally perceive vaping to be a risk factor for contracting COVID-19. However, perceived COVID risk does not seem to mitigate susceptibility to future vaping among those with recent vaping experience. Whether we can productively incorporate COVID risk information into vaping prevention messages is an important topic for additional research.

2. In addition to research in the U.S. context, you’ve also researched e-cigarette sales in China. What tactics have been used to market these products in China and what makes them appealing to consumers? 

About 90 percent of the e-cigarettes on the global market are produced in China. While relatively low compared to those in the United States and Europe, the rates of e-cigarette use among Chinese adults and youth have been increasing in recent years. Until 2021, e-cigarettes were not considered a tobacco product, health product, or medical device in China. They were treated as a common electronic product and were not subject to strict regulations over their manufacturing, marketing, or distribution. 

E-commerce platforms are the primary venue for e-cigarette sales in China. Some colleagues and I studied the promotional tactics manufacturers have used to sell e-cigarettes on T-Mall, the largest business-to-consumer online marketplace in China. Our study showed that manufacturers tout claims of e-cigarettes being a cessation device and healthy. Tastes and flavors are strongly advertised, as are e-cigarettes’ portability, easy use, and high-tech feel in design and packaging. In addition, sellers make claims about battery capacity, vapor output, and general product quality. Many products prominently display endorsements from celebrities, although the veracity of such endorsement is uncertain. Only a small minority of the products bear any warnings about the potential harms of e-cigarette use. We examined the actual sales records of the products and found that health claims, quality claims, and celebrity endorsement are strongly associated with sales volume. These findings reveal a largely unregulated marketplace filled with unsubstantiated claims about health, safety, and cessation outcomes. 

In March 2021, China proposed revisions to its tobacco control law and formally recognized e-cigarettes as a tobacco product. The revised law expresses intentions to regulate the e-cigarette market the same way as conventional cigarettes. I am hopeful that this will lead to better practices in e-cigarette marketing and less uptake of e-cigarette use among China’s youth and other tobacco-naive populations.   

3. You’ve also looked specifically at campaigns to promote smoking cessation among first-generation Chinese and Korean immigrants. What methods were most effective among these groups? 

China and Korea have some of the highest smoking rates in the world, particularly among men. Many of the male, first-generation, Chinese and Korean immigrants in the United States are smokers. These groups are hard to reach with traditional intervention efforts because of language, economic, and cultural barriers. To promote smoking cessation among these immigrant groups, we must find innovative ways to reach and engage them. 

My research shows that text messaging is a high-efficiency and low-cost way to reach members of these immigrant populations. Mobile-based social media platforms, such as WeChat for Chinese immigrants and KakaoTalk for Korean immigrants, are also promising vehicles for disseminating intervention messages. As with any immigrant and minority population, culturally tailored messaging is a must for interventions targeting Chinese and Korean immigrant smokers. Emphasizing personal risk alone is not enough to motivate quitting among these groups. My research shows that messages that reflect the East Asian cultural norms and the lived experience of immigrants tend to produce greater receptivity. For example, messages highlighting the harms of smoking to loved ones, especially children, and the risk of increased stigmatization because of smoking resonated particularly well with the participants in my study. Quitting tips that are culturally appropriate are important to include in cessation intervention programs targeting these groups. 

Furthermore, because literacy is a challenge for many members of the Chinese and Korean immigrant communities, the use of graphics can be particularly helpful in cessation messaging. My work shows that, when compared to text-only messages, graphic messages can lead to more favorable changes in quitting attitudes and stronger emotional responses, both of which are associated with future quitting behavior.

One of the most important things I learned from doing this research is that interventions that target Chinese and Korean immigrant smokers are few and far between. These immigrant groups face significant tobacco-related health disparities and deserve greater research attention and more generous allocation of intervention resources. I hope more Communication researchers will direct their interest and energy to the promotion of smoking cessation and the general well-being of these uniquely vulnerable populations.     

4. Since 2014, you’ve served as a subject matter expert and advisor for the Division of Research and Evaluation in the Office of Health Communication and Education at the FDA’s Center for Tobacco Products. Can you tell us a bit about your work with the FDA? 

In 2013, I was selected into a Tobacco Regulatory Science Fellowship program jointly sponsored by the FDA and the Institute of Medicine (now National Academy of Medicine). The fellowship enabled me to take a year-long leave from George Mason University to work full time at the FDA’s Center for Tobacco Products (CTP). Coincidentally, that year also marked the launch of the FDA’s first national youth tobacco education campaign, The Real Cost. The fellowship experience opened my eyes to the vast and complex landscape of tobacco control in the United States. It also deepened my appreciation of the important contributions Health Communication scholarship can make to tobacco education efforts and public health in general. After the fellowship, I have continued to stay involved by serving as a subject matter expert and scientific adviser on research and evaluation in the FDA office that is responsible for managing the campaigns. In those roles, I provide scientific input on a range of research activities in support of the campaigns, including foundational audience analysis, advertising copy testing, and longitudinal outcome evaluation. Each week, I dedicate about 10 to 12 hours of my time to FDA work. Over the years, I have learned a great deal about how campaigns work and how science, creativity, and political will are all indispensable to the continued success of tobacco control efforts. I have also developed great friendships with colleagues both within and outside of the FDA who have worked tirelessly on the campaigns. They are some of the most talented and dedicated professionals I know and the opportunity to work with them is a true honor and privilege.

5. In addition to being a prolific researcher, you’re an award-winning mentor, having received the CGSA Faculty Mentor Award from the Department of Communication at George Mason University. How do you approach mentorship and what do you strive to communicate to your advisees? 

The most rewarding part of being a professor is to witness the growth and success of your students. Over the years, I have had the pleasure to work with many talented and driven young scholars both in and outside of my department and university. My approach to mentorship is relationship based. I strive to genuinely know the person I am mentoring, not just what they can do as a learner and researcher. At the very core of a healthy and productive mentor-mentee relationship is active listening. It is not easy to listen well when everybody is busy. But I have found that being generous with the time that I share with students can make a huge difference in their mentorship experience and their willingness to share, engage, and persevere through challenges. I emphasize trust and respect in the mentor-mentee relationship. I want my mentees to know that they can trust me to understand their perspectives, interests, and concerns. I also want them to know that I respect their autonomy, intellectual ability, and motivation to succeed. With strong personal connection, mutual trust, and respect, the mentor-mentee relationship can evolve into long-lasting friendships and collaboration. I am proud to say that I have formed such bonds with many of my advisees and mentees. 

Watch a video with additional insights from Xiaoquan Zhao!