Lessons Learned from Developing Tailored Community Communication Campaigns in the HEALing Communities Study.

This paper outlines lessons learned from tailoring communication campaigns to increase demand for, and reduce stigma toward, evidence-based practices to reduce opioid overdose deaths in 66 communities participating in the HEALing (Helping to End Addiction Long-termSM) Communities Study (HCS). We present nine lessons gathered about how to engage local communities in both virtual and in-person opioid messaging and distribution between February 2019 and June 2022. The research team created four communication campaigns and did extensive, tailored marketing and promotion to assist communities in implementing evidence-based clinical activities to reduce opioid overdose mortality. Various strategies and venues were used to amplify HCS messages, using free and paid outlets for message distribution, focusing primarily on social media due to the COVID-19 pandemic. Increasing the availability of medications for opioid use disorder and naloxone, as HCS attempted, is not enough; getting people to accept and use them depends on communication efforts. This paper focuses on the process of preparing communities for communication campaign activities, which we hope can help guide other communities preparing for opioid or substance-related campaigns in the future.

Eudaimonic Testimonial Vs. Didactic Presentation Impact on Willingness to Engage in Conversations about End-of-Life Care: The Moderating Role of Modeling.

Using the mediated wisdom of experience (MWOE) theoretical framework, this study examines how eudaimonic testimonials versus comparable didactic presentations, and the presence or absence of modeling target behavior, influence death acceptance and intentions to converse about end-of-life care preferences. Effects for testimonials on attitudes and behaviors proved contingent on modeling. When testimonials incorporated modeled behavior, individuals were more likely to intend to carry out conversations about end-of-life conversations. However, when the testimonials did not provide modeled examples of conversations about death, individuals were more likely to experience anxiety and less likely to intend to engage in such conversations. Mediation analyses found that testimonials indirectly increased attitudes and intentions to have end-of-life conversations through emotional range and death acceptance. Mediation analyses also indicated modeling such conversations increased attitudes and intentions toward having end-of-life conversations via identification and self-efficacy.

Increasing Alcohol Control Policy Support: The Mediating Role of Empathy and Emotions.

Background: Mass media messages have the potential to reduce alcohol-related harm through increasing support for alcohol-control policies. Objectives: In Study 1, we experimentally examined the incidental effects of alcohol mention in news articles about accidents and crime and found evidence that messages mentioning alcohol as a causal factor in the accident or crime can activate empathic and emotional responses, which in turn increase support for alcohol control policy. In Study 2, anti-drinking and driving public service announcements (PSAs) were edited to either portray consequences of drinking and driving for the driver only or for both the driver and innocent others. Results: The versions of the PSAs that showed consequences to others were more successful at eliciting alcohol-control policy support than the versions showing only consequences to the self. As hypothesized, empathy that was directed toward victims (but not drivers under the influence) and negative emotions were supported as mediators of this relationship. Although negative affect and feelings of empathy for the victims of drunk driving are not pleasant emotions to experience, they appear to play an important role in increasing support for public policies to increase safety without having a negative impact on viewer's evaluations of the PSA. Conclusions: Results from the two studies provide evidence that empathy and emotions can play a mediating role between message characteristics (either intentional or incidental) and alcohol control policy support.

Adolescent males' responses to blu's fake warnings.

OBJECTIVE: Blu's 'Something Better' advertising campaign ran in popular print magazines in 2017. The campaign included advertisements with fake warnings conveying positive messages, which mimicked the Food and Drug Administration (FDA)'s warning requirements for electronic cigarette (e-cigarette) advertisements that took effect in 2018. We report adolescent males' recall of these fake warnings and how exposure to fake warnings affected recall of other advertisement components, including the actual warning or health risks, brand and product. METHODS: Ohio males ages 12-19 years (N = 775; 73.8 % white non-Hispanic) were randomly assigned to view an e-cigarette advertisement with or without a fake warning. Afterward, they were asked what they remembered most about the advertisement. Responses were qualitatively coded. Statistical analyses included survey-weighted descriptive statistics and logistic regression. RESULTS: Of participants who viewed an e-cigarette advertisement with a fake warning, 27.0 % reported the fake warning was what they remembered most, and 18.8 % repeated the fake warning message. Participants viewing advertisements with a fake warning had lower odds of recalling the actual warning or health risks (OR = 0.29; 95% CI: 0.11 to 0.77) or brand (OR = 0.43; 95% CI: 0.22 to 0.85), compared with participants viewing other e-cigarette advertisements. CONCLUSIONS: Adolescents viewing an advertisement with a fake warning were less likely to recall the advertisement's actual warning or health risks. Although e-cigarette advertisements now carry large FDA-mandated warnings, this tactic could be used for cigarette advertisements that continue to carry small warnings in the USA. Findings underscore the necessity of tobacco advertisement surveillance and study of advertisements' effects on adolescents.

Rumor Acceptance during Public Health Crises: Testing the Emotional Congruence Hypothesis.

Rumors pose a significant challenge to officials combatting a public health crisis. The flow of unsubstantiated and often inaccurate information can dilute the effects of more accurate messaging. Understanding why rumors thrive in this context is a crucial first step to constraining them. We propose a novel mechanism for explaining rumor acceptance during a health crisis, arguing that the congruence between one's emotional state and the emotion induced by a rumor leads people to believe the rumor. Data collected using a novel experimental design provide preliminary evidence for our emotional congruence hypothesis. Participants who felt angry were more likely to accept anger-inducing rumors than those who were not angry. We discuss the implications of this insight for public health officials combatting rumors during a health crisis.

Randomized Trial Evaluating Targeted Photographic Health Communication Messages in Three Stigmatized Populations: Physically-Disabled, Senior, and Overweight/Obese Individuals.

The homophily principle that perceived similarities among people produce positive reactions is a cross-cultural, global phenomenon. The prediction that photographs depicting models similar to the target population improve health communication was tested. Three nationally-representative samples (n = 1,796) of adults who are disabled, seniors, or considered overweight/obese were selected from GfK's Knowledge Panel®. Participants read a message promoting physical activity and improved diets and responded to assessments of behavioral intentions, outcome and self-efficacy expectations, and identification. Photographs from a stock photograph service versus photographs created for the research project to match the three populations, Real Health Photos (RHP), were included in the message. Structural equation modeling confirmed that RHP which matched the population increased behavioral intentions mediated by identification (p < 0.05) in the physically-disabled and overweight/obese samples. Messages with only half of the matched RHP images had these same positive indirect effects (p < 0.05). Matched visual images in health messages improved effectiveness by capitalizing on the homophily and identification processes. Health educators should leverage these hardwired, evolutionary, biological phenomena that extend to health status as well as race and ethnicity. For optimal effects, not all persons shown need to be homophilous to the target audience, reducing logistical difficulties in showing diverse persons of various types.

Tobacco and Alcohol on Television: A Content Analysis of Male Adolescents' Favorite Shows.

INTRODUCTION: Media tobacco and alcohol portrayals encourage adolescent substance use. Preventing adolescent initiation with these substances is critical, as they contribute to leading causes of morbidity and mortality in the United States. Television tobacco and alcohol portrayals have not been examined for more than 7 years. This study analyzed tobacco and alcohol portrayals on adolescents' favorite television shows and evaluated the rate of portrayals by parental rating. METHODS: Adolescent males (N = 1,220) from Ohio reported 3 favorite television shows and how frequently they watch them. For each of the 20 most-watched shows in the sample, 9 episodes were randomly selected and coded for visual and verbal tobacco and alcohol incidents. Demographics of characters who used or interacted with the substances were recorded. Negative binomial regression modeled rates of tobacco and alcohol incidents per hour by parental rating. RESULTS: There were 49 tobacco and 756 alcohol portrayals across 180 episodes. Characters using the products were mostly white, male, and adult. The rate of tobacco incidents per hour was 1.2 for shows rated TV-14 (95% CI, 0.4-3.6) and 1.1 for shows rated TV-MA (95% CI, 0.3-4.5). The estimated rate of alcohol incidents per hour was 20.9 for shows rated TV-14 (95% CI, 6.3-69.2) and 7.2 for shows rated TV-MA (95% CI, 1.5-34.1). CONCLUSIONS: Adolescent males' favorite television shows rated TV-14 expose them to approximately 1 tobacco incident and 21 alcohol incidents per hour on average. Limiting tobacco and alcohol incidents on television could reduce adolescents' risk of substance use.

Attitudes toward Tobacco, Alcohol, and Non-Alcoholic Beverage Advertisement Themes among Adolescent Boys.

BACKGROUND: Previous studies have examined what adolescents find appealing in tobacco and alcohol advertisements and how different themes in advertisements are used to manipulate consumer behaviors. Yet, we know little about the relationship between the themes portrayed in advertisements and youth attitudes towards those themes. OBJECTIVES: This study compared attitudes towards advertisements for different consumer products in a sample of urban and rural adolescent boys in order to examine how key marketing themes impact adolescent attitudes towards those advertisements. METHODS: Participants were 11- to 16-year-old boys (N = 1220) residing in either urban or rural Ohio Appalachian counties. Each participant viewed five print advertisements (one each for cigarettes, electronic cigarettes (e-cigarettes), smokeless tobacco (SLT), non-alcoholic beverages, and alcohol), presented in a random order, for eight seconds each. All advertisements had appeared in magazines that adolescent males commonly read. Attitudes towards each of the five advertisements were assessed. The advertisements were then coded for the presence of various themes, including social acceptance and masculinity. Analyses were conducted to determine associations between advertisement type and the attitude measure, and between the presence of a theme and the attitude measure. RESULTS: Overall, participants preferred non-tobacco advertisements to tobacco advertisements, rural participants had less positive attitudes and participants who had peers who used tobacco had more positive attitudes. Social acceptance and entertainment themes increased the appeal of SLT advertisements, and sex appeal increased the appeal of e-cigarette advertisements. Conclusions/Importance: Findings suggest that advertisements that promote the social nature of use in SLT advertisements may be of particular concern for their influence on adolescent boys.

Anatomy of the pedicled anterolateral thigh flap for phalloplasty in transitioning-males.

Incidence of transexualism and request for neophalloplasty is increasing yielding a current prevalence of trans-male in the USA of 1:2500. Surgeons have explored various techniques to improve desirable outcomes of neophallic construction, decrease the length of surgery, and minimize stigmatizing scars. The anterolateral thigh (ALT) flap is an alternative to the traditional radial forearm flap for patients who do not want a forearm scar. Surgical text descriptions were enhanced by the creation of new anatomic illustrations. Anatomy of the donor and recipient sites as well as the surgical technique leading to creation of the neophallus are demonstrated in detail with new relevant illustrations. The ALT flap is a skin, fat and fascia flap that is usually supplied by the descending branch of the lateral circumflex femoral vessels and the lateral femoral cutaneous nerve. However, variability in neurovascular supply does exist with important clinical implications. In the pedicled surgical procedure, neurovascular supply is left partly attached to the donor site ("pedicle") and simply transposed to the perineum, keeping the pedicle intact as a conduit to supply the tissue with blood and innervation. ALT flap offers clinical advantages of less obvious donor site concealable with clothing, decreased surgical time, preservation of erogenous sensation and vascular supply of the flap without microsurgical anastomosis of nerves and vessels, and good potential for urethroplasty. This surgery may be difficult in patients with thicker skin and more subcutaneous thigh fat. Clin. Anat, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Neovaginal Construction with Pelvic Peritoneum: Reviewing an Old Approach for a New Application.

Transgender reassignment surgeries have become a major topic of interest within the last decade. Although there are numerous surgical techniques for male-to-female reassignment, a physician must assess each patient's anatomy and past medical history to determine the most suitable technique. Additionally, patient preference is important. The neovaginal constructive technique most commonly used in male-to-female reassignment surgery is penile skin inversion, but various other techniques and tissues can also be used including pelvic peritoneum, buccal mucosa, and bowel. Surgical text descriptions were enhanced by creating new anatomical illustrations. Donor and recipient site anatomies, and the surgical technique leading to creation of the neovagina, are demonstrated in detail with relevant illustrations. A review of the literature concerning the anatomy, procedure development, and outcomes is presented. The pelvic peritoneum was originally used in neovaginal construction for females with vaginal agenesis as a result of MRKH syndrome. The use of this technique to create a neovagina in male-to-female transgender reassignment surgery has become appealing owing to the relative ease of the procedure, low complication rates, and overall high patient satisfaction. This technique offers a potential new choice for transgender male-to-female neovaginal construction, but further studies are needed to confirm its successful use in transgender surgery. Clin. Anat. 31:175-180, 2018. © 2017 Wiley Periodicals, Inc.

Alcohol harm reduction advertisements: a content analysis of topic, objective, emotional tone, execution and target audience.

BACKGROUND: Public health mass media campaigns may contribute to reducing the health and social burden attributed to alcohol consumption, but little is known about which advertising characteristics have been used, or have been effective, in alcohol harm reduction campaigns to date. As a first step towards encouraging further research to identify the impact of various advertising characteristics, this study aimed to systematically identify and examine the content of alcohol harm reduction advertisements (ads). METHOD: Ads were identified through an exhaustive internet search of Google, YouTube, Vimeo, and relevant government and health agency websites. Eligible ads were: English language, produced between 2006 and 2014, not primarily focused on drink-driving or alcohol in pregnancy, and not alcohol industry funded. Systematic content analysis of all ads was performed; each ad was double-coded. RESULTS: In total, 110 individual ads from 72 different alcohol harm reduction campaigns were identified, with the main source countries being Australia (40%) and the United Kingdom (26%). The dominant topic for 52% of ads was short-term harms, while 10% addressed long-term harms, 18% addressed underage drinking, 17% communicated a how-to-change message, and 3% advocated for policy change. The behavioural objective of most ads was to motivate audiences to reduce their alcohol consumption (38%) or to behave responsibly and/or not get drunk when drinking (33%). Only 10% of all ads mentioned low-risk drinking guidelines. Eighty-seven percent of ads used a dramatisation execution style and 74% had a negative emotional tone. Ninety percent of ads contained messages or content that appeared to target adults, and 36% specifically targeted young adults. CONCLUSIONS: Some message attributes have been employed more frequently than others, suggesting several promising avenues for future audience or population-based research to compare the relative effectiveness of different characteristics of alcohol harm reduction ads. Given most alcohol-attributable harm is due to long-term disease, these findings suggest future campaigns may fill a potentially important gap if they were to focus on long-term harms. There is scope for such long-term harm campaigns to place greater emphasis on encouraging reduced personal consumption of alcohol, potentially through more frequent communication of low-risk drinking guidelines.

Using Health Conditions for Laughs and Health Policy Support: The Case of Food Allergies.

Health conditions are sometimes included in entertainment media comedies as a context for and as a source of humor. Food allergies are a typical case in point: They are potentially life-threatening yet may be used in humorous contexts. We conducted a content analysis of food allergies in entertainment media and tested the effects of humorous portrayals from an exemplar entertainment program. The content analysis confirmed that when food allergies were portrayed in television and the movies, it was most frequently in a humorous context and often contained inaccurate information. A follow-up experiment showed viewing a humorous portrayal of food allergies had an indirect negative effect on related health policy support via decreased perceived seriousness of food allergies. Inclusion of an educational video eliminated this effect on reduced policy support, with cognitive dissonance as a mediator. Findings support the hypothesis that portraying a health condition in a humorous context may reduce perceptions of seriousness and willingness to support public health policies to address risks associated with the condition, supporting and extending prior research findings.

Process Evaluation of Cancer Prevention Media Campaigns in Appalachian Ohio.

The purpose of this study is to provide process data from campaigns (2009-2010) to improve colorectal cancer (CRC; intervention) screening and fruit and vegetable (F&V; comparison) consumption in 12 Appalachian Ohio counties. County-specific campaigns included one billboard, posters, and articles for local newspapers. Participants in CRC screening counties who reported seeing CRC screening billboards had greater intention to talk to a doctor/nurse about screening in the next 6 months (odds ratio [OR] = 2.92, 95% confidence interval [CI; 1.71, 4.99]) and had twice the odds of talking to a doctor/nurse about screening in the past year (OR = 2.15, 95% CI [1.29, 3.60]) compared to those who did not see the billboards. Participants in F&V counties who reported seeing F&V billboards had twice the odds (OR = 2.27, 95% CI [1.35, 3.84]) of talking to a doctor/nurse in the past year about F&Vs compared to those who did not see the billboards. Participants who reported campaign exposure lived closer to the billboards compared to those who did not report campaign exposure (mean distance in miles from home to billboard: 8.8 vs. 10.9; p < .01). Most participants reported campaign messages were clear and important. Results suggest that partnering with community members to develop campaign materials is important to ensure cultural appropriateness and that exposure to the intervention components may affect health-related outcomes.

Use of Marijuana Edibles by Adolescents in California.

We explored how adolescent marijuana edible users differ in regards to marijuana use and related beliefs from marijuana users who do not use edibles. We analyzed California Healthy Kids Survey data collected in one Northern California school district with a racially and ethnically diverse student population. Survey respondents were youth in grades 9-12. Overall, 33% of respondents reported having used marijuana in their lifetime, and 50% of lifetime marijuana users reported using marijuana in the past 30 days. Seventy-two percent of lifetime marijuana users and 82% of past month marijuana users reported having used edibles in their lifetime. Comparing marijuana users who have never used edibles to those users who have, we found that edible users reported using marijuana more frequently in their lifetime. Edible users were also more likely to have used marijuana in the past 30 days, more frequently in the past 30 days, more likely on school property and more frequently on school property. Edible users and non-users differed in their perceptions of risk; edible users were less likely to agree that edible use is very risky. Edible users also reported a younger age of first marijuana use and more attempts to stop using marijuana than non-edible users. Multi-level regression analyses indicate that prevalence of edible use among marijuana users was related to perceived risk of edible use. Perceived risk of edible use among marijuana users was higher among marijuana users who do not use edibles, females, and those youth who perceive school rules to be clear. The findings indicate that prevalence of edible use is high among marijuana users, especially frequent users.

Teen Use of Marijuana Edibles: A Focus Group Study of an Emerging Issue.

Recent research indicates that marijuana-infused food product (i.e., edible) use is becoming nearly as common as smoking marijuana where medical marijuana is available. This study explores edible use among teens. We conducted four focus groups in the San Francisco Bay Area with youth, ages 15-17. The focus groups were divided by gender and whether they used marijuana. Some teens mentioned edible use at school. Youth reported that teens consume edibles, primarily to reduce the likelihood of getting caught. Edibles are also attractive to those who do not like to smoke or have concerns about smoking. Both male and female respondents suggested that females are more likely than males to prefer edibles over smoking, one reason for which may be to avoid smelling like marijuana smoke. For some young women, edibles may be a way to avoid publicly presenting themselves as marijuana users. Findings also suggest that youth have access to edibles through multiple sources. Youth reported that they can purchase edibles at school from other students who either make the edibles themselves or are reselling edibles obtained from dispensaries. Both users and non-users were aware of potentially negative consequences related to edible use. Some youth mentioned that they have heard of youth dying from edibles, and several reported being concerned about the high produced by edibles. Female non-users appeared to be more concerned than others about edibles and compared them to drinks that could be spiked with drugs. However, sentiment among some male marijuana users was that if you cannot handle edibles you should not be using them. These findings suggest that strategies to curb access to edibles and use among youth, such as restricting sales of edibles with strong youth appeal and educating youth on the risks of edibles, will need to be developed.

Point-of-sale tobacco marketing in rural and urban Ohio: Could the new landscape of Tobacco products widen inequalities?

Considerable research has examined how cigarette point-of-sale advertising is closely related to smoking-related disparities across communities. Yet few studies have examined marketing of alternative tobacco products (e.g., e-cigarettes). The goal of the present study was to examine external point-of-sale marketing of various tobacco products and determine its association with community-level demographics (population density, economic-disadvantage, race/ethnicity) in urban and rural regions of Ohio. During the summer of 2014, fieldworkers collected comprehensive tobacco marketing data from 199 stores in Ohio (99 in Appalachia, 100 in Columbus), including information on external features. The address of each store was geocoded to its census tract, providing information about the community in which the store was located. Results indicated that promotions for e-cigarettes and advertising for menthol cigarettes, cigarillos, and cigars were more prevalent in communities with a higher percentage of African Americans. Cigarillos advertising was more likely in high-disadvantage and urban communities. A greater variety of products were also advertised outside retailers in urban, high-disadvantage, African American communities. Findings provide evidence of differential tobacco marketing at the external point-of-sale, which disproportionately targets urban, economically-disadvantaged, and African American communities. There is a need for tobacco control policies that will help improve equity and reduce health disparities.

Self-Deprecating Humor Versus Other-Deprecating Humor in Health Messages.

Humor is sometimes used in health messages. However, little is known about contingencies under which different types of humor may or may not be effective. This experiment crossed humorous versus nonhumorous and self- versus other-deprecating messages about binge drinking, and tested how differences in personal investment in alcohol use moderates the effects of such messages on college binge drinkers. Results showed significant 3-way interaction effects on subjective norms and behavioral intentions largely consistent with hypotheses. Assessment of significant differences in the interactions indicated that for binge drinkers who were not high in personal investment in alcohol use, other-deprecating humor tended to reduce their perceived subjective norms about the acceptability of binge drinking behavior and their behavioral intentions. The effect of the experimental manipulation on subjective norms among these binge drinkers was shown to mediate the effect on intentions to binge drink in the future. Theoretical and practical implications are discussed.

Injury news coverage, relative concern, and support for alcohol-control policies: an impersonal impact explanation.

Research on the impersonal impact hypothesis suggests that news (especially print) coverage of health and safety risks primarily influences perceptions of risk as a societal issue, and not perceptions of personal risk. The authors propose that the impersonal impact of news-impact primarily on concerns about social-level risks-will mediate effects of news stories on support for public health policies; such effects substantively matter as evidence suggests health policies, in turn, have important effects on protective behaviors and health outcomes. In an experiment using 60 randomly selected violent crime and accident news stories manipulated to contain or not contain reference to alcohol use as a causative factor, the authors find that the effect of stories that mention alcohol as a causative factor on support for alcohol-control policies is mediated by social-level concern and not by personal-level concern. In so doing, the authors provide a theoretical explanation as well as empirical evidence regarding the potential for news coverage-including breaking or episodic news-to influence health-related public policy.

Comparing local TV news with national TV news in cancer coverage: an exploratory content analysis.

The authors compared local TV news with national TV news in terms of cancer coverage using a nationally representative sample of local nightly TV and national network TV (i.e., ABC, CBS, NBC, and CNN) cancer news stories that aired during 2002 and 2003. Compared with national TV news, local TV cancer stories were (a) much shorter in length, (b) less likely to report on cancer prevention (i.e., preventive behaviors and screening tests), and (c) less likely to reference national organizations (i.e., National Cancer Institute, American Cancer Society, National Institutes of Health, Centers for Disease Control and Prevention, Food and Drug Administration) that have made clear recommendations about ways to prevent cancer. The implications of these findings for health communication research and cancer education were discussed.

Effect of nicotine replacement therapy on quitting by young adults in a trial comparing cessation services.

CONTEXT: Young adult smokers have the highest smoking prevalence among all US age groups but are least likely to use evidence-based cessation counseling or medication to quit. OBJECTIVE: Use and effectiveness of nicotine patch were explored in a randomized trial evaluating smoking cessation interventions with this population. PARTICIPANTS: Smokers aged 18 to 30 (n = 3094) were recruited through online and off-line methods and from telephone quit lines and analyzed. DESIGN: Smokers were enrolled in a pretest-posttest trial, and randomized to 1 of 3 cessation services. SETTING: Trial delivering counseling services by self-help booklet, telephone quit lines, or online expert system in the 48 continental United States. INTERVENTION: Smokers could request a free 2-week course of nicotine replacement therapy (NRT) patches from the project. MAIN OUTCOME MEASURE: Follow-up surveys at 12 and 26 weeks assessed smoking abstinence, use of NRT, counseling, and other cessation medications, and smoking-related variables. RESULTS: Overall, 69.0% of smokers reported using NRT (M = 3.2 weeks) at 12 weeks and 74.8% (M = 3.3 weeks) at 26 weeks. More smokers who were sent the free nicotine patches (n = 1695; 54.8%) reported using NRT than those who did not receive them (12 weeks: 84.3% vs 41.9%, P < .001; 26 weeks: 87.6% vs 51.1%, P < .001). The use of NRT was associated with greater smoking abstinence at 12 weeks (P < .001) and 26 weeks (P < .05), especially if used for more than 2 weeks (P < .001). Smokers assigned to a self-help booklet or cessation Web site and heavier smokers were most likely to use NRT (P < .05), whereas those reporting marijuana use and binge drinking used NRT less (P < .05). CONCLUSIONS: Many young adults were willing to try NRT, and it appeared to help them quit in the context of community-based cessation services. Strategies should be developed to make NRT available to this age group and support them in using it to prevent lifelong smoking.