Evaluating The Real Cost Digital and Social Media Campaign: Longitudinal Effects of Campaign Exposure on E-cigarette Beliefs.

INTRODUCTION: Over the past decade, youth e-cigarette use has risen exponentially. At the same time, digital media use increased markedly while the use of traditional broadcast TV declined. In response, the U.S. Food and Drug Administration's The Real Cost public education campaign shifted to communicating the harms of e-cigarette via primarily digital and social platforms. This study evaluated longitudinal associations between exposure to campaign advertisements and changes in campaign-specific beliefs among US youth. METHODS: A nationally representative longitudinal cohort of youth (aged 11-16 years at baseline) was surveyed five times. Building on earlier work, we analyzed data from the last three waves (April-July 2020; January-April 2021; and August-October 2021; N = 2625). We assessed self-reported exposure to six ads and agreement with 11 beliefs that were each targeted by one or more ads. Eleven weighted panel regression models assessed whether ad exposure predicted changes in campaign-specific beliefs over time. RESULTS: We observed significant associations between ad exposure and increases in at least one campaign-specific belief for five of the six ads. Across the 11 beliefs, we observed associations between increased exposure and increases in 6 beliefs related to e-cigarettes and toxic metals, lung damage, dangerous ingredients, anxiety, cigarette use, and disappointing important people. CONCLUSIONS: We found evidence that self-reported exposure to this digital and social media campaign was successful at influencing youth, providing support for the effectiveness of the campaign's adaption to address youth's changes in tobacco and media use habits. IMPLICATIONS: The Food and Drug Administration's The Real Cost public education campaign educates youth about the dangers of e-cigarette use. This study evaluates longitudinal associations between exposure to The Real Cost's advertisements and changes in campaign-specific beliefs among youth. Considering evolving trends in youth media consumption, the campaign adapted its media approach to increase delivery across digital and social media platforms. Our findings indicate that the campaign reached its intended audience and increased youth beliefs around the harm of e-cigarettes and the consequences of e-cigarette use, offering evidence for the effectiveness of digital and social media youth prevention efforts within a fragmented digital environment.

Measuring the impact of state and local Tobacco 21 policies in the United States: A longitudinal study of youth and young adults ages 15-21.

INTRODUCTION: Tobacco 21 (T21) policies, which prohibit tobacco sales to individuals under 21, aim to reduce youth tobacco use by limiting youth access to these products. Little, however, is known about the longitudinal effect of T21 policies on youth tobacco use behaviors at the national level. METHODS: Participants aged 15-21 years from a longitudinal study conducted between May 2014 and May 2019 (n = 13,990) were matched to geocoded T21 policies. Generalized linear mixed models examined the association of direct and bordering T21 policy exposure and cigarette and e-cigarette use and intention to use, accounting for individual characteristics. RESULTS: Controlling for sociodemographic and psychosocial covariates, there were statistically significant positive associations between T21 exposure and e-cigarette use (OR = 1.45 [1.03,2.06], p < .003) and intention to use e-cigarettes (OR = 1.54 [1.05,2.26], p < .027). We found no association between T21 policy exposure and cigarette use or intention to use cigarettes. Furthermore, exposure to T21 policies did not significantly modify the relationship between age and either cigarette outcome. CONCLUSIONS: This is the first longitudinal study to evaluate state and local T21 policies at the national level. Our analyses demonstrate that existing T21 policies are not sufficient to reduce youth tobacco use and intentions to use, and suggest that T21 policies need to be a part of a comprehensive tobacco policy landscape. Our findings suggest further research is warranted on state and local T21 policy enforcement and implementation, including how T21 may differentially impact cigarette and e-cigarette use, and may have implications for the federal T21 policy. IMPLICATIONS: This research evaluates state and local T21 policies in the United States longitudinally, finding that T21 policies are not sufficient to stem e-cigarette use among adolescents and young adults. These findings support further policy action and suggest that local and state T21 policies are not sufficient to reduce tobacco use and rather, need to be part of a broader, more comprehensive set of tobacco control policies. Further research on enforcement and implementation challenges of T21 policies and the impacts of the new federal T21 policy is warranted.

Disparities in Nicotine Addictiveness and Cancer Harm Perceptions Among U.S. Adults: A Trend Analysis Using the Health Information National Trends Survey.

INTRODUCTION: Recent research has found widespread misperceptions about nicotine. This study tests perceptions among U.S. adults with respect to nicotine addictiveness and cancer harm, while distinguishing between nicotine misperceptions (ie an incorrect response) and "don't know" (DK) responses. AIMS AND METHODS: Data from three cycles of the Health Information National Trends Survey, fielded in 2015, 2017, and 2019 were merged for analysis. Weighted multinominal logistic regression models were conducted where nicotine addictiveness and cancer harm beliefs (DK, incorrect, and correct responses) were regressed on survey year and demographic variables. We also tested for interactions between survey year and demographic variables to assess if previously identified disparities had evolved during these years. RESULTS: Analyses showed lower odds of misperceptions about nicotine addictiveness, but higher odds of misperceptions about nicotine cancer harm in 2019 compared to 2015. There was no change in DK responses during these years. Disparities by sociodemographics and tobacco use status were observed, mostly for cancer harm. Survey year significantly interacted with age in the model for cancer harm, which was driven primarily by increased incorrect responses and decreased DK responses over time among the youngest age group (18-34 years). There were no significant interactions between survey year and race and ethnicity or level of educational attainment. CONCLUSIONS: Disparities in nicotine addictiveness and cancer harm perceptions reflect the uneven distribution of knowledge in the U.S. adult population. Nicotine cancer harm misperceptions are increasing and educational efforts to address this misperception are warranted. IMPLICATIONS: Future educational efforts targeting nicotine addictiveness beliefs may benefit by focusing on DK responders. The growing trend of misperceptions of nicotine's role in cancer harm may negatively impact perceptions about nicotine replacement therapy and low nicotine content cigarettes. Future efforts should focus on correcting nicotine cancer harm misperception, particularly among young adults.

Early evidence of the associations between an anti-e-cigarette mass media campaign and e-cigarette knowledge and attitudes: results from a cross-sectional study of youth and young adults.

OBJECTIVE: Antismoking mass media campaigns have contributed to significant declines in combustible tobacco use among young people. This study evaluates a national anti-e-cigarette campaign to determine its association with knowledge, attitudes and beliefs in the context of increasing e-cigarette use in the USA. METHODS: A national sample of respondents aged 15-24 years (n=8421) was drawn from a repeated cross-sectional online panel survey (220 participants/week) (October 2018 to December 2019). Self-reported exposure to the truth anti-e-cigarette campaign was measured according to level of ad awareness. Outcomes were subjective knowledge of campaign-targeted facts about e-cigarettes and attitudinal constructs about perceived e-cigarette harm, social unacceptability and anti-industry sentiments. Covariates included respondent demographics, current e-cigarette use and cigarette use, parental smoking, sensation seeking, mental health and growth in e-cigarette sales. RESULTS: Ad awareness was associated with knowledge that e-cigarette users are more likely to start smoking (low OR: 1.28, 95% CI 1.14 to 1.44; high OR: 1.88, 95% CI 1.66 to 2.13) and of the nicotine content of JUUL compared with cigarettes (low OR: 1.63, 95% CI 1.45 to 1.82; high OR: 2.50, 95% CI 2.21 to 2.84). High ad awareness was associated with knowledge that the long-term health effects of JUUL use are unknown (OR: 1.88, 95% CI 1.57 to 2.28). High ad awareness was associated with significantly higher perceived product harm (OR: 1.35, 95% CI 1.18 to 1.54), social unacceptability (OR: 1.32, 95% CI 1.15 to 1.53) and anti-industry attitudes (OR: 1.40, 95% CI 1.21 to 1.62), compared with respondents with no awareness. CONCLUSIONS: Young people with awareness of anti-e-cigarette ads demonstrate higher levels of campaign-targeted knowledge, attitudes and beliefs. Future campaign evaluation priorities include measuring the campaign effects on e-cigarette use behaviours.

Effects of a National Campaign on Youth Beliefs and Perceptions About Electronic Cigarettes and Smoking.

INTRODUCTION: Our study assesses the relationship between the exposure of youth to the US Food and Drug Administration's national tobacco public education campaign, The Real Cost, and changes in campaign-focused risk perceptions and beliefs. METHODS: A nationally representative cohort study of youth was conducted from June 2018 to July 2019, consisting of a baseline and one follow-up survey. We performed logistic regressions to examine the association between campaign exposure and beliefs. Exposure was measured by self-report as the frequency of exposure to individual campaign advertisements about the health consequences of e-cigarette use and of smoking cigarettes. RESULTS: We found that increased levels of exposure to campaign advertising was associated with a significant increase in the odds of reporting agreement with campaign-specific beliefs. Positive patterns of findings were found across multiple items selected by specific advertisements, whereas unrelated beliefs were not associated with advertisement exposure. CONCLUSION: A sustained national tobacco public education campaign can change beliefs about the harms of e-cigarette use and cigarette smoking among youth. Combined with other findings from The Real Cost evaluation, results indicate that prevention mass media campaigns continue to be an effective and cost-efficient approach to reduce the health and financial cost of tobacco use in the US.

Evidence of the impact of a national anti-tobacco prevention campaign across demographic subgroups.

Mass media campaigns are an effective population-level intervention for preventing tobacco use. However, little evidence exists for whether these campaigns similarly influence demographic subgroups. This study examined the effects of the truth® campaign to reduce tobacco use among demographic subgroups. We used data from a national, continuous, cross-sectional tracking survey of 15-24-year-olds (n = 32 331). We used a measure of weekly aggregated campaign exposure to assess whether cigarette smoking intentions and current cigarette use varied by race/ethnicity, financial situation and population density subgroups, controlling for factors known to be associated with tobacco use. Examining estimates across subgroup categories in light of the overall model estimates revealed that the effects of week-level campaign exposure on cigarette smoking intentions and current cigarette use were similar across subgroups. Wald tests of equality across estimates in each subgroup suggested that the estimates did not differ from one another in any given instance. The truth campaign does not differ significantly in its capacity to prompt declines in tobacco use across a broad spectrum of US youth and young adults. Mass media tobacco prevention campaigns can be an effective and critical component of a comprehensive tobacco control program, particularly with respect to reducing tobacco-related disparities among demographic subgroups.

A longitudinal analysis of e-cigarette use and cigar, little cigar or cigarillo initiation among youth and youth adults: 2017-2019.

PURPOSE: To examine whether youth and young adult e-cigarette use is associated with initiation of cigars, little cigars, or cigarillos (CLCCs) and current use of flavored CLCCs. BASIC PROCEDURES: The sample is drawn from the Truth Longitudinal Cohort, a probability-based longitudinal cohort of youth and young adults recruited at ages 15-21 and surveyed every six months. The sample for this study was CLCC-naïve defined as those who had never used CLCCs as of 2017 (N = 5586). The outcomes were the odds of (1) initiating any CLCC use and (2) reporting current (past 30-day) use of flavored CLCCs from 2018 to late 2019. The main predictor was use of e-cigarettes by 2018. RESULTS: The odds of initiating a CLCC was greater for those who had used ever used JUUL (OR: 3.30, p < 0.001) or were current users of another type of e-cigarette by 2018 (OR: 3.57, p < 0.001). Odds of CLCC initiation was also greater for those who had ever used combustible cigarettes (OR: 1.62, p < 0.05), were current smokers (OR: 3.12, p < 0.001) or had used marijuana (OR: 1.92, p < 0.001) by 2018. E-cigarette use that occurred by 2018 was associated with greater odds of current use of flavored CLCCs compared to non-flavored CLCCs (ever users of JUUL: OR: 2.57, p < 0.01; current users of some other e-cigarette: OR: 3.06, p < 0.05). CONCLUSION AND RELEVANCE: This study raises new concerns about the effects of e-cigarette use on subsequent combustible tobacco use. Restrictions on CLCCs should be considered in conjunction with current policies designed to reduce the youth vaping epidemic.

Association between e-cigarette use and future combustible cigarette use: Evidence from a prospective cohort of youth and young adults, 2017-2019.

INTRODUCTION: A surge in popularity of e-cigarettes prompts concern given the association between e-cigarettes and future cigarette use. However, much of the evidence for this association comes from early, less efficient, and lower nicotine e-cigarettes than are available and widely used now. The goal of this study was to examine the relationship between e-cigarette use in 2018 and subsequent smoking initiation and continued e-cigarette use. METHODS: Participants included members of a national longitudinal panel of youth and young adults aged 15-27 who, in 2017, reported never having used a nicotine containing product (n = 3360). Logistic regression analyses assessed associations between participants' self-reported ever e-cigarette use in 2018 and ever cigarette use, current cigarette use, and current e-cigarette use in 2019, after controlling for demographic and psychosocial variables. RESULTS: Compared with those who still had never used an e-cigarette, those who reported ever e-cigarette use in 2018 had significantly higher odds of ever cigarette use (aOR = 7.29, 95% CI [4.10, 12.97]), current cigarette use (aOR = 8.26, 95% CI [3.17, 21.53]), and current e-cigarette use (aOR = 9.70, 95% CI [6.41, 14.69]) one year later in 2019. CONCLUSIONS: These findings show that the pod mod style, high nicotine containing e-cigarettes subject young users to the same risks of transitioning to combustible cigarettes as their earlier, less efficient predecessors. Strong regulation of all nicotine products, including e-cigarettes, is needed to prevent the trajectory of e-cigarette to cigarette use among youth and young adults.

Exposure to tobacco content in episodic programs and tobacco and E-cigarette initiation.

While prior research suggests a relationship between exposure to tobacco content in movies and smoking, less is known about the impact of exposure to tobacco through episodic programs. This study assessed the relationship between exposure to tobacco content in programs on Netflix and broadcast or cable TV and initiation of combustible tobacco or e-cigarette use among young people. A nationally representative, longitudinal sample (ages 15-21 at baseline) was surveyed about exposure to episodic programs previously analyzed for the presence of tobacco and subsequent use of combustible tobacco and e-cigarettes. Logistic regression models assessed associations between exposure to tobacco imagery and future initiation of combustible tobacco and e-cigarettes among those who were nicotine naïve (N = 4604). Data were collected in February-May 2018 and February-May 2019. All analyses were conducted in 2019. Results suggest a dose-response relationship between exposure to tobacco and vaping initiation, whereby the higher the exposure, the greater the odds of subsequent initiation (OR(low) = 2.19, 95%CI = 1.38-3.48; OR(medium) = 2.20, 95%CI = 1.34-3.64; OR(high) = 3.17, 95%CI = 1.71-5.88). There was no significant association between exposure to tobacco imagery and smoking initiation. Tobacco imagery is common in episodic programming popular among young people. Results suggest exposure to tobacco in episodic programs may impact future e-cigarette use. Ongoing monitoring of the impact of tobacco content in episodic programs is needed as the number of available programs continues to increase. Findings highlight the need for policy and advocacy efforts to reduce young people's exposure to tobacco content across all media platforms.

Prescription Opioid Misuse: Examining the Role of Opioid-Related Attitudes among Youth and Young Adults by Sexual Orientation.

Background: High prevalence of opioid misuse has been noted among youth and young adults-particularly among those who identify as lesbian/gay or bisexual (LGB). Yet, little is known about the relationship between opioid-related attitudes and misuse among those who identify as LGB. Objectives: This study examined the role of opioid-related attitudes (i.e. acceptance of misuse and risk perception) in relation to ever and past 6-month prescription opioid misuse, stratified by sexual orientation. Methods: This study used a nationally representative, probability-based sample of youth and young adults aged 15-34 (N = 12,745; lesbian/gay = 398, bisexual = 857, heterosexual = 11,490). Data were collected via online surveys in Spring 2018. Wald chi-square tests assessed differences in ever and past 6-month opioid misuse by sexual orientation identity. Weighted adjusted logistic regression models estimated the influence of opioid-related attitudes (acceptance of misuse and risk perceptions) in relation to ever and past 6-month opioid misuse, controlling for demographic characteristics, other past drug use, and psychosocial variables. Results: Logistic regression models indicated that attitudes related to the acceptance of opioid misuse was predictive of (a) higher odds of ever misuse among heterosexual and bisexual individuals and (b) higher odds of past 6-month misuse regardless of sexual orientation. Conclusions: Prescription opioid misuse among LGB youth and young adults may be addressed by shifting key attitudes surrounding opioids. To help stem this deadly epidemic, prevention efforts should be guided by the unique stressors facing the LGB community and focus on reducing the acceptability of misusing opioids.

Using Aggregate Temporal Variation in Ad Awareness to Assess the Effects of the truth® Campaign on Youth and Young Adult Smoking Behavior.

Mass media campaigns are one of the most effective population-level interventions for the prevention of tobacco use. However, accurately evaluating the effectiveness of these campaigns presents several challenges, particularly as campaign delivery becomes increasingly fractured across media platforms. There are a number of weaknesses associated with traditional, individual-level measures of campaign exposure in an increasingly socially networked, digital media ecosystem. This study evaluated the national truth® campaign using a novel method to measure campaign exposure through an aggregate weekly exogenous measure of awareness. We generated this exogenous measure from a continuous, cross-sectional tracking survey to predict intentions to smoke and current tobacco use among youth in the United States. Results from multi-level models indicated that weeks with aggregate campaign awareness greater than 65% were associated with lower odds of current tobacco use. We conclude with a discussion of implications and practical considerations for using this method for media campaign evaluation.

Smokers' behavioral intentions in response to a low-nicotine cigarette policy.

INTRODUCTION: Evidence suggests that reducing the nicotine concentration in cigarettes to sub-addictive levels would reduce use. Until a low-nicotine cigarette policy is enacted, population-level effects are unknown. This study examines the behavioral intentions of current U.S. cigarette smokers if a low-nicotine policy were implemented. METHODS: Data were drawn from a nationally representative probability-based panel and opt-in panel. Weighted logistic regressions examined likelihood to (1) smoke lower nicotine cigarettes, (2) quit using tobacco, (3) use e-cigarettes, (4) illegally buy high-nicotine cigarettes, and (5) smoke cigars, cigarillos, or little cigars (CLCCs) among smokers, controlling for demographics, tobacco products used, dependence, and intentions to quit cigarettes. Latent class analyses (LCA) characterized patterns of behavioral intentions. RESULTS: If a low-nicotine policy were implemented, most participants indicated a likelihood to smoke low-nicotine cigarettes (78.4%) or quit tobacco (61.9%), followed by use e-cigarettes (46.5%). Individuals with greater dependence had greater odds of intending to smoke low-nicotine cigarettes, use e-cigarettes, and illegally buy high-nicotine cigarettes. Current e-cigarette or CLCCs users had higher odds of intending to use these products. LCA revealed that individuals would 1) use low-nicotine cigarettes with low intentions to use other tobacco products or 2) use multiple tobacco products, including low-nicotine cigarettes. CONCLUSIONS: A reduced nicotine standard for all combustible tobacco products is needed given that many tobacco users would likely intend to continue to use tobacco products. Differences in intentions by tobacco use and demographic characteristics indicate a need for additional cessation support and education around the harms of continued use of combustible tobacco.

The Role of Emotions and Perceived Ad Effectiveness: Evidence From the Truth FinishIt Campaign.

PURPOSE: Examine association between emotional valence and intensity prompted by anti-tobacco advertising messages and perceived ad effectiveness among youth/young adults. DESIGN: Online forced-exposure survey data from a nationally weighted, cross-sectional sample of youth/young adults, collected periodically over a 4-year period. SETTING: National. PARTICIPANTS: Thirty-seven cross-sectional surveys conducted online from June 2015 to January 2018; total N = 9534. All participants, aged 15 to 21, were in the intervention; no control group. INTERVENTION: Individuals participating in premarket testing of truth ads were forced exposed to one of 37 anti-tobacco ads. MEASURES: Emotional response, emotional intensity, and perceived ad effectiveness. Emotional response has been previously studied and measured. Including the discrete measure of "concerned" in positive emotions is unique to our study. It patterned with the other positive emotions when each ad was examined by each emotion. Intensity as measured in this study through the 5-point scale ("how much does this ad make you feel") is unique in the anti-tobacco ad literature. Although several past studies ranked the degree of emotion elicited by ads, they have not incorporated the intensity of emotion as reported by the participant themselves. The scale was used to determine whether perceived ad effectiveness is similar to those used in previous studies. ANALYSIS: Linear regressions were estimated to assess type of emotional sentiment and level of intensity in relation to perceived effectiveness of the message. RESULTS: All 9534 participants were exposed; no control group. The ßs indicate how strongly the emotion variable influences the study outcome of perceived ad effectiveness. Positive emotions (ß = .76) were more highly associated with perceived ad effectiveness (ß = .06). Higher intensity with positive emotional sentiment and high-intensity negative produced the highest scores for perceived ad effectiveness (ß = .30). CONCLUSION: Eliciting a positive, high-impact emotional response from viewers can help improve perceived effectiveness, and in turn, overall ad effectiveness.

Longitudinal Tobacco Use Transitions Among Adolescents and Young Adults: 2014-2016.

INTRODUCTION: Among youth, the frequency and prevalence of using more than one tobacco (small cigar, cigarette, and hookah) or nicotine-containing product (e-cigarettes-ENDS) are changing. These shifts pose challenges for regulation, intervention, and prevention campaigns because of scant longitudinal data on the stability of use patterns in this changing product landscape. METHODS: A nationally representative longitudinal survey of 15- to 21-year olds (n = 15,275) was used to describe transitions between never use, noncurrent use, and past 30-day use of combustible tobacco, e-cigarettes (ENDS), and dual use of both kinds of products. A multistate model was fit to observations collected every 6 months across 2.5 years to estimate the probability of transitions between states (TPs), the average time in state (sojourn time), and the effect of age on transitions. RESULTS: Current state strongly predicted future state over time intervals of 1 year or less, but only weakly predicted future state at longer intervals: TP to noncurrent use was higher for ENDS-only than combustible-only users over a 6-month interval but was similar for both groups over a 2-year interval. Sojourn time was significantly longer for combustible-only (0.52 years) and dual use (0.55 years) than ENDS-only use (0.27 years); older youth were more likely than younger youth to stay combustible tobacco users or noncurrent users. CONCLUSIONS: The dynamics of transitions between combustible tobacco products and ENDS in a population of youth and young adults suggest that policy and prevention efforts must consider the frequent changes and instability over a 1-year or less time period in use patterns among young people. IMPLICATIONS: The study addresses an urgent need in public health for timely information on how youth and young adults use tobacco and nicotine products. We found that youth, particularly adolescents, moved frequently between using ENDS and combustible tobacco products either alone or together. Importantly, the utility of current-use states for predicting future use states declined for time horizons longer than 1 year. Our results demonstrate a need for caution in interpreting product transitions. Longitudinal data with frequent observations and coverage of a wide range of possible product types is required to fully characterize usage patterns in youth.

Prevalence and correlates of JUUL use among a national sample of youth and young adults.

OBJECTIVE: To estimate the prevalence of JUUL use and identify demographic and psychosocial correlates of use among youth and young adults in the USA. METHODS: A national, probability-based sample was recruited via address-based sampling, with subsamples recruited from an existing probability-based online panel. Participants (N=14 379) ages 15-34 were surveyed about JUUL use, tobacco use, electronic nicotine delivery system (ENDS) harm perceptions, sensation seeking and demographic characteristics. Data were collected February-May 2018. Χ2 analyses assessed differences in JUUL use by demographic and psychosocial characteristics. Logistic regressions identified significant correlates of ever and current JUUL use. RESULTS: Overall, 6.0% reported ever JUUL use, and 3.3% reported past 30-day (ie, current) use. Rates were higher among participants aged 15-17 and 18-21 years, with 9.5% and 11.2% reporting ever use, and 6.1% and 7.7% reporting current use, respectively. Among current users aged 15-17 years, 55.8% reported use on 3 or more days in the past month, and over a quarter reported use on 10-30 days. Significant correlates of use included younger age, white race, greater financial comfort, perceptions of ENDS as less harmful than cigarettes, household ENDS use, high sensation seeking and current combustible tobacco use. CONCLUSION: JUUL use was significantly higher among young people, with those under 21 having significantly higher odds of ever and current use. Frequency of use patterns suggest youth may not be experimenting with the device but using it regularly. Given the high nicotine content of JUUL, there is concern over the potential for addiction and other serious health consequences among young people. Findings suggest strong regulatory actions are needed to prevent youth and young adult uptake.

Building capacity to implement tobacco-free policies in college and university settings with underserved populations.

INTRODUCTION: This study aimed to facilitate the process of policy adoption and implementation across community colleges and Historically Black Colleges and Universities (HBCUs) to develop, adopt, and implement a 100% smoke- or tobacco-free policy. METHODS: In total, 135 community colleges and HBCUs took part in the program. This multiple-site case study analyzed each institution's online self-reported surveys every 6 months to record progress on each of five core project elements. Data were analyzed in June 2017. RESULTS: Overall, 77 of 135 institutions adopted a smoke- or tobacco-free policy during the college initiative program that led to a broader public health impact of more than 717000 students and employees protected from the harms of smoking and secondhand smoke. A regression analysis also found that ongoing/completed policy activities and perceived importance of having a 100% smoke- or tobacco-free policy presented greater odds of an institution passing or adopting a policy. CONCLUSIONS: Population-level impact and total number of people reached by this initiative is notable, though moving smoking off campus can have unintended impacts. This suggests policy change should include cessation efforts, policy compliance and policies into the broader community when possible through community partnerships.

A multidisciplinary approach to health campaign effectiveness.

Campaign costs are rising, making ad execution testing more critical to determine effectiveness prior to media spending. Premarket testing occurs prior to messages' airing while in-market testing examines message attributes when messages are aired within a real-world setting, where context plays an important role in determining audience response. These types of ad testing provide critical feedback to help develop and deploy campaigns. Due to recent changes in media delivery platforms and audience tobacco use behavior, this study analyzes two nationally representative youth samples, aged 15-21, to examine if pre-market ad testing is an indicator of in-market ad performance for public health campaigns, which rely on persuasive messages to promote or reduce health behaviors rather than selling a product. Using data from the Truth® campaign, a national tobacco use prevention campaign targeted to youth and young adults, findings indicate strong associations between pre-market scores and in-market ad performance metrics.

The Association Between Menthol Perceptions and Support for a Policy Ban Among US Smokers.

Objective: To examine the relationship between menthol perceptions and support for a national menthol ban. Participants: Data were collected from a nationally representative probability-based panel of adults aged ≥18 years during June 21, 2016 through July 18, 2016. A total of 1,303 respondents, including an oversample of 300 African Americans, completed the survey. Main Outcome Measures: Weighted logistic regression models examined the relationship between menthol perceptions, specifically related to health and addiction, and the outcome measure: support for a menthol ban, by menthol smoking status. All models controlled for age, sex, education level, and race/ethnicity. Results: The association between reporting accurate menthol health perceptions differed by menthol preference. Among non-menthol smokers, there was no association between accurate menthol health perceptions and support of a menthol ban while more accurate menthol perceptions of addiction were associated with greater support of a menthol ban (aOR=2.83, CI=1.19-6.72). Among menthol smokers, more accurate health-related menthol perceptions were associated with increased odds of supporting a menthol ban (aOR=3.90, CI=1.02-14.79) while more accurate menthol addiction perceptions were not. Conclusions: Fewer current menthol smokers support a menthol ban than current non-menthol smokers given its effect on their preferred product. Given the large proportions of smokers who have misperceptions of the health consequences and addictive properties of menthol, there is a moral imperative to inform those who use these products. Findings suggest the need for tailored messaging strategies targeted to reach menthol smokers who will be most impacted by a ban, but also have the most to gain from such a policy change.

Estimating the Pathways of an Antitobacco Campaign.

PURPOSE: This study examined mechanisms through which the truth campaign, a national mass media antismoking campaign, influences smoking-related attitudes, and progression of tobacco use over time in youth and young adults. METHODS: Structural equation modeling tested causal pathways derived from formative research and behavioral theory with a nationally representative longitudinal sample of 15-21-year-olds (n = 8747) over 24 months. Data were collected from 2014 to 2016, and analyses were conducted in 2017. RESULTS: Greater ad awareness predicted strengthening of attitudes targeted by the campaign (i.e., feelings of independence from tobacco, antitobacco industry sentiment, decreasing acceptance of social smoking, and decreasing acceptance of smoking imagery), and attitude changes were significantly associated with greater support for an antitobacco social movement (e.g., agreement to the item "I would be part of a movement to end smoking"). Greater social movement support predicted a slower rate of progression on smoking intensity after two years of the campaign. CONCLUSIONS: Findings suggest that engaging youth and young adults in a cause-based social movement for promoting health can be a powerful strategy to drive positive behavior change. Messages targeting attitudes that resonate with values important to this age group, including independence and connectedness, are particularly effective. Investments in national antitobacco public education campaigns are key policy interventions which continue to help prevent tobacco use among youth and young adults.

Victim Offender Overlap: Dual Trajectory Examination of Victimization and Offending among Young Felony Offenders over Seven Years.

The relationship between victimization and offending has been shown consistently across different samples, settings, and crime types. This study uses data from the Pathways to Desistance Study to examine dual trajectories of offending between the ages of 15 and 24 in a sample of male felony offenders. The dual trajectory models demonstrate substantial convergence in victimization and offending. And while there are sizable numbers of youth who continue to be victimized, but desist or decrease in their offending behaviors, very few youth continue to offend in the absence of continued victimization. This study also proposes and tests three criminological theories that have been employed as explanations for the victim-offender overlap - low self-control, lifestyles/routine activities, and street-code attitudes. The logistic regression results indicate that involvement in risky and/or unstructured, unsupervised activities is a key correlate of the victim-offender overlap. The strength of the relationship between routine activity variables and the victim-offender overlap supports the provision of structured, supervised activities for youth and young adults as a way of preventing future victimization and offending, particularly among youth who have high exposure to violence.