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.

Content analysis of tobacco in episodic programming popular among youth and young adults.

BACKGROUND: While evidence exists supporting a causal relationship between exposure to tobacco content in movies and youth smoking, research is limited on the prevalence and impact of tobacco content in episodic programming aired on television (TV) and online streaming platforms. The purpose of this study was to analyse episodic programming popular among young people to estimate the prevalence of tobacco imagery. METHODS: An online survey of participants aged 15-24 years (n=750) recruited from an existing panel was used to gauge viewership of episodic programming aired on Netflix, broadcast TV and cable TV. Two trained coders independently watched the entire 2015/2016 and 2016/2017 seasons of 14 programmes aired on a streaming platform, Netflix, and across broadcast and cable TV. The coding scheme was based on existing methods which involve documenting both the type of tobacco product featured and, if applicable, user information. RESULTS: Eighty-six per cent of Netflix programmes and 86% of broadcast and cable TV programmes had at least one occurrence of tobacco. Netflix programmes had more total occurrences (n=1185) compared with the broadcast or cable programmes (n=482). Most of the tobacco occurrences included cigarettes being actively used by a character. CONCLUSIONS: Given the high prevalence of tobacco use found in these entertainment channels, the level of exposure to tobacco use among youth and young adults is very concerning and is serving to circumvent the restrictions of tobacco advertising on broadcast TV. Further research is needed to understand the influence of this exposure on smoking behaviour.

Recruiting and retaining youth and young adults: challenges and opportunities in survey research for tobacco control.

INTRODUCTION: Evaluation studies of population-based tobacco control interventions often rely on large-scale survey data from numerous respondents across many geographic areas to provide evidence of their effectiveness. Significant challenges for survey research have emerged with the evolving communications landscape, particularly for surveying hard-to-reach populations such as youth and young adults. This study combines the comprehensive coverage of an address-based sampling (ABS) frame with the timeliness of online data collection to develop a nationally representative longitudinal cohort of young people aged 15-21. METHODS: We constructed an ABS frame, partially supplemented with auxiliary data, to recruit this hard-to-reach sample. Branded and tested mail-based recruitment materials were designed to bring respondents online for screening, consent and surveying. Once enrolled, respondents completed online surveys every 6 months via computer, tablet or smartphone. Numerous strategies were utilized to enhance retention and representativeness RESULTS: Results detail sample performance, representativeness and retention rates as well as device utilization trends for survey completion among youth and young adult respondents. Panel development efforts resulted in a large, nationally representative sample with high retention rates. CONCLUSIONS: This study is among the first to employ this hybrid ABS-to-online methodology to recruit and retain youth and young adults in a probability-based online cohort panel. The approach is particularly valuable for conducting research among younger populations as it capitalizes on their increasing access to and comfort with digital communication. We discuss challenges and opportunities of panel recruitment and retention methods in an effort to provide valuable information for tobacco control researchers seeking to obtain representative, population-based samples of youth and young adults in the U.S. as well as across the globe.