Adolescent risk perceptions of ENDS use: Room for change in tobacco education.

Electronic Nicotine Delivery Systems (ENDS) have surpassed combustible cigarettes as the most commonly used tobacco product among U.S. middle and high school students, and research shows that youth do not perceive great risk of harm from regular ENDS use. FDA's public education campaigns help educate youth about the potential risks of using tobacco products and three separate experimental copy testing/ad testing studies (N = 1907) were conducted in support of the FDAs "The Real Cost" (TRC) Cigarette and ENDS Campaigns. These studies provided data for the current investigation which used harm perception items to assess perceived risks of cigarette or ENDS use among adolescents after viewing a public health education advertisement. Eligible youth aged 13-17 who were susceptible, or experimenting, with cigarettes or vaping products were recruited online and randomized into either an ad viewing exposure group, or a non-ad viewing control group. The ads focused on health effects, addiction, or both. Effect sizes on key harm perception measures between groups were computed and standardized to allow for comparisons. Both TRC Cigarette and TRC ENDS ads were able to change harm and addiction perceptions (p < .05); however, effect sizes were significantly larger for items related to health effects for ENDS vs cigarettes (p < .05). When designing youth focused ENDS education campaigns, practitioners should present novel facts in order to take advantage of large effect sizes. Evaluators of early campaign efforts to educate youth about these products may anticipate significant increases in health-related risk perceptions.

Reactions to electronic nicotine delivery system (ENDS) prevention messages: results from qualitative research used to inform FDA's first youth ENDS prevention campaign.

BACKGROUND: Youth e-cigarette use is a major public health concern. Large-scale tobacco prevention campaigns are a proven strategy to prevent tobacco use. There is a gap in understanding what types of e-cigarette prevention messages might be most effective. This study addresses this gap by reporting youth reactions to health messages aimed at preventing e-cigarette use. METHODS: In 2018, twenty-four focus groups, with 159 teens (12-17) at risk for or experimenting with e-cigarettes were conducted in four cities across the USA. During focus groups, youth responded to creative concepts dealing with (1) the addictive nature of e-cigarettes, (2) the fact that e-cigarettes come in flavours, which may encourage youth initiation, and nicotine which may lead to addiction, or (3) that youth who use e-cigarettes are more likely to use cigarettes. Youth also gave feedback to specific facts about harmful and potentially harmful chemicals in e-cigarettes. Transcripts were analysed using thematic analysis. RESULTS: Messages focusing on addiction alone did not resonate with participants. While youth found the idea that e-cigarettes may contain nicotine and can be addictive believable, with many describing personal experiences of addiction, they questioned how bad this really was, comparing addiction to e-cigarettes to things like being addicted to food. Participants wanted more information about negative consequences of vaping. Concepts paired with strong health effects messages resonated with participants. CONCLUSION: These focus groups clarified which e-cigarette prevention messages might be most persuasive to teens. Youth in this study responded favourably to messages stating specific health consequences of e-cigarette use.

Lessons on Addiction Messages From "The Real Cost" Campaign.

INTRODUCTION: A key strategy in reducing the public health burden of cigarette smoking is preventing youth from ever becoming addicted to cigarettes in the first place. However, there is limited research exploring youth responses to addiction messages. This study assesses youths' responses to the U.S. Food and Drug Administration's "The Real Cost" campaign messaging depicting addiction as a "loss of control." METHODS: Between 2013 and 2016, three focus group studies and four copy testing studies were conducted to assess reactions to advertising concepts and near-final videos. Participants were aged 12-17 years and ethnically and geographically diverse. Researchers conducted a thematic secondary analysis of focus group transcripts and open-ended survey questions from the copy testing studies. Data analysis for this study took place in 2017. RESULTS: Youth responded favorably to loss of control messages showing real, often short-term, consequences of addiction, such as choosing to spend money on cigarettes instead of going to a movie, and depictions of scenarios that were relatable to youth. Youth also responded favorably to messages describing how nicotine changes the brain. A portion of youth remained skeptical, stating they felt the consequences depicted were unrealistic. CONCLUSIONS: This study shows that by framing addiction as a loss of control and tying that loss of control to short-term health and social consequences, addiction becomes more concrete and understandable, and the consequences feel more relatable and relevant to youth. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.