Developing Smokeless Tobacco Prevention Messaging for At-Risk Youth: Early Lessons from "The Real Cost" Smokeless Campaign.

Introduction: Smokeless tobacco (SLT) use continues to be a significant public health challenge in the United States, particularly among young males in rural areas, where use remains disproportionately high. In support of the U.S. Food and Drug Administration's first nationwide SLT public education campaign, formative research was conducted to inform campaign strategy development and test creative concepts. Methods: Qualitative research methods were used to inform the strategic direction of the campaign, identify salient message themes, and refine creative concepts. Focus groups were conducted with 252 rural male youth ages 12-17 in seven states. Groups were organized by SLT status (i.e., at-risk for initiating vs. experimenting with SLT) and age group. Results: SLT use is culturally ingrained in rural communities, and rural youth are commonly exposed to SLT through close relationships. Among this group, "dipping" (SLT use) has strong cultural significance and is perceived as safe. Members of the target audience are receptive to straightforward facts delivered by authentic messengers about the potentially harmful consequences of SLT use, specifically those that leverage the progression of short-term consequences (e.g., white patches) to long-term health effects. Conclusions: This study addresses SLT literature gaps related to youth knowledge, attitudes, and beliefs by summarizing audience learnings from formative research that was used to develop the first national SLT public education campaign.

Youth Receptivity to FDA's The Real Cost Tobacco Prevention Campaign: Evidence From Message Pretesting.

In February 2014, the Food and Drug Administration launched The Real Cost, a national youth tobacco prevention campaign. This article examines youth receptivity to potential campaign ads using data from 3 message pretesting studies featuring the same design and consistent instrumentation. A total of 3,258 adolescents ages 13-17 were randomized to either an ad-viewing condition or a no-exposure control condition. Perceived ad effectiveness, smoking-related beliefs, and attitudes were measured as outcome variables. The sample consisted of both experimental smokers (58%) and current nonsmokers at risk for cigarette initiation (42%). A total of 14 ads were tested across the three studies. Participants who viewed the ads generally considered them to be effective (with a mean perceived ad effectiveness score of 3.66 on a scale from 1 to 5). Compared to those in the control condition, participants in the ad-viewing condition reported stronger beliefs about the health risks of smoking (p < .001), a greater likelihood that smoking would lead to loss of control in life (p < .001), and more negative attitudes toward smoking (p < .001). Responses to campaign ads were largely consistent between experimenters and at-risk nonsmokers. Implications of the findings for the campaign are discussed.

Gender and racial/ethnic differences in patterns of adolescent alcohol use and associations with adolescent and adult illicit drug use.

OBJECTIVES: The study objective was to use latent class analyses (LCAs) to identify gender- and racial/ethnic-specific groups of adolescent alcohol users and associations between alcohol use group and adolescent and adulthood illicit drug use in a nationally-representative US sample. METHODS: We used Wave I (1994-1995, adolescence) of the National Longitudinal Study of Adolescent Health to conduct LCAs by gender and race/ethnicity and measure associations between class membership and Wave I and Wave III (2001-2002, young adulthood) drug use. Participants included white (n=9548), African American (n=4005) and Hispanic (n=3184) participants. LCAs were based on quantity and frequency of adolescent alcohol use; physiological and social consequences of use; and peer use. RESULTS: Males and females were characterized by different alcohol use typologies and consequences. Males in the highest severity class (i.e. drank both heavily and frequently) experienced disproportionate risk of alcohol-related consequences compared with abstainers and other alcohol-using groups. Females who drank heavily when drinking even if only occasionally, experienced high risk of alcohol-related consequences. Substantial proportions of males reported diverse alcohol-related problems, whereas females most commonly reported alcohol-related problems with dating and sexual experiences. Though levels of alcohol use and report of problems associated with use were higher among white versus minority populations, other racial/ethnic differences in patterns of alcohol use were minimal. Classification in any drinking class was a strong risk factor for adolescent and adulthood illicit drug use, with heavy drinkers at greatest risk of drug use. CONCLUSIONS: Gender-specific adolescent alcohol and substance use prevention programs are warranted.

Race differences in longitudinal associations between adolescent personal and peer marijuana use and adulthood sexually transmitted infection risk.

To assess whether adolescent marijuana exposure represents a modifiable predictor of risk of sexually transmitted infections as adults, we used nationally representative, longitudinal data from Waves I (1994-1995, adolescence) and III (2001-2002, adulthood) of the National Longitudinal Study of Adolescent Health (N = 10,738) to examine racial and gender differences in associations between adolescent marijuana use, current use, and peer use and adulthood multiple partnerships, self-reported sexually transmitted infections, and biologically confirmed sexually transmitted infections. The risk of sexually transmitted infections as adults was predicted by adolescent marijuana use in all groups except Black women and by peer marijuana use among Black men. Adolescents who use or have friends who use marijuana constitute priority populations for sexually transmitted infection prevention.

Longitudinal associations between adolescent alcohol use and adulthood sexual risk behavior and sexually transmitted infection in the United States: assessment of differences by race.

OBJECTIVES: We examined race differences in the longitudinal associations between adolescent alcohol use and adulthood sexually transmitted infection (STI) risk in the United States. METHODS: We estimated multivariable logistic regression models using Waves I (1994-1995: adolescence) and III (2001-2002: young adulthood) of the National Longitudinal Study of Adolescent Health (n = 10 783) to estimate associations and assess differences between Whites and African Americans. RESULTS: In adjusted analyses, adolescent alcohol indicators predicted adulthood inconsistent condom use for both races but were significantly stronger, more consistent predictors of elevated partnership levels for African Americans than Whites. Among African Americans but not Whites, self-reported STI was predicted by adolescent report of any prior use (adjusted odds ratio [AOR] = 1.47; 95% confidence interval [CI] = 1.00, 2.17) and past-year history of getting drunk (AOR = 1.53; 95% CI = 1.01, 2.32). Among Whites but not African Americans, biologically confirmed STI was predicted by adolescent report of past-year history of getting drunk (AOR = 1.68; 95% CI = 1.07, 2.63) and consistent drinking (AOR = 1.65; 95% CI = 1.03, 2.65). CONCLUSIONS: African American and White adolescent drinkers are priority populations for STI prevention. Prevention of adolescent alcohol use may contribute to reductions in adulthood STI risk.