Perceived Message Effectiveness and Campaign-Targeted Beliefs: Evidence of Reciprocal Effects in Youth Tobacco Prevention.

Perceived message effectiveness (PE) has been widely used in campaign formative research and evaluation. The relationship between PE and actual message effectiveness (AE) is often assumed to be causal and unidirectional, but careful conceptualization and empirical testing of this and other causal possibilities are generally lacking. In this study, we investigated the potential reciprocity in the relationship between PE and AE in the context of a national youth tobacco education campaign. In so doing, we also sought to generate much needed evidence on PE's utility to predict campaign-targeted outcomes in youth tobacco prevention. Using five waves of campaign evaluation data (N = 1,128), we found significant lagged associations between PE and campaign-targeted beliefs, and vice versa. These results suggest a dynamic, mutually influencing relationship between PE and AE and call for greater attention to such dynamics in campaign research.

Effect of a Statewide Media Campaign on Smoking Cessation Among Florida Adults.

INTRODUCTION: Since December 2010, Florida's Bureau of Tobacco Free Florida has aired a statewide tobacco education campaign to encourage smoking cessation. The Tobacco Free Florida campaign consists of evidence-based advertisements primarily characterized by strong emotional content and graphic imagery designed to increase awareness of the health risks of tobacco use. We evaluated the effect of the media campaign on population-level quit attempts by using a statewide representative sample of Florida adults aged 18 or older. METHODS: We examined data from 5,418 Florida adult cigarette smokers and recent quitters aged 18 or older from the Florida Adult Tobacco Survey, an annual, cross-sectional survey conducted from 2011 through 2018. The primary outcome was incidence of quit attempts in the previous 12 months. We used multivariable logistic regression models to estimate the odds of making a quit attempt as a function of advertising levels across state media markets. Rates of quit attempts in Florida were also estimated. RESULTS: Approximately 66% of smokers in the study made at least 1 quit attempt. Exposure to the campaign was associated with increased odds of a quit attempt in the previous 12 months (odds ratio = 1.25; P = .02) among smokers and recent quitters. The Tobacco Free Florida campaign was associated with an estimated 332,604 additional smokers making quit attempts per year during the study period. CONCLUSION: The Tobacco Free Florida campaign affected cessation-related behaviors in Florida over an 8-year period. Evidence-based state tobacco education campaigns can accelerate progress toward the goal of reducing adult smoking.

Impact of The Real Cost Media Campaign on Youth Smoking Initiation.

INTRODUCTION: The purpose of this study was to assess the relationship between youth exposure to the U.S. Food and Drug Administration's national tobacco public education campaign, The Real Cost, and changes in smoking initiation. METHODS: From November 2013 to November 2016, a longitudinal study of youth was conducted with a baseline and 4 post-campaign follow-up surveys. The sample consisted of nonsmoking youths from 75 U.S. media markets (n=5,103) who completed a baseline and at least 1 follow-up survey. Exposure was measured by media market-level target rating points and self-reported ad exposure frequency. Smoking initiation was examined among youths who had never smoked at baseline and defined as first trial of a cigarette. Discrete-time survival models using logistic regression and controlling for confounding influences were estimated. Analyses were conducted in 2018. RESULTS: The odds of reporting smoking initiation at follow-up was lower among youths in media markets with higher levels of campaign advertisements than among those with less. Both between-wave and cumulative target rating points were associated with decreased risk of smoking initiation (AOR=0.69 [p<0.01] and AOR=0.89 [p<0.05], respectively); for every 3,500 between-wave target rating points on air, there was an associated 30% reduction in the hazard of smoking initiation among youths. Results from self-reported recall of the campaign advertisements found similar dose-response effects. The campaign is associated with an estimated 380,000-587,000 youths aged 11-19 years being prevented from initiating smoking nationwide. CONCLUSIONS: Sustained national tobacco public education campaigns like The Real Cost can change population-level smoking initiation among youths, preventing future generations from tobacco-related harms.

Cost-Effectiveness Analysis of The Real Cost Campaign's Effect on Smoking Prevention.

INTRODUCTION: A previous study found that the Food and Drug Administration's The Real Cost national tobacco education campaign was associated with preventing approximately 350,000 U.S. youth from initiating smoking between 2014 and 2016. This study translates the reduction in smoking initiation into monetary terms by examining the cost effectiveness of the campaign. METHODS: The cost effectiveness of The Real Cost was assessed by measuring efficiency in two ways: (1) estimating the cost per quality-adjusted life year saved and (2) estimating the total monetary return on investment by comparing the cost savings associated with the campaign to campaign expenditures. Analyses were conducted in 2017. RESULTS: The Real Cost averted an estimated 175,941 youth from becoming established smokers between 2014 and 2016. Campaign expenditures totaled $246,915,233. The cost per quality-adjusted life year saved of the campaign was $1,337. When considering the costs of smoking, the averted established smokers represent >$31 billion in cost savings ($1.3 billion when only external costs considered). The overall return on investment of the campaign was $128 in cost savings for every $1 spent ($4 for every $1 spent when only external costs considered). These conclusions were robust to sensitivity analyses surrounding the parameters. CONCLUSIONS: Campaign expenditures were cost efficient. The cost savings resulting from The Real Cost represent a large reduction in the financial burden to individuals, their families, and society as a result of tobacco. Public health campaigns, like The Real Cost, that reduce tobacco-related morbidity and mortality for a generation of U.S. youth also provide substantial cost savings.

Examining Youth Dual and Polytobacco Use with E-Cigarettes.

E-cigarettes and other non-cigarette tobacco products are increasingly popular among youth. Little is known to inform public health efforts to reduce youth use. We examined psychosocial correlates of single and multiple tobacco product use among youth e-cigarette users. Data were from the 2014 Florida Youth Tobacco Survey (N = 69,923), a representative sample of Florida middle and high school students. Associations between combinations of e-cigarette, cigarette and other tobacco product (OTP) use and psychosocial variables were examined using multinomial logistic regression with an analytic sample of N = 2756. Most e-cigarette-using youth used at least one other product (81%). Perceiving cigarettes as easy to quit was significantly associated with greater likelihood of combined e-cigarette/OTP use (relative risk ratio (RRR) = 2.51, p < 0.001) and combined e-cigarette/cigarette/OTP use (RRR = 3.20, p < 0.0001). Thinking you will be smoking cigarettes in 5 years was associated with product combinations that include cigarettes. Tobacco company marketing receptivity was associated with multiple product user types. Given that specific psychosocial factors put youth at risk for concurrent use of e-cigarettes with tobacco products, public health efforts should address polytobacco use specifically, instead of individual product use. Youth perceptions about the ease of quitting cigarettes, intentions to continue smoking cigarettes and receptivity to tobacco company marketing are promising areas for messaging aimed at reducing e-cigarette polytobacco product use.

Perceptions of the relative harmfulness of marijuana and alcohol among adults in Oregon.

This study documents perceptions of the relative harmfulness of marijuana and alcohol to a person's health among adults in Oregon just before the first legal sales of marijuana for recreational use. We surveyed 1941 adults in Oregon in September 2015. Respondents were recruited using an address-based sampling (ABS) frame (n = 1314) and social media advertising (n = 627). Respondents completed paper surveys (ABS-mail, n = 388) or online surveys (ABS-online, n = 926; social media, n = 627). We used descriptive statistics and logistic regression models to examine perceptions of the relative harmfulness of marijuana and alcohol by sample characteristics, including substance use. About half of adults in Oregon (52.5%) considered alcohol to be more harmful to a person's health than marijuana. A substantial proportion considered the substances equally harmful (40.0%). Few considered marijuana to be more harmful than alcohol (7.5%). In general, respondents who were younger, male, and not Republican were more likely than others to consider alcohol more harmful than marijuana. Respondents who were older, female, and Republican were more likely to consider marijuana and alcohol equally harmful. Most individuals who reported using both marijuana and alcohol (67.7%) and approximately half of those who used neither substance (48.2%) considered alcohol to be more harmful than marijuana. Perceptions about the relative harmfulness of marijuana and alcohol may have implications for public health. As state lawmakers develop policies to regulate marijuana, it may be helpful to consider the ways in which those policies may also affect use of alcohol and co-use of alcohol and marijuana.

Effect of a National Tobacco Public Education Campaign on Youth's Risk Perceptions and Beliefs About Smoking.

PURPOSE: To assess the relationship between youth's exposure to the Food and Drug Administration's national tobacco public education campaign, The Real Cost, and changes in campaign-targeted beliefs. DESIGN: Longitudinal design with baseline survey and 2 postcampaign follow-up surveys. SAMPLE: Youth from 75 US media markets (N = 1680) who completed all 3 surveys and had experimented with or were susceptible to future cigarette smoking. MEASURES: Exposure was measured by self-reported frequency of ad exposure and media market-level target rating points. Agreement with 30 self-reported tobacco-related beliefs was assessed in 3 categories: (1) beliefs specifically targeted by campaign messages (campaign-targeted belief), (2) beliefs not targeted by the campaign (nontargeted beliefs), and (3) beliefs corresponding to other media campaigns on air concurrent with The Real Cost (ambiguous beliefs). ANALYSIS: Descriptive analyses of aggregate changes in beliefs and logistic regressions to examine the association between campaign exposure and beliefs. INTERVENTION: The Real Cost. RESULTS: Agreement with campaign-targeted beliefs increased from baseline to first and second follow-ups, with a mean relative increase of 10.4% and 11.5%, respectively. Nontargeted beliefs did not change substantially. Both measures of campaign exposure were positively associated with increased odds of agreeing with 5 of 8 campaign-targeted beliefs. Exposure was not significantly associated with 12 of 14 nontargeted tobacco-related beliefs. DISCUSSION: A sustained national tobacco public education campaign can change population-level perceptions of tobacco-related harms among youth.

New product trial, use of edibles, and unexpected highs among marijuana and hashish users in Colorado.

OBJECTIVE: This study examines the relationships between trial of new marijuana or hashish products and unexpected highs, and use of edible products and unexpected highs. METHODS: We conducted an online survey of 634 adult, past-year marijuana users in Colorado. We used logistic regression models to examine the relationship between new product trial or edible use and unexpected highs. RESULTS: In the first year that recreational marijuana was legal in Colorado, 71.4% of respondents tried a new marijuana or hashish product, and 53.6% used an edible product. Trial of new products was associated with greater odds of experiencing an unexpected high after controlling for age, gender, education, mental health status, current marijuana or hashish use, and mean amount of marijuana or hashish consumed in the past month (OR=2.13, p<0.001). Individuals who reported having used edibles had greater odds of experiencing an unexpected high, after controlling for the same set of variables (OR=1.56, p<0.05). CONCLUSION: People who try new marijuana or hashish products, or use edible marijuana or hashish products, are at greater risk for an unexpected high. It is possible that some negative outcomes associated with marijuana use and unexpected highs may be averted through a better understanding of how to use product packaging to communicate with consumers.

Association Between The Real Cost Media Campaign and Smoking Initiation Among Youths - United States, 2014-2016.

In the United States, approximately 900,000 youths smoke their first cigarette each year (1). Health communication interventions are evidence-based strategies for preventing the initiation of tobacco use, promoting and facilitating cessation, and changing beliefs and attitudes about tobacco use (2,3). This report describes the association between the Food and Drug Administration's (FDA's) first national tobacco public education campaign, The Real Cost, and rates of smoking initiation among youths in the United States from 2014 to 2016. A nationally representative cohort study of youths (N = 5,185) was conducted during November 2013-March 2016. Results from a discrete-time survival model indicate that, among youths who reported never having smoked a cigarette in the baseline survey, the odds of reporting smoking initiation at follow-up were lower among youths with frequent exposure to campaign advertisements than among those with little or no exposure (adjusted odds ratio [aOR] = 0.70, 95% confidence interval [CI] = 0.55-0.91). Based on the results of the model, The Real Cost is associated with an estimated 348,398 U.S. youths aged 11-18 years who did not initiate smoking during February 2014-March 2016. Sustained youth-focused tobacco education campaigns, such as The Real Cost, can help speed progress toward preventing tobacco use among youths in the United States.

Association between self-reports of being high and perceptions about the safety of drugged and drunk driving.

This study examines the relationship between self-reports of being high on marijuana and perceptions about driving high or drunk. Data were collected in 2014 from an online convenience sample of adult, past 30-day marijuana and hashish users in Colorado and Washington (n = 865). Respondents were asked, "Were you high or feeling the effects of marijuana or hashish when you took this survey?" Logistic regression was used to assess the relationship between being high and beliefs about driving high, controlling for demographics and marijuana use. Respondents who reported being high at the time of survey administration had higher odds of agreeing with the statements, "I can safely drive under the influence of marijuana" (OR = 3.13, P < 0.001) and "I can safely drive under the influence of alcohol" (OR = 3.71, P < 0.001) compared with respondents who did not report being high. Respondents who were high also had higher odds of being open to driving high under certain circumstances. Being high may influence perceptions about the safety of drugged and drunk driving. The effectiveness of public health messages to prevent drugged and drunk driving may depend in part on how persuasive they are among individuals who are high.

Exploring Differences in Youth Perceptions of the Effectiveness of Electronic Cigarette Television Advertisements.

INTRODUCTION: Studies suggest that exposure to televised electronic cigarette (e-cigarette) advertising contributes to the recent increase in e-cigarette use among youth. This study examines the relationship between perceptions of e-cigarette advertisements and attitudes toward and intentions to use e-cigarettes among youth who had never used e-cigarettes. METHODS: In May 2014, we conducted an online survey of 5020 youth aged 13 to 17. Participants were randomly assigned to answer questions about their attitudes toward and intentions to use e-cigarettes before or after viewing e-cigarette advertisements. Perceived effectiveness (PE) of advertisements was measured after ad exposure. Ordinary least squares models were used to assess the relationship between PE and study outcomes. RESULTS: Among never e-cigarette users, greater PE was associated with more positive attitudes toward e-cigarettes (b = 0.74, P < .001) and intentions to use e-cigarettes (b = 0.16, P < .001). Findings suggest that PE is predictive of outcomes controlling for study condition, youth demographics, and media use variables. CONCLUSIONS: After ad exposure, youth who have never used e-cigarettes previously perceive e-cigarettes as cooler, more fun, healthier, and more enjoyable. Youth who thought the ads were more effective were more likely to have a positive attitude toward e-cigarettes and greater intention to try e-cigarettes in the future. Restricting televised e-cigarette advertising may reduce e-cigarette initiation among youth. IMPLICATIONS: Previous studies demonstrate that, among adults, PE is antecedent to actual ad effectiveness across a range of behaviors. To our knowledge, this is the first study to document the relationship between PE and advertising effectiveness among youth. It provides evidence that PE may be a useful tool to quantify the potential influence of advertising on youth-advertising that, in this case, is designed to market a consumer good that may be harmful to youth but that may also be used to develop public health campaigns.

Youth's Awareness of and Reactions to The Real Cost National Tobacco Public Education Campaign.

In 2014, the Food and Drug Administration (FDA) launched its first tobacco-focused public education campaign, The Real Cost, aimed at reducing tobacco use among 12- to 17-year-olds in the United States. This study describes The Real Cost message strategy, implementation, and initial evaluation findings. The campaign was designed to encourage youth who had never smoked but are susceptible to trying cigarettes (susceptible nonsmokers) and youth who have previously experimented with smoking (experimenters) to reassess what they know about the "costs" of tobacco use to their body and mind. The Real Cost aired on national television, online, radio, and other media channels, resulting in high awareness levels. Overall, 89.0% of U.S. youth were aware of at least one advertisement 6 to 8 months after campaign launch, and high levels of awareness were attained within the campaign's two targeted audiences: susceptible nonsmokers (90.5%) and experimenters (94.6%). Most youth consider The Real Cost advertising to be effective, based on assessments of ad perceived effectiveness (mean = 4.0 on a scale from 1.0 to 5.0). High levels of awareness and positive ad reactions are requisite proximal indicators of health behavioral change. Additional research is being conducted to assess whether potential shifts in population-level cognitions and/or behaviors are attributable to this campaign. Current findings demonstrate that The Real Cost has attained high levels of ad awareness which is a critical first step in achieving positive changes in tobacco-related attitudes and behaviors. These data can also be used to inform ongoing message and media strategies for The Real Cost and other U.S. youth tobacco prevention campaigns.

A Randomized Trial of the Effect of E-cigarette TV Advertisements on Intentions to Use E-cigarettes.

INTRODUCTION: Adolescents' use of electronic cigarettes (e-cigarettes) and exposure to e-cigarette TV advertising have increased in recent years, despite questions about their safety. The current study tests whether exposure to e-cigarette TV advertisements influences intentions to use e-cigarettes in the future and related attitudes. METHODS: A parallel-group randomized controlled experiment was conducted and analyzed in 2014 using an online survey with a convenience sample of 3,655 U.S. adolescents aged 13-17 years who had never tried e-cigarettes. Adolescents in the treatment group viewed four e-cigarette TV advertisements. RESULTS: Adolescents in the treatment group reported a greater likelihood of future e-cigarette use compared with the control group. ORs for the treatment group were 1.54 (p=0.001) for trying an e-cigarette soon; 1.43 (p=0.003) for trying an e-cigarette within the next year; and 1.29 (p=0.02) for trying an e-cigarette if a best friend offered one. Adolescents in the treatment group had higher odds of agreeing that e-cigarettes can be used in places where cigarettes are not allowed (OR=1.71, p<0.001); can be used without affecting those around you (OR=1.83, p<0.001); are a safer alternative to cigarettes (OR=1.19, p=0.01); and are less toxic (OR=1.16, p=0.03). CONCLUSIONS: Exposure to e-cigarette advertising had relatively large and consistent effects across experimental outcomes. Together with the simultaneous increase in e-cigarette advertising exposure and e-cigarette use among adolescents, findings suggest that e-cigarette advertising is persuading adolescents to try this novel product. This raises concerns that continued unregulated e-cigarette advertising will contribute to potential individual- and population-level harm.

Impact of a U.S. antismoking national media campaign on beliefs, cognitions and quit intentions.

In 2012, the Centers for Disease Control and Prevention launched a national tobacco education campaign, Tips From Former Smokers, that consisted of graphic, emotionally evocative, testimonial-style advertisements. This longitudinal study examines changes in beliefs, tobacco-related cognitions and intentions to quit smoking among U.S. adult smokers after a 12-week airing of the campaign (n = 4040 adult smokers pre- and post-campaign). Exposure to the campaign was associated with greater odds of intending to quit within the next 30 days [odds ratio (OR) = 1.28, P < 0.01] and within the next 6 months (OR = 1.12, P < 0.05), and quit intentions were stronger among respondents with greater campaign exposure (OR = 1.12, P < 0.01). Campaign exposure was also associated with significant changes in beliefs about smoking-related risks (ORs = 1.15-2.40) and increased worries about health (b = 0.30, P < 0.001). Based on study change rates applied to U.S. census data, an estimated 566 000 additional U.S. smokers reported their intention to quit smoking within the next 6 months as a result of viewing campaign advertisements. Campaign effects were consistent with the theory of reasoned action and an expanding body of research demonstrating that graphic, emotional advertisements are highly effective for prompting positive cessation-related cognitions and behavioral intentions.

Using mass media campaigns to reduce youth tobacco use: a review.

OBJECTIVE: This review synthesizes the published literature on using mass media campaigns to reduce youth tobacco use, with particular focus on effects within population subgroups and the relative effectiveness of campaign characteristics. DATA SOURCE: A search of PubMed and PsycINFO conducted in March of 2014 yielded 397 studies with 34 suitable for inclusion. STUDY INCLUSION AND EXCLUSION CRITERIA: Included were quantitative studies that evaluate an antitobacco media campaign intended to influence youth cognitions or behavior or explore the relative effectiveness of campaign characteristics among youth. DATA EXTRACTION: An automated search and assessment of suitability for inclusion was done. DATA SYNTHESIS: Study outcomes were compared and synthesized. RESULTS: Antitobacco media campaigns can be effective across racial/ethnic populations, although the size of the campaign effect may differ by race/ethnicity. Evidence is insufficient to determine whether campaign outcomes differ by socioeconomic status (SES) and population density. Youth are more likely to recall and think about advertising that includes personal testimonials; a surprising narrative; and intense images, sound, and editing. Evidence in support of using a health consequences message theme is mixed; an industry manipulation theme may be effective in combination with a health consequences message. Research is insufficient to determine whether advertising with a secondhand smoke or social norms theme influences youth tobacco use. CONCLUSION: Our recommendation is to develop antitobacco campaigns designed to reach all at-risk youth, which can be effective across racial/ethnic populations. Research priorities include assessing campaign influence among lower SES and rural youth, disentangling the effects of message characteristics, and assessing the degree to which this body of evidence may have changed as a result of changes in youth culture and communication technology.

The impact of a state-sponsored mass media campaign on use of telephone quitline and web-based cessation services.

INTRODUCTION: Most US smokers do not use evidence-based interventions as part of their quit attempts. Quitlines and Web-based treatments may contribute to reductions in population-level tobacco use if successfully promoted. Currently, few states implement sustained media campaigns to promote services and increase adult smoking cessation. This study examines the effects of Florida's tobacco cessation media campaign and a nationally funded media campaign on telephone quitline and Web-based registrations for cessation services from November 2010 through September 2013. METHODS: We conducted multivariable analyses of weekly media-market-level target rating points (TRPs) and weekly registrations for cessation services through the Florida Quitline (1-877-U-CAN-NOW) or its Web-based cessation service, Web Coach (www.quitnow.net/florida). RESULTS: During 35 months, 141,221 tobacco users registered for cessation services through the Florida Quitline, and 53,513 registered through Web Coach. An increase in 100 weekly TRPs was associated with an increase of 7 weekly Florida Quitline registrants (ß = 6.8, P < .001) and 2 Web Coach registrants (ß = 1.7, P = .003) in an average media market. An increase in TRPs affected registrants from multiple demographic subgroups similarly. When state and national media campaigns aired simultaneously, approximately one-fifth of Florida's Quitline registrants came from the nationally advertised portal (1-800-QUIT-NOW). CONCLUSION: Sustained, state-sponsored media can increase the number of registrants to telephone quitlines and Web-based cessation services. Federally funded media campaigns can further increase the reach of state-sponsored cessation services.

The influence of antismoking television advertisements on cessation by race/ethnicity, socioeconomic status, and mental health status.

Disparities in tobacco use and smoking cessation by race/ethnicity, education, income, and mental health status remain despite recent successes in reducing tobacco use. It is unclear to what extent media campaigns promote cessation within these population groups. This study aims to (1) assess whether exposure to antitobacco advertising is associated with making a quit attempt within a number of population subgroups, and (2) determine whether advertisement type differentialy affects cessation behavior across subgroups. We used data from the New York Adult Tobacco Survey (NY-ATS), a cross-sectional, random-digit-dial telephone survey of adults aged 18 or older in New York State conducted quarterly from 2003 through 2011 (N = 53,706). The sample for this study consists of 9,408 current smokers from the total NY-ATS sample. Regression methods were used to examine the effect of New York State's antismoking advertising, overall and by advertisement type (graphic and/or emotional), on making a quit attempt in the past 12 months. Exposure to antismoking advertising was measured in two ways: gross rating points (a measure of potential exposure) and self-reported confirmed recall of advertisements. This study yields three important findings. First, antismoking advertising promotes quit attempts among racial/ethnic minority smokers and smokers of lower education and income. Second, advertising effectiveness is attributable in part to advertisements with strong graphic imagery or negative emotion. Third, smokers with poor mental health do not appear to benefit from exposure to antismoking advertising of any type. This study contributes to the evidence about how cessation media campaigns can be used most effectively to increase quit attempts within vulnerable subgroups. In particular, it suggests that a general campaign can promote cessation among a range of sociodemographic groups. More research is needed to understand what message strategies might work for those with poor mental health.

The use of social media by state tobacco control programs to promote smoking cessation: a cross-sectional study.

BACKGROUND: The promotion of evidence-based cessation services through social media sites may increase their utilization by smokers. Data on social media adoption and use within tobacco control programs (TCPs) have not been reported. OBJECTIVE: This study examines TCP use of and activity levels on social media, the reach of TCP sites, and the level of engagement with the content on sites. METHODS: A cross-sectional descriptive study of state TCP social media sites and their content was conducted. RESULTS: In 2013, 60% (30/50) of TCPs were using social media. Approximately one-quarter (26%, 13/50) of all TCPs used 3 or more social media sites, 24% (12/50) used 2, and 10% (5/50) used 1 site. Overall, 60% (30/50) had a Facebook page, 36% (18/50) had a Twitter page, and 40% (20/50) had a YouTube channel. The reach of social media was different across each site and varied widely by state. Among TCPs with a Facebook page, 73% (22/30) had less than 100 likes per 100,000 adults in the state, and 13% (4/30) had more than 400 likes per 100,000 adults. Among TCPs with a Twitter page, 61% (11/18) had less than 10 followers per 100,000 adults, and just 1 state had more than 100 followers per 100,000 adults. Seven states (23%, 7/30) updated their social media sites daily. The most frequent social media activities focused on the dissemination of information rather than interaction with site users. Social media resources from a national cessation media campaign were promoted infrequently. CONCLUSIONS: The current reach of state TCP social media sites is low and most TCPs are not promoting existing cessation services or capitalizing on social media's interactive potential. TCPs should create an online environment that increases participation and 2-way communication with smokers to promote free cessation services.

Exposure to electronic cigarette television advertisements among youth and young adults.

BACKGROUND AND OBJECTIVE: Currently, the US Food and Drug Administration does not regulate electronic cigarette (e-cigarette) marketing unless it is advertised as a smoking cessation aid. To date, the extent to which youth and young adults are exposed to e-cigarette television advertisements is unknown. The objective of this study was to analyze trends in youth and young adult exposure to e-cigarette television advertisements in the United States. METHODS: Nielsen data on television household audiences' exposure to e-cigarette advertising across US markets were examined by calendar quarter, year, and sponsor. RESULTS: Youth exposure to television e-cigarette advertisements, measured by target rating points, increased 256% from 2011 to 2013. Young adult exposure increased 321% over the same period. More than 76% of all youth e-cigarette advertising exposure occurred on cable networks and was driven primarily by an advertising campaign for 1 e-cigarette brand. CONCLUSIONS: E-cigarette companies currently advertise their products to a broad audience that includes 24 million youth. The dramatic increase in youth and young adult television exposure between 2011 and 2013 was driven primarily by a large advertising campaign on national cable networks. In the absence of evidence-based public health messaging, the current e-cigarette television advertising may be promoting beliefs and behaviors that pose harm to the public health. If current trends in e-cigarette television advertising continue, awareness and use of e-cigarettes are likely to increase among youth and young adults.

The impact of cessation media messages on cessation-related outcomes: results from a national experiment of smokers.

PURPOSE: Examine effects of exposure to two types of cessation advertisements on changes in cessation-related outcomes. DESIGN: Experimental data from a nationally representative, longitudinal sample of smokers, collected in three waves over 4 weeks. SETTING: National. Subjects. Three thousand and two adult U.S. smokers aged 18+ completed baseline and follow-up interviews at 2 and 4 weeks, from December 2010 to February 2011. INTERVENTION: Six randomly assigned conditions consisting of repeated exposure to cessation advertisements: why-to-quit advertisements featuring emotional, personal testimonies (1: WTQ-T) or graphic images (2: WTQ-G); how-to-quit advertisements (3: HTQ), a combination of both (4: WTQ-T + HTQ; 5: WTQ-G + HTQ), and no-ad condition (6: control). MEASURES: Cessation-related beliefs, attitudes, intentions, and quitting behavior. ANALYSIS: Multivariable ordinary least squares and logistic regressions testing whether exposure to antitobacco television advertisements were associated with changes in tobacco-related outcomes. RESULTS: Exposure to WTQ-T or WTQ-G advertisements, both alone and combined with HTQ advertisements, elicited positive change in beliefs, attitudes, and intentions as compared to controls. Smokers in three of four WTQ conditions were substantially more likely to have quit smoking at 4 weeks than controls (odds ratios range from 5.9 to 10.1, p < .05 or better). No effects were found for the HTQ-only condition. CONCLUSION: Exposure to WTQ advertisements markedly increases the odds that a smoker will quit in the study period, suggesting positive movement toward successful, long-term cessation. HTQ advertisements did not enhance advertising effectiveness and may not be suitable as a primary message strategy.