Reach, Receptivity, And Beliefs Associated With the Fresh Empire Campaign to Prevent and Reduce Cigarette Use Among Youth in the United States.

PURPOSE: To determine the association between exposure to FDA's Fresh Empire tobacco public education campaign and tobacco-related beliefs. DESIGN: Repeated cross-sectional data collection design with embedded longitudinal cohort over six data collection waves. SETTING: 30 US evaluation markets. SAMPLE: Hip Hop peer crowd-identified US youth aged 12-18 (N = 5,378). MEASURES: Self-reported brand and video ad awareness (saw any ad at least sometimes) and perceived effectiveness (1-5 scale) to describe campaign awareness and receptivity. Exogenous exposure was measured using population-adjusted broadcast and digital video impressions. Tobacco-related beliefs included beliefs about smoking risks, attitudes towards tobacco-free people and lifestyles, and normative beliefs about smoking. ANALYSIS: Descriptive analyses of awareness, receptivity, and agreement with tobacco-related beliefs. Logistic regression models to determine the relationship between broadcast and digital video impressions and beliefs. INTERVENTION: Fresh Empire campaign. RESULTS: The campaign generated a high level of reach (71% brand and 66% video ad awareness at final wave) and messages were well-received (across waves 3.5-4.1 mean perceived effectiveness scores). Higher broadcast television exposure was associated with increased agreement with five beliefs related to addiction/control, being a bad influence on family/friends, and cosmetic effects of smoking (breath and attractiveness) (ORs = 1.16-1.27, (Ps < .05)). CONCLUSION: Fresh Empire successfully reached and resonated with Hip Hop-identified youth. The campaign was associated with a limited number of targeted beliefs.

Assessing quality-adjusted years of life lost associated with exclusive cigarette smoking and smokeless tobacco use.

The main purpose of this analysis is to quantify quality adjusted life years (QALYs) lost associated with lifetime exclusive cigarette or smokeless tobacco use among U.S. adults. Multiple waves of National Health Interview Survey (NHIS) data linked to death certificate records were used to define current exclusive cigarette and smokeless tobacco use and associated mortality risks. NHIS data were used to assess health-related quality of life (HRQOL). Regression and Cox proportional hazard modeling were used to adjust HRQOL and mortality risk associated with tobacco use for age, sex, race/ethnicity, body mass index, education, and household poverty level. QALYs were estimated based on adjusted HRQOL and mortality risks. All analyses were initiated in 2019 and completed in 2020. Male current exclusive cigarette smokers, aged 25 to 29 years would lose 8.1 QALYs (SE = 0.09), and male current exclusive smokeless tobacco users aged 25 to 34 would lose 4.1 QALYs (SE = 0.22), compared to never users of tobacco. Current exclusive cigarette or smokeless tobacco use is associated with QALY loss. QALYs lost can be lessened through preventing the initiation of tobacco product use or helping tobacco product users quit as early in life as possible.

Telemedicine works for treating substance use disorder: The STAR clinic experience during COVID-19.

The coronavirus disease 2019 has exposed many opportunities for improvement in treatment for substance use disorders. Regulators can ensure higher quality treatment for addiction when acknowledging telemedicine as a necessary treatment option and amending regulations to allow for telehealth parity across the United States.

LGBT young adults' awareness of and receptivity to the This Free Life tobacco public education campaign.

PURPOSE: This study measures awareness of and receptivity to the Food and Drug Administration's This Free Life campaign seeking to change tobacco-related attitudes and beliefs among lesbian, gay, bisexual and/or transgender (LGBT) young adults. METHODS: Participants were young adults who self-identify as LGBT. The evaluation uses a treatment-control design. This study includes data from four survey rounds with participants from each round invited to participate in subsequent rounds and new participants invited to account for attrition. Bivariate analyses assess treatment-control differences in campaign awareness by round. We used multivariable logistic regression models with a time×treatment interaction and covariates to assess whether increases in awareness were greater in treatment than control from follow-ups 1 to 4. Descriptive statistics describe perceived effectiveness and models explore covariates of perceived effectiveness. RESULTS: At each round, an increasing number of participants in treatment were brand aware (25%-67%) and reported high (16%-34%) and medium (16%-25%) video awareness compared with control (all p<0.001). Regressions revealed interactions in brand and video awareness, wherein the effect of treatment on awareness increased more over time, with significant treatment-control differences in change from follow-up 1 to 4 (all p<0.05). Reactions to all but one ad were positive (one neutral) with mean perceived effectiveness scores from 3.21 to 3.92 ('neither disagree nor agree' to 'agree' on 5-point scale). Perceived effectiveness differed by LGBT identity (all p<0.05). CONCLUSIONS: At follow-up 4, This Free Life reached most of the campaign audience in treatment markets and has achieved higher awareness in treatment than control markets, at individual survey rounds and over time.

An Experimental Study of Nicotine Warning Statements in E-cigarette Tweets.

INTRODUCTION: It is unclear whether warnings on electronic cigarette (e-cigarette) advertisements required by the US Food and Drug Administration (FDA) will apply to social media. Given the key role of social media in marketing e-cigarettes, we seek to inform FDA decision making by exploring how warnings on various tweet content influence perceived healthiness, nicotine harm, likelihood to try e-cigarettes, and warning recall. METHODS: In this 2 × 4 between-subjects experiment participants viewed a tweet from a fictitious e-cigarette brand. Four tweet content versions (e-cigarette product, e-cigarette use, e-cigarette in social context, unrelated content) were crossed with two warning versions (absent, present). Adult e-cigarette users (N = 994) were recruited via social media ads to complete a survey and randomized to view one of eight tweets. Multivariable regressions explored effects of tweet content and warning on perceived healthiness, perceived harm, and likelihood to try e-cigarettes, and tweet content on warning recall. Covariates were tobacco and social media use and demographics. RESULTS: Tweets with warnings elicited more negative health perceptions of the e-cigarette brand than tweets without warnings (p < .05). Tweets featuring e-cigarette products (p < .05) or use (p < .001) elicited higher warning recall than tweets featuring unrelated content. CONCLUSIONS: This is the first study to examine warning effects on perceptions of e-cigarette social media marketing. Warnings led to more negative e-cigarette health perceptions, but no effect on perceived nicotine harm or likelihood to try e-cigarettes. There were differences in warning recall by tweet content. Research should explore how varying warning content (text, size, placement) on tweets from e-cigarette brands influences health risk perceptions. IMPLICATIONS: FDA's 2016 ruling requires warnings on advertisements for nicotine-containing e-cigarettes, but does not specify whether this applies to social media. This study is the first to examine how e-cigarette warnings in tweets influence perceived healthiness and harm of e-cigarettes, which is important because e-cigarette brands are voluntarily including warnings on Twitter and Instagram. Warnings influenced perceived healthiness of the e-cigarette brand, but not perceived nicotine harm or likelihood to try e-cigarettes. We also saw higher recall of warning statements for tweets featuring e-cigarettes. Findings suggest that expanding warning requirements to e-cigarette social media marketing warrants further exploration and FDA consideration.

Awareness of and Receptivity to the Fresh Empire Tobacco Public Education Campaign Among Hip Hop Youth.

PURPOSE: The aim of the study was to assess awareness of and receptivity to the U.S. Food and Drug Administration's Fresh Empire tobacco public education campaign designed to reach Hip Hop-identified youth, who are at higher smoking risk. METHODS: The evaluation uses a randomized treatment-control design with 15 campaign-targeted treatment and 15 control markets. We conducted surveys among 12- to 17-year-olds before campaign launch and at approximately 6-month intervals. Analyses explore treatment-control differences in Fresh Empire brand and video advertisement awareness at individual survey rounds and over time and perceived effectiveness of advertisements. RESULTS: Awareness of the Fresh Empire brand was higher among youth in treatment than control markets following campaign launch (ps < .01). Awareness of the Fresh Empire brand increased more in treatment than control over time (adjusted odds ratio = 3.26, 95% confidence interval = 1.90-5.58). At follow-ups 1 and 3, youth in treatment (vs. control) were more likely to report high and less likely to report low awareness of video advertisements (ps < .05). There were no treatment-control differences in video awareness at follow-up 2 (not significant). Fresh Empire video advertisements had perceived effectiveness scores ranging from 3.66 to 4.11 (1-5 scale) across three survey rounds. CONCLUSIONS: Among the campaign audience of Hip Hop-identified youth, awareness of the Fresh Empire campaign was higher in treatment than control markets at individual survey rounds, and increases in campaign awareness were greater in treatment than control markets over time. Campaign advertisements also elicited positive audience reactions. Findings suggest that heavily digital campaigns may take longer to achieve Centers for Disease Control and Prevention-recommended 75% quarterly awareness.

Peer crowd segmentation for targeting public education campaigns: Hip hop youth and tobacco use.

This study examines the potential association between strength of Hip Hop peer crowd identification and tobacco use in one of the first large samples of Hip Hop youth in the United States. Data are from a geographically-targeted, address-based convenience sample of 2194 youths aged 12-17 who identify with the Hip Hop peer crowd collected via in-person and web interviews in 30 U.S. media markets in 2015. We examined strength of Hip Hop peer crowd identification, perceived peer tobacco use, and tobacco use outcomes. Overall, 18.3% of Hip Hop youth reported current blunt (cigar with added marijuana) use, followed by electronic cigarettes (e-cigarettes) (11.6%), cigar (without added marijuana) (8.8%), hookah (6.5%), and cigarette (5.6%) use. Stronger Hip Hop peer crowd identification was associated with increased odds of using cigarettes (OR = 2.25, p < 0.05), cigars (OR = 2.14, p < 0.05), and blunts (OR = 1.61, p < 0.05), controlling for demographic characteristics and perceived peer tobacco use. Results suggest that a Hip Hop peer crowd-targeted public education prevention campaign for youth can be promising for a variety of tobacco products.

Recruiting Hard-to-Reach Populations for Survey Research: Using Facebook and Instagram Advertisements and In-Person Intercept in LGBT Bars and Nightclubs to Recruit LGBT Young Adults.

BACKGROUND: Tobacco public education campaigns focus increasingly on hard-to-reach populations at higher risk for smoking, prompting campaign creators and evaluators to develop strategies to reach hard-to-reach populations in virtual and physical spaces where they spend time. OBJECTIVE: The aim of this study was to describe two novel recruitment strategies (in-person intercept interviews in lesbian, gay, bisexual, and transgender [LGBT] social venues and targeted social media ads) and compares characteristics of participants recruited via these strategies for the US Food and Drug Administration's This Free Life campaign evaluation targeting LGBT young adults who smoke cigarettes occasionally. METHODS: We recruited LGBT adults aged 18-24 years in the United States via Facebook and Instagram ads (N=1709, mean age 20.94, SD 1.94) or intercept in LGBT social venues (N=2348, mean age 21.98, SD 1.69) for the baseline evaluation survey. Covariates related to recruitment strategy were age; race or ethnicity; LGBT identity; education; pride event attendance; and alcohol, cigarette, and social media use. RESULTS: Lesbian or gay women (adjusted odds ratio, AOR 1.88, 95% CI 1.54-2.29, P<.001), bisexual men and women (AOR 1.46, 95% CI 1.17-1.82, P=.001), gender minorities (AOR 1.68, 95% CI 1.26-2.25, P<.001), and other sexual minorities (AOR 2.48, 95% CI 1.62-3.80, P<.001) were more likely than gay men to be recruited via social media (than intercept). Hispanic (AOR 0.73, 95% CI 0.61-0.89, P=.001) and other or multiracial, non-Hispanic participants (AOR 0.70, 95% CI 0.54-0.90, P=.006) were less likely than white, non-Hispanic participants to be recruited via social media. As age increased, odds of recruitment via social media decreased (AOR 0.76, 95% CI 0.72-0.80, P<.001). Participants with some college education (AOR 1.27, 95% CI 1.03-1.56, P=.03) were more likely than those with a college degree to be recruited via social media. Participants reporting past 30-day alcohol use were less likely to be recruited via social media (AOR 0.33, 95% CI 0.24-0.44, P<.001). Participants who reported past-year pride event attendance were more likely to be recruited via social media (AOR 1.31, 95% CI 1.06-1.64, P=.02), as well as those who used Facebook at least once daily (AOR 1.43, 95% CI 1.14-1.80, P=.002). Participants who reported using Instagram at least once daily were less likely to be recruited via social media (AOR 0.73, 95% CI 0.62-0.86, P<.001). Social media recruitment was faster (incidence rate ratio, IRR=3.31, 95% CI 3.11-3.52, P<.001) and less expensive (2.2% of combined social media and intercept recruitment cost) but had greater data quality issues-a larger percentage of social media respondents were lost because of duplicate and low-quality responses (374/4446, 8.41%) compared with intercept respondents lost to interviewer misrepresentation (15/4446, 0.34%; P<.001). CONCLUSIONS: Social media combined with intercept provided access to important LGBT subpopulations (eg, gender and other sexual minorities) and a more diverse sample. Social media methods have more data quality issues but are faster and less expensive than intercept. Recruiting hard-to-reach populations via audience-tailored strategies enabled recruitment of one of the largest LGBT young adult samples, suggesting these methods' promise for accessing hard-to-reach populations.