National Youth tobacco surveys (2014-2019) show increasing beliefs in the harm and relative addiction of e-cigarettes but decreasing associations between those beliefs and e-cigarette use.

BACKGROUND: To evaluate the potential efficacy of increasing harm and relative addiction beliefs in discouraging e-cigarette use, we examined how adolescents' beliefs about e-cigarettes have changed over 6 years and how the predictive validity of these beliefs has changed over time. METHODS: Using data from the 2014-2019 National Youth Tobacco Survey (NYTS) (grades 6-12; N = 117,472), we evaluated the association between adolescents' beliefs about the harm and relative addiction of e-cigarettes and current e-cigarette use, as well as susceptibility to use. Logistic regressions and pairwise contrasts were used to analyze changes in these beliefs and determine how well these beliefs predict ever use, current use, and susceptibility to use over time. RESULTS: E-cigarette harm and relative addiction beliefs tended to increase over time. In most years, these beliefs were negatively associated with e-cigarette use, including ever use, current use, and susceptibility to use. Interactions between these beliefs were also observed in some years such that harm belief better predicted use when e-cigarettes were also perceived as more addictive. Survey year also interacted with health harm and relative addiction beliefs such that the predictive validity of these beliefs for e-cigarette use decreased over time. CONCLUSIONS: Beliefs about e-cigarette harm and relative addiction have increased over time and predict use of, and susceptibility to, e-cigarettes among US adolescents. However, the predictive validity of these beliefs has decreased over time. Future research should explore the reasons for the decreased predictive validity of health beliefs in e-cigarette use and identify constructs that predict adolescent e-cigarette use over and above general harm and relative addiction beliefs.

Perceived effectiveness of objective elements of vaping prevention messages among adolescents.

INTRODUCTION: In recent years, vaping prevention campaigns have proliferated in response to a surge of e-cigarette use among adolescents in the USA. To date, the research literature has provided minimal guidance as to what vaping prevention message elements have the greatest potential for discouraging vaping, are ineffective or have unintended negative effects. The purpose of the current study was to identify and test a large set of vaping prevention ads used by federal, state, local and non-governmental agencies, examining how objectively coded message elements of vaping prevention messages might affect youth. METHODS: A convenience sample of adolescents (N=1501) completed an online survey with each participant rating seven randomly selected vaping prevention ads from a pool of 220 ads on perceived message effectiveness (PME) and vaping appeal. Ads were coded on 37 objective elements in three message categories: themes, imagery and other features. Analyses examined how objective elements predicted PME. RESULTS: Addiction, chemicals, negative health symptoms and effects, and cigarette comparison themes were associated with higher PME, as were graphic images and warning symbols. Industry targeting, environmental impact, flavour themes, images of food and people's faces were associated with lower PME, as were hashtags, statistics and first-person language or the word 'teen'. Most elements were not associated with appeal, but ads with a flavour theme were associated with increased vaping appeal. CONCLUSION: Promising vaping prevention messages focus on the adverse consequences of vaping, use negative imagery and avoid speaking for teens using their vernacular or perspective.

Aided recall of The Real Cost e-cigarette prevention advertisements among a nationally representative sample of adolescents.

E-cigarette use among youth remains a significant public health concern. In 2018, The Real Cost campaign began disseminating messages about the harms of vaping, primarily using digital media. We sought to determine the prevalence of aided recall of The Real Cost e-cigarette prevention ads and identify potential differences by participant characteristics. Participants were a nationally representative sample of adolescents living in United States (US) households recruited by the National Opinion Research Center (NORC) at the University of Chicago's AmeriSpeak panel in September and October of 2020. A total of 623 adolescents completed the survey. Analyses were weighted to represent the distribution of youth in the US, and effect sizes for individual characteristics were estimated using an adjusted marginalized two-part model. Seventy-one percent of adolescents recalled at least one of the five The Real Cost e-cigarette prevention ads, with individual ad recall ranging from a low of 38.8% (for Magic) to a high of 50.1% (for Narrative). Adjusted estimates of aided recall identified significantly higher recall among Black adolescents and those that used social media at medium or high frequencies (p < 0.05). Results support ongoing efforts by the FDA to reach youth with e-cigarette prevention messages using primarily digital media.

What's in the message? An analysis of themes and features used in vaping prevention messages.

Introduction: Federal, state, local, and non-government officials have developed and implemented a variety of vaping prevention messages to curtail the vaping epidemic among youth in the US. This study sought to collect a comprehensive set of vaping prevention messages and characterize the themes and features of those messages. Methods: We used a two-fold search strategy to identify messages, utilizing the existing content database from Vaping Prevention Resource (vapingprevention.org) and supplementing those messages with web searches. Potential messages were included if they were vaping prevention-oriented, appropriate or relevant for youth, and in a static web or print format. Results: A total of 220 messages met criteria. Messages were coded on the presence or absence of 37 objective features within five categories: message themes, imagery, text features, message perspective, and other (e.g., source). The most common themes were nicotine addiction (32%), chemicals (30%), health effects (24%), and industry targeting (19%). Eighty-five percent of messages included imagery, with 27% showing a vaping device, 22% showing smoke or vapor, and 21% showing a person's face. Just over half (56%) included a message source. Conclusions: Vaping prevention messages for youth have commonly focused on addiction and health risks of vaping, and they vary on a series of text and image features. Further research is needed to understand the efficacy of messaging approaches in preventing vaping among youth.