Evaluating The Real Cost Digital and Social Media Campaign: Longitudinal Effects of Campaign Exposure on E-cigarette Beliefs.

INTRODUCTION: Over the past decade, youth e-cigarette use has risen exponentially. At the same time, digital media use increased markedly while the use of traditional broadcast TV declined. In response, the U.S. Food and Drug Administration's The Real Cost public education campaign shifted to communicating the harms of e-cigarette via primarily digital and social platforms. This study evaluated longitudinal associations between exposure to campaign advertisements and changes in campaign-specific beliefs among US youth. METHODS: A nationally representative longitudinal cohort of youth (aged 11-16 years at baseline) was surveyed five times. Building on earlier work, we analyzed data from the last three waves (April-July 2020; January-April 2021; and August-October 2021; N = 2625). We assessed self-reported exposure to six ads and agreement with 11 beliefs that were each targeted by one or more ads. Eleven weighted panel regression models assessed whether ad exposure predicted changes in campaign-specific beliefs over time. RESULTS: We observed significant associations between ad exposure and increases in at least one campaign-specific belief for five of the six ads. Across the 11 beliefs, we observed associations between increased exposure and increases in 6 beliefs related to e-cigarettes and toxic metals, lung damage, dangerous ingredients, anxiety, cigarette use, and disappointing important people. CONCLUSIONS: We found evidence that self-reported exposure to this digital and social media campaign was successful at influencing youth, providing support for the effectiveness of the campaign's adaption to address youth's changes in tobacco and media use habits. IMPLICATIONS: The Food and Drug Administration's The Real Cost public education campaign educates youth about the dangers of e-cigarette use. This study evaluates longitudinal associations between exposure to The Real Cost's advertisements and changes in campaign-specific beliefs among youth. Considering evolving trends in youth media consumption, the campaign adapted its media approach to increase delivery across digital and social media platforms. Our findings indicate that the campaign reached its intended audience and increased youth beliefs around the harm of e-cigarettes and the consequences of e-cigarette use, offering evidence for the effectiveness of digital and social media youth prevention efforts within a fragmented digital environment.

Changes in E-cigarette Use Among Youth and Young Adults During the COVID-19 Pandemic: Insights Into Risk Perceptions and Reasons for Changing Use Behavior.

INTRODUCTION: This study assessed changes in e-cigarette use since the COVID-19 pandemic began and reasons for these changes among US youth and young adults. AIMS AND METHODS: We combined data from two cross-sectional samples of youth and young adult (15-24 years) participants of a monthly surveillance study (data collected in April and June 2021). Analyses were restricted to past-year e-cigarette users who reported using e-cigarettes before the pandemic (n = 1762). Participants reported changes in e-cigarette use since the pandemic began, reasons for changing their behavior, and their perceptions around COVID-19 risk related to e-cigarette use. Multinomial logistic regression models assessed associations between demographics and COVID vaping risk perceptions and changes in e-cigarette use. RESULTS: Over a third of the sample (37.9%) reported increasing e-cigarette use, while 28.9% reported decreasing use, and 33.1% reported no change. Analyses revealed associations between change in e-cigarette use and age, race and ethnicity, e-cigarette use status, and COVID vaping risk perceptions. The most common reason for increasing use was managing stress (36%); the most common reasons for decreasing use included fewer social interactions (22%) and concerns over general health (18%). Results also indicated differences in reasons for decreasing use by race and ethnicity, and differences in reasons for both increasing and decreasing use by age. CONCLUSIONS: This study provides recent data on how the ongoing and evolving COVID-19 pandemic has impacted youth and young adults' e-cigarette use. Findings identify subpopulations that may benefit from e-cigarette prevention interventions, as well as insights that may inform the content and delivery of such interventions. IMPLICATIONS: This study provides recent insights into if and why the ongoing COVID-19 pandemic has impacted e-cigarette use behavior among youth and young adults. Findings contribute to the understanding of the role e-cigarettes play in young people's lives-insights that can inform youth and young adult prevention efforts.

Effects of a National Campaign on Youth Beliefs and Perceptions About Electronic Cigarettes and Smoking.

INTRODUCTION: Our study assesses the relationship between the exposure of youth to the US Food and Drug Administration's national tobacco public education campaign, The Real Cost, and changes in campaign-focused risk perceptions and beliefs. METHODS: A nationally representative cohort study of youth was conducted from June 2018 to July 2019, consisting of a baseline and one follow-up survey. We performed logistic regressions to examine the association between campaign exposure and beliefs. Exposure was measured by self-report as the frequency of exposure to individual campaign advertisements about the health consequences of e-cigarette use and of smoking cigarettes. RESULTS: We found that increased levels of exposure to campaign advertising was associated with a significant increase in the odds of reporting agreement with campaign-specific beliefs. Positive patterns of findings were found across multiple items selected by specific advertisements, whereas unrelated beliefs were not associated with advertisement exposure. CONCLUSION: A sustained national tobacco public education campaign can change beliefs about the harms of e-cigarette use and cigarette smoking among youth. Combined with other findings from The Real Cost evaluation, results indicate that prevention mass media campaigns continue to be an effective and cost-efficient approach to reduce the health and financial cost of tobacco use in the US.

Over and under-regulation in the Colorado Cannabis industry - A data-analytic perspective.

With the State of California legalizing recreational cannabis sales on January 1, 2018, the regulatory process is once more in the forefront of cannabis research. Colorado, often held up as a model of legalization policy, was the first state to implement retail sale of recreational cannabis on January 1st, 2014. However, a combination of subsequent under-regulation and over-regulation, inconsistently applied across issues such as retail licencing, chemical testing, cannabis derivatives, municipality approval for growers, and financing, have not only held back the industry in Colorado but also negatively impacted public health, oversight, and have potentially increased the availability of illegal cannabis. We argue that a data-analytic approach to the industry is potentially the most effective way to resolve these concerns, since in the absence of consistent and reliable data, policymakers are apt to satisfy individual policy concerns without considering the industry as a whole. In this paper we present a data-analytic framework for the cannabis industry, offering a theoretically-driven justification for our approach, and describe implications for research on drug and information policy. The framework may serve as a model for other states or countries contemplating cannabis legalisation. As four new states legalised recreational cannabis in 2016, the implications of this research for policymakers has dramatically increased.