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

Abstract

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.

Predicting Age Groups of Reddit Users Based on Posting Behavior and Metadata: Classification Model Development and Validation (Preprint)

“…Running effective public health education campaigns requires organizations to tailor messages and provide outreach that resonates with their target audience. For example, the US Food and Drug Administration (FDA) Center for Tobacco Products has developed separate public education campaigns on the health consequences of tobacco products for at-risk teens [1]; lesbian, gay, bisexual, and transgender young adults [2]; multicultural youth [3]; rural male teens [4]; and adult smokers [5]. With increased media consumption and interpersonal interactions occurring online, social media platforms have become important in both engaging target audiences in public education campaigns and in understanding behaviors and perceptions around emerging public health issues across these target audiences.…”

Cumulative disadvantage as a framework for understanding rural tobacco use disparities.

“…Given the relatively high levels of religiosity in rural areas (Dillon & Henly, 2008), messages from religious leaders or that have religion-based framing may be effective (Kostygina et al, 2014; Lewis-Thames et al, 2020). On the other hand, several studies suggest that health-related messages are effective without cultural adaptation (e.g., Patten et al, 2018; Walker et al, 2018). Because cultural tailoring of antitobacco media is a practice widely used (Talbot et al, 2019b), more work is needed to determine whether incorporating rural themes is essential for increasing effectiveness.…”

The FDA’s Diverse and Dynamic Activities in the Social and Behavioral Sciences: Advancing and Supporting Health Equity

“…Campaigns aimed at preventing and reducing tobacco use across diverse target populations include FDA’s Fresh Empire campaign, the first tobacco public education campaign designed to reach African American, Hispanic, and/or Asian American/Pacific Islander youth ages 12 to 17 years who identify with the Hip Hop crowd 8 , 9 ; This Free Life campaign designed to prevent and reduce tobacco use among LGBT young adults who use tobacco occasionally 10 ; and “The Real Cost” Smokeless Tobacco prevention campaign that seeks to educate rural male teenagers about the health risks of using smokeless tobacco products. 11 …”