Impact of The Real Cost Media Campaign on Youth Smoking Initiation

Abstract

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 betweenwave 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.

Validating Self-Reported Ad Recall as a Measure of Exposure to Digital Advertising: An Exploratory Analysis Using Ad Tracking Methodology

“…The impact of these anti-tobacco campaigns has been established by evaluation studies that examine the relationship between campaign exposure and changes in anti-tobacco knowledge, attitudes, beliefs, and tobacco use behavior [7][8][9][10][11][12][13][14][15]. Critical to the success of these campaigns is sufficient exposure to campaign messages in order demonstrate a population-level effect.…”

“…No standardized process has yet been developed to convert a raw count of impressions to a metric analogous to television GRPs. A recent evaluation of the U.S. Food and Drug Administration's smoking-prevention campaign "The Real Cost" incorporated both television and digital Targeted Rating Points (i.e., TRPs, which are GRPs specific to the targeted audience) in their measure of campaign exposure [11]. However, a method of calculating digital TRPs was not established, and, the authors were unable to determine whether there was an independent effect of the digital ads on campaign outcomes.…”

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

“…Campaign effects are monitored through longitudinal evaluation surveys of a probability-based youth sample. Evidence so far suggests that campaign advertising has reached the vast majority of its target population and prevented a substantial number of youth from smoking initiation (Duke et al, 2015(Duke et al, , 2018(Duke et al, , 2019Farrelly et al, 2017).…”

“…This study focuses on video advertisements, the only form of advertising where PE ratings were consistently obtained in the outcome evaluation. Description of all TRC video ads and their dates of airing are available in a previous publication (Duke et al, 2019).…”

“…Additional environmental data from external sources were also added to the survey, including state adult smoking prevalence from the 2013 Behavioral Risk Factor Surveillance System, market median population size, market median income, and media market education level. More details about these control variables are available elsewhere (Duke et al, 2019).…”