Anna J. MacMonegle

Youth's Awareness of and Reactions to The Real Cost National Tobacco Public Education Campaign:

In 2014, the Food and Drug Administration (FDA) launched its first tobacco-focused public education campaign, The Real Cost, aimed at reducing tobacco use among 12- to 17-year-olds in the United States. This study describes The Real Cost message strategy, implementation, and initial evaluation findings. The campaign was designed to encourage youth who had never smoked but are susceptible to trying cigarettes (susceptible nonsmokers) and youth who have previously experimented with smoking (experimenters) to reassess what they know about the “costs” of tobacco use to their body and mind. The Real Cost aired on national television, online, radio, and other media channels, resulting in high awareness levels. Overall, 89.0% of U.S. youth were aware of at least one advertisement 6 to 8 months after campaign launch, and high levels of awareness were attained within the campaign’s two targeted audiences: susceptible nonsmokers (90.5%) and experimenters (94.6%). Most youth consider The Real Cost advertising to be effective, based on assessments of ad perceived effectiveness (mean = 4.0 on a scale from 1.0 to 5.0). High levels of awareness and positive ad reactions are requisite proximal indicators of health behavioral change. Additional research is being conducted to assess whether potential shifts in population-level cognitions and/or behaviors are attributable to this campaign. Current findings demonstrate that The Real Cost has attained high levels of ad awareness which is a critical first step in achieving positive changes in tobacco-related attitudes and behaviors. These data can also be used to inform ongoing message and media strategies for The Real Cost and other U.S. youth tobacco prevention campaigns.

Impact of a U.S. antismoking national media campaign on beliefs, cognitions and quit intentions

In 2012, the Centers for Disease Control and Prevention launched a national tobacco education campaign, Tips From Former Smokers, that consisted of graphic, emotionally evocative, testimonial-style advertisements. This longitudinal study examines changes in beliefs, tobacco-related cognitions and intentions to quit smoking among U.S. adult smokers after a 12-week airing of the campaign (n = 4040 adult smokers pre- and post-campaign). Exposure to the campaign was associated with greater odds of intending to quit within the next 30 days [odds ratio (OR) = 1.28, P < 0.01] and within the next 6 months (OR = 1.12, P < 0.05), and quit intentions were stronger among respondents with greater campaign exposure (OR = 1.12, P < 0.01). Campaign exposure was also associated with significant changes in beliefs about smoking-related risks (ORs = 1.15-2.40) and increased worries about health (b = 0.30, P < 0.001). Based on study change rates applied to U.S. census data, an estimated 566 000 additional U.S. smokers reported their intention to quit smoking within the next 6 months as a result of viewing campaign advertisements. Campaign effects were consistent with the theory of reasoned action and an expanding body of research demonstrating that graphic, emotional advertisements are highly effective for prompting positive cessation-related cognitions and behavioral intentions.

Mortality and Economic Costs From Regular Cigar Use in the United States, 2010

OBJECTIVES We estimated annual mortality, years of potential life lost, and associated economic costs attributable to regular cigar smoking among US adults aged 35 years or older. METHODS We estimated cigar-attributable mortality for the United States in 2010 using the Centers for Disease Control and Preventions Smoking-Attributable Mortality, Morbidity, and Economic Costs methodology for smoking-related causes of death. We obtained cigar prevalence from the National Adult Tobacco Survey, relative risks from the Cancer Prevention Studies I and II, and annual US deaths from the National Vital Statistics System. We also estimated the economic cost of this premature mortality using the value of a statistical life-year. RESULTS Regular cigar smoking was responsible for approximately 9000 premature deaths and more than 140,000 years of potential life lost among US adults aged 35 years or older in 2010. These years of life had an economic value of approximately

The Marketing of Dissolvable Tobacco: Social Science and Public Policy Research Needs:

23 billion. CONCLUSIONS . The health and economic burden of cigar smoking in the United States is large and may increase over time because of the increasing consumption of cigars in the United States.

The Impact of a State-Sponsored Mass Media Campaign on Use of Telephone Quitline and Web-Based Cessation Services

The latest generation of smokeless tobacco products encompasses a wide range of offerings, including what is commonly referred to as dissolvable tobacco. Designed to deliver nicotine upon dissolving or disintegrating in a users mouth, dissolvable tobacco products currently appear in various United States markets as strips, orbs, sticks, and lozenges. The emergence of these new products poses distinct opportunities and challenges for social and behavioral science and public health research and raises important public policy questions.

Effect of a National Tobacco Public Education Campaign on Youth’s Risk Perceptions and Beliefs About Smoking:

Introduction Most US smokers do not use evidence-based interventions as part of their quit attempts. Quitlines and Web-based treatments may contribute to reductions in population-level tobacco use if successfully promoted. Currently, few states implement sustained media campaigns to promote services and increase adult smoking cessation. This study examines the effects of Florida’s tobacco cessation media campaign and a nationally funded media campaign on telephone quitline and Web-based registrations for cessation services from November 2010 through September 2013. Methods We conducted multivariable analyses of weekly media-market–level target rating points (TRPs) and weekly registrations for cessation services through the Florida Quitline (1-877-U-CAN-NOW) or its Web-based cessation service, Web Coach (www.quitnow.net/florida). Results During 35 months, 141,221 tobacco users registered for cessation services through the Florida Quitline, and 53,513 registered through Web Coach. An increase in 100 weekly TRPs was associated with an increase of 7 weekly Florida Quitline registrants (β = 6.8, P < .001) and 2 Web Coach registrants (β = 1.7, P = .003) in an average media market. An increase in TRPs affected registrants from multiple demographic subgroups similarly. When state and national media campaigns aired simultaneously, approximately one-fifth of Florida’s Quitline registrants came from the nationally advertised portal (1-800-QUIT-NOW). Conclusion Sustained, state-sponsored media can increase the number of registrants to telephone quitlines and Web-based cessation services. Federally funded media campaigns can further increase the reach of state-sponsored cessation services.

Examining Youth Dual and Polytobacco Use with E-Cigarettes

Purpose: To assess the relationship between youth’s exposure to the Food and Drug Administration’s national tobacco public education campaign, The Real Cost, and changes in campaign-targeted beliefs. Design: Longitudinal design with baseline survey and 2 postcampaign follow-up surveys. Sample: Youth from 75 US media markets (N = 1680) who completed all 3 surveys and had experimented with or were susceptible to future cigarette smoking. Measures: Exposure was measured by self-reported frequency of ad exposure and media market–level target rating points. Agreement with 30 self-reported tobacco-related beliefs was assessed in 3 categories: (1) beliefs specifically targeted by campaign messages (campaign-targeted belief), (2) beliefs not targeted by the campaign (nontargeted beliefs), and (3) beliefs corresponding to other media campaigns on air concurrent with The Real Cost (ambiguous beliefs). Analysis: Descriptive analyses of aggregate changes in beliefs and logistic regressions to examine the association between campaign exposure and beliefs. Intervention: The Real Cost. Results: Agreement with campaign-targeted beliefs increased from baseline to first and second follow-ups, with a mean relative increase of 10.4% and 11.5%, respectively. Nontargeted beliefs did not change substantially. Both measures of campaign exposure were positively associated with increased odds of agreeing with 5 of 8 campaign-targeted beliefs. Exposure was not significantly associated with 12 of 14 nontargeted tobacco-related beliefs. Discussion: A sustained national tobacco public education campaign can change population-level perceptions of tobacco-related harms among youth.

Cost-Effectiveness Analysis of The Real Cost Campaign's Effect on Smoking Prevention

E-cigarettes and other non-cigarette tobacco products are increasingly popular among youth. Little is known to inform public health efforts to reduce youth use. We examined psychosocial correlates of single and multiple tobacco product use among youth e-cigarette users. Data were from the 2014 Florida Youth Tobacco Survey (N = 69,923), a representative sample of Florida middle and high school students. Associations between combinations of e-cigarette, cigarette and other tobacco product (OTP) use and psychosocial variables were examined using multinomial logistic regression with an analytic sample of N = 2756. Most e-cigarette-using youth used at least one other product (81%). Perceiving cigarettes as easy to quit was significantly associated with greater likelihood of combined e-cigarette/OTP use (relative risk ratio (RRR) = 2.51, p < 0.001) and combined e-cigarette/cigarette/OTP use (RRR = 3.20, p < 0.0001). Thinking you will be smoking cigarettes in 5 years was associated with product combinations that include cigarettes. Tobacco company marketing receptivity was associated with multiple product user types. Given that specific psychosocial factors put youth at risk for concurrent use of e-cigarettes with tobacco products, public health efforts should address polytobacco use specifically, instead of individual product use. Youth perceptions about the ease of quitting cigarettes, intentions to continue smoking cigarettes and receptivity to tobacco company marketing are promising areas for messaging aimed at reducing e-cigarette polytobacco product use.

Association Between The Real Cost Media Campaign and Smoking Initiation Among Youths — United States, 2014–2016

INTRODUCTION A previous study found that the Food and Drug Administrations The Real Cost national tobacco education campaign was associated with preventing approximately 350,000 U.S. youth from initiating smoking between 2014 and 2016. This study translates the reduction in smoking initiation into monetary terms by examining the cost effectiveness of the campaign. METHODS The cost effectiveness of The Real Cost was assessed by measuring efficiency in two ways: (1) estimating the cost per quality-adjusted life year saved and (2) estimating the total monetary return on investment by comparing the cost savings associated with the campaign to campaign expenditures. Analyses were conducted in 2017. RESULTS The Real Cost averted an estimated 175,941 youth from becoming established smokers between 2014 and 2016. Campaign expenditures totaled

Do different styles of antismoking ads influence the types of smokers who call quitlines

246,915,233. The cost per quality-adjusted life year saved of the campaign was