The Real Cost Youth E-Cigarette Prevention Campaign stopped an estimated 444,252 U.S. youth from initiating e-cigarette use between 2023 and 2024, according to a recent study.
In the longitudinal study, published in the American Journal of Preventive Medicine, investigators evaluated the impact of The Real Cost campaign on e-cigarette initiation among U.S. youth aged 11 to 18 years. They utilized a nationally representative sample and analyzed data from two waves of a longitudinal evaluation. Baseline data were collected between August and December 2023, with follow-up occurring from June to September 2024. The final analytic sample included 3,408 youth who had never used an e-cigarette at baseline and completed the follow-up survey.
The investigators measured campaign exposure using a self-reported frequency index (range = 0–16) based on the respondents' recall of four campaign advertisements. E-cigarette initiation was defined as transitioning from never having used an e-cigarette at baseline to reporting any use at follow-up. The investigators assessed the association between campaign exposure and e-cigarette initiation using a discrete-time survival analysis logistic regression model, adjusting for demographic and behavioral covariates, including age, household tobacco use, social media exposure, and sensation-seeking tendencies.
At follow-up, 6.8% of the respondents reported initiating e-cigarette use. The investigators demonstrated a significant inverse relationship between campaign exposure and e-cigarette initiation. For each 1 unit increase in the exposure index, the probability of initiation decreased by 6% (adjusted odds ratio [OR] = 0.94, 95% confidence interval [CI] = 0.90–0.99). Extrapolating these findings to the national youth population, the investigators, led by Anna MacMonegle, MA, of the Center for Communication and Media Impact at RTI International, estimated that campaign exposure prevented 444,252 (95% CI = 73,639–814,866) U.S. youth from initiating e-cigarette use between 2023 and 2024. Sensitivity analyses, including alternative exposure models, confirmed the robustness of these findings.
Additional analyses identified key risk factors for e-cigarette initiation, including higher social media use (adjusted OR = 1.70, 95% CI = 1.39–2.07), greater sensation-seeking tendencies (adjusted OR = 1.36, 95% CI = 1.15–1.60), and lower parental communication satisfaction (adjusted OR = 0.74, 95% CI = 0.63–0.86).
Study limitations included the inability to fully account for concurrent tobacco control policies, including FDA regulations restricting flavored e-cigarettes, which may have influenced youth e-cigarette initiation. Self-reported recall of advertisement frequency may have also introduced recall bias. However, the findings suggested an association between The Real Cost campaign and reduced e-cigarette initiation, aligning with prior research on public health campaigns in tobacco prevention.
The investigators reported no financial conflicts of interest, and the findings do not necessarily represent the official position of the FDA.
