Objective:
To evaluate the impact of The Real Cost campaign on e-cigarette initiation among U.S. youth aged 11 to 18 years.
Approach:
- Study Design: A longitudinal study using a nationally representative sample, with baseline data collected between August and December 2023 and follow-up from June to September 2024.
- Sample Size: The final analytic sample included 3,408 youth who had never used an e-cigarette at baseline.
- Measurement: Campaign exposure was measured using a self-reported frequency index based on recall of four campaign advertisements.
- Analysis: The association between campaign exposure and e-cigarette initiation was assessed using discrete-time survival analysis logistic regression, adjusting for demographic and behavioral covariates.
Key Findings:
- 6.8% of respondents reported initiating e-cigarette use at follow-up.
- There was 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 OR = 0.94).
- The campaign exposure is estimated to have prevented 444,252 U.S. youth from initiating e-cigarette use between 2023 and 2024.
- Key risk factors for e-cigarette initiation included higher social media use, greater sensation-seeking tendencies, and lower parental communication satisfaction.
Interpretation:
Limitations:
- Inability to fully account for concurrent tobacco control policies, including FDA regulations on flavored e-cigarettes.
- Potential recall bias from self-reported advertisement frequency.
Conclusion:
Sources:
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