The prevalence of e-cigarette use has risen rapidly since introduction of this product to the United States in 2007. Quiz Ref ID Among US high school students, the prevalence of past 30-day use of e-cigarettes increased 10-fold from 1.5% in 2011 to 16.0% in 2015, when the prevalence of past 30-day e-cigarette use in this population exceeded its prevalence of past 30-day cigarette smoking (9.3%).¹ e-Cigarette use occurs at an appreciable prevalence among both cigarette-smoking and never cigarette-smoking youth.^2-4 Furthermore, longitudinal studies^5-10 have reported that e-cigarette use is associated with an increased risk of cigarette smoking initiation among never cigarette-smoking adolescents and young adults even after adjusting for known demographic, psychosocial, and behavioral risk factors. Recently, the US Surgeon General noted this increased risk as an important public health concern.¹¹

Objectives: Behavior change campaigns typically try to change beliefs that influence behaviors, with targeted beliefs comprising the campaign theme. We present an empirical approach for choosing among a large number of potential themes, and results from the implementation of this approach for campaigns aimed at 4 behavioral targets: (1) preventing smoking initiation among youth, and (2) preventing initiation, (3) stopping progression to daily smoking and (4) encouraging cessation among young adults. Methods: An online survey of 13- to 17-year-olds and 18- to 25-year-olds in the United States (US), in which 20 potential campaign themes were represented by 154 beliefs. For each behavioral target, themes were ranked based on the strength of belief-intention and belief-behavior associations and size of the population not already endorsing the beliefs. Results: The most promising themes varied across behavioral targets but 3 were consistently promising: consequences of smoking for mood, social acceptance and social popularity. Conclusions: Using a robust and systematic approach, this study provides campaign developers with empirical data to inform their selection of promising themes. Findings related to the campaign to prevent initiation among youth informed the development of the US Food and Drug Administration's “The Real Cost” campaign.

A recent study of adult smokers who vape found that disposable/cigalike electronic (e-) cigarette devices were more commonly used than later generation devices. However, whether these trends reflect patterns among adolescents and young adults, many of whom have limited or no history of combustible cigarette use, has not been studied. Participants were drawn from eight locally, regionally, and US nationally representative studies. Surveys took place between Fall 2014 and Spring 2016; participants were residents of California (3 studies), Texas (2 studies), Connecticut (1 study), or randomly selected from the US population (2 studies). Data were collected from middle and high school students (4 studies), young adults under 30 (3 studies), or a mixture (1 study) to assess type of e-cigarette device used among past-30 day e-cigarette users: disposable/cigalike, or later generation e-cigarette device. Fewer than 15% of participants in each study reported primarily using a disposable/cigalike device in the past month (across all studies: 7.5%; 95%CI: 4.9%, 10.5%). The proportion using later generation devices ranged from 58% to 86% across studies; overall, 77.0% (95%CI: 70.5%, 82.9%) reported primary use of a later generation device. Combined, 13.2% (95%CI: 5.9%, 22.8%) reported “don’t know” or were missing data. Among adolescent and young adult e-cigarette users, primary use of disposable/cigalike devices was rare. Future research should continue to evaluate the type of device used by adolescents and young adults, as these data may be relevant to regulatory oversight of e-cigarettes recently acquired by the Food and Drug Administration Center for Tobacco Products. In this pooled analysis of adolescent and young adult vapers, primary use of later generation e-cigarette devices was substantially more common than use of disposable/cigalike devices. The type of device predominantly used by adolescents and young adults has regulatory implications for policy to reduce adolescent use of e-cigarettes.

This study examined the role of interpersonal communication in the context of a mass media anti-smoking campaign. Specifically, it explored whether conversations about campaign ads and/or about quitting mediated campaign exposure effects on 2 quitting behaviors (sought help to quit and tried to quit smoking completely), as well as the relation between ad-related and quitting-related conversations. Data were collected before the campaign and monthly for 16 months during the campaign through cross-sectional telephone surveys among a sample of 3,277 adult Philadelphia smokers. Follow-up interviews were conducted among 877 participants 3 months after their first survey. Cross-sectional and longitudinal mediation models with bootstrap procedures assessed the indirect effects of campaign exposure on outcomes through conversations, and the indirect effects of conversations about ads on outcomes through conversations about quitting. In addition, lagged regression analyses tested the causal direction of associations between the variables of interest. The results partially support hypotheses that conversations about quitting mediate campaign effects on quitting-related behaviors and, in line with previous research, that conversations about the ads have indirect effects on quitting-related behaviors by triggering conversations about quitting. These findings demonstrate the importance of considering interpersonal communication as a route of campaign exposure effects when evaluating and designing future public health campaigns.

Once a target audience and a health behavior of interest are selected for a potential mass media campaign, the next task is selecting beliefs about the health behavior to serve as the basis for campaign message content. For novel health behaviors, such as the use of emerging tobacco products, limited empirical research on beliefs about these behaviors exists. A multimethod approach was applied to generate potential campaign beliefs for emerging behaviors. Three methods were conducted in this investigation in order to generate a list of potential testable campaign beliefs, using youth e-cigarette use as a case study: (1) a search of published and unpublished literature including gathering measures from several national surveys (through 2016), (2) an online elicitation survey (conducted in 2016), and (3) unsupervised topic modeling of media texts (from 2014 to 2015, analyzed in 2016). Details are provided on how each method was employed to both generate and prioritize beliefs related to youth e-cigarette use into a final set of 115 beliefs across 23 belief themes. This multimethod approach can provide four utilities when thinking through a health campaign for novel health behaviors: (1) developing an exhaustive and complementary list of beliefs, (2) generating overarching themes and distilling larger themes into more nuanced beliefs, (3) identifying language most relevant to the target population, and (4) prioritizing beliefs for message pilot testing with members of the target audience. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.