Anti-vaping advertisements effective on youth

Vaping prevention advertisements successfully lower the risk of vaping in adolescents, according to a recent study in JAMA Network Open.

Over 2 million US middle and high schoolers used vape in 2021, making them susceptible to nicotine addiction and at a greater risk of lung diseases. Tobacco prevention advertisements have been proposed as a potential solution, as they have been shown to reduce willingness to vape.

Concerns about widespread implementation of vaping prevention campaigns include lack of data from randomized clinical trials (RCTs) and that advertisements warning against vaping could lead adolescents to use more harmful tobacco products.

To analyze the effects of vaping prevention advertisements, investigators studied the impact of anti-vaping ads from the US Food and Drug Administration (FDA) Real Cost national vaping prevention campaign.

Adolescents aged 13 to 17 years living in the United States were selected for the study if they could read, write, and speak English and were at risk of e-cigarette use. E-cigarette susceptibility was determined if adolescents answered any of 5 e-cigarette susceptibility items with 2 or greater on a 4-point response scale.

Participants were randomized into 3 groups during the RCT, then participated in 4 weekly online visits throughout the 3-week trial period. Visits 1, 2, and 3 had participants watch a random set of advertisements from FDA Real Cost vaping prevention, focused on health harms and addiction for trial groups 1 and 2 respectively.

A control group was instead exposed to investigator-created neutral videos on vaping. None of the 3 groups were aware of the content the videos would contain before watching. After each visit, participants completed surveys on primary and secondary outcomes.

In the health harms intervention group, participants watched advertisements focused on the toxic substances found in e-cigarette products and how they can lead to lung damage. In the addiction intervention group, participants watched advertisements outlining the effects of nicotine addiction. 

In the control group, participants watched 3-second videos about vaping presented as black text on a white screen read by a narrator. Product definitions, farming practices, and manufacturing practices based on data from sources such as Wikipedia made up the content of these videos.

Participants started the first session by filling out a survey on vaping and smoking use. Afterward, they would watch the videos corresponding to their group and fill out a survey on reactions. During visits 2 and 3, participants answered surveys on their susceptibility to vaping and smoking, then completed the same videos and reaction survey.

For the final week, participants filled out surveys on vaping and smoking susceptibility, beliefs on smoking and vaping, and vaping and smoking behavior. Investigators measured susceptibility to vaping as the primary outcome, while secondary outcomes were related to those which elicited behavior change.

The 1514 participants were divided into thirds, and 91% showed retention at visit 4. About 70% of participants were high school students, and about 95% were heterosexual.

The Real Cost groups had lower susceptibility to vaping than the control group on visit 4. Higher attention was also reported among this group. Addiction risk beliefs and health harm risk beliefs were greater in this intervention group than the control group, while number of days vaped was lower. Similar trends toward smoking were observed.

By visit 4, there were little to no differences in vaping and smoking beliefs and trends between the health harms and addiction groups. Smoking outcomes were the same for both groups. This suggests that vaping prevention advertisements can influence adolescents’ beliefs toward vaping.

Reference

Noar SM, Gottfredson NC, Kieu T, Rohde JA, Hall MG, Ma H, et al. Impact of vaping prevention advertisements on US adolescents: arandomized clinical trial. JAMA Netw Open. 2022;5(10):e2236370. doi:10.1001/jamanetworkopen.2022.36370