• Article

Effect of a national tobacco public education campaign on youth's risk perceptions and beliefs about smoking


Duke, J. C., Farrelly, M. C., Alexander, T. N., MacMonegle, A. J., Zhao, X., Allen, J. A., ... Nonnemaker, J. (2017). Effect of a national tobacco public education campaign on youth's risk perceptions and beliefs about smoking. American Journal of Health Promotion. DOI: 10.1177/0890117117720745


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.


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.