Digital and social media platform use and awareness of "the real cost" e-cigarette youth prevention campaign ads among U.S. youth

Abstract

INTRODUCTION: For 10 years, "The Real Cost" has adapted to changing youth media use, with today's strategy focused on digital and social media. This study explores media platform use among "The Real Cost" Youth E-Cigarette Prevention Campaign audience, including audience segment differences and the relationship between platform use and campaign awareness.

METHODS: Data were from 2 waves of the campaign evaluation: baseline (n=5,257), collected in 2023, and first follow-up (n=4,067), collected in 2024 (data were analyzed in 2024 and 2025). The sample includes U.S. youth aged 11-17 years at baseline. Descriptive analyses explored the patterns of individual digital and social media platform use (e.g., YouTube, Instagram). Weighted bivariate analyses and chi-squares explored subgroup differences in platform use. Multivariable regressions were run for media use indices (any use, heavy use, frequency of use) with (1) demographic and tobacco use characteristics as independent variables and (2) campaign E-cigarette ad awareness (any awareness, frequency of awareness) as dependent variables.

RESULTS: Almost all youth reported multiple platform use. The most commonly used platforms were also used most heavily. Older youth, youth reporting psychological distress, and youth who ever or currently used E-cigarettes had higher use (all media use indices) than referent groups. All indices were positively associated with any campaign ad awareness.

CONCLUSIONS: Certain audience segments, including older youth and youth reporting E-cigarette use, consumed more media, suggesting ample opportunities to reach these segments efficiently. Airing the campaign on various media platforms reaches teens on the digital and social platforms where they spend time.