Publications by authors named "Elizabeth C Hair"

59 Publications

Early evidence of the associations between an anti-e-cigarette mass media campaign and e-cigarette knowledge and attitudes: results from a cross-sectional study of youth and young adults.

Tob Control 2021 Jul 21. Epub 2021 Jul 21.

Truth Initiative Schroeder Institute, Washington, DC, USA.

Objective: Antismoking mass media campaigns have contributed to significant declines in combustible tobacco use among young people. This study evaluates a national anti-e-cigarette campaign to determine its association with knowledge, attitudes and beliefs in the context of increasing e-cigarette use in the USA.

Methods: A national sample of respondents aged 15-24 years (n=8421) was drawn from a repeated cross-sectional online panel survey (220 participants/week) (October 2018 to December 2019). Self-reported exposure to the truth anti-e-cigarette campaign was measured according to level of ad awareness. Outcomes were subjective knowledge of campaign-targeted facts about e-cigarettes and attitudinal constructs about perceived e-cigarette harm, social unacceptability and anti-industry sentiments. Covariates included respondent demographics, current e-cigarette use and cigarette use, parental smoking, sensation seeking, mental health and growth in e-cigarette sales.

Results: Ad awareness was associated with knowledge that e-cigarette users are more likely to start smoking (low OR: 1.28, 95% CI 1.14 to 1.44; high OR: 1.88, 95% CI 1.66 to 2.13) and of the nicotine content of JUUL compared with cigarettes (low OR: 1.63, 95% CI 1.45 to 1.82; high OR: 2.50, 95% CI 2.21 to 2.84). High ad awareness was associated with knowledge that the long-term health effects of JUUL use are unknown (OR: 1.88, 95% CI 1.57 to 2.28). High ad awareness was associated with significantly higher perceived product harm (OR: 1.35, 95% CI 1.18 to 1.54), social unacceptability (OR: 1.32, 95% CI 1.15 to 1.53) and anti-industry attitudes (OR: 1.40, 95% CI 1.21 to 1.62), compared with respondents with no awareness.

Conclusions: Young people with awareness of anti-e-cigarette ads demonstrate higher levels of campaign-targeted knowledge, attitudes and beliefs. Future campaign evaluation priorities include measuring the campaign effects on e-cigarette use behaviours.
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http://dx.doi.org/10.1136/tobaccocontrol-2020-056047DOI Listing
July 2021

Evidence of the impact of a national anti-tobacco prevention campaign across demographic subgroups.

Health Educ Res 2021 Jul 5. Epub 2021 Jul 5.

Schroeder Institute at Truth Initiative, 900 G Street, NW, Fourth Floor, Washington, DC 20001, USA.

Mass media campaigns are an effective population-level intervention for preventing tobacco use. However, little evidence exists for whether these campaigns similarly influence demographic subgroups. This study examined the effects of the truth® campaign to reduce tobacco use among demographic subgroups. We used data from a national, continuous, cross-sectional tracking survey of 15-24-year-olds (n = 32 331). We used a measure of weekly aggregated campaign exposure to assess whether cigarette smoking intentions and current cigarette use varied by race/ethnicity, financial situation and population density subgroups, controlling for factors known to be associated with tobacco use. Examining estimates across subgroup categories in light of the overall model estimates revealed that the effects of week-level campaign exposure on cigarette smoking intentions and current cigarette use were similar across subgroups. Wald tests of equality across estimates in each subgroup suggested that the estimates did not differ from one another in any given instance. The truth campaign does not differ significantly in its capacity to prompt declines in tobacco use across a broad spectrum of US youth and young adults. Mass media tobacco prevention campaigns can be an effective and critical component of a comprehensive tobacco control program, particularly with respect to reducing tobacco-related disparities among demographic subgroups.
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http://dx.doi.org/10.1093/her/cyab025DOI Listing
July 2021

A longitudinal analysis of e-cigarette use and cigar, little cigar or cigarillo initiation among youth and youth adults: 2017-2019.

Drug Alcohol Depend 2021 Sep 23;226:108821. Epub 2021 Jun 23.

Schroeder Institute at Truth Initiative, Washington, DC, USA; School of Global Public Health, New York University, New York, NY, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Purpose: To examine whether youth and young adult e-cigarette use is associated with initiation of cigars, little cigars, or cigarillos (CLCCs) and current use of flavored CLCCs.

Basic Procedures: The sample is drawn from the Truth Longitudinal Cohort, a probability-based longitudinal cohort of youth and young adults recruited at ages 15-21 and surveyed every six months. The sample for this study was CLCC-naïve defined as those who had never used CLCCs as of 2017 (N = 5586). The outcomes were the odds of (1) initiating any CLCC use and (2) reporting current (past 30-day) use of flavored CLCCs from 2018 to late 2019. The main predictor was use of e-cigarettes by 2018.

Results: The odds of initiating a CLCC was greater for those who had used ever used JUUL (OR: 3.30, p < 0.001) or were current users of another type of e-cigarette by 2018 (OR: 3.57, p < 0.001). Odds of CLCC initiation was also greater for those who had ever used combustible cigarettes (OR: 1.62, p < 0.05), were current smokers (OR: 3.12, p < 0.001) or had used marijuana (OR: 1.92, p < 0.001) by 2018. E-cigarette use that occurred by 2018 was associated with greater odds of current use of flavored CLCCs compared to non-flavored CLCCs (ever users of JUUL: OR: 2.57, p < 0.01; current users of some other e-cigarette: OR: 3.06, p < 0.05).

Conclusion And Relevance: This study raises new concerns about the effects of e-cigarette use on subsequent combustible tobacco use. Restrictions on CLCCs should be considered in conjunction with current policies designed to reduce the youth vaping epidemic.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108821DOI Listing
September 2021

Effects of branded health messages on e-cigarette attitudes, intentions, and behaviors: a longitudinal study among youth and young adults.

BMC Public Health 2021 06 15;21(1):1144. Epub 2021 Jun 15.

Truth Initiative Schroeder Institute®, Washington, DC, USA.

Background: Launched in 2000, the truth campaign was one of the first health-related campaigns to embrace the building of a brand to further amplify its message, such as by building brand equity. Brand equity is an asset that represents the audience's perception of the brand. Previous research supports that strong brand equity is associated with lower tobacco intentions and behaviors; however, brand equity and its change over time have not been studied as it relates to e-cigarettes. This study examines the effects of change in brand equity on e-cigarette attitudes, intentions, and behaviors among youth and young adults.

Methods: The sample (N = 6427) is from the Truth Longitudinal Cohort, a nationally representative, longitudinal cohort of youth and young adults, ages 15-24. Variables include brand equity tobacco scale, demographic characteristics, and e-cigarette use status. The outcomes included anti-e-cigarette attitudes, intentions to use e-cigarettes, and use of e-cigarettes. Multiple and logistic regression models determined the relationship between change in brand equity from respondents at Spring 2018 to Spring 2019 and respondent e-cigarette outcomes at Fall 2019. All models controlled for demographic characteristics and cigarette use.

Results: Mean brand equity scores in Spring 2018 were significantly associated with greater anti-e-cigarette attitudes (β = 0.17, 95% CI: 0.15, 0.19), lower odds of intention to use (OR = 0.75, 95% CI: 0.66, 0.85), and lower odds of current use (OR = 0.81, 95% CI: 0.72, 0.92). Change in brand equity from Spring 2018 to Spring 2019 was significantly associated with greater anti-e-cigarette attitudes (β = 0.09, 95% CI: 0.06, 0.11) and lower odds of intention to use (OR = 0.79, 95% CI: 0.67, 0.93), but not associated with current use behaviors.

Conclusions: Strengthening brand equity is an effective strategy for influencing anti-e-cigarette related attitudes and intentions, much like it is for anti-smoking campaigns. More research needs to be done on the relationship between change in brand equity and e-cigarette behavior to better understand how brand equity can be wielded to influence change in e-cigarette use behavior.
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http://dx.doi.org/10.1186/s12889-021-11092-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207642PMC
June 2021

Identifying message themes to prevent e-cigarette use among youth and young adults.

Prev Med 2021 09 10;150:106683. Epub 2021 Jun 10.

Schroeder Institute at Truth Initiative, 900 G Street, NW, Fourth Floor, Washington, DC 20001, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA; School of Global Public Health, New York University, 665 Broadway, Eleventh Floor, New York, NY 10012, USA. Electronic address:

In 2020, almost 20% of high school students reported current e-cigarette use. Mass media tobacco prevention campaigns are effective for preventing tobacco use among youth and young adults but selecting messages that will have maximum impact on the target audience is a significant challenge for campaign developers. This study describes the method for identification of potential messaging targets for a national anti-vape mass media campaign using criteria proposed by Hornik and Woolf in their health communication framework. A national sample of 15- to 24-year-olds (N = 1564) was recruited via an online panel in May 2020. Participants endorsed a series of vape-related attitudinal items. Items were considered potential message targets if they distinguished between the four vape use groups (current users, ever users, susceptible never-users, and non-susceptible never-users) and if less than 70% of respondents endorsed the anti-vape item response. The resulting items targeted five potential message themes, each forming a scale measured with three to four individual items. Message themes included social acceptability of vaping, anti-vape industry sentiment, independence from vaping, non-vaping identity, and perceived risk of harm. Findings were used to inform the development of truth® campaign messaging focused on reducing the prevalence of e-cigarette use among youth and young adults.
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http://dx.doi.org/10.1016/j.ypmed.2021.106683DOI Listing
September 2021

E-Cigarette Use Among Youths and Young Adults During the COVID-19 Pandemic: United States, 2020.

Am J Public Health 2021 06 15;111(6):1132-1140. Epub 2021 Apr 15.

All authors are with the Schroeder Institute at Truth Initiative, Washington, DC.

To determine whether the COVID-19 pandemic affected e-cigarette use among young people in the United States. Data came from a weekly cross-sectional online survey of youths and young adults (aged 15-24 years). Logistic regression analyses measured odds of past-30-day e-cigarette use (n = 5752) following widespread stay-at-home directives (March 14-June 29, 2020), compared with the pre‒COVID-19 period (January 1-March 13, 2020). Logistic regression among a subsample of current e-cigarette users (n = 779) examined factors associated with reduced use following stay-at-home orders. Odds of current e-cigarette use were significantly lower during the COVID-19 pandemic compared with the pre‒COVID-19 period among youths aged 15 to 17 years (odds ratio [OR] = 0.72; 95% confidence interval [CI] = 0.54, 0.96) and young adults aged 18 to 20 years (OR = 0.65; 95% CI = 0.52, 0.81). E-cigarette users with reduced access to retail environments had higher odds of reporting reduced e-cigarette use (OR = 1.51; 95% CI = 1.07, 2.14). COVID-19 stay-at-home directives present barriers to e-cigarette access and are associated with a decline in e-cigarette use among young people. Findings support the urgent implementation of interventions that reduce underage access to e-cigarettes to accelerate a downward trajectory of youth and young adult e-cigarette use.
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http://dx.doi.org/10.2105/AJPH.2021.306210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101576PMC
June 2021

Youth and young adult risk perceptions and behaviours in response to an outbreak of e-cigarette/vaping-associated lung injury (EVALI) in the USA.

Tob Control 2021 Jan 13. Epub 2021 Jan 13.

Schroeder Institute, Truth Initiative, Washington, DC, USA.

Objective: To determine whether awareness of emerging vaping-attributable health conditions influences vaping-related risk perceptions and behaviours among young people.

Design: Respondents aged 15-24 years (n=3536) were drawn from a repeated cross-sectional online panel survey (222 participants/week) during an e-cigarette/vaping-associated lung injury (EVALI) outbreak in the USA (September 2019-January 2020). Logistic regression models tested for associations between EVALI awareness and perceived lung injury risk and product harm, stratified by e-cigarette/vape use and controlling for awareness of other e-cigarette/vaping news stories, demographic characteristics and outbreak week. Other models measured the association between perceived risk of lung injury and intentions to use (non-users) or intentions to quit (current users) e-cigarettes/vape products. Changes in national retail e-cigarette sales data were examined during national EVALI outbreak reporting.

Results: EVALI awareness was associated with: perceived risk of lung injury (current users OR 1.59, p=0.004; non-users OR 2.11, p<0.001); belief that e-cigarettes/vapes contain dangerous chemicals (current users OR 1.47, p=0.017; non-users OR 1.88, p<0.001) and belief that e-cigarettes/vapes are harmful (current users OR 1.66, p=0.002; non-users OR 1.67, p<0.001). Perceived risk of lung injury from e-cigarette/vape use was associated with intentions to own e-cigarette/vape products (ever-users OR 0.25, p<0.001; never-users OR 0.61, p=0.004) and intentions to quit among current users (OR 2.02, p=0.002). Declines in e-cigarette sales were observed following news of the EVALI outbreak.

Conclusions: News of vaping-attributable health conditions may prevent e-cigarette/vape use and encourage cessation among young people. Tobacco control campaigns should address uncertain health effects of e-cigarettes or vape products and align with risk communication by public health agencies during outbreaks.
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http://dx.doi.org/10.1136/tobaccocontrol-2020-056090DOI Listing
January 2021

Effects of Multiple Exposures and Ad-Skipping Behavior on Recall of Health Messages on YouTube.

Int J Environ Res Public Health 2020 11 14;17(22). Epub 2020 Nov 14.

Schroeder Institute, Truth Initiative, Washington, DC 20001, USA.

Although measuring exposure to public health messages is key to understanding campaign effectiveness, little is known about how exposure to and avoidance of digital ad messages may influence self-reported ad recall. A sample of 15-24-year-olds ( = 297) received a varying number of forced-view and skippable test ads across multiple simulated YouTube sessions. Each session was coded for whether the participant viewed the ad or skipped it. While a majority of participants recalled the test ad, the odds of ad recall did not vary by number of sessions (opportunities for exposure). Rather, ad recall was sensitive to the number of completed ad views such that odds of ad recall doubled for each additional time the ad was completely viewed. Findings suggest that public health digital message exposure and recall can be optimized with sufficient attention paid to the proportions of forced-view ads aired when aiming to reach younger audiences.
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http://dx.doi.org/10.3390/ijerph17228427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7696643PMC
November 2020

Association between e-cigarette use and future combustible cigarette use: Evidence from a prospective cohort of youth and young adults, 2017-2019.

Addict Behav 2021 01 31;112:106593. Epub 2020 Jul 31.

Schroeder Institute at Truth Initiative, Washington, DC, USA; Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; College of Global Public Health, New York University, New York, NY, USA.

Introduction: A surge in popularity of e-cigarettes prompts concern given the association between e-cigarettes and future cigarette use. However, much of the evidence for this association comes from early, less efficient, and lower nicotine e-cigarettes than are available and widely used now. The goal of this study was to examine the relationship between e-cigarette use in 2018 and subsequent smoking initiation and continued e-cigarette use.

Methods: Participants included members of a national longitudinal panel of youth and young adults aged 15-27 who, in 2017, reported never having used a nicotine containing product (n = 3360). Logistic regression analyses assessed associations between participants' self-reported ever e-cigarette use in 2018 and ever cigarette use, current cigarette use, and current e-cigarette use in 2019, after controlling for demographic and psychosocial variables.

Results: Compared with those who still had never used an e-cigarette, those who reported ever e-cigarette use in 2018 had significantly higher odds of ever cigarette use (aOR = 7.29, 95% CI [4.10, 12.97]), current cigarette use (aOR = 8.26, 95% CI [3.17, 21.53]), and current e-cigarette use (aOR = 9.70, 95% CI [6.41, 14.69]) one year later in 2019.

Conclusions: These findings show that the pod mod style, high nicotine containing e-cigarettes subject young users to the same risks of transitioning to combustible cigarettes as their earlier, less efficient predecessors. Strong regulation of all nicotine products, including e-cigarettes, is needed to prevent the trajectory of e-cigarette to cigarette use among youth and young adults.
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http://dx.doi.org/10.1016/j.addbeh.2020.106593DOI Listing
January 2021

Exposure to tobacco content in episodic programs and tobacco and E-cigarette initiation.

Prev Med 2020 10 1;139:106169. Epub 2020 Aug 1.

Schroeder Institute at Truth Initiative, Washington, DC, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, NY, USA.

While prior research suggests a relationship between exposure to tobacco content in movies and smoking, less is known about the impact of exposure to tobacco through episodic programs. This study assessed the relationship between exposure to tobacco content in programs on Netflix and broadcast or cable TV and initiation of combustible tobacco or e-cigarette use among young people. A nationally representative, longitudinal sample (ages 15-21 at baseline) was surveyed about exposure to episodic programs previously analyzed for the presence of tobacco and subsequent use of combustible tobacco and e-cigarettes. Logistic regression models assessed associations between exposure to tobacco imagery and future initiation of combustible tobacco and e-cigarettes among those who were nicotine naïve (N = 4604). Data were collected in February-May 2018 and February-May 2019. All analyses were conducted in 2019. Results suggest a dose-response relationship between exposure to tobacco and vaping initiation, whereby the higher the exposure, the greater the odds of subsequent initiation (OR(low) = 2.19, 95%CI = 1.38-3.48; OR(medium) = 2.20, 95%CI = 1.34-3.64; OR(high) = 3.17, 95%CI = 1.71-5.88). There was no significant association between exposure to tobacco imagery and smoking initiation. Tobacco imagery is common in episodic programming popular among young people. Results suggest exposure to tobacco in episodic programs may impact future e-cigarette use. Ongoing monitoring of the impact of tobacco content in episodic programs is needed as the number of available programs continues to increase. Findings highlight the need for policy and advocacy efforts to reduce young people's exposure to tobacco content across all media platforms.
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http://dx.doi.org/10.1016/j.ypmed.2020.106169DOI Listing
October 2020

Sociodemographic Disparities in the Tobacco Retail Environment in Washington, DC: A Spatial Perspective.

Ethn Dis 2020 9;30(3):479-488. Epub 2020 Jul 9.

Schroeder Institute at Truth Initiative, Washington, DC.

Objective: Studies assessing sociodemographic disparities in the tobacco retail environment have relied heavily on non-spatial analytical techniques, resulting in potentially misleading conclusions. We utilized a spatial analytical framework to evaluate neighborhood sociodemographic disparities in the tobacco retail environment in Washington, DC (DC) and the DC metropolitan statistical area (DC MSA).

Methods: Retail tobacco availability for DC (n=177) and DC MSA (n=1,428) census tract was assessed using adaptive-bandwidth kernel density estimation. Density surfaces were constructed from DC (n=743) and DC MSA (n=4,539) geocoded tobacco retailers. Sociodemographics were obtained from the 2011-2015 American Community Survey. Spearman's correlations between sociodemographics and retail density were computed to account for spatial autocorrelation. Bivariate and multivariate spatial lag models were fit to predict retail density.

Results: DC and DC MSA neighborhoods with a higher percentage of Hispanics were positively correlated with retail density (rho = .3392, P = .0001 and rho = .1191, P = .0000, respectively). DC neighborhoods with a higher percentage of African Americans were negatively correlated with retail density (rho = -.3774, P = .0000). This pattern was not significant in DC MSA neighborhoods. Bivariate and multivariate spatial lag models found a significant inverse relationship between the percentage of African Americans and retail density (Beta = -.0133, P = .0181 and Beta = -.0165, P = .0307, respectively).

Conclusions: Associations between neighborhood sociodemographics and retail density were significant, although findings regarding African Americans are inconsistent with previous findings. Future studies should analyze other geographic areas, and account for spatial autocorrelation within their analytic framework.
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http://dx.doi.org/10.18865/ed.30.3.479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360184PMC
April 2021

Building capacity to implement tobacco-free policies in college and university settings with underserved populations.

Tob Prev Cessat 2019 2;5:14. Epub 2019 Apr 2.

Schroeder Institute at Truth Initiative, Washington, DC, United States.

Introduction: This study aimed to facilitate the process of policy adoption and implementation across community colleges and Historically Black Colleges and Universities (HBCUs) to develop, adopt, and implement a 100% smoke- or tobacco-free policy.

Methods: In total, 135 community colleges and HBCUs took part in the program. This multiple-site case study analyzed each institution's online self-reported surveys every 6 months to record progress on each of five core project elements. Data were analyzed in June 2017.

Results: Overall, 77 of 135 institutions adopted a smoke- or tobacco-free policy during the college initiative program that led to a broader public health impact of more than 717000 students and employees protected from the harms of smoking and secondhand smoke. A regression analysis also found that ongoing/completed policy activities and perceived importance of having a 100% smoke- or tobacco-free policy presented greater odds of an institution passing or adopting a policy.

Conclusions: Population-level impact and total number of people reached by this initiative is notable, though moving smoking off campus can have unintended impacts. This suggests policy change should include cessation efforts, policy compliance and policies into the broader community when possible through community partnerships.
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http://dx.doi.org/10.18332/tpc/105677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7205066PMC
April 2019

Prescription Opioid Misuse: Examining the Role of Opioid-Related Attitudes among Youth and Young Adults by Sexual Orientation.

Subst Use Misuse 2020 23;55(10):1601-1609. Epub 2020 Apr 23.

Schroeder Institute at Truth Initiative, Washington, DC, USA.

: High prevalence of opioid misuse has been noted among youth and young adults-particularly among those who identify as lesbian/gay or bisexual (LGB). Yet, little is known about the relationship between opioid-related attitudes and misuse among those who identify as LGB. : This study examined the role of opioid-related attitudes (i.e. acceptance of misuse and risk perception) in relation to ever and past 6-month prescription opioid misuse, stratified by sexual orientation. : This study used a nationally representative, probability-based sample of youth and young adults aged 15-34 ( = 12,745; lesbian/gay = 398, bisexual = 857, heterosexual = 11,490). Data were collected online surveys in Spring 2018. Wald chi-square tests assessed differences in ever and past 6-month opioid misuse by sexual orientation identity. Weighted adjusted logistic regression models estimated the influence of opioid-related attitudes (acceptance of misuse and risk perceptions) in relation to ever and past 6-month opioid misuse, controlling for demographic characteristics, other past drug use, and psychosocial variables. : Logistic regression models indicated that attitudes related to the acceptance of opioid misuse was predictive of (a) higher odds of misuse among heterosexual and bisexual individuals and (b) higher odds of past 6-month misuse regardless of sexual orientation. : Prescription opioid misuse among LGB youth and young adults may be addressed by shifting key attitudes surrounding opioids. To help stem this deadly epidemic, prevention efforts should be guided by the unique stressors facing the LGB community and focus on reducing the acceptability of misusing opioids.
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http://dx.doi.org/10.1080/10826084.2020.1753774DOI Listing
June 2021

Early Evidence of an Opioid Education Campaign: A Case Study of Rhode Island.

J Public Health Manag Pract 2020 May/Jun;26(3):252-258

Schroeder Institute at Truth Initiative, Washington, District of Columbia (Drs Rath, Hair, Barton, Kreslake, and Vallone); Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Drs Rath, Hair, and Vallone); Crux Research, Honeoye Falls, New York, New York (Mr Geraci and Ms Palmerini); Office of Governor Gina M. Raimondo, Providence, Rhode Island (Mr Coderre); and Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, New York (Dr Vallone).

Context: The opioid crisis poses a significant burden at a national level, and certain states have seen particularly high rates of misuse, addiction, and overdose. In 2017, Rhode Island reported opioid-related deaths nearly twice the national average.

Objective: To test message efficacy and evaluate the effectiveness of campaign messaging to shift attitudes/beliefs related to opioid misuse in Rhode Island.

Design: In phase 1, near-final versions of 6 advertisements were shown to a sample of the target audience via an online survey portal to assess responses to the messages (N = 1210). Phase 2 of the study employed a pre/posttest design whereby 2 cross-sectional surveys were conducted, first prior to the campaign launch (N = 456) and another survey 6 months later in Rhode Island (N = 433).

Setting: Phase 1 was conducted online using a nationally representative panel, and phase 2 included a convenience sample of participants in Rhode Island recruited to undergo an online survey.

Participants: Eighteen- to 29-year-old members of a nationally representative online panel (phase 1) and 15- to 34-year-olds living in the state of Rhode Island during data collection periods.

Main Outcome Measure(s): Empathy and destigmatization ("someone like me could become addicted..." and "those who are dependent on prescription opioids are victims") and perceived risk of developing dependence on opioids.

Results: In both phases, there was an increase in empathy ("someone") (phase 1: pretest [31%], posttest [42%; z = 5.5, P < .0001] and phase 2 [34% baseline vs 41% follow-up; z = 2.0, P = .04]) and destigmatization ("victims") (phase 1: pretest [54%], posttest [58%; z = 2.2, P = .01] and phase 2 [46% baseline vs 54% follow-up; z = 2.2, P = .03]). There was also an increase in perceived risk: phase 1 (pretest [65%], posttest [75%; z = 5.4, P < .0001]) and phase 2 (66% baseline vs 74% follow-up; z = 2.5, P = .01).

Conclusions: This study demonstrated the potential efficacy of a media campaign to shift young adults' opioid-related attitudes.
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http://dx.doi.org/10.1097/PHH.0000000000001154DOI Listing
April 2021

Validating Self-Reported Ad Recall as a Measure of Exposure to Digital Advertising: An Exploratory Analysis Using Ad Tracking Methodology.

Int J Environ Res Public Health 2020 03 25;17(7). Epub 2020 Mar 25.

Schroeder Institute at Truth Initiative, Washington, DC 20001, USA.

Many mass media campaigns aimed at changing young people's health behavior air on digital platforms rather than on broadcast media (e.g., television), given the intended audience's preference for web-based communication. While research suggests self-reported ad recall correlates with exposure to television advertising, it remains unclear whether self-report measures are correlated with exposure to digital advertising. This study examined the association between an objective measure of digital ad exposure and self-reported recall of digital ads from the truth tobacco prevention campaign. Digital ad tracking methodology was employed to identify members of an online panel (ages 18-34) who had been exposed to ads during their regular web browsing. Demographics of exposed participants were used to develop a matched control group of non-exposed panel members. Members of the Exposed group ( = 458) and matched Control participants ( = 506) were surveyed on recall of truth ads, media use, and demographics. Results indicated that Exposed participants had significantly higher odds of reporting ad recall compared to Control participants. With each additional ad exposure, the odds of self-reporting higher frequency of ad exposure increased by 8% (OR = 1.08, 95% CI = 1.01-1.16). Findings suggest self-reported measures of ad recall are a valid measure of campaign exposure in a digital media environment.
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http://dx.doi.org/10.3390/ijerph17072185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177256PMC
March 2020

Using Aggregate Temporal Variation in Ad Awareness to Assess the Effects of the truth® Campaign on Youth and Young Adult Smoking Behavior.

J Health Commun 2020 03 4;25(3):223-231. Epub 2020 Mar 4.

Schroeder Institute at Truth Initiative, Washington, DC, USA.

Mass media campaigns are one of the most effective population-level interventions for the prevention of tobacco use. However, accurately evaluating the effectiveness of these campaigns presents several challenges, particularly as campaign delivery becomes increasingly fractured across media platforms. There are a number of weaknesses associated with traditional, individual-level measures of campaign exposure in an increasingly socially networked, digital media ecosystem. This study evaluated the national truth® campaign using a novel method to measure campaign exposure through an aggregate weekly exogenous measure of awareness. We generated this exogenous measure from a continuous, cross-sectional tracking survey to predict intentions to smoke and current tobacco use among youth in the United States. Results from multi-level models indicated that weeks with aggregate campaign awareness greater than 65% were associated with lower odds of current tobacco use. We conclude with a discussion of implications and practical considerations for using this method for media campaign evaluation.
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http://dx.doi.org/10.1080/10810730.2020.1733144DOI Listing
March 2020

Electronic Cigarette and JUUL Use Among Adolescents and Young Adults.

JAMA Pediatr 2020 03;174(3):277-286

Schroeder Institute, Truth Initiative, Washington, District of Columbia.

Importance: The increasing use rates of electronic cigarettes (e-cigarettes) among young people in the United States have been largely associated with the emergence of high-nicotine-delivery device JUUL. Relevant data are needed to monitor e-cigarette, specifically JUUL, use to help inform intervention efforts.

Objective: To estimate the prevalence, patterns, and factors associated over time with e-cigarette use among adolescents and younger adults in the United States.

Design, Setting, And Participants: Two nationally representative longitudinal samples of adolescents and younger adults aged 15 to 34 years were drawn from the Truth Longitudinal Cohort, a national, probability-based cohort. Participants in this cohort were recruited through address-based sampling, and subsamples were recruited from a probability-based online panel. The present cohort study used data from follow-up online surveys, specifically, wave 7 (N = 14 379; collected from February 15, 2018, to May 25, 2018) and wave 8 (N = 12 114; collected from February 10, 2019, to May 17, 2019). Respondents reported their use of e-cigarettes, JUUL, and combustible tobacco products as well as their harm perceptions, household smoking status, sensation-seeking, friends' e-cigarette use, and demographic information.

Main Outcomes And Measures: The main outcomes were ever and current (past 30 days) JUUL use. χ2 Analyses assessed differences in JUUL use by psychosocial and demographic characteristics. Logistic regression models identified the significant factors associated with wave 8 ever and current JUUL use among wave 7 e-cigarette-naive participants.

Results: A total of 14 379 participants (mean [SD] age, 24.3 [0.09] years; 8142 female [51.0%]) were included in wave 7 and 12 114 (mean [SD] age, 24.5 [0.10] years; 6835 female [50.1%]) in wave 8. JUUL use statistically significantly increased from wave 7 to wave 8 among ever users (6.0% [n = 1105] to 13.5% [2111]; P < .001) and current users (3.3% [680] to 6.1% [993]; P < .001). JUUL use increased among every age group and was highest among those aged 18 to 20 years (23.9% [491] ever users and 12.8% [340] current users) and 21 to 24 years (18.1% [360] ever users and 8.2% [207] current users). Users reported a higher prevalence of frequent use in wave 8 compared with wave 7 (37.6% vs 26.1%; P < .01). Significant factors associated with future JUUL use among e-cigarette-naive participants included younger age, combustible tobacco use, lower harm perceptions, sensation seeking, and friends' e-cigarette use.

Conclusions And Relevance: This study found that the e-cigarette device JUUL appears to be associated with the youth e-cigarette epidemic, attracting new users and facilitating frequent use with their highly addictive nicotine content and appealing flavors. Findings of this study underscore the critical need for increased e-cigarette product regulation at the federal, state, and local levels.
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http://dx.doi.org/10.1001/jamapediatrics.2019.5436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990671PMC
March 2020

The availability of retail tobacco near federally qualified healthcare facilities and addiction treatment centers in New York State.

Prev Med Rep 2020 Mar 13;17:100989. Epub 2019 Nov 13.

Truth Initiative Schroeder Institute, Washington, DC, USA.

The effectiveness of tobacco control policies that create smoke-free healthcare facilities and encourage the delivery of tobacco dependence treatment may be undermined by the availability of retail tobacco in the surrounding environments. This study examined the availability of retail tobacco in relation to: federally qualified health centers and look-a-like (FQHC/LAL) healthcare facilities (n = 706) as well as substance abuse and addiction treatment centers (n = 953) across New York State (NYS) in 2018. A statewide tobacco retailer density surface using static-bandwidth kernel density estimation was constructed from geocoded licensed tobacco vendors (n = 21,314). For each healthcare facility, tobacco retailer density (retailers per square mile) was extracted from the underlying NYS density surface. Proximity from each healthcare facility to the nearest tobacco vendor was calculated in walkable miles. Across NYS, tobacco retailer density ranged from 0 to 41.02 retailers per square mile. The availability of retailer tobacco near FQHC/LAL healthcare facilities and substance abuse and addiction treatment centers was higher in metropolitan areas than less urban areas as expected. School-based FQHC/LAL healthcare facilities had higher density than all other FQHC/LAL healthcare facilities types (Mean = 20.82 vs. 17.04, p = 0.0042), while opioid abuse and addiction treatment centers had on average higher density (Mean = 20.42 vs. 9.81, p < 0.0001) and closer proximity to a tobacco vendor (Mean = 0.14 vs. 0.36, p < 0.0001) than other substance abuse and addiction treatment centers. State and local tobacco control retailer reduction policies should be considered to reduce the availability of retail tobacco surrounding these facilities.
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http://dx.doi.org/10.1016/j.pmedr.2019.100989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957849PMC
March 2020

Differential Relationship between Tobacco Control Policies and U.S. Adult Current Smoking by Poverty.

Int J Environ Res Public Health 2019 10 26;16(21). Epub 2019 Oct 26.

Schroeder Institute, Truth Initiative, 900 G Street Northwest, Fourth Floor, Washington, DC 20001, USA.

The study's purpose was to identify differences in the relationship between tobacco control policies and smoking by poverty. We matched state smoke-free air law coverage (SFALs), tobacco control funding (TCF), and cigarette taxes with individual current smoking and demographics from supplements to the Current Population Survey (1985-2015). We regressed (logistic) smoking on policy variables, poverty (<138% of poverty line versus ≥138% of poverty line), interactions of policy and poverty, and covariates, presenting beta coefficients instead of odds ratios because it is difficult to interpret interactions using odds ratios (they are ratios of odds ratios). We coded SFALs as (1) proportion of state covered by 100% workplace, restaurant and bar laws (SFAL-All) or (2) proportion of state covered by workplace laws (SFAL-WP) and proportion covered by restaurant or bar laws (SFAL-RB). In the SFAL-All model, SFAL-All (Beta coeff: -0.03, 95% CI: -0.06, -0.002), tax (Coeff: -0.06, 95% CI: -0.07, -0.05), and TCF (Coeff: -0.01, 95% CI: -0.01, -0.001) were associated with less smoking. In this model, the interaction of SFAL-All by poverty was significant (Coeff: 0.08, 95% CI: 0.02, 0.13). In the SFAL-WP/RB model, SFAL-RB (Coeff: -0.05, 95% CI: -0.08, -0.02), tax (Coeff: -0.05, 95% CI: -0.06, -0.04), and TCF (Coeff: -0.01, 95% CI: -0.01, -0.00) were significant. In the same model, SFAL-WP (Coeff: 0.09, 95% CI: 0.03, 0.15), SFAL-RB (Coeff: -0.14, 95% CI: -0.19, -0.09), and TCF (Coeff: 0.01, 95% CI: 0.00, 0.02) interacted with poverty. Tax by poverty was of borderline significance in this model (Coeff = 0.02, 95% CI: -0.00, 0.04, = 0.050). Among adults, SFALs, TCF, and tax were associated with less current smoking, and SFALs and TCF had differential relationships with smoking by poverty.
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http://dx.doi.org/10.3390/ijerph16214130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6862047PMC
October 2019

Smokers' behavioral intentions in response to a low-nicotine cigarette policy.

Drug Alcohol Depend 2019 12 18;205:107645. Epub 2019 Oct 18.

Truth Initiative Schroeder Institute, 900 G Street NW, Washington, D.C., 20001, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Global Institute of Public Health, New York University, New York, NY 10012, USA. Electronic address:

Introduction: Evidence suggests that reducing the nicotine concentration in cigarettes to sub-addictive levels would reduce use. Until a low-nicotine cigarette policy is enacted, population-level effects are unknown. This study examines the behavioral intentions of current U.S. cigarette smokers if a low-nicotine policy were implemented.

Methods: Data were drawn from a nationally representative probability-based panel and opt-in panel. Weighted logistic regressions examined likelihood to (1) smoke lower nicotine cigarettes, (2) quit using tobacco, (3) use e-cigarettes, (4) illegally buy high-nicotine cigarettes, and (5) smoke cigars, cigarillos, or little cigars (CLCCs) among smokers, controlling for demographics, tobacco products used, dependence, and intentions to quit cigarettes. Latent class analyses (LCA) characterized patterns of behavioral intentions.

Results: If a low-nicotine policy were implemented, most participants indicated a likelihood to smoke low-nicotine cigarettes (78.4%) or quit tobacco (61.9%), followed by use e-cigarettes (46.5%). Individuals with greater dependence had greater odds of intending to smoke low-nicotine cigarettes, use e-cigarettes, and illegally buy high-nicotine cigarettes. Current e-cigarette or CLCCs users had higher odds of intending to use these products. LCA revealed that individuals would 1) use low-nicotine cigarettes with low intentions to use other tobacco products or 2) use multiple tobacco products, including low-nicotine cigarettes.

Conclusions: A reduced nicotine standard for all combustible tobacco products is needed given that many tobacco users would likely intend to continue to use tobacco products. Differences in intentions by tobacco use and demographic characteristics indicate a need for additional cessation support and education around the harms of continued use of combustible tobacco.
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http://dx.doi.org/10.1016/j.drugalcdep.2019.107645DOI Listing
December 2019

Cost-Effectiveness of Using Mass Media to Prevent Tobacco Use among Youth and Young Adults: The FinishIt Campaign.

Int J Environ Res Public Health 2019 11 6;16(22). Epub 2019 Nov 6.

Schroeder Institute at Truth Initiative, Washington, DC 20001, USA.

Mass media campaigns have been hailed as some of the most effective tobacco prevention interventions. This study examined the cost-effectiveness of the national tobacco prevention campaign, truth FinishIt, to determine the cost per quality-adjusted life year (QALY) saved and the return on investment (ROI). The cost-utility analysis used four main parameters: program costs, number of smoking careers averted, treatment costs, and number of QALYs saved whenever a smoking career is averted. Parameters were varied to characterize cost-effectiveness under different assumptions (base case, conservative, optimistic, and most optimistic). The ROI estimate compared campaign expenditures to the cost saved due to the campaign implementation. Analyses were conducted in 2019. The base case analysis indicated the campaign results in a societal cost savings of $3.072 billion. Under the most conservative assumptions, estimates indicated the campaign was highly cost-effective at $1076 per QALY saved. The overall ROI estimate was $174 ($144 in costs to smokers, $24 in costs to the smoker's family, and $7 in costs to society) in cost savings for every $1 spent on the campaign. In all analyses, the FinishIt campaign was found to reach or exceed the threshold levels of cost savings or cost-effectiveness, with a positive ROI. These findings point to the value of this important investment in the health of the younger generation.
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http://dx.doi.org/10.3390/ijerph16224312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6888078PMC
November 2019

JUUL in School: Teacher and Administrator Awareness and Policies of E-Cigarettes and JUUL in U.S. Middle and High Schools.

Health Promot Pract 2020 01 18;21(1):20-24. Epub 2019 Sep 18.

Schroeder Institute, Truth Initiative, Washington, DC, USA.

Electronic cigarette (e-cigarette) use, including JUUL, has risen to epidemic levels among high school and middle school students in the United States. Schools serve as a key environment for prevention and intervention efforts to address e-cigarette use, yet little is known about the awareness of and response to e-cigarettes in schools. This national survey of middle and high school teachers and administrators ( = 1,420) measured JUUL awareness, e-cigarette policies, and barriers to enforcement in schools. While two thirds of respondents had heard of a product called JUUL (67.6%), less than half accurately identified a photo of a JUUL as a vaping device/e-cigarette (47.3%). Awareness of JUUL (80.9%) was higher among high school teachers (83.3%) than among middle school teachers (78.3%). A large majority of respondents reported that their school had an e-cigarette policy (82.9%), but less than half of the sample worked in a school with a policy that specifically included JUUL (43.4%). Those working in a school with an e-cigarette policy in place noted that e-cigarettes' discreet appearance (65.6%) and difficulties in identifying origin of vapor or scent (46.1%) made the policy difficult to enforce. Efforts to increase middle and high school staff awareness of the ever-evolving e-cigarette market are essential to help prevent youth use. Adoption and enforcement of policies will be critical to ensure that schools remain tobacco-free spaces.
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http://dx.doi.org/10.1177/1524839919868222DOI Listing
January 2020

Cigarette smoking, prescription opioid use and misuse among young adults: An exploratory analysis.

Prev Med 2019 12 10;129:105845. Epub 2019 Sep 10.

Schroeder Institute at Truth Initiative, 900 G St. NW, Washington, DC, USA. Electronic address:

Young adults have the highest prevalence of misuse of prescription opioids. In 2016, 7.1% of 18- to 25-year-olds reported misuse, meaning use other than as prescribed. While smoking is known to be associated with opioid use, to our knowledge no study has examined the relationships between smoking, prescribed use of opioids, and opioid misuse in young adults at the population level. Online survey data were collected in spring 2018 from a nationally representative sample of 18-25-year-olds from the Truth Longitudinal Cohort (N = 10,502). Respondents self-reported cigarette smoking, and both lifetime and recent (past 6-month) prescribed use and misuse of opioids. Generalized ordered logistic regression modeling was used to determine associations between cigarette smoking and recent prescribed use and misuse while controlling for demographic characteristics, other substance use, sensation seeking, and mental health status. Overall, 61.0% of respondents reported lifetime prescribed use of opioids and 16% reported recent prescribed use. Lifetime misuse was reported by 19.4%, with 7.8% reporting recent misuse. Together, the models revealed a graded relationship, with current smokers having higher odds of both prescribed use and misuse, never smokers having lowest odds of use or misuse, and ever smokers, those who had smoked but not in the past 30 days, falling between current and never smokers. Findings indicate a clear association between smoking and use of opioids even after accounting for a strong association between prescribed use and misuse among young adults.
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http://dx.doi.org/10.1016/j.ypmed.2019.105845DOI Listing
December 2019

Parents' Awareness and Perceptions of JUUL and Other E-Cigarettes.

Am J Prev Med 2019 11 13;57(5):695-699. Epub 2019 Aug 13.

Schroeder Institute at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; College of Global Public Health, New York University, New York, New York.

Introduction: The purpose of this study is to examine awareness, attitudes, and related knowledge of e-cigarettes, and JUUL specifically, among parents of middle and high school students.

Methods: Data were collected in October-November 2018 from a nationally representative sample of U.S. parents of middle and high school students aged 11-18 years (n=2,885) to examine e-cigarette and JUUL awareness, concern about e-cigarette use, and school communication regarding e-cigarettes. Weighted frequencies and percentages are reported; Rao-Scott chi-square tests examined differences by school level. Data were analyzed in 2019.

Results: Although most parents (96.2%) had seen or heard of e-cigarettes, only 55.9% had seen or heard of JUUL, and only 44.2% accurately identified an image of JUUL as a vaping device. Many parents reported concern about adolescent e-cigarette use (60.6%), but fewer reported concern about their own child's use (32.9%). Most parents (73.5%) reported receiving no communication from their child's school about e-cigarettes or JUUL.

Conclusions: There are notable gaps in parents' awareness of JUUL. School-to-parent communication efforts are necessary to build parents' knowledge of e-cigarettes like JUUL to prevent the growing youth uptake of these novel and addictive products.
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http://dx.doi.org/10.1016/j.amepre.2019.06.012DOI Listing
November 2019

Longitudinal Response to Restrictions on Menthol Cigarettes Among Young Adult US Menthol Smokers, 2011-2016.

Am J Public Health 2019 10 15;109(10):1400-1403. Epub 2019 Aug 15.

At the time of the study, the authors were with the Truth Initiative Schroeder Institute, Washington, DC.

To examine responses to hypothetical restrictions on menthol cigarettes among young adult menthol smokers in the United States. We surveyed Truth Initiative Young Adult Cohort respondents 18 to 34 years of age every 6 months from December 2011 through October 2016. Menthol cigarette smokers (n = 806, n = 1963 observations) indicated their response if menthol cigarettes were unavailable. Weighted analyses accounting for repeated measures were used to estimate the prevalence and correlates of responses and trends over time. Overall, 23.5% of young adult menthol smokers said they would quit if menthol cigarettes were unavailable, with this response largely unchanged between 2011 and 2016. There was a significant increase in the switch to another tobacco product response (from 7.4% to 13.2%;  = .01) associated with current noncigarette use. In adjusted analyses, African Americans, women, those with less than a high school education, and those with any quit intention were more likely to say they would quit smoking. Increased intentions to switch products suggest the acceptability and availability of alternatives to menthol cigarette smokers. Menthol cigarette restrictions benefit vulnerable groups and those interested in quitting, but the availability of menthol in noncigarette products could limit benefits.
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http://dx.doi.org/10.2105/AJPH.2019.305207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6726504PMC
October 2019

Patterns of nicotine concentrations in electronic cigarettes sold in the United States, 2013-2018.

Drug Alcohol Depend 2019 10 19;203:1-7. Epub 2019 Jul 19.

Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road Atlanta, GA, 30329, USA. Electronic address:

Introduction: Considerable declines in cigarette smoking have occurred in the U.S. over the past half century. Yet emerging tobacco products, including e-cigarettes, have increased in popularity among U.S. youth and adults in recent years. Nicotine content is an important factor in weighing the potential benefits and risks of e-cigarettes on individual and population level health. This study examined how nicotine concentrations of e-cigarette products sold have changed from 2013 to 2018.

Methods: E-cigarette sales data aggregated in 4-week periods from March 2, 2013 to September 8, 2018 (66 months total) from convenience store and mass market channels were obtained from Nielsen. Internet and vape shop sales were not available. Internet searches were used to supplement information for nicotine concentration and flavor. Products were categorized by nicotine concentration, flavor, type (disposable or rechargeable), and brand. Dollar sales, unit sales, and average nicotine concentration were assessed.

Results: During 2013-2018, the average nicotine concentration in e-cigarettes sold increased overall, for all flavor categories, and for rechargeable e-cigarettes. The proportion of total dollar sales comprised of higher nicotine concentration e-cigarettes (>4% mg/mL) increased from 12.3% to 74.7% during 2013-2018, with a similar increase in unit share. Zero-nicotine products accounted for less than 1% of dollar market share across all years analyzed.

Conclusions: E-cigarettes with higher nicotine concentrations comprise a substantial and increasing portion of U.S. e-cigarette sales. Higher nicotine concentrations may influence patterns of e-cigarette use, including harms from e-cigarette initiation among youth and potential health benefits for adult smokers switching completely to e-cigarettes.
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http://dx.doi.org/10.1016/j.drugalcdep.2019.05.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6765364PMC
October 2019

The Role of Emotions and Perceived Ad Effectiveness: Evidence From the Truth FinishIt Campaign.

Am J Health Promot 2019 11 23;33(8):1152-1158. Epub 2019 Jul 23.

Schroeder Institute at Truth Initiative, Washington, DC, USA.

Purpose: Examine association between emotional valence and intensity prompted by anti-tobacco advertising messages and perceived ad effectiveness among youth/young adults.

Design: Online forced-exposure survey data from a nationally weighted, cross-sectional sample of youth/young adults, collected periodically over a 4-year period.

Setting: National.

Participants: Thirty-seven cross-sectional surveys conducted online from June 2015 to January 2018; total N = 9534. All participants, aged 15 to 21, were in the intervention; no control group.

Intervention: Individuals participating in premarket testing of truth ads were forced exposed to one of 37 anti-tobacco ads.

Measures: Emotional response, emotional intensity, and perceived ad effectiveness. Emotional response has been previously studied and measured. Including the discrete measure of "concerned" in positive emotions is unique to our study. It patterned with the other positive emotions when each ad was examined by each emotion. Intensity as measured in this study through the 5-point scale ("how much does this ad make you feel") is unique in the anti-tobacco ad literature. Although several past studies ranked the degree of emotion elicited by ads, they have not incorporated the intensity of emotion as reported by the participant themselves. The scale was used to determine whether perceived ad effectiveness is similar to those used in previous studies.

Analysis: Linear regressions were estimated to assess type of emotional sentiment and level of intensity in relation to perceived effectiveness of the message.

Results: All 9534 participants were exposed; no control group. The βs indicate how strongly the emotion variable influences the study outcome of perceived ad effectiveness. Positive emotions (β = .76) were more highly associated with perceived ad effectiveness (β = .06). Higher intensity with positive emotional sentiment and high-intensity negative produced the highest scores for perceived ad effectiveness (β = .30).

Conclusion: Eliciting a positive, high-impact emotional response from viewers can help improve perceived effectiveness, and in turn, overall ad effectiveness.
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http://dx.doi.org/10.1177/0890117119864919DOI Listing
November 2019

Content analysis of tobacco in episodic programming popular among youth and young adults.

Tob Control 2020 07 3;29(4):475-479. Epub 2019 Jul 3.

Schroeder Institute, Truth Initiative, Washington, DC, USA.

Background: While evidence exists supporting a causal relationship between exposure to tobacco content in movies and youth smoking, research is limited on the prevalence and impact of tobacco content in episodic programming aired on television (TV) and online streaming platforms. The purpose of this study was to analyse episodic programming popular among young people to estimate the prevalence of tobacco imagery.

Methods: An online survey of participants aged 15-24 years (n=750) recruited from an existing panel was used to gauge viewership of episodic programming aired on Netflix, broadcast TV and cable TV. Two trained coders independently watched the entire 2015/2016 and 2016/2017 seasons of 14 programmes aired on a streaming platform, Netflix, and across broadcast and cable TV. The coding scheme was based on existing methods which involve documenting both the type of tobacco product featured and, if applicable, user information.

Results: Eighty-six per cent of Netflix programmes and 86% of broadcast and cable TV programmes had at least one occurrence of tobacco. Netflix programmes had more total occurrences (n=1185) compared with the broadcast or cable programmes (n=482). Most of the tobacco occurrences included cigarettes being actively used by a character.

Conclusions: Given the high prevalence of tobacco use found in these entertainment channels, the level of exposure to tobacco use among youth and young adults is very concerning and is serving to circumvent the restrictions of tobacco advertising on broadcast TV. Further research is needed to understand the influence of this exposure on smoking behaviour.
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http://dx.doi.org/10.1136/tobaccocontrol-2019-055010DOI Listing
July 2020

Characterising JUUL-related posts on Instagram.

Tob Control 2020 11 2;29(6):612-617. Epub 2019 Jul 2.

Schroeder Institute, Truth Initiative, Washington, District of Columbia, USA.

Background: JUUL, a high-tech, popular vaping device, was the first major electronic cigarette (e-cigarette) brand to incorporate social media into its marketing strategy. There is growing concern around the increasing use of JUUL and other electronic nicotine delivery devices among youth, and their potential to addict a new generation to nicotine. The current study analysed the amount and characteristics of JUUL-related posts on Instagram, a social media platform used frequently among youth and young adults.

Methods: Hashtag-based keyword queries (n=50) were used to collect JUUL-related posts from the Instagram application programming interface, March 2018-May 2018. Using a combination of machine learning methods, keyword algorithms and human coding, posts were characterised as featuring content related to product promotion, nicotine and addiction, youth culture and lifestyle.

Results: Keyword queries captured 14 838 JUUL-relevant posts by 5201 unique users. Over one-third of posts were promotional (eg, linked to commercial website) and 11% contained nicotine and addiction-related information. Approximately half of posts featured content related to youth (55%) or lifestyle (57%). Youth-related content or lifestyle appeals were also notably present within promotional posts and nicotine and addiction-related posts, respectively. Nicotine and addiction-related posts featured memes, hashtags (eg, #nichead, #juulbuzz) and tag lines (eg, 'more flavor, more buzz').

Conclusions: Findings reveal a proliferation of JUUL-related content on Instagram, which focused on product promotion and nicotine and addiction that included youth culture and lifestyle appeals. Regulatory actions should focus on restricting promotional efforts for e-cigarette products, particularly on social media platforms where young people are a primary audience.
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http://dx.doi.org/10.1136/tobaccocontrol-2018-054824DOI Listing
November 2020

Exposure and reach of the US court-mandated corrective statements advertising campaign on broadcast and social media.

Tob Control 2020 07 21;29(4):420-424. Epub 2019 Jun 21.

Schroeder Institute, Truth Initiative, Washington, District of Columbia, USA.

Objective: As a remedy to committing fraud and violating civil racketeering laws, in November 2017, four major tobacco companies were court-ordered to develop and disseminate corrective statements regarding smoking health risks using mass media channels. We aimed to describe the nature, timing, reach of and exposure to the court-mandated tobacco industry corrective advertising campaign on social, broadcast and print media.

Methods: Data from social, print and broadcast media were used to measure potential exposure to corrective messages. Keyword rules were used to collect campaign-related posts from the Twitter Firehose between November 2017 and January 2018. Data were analysed using a combination of machine learning, keyword algorithms and human coding. Posts were categorised by source (commercial/institutional, organic) and content type (eg, sentiment). Analysis of social media data was triangulated with ratings data for television advertising and print advertising expenditure data.

Results: Keyword filters retrieved 13 846 tweets posted by 9232 unique users. The majority of tweets were posted by institutional/commercial sources including news organisations, bots and tobacco control-related accounts and contained links to news and public health-related websites. Approximately 60% of campaign-related tweets were posted during the first week of campaign launch. Household exposure to the televised corrective advertisements averaged 0.56 ads per month.

Discussion: The corrective campaign failed to generate social media engagement. The size and timing of the advertising buys were not consistent with strategies effective in generating high sustained impact and audience reach, particularly among youth.
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http://dx.doi.org/10.1136/tobaccocontrol-2018-054762DOI Listing
July 2020
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