Focus and Key Findings: The study of the Effect of a National Tobacco Public Education Campaign on Youth’s Risk Perceptions and Beliefs About Smoking assessed the relationship between youth exposure to the national public tobacco education campaign, The Real Cost, and changes in beliefs targeted by the campaign. The study examined: “(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).” According to the results, The Real Cost campaign resulted in an increase of agreement with campaign-targeted beliefs with no significant change in nontargeted beliefs or ambiguous beliefs.
Background: The Real Cost, was developed by the Food and Drug Administration’s (FDA) Center for Tobacco Products (CTP) in February 2014 as a means to increase the prevention and reduction of the amount of tobacco use among youth (ages 12 to 17) in the United States. The campaign was formed on a theoretical framework based on behavior. Specifically, the campaign was developed using the Theory of Planned Behavior. The Theory of Planned behavior states that “behavior change is a result of changes in beliefs that, in turn, influence attitudes toward a behavior, perceptions of associated social norms, and/or self-efficacy to engage in or refrain from a behavior.”
It is important to note that The Real Cost aired subsequent to previous tobacco education campaigns directed at youth. According to previous studies of such campaigns, evidence strongly suggests “mass media campaigns are widely considered to be a “best practice for tobacco control”.” Previous studies also showed that campaigns designed to specifically target a general population of at-risk youth were effective across several variables such as gender and race/ethnicity. With previous studies showing the effectiveness of mass media tobacco campaigning, The Real Cost served as an effective tool used to continue “reducing youth smoking prevalence, preventing initiation, and disrupting progression to established smoking.” Thus, furthering the influence and potential impacts of targeted youth tobacco education campaigns.
Design: Evaluators used a longitudinal study design with a baseline survey and two post-campaign launch surveys (totaling up to three surveys). Longitudinal studies are designed to follow the same sample of participants over time. This differs from a cross-sectional study where researchers (evaluators) observe a sample of participants and data is collected at one point in time from that sample. There are three different designs for longitudinal studies: trend, cohort, and panel. Trend studies survey a sample population at different points in time, cohort studies survey a sample population over time with the possibility of differing samples studied, and panel studies survey the same sample population and collect data over various points in time. By using the aforementioned time series designs, researchers are able to collect and analyze data, and, to their benefit, present findings depicting final result alongside any notable changes over time.
As mentioned in the background section, this study sample of participants was comprised of youth in the United States between the ages of 12 and 17. However, the baseline ages were between 11 and 16 to ensure participants would age into the campaigns targeted audience (youth aged 12 to 17) group. Researchers (evaluators) used an “address-based sampling frame to randomly draw households clustered in US census block groups within 75 media markets and supplementing the frame with market research databases to identify households likely to have at least 1 eligible youth (approximately 5% of households).”
The final sample size (post-second follow-up interview) was 5240. From the sample size drawn from the pool of eligible participants, researchers (evaluators) targeted a primary audience. This consisted of youth experimenters (“youth who reported smoking fewer than 100 cigarettes in their lifetime at baseline”) and susceptible smokers (“never smokers [not even 1 or 2 puffs] who indicated an openness to trying cigarettes at baseline”). Table 1 below illustrates the above.
Data Collection Methods: Researchers (evaluators) conducting the longitudinal study here repeatedly observed the same sample of participants from November 11, 2013 to July 4, 2015. Thus, one can conclude that a panel design was used. To conduct and gather data for this longitudinal (panel) study, researchers (evaluators) used personal surveys. True to the survey method, a letter of intent was mailed to each selected address. Shortly after the letter of intent was mailed, an interviewer visited each address to secure either an immediate or a scheduled interview. The first interview was conducted in-person and resulted in baseline data-collection. The first follow-up interview and second follow-up interviews were conducted in-person or online after researchers (evaluators) obtained parental and youth consent. The sample population was also incentivized. Youth participants received $20 post-baseline survey and $20 or $25 for completion of the first and second follow-up surveys.
Baseline Data Collection (Survey 1): November 11, 2013 through March 31, 2014
First Follow-up Interview (Survey 2): July 24, 2014 through October 27, 2014
Second Follow-up Interview (Survey 3): April 6, 2015 through July 4, 2015
Key Evaluation Questions: To examine the impact of The Real Cost, evaluators asked the following questions:
Baseline Interview
1. Do you think you will try a cigarette soon?
2. Do you think you will smoke a cigarette anytime during the next year?
3. If one of your best friends offered you a cigarette, would you smoke it?
First and Second Follow-up Interviews
1. In the past 3 months have you seen or heard the following slogan or theme [The Real Cost]?
2. To assess the frequency of exposure to the ads in the campaign, participants were not asked a specific question. Participants watched the ads and reported the frequency of which they saw each ad (self- reporting).
3. Researchers also assessed exposure to other media campaigns by showing participants the campaign logo and asking: In the past 3 months have you seen or heard the following slogan or theme [alternative media campaign]?
The study also examined potential confounders by asking questions related to the following:
1. Risky behaviors.
2. Educational plans.
3. School environment.
4. School performance.
5. Parent communication.
Analysis and Results: Researchers (evaluators) used descriptive statistics to summarize the data collected during the study period. Specifically, multivariate regression models. According to the results, The Real Cost campaign resulted in an increase of agreement with campaign-targeted beliefs with no significant change in nontargeted beliefs or ambiguous beliefs. Figure 3 below illustrates these results.
Based on the previous tobacco education campaign studies and the findings presented in this study, I agree that there is a noticeable increase in agreement with campaign-targeted beliefs. I would like to place emphasis on a factor that I deem to be of high importance: random sampling and generalizability. This is of significance because it allows researchers (evaluators) to gather participants that will be representative of the larger population, thereby allowing us to extend the findings among the sample to the larger population. This has proven to be evident in previous tobacco education campaign studies and The Real Cost study.