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Understanding Potential Mechanisms of Vaping Prevention Messages: A Mediation Analysis of the Real Cost Campaign Advertisements

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Title: Understanding Potential Mechanisms of Vaping Prevention Messages: A Mediation Analysis of the Real Cost Campaign Advertisements
Language: English
Authors: Talia Kieu (ORCID 0000-0001-9171-3388), Haijing Ma, Jacob A. Rohde, Nisha Gottfredson O'Shea, Marissa G. Hall, Noel T. Brewer, Seth M. Noar
Source: Health Education & Behavior. 2025 52(1):102-112.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 11
Publication Date: 2025
Sponsoring Agency: National Cancer Institute (NCI) (DHHS/NIH)
Food and Drug Administration (FDA) (DHHS/PHS), Center for Tobacco Products (CTP)
Contract Number: R01CA246600
Document Type: Journal Articles
Reports - Research
Descriptors: Public Education, Smoking, Prevention, Advertising, At Risk Persons, Risk Management, Adolescents, Attitude Change, Beliefs, Addictive Behavior, Health Behavior, Social Influences, Self Efficacy, Behavior Change, Individual Characteristics
DOI: 10.1177/10901981241278565
ISSN: 1090-1981
1552-6127
Abstract: The U.S. Food and Drug Administration (FDA) developed a public education campaign, The Real Cost, that reduced youth susceptibility to tobacco product use. We sought to identify the mechanisms that may underlie the impact of The Real Cost ads on susceptibility to vaping to inform youth tobacco prevention campaigns. Our online randomized controlled trial (clinicaltrials.gov, identifier NCT04836455) examined a large sample of U.S. adolescents (n = 1,348) who had multiple exposures to Real Cost ads or control videos over a 3-week period in 2021. To examine potential mediating pathways between The Real Cost ads and susceptibility to vaping, we examined theory-based psychosocial and message-related variables. The largest impact of The Real Cost ads on susceptibility was via more negative attitudes toward vaping ([beta][subscript a]*[beta][subscript b]= -0.16; 95% confidence interval [CI] = [-0.25, -0.06]). Other mediation paths were via improved health harm risk beliefs ([beta][subscript a]*[beta][subscript b] = -0.08; 95% CI = [-0.13, -0.04]), addiction risk beliefs ([beta][subscript a]*[beta][subscript b] = -0.04; 95% CI = [-0.06, -0.01]), injunctive norms against vaping ([beta][subscript a]*[beta][subscript b] = -0.05; 95% CI = [-0.09, -0.02]), negative affect ([beta][subscript a]*[beta][subscript b] = -0.05; 95% CI = [-0.08, -0.02]), and cognitive elaboration ([beta][subscript a]*[beta][subscript b] = -0.03; 95% CI = [-0.05, -0.003]). Our findings suggest that ads that target negative attitudes may decrease susceptibility to vaping among youth. Our findings also introduce normative pressure as a novel factor that may be important for vaping prevention messages.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1467241
Database: ERIC
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  Data: Understanding Potential Mechanisms of Vaping Prevention Messages: A Mediation Analysis of the Real Cost Campaign Advertisements
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  Data: <searchLink fieldCode="AR" term="%22Talia+Kieu%22">Talia Kieu</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-9171-3388">0000-0001-9171-3388</externalLink>)<br /><searchLink fieldCode="AR" term="%22Haijing+Ma%22">Haijing Ma</searchLink><br /><searchLink fieldCode="AR" term="%22Jacob+A%2E+Rohde%22">Jacob A. Rohde</searchLink><br /><searchLink fieldCode="AR" term="%22Nisha+Gottfredson+O'Shea%22">Nisha Gottfredson O'Shea</searchLink><br /><searchLink fieldCode="AR" term="%22Marissa+G%2E+Hall%22">Marissa G. Hall</searchLink><br /><searchLink fieldCode="AR" term="%22Noel+T%2E+Brewer%22">Noel T. Brewer</searchLink><br /><searchLink fieldCode="AR" term="%22Seth+M%2E+Noar%22">Seth M. Noar</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Health+Education+%26+Behavior%22"><i>Health Education & Behavior</i></searchLink>. 2025 52(1):102-112.
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  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
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  Data: 11
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  Data: 2025
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  Data: National Cancer Institute (NCI) (DHHS/NIH)<br />Food and Drug Administration (FDA) (DHHS/PHS), Center for Tobacco Products (CTP)
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="DE" term="%22Public+Education%22">Public Education</searchLink><br /><searchLink fieldCode="DE" term="%22Smoking%22">Smoking</searchLink><br /><searchLink fieldCode="DE" term="%22Prevention%22">Prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Advertising%22">Advertising</searchLink><br /><searchLink fieldCode="DE" term="%22At+Risk+Persons%22">At Risk Persons</searchLink><br /><searchLink fieldCode="DE" term="%22Risk+Management%22">Risk Management</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Attitude+Change%22">Attitude Change</searchLink><br /><searchLink fieldCode="DE" term="%22Beliefs%22">Beliefs</searchLink><br /><searchLink fieldCode="DE" term="%22Addictive+Behavior%22">Addictive Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Behavior%22">Health Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Influences%22">Social Influences</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Efficacy%22">Self Efficacy</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Change%22">Behavior Change</searchLink><br /><searchLink fieldCode="DE" term="%22Individual+Characteristics%22">Individual Characteristics</searchLink>
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  Data: 10.1177/10901981241278565
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  Data: 1090-1981<br />1552-6127
– Name: Abstract
  Label: Abstract
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  Data: The U.S. Food and Drug Administration (FDA) developed a public education campaign, The Real Cost, that reduced youth susceptibility to tobacco product use. We sought to identify the mechanisms that may underlie the impact of The Real Cost ads on susceptibility to vaping to inform youth tobacco prevention campaigns. Our online randomized controlled trial (clinicaltrials.gov, identifier NCT04836455) examined a large sample of U.S. adolescents (n = 1,348) who had multiple exposures to Real Cost ads or control videos over a 3-week period in 2021. To examine potential mediating pathways between The Real Cost ads and susceptibility to vaping, we examined theory-based psychosocial and message-related variables. The largest impact of The Real Cost ads on susceptibility was via more negative attitudes toward vaping ([beta][subscript a]*[beta][subscript b]= -0.16; 95% confidence interval [CI] = [-0.25, -0.06]). Other mediation paths were via improved health harm risk beliefs ([beta][subscript a]*[beta][subscript b] = -0.08; 95% CI = [-0.13, -0.04]), addiction risk beliefs ([beta][subscript a]*[beta][subscript b] = -0.04; 95% CI = [-0.06, -0.01]), injunctive norms against vaping ([beta][subscript a]*[beta][subscript b] = -0.05; 95% CI = [-0.09, -0.02]), negative affect ([beta][subscript a]*[beta][subscript b] = -0.05; 95% CI = [-0.08, -0.02]), and cognitive elaboration ([beta][subscript a]*[beta][subscript b] = -0.03; 95% CI = [-0.05, -0.003]). Our findings suggest that ads that target negative attitudes may decrease susceptibility to vaping among youth. Our findings also introduce normative pressure as a novel factor that may be important for vaping prevention messages.
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  Data: 2025
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        Value: 10.1177/10901981241278565
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      – Text: English
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        PageCount: 11
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