INTRODUCTION:Waterpipe tobacco smoking (WTS) is associated with health harms, yet the United States requires only a single text warning. METHODS:We developed 30 text warnings, across 12 health themes, based on scientific evidence and expert input. Text warnings were tested in an online survey among a national convenience sample of US young adults (18-29, Study 1). We then selected six text warnings and paired each with three images, creating 18 pictorial warnings that were tested in an online survey among a second national convenience sample of US young adults (18-29, Study 2). RESULTS:Study 1 had 822 participants (33% past-year WTS, 43.6% susceptible, 23.5% not susceptible). Text warnings performed similarly, and there were no differences across themes on perceived message effectiveness (PME) (Means = 3.59-3.79), learning (Means = 2.71-2.91), or cognitive elaboration (Means = 3.48-3.68). There were differences between user groups for PME (F1,2 = 32.26, p < .05), cognitive elaboration (F1,2 = 32.26, p < .05), and learning (F1,2 = 9.53, p < .05); yet differences did not vary by theme. Study 2 had 902 participants (33.5% past-year WTS, 33.4% susceptible, 33.2% not susceptible). We found significant differences in PME, emotional reactions, and visual-verbal congruency between the three pictorial warnings tested for each text warning; however, ratings were similar across user groups. We selected the most promising pictorial warning for each corresponding text warning. CONCLUSIONS:Text warnings covering a range of health harms may be effective and should be considered by the US Food and Drug Administration. Moreover, the United States and other countries should consider utilizing pictorial warnings to further enhance comprehension and potential effectiveness in discouraging WTS. IMPLICATIONS:We developed and tested text and pictorial warnings that could be used to communicate the harms of WTS to young adults in the United States, who have the highest rates of WTS. A wide range of text warning statements was found to elicit moderately high ratings of perceived message effectiveness and cognitive elaboration. A more comprehensive set of text warnings could provide further understanding of the harms of WTS. Moreover, pictorial warnings could further enhance comprehension of health harms and potentially discourage WTS.

INTRODUCTION:Around 30% of youth who use tobacco use multiple tobacco products (MTPs), yet little research has evaluated campaign ads to address youth MTP use. METHODS:We qualitatively examined how youth who use MTPs perceive tobacco prevention and cessation ads. Between February 2023 and January 2024, we held seven virtual focus groups with 30 US youth (ages 14-20 years) who reported using both e-cigarettes and a combustible tobacco product in the past 30 days. Participants were shown five static tobacco prevention and cessation ads that addressed single and MTPs. Participants were asked about their reactions to the ads, including whether they were effective or relatable, and suggested changes to the ads. We performed a thematic analysis. RESULTS:Participants were, on average, 18.7 years old. Most participants were female (73%), white (47%), and lesbian, gay, or bisexual (63%). Four central themes emerged: (1) Ads about MTPs were perceived as more effective than ads about single tobacco products because they were relevant and informative; (2) Participants recommended that MTP ads should specify "vaping and smoking" or "nicotine" to refer to MTPs rather than "tobacco"; (3) Participants described ads with youth vernacular as ineffective and unrelatable and exhibited message fatigue; and (4) Ads that featured shared health consequences of MTP use, especially with graphic, fear-arousing images, were perceived as most effective. CONCLUSIONS:Findings suggest ads about MTPs could be effective among youth who use MTPs. Promising MTP ads could specify "vaping and smoking" and highlight shared health effects across MTPs using graphic, fear-arousing images. IMPLICATIONS:Multiple tobacco product (MTP) use (ie the use of two or more tobacco products in the past 30 days) is a common pattern of tobacco use among youth, yet little research has developed or evaluated campaign ads addressing MTP use. We conducted a qualitative study to examine how youth who use MTPs perceive tobacco prevention and cessation ads. Findings suggest ads about MTPs could be effective, especially if they specify "vaping and smoking" and highlight shared health effects of MTPs using graphic, fear-arousing images.

Background The use of electronic nicotine delivery systems (ENDS) has risen significantly among US young adults, mainly driven by marketing, product design, and addictive nicotine. Pictorial warning labels (PWLs) effectively inform consumers about the risks associated with ENDS use, yet young users were rarely involved in their development. A set of 24 PWLs, categorized into three themes, was developed by a panel of international tobacco control experts via a Delphi study: ENDS toxicity, health risks, and specific harm. In this study, we involved young ENDS users through a mixed-methods approach, including a rating survey to identify the most effective warnings and focus group discussions to gather their feedback on the PWLs design, content, and needed improvements.Methods We conducted 22 HIPAA-compliant Zoom focus groups with 61 ENDS users (57% females, aged 21-29). Guided by the Message Impact Framework, participants completed an anonymous rating survey of the PWLs to assess attention, reactions, and perceived effectiveness, followed by in-depth discussions of each PWL. Descriptive statistical analysis was conducted for the rating survey. Focus group sessions were audio-recorded, transcribed, and thematically analyzed.Results Survey results showed toxicity-focused PWLs outperformed those on health effects and specific harm across most outcomes. Focus group results showed warnings depicting human suffering were most impactful. Relevance to participants (e.g., pregnancy, health experiences) emerged as influential factors shaping perceptions of warning effectiveness. Metaphorical images were often perceived as confusing or less believable, thereby diminishing their persuasive potential. Participants recommended applying clear, simple visual and verbal explanations.Conclusions This study identified promising PWLs for young adult ENDS users and provides practical guidance to strengthen warning design and regulatory efforts. Warnings featuring clear, literal imagery and human health consequences elicited greater fear, perceived severity, and motivation to reconsider ENDS use, whereas metaphor-based images were often viewed as less credible or confusing. The convergence of quantitative and qualitative findings underscores the importance of targeting emotional and cognitive message responses to enhance warning effectiveness. Since personal relevance varies per individual, using a rotating, diverse portfolio of ENDS warnings targeting different health risks likely improves subgroup resonance and maximizes population impact.

OBJECTIVE:To systematically review and meta-analyze correlates of condom use among Black adolescents and assess the moderating roles of gender and age. METHOD:A systematic search was conducted of studies published between January 2000 and February 2024 using Medline, CINAHL, PsycINFO, and Communication Source databases. Studies were included if they sampled adolescents from the United States, included an adolescent report of condom use behavior and one of 36 correlates of interest, included a bivariate statistical association between a correlate and condom use, were in English, and at least 90% of participants self-identified as Black. Data extracted included sample size, participant demographics, research design, and condom use measurement characteristics. Correlation coefficients and 95% CI were computed, and random effects meta-analyses were used. RESULTS:Forty-two studies with 47 independent samples were included (16,740 adolescents; weighted mean age = 16.16). Nine correlates were significantly associated with condom use. Condom communication with a partner had the largest mean effect size (r = .42, 95% CI; .13-.65; p = .006), followed by condom use intentions (r = .32, 95% CI; .21-.43; p ≤ .001). Although 61% of effects were heterogeneous, we were only able to examine moderation by age for two correlates (i.e., gender, substance use/abuse) due to a lack of studies. Moderation analyses were not significant. CONCLUSIONS:This study identified the strongest correlates of condom use among Black adolescents and highlighted notable gaps in previous research. Results can be used to guide future work with this population, including the development of sexual health interventions tailored for Black adolescents. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Despite the routine use of a variety of message evaluation (ME) measures (e.g., perceived message effectiveness) in formative research for tobacco education campaigns, studies assessing the validity of these measures for predicting actual message effectiveness (AME) (e.g., intention to use e-cigarettes) are needed. A within-subjects experiment with adolescents (N = 2,120) was conducted with youth-focused e-cigarette prevention ads to examine and compare the validity of 10 ME measures often used in message pretesting studies. Aggregate message-level ME scores were created and their relationship with outcomes commonly targeted by tobacco prevention campaigns was assessed, while controlling for individual characteristics and baseline measures of the outcomes. More ME measures predicted intention to use e-cigarettes than other e-cigarette-related outcomes. Perceived message effectiveness (PME), assessed as message perceptions and as effects perceptions, psychological reactance, and perceived argument strength were the strongest predictors of intention to use e-cigarettes. Other ME measures, such as information seeking and positive emotional reactions, predicted outcomes that PME measures did not. However, due to the use of aggregate message-level ME scores, none of the ME measures were particularly strong predictors of AME. The lack of variation in the association between ME measures and intention to use e-cigarettes by e-cigarette use status suggests these ME measures are broadly applicable. These findings support the validity of ME measures and suggest that to better anticipate potential message effects on multiple tobacco education campaign outcomes, it may be worthwhile to include other ME measures in addition to message or effects perceptions in message pretesting.

The media effects discipline has bequeathed scholars with an endlessly pliable set of theories helping establish the field of communication. Recent decades, however, witnessed a growing chorus of criticism pointing to theories’ anachronistic nature to suggest that ideas once known for their originality and conceptual heft overstayed their welcome. If there is intellectual disagreement, it is in fact a propitious moment to infuse the marketplace of ideas with critical data. To this end, meta- and interrupted time series-analyses of seven key media effects theories (K = 588, N = 525,670) identify a decline in effect sizes over time, while moderation analyses point to methodological and technological culprits. As it turns out, effect sizes linked with media effects theories get smaller but more statistically significant. Optimistically, this may signal that, just like humans, theories that grow long in the tooth lose some of their youthful spark but gain stability.

BACKGROUND:Stigma directly contributes to physical, social, and psychic harm in people who use drugs. Current stigma frameworks privilege perspectives of stigmatizers, discounting the subjective lived experience of the stigmatized. Acknowledging that stigma is a universal phenomenon that manifests locally, we aimed to identify salient stigma-related attitudes, beliefs, behaviors, and experiences among people who use drugs in the rural Appalachian region of the United States. METHODS:Twenty-two people who use drugs residing in rural Ohio participated in qualitative interviews, sharing perspectives on and experiences with substance use stigma. Data were analyzed in three iterative rounds (using Rigorous and Accelerated Data Reduction, reflexive thematic analysis, in-vivo coding and analysis) then summarized in an experiential framework. RESULTS AND DISCUSSION:We organize and describe three salient facets of rural substance use stigma shared by participants: manifestations (stereotypes, prejudice, discrimination), outcomes (immediate reactions and personal consequences), and responses (adaptive and maladaptive coping styles). We discuss how these experiences are situated in cultural context and may be shaped by values like family, community, and self-reliance. CONCLUSION:Our study provides a conceptual framework for understanding the lived experience of substance use stigma in one sociocultural context. This framework has immediate utility for informing stigma reduction efforts in rural Appalachia and may be adapted to other contexts where the local character of stigma is of theoretical or practical import.

A variety of conceptual approaches to understanding health behavior exist. While an individual's health behavior is likely the product of numerous levels of influence, including interpersonal, group, community, and institutional/policy levels, much theory and research have focused on understanding health behavior at the individual level. In this realm, there are a variety of behavioral theories that advance our understanding of what motivates people to engage in healthy and unhealthy behaviors. These theories vary, and can be grouped according to value‐expectancy approaches, risk‐oriented theories, social cognitive theory, and stage theories.

BACKGROUND:Stigma is a barrier to help-seeking in rural-dwelling people who use drugs. However, little is known about whether stigma is experienced in patterned ways, and what characteristics are associated with these patterns. METHODS:Data came from a cohort of people who use drugs at eight geographically diverse Rural Opioid Initiative sites (n = 3048). We used three-step latent class analysis to classify participants by patterns of felt substance use stigma, then used multinomial logistic regression to explore demographic, health, and substance-related covariates associated with class membership. RESULTS:Based on fit statistics and interpretability, we selected a five-class solution. Four classes were patterned by severity: Low Stigma (23.7%), Medium-Low Stigma (12.5%), Medium-High Stigma (34.9%), and High Stigma (24.7%). The fifth class ("High Fearers/Low Perceivers," 4.3%) reported high shame and fear of rejection but low perceived stigma from others. Members of higher stigma classes were more likely to have criminal-legal system involvement, inject drugs, and avoid healthcare and drug treatment. In contrast analyses, "High Fearers/Low Perceivers" were more likely to be younger and women, and less likely to have criminal-legal system involvement, experience homelessness, or inject drugs compared with other classes. CONCLUSION:Rural people who use drugs experience substance use stigma in distinct severity-based patterns, with four classes ranging from low to high stigma across all dimensions. A fifth, smaller class reports high internalized stigma despite low perceived stigma from others, potentially suggesting non-disclosure of substance use. These distinct profiles and their correlates offer targets for tailored stigma interventions.

Background This study reports on the development of pictorial health warning labels for electronic nicotine delivery system (ENDS) using the Delphi approach with a panel of tobacco control experts. Twenty-four evidence-based ENDS-specific warnings corresponding to three themes (toxicity, health risks and specific harm) were developed and used in the Delphi study. Methods We conducted a three-round online Delphi study among 60 experts (55% female) between June 2022 and April 2023. We balanced the panel in areas of expertise and positions relevant to ENDS (risks, benefits). In round 1, participants rated the warnings on attention, relevance to evidence and perceived effectiveness (harm perception, motivation to quit) and provided suggestions for improvement. In rounds 2 and 3, participants ranked the revised warnings based on importance in each theme. We assessed levels of agreement between participants using interquartile deviations and medians. Results Warnings in theme 1, toxicity, received the highest ratings for perceived effectiveness on harm perception and encouraging quitting ENDS (p<0.05). Experts recommended using clear and affirmative text paired with emotion-provoking pictures and avoiding the rare side effects of ENDS. Most of the top-ranked warnings were from theme 3, ENDS-specific harm, pertained to lung damage, dual use of ENDS and cigarettes, nicotine addiction among youth, anti-ENDS industry sentiment and toxicity. Discussion This study developed 24 evidence-based ENDS health warning labels using a systematic process that included several rounds of expert panel feedback. These warnings can be used to advance ENDS prevention and tobacco control policies and further target different populations.

INTRODUCTION:To address youth and young adult vaping, the Food and Drug Administration and other organizations have launched vaping prevention video ads. However, limited research exists on the objective features of these ads (i.e., observable and systematically codable elements). This study identified and described these features through a content analysis. METHODS:A total of 302 video ads, released between 2015 and 2024, were collected on the basis of the following criteria: focused on vaping prevention, targeted youth or young adults, 35 seconds or shorter, and in English. Twenty-nine codes were developed to capture objective features in 5 categories: (1) message themes; (2) structural features (genre, visual, audio, and format); (3) tobacco product depictions; (4) audience targeting; and (5) other features, such as source and length. Data were analyzed in 2024. RESULTS:Most ads (49.3%) were from U.S. national organizations, followed by U.S. state governments (43.7%) and international sources (7.0%). Nearly half (46.0%) were 11-20 seconds. Nicotine addiction was the most common primary theme (34.4%), followed by harmful chemicals/metals (16.2%) and mental health (13.9%). Ads predominantly used live action (68.2%), visual effects (54.0%), background music (78.5%), and an acted-out format (57.3%). Vaping imagery appeared in most ads (68.5%). Few ads were explicitly designed for specific racial/ethnic (3.6%) or lesbian, gay, or bisexual (0.3%) communities. CONCLUSIONS:This study provides the groundwork for future research to identify which objective ad features most effectively influence vaping-related outcomes. Findings also serve as a practical resource for campaign developers who design ads on the basis of objective features.

BACKGROUND:Stigma in people who use drugs predicts treatment engagement, psychosocial health, and overdose, yet there are few evidence-based interventions to support people who use drugs in managing and coping with substance-related stigma and even fewer for people in active use. mHealth is one option to engage this hard-to-reach population. METHODS:Premised on the theory of stigma resistance, this mixed-methods study explored the feasibility, acceptability, and preliminary effectiveness of Project RESTART, a four-week, automated text message intervention for rural-dwelling people who use drugs (n = 30) using a one-group pre-post design. The study recruited participants from syringe service programs and by word-of-mouth. RESULTS:Key outcomes included high retention (90 %), message engagement (median responses: 4, interquartile range: 1-17), acceptability (mean item score: 3.55, standard deviation: 0.34, range: 1-4), and preliminary effectiveness in the main outcomes (Cohen's d: stigma resistance (0.56), self-stigma (0.50)). Results were corroborated in sub-sample follow-up interviews (n = 13). CONCLUSION:These promising findings suggest text messaging is a feasible and acceptable modality for delivering stigma education and coping resources. Effectiveness should be established in a full-scale randomized controlled trial. This trial was registered at ClinicalTrials.gov on February 20, 2024 (NCT06281548).

Perceived message effectiveness (PME) is used in message pre-testing and as an indicator of campaign receptivity. Studies have yet to examine whether PME changes in response to repeated exposures to messages and whether the pattern of change differs for effects perceptions (i.e., perceived impact of messages on intended outcomes) versus message perceptions (i.e., judgments of a message's ability to foster message processing). To address these gaps, we conducted a 3-week randomized clinical trial (RCT) with parallel assignment among 1,514 US adolescents aged 13-17 years who were susceptible to vaping or used e-cigarettes in the past 30 days. Repeated exposures to vaping prevention video ads over time increased both effects perceptions (p < .001) and message perceptions (p < .05), with a larger mean increase for effects perceptions than message perception (mean difference of .32 vs .05). Our findings suggest that effects perception measures are more likely to change in response to repeated message exposures over time. Understanding distinct patterns in PME following repeated exposure could help researchers better interpret PME data in both formative and process evaluations, particularly for health campaigns aimed at behavior change.

OBJECTIVE:Little research has examined rates or correlates of adherence to Open Science practices such as data sharing. We investigated how often researchers share data for inclusion in a meta-analysis and their reasons for not sharing data, and tested factors that could be associated with data sharing. METHODS:We requested data for 189 studies (167 authors) as part of a National Cancer Institute-funded meta-analysis of quit intentions and smoking cessation. Authors were contacted via email up to 4 times. We tracked responses, reasons for not sharing data, and coded 23 features of the author team (eg, number of authors and h-index), the request (eg, amount of information requested), and the study (eg, year of publication and preregistration). RESULTS:Thirty-five percent of authors provided the requested data, 21% responded but did not provide data, and 44% never responded to our request. Of the 37 reasons offered for not sharing data, the most common were loss of access to data (76%) and lack of time (11%). More recent trials, fewer citations, publication in medical (vs. behavioral) journals, and study preregistration were each associated with providing the requested data (Ps < .05). CONCLUSIONS:Contacting authors for unpublished data resulted in a moderate response rate (56%) and modest provision of data (35%). Barriers to data sharing such as access and time constraints highlight challenges faced by behavioral health researchers in promoting transparency. The factors associated with responsiveness underscore the importance of journal policies and Open Science practices in enhancing data sharing.

PURPOSE:While most tobacco prevention and cessation ads focus on a single product, little research exists on developing campaigns to influence youth who use multiple tobacco products (MTPs). METHODS:To examine the effects of message themes in ads targeting MTP use, we conducted an online within-subjects experiment with n = 310 US youth (ages 13-20) who reported past 30-day vaping and smoking cigarettes or cigars. Participants were randomly assigned to rate 6 messages from different themes about the consequences of vaping and smoking (e.g., "Vaping and smoking can lead to anxiety and irritability") from a pool of 49 messages. RESULTS:Regarding intended effects, all message themes performed significantly better than control on perceived message effectiveness (PME) (p < .01). In addition, themes about chemical exposures and health effects on organs with explanations for how health effects occurred led to higher PME than most other themes (including health effects on organs without explanations), while the nicotine addiction theme led to lower PME than most other themes (p < .05). Regarding unintended effects, health effects on organs with explanations led to a greater likelihood of thinking vaping is more harmful than smoking versus control (p < .05), although unintended effects were smaller than intended effects. DISCUSSION:Themes about chemical exposures and health effects on organs with explanations were perceived as more effective than other themes for ads targeting youth who use MTPs. However, health effects on organs with explanations also increased vaping relative harm, and future research is needed to examine any potential unintended consequences on behavior from such messaging.

A single text-only e-cigarette warning about nicotine addiction is required by the US Food and Drug Administration in the US, yet little is known about whether health harms warnings are more effective than the required nicotine addiction warning. To assess the effectiveness of text-only e-cigarette warnings on message processing, risk belief, and behavioral intention outcomes, as well as the impact of health harm warnings and the required nicotine addiction warning or similar addiction warnings. A comprehensive search was conducted using PubMed, Embase, Scopus, PsycINFO, and Business Source Premier from inception through February 2024. Review articles were also examined for potential studies. Experimental studies that randomized participants to view nicotine addiction or health harms e-cigarette warnings were included. Studies had to report 1 or more message processing, risk perception, or behavioral intention outcomes. Using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines, 2 independent coders (Y.J. and J.S.) screened and coded all studies. Effect sizes characterizing overall warning effects and health harm vs addiction warning effects were calculated using the standardized mean difference (d). Effect sizes were pooled using random-effects models and tested for heterogeneity using the Q statistic and I2. Effect sizes with their 95% CIs, as well as prediction intervals, are reported. The outcomes were attention, negative affect, and effects perceptions (message processing); addiction, risk, and relative risk beliefs (risk perceptions); and intentions to vape and intentions to quit vaping (behavioral intentions). Across 24 studies with 22 549 participants (mean [SD] age, 27.91 [6.36] years; 53.9% female), e-cigarette text-only warnings were associated with improvement of most outcomes. Compared to control, e-cigarette warnings were associated with greater attention (d, 0.52; 95% CI, 0.33-0.70), negative affect (d, 0.65; 95% CI, 0.49-0.81), and effects perceptions (d, 0.95; 95% CI, 0.69-1.21), as well as increased addiction beliefs (d, 0.24; 95% CI, 0.05-0.42) and risk beliefs (d, 0.26; 95% CI, 0.16-0.36) but not relative risk beliefs (d, 0.00; 95% CI, −0.11 to 0.12). E-cigarette warnings also were associated with reduced intentions to vape (d, −0.14; 95% CI, −0.27 to −0.01) and increased intentions to quit vaping (d, 0.34; 95% CI, 0.09-0.58). Health harm warnings outperformed nicotine addiction warnings on many outcomes. Compared to addiction warnings, health harm warnings were associated with more negative affect (d, 0.44; 95% CI, 0.32-0.52), attention (d, 0.37; 95% CI, 0.26-0.49), and effects perceptions (d, 0.36; 95% CI, 0.23-0.49), as well as increased risk beliefs (d, 0.07; 95% CI, 0.00-0.13) and intentions to quit vaping (d, 0.17; 95% CI, 0.06-0.27). There were no differences in addiction beliefs, relative risk beliefs, or intentions to vape for health harms vs addiction warnings. In this meta-analysis of experimental studies, text-only e-cigarette warnings were associated with increased beliefs about the harm and addictiveness of e-cigarettes without creating the misperception that e-cigarettes are more harmful than cigarettes. Warnings were also associated with reduced intentions to vape and increased intentions to quit vaping. These findings support adding health harms to e-cigarette warnings and have important implications for warning policy.

Introduction Despite an evolving e-cigarette environment, few studies have looked at adolescent exposure to e-cigarette advertising over time and its associations with curiosity about and susceptibility to using e-cigarettes. We examined e-cigarette advertising exposure and its associations with curiosity and susceptibility across multiple years among adolescents who have never used e-cigarettes. Methods We obtained data from the National Youth Tobacco Surveys (NYTSs), 2014-2020 (N = 97,496). The NYTS identified e-cigarette advertising exposure from four channels: Internet, newspapers and magazines, convenience stores, and TV. Logistic regressions explored e-cigarette advertising exposure over time and the associations between exposure from the four channels and both curiosity and susceptibility to using e-cigarettes. Results Youth exposure to e-cigarette advertising on the Internet and in convenience stores formed an increase-decrease-increase pattern from 2014 to 2020, whereas exposure in newspapers and magazines and on TV generally decreased over this period. Exposure on the Internet and in convenience stores was consistently associated with curiosity and susceptibility; but exposure in newspapers and magazines and on TV was sporadically associated with the outcomes. Conclusions Despite a changing e-cigarette marketplace, youth were consistently exposed to e-cigarette advertising, especially on the Internet and in convenience stores. This pattern is worrisome, as it may increase youth curiosity and susceptibility to using e-cigarettes. Comprehensive tobacco prevention efforts to prevent e-cigarette use in adolescents should continue to restrict e-cigarette advertising and marketing, thereby reducing exposure and discouraging e-cigarette use. Regular efforts should also be made to educate adolescents about the risks of using e-cigarettes to counteract the impact of high e-cigarette advertising exposure.

While research on youth vaping prevention has begun to grow, little work has examined language choice in vaping prevention messages. This study examined adolescents' responses to vaping prevention statements that varied on three features: behavioral framing, linguistic certainty, and target specification. We conducted a 2 (behavioral framing) by 2 (linguistic certainty) by 2 (target specification) by 3 (risk type) plus control condition between-subjects experiment using a national probability sample. Adolescents (N = 1,603) were randomly assigned to one of 25 conditions in which they viewed a vaping prevention statement (or a control statement about vape litter) followed by measures of perceived message effectiveness (PME), perceived severity and susceptibility of vaping risks, message trustworthiness, message relevance, and intentions to seek more information about vaping risks. Results showed main effects of behavioral framing, such that a declarative frame ("Vaping can … ") led to higher PME, higher perceived severity, and greater information seeking intentions than a contingent frame ("If you vape, it can…"), while an interaction revealed that most declarative frame effects were driven by adolescents who were susceptible to vaping. There were also main effects of linguistic certainty, such that the word "can" ("Vaping can … ") led to higher PME, higher perceived susceptibility and severity, and greater information seeking intentions than the word "could" ("Vaping could … "). No main effect of target specification ("you" vs. "teens") was observed. Overall, findings suggest that vaping prevention messages that communicate greater certainty have greater behavior change potential.

INTRODUCTION:We examined awareness and perceptions of the US Food and Drug Administration (FDA) JUUL marketing denial order (MDO) that occurred in June 2022 among a nationally representative sample of US adolescents. AIMS AND METHODS:Data were collected in August 2022 via an online survey (n = 1603). Adolescents were asked whether they had heard about the JUUL MDO, and, if yes, where they heard the news. Those who had heard were asked about the MDO's impact on their harm beliefs about JUUL and vape products in general. We examined correlates of awareness of the MDO and of increased JUUL and vape harm perceptions. RESULTS:Twenty-seven percent of adolescents had heard about the MDO. Older adolescents (adjusted odds ratio [aOR] = 1.13) and LGBTQ+ adolescents (aOR = 2.05) had significantly higher odds of having heard the news, while those who identified as Black or African American had significantly lower odds of having heard (aOR = 0.56). Most participants who were aware of the MDO indicated that they had higher harm perceptions about JUUL itself (77.9%) and vapes in general (79.6%). Youths susceptible to vaping and current users were less likely to report increased harm perceptions about JUUL (B = -0.34 and -0.46, respectively) and vapes in general (B = -0.27 and -0.43) compared with youth not susceptible to vaping. CONCLUSIONS:The results of this nationally representative survey demonstrate that over one-quarter of US youth heard about the JUUL MDO and the vast majority of those indicated increased harm perceptions about vapes. Large-scale news events about vaping can reach youth audiences and may impact what youth think about the harms of vaping. IMPLICATIONS:Analysis of a nationally representative survey of adolescents aged 13-17 revealed that more than 25% had heard about the marketing denial order issued to JUUL Labs by the FDA in June of 2022. We also found that the vast majority of adolescents reported increased JUUL and vape harm perceptions in response to hearing about the MDO. This indicates that news coverage about vaping-including coverage of regulatory actions-can reach and potentially impact adolescents. It is therefore important to monitor news coverage about vaping, how it is framed and discussed across media platforms, and its reach among priority populations.

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 (βa*βb = -0.16; 95% confidence interval [CI] = [-0.25, -0.06]). Other mediation paths were via improved health harm risk beliefs (βa*βb = -0.08; 95% CI = [-0.13, -0.04]), addiction risk beliefs (βa*βb = -0.04; 95% CI = [-0.06, -0.01]), injunctive norms against vaping (βa*βb = -0.05; 95% CI = [-0.09, -0.02]), negative affect (βa*βb = -0.05; 95% CI = [-0.08, -0.02]), and cognitive elaboration (βa*βb = -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.