Population-level impact of 'The Real Cost' campaign on youth smoking risk perceptions and curiosity, United Sates 2018-2020.

Introduction: The FDA's 'The Real Cost' tobacco prevention campaign aimed to counter tobacco marketing efforts directed toward children and youths. Our objectives were to explore the associations between exposure to the FDA's campaign and cigarette risk perception among the US adolescent population, and between exposure and cigarette smoking curiosity among adolescents who never smoked cigarettes.

Methods: We analyzed 3 cycles of National Youth Tobacco Survey (NYTS 2018-2020, n=53738). Multivariable logistic regression models were fitted to measure the relationship between campaign exposure and cigarettes risk perception (among all), as well as the relationship between campaign exposure and cigarette curiosity (among cigarette never smokers).

Results: Majority of youths have reported exposure to the campaign 63% between 2018-2020. The odds of youths perceiving cigarettes as risky were 1.6 times higher among exposed compared to those not exposed (adjusted odds ratio, AOR=1.60; 95% CI: 1.43-1.79). There were some racial disparities in risk perceptions among Hispanics and Non-Hispanic Blacks across exposure groups. Exposure was associated with higher cigarettes curiosity odds among Hispanic youths who never smoked (AOR=1.26; 95% CI: 1.10-1.44) compared to their Non-Hispanic White peers.

Conclusions: The FDA's 'The Real Cost' campaign had exposure levels deemed essential for population-level perceptions change. Exposure was associated with youths having higher risk perceptions about the negative health outcomes related to cigarette smoking. However, students that never smoked were more curious about smoking with campaign exposure. Therefore, future health communication plans should consider both the potential benefits and possible unintended consequences prior to launching such campaigns.