Effectiveness of Youth Tobacco Prevention Ads: Meta-Analysis of a Decade's Worth of Copy-Testing Data.

Abstract

The U.S. Food and Drug Administration has launched multiple large-scale youth tobacco prevention campaigns since 2014. Prior to launching campaigns, the U.S. Food and Drug Administration conducts copy-testing studies with youth aged 12-17 years using an experimental design (ad exposure versus no ad control) to evaluate potential ad effects on 4 outcome measures: attitudes toward tobacco use and beliefs about negative health consequences, harmful and potentially harmful constituents, and addiction. A series of meta-analyses examined the difference between exposure and control groups for each of the 4 outcome measures across 10 copy-testing studies conducted from 2013 to 2020. Potential heterogeneity in these differences was explored by campaign, tobacco product, audience characteristic, and message theme. Analysis was performed in 2024. A total of 42 ads were included in the analysis. The average effect size (Hedge's g) across all ads was 0.446 (95% CI=0.312, 0.581) for attitude, 0.319 (95% CI=0.155, 0.483) for negative health consequence beliefs, 0.246 (95% CI=0.057, 0.436) for harmful and potentially harmful constituent beliefs, and 0.347 (95% CI=0.254, 0.441) for addiction beliefs. Larger effect sizes were observed for electronic cigarette ads than for ads for other products. Ads featuring harmful and potentially harmful constituent and addiction themes generated larger effect sizes on their respective targeted beliefs than ads that did not feature these themes. Findings of this study provide evidence that ads from the U.S. Food and Drug Administration's tobacco prevention campaigns have the potential to positively influence relevant beliefs and attitudes among their intended youth audiences. Patterns of variation in effect sizes largely support the success of belief targeting in campaign development.