Attentional, Affective, and Cognitive Responses to the Food and Drug Administration's "The Real Cost" Youth Cigarette and E-Cigarette Prevention Campaigns Among Young Adults.

Abstract

Research using self-reported measures demonstrates that "The Real Cost" Youth Cigarette and E-Cigarette Prevention Campaigns affect tobacco-related beliefs, attitudes, behavioral intentions, and behaviors. This study provides insights by assessing attentional, affective, and cognitive responses to ads from "The Real Cost" campaigns among U.S. young adults using non-self-report measures. Attentional, affective, and cognitive responses (eye tracking, facial electromyography, electrodermal activity, functional near-infrared spectroscopy, and heart rate, collected from 2023 to 2024 and analyzed in 2024-2025) were measured during exposure to campaign ads in a Baltimore-area convenience sample of n=25 young adults who were susceptible to or experimenting with e-cigarettes and n=25 young adults who were susceptible to or experimenting with cigarettes. Faces generally attracted the most visual attention. All ads evoked increased cognitive activity associated with self-referential processing of the messages, and 2 e-cigarette campaign ads evoked cognitive activity associated with defensive processing. Heart rate decreased while watching most ads, indicating that participants devoted cognitive resources to message processing. Affective responses varied across ads. Attentional, affective, and cognitive responses indicated a favorable response to campaign ads. Decreases in heart rate and increases in cognitive activity in the medial prefrontal cortex are associated with message processing and message-consistent behavior change. Some of the e-cigarette ads but none of the cigarette ads elicited cognitive activity associated with defensive processing, potentially owing to young adult's perceptions of e-cigarettes as less harmful than cigarettes. More work will advance the understanding of the rationale for increases in activity associated with defensive processing in response to the e-cigarette ads.