Examining Youth Awareness of "The Real Cost" Campaigns: An Audience Segmentation Analysis of Data From a Campaign Evaluation Study.

Abstract

Public health campaigns should ensure that they reach all segments of intended audiences. This study examines whether awareness of Food and Drug Administration's "The Real Cost" e-cigarette and cigarette prevention campaigns differs among segments of the national youth audience. Follow-up data (collected in June-September 2024) from campaign evaluations were analyzed in 2025. Weighted means of brand awareness and awareness of e-cigarette and cigarette prevention advertisements were examined among all respondents (n=4,067) and among audience segments defined by sociodemographic and tobacco-related variables. F-tests were used to compare audience segment awareness to the grand mean. Logistic regression models were used to test for group differences, controlling for age and tobacco use. Half of the respondents reported brand awareness (mean=48.4%). Brand awareness was higher than the grand mean among youth aged 15-17 years; youth who reported another sexual orientation (other than straight, bisexual, or gay or lesbian); and youth in households earning ≥ $110,000 annually. Brand awareness was lower among Black, non-Hispanic youth, and youth aged 11-14 years. Most youth reported e-cigarette prevention ad awareness (mean=75.2%), with higher awareness among Hispanic youth and youth with mild or moderate psychological distress. Fewer youth reported cigarette prevention ad awareness (mean=44.6%), with higher awareness among youth reporting severe psychological distress and youth in households earning <$30,000 annually. Unadjusted findings were consistent with findings from logistic regression models. The campaigns are effectively reaching youth across audience segments. Continued awareness monitoring helps to ensure that tobacco prevention campaigns designed for a general youth audience promote healthy behaviors across their audience.