Recall of “The Real Cost” Anti-Smoking Campaign Is Specifically Associated With Endorsement of Campaign-Targeted Beliefs

Abstract

Though previous research suggests the FDA’s “The Real Cost” anti-smoking campaign has reduced smoking initiation, the theorized pathway of effects (through targeted beliefs) has not been evaluated. This study assesses the relationship between recall of campaign television advertisements and ad-specific anti-smoking beliefs. Respondents in a nationally representative survey of nonsmoking youths age 13–17 (n = 4,831) reported exposure to four The Real Cost advertisements and a fake ad, smoking-relevant beliefs, and nonsmoking intentions. Analyses separately predicted each targeted belief from specific ad recall, adjusting for potential confounders and survey weights. Parallel analyses with non-targeted beliefs showed smaller effects, strengthening claims of campaign effects. Recall of four campaign ads (but not the fake ad) significantly predicted endorsement of the ad-targeted belief (Mean β = .13). Two-sided sign tests indicated stronger ad recall associations with the targeted belief relative to the non-targeted belief (p < .05). Logistic regression analyses indicated that respondents who endorsed campaign-targeted beliefs were more likely to have no intention to smoke (p < .01). This study is the first to demonstrate a relationship between recall of ads from The Real Cost campaign and the theorized pathway of effects (through targeted beliefs). These analyses also provide a methodological template for showing campaign effects despite limitations of available data.

Acknowledgments

The authors would like to acknowledge Danielle Naugle, Michelle Jeong, and Janet Audrain-McGovern for their contributions to survey development, and Tesfa Alexander for providing information about the airing of The Real Cost ads.

Funding

Research reported in this publication was supported by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) and FDA Center for Tobacco Products (CTP) under Award Number P50CA179546. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration (FDA).

Notes

¹ The Institutional Review Board at the University of Pennsylvania did not require parental consent for respondents aged 16–17.

² Generally, there were very low rates of missing data. However, the Wrinkle belief, Teeth belief, and parent education variables had missing values for more than 1% of responses. To test whether these missing cases influenced our results, we employed Manski–Horowitz logical bounds (Horowitz & Manski, 2006), separately replacing the missing values with the lowest and highest value on each variable and rerunning regression models. We recoded all missing values for the Wrinkle belief to “strongly disagree” in one model and “strongly agree” in another, completed the same procedure for the Teeth belief, and reran the regression models. Using the same approach, we created two new parent education variables in which missing values were separately replaced with the lowest and highest parent education value. We then ran two additional models for each ad recall/targeted belief pair, separately replacing parent education with the new bounded parent education variables. The results from all new models did not differ substantially from the original models. We believe this provides sufficient evidence that the missingness of these items did not affect study outcomes.

Additional information

Funding

Research reported in this publication was supported by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) and FDA Center for Tobacco Products (CTP) under Award Number P50CA179546. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration (FDA).