Identifying Promising Message Themes for Youth Who Use Multiple Tobacco Products.

Purpose: While most tobacco prevention and cessation ads focus on a single product, little research exists on developing campaigns to influence youth who use multiple tobacco products (MTPs).

Methods: To examine the effects of message themes in ads targeting MTP use, we conducted an online within-subjects experiment with n = 310 US youth (ages 13-20) who reported past 30-day vaping and smoking cigarettes or cigars. Participants were randomly assigned to rate 6 messages from different themes about the consequences of vaping and smoking (e.g., "Vaping and smoking can lead to anxiety and irritability") from a pool of 49 messages.

Results: Regarding intended effects, all message themes performed significantly better than control on perceived message effectiveness (PME) (p < .01). In addition, themes about chemical exposures and health effects on organs with explanations for how health effects occurred led to higher PME than most other themes (including health effects on organs without explanations), while the nicotine addiction theme led to lower PME than most other themes (p < .05). Regarding unintended effects, health effects on organs with explanations led to a greater likelihood of thinking vaping is more harmful than smoking versus control (p < .05), although unintended effects were smaller than intended effects.

Discussion: Themes about chemical exposures and health effects on organs with explanations were perceived as more effective than other themes for ads targeting youth who use MTPs. However, health effects on organs with explanations also increased vaping relative harm, and future research is needed to examine any potential unintended consequences on behavior from such messaging.