• Elise M Stevens, Emily T Hébert, Brittney Keller-Hamilton, Summer G Frank-Pearce, Alayna P Tackett, Glenn Leshner, and Theodore L Wagener.
• Department of Population and Quantitative Health Sciences, Division of Preventative and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: elise.stevens@umassmed.edu.
• Am J Prev Med. 2021 May 1; 60 (5): 706710706-710.

IntroductionE-cigarette use is rising among youth. Advertising and anti-tobacco campaigns may be associated with the use of E-cigarettes and other tobacco products. This study examines the associations between tobacco use and exposure to The Real Cost's first campaign focusing on E-cigarettes.MethodsUsing the 2019 National Youth Tobacco Survey, a national survey of middle and high school students, the associations between exposure to The Real Cost anti-tobacco campaign, exposure to pro-tobacco advertising, and the use of tobacco products in the past 30 days (exclusive E-cigarettes, exclusive other tobacco use, and dual/poly use of E-cigarettes and other tobacco products) was examined. Other tobacco included anything but E-cigarettes.ResultsParticipants (N=13,165) were aged 11-17 years. Exposure to The Real Cost campaign was associated with decreased odds of using other tobacco products (AOR=0.60, 95% CI=0.43, 0.84) and dual/poly use (AOR=0.77, 95% CI=0.63, 0.94) but not E-cigarette use. Greater E-cigarette advertising exposure was associated with increased odds of being an exclusive E-cigarette user (AOR=1.90, 95% CI=1.52, 2.30) or dual/poly user (AOR=1.69, 95% CI=1.31, 2.18). Greater exposure to other tobacco advertising was associated with increased odds of being a dual/poly user (AOR=1.32, 95% CI=1.01, 1.71) but lower odds of exclusive E-cigarette use (AOR=0.76, 95% CI=0.60, 0.97).ConclusionsExposure to The Real Cost campaign was associated with decreased odds of using other tobacco products and dual/poly products. Exposure to pro-tobacco advertising was also associated with use. Future studies should assess the long-term effectiveness of anti-tobacco messaging.Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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