• Maria L Roditis, Chaunetta Jones, Atanaska P Dineva, and Tesfa N Alexander.
• Office of Health Communication and Education, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland. Electronic address: maria.roditis@fda.hhs.gov.
• Am J Prev Med. 2019 Feb 1; 56 (2 Suppl 1): S24-S30.

IntroductionA key strategy in reducing the public health burden of cigarette smoking is preventing youth from ever becoming addicted to cigarettes in the first place. However, there is limited research exploring youth responses to addiction messages. This study assesses youths' responses to the U.S. Food and Drug Administration's "The Real Cost" campaign messaging depicting addiction as a "loss of control."MethodsBetween 2013 and 2016, three focus group studies and four copy testing studies were conducted to assess reactions to advertising concepts and near-final videos. Participants were aged 12-17 years and ethnically and geographically diverse. Researchers conducted a thematic secondary analysis of focus group transcripts and open-ended survey questions from the copy testing studies. Data analysis for this study took place in 2017.ResultsYouth responded favorably to loss of control messages showing real, often short-term, consequences of addiction, such as choosing to spend money on cigarettes instead of going to a movie, and depictions of scenarios that were relatable to youth. Youth also responded favorably to messages describing how nicotine changes the brain. A portion of youth remained skeptical, stating they felt the consequences depicted were unrealistic.ConclusionsThis study shows that by framing addiction as a loss of control and tying that loss of control to short-term health and social consequences, addiction becomes more concrete and understandable, and the consequences feel more relatable and relevant to youth.Supplement InformationThis article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.Copyright © 2018. Published by Elsevier Inc.

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