• Rui Pei, Ralf Schmälzle, Elissa C Kranzler, Matthew B O'Donnell, and Emily B Falk.
• Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: rui.pei@asc.upenn.edu.
• Am J Prev Med. 2019 Feb 1; 56 (2 Suppl 1): S40-S48.

IntroductionInterpersonal communication can reinforce media effects on health behavior. Recent studies have shown that brain activity in the medial prefrontal cortex during message exposure can predict message-consistent behavior change. Key next steps include examining the relationship between neural responses to ads and measures of interpersonal message retransmission that can be collected at scale.MethodsNeuroimaging, self-report, and automated linguistic measures were utilized to investigate the relationships between neural responses to tobacco prevention messages, sharing engagement, and smoking-relevant belief changes. Thirty-seven adolescent nonsmokers viewed 12 ads from the U.S. Food and Drug Administration's "The Real Cost" campaign during a functional magnetic resonance imaging scan session (2015-2016). Data were analyzed between 2016 and 2017. The extent that participants talked in detail about the main message of the ads, or sharing engagement, was measured through transcripts of participants' subsequent verbal descriptions using automated linguistic coding. Beliefs about the consequences of smoking were measured before and after the main experiment using surveys.ResultsIncreased brain activation in self- and value-related subregions of the medial prefrontal cortex during message exposure was associated with subsequent sharing engagement when participants verbally talked about the ads. In addition, sharing engagement was significantly associated with changes in participants' beliefs about the social consequences of smoking.ConclusionsNeural activity in self- and value-related subregions of the medial prefrontal cortex during exposure to "The Real Cost" campaign was associated with subsequent sharing engagement, which in turn was related to social belief change. These results provide new insights into the link between neurocognitive responses to ads, the content of interpersonal sharing, and downstream health-relevant outcomes.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 Elsevier Ltd. All rights reserved.

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