ArticleAmerican journal of preventive medicine2019
Impact of The Real Cost Media Campaign on Youth Smoking Initiation.
Article in American journal of preventive medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
50 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Effectiveness of Youth Tobacco Prevention Ads: Meta-Analysis of a Decade's Worth of Copy-Testing Data.American journal of preventive medicine · 2026Pooled it
- A systematic review and network meta-analysis of population-level interventions to tackle smoking behaviour.Nature human behaviour · 2024Pooled it
- Tailoring e-Cigarette Health Messages by Vaping Status: How Source and Message Presentation Type Shape Young Adults' Perceptions.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2026Trial
- Understanding Potential Mechanisms of Vaping Prevention Messages: A Mediation Analysis of the Real Cost Campaign Advertisements.Health education & behavior : the official publication of the Society for Public Health Education · 2025Trial
- The Development and Testing of a Point-of-Sale E-Cigarette Health Communication Campaign.Health communication · 2024Trial
- Communicating the benefits of quitting smoking on mental health increases motivation to quit in people with anxiety and/or depression.Addictive behaviors · 2024Trial
- The Impact of The Real Cost Vaping and Smoking Ads across Tobacco Products.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2023Trial
- Effects of Vaping Prevention Messages on Electronic Vapor Product Beliefs, Perceived Harms, and Behavioral Intentions among Young Adults: A Randomized Controlled Trial.International journal of environmental research and public health · 2022Trial
- Impact of Vaping Prevention Advertisements on US Adolescents: A Randomized Clinical Trial.JAMA network open · 2022Trial
- "The Real Cost" Smokeless campaign: changes in beliefs about smokeless tobacco among rural boys, a longitudinal randomized controlled field trial.BMC public health · 2021Trial
- Evaluating the actual and perceived effectiveness of E-cigarette prevention advertisements among adolescents.Addictive behaviors · 2020Trial
- Identifying key beliefs for anti-disinformation messaging for Black adults about proposed US bans on menthol cigarettes and flavored cigars.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2026Article
- The Impact of "The Real Cost" on E-cigarette Initiation Among U.S. Youth.American journal of preventive medicine · 2026Article
- Exploring Attention to Digital Ads: How Audiences Attend to and Respond to "The Real Cost" Youth E-Cigarette Prevention Campaign Ads.American journal of preventive medicine · 2026Article
- Attentional, Affective, and Cognitive Responses to the Food and Drug Administration's "The Real Cost" Youth Cigarette and E-Cigarette Prevention Campaigns Among Young Adults.American journal of preventive medicine · 2026Article
- Review
- Perceptions of Prevention and Cessation Ads among US Youth Who Use Multiple Tobacco Products: A Qualitative Study.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2026Article
- Exploring demographic-behavioural profiles in a large cohort of Japanese adults: a latent class analysis approach for 137 357 individuals.BMJ public health · 2026Article
- Article
- Cigarette smoking decline among US young adults from 2000 to 2019, in relation to state-level cigarette price and tobacco control expenditure.Tobacco control · 2025Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
introductionThe purpose of this study was to assess the relationship between youth exposure to the U.S. Food and Drug Administration's national tobacco public education campaign, The Real Cost, and changes in smoking initiation.
methodsFrom November 2013 to November 2016, a longitudinal study of youth was conducted with a baseline and 4 post-campaign follow-up surveys. The sample consisted of nonsmoking youths from 75 U.S. media markets (n=5,103) who completed a baseline and at least 1 follow-up survey. Exposure was measured by media market-level target rating points and self-reported ad exposure frequency. Smoking initiation was examined among youths who had never smoked at baseline and defined as first trial of a cigarette. Discrete-time survival models using logistic regression and controlling for confounding influences were estimated. Analyses were conducted in 2018.
resultsThe odds of reporting smoking initiation at follow-up was lower among youths in media markets with higher levels of campaign advertisements than among those with less. Both between-wave and cumulative target rating points were associated with decreased risk of smoking initiation (AOR=0.69 [p<0.01] and AOR=0.89 [p<0.05], respectively); for every 3,500 between-wave target rating points on air, there was an associated 30% reduction in the hazard of smoking initiation among youths. Results from self-reported recall of the campaign advertisements found similar dose-response effects. The campaign is associated with an estimated 380,000-587,000 youths aged 11-19 years being prevented from initiating smoking nationwide.
conclusionsSustained national tobacco public education campaigns like The Real Cost can change population-level smoking initiation among youths, preventing future generations from tobacco-related harms.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.