Awareness of "The Real Cost" Campaign Among US Middle and High School Students: National Youth Tobacco Survey, 2017

Objectives: Monitoring awareness of a public education campaign can help to better understand the extent of sustained population-level exposure to the campaign. We examined unaided awareness (awareness that does not include a visual image to remind the respondent of the campaign or advertisement) and correlates of unaided awareness of "The Real Cost," a national youth tobacco education campaign developed by the US Food and Drug Administration and implemented in 2014. Methods: This secondary analysis examined unaided campaign awareness by using data from the 2017 National Youth Tobacco Survey, a nationally representative school-based sample of young persons aged 9-19 years (n = 17 269) surveyed approximately 3 years after campaign launch. We compared unaided campaign awareness among various cigarette user groups (experimenters, susceptible nonsmokers, current or former smokers, and nonsusceptible nonsmokers). We examined associations between unaided campaign awareness and demographic and tobacco-related correlates, overall and by cigarette user group. Results: Three years after "The Real Cost" campaign was launched, most middle and high school students (58.5%) still reported unaided campaign awareness. Of 17 269 middle and high school students in the sample, 62.0% of susceptible nonsmokers and 64.5% of experimenters reported unaided campaign awareness. Among susceptible nonsmokers, unaided campaign awareness differed by age and race/ethnicity and was higher among students with greater tobacco-related harm perceptions (vs lower harm perceptions) and exposure to pro-tobacco marketing (vs no exposure). Conclusions: Future surveillance and research could examine awareness of "The Real Cost" campaign and effects of the campaign on young persons' knowledge, attitudes, and beliefs to further assess the public health impact of tobacco prevention campaigns.