Perceptions of Prevention and Cessation Ads among US Youth Who Use Multiple Tobacco Products: A Qualitative Study

Around 30% of youth who use tobacco use multiple tobacco products (MTPs), yet little research has evaluated campaign ads to address youth MTP use.

We qualitatively examined how youth who use MTPs perceive tobacco prevention and cessation ads. Between February 2023 and January 2024, we held seven virtual focus groups with 30 US youth (ages 14-20 years) who reported using both e-cigarettes and a combustible tobacco product in the past 30 days. Participants were shown five static tobacco prevention and cessation ads that addressed single and MTPs. Participants were asked about their reactions to the ads, including whether they were effective or relatable, and suggested changes to the ads. We performed a thematic analysis.

Participants were, on average, 18.7 years old. Most participants were female (73%), white (47%), and lesbian, gay, or bisexual (63%). Four central themes emerged: (1) Ads about MTPs were perceived as more effective than ads about single tobacco products because they were relevant and informative; (2) Participants recommended that MTP ads should specify "vaping and smoking" or "nicotine" to refer to MTPs rather than "tobacco"; (3) Participants described ads with youth vernacular as ineffective and unrelatable and exhibited message fatigue; and (4) Ads that featured shared health consequences of MTP use, especially with graphic, fear-arousing images, were perceived as most effective.

Findings suggest ads about MTPs could be effective among youth who use MTPs. Promising MTP ads could specify "vaping and smoking" and highlight shared health effects across MTPs using graphic, fear-arousing images.

Multiple tobacco product (MTP) use (ie the use of two or more tobacco products in the past 30 days) is a common pattern of tobacco use among youth, yet little research has developed or evaluated campaign ads addressing MTP use. We conducted a qualitative study to examine how youth who use MTPs perceive tobacco prevention and cessation ads. Findings suggest ads about MTPs could be effective, especially if they specify "vaping and smoking" and highlight shared health effects of MTPs using graphic, fear-arousing images.