Purpose: This study examines the pathways through which e-cigarette users' awareness of the truth® campaign influences e-cigarette use frequency over time.
Design and setting: Data included four waves (2020-2023) of the Truth Longitudinal Cohort, a probability-based, nationally representative survey.
Participants: The analytic sample was 15-24-year-olds who reported current e-cigarette use at baseline (N = 718). Wave-by-wave retention rates were 64% to 69%.
Measures: Respondents' cumulative awareness of truth® ads was calculated (Waves 1-2). Strength of agreement with campaign-targeted attitudes was measured on five-point scales (Wave 2). The outcome was change in the 4-level frequency of e-cigarette use (Waves 2-4).
Analysis: Latent growth structural equation modeling examined the pathway from cumulative ad awareness to the frequency of e-cigarette use via campaign-targeted attitudes.
Results: Model fit estimates identified a three-step pathway by which awareness of the campaign reduced e-cigarette use. Ad awareness was significantly associated with stronger campaign-targeted attitudes: perceived risk (β = .20, P < .0001); anti-vape industry (β = .13, P = .003); independence from addiction (β = .13, P = .004); and affinity with groups that reject vaping (β = .18, P < .0001). Each attitude was significantly associated with stronger perceived norms against e-cigarette use (respectively: β = .25, P < .0001; β = .15, P < .0001; β = .12, P = .018; β = .27, P < .0001). Perceived norms against e-cigarette use had a significant negative relationship with growth in e-cigarette use frequency over time (β = -.23, P < .0001).
Conclusion: Greater truth® anti-vaping ad awareness strengthens campaign-targeted attitudes among current users, increasing perceived norms against e-cigarette use and reducing use over time.
Keywords: adolescent health; behavior change; electronic cigarettes (e-cigarettes); social norms; tobacco cessation.