Perceptions of prevention and cessation ads among US youth who use multiple tobacco products: A qualitative study

Background 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. Methods 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 tobacco prevention and cessation ads that addressed single and multiple tobacco products. 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 content analysis. Results Participants were, on average, 18.7 years. 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, especially with graphic, fear-arousing images, were perceived as most effective. Conclusions 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. IMPLICATIONS Multiple tobacco product use (i.e., 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 multiple tobacco product use. We conducted a qualitative study to examine how youth who use multiple tobacco products perceive tobacco prevention and cessation ads. Findings suggest ads about multiple tobacco products could be effective, especially if they specify “vaping and smoking” and highlight shared health effects of multiple tobacco products using graphic, fear-arousing images.