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• W2908610813 abstract "In 2014, the U.S. Food and Drug Administration launched its first youth smoking prevention media campaign, “The Real Cost,” with the goal of preventing cigarette smoking among at-risk youth aged 12–17 years in the U.S. This paper examines how the paid media strategy was developed, implemented, and refined between 2013 and 2016. Specifically, this paper discusses how research and best practices informed the media targeting strategy used to implement a multifaceted national campaign that successfully reached and influenced thousands of teens at risk for cigarette smoking.Supplement informationThis article is part of a supplement entitled Fifth Anniversary Retrospective of “The Real Cost,” the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration. In 2014, the U.S. Food and Drug Administration launched its first youth smoking prevention media campaign, “The Real Cost,” with the goal of preventing cigarette smoking among at-risk youth aged 12–17 years in the U.S. This paper examines how the paid media strategy was developed, implemented, and refined between 2013 and 2016. Specifically, this paper discusses how research and best practices informed the media targeting strategy used to implement a multifaceted national campaign that successfully reached and influenced thousands of teens at risk for cigarette smoking. This article is part of a supplement entitled Fifth Anniversary Retrospective of “The Real Cost,” the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration. The U.S. Food and Drug Administration's (FDA) youth smoking prevention media campaign, “The Real Cost,” primarily targets youth aged 12–17 years who have never smoked, but are susceptible to smoking, and those who have experimented with smoking in the past, but who have smoked fewer than 100 cigarettes in their lifetime.1Santiago S Talbert EC Benoza G Finding Pete and Nikki: defining the target audience for “The Real Cost” campaign.Am J Prev Med. 2019; 56: S9-S15Scopus (10) Google Scholar Educating this audience about the harms of cigarette smoking requires reaching them in a crowded and constantly evolving media landscape. Today's youth are savvy and voracious media consumers who have access to nearly limitless content,2Pew Research CenterTeens, social media & technology overview 2015.www.pewinternet.org/2015/04/09/mobile-access-shifts-social-media-use-and-other-online-activities/Date: Accessed February 12, 2018Google Scholar so the challenge for “The Real Cost” is to reach these teens at a time and place where they will be most receptive to the campaign's messages. It is well documented that mass media campaigns can change attitudes about tobacco use3Duke JC Farrelly MC Alexander TN et al.Effect of a national tobacco public education campaign on youth's risk perceptions and beliefs about smoking.Am J Health Promot. 2018; 32: 1248-1256https://doi.org/10.1177/0890117117720745Crossref PubMed Scopus (36) Google Scholar, 4Farrelly MC Davis KC Duke J Messeri P Sustaining “truth”: changes in youth tobacco attitudes and smoking intentions after 3 years of a national antismoking campaign.Health Educ Res. 2009; 24: 42-48https://doi.org/10.1093/her/cym087Crossref PubMed Scopus (82) Google Scholar, 5Cowell AJ Farrelly MC Chou R Vallone DM Assessing the impact of the national “truth” antismoking campaign on beliefs, attitudes, and intent to smoke by race/ethnicity.Ethn Health. 2009; 14: 75-91https://doi.org/10.1080/13557850802257715Crossref PubMed Scopus (47) Google Scholar and reduce smoking prevalence6Sly DF Hopkins RS Trapido E Ray S Influence of a counteradvertising media campaign on initiation of smoking: the Florida “truth” campaign.Am J Public Health. 2001; 91: 233-238https://doi.org/10.2105/AJPH.91.2.233Crossref PubMed Scopus (160) Google Scholar, 7Chen X Li G Unger JB et al.Secular trends in adolescent never smoking from 1990 to 1999 in California: an age-period cohort analysis.Am J Public Health. 2003; 93: 2099-2104https://doi.org/10.2105/AJPH.93.12.2099Crossref PubMed Scopus (36) Google Scholar, 8Gilpin EA Emery SL Farkas AJ et al.The California Tobacco Control Program: A Decade of Progress, Results From the California Tobacco Surveys, 1990–1998. University of California, San Diego, La Jolla, CA2001Google Scholar, 9Roeseler A Burns D The quarter that changed the world.Tob Control. 2010; 9: i3-i15https://doi.org/10.1136/tc.2009.030809Crossref Scopus (73) Google Scholar, 10Farrelly MC Nonnemaker J Davis KC Hussin A The influence of the national truth campaign on smoking initiation.Am J Prev Med. 2009; 36: 379-384https://doi.org/10.1016/j.amepre.2009.01.019Abstract Full Text Full Text PDF PubMed Scopus (173) Google Scholar, 11Wilson LM Avila Tang E Chander G et al.Impact of tobacco control interventions on smoking initiation, cessation, and prevalence: a systematic review.J Environ Public Health. 2012; 2012961724.https://doi.org/10.1155/2012/961724Crossref PubMed Scopus (171) Google Scholar, 12Weiss JW Cen S Schuster DV et al.Longitudinal effects of pro-tobacco and anti-tobacco messages on adolescent smoking susceptibility.Nicotine Tob Res. 2006; 8: 455-465https://doi.org/10.1080/14622200600670454Crossref PubMed Scopus (71) Google Scholar, 13Farrelly MC Duke JC Nonnemaker J et al.Association between The Real Cost media campaign and smoking initiation among youths—United States, 2014–2016.MMWR Morb Mortal Wkly Rep. 2017; 66: 47-50https://doi.org/10.15585/mmwr.mm6602a2Crossref PubMed Scopus (91) Google Scholar and the risk of initiation.14Terry-McElrath YM Wakefield MA Emery S et al.State anti-tobacco advertising and smoking outcomes by gender and race/ethnicity.Ethn Health. 2007; 12: 339-362https://doi.org/10.1080/13557850701300723Crossref PubMed Scopus (34) Google Scholar, 15Bauer UE Johnson TM Hopkins RS Brooks RG Changes in youth cigarette use and intentions following implementation of a tobacco control program: findings from the Florida Youth Tobacco Survey, 1998–2000.JAMA. 2000; 284: 723-728https://doi.org/10.1001/jama.284.6.723Crossref PubMed Scopus (162) Google Scholar, 16Niederdeppe J Farrelly MC Haviland ML Confirming “truth”: more evidence of a successful tobacco countermarketing campaign in Florida.Am J Public Health. 2004; 94: 255-257https://doi.org/10.2105/AJPH.94.2.255Crossref PubMed Scopus (95) Google Scholar, 17Biener L Adult and youth response to the Massachusetts anti-tobacco television campaign.J Public Health Manag Pract. 2000; 6: 40-44https://doi.org/10.1097/00124784-200006030-00007Crossref PubMed Scopus (46) Google Scholar, 18White VM Warne CD Spittal MJ et al.What impact have tobacco control policies, cigarette price and tobacco control programme funding had on Australian adolescents’ smoking? Findings over a 15-year period.Addiction. 2011; 106: 1493-1502https://doi.org/10.1111/j.1360-0443.2011.03429.xCrossref PubMed Scopus (58) Google Scholar, 19Farrelly MC Davis KC Haviland ML et al.Evidence of a dose-response relationship between “truth” antismoking ads and youth smoking prevalence.Am J Public Health. 2005; 95: 425-431https://doi.org/10.2105/AJPH.2004.049692Crossref PubMed Scopus (404) Google Scholar The Centers for Disease Control and Prevention (CDC) developed best practices for comprehensive tobacco control programs that outline three critical steps to implementing a successful mass media campaign, including (1) achieving sufficient levels of ad awareness, (2) changing campaign-targeted attitudes and beliefs, and (3) changing smoking intentions and behaviors.20CDCBest Practices for Comprehensive Tobacco Control Programs–2014. HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA2014Google Scholar FDA worked with its contractors to adapt this evidence-based framework into a logic model to guide the campaign program's overarching objectives in the near and long term (Figure 1). To attain the levels of advertising exposure and awareness necessary to influence smoking-related attitudes and beliefs and change youth intentions and behavior, “The Real Cost” followed CDC's established best practice of achieving at least 75% reach of the target audience a minimum of 15 times per quarter.20CDCBest Practices for Comprehensive Tobacco Control Programs–2014. HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA2014Google Scholar An independent evaluation of “The Real Cost” was conducted from November 2013 to March 2016, with a nationally representative sample of youth, to examine campaign goals of awareness, attitude, and behavior change. Results from this evaluation demonstrated that the media buy was successful in achieving high levels of campaign awareness among the hard-to-reach target audience: more than 90% of youth surveyed were aware of at least one advertisement 6 to 8 months after campaign launch.21Duke JC Alexander TN Zhao X et al.Youth's awareness of and reactions to The Real Cost national tobacco public education campaign.PLoS One. 2015; 10e0144827.https://doi.org/10.1371/journal.pone.0144827Crossref PubMed Scopus (76) Google Scholar A study by Farrelly et al.13Farrelly MC Duke JC Nonnemaker J et al.Association between The Real Cost media campaign and smoking initiation among youths—United States, 2014–2016.MMWR Morb Mortal Wkly Rep. 2017; 66: 47-50https://doi.org/10.15585/mmwr.mm6602a2Crossref PubMed Scopus (91) Google Scholar analyzed data from this evaluation and found that campaign exposure was associated with a 30% decrease in the risk for smoking initiation among the sample. From the results of a survival analysis incorporating this decrease in risk, the evaluation determined that the campaign prevented an estimated 350,000 youth aged 11–18 years from initiating smoking during those years. This paper explains how research in teen media consumption behaviors provided the insights used to develop “The Real Cost” campaign's successful media strategy and implementation plan, and offers practical information to public health professionals interested in reaching at-risk youth audiences through paid media. In today's fractured media environment, teens receive messages from a variety of distinct channels, including TV, online, radio, out of home, magazines, and cinema.22Carson-Chahhoud KV Ameer F Sayehmiri K et al.Mass media interventions for preventing smoking in young people.Cochrane Database Syst Rev. 2017; CD001006.https://doi.org/10.1002/14651858.CD001006.pub3PubMed Google Scholar, 23Pew Research CenterTeens and social media.www.pewinternet.org/2007/12/19/teens-and-social-media/Date: Accessed February 12, 2018Google Scholar Media plans that incorporate a sophisticated understanding of audience media targeting options, including how to integrate offline and online channels, can help public health practitioners create multifaceted media strategies capable of engaging the right people at the right time with the right message.21Duke JC Alexander TN Zhao X et al.Youth's awareness of and reactions to The Real Cost national tobacco public education campaign.PLoS One. 2015; 10e0144827.https://doi.org/10.1371/journal.pone.0144827Crossref PubMed Scopus (76) Google Scholar, 24Davis KC Shafer PR Rodes R et al.Does digital video advertising increase population-level reach of multimedia campaigns? Evidence from the 2013 Tips From Former Smokers Campaign.J Med Internet Res. 2016; 18: e235https://doi.org/10.2196/jmir.5683Crossref PubMed Scopus (23) Google Scholar,25Shaniece C Blaine RE Palamé MA et al.Marketing for the Massachusetts Childhood Obesity Research Demonstration Study: a case study.Health Promot Pract. In press. Online March 22, 2018.; https://doi.org/10.1177/1524839918760842Google Scholar In addition to addressing these fundamental principles, “The Real Cost” had several additional challenges, including: differentiating and targeting an at-risk youth population; engaging at-risk youth with tobacco prevention content they are not typically interested in viewing; and ensuring the campaign had the necessary relevance and credibility so when youth did engage, they were receptive to and believed the messages. Bringing “The Real Cost” campaign to life in-market involved developing a well-researched, multifaceted approach based on the target audience's interests and media consumption habits. Although the campaign targets at-risk youth, there are similarities in the media behaviors and preferences of all teens. To begin the media strategy development, FDA's marketing contractor for “The Real Cost” campaign, FCB New York (FCB), and their media partner, Initiative, started by identifying common characteristics of teen media behavior based on findings from internal, unpublished research and data from sources, such as the Pew Research Center.26Pew Research CenterSmartphone ownership update: September 2012.www.pewinternet.org/2012/09/11/smartphone-ownership-update-september-2012/Date: Accessed February 12, 2018Google Scholar, 27Pew Research CenterTeens & online video.www.pewinternet.org/2012/05/03/teens-online-video/Date: Accessed February 12, 2018Google Scholar, 28Pew Research CenterTeens, smartphones & texting.www.pewinternet.org/2012/03/19/teens-smartphones-texting/Date: Accessed February 12, 2018Google Scholar, 29Pew Research CenterTeens haven't abandoned Facebook (yet).www.pewinternet.org/2013/08/15/teens-havent-abandoned-facebook-yet/Date: Accessed February 12, 2018Google Scholar, 30Pew Research CenterTeens, social media, and privacy.www.pewinternet.org/2013/05/21/teens-social-media-and-privacy/Date: Accessed February 12, 2018Google Scholar A high-level distillation of this analysis suggests: teens’ primary screen is mobile—their phones are an extension of themselves; the content and who delivers that content matters more than where it is delivered; teen's preferences constantly change—what is “in” today may be “out” tomorrow, and what is “in” tomorrow may not even exist today; and social media is one of the main places teens share and communicate, but exactly how and where is ever changing. These insights informed the initial media planning process, including emphasizing mobile advertising and ensuring paid social media was a significant portion of the media investment—about 6% of the total buy—while also reinforcing the importance of consistently seeking research to provide new insights into the rapidly changing youth media environment. Although most teens have similar interests in music, gaming, and sports, FDA also needed to understand what sets “The Real Cost” at-risk youth apart and gain a better understanding of the target audience's media usage and interests, which tend to be less mainstream than the general teen population. To obtain these insights, FCB and Initiative analyzed data collected by Teenage Research Unlimited, now Kantar. aTeenage Research Unlimited was acquired in 2007 by WPP and Kantar. Kantar provides current and comprehensive data on tween, teen, and 20-something lifestyles, attitudes, values, media consumption, products, trends, and brand usage. To obtain teen-specific data, Kantar interviews 2,000 teens aged 12–19 years, in two waves per year, via an incentivized online survey. Samples are nationally representative of the teen population in terms of age, gender, ethnicity, and region of the U.S. Data can also be filtered to simulate the characteristics of at-risk behavior. Such filters include attitudes toward smoking and self-identified psychographic risk factors (e.g., rebelliousness, social isolation, or feelings of stress) and environmental factors (e.g., poor school or home environment). This analysis identified five “passion points” of at-risk teens: (1) alternative music, fashion and style; (2) extreme sports; (3) irreverent, snarky comedy; (4) high-sensory gaming; and (5) science fiction, fantasy, and horror genres. According to Kantar, at-risk youth “over index” (i.e., are above the 100 average for all teens) in these five media categories. In other words, they tend to engage more with this type of content than their mainstream peers (Table 1).Table 1At-Risk Teen Media Consumption BehaviorsaTeenage Research Unlimited (TRU). Passion Points: Index of At-Risk Teens 12–17 vs Total Teen 12–17 Population. TRU Perceptions & Priorities 2014. Youth Monitor 2013.Passion pointExamples (index)bOn this scale, a score >100 indicates at-risk youth consume these media more than their mainstream peers.Media channelsAlternative musicMetallica (173)Arcade Fire (142)Spotify, Pandora, SoundCloudExtreme sportsSkateboarding (195)Dirt biking (156)X-Games, ESPNIrreverent comedyAwkward (192)Futurama (157)Comedy Central, YouTubeHigh-sensory gamingFirst-person shooter (130)Fighting (120)X-Box One, EA Sports, GameLoftScience fiction/fantasy/horrorVampire Diaries (183)Teen Wolf (146)The CW, MTVa Teenage Research Unlimited (TRU). Passion Points: Index of At-Risk Teens 12–17 vs Total Teen 12–17 Population. TRU Perceptions & Priorities 2014. Youth Monitor 2013.b On this scale, a score >100 indicates at-risk youth consume these media more than their mainstream peers. Open table in a new tab Identifying specific passion points allows “The Real Cost” to differentiate and target at-risk teens within specific media channels. For example, by combining the insight about at-risk teens’ alternative music preference with Nielsen bNielsen measures TV, radio, print, and digital media impressions using a variety of methods to determine viewership. These impressions are translated into ratings based on the potential audience within any given area or demographic. and Simmons cSimmons Research is a consumer intelligence company that provides audience insights to media companies based on a combination of behavioral, lifestyle, and demographic data. data, the campaign aired advertising during the most relevant alternative music playlists on music streaming platforms, such as Pandora, Spotify, and SoundCloud; determined content targeting on YouTube; developed custom playlists on Music Choice video on demand; and selected appropriate TV programs on Fuse. In addition, these data can inform specific media purchasing strategies, enabling the campaign to hand-pick programs like Family Guy, rather than purchasing advertising space more generally on mainstream channels, such as Fox. Thus, these data provide insights that form the foundation of a media strategy designed to reach and engage at-risk youth with tobacco-prevention messaging where these youths are already consuming content. To successfully reach the at-risk teen target and make them hyperconscious of the risks of every cigarette, “The Real Cost” strategy is to surround them with the campaign's messages using a sophisticated media integration that will capture their attention. The initial framework for “The Real Cost” campaign's media targeting approach was grounded by the following goals:•Target delivery: Deliver advertising to at least 75% of the target audience 15 times per quarter to increase the likelihood of high levels of campaign awareness.•Media mix: Encourage engagement with campaign messages through a diverse and digitally integrated media mix that reflects the way at-risk youth choose to consume entertainment, social content, and information.•Geographic allocation: Execute a national media strategy in all 210 media markets. In 2014, the campaign also implemented a 75% media “heavy-up” strategy in 16 markets to improve FDA's ability to measure campaign effectiveness; however, this was determined to be unnecessary, and in 2015 all media funds went into the national media buy. dOf the total $85 million media budget for 2014, a total of $72 million was allocated to the national media buy. The remaining $13 million supported a “local heavy-up” strategy to purchase additional media in 16 markets. The rationale of this heavy-up strategy was to determine if the difference between the national and the heavy-up markets would provide sufficient variance in awareness to demonstrate the outcome goal of 75% ad awareness. However, after the first year it was determined this was not necessary due to the 90% ad awareness achieved by the campaign. Thus, in 2015 the full $85 million was used to support the national media buy.dOf the total $85 million media budget for 2014, a total of $72 million was allocated to the national media buy. The remaining $13 million supported a “local heavy-up” strategy to purchase additional media in 16 markets. The rationale of this heavy-up strategy was to determine if the difference between the national and the heavy-up markets would provide sufficient variance in awareness to demonstrate the outcome goal of 75% ad awareness. However, after the first year it was determined this was not necessary due to the 90% ad awareness achieved by the campaign. Thus, in 2015 the full $85 million was used to support the national media buy. To reach the approximately 10 million youth in the target audience,1Santiago S Talbert EC Benoza G Finding Pete and Nikki: defining the target audience for “The Real Cost” campaign.Am J Prev Med. 2019; 56: S9-S15Scopus (10) Google Scholar the 2014 media plan called for a total budget of $85 million. This money was allocated across various media to surround the at-risk teen target audience with the campaign's messaging. As Table 2 indicates, insights learned in 2014 informed media purchase adjustments in 2015. For example, although the overall percentage of funds allocated to video remained the same for both years, in 2015 the campaign increased digital video by 12% and decreased TV spending to align with teen's media usage as they began consuming more and more online content. In 2015, the campaign also added an “opportunistic” fund to take advantage of new opportunities that could arise during the year. For example, Tumblr was not part of the campaign at launch; however, research from the GlobalWebIndex in December 2014 indicated Tumblr was the fastest growing social media site.31Mendoza M Facebook popularity drops among teens as Tumblr, Pinterest, Snapchat gain steam.Tech Times. Accessed February 12, 2018www.techtimes.com/articles/21171/20141201/facebook-popularity-drops-among-teens-as-tumblr-pinterest-snapchat-gain-steam.htmGoogle Scholar The 2015 opportunistic fund allowed the campaign to take advantage of this emerging platform to engage teens as their media behaviors shifted.Table 2“The Real Cost” Media Allocations and Planned GRPsaAll GRPs are nationalized, teen estimates and are based on planned GRP levels, not actualized. by Channel, 2014–2015Media channel2014, %2014 Planned GRPs, n2015, %2015 Planned GRPs, nVideo (TV, cinema, and online)683,694683,992Online (banner ads, social media, search)232,356193,348Out-of-home (e.g., bus shelters, malls, skate park murals)52184240Radio (terrestrial)34642480Print (magazines)11591129OpportunisticbOpportunistic funds are held in reserve to take advantage of media events or unexpected opportunities as the media year unfolds.GRP, gross ratings point.0—4—a All GRPs are nationalized, teen estimates and are based on planned GRP levels, not actualized.b Opportunistic funds are held in reserve to take advantage of media events or unexpected opportunities as the media year unfolds.GRP, gross ratings point. Open table in a new tab “The Real Cost” campaign's media strategy involves a layered approach, where teens receive messages from: (1) the brand in the form of paid media; (2) relevant “messengers,” defined as celebrities and public figures popular among the target audience; and (3) messages spread by word of mouth through peer-to-peer discussions within the campaign's social media communities. This layered approach surrounds the target audience with campaign content that does not just come from the campaign itself, but also relevant messengers and peers. This approach raises campaign awareness by exposing campaign messages to youth through additional channels, such as the celebrities’ social media, and increases campaign relevance and credibility by having external voices that teens respect share campaign messages.32Hoffman SJ Mansoor Y Natt N et al.Celebrities’ impact on health-related knowledge, attitudes, behaviors, and status outcomes: protocol for a systematic review, meta-analysis, and meta-regression analysis.Syst Rev. 2017; 6: 13https://doi.org/10.1186/s13643-016-0395-1Crossref PubMed Scopus (41) Google Scholar, 33GoogleWhy YouTube stars are more influential than traditional celebrities.www.thinkwithgoogle.com/consumer-insights/youtube-stars-influence/Date: Accessed February 12, 2018Google Scholar An adolescent that was aged 13 years in 2014 was aged 3 years when Facebook was invented, making them one of the first generations to grow up during a time marked by the increasing convergence of analog and digital lives. Recognizing the opportunities afforded by social media, “The Real Cost” launched in 2014 with two of the largest platforms in the social media landscape at the time: Facebook and Twitter. The campaign's initial goals on social media were to: (1) become a trusted voice on youth tobacco prevention, correcting misinformation and offering personally relevant tobacco-related content; (2) encourage dialogue with candid and conversational content; and (3) promote a safe environment to offer support, share facts, and provide resources. Facebook was, and remains, the campaign's primary two-way conversation channel. Teens regularly ask questions, discuss the campaign's posts and ads, and provide feedback. Facebook also allows the campaign to provide a platform for peer-to-peer dialogue. Teens often tag each other by typing their friend's name in the comment area. This can indicate that a sibling, boy/girlfriend, or friend is concerned that someone they care for is considering using or has begun experimenting with tobacco. “The Real Cost” is respectful of these interactions, allowing them to occur organically and only inserting commentary when asked a question or when needed to correct misinformation. The initial strategy for Twitter was to provide short-form content and facts about the harms of tobacco use. Twitter also provided the (then unique) opportunity to use hashtags to allow the campaign to insert messaging into ongoing conversations. For example, the campaign used #smoking or #cigarettes to share a message about the harms of tobacco, so others searching these hashtags would see the campaign's prevention message. Hashtags also enable the campaign to be more culturally relevant so the content resonates with teens.34Vallone D Smith A Kenney T et al.Agents of social change: a model for targeting and engaging Generation Z across platforms: how a nonprofit rebuilt an advertising campaign to curb smoking by teens and young adults.J Advert Res. 2016; 56: 414-425https://doi.org/10.2501/JAR-2016-046Crossref Scopus (19) Google Scholar, 35DeMers J Appropriate or not? A quick-reference resource on hashtag use.Forbes. Accessed February 12, 2018www.forbes.com/sites/jaysondemers/2016/06/25/appropriate-or-not-a-quick-reference-resource-on-hashtag-use/#34bdbde4a6f7Google Scholar In early 2016, “The Real Cost” significantly reduced its Twitter content strategy. This was for three reasons: first, youth began moving away from the platform in favor of Tumblr, Instagram, and Snapchat; second, the anonymity of participants meant it was often difficult to accurately assess whether the campaign was engaging the at-risk youth target; and third, the engagement rate on Twitter was less than 3%, far lower than all other social media channels for “The Real Cost,” so the investment in content creation was no longer an efficient use of resources. The campaign continues to answer questions, provide resources, and correct misinformation, but no longer posts content consistently, instead launching on Tumblr in late 2014 and Instagram in 2015. Tumblr is essentially a popular online scrapbook where teens can post images, GIFs (graphics interchange format), videos, and other content anonymously. FCB's analysis of Tumblr in 2014 determined there was a significant amount of pro-tobacco advertising; thus, “The Real Cost” could provide users with important tobacco prevention messaging by engaging on the site. Tumblr is a heavily visual platform, so the campaign focuses more on animations, short-form video content, and multi-image posts to capture youth attention. By 2015, about 52% of teens were posting selfies, sharing visual moments of their day, and using multiple hashtags on Instagram.2Pew Research CenterTeens, social media & technology overview 2015.www.pewinternet.org/2015/04/09/mobile-access-shifts-social-media-use-and-other-online-activities/Date: Accessed February 12, 2018Google Scholar, 36Jang JY Han K Shih PC Lee D Generation Like: comparative characteristics in Instagram.in: CHI ‘15 Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems, Seoul, Republic of Korea, Seoul, Republic of KoreaApril 18–23, 2015.https://doi.org/10.1145/2702123.2702555Crossref Scopus (89) Google Scholar A distinctly visual channel, teens use Instagram to gain attention, share their feelings, and follow celebrities and entertainers they like.31Mendoza M Facebook popularity drops among teens as Tumblr, Pinterest, Snapchat gain steam.Tech Times. Accessed February 12, 2018www.techtimes.com/articles/21171/20141201/facebook-popularity-drops-among-teens-as-tumblr-pinterest-snapchat-gain-steam.htmGoogle Scholar To match the tone and visual style of Instagram, “The Real Cost” developed more lifestyle content, such as quizzes, lists, and GIFs. The campaign also uses hashtags to raise campaign awareness, increase engagement with messages, and interact with youth authentically on the platform.37Contreras C 7 ways to engage millennials and Gen Z on social media in 2018.Social Media Week. Accessed February 12, 2018https://socialmediaweek.org/blog/2017/12/7-ways-engage-millennials-gen-z-social-media-2018/Google Scholar, 38Osman M 18 Instagram stats every marketer should know for 2018.SproutSocial. Accessed February 12, 2018https://sproutsocial.com/insights/instagram-stats/Google Scholar, 39Conner C Why you need a hashtag strategy for your business.Forbes. Accessed February 12, 2018www.forbes.com/sites/cherylsnappconner/2013/06/22/why-you-need-a-hashtag-strategy-for-your-business/#4f5f423d7370Google Scholar Social media sites establish an important presence for “The Real Cost” and provide opportunities for teens to engage more directly with the campaign's messaging. Now 4 years into the campaign, “The Real Cost” uses Facebook, Instagram, and Tumblr regularly to educate and inform youth. Each channel has its own role and approach, as outlined in Table 3.Table 3Social Media Channel Roles for “The Real Cost”FacebookInstagramTumblrConversationalVisually arrestingDisrupt the normEngage in Q&ACreate thought-provoking contentCounter pro-tobacco messagingProvide facts and empathetic messaging to start the conversation with youthAct as the voice of opposition to glamorized smoking contentPost unique, unexpected content to cause youth to rethink their relationship with tobaccoQ&A, question and answer. Open table in a new tab Q&A, question and answer. Community management is the backbone of any social media strategy. “The Real Cost” uses community management to ensure conversations stay on topic and appropriate and to respond directly to teens. The campaign monitors social media 12 hours per day, filtering out inappropriate comments and responding to youth. Responses are based on pre-approved, scientifically accurate facts, but are also personalized to youth, calling them by name and acknowledging their stories and perspectives. The campaign corrects misinformation and ensures the conversation remains respectful, though the community occasionally “polices” itself. Youth regularly acknowledge and appreciate the campaign's direct engagement, even when they disagree with the information provided. Monitoring social media also provides a glimpse into the lives, language, and beliefs of teens. The campaign observes and learns from what teens are saying and how they talk about tobacco in their natural online environment. Social media monitoring also ensures that “The Real Cost” is constantly attuned to teens’ real-time concerns, passions, and evolving attitudes. This constant feedback provides macro insights that inform strategy as well as micro trends from the campaign's own social media channels that present actionable insights to adjust content, paid media strategy, or channel refinements. Teen attitudes and beliefs shared through social media posts also serve as an inspiration and a foundation for future creative and content ideas, while providing insight on emerging social trends. From the internal analysis, from launch in February 2014 to March 2016, “The Real Cost” saw more than 13.5 million social media engagements, including likes, comments, and shares. The significant investment in content development, community management, and paid promotion of social content enables “The Real Cost” to engage youth in a low-interest topic, encourage peer-to-peer discussions about the harms of tobacco, and maintain the campaign's reputation as a trusted voice in the online community. An important component to the media strategy is using relevant messengers, such as celebrities or sports figures that teens revere, to share campaign messages. Using messengers gives additional weight and validity to the message, increasing the likelihood youth will engage with the content and that when they do engage, they will be receptive to and believe the message. For these reasons, “The Real Cost” uses messengers to push messaging into the larger world of the target audience in interesting and sometimes surprising ways. In 2014, “The Real Cost” worked with two of the most popular teen shows on television, ABC Family's Pretty Little Liars and The Fosters. The campaign collaborated with Janell Parrish from Pretty Little Liars and Cierra Ramirez from The Fosters to create 30-second videos, Instagram content, and a live chat session, in addition to branding their websites and placing ads during both shows’ season finales. An important part of developing this type of content is ensuring the message coming from the talent is authentic. “The Real Cost” achieved this by taking video of Janell Parrish as she danced and integrating interview footage of her talking about how smoking could get in the way of her passion for dancing. The campaign used a similar approach for Cierra Ramirez, with footage of her singing in a recording studio interspersed with her sharing how smoking could damage her voice. According to internal analysis, these two programs garnered 92 million teen TV impressions, 1.1 million digital impressions, and more than 32,000 social media engagements. “The Real Cost” messenger strategy uses different types of talent, across different channels and platforms, to surround youth with the campaign's messages. Following this strategy, in 2015, “The Real Cost” partnered with SMOSH, two YouTube comedians with more than 20 million followers. The campaign worked with these talented comedians to develop a 3-minute rap video that shares funny vignettes of “21 things I'd rather do than smoke.” In 3 weeks, the video garnered more than 2.7 million views, and to date has more than 6.4 million. This is another benefit of leveraging YouTube celebrities; the content stays online long after the initial publication and continues to spread the campaign's messages. Results from internal analyses show that from 2014 to 2016, “The Real Cost” exceeded paid media goals by reaching 95% of teens >20 times per quarter and delivering >4.7 billion teen impressions in 2 years. Achieving these levels of reach and frequency led to the campaign attaining 90% ad awareness among the target audience 6 to 8 months after campaign launch.21Duke JC Alexander TN Zhao X et al.Youth's awareness of and reactions to The Real Cost national tobacco public education campaign.PLoS One. 2015; 10e0144827.https://doi.org/10.1371/journal.pone.0144827Crossref PubMed Scopus (76) Google Scholar The campaign continues to achieve high levels of exposure by emphasizing at-risk teen passion points, immersing youth in a layered media mix designed to surround them with campaign messages, and leveraging relevant messengers to spread awareness and increase campaign and message credibility. This multifaceted approach encourages youth engagement with “The Real Cost” messages, which presents relevant facts and information about the harms of tobacco use that shift knowledge, attitudes, beliefs, and ultimately intentions and behaviors, leading to a significant decline in youth tobacco use.12Weiss JW Cen S Schuster DV et al.Longitudinal effects of pro-tobacco and anti-tobacco messages on adolescent smoking susceptibility.Nicotine Tob Res. 2006; 8: 455-465https://doi.org/10.1080/14622200600670454Crossref PubMed Scopus (71) Google Scholar Despite the challenges of reaching media-savvy teens in a fragmented broadcasting environment with a low-interest topic, “The Real Cost” successfully engaged and educated youth.13Farrelly MC Duke JC Nonnemaker J et al.Association between The Real Cost media campaign and smoking initiation among youths—United States, 2014–2016.MMWR Morb Mortal Wkly Rep. 2017; 66: 47-50https://doi.org/10.15585/mmwr.mm6602a2Crossref PubMed Scopus (91) Google Scholar High levels of campaign awareness and positive perceptions of the campaign among the target audience suggests that the campaign's messages broke through the advertising clutter, created meaningful experiences that felt organic to each platform,21Duke JC Alexander TN Zhao X et al.Youth's awareness of and reactions to The Real Cost national tobacco public education campaign.PLoS One. 2015; 10e0144827.https://doi.org/10.1371/journal.pone.0144827Crossref PubMed Scopus (76) Google Scholar and encouraged the target audience to engage by viewing content and responding in social media. Through a data-driven media strategy, the campaign identified and used effective channels and relevant messengers, tracked trends in real time, and used social media to continuously reassess the target audience and the shifting media landscape. “The Real Cost” continues to evolve as the target audience and media landscape evolves, to reach youth who are at risk for cigarette smoking and contributing to the campaign's public health goals of preventing youth tobacco use." @default.
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• W2908610813 title "“The Real Cost”: Reaching At-Risk Youth in a Fragmented Media Environment" @default.
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