Creating More Effective Vape Education Campaigns: Qualitative Feedback from Teens in Nine US States

Background: Successful media campaigns to reduce teen cigarette smoking indicate a similar approach may work for vaping, though message testing research is necessary to identify effective topics and approaches. Leveraging data from message testing studies across nine U.S. states, we identify promising topics and approaches and explore how the COVID-19 pandemic affected teens' reactions to vape education commercials. Methods: Teens ages 13-18 (N = 337) who vaped or were susceptible nonusers participated in focus groups and interviews (2018-2021) to review 35 creative concepts and commercials for Behind the Haze (BTH), a vaping education campaign. After viewing each video, participants assessed its perceived effectiveness (PE) and discussed their reactions. We conducted a reflexive thematic analysis of transcripts to identify crosscutting themes and compared PE scores for each video. Results: Key features of effective commercials included detailed facts accompanied by explanatory visuals, metaphors, and empathy. Promising topics included chemicals, physical consequences, and mental health, while addiction and industry deception messages were less impactful. The pandemic drew attention to mental health and immunity messages. Impact of one's vaping on friends emerged as a promising topic. Conclusions: While some tactics from successful cigarette prevention campaigns apply to vaping, others like anti-industry messaging do not. Fact-focused messaging on chemicals, physical consequences, and mental health accompanied by impactful graphics and attention-grabbing twists should be the focus of vape education campaigns. Frequent message testing research such as that conducted to inform BTH is necessary to identify promising and sometimes unexpected messaging approaches for timely and relevant teen vaping education materials.