A mysterious substance crawls under a teen girl’s skin and across her face. The camera zooms into her lungs, where you can see worm-like animals eating away at her organs. “There’s an epidemic spreading,” a voice proclaims. “It’s not a parasite, not an infection, not a virus. It’s vaping.”
This ad is part of an anti-vaping campaign launched last fall by the Food and Drug Administration. The campaign, which focuses on the health risks of vaping, is accordingly going for an “irreverent” tone — the FDA told NBC News it was planned to meet kids on their own turf through social media and in school bathrooms. One school bathroom poster created by the campaign reads, “Strangely enough, some kids come here to put crap into their bodies.”
But appealing to kids’ digital savvy is not enough. If the FDA wants to convince kids to stop vaping, it needs to tap into messaging that appeals to kids’ sense of rebellion, not fear of health risks. Why? Because kids today don’t see vaping as particularly harmful.
Youth vaping is an epidemic. More than 3.6 million kids vape in the US today, equating to 20 percent of high schoolers and 5 percent of middle schoolers. In fact, there was a historically large increase between 2017 and 2018.
Juul, the most popular brand, looks like a flash drive and can be charged in a USB port. One Juul pod contains the same amount of nicotine as a pack of cigarettes. Therein lies the risk: High nicotine content can quickly lead to addiction, increasing the chances a teenager will turn to traditional cigarettes later on.
The vaping industry has been enormously successful at getting kids hooked. The marketing is spot-on. It’s targeted directly to teenage rationale. Though, for the record, the companies say doing so is “antithetical to [their] mission.” But their actions suggest otherwise; ads for Juul featuring bright colors, young models, and a thinly veiled promise of beauty and popularity, mirroring the ads made by cigarette companies decades ago. (Juul has stopped this youth-targeted marketing.)
Now, like cigarettes before them, vaping has become the target of anti-drug campaigns from public health-oriented nonprofits and government organizations like the FDA.
But what exactly makes an anti-drug campaign successful, and can it be applied to vaping? After all, the message at the core of most anti-drug messaging — and, it seems, at the core of the most recent FDA campaign — is that drugs are harmful. But kids see vaping as relatively harmless, or at least, less harmful than smoking cigarettes. (It’s worth noting that this may actually be true for those who are already hooked on smoking and looking to quit. But emphasizing this may suggest to teenagers that vaping is a safe and approved alternative, which is not the case.)
Most adults remember going through some kind of anti-drug program in school. Years later, researchers are still trying to figure out what anti-drug messaging is actually effective. The success of these campaigns depends on the drug, its pre-established societal standing, and the targeted audience. Discouraging teens from drinking alcohol is going to be different than discouraging them from driving under the influence because dissuading teen experimentation is different from encouraging risk reduction. Successfully addressing these unique public health issues requires varied approaches.
The original Drug Abuse Resistance Education, or D.A.R.E, program is the poster child of a mismatch between message and audience. Launched in 1983, the D.A.R.E. program was aimed at school-age children and emphasized the dangers of drugs, requiring students to take a pledge that they wouldn’t use them. The scaremongering proved ineffective; the “Just Say No!” mantra didn’t provide any explanation to kids as to why drugs were dangerous.
What’s worse, the D.A.R.E. program may have increased teen curiosity. As Dr. Michael Siegel, a national expert in tobacco use at Boston University School of Public Health, notes, teens like to rebel. When constantly told not to do drugs, the forbidden became ever more enticing. (Thankfully, D.A.R.E. has since changed its tactics.)
What has proven effective is anti-drug campaigns guided by youth psychology such as Above the Influence and the Truth campaign. Neither harps on the negative consequences of drugs or makes them “off limits.” Instead, Above the Influence encourages teenagers to explore the freedom that comes with a drug-free lifestyle and Truth encourages rebellion by reminding kids that the cigarette executives are deceiving them on purpose.
Current anti-vaping campaigns are often based on successful anti-smoking campaigns. The most successful, such as Tips, used scare tactics and negative messaging to emphasize the health risks. It worked because everyone knew smoking was dangerous. But kids don’t think vaping is bad for them. Emphasizing the dangers won’t work. In one study, even dual users, those who vape and smoke, were more skeptical than smokers about anti-vaping ads that focused on health risks since they already believed vaping was healthier than smoking.
Alcohol use campaigns face a similar struggle. Campaigns against drunk driving have been successful because people already believe it’s risky. But campaigns aimed at reducing consumption are up against the societal acceptance of drinking, perceived minimal risk, and the constant barrage of alcohol advertising — all factors at the forefront of the fight against youth vaping.
What may be the most effective approach to youth vaping is to take a page out of the industry’s playbook and tailor anti-vaping ads to what motivates kids. According to Siegel, that means playing into rebellion and independence, like the Above the Influence or Truth campaigns.
If kids see vaping as rebellious, public health needs to take back that narrative and prove not vaping is the true rebellion, according to Siegel. Rebels pride themselves on their independence. Yet vaping, particularly Juuling, can lead to addiction, which is the exact opposite.
Siegel suggests creating a tangible enemy to show kids that some company or entity wants to get them hooked. He picks Juul, since it’s the most popular brand and has the most potent nicotine delivery system. This promotes an “us against them” mentality, pitting the kids against the industry. Then “we can harness the core values of both autonomy and rebellion and create a youth rebellion against the entire concept of Juul,” he says.
Getting kids to stop vaping seems near impossible, especially given the power of addiction. It’s also an unfair matchup. The vaping industry has money to spend on advertising and success produces financial gains. Public health already has limited resources, and success doesn’t bring in more.
But a new generation is now addicted to nicotine, despite decades of progress. While the fight will always be an uphill battle, the FDA and the surgeon general have become critical allies through education campaigns and regulatory action. Harnessing both their influence and teenagers’ innate sense of rebellion, public health may eventually even the playing field with the vaping industry.
Elsa Pearson, MPH, is a policy analyst at Boston University School of Public Health.
Austin Frakt, PhD, is the director of the Partnered Evidence-Based Policy Resource Center, Veterans Health Administration; an associate professor at Boston University’s School of Public Health; and an adjunct associate professor with the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health.