There are at least four broad approaches that can be taken when developing a mass media campaign to reduce the prevalence of smoking among young people. First, a campaign may try to directly influence individual-level predictors of smoking behavior, such as knowledge about the ingredients in tobacco products or the negative health effects of tobacco use, or tobacco-related beliefs (eg, impact of smoking on sport participation), self-efficacy (eg, refusal efficacy), or perceived social norms (eg, approval of smoking among peers). Alternatively, a campaign may try to indirectly influence an individual’s behavior by targeting others within the individual’s social environment. For instance, given the demonstrated association between exposure to direct peer pressure to smoke and an increased risk for smoking initiation (Australian Government Department of Health and Ageing, 2005; US Department of Health and Human Services, 2012), one possible objective for a mass media campaign may be to discourage young people from pressuring their friends to try smoking. If successful, such a campaign would reduce the likelihood that an individual was exposed to direct peer pressure to smoke, thereby reducing their risk for smoking initiation. In Table 1 (Page 4), we have identified 22 individual-level and social-level factors that we believe have the potential to be targeted in a tobacco control communication campaign that is directly targeted at young people. Table 1 lists these factors, the level of evidence linking the factor to smoking behavior among young people, and the extent to which this factor has been targeted and influenced by previous mass media campaigns. These individually focused, youth-directed factors (and campaigns that address them) are the predominant approaches that have been taken in efforts to reduce tobacco use among young people. However, there are two other approaches which have some history and the potential to form the basis for a mass media campaign. While these two alternative approaches (changing environments and reducing adult smoking behavior) are described in the following paragraphs, they are not the main focus of the detailed tables provided later in this document, given our assumption that an FDA-sponsored smoking prevention campaign is likely to adopt an approach of directly targeting the smoking behavior of young people.

A third approach for mass media campaigns is to work to create environments that are less conducive to smoking. For example, there is evidence that young people are at an increased risk for smoking when smoking is tolerated at their school, when they live or go to school in areas with a greater density of tobacco retailers, and when they are exposed to point-of-sale tobacco displays (US Department of Health and Human Services, 2012). Conversely, smoking bans in the home, clean indoor air laws in public places, and increases in the price of tobacco all serve as protective factors against smoking among young people (US Department of Health and Human Services, 2012). In efforts to address these environmental influences, mass media campaigns can be used to explicitly encourage legislators and regulatory bodies to take action, or they can used in a more