Wave 3 Phase 1 Qualitative Research: General Market ("The Real Cost") At-Risk Youth Tobacco Prevention Focus Groups (Change)

FDA CENTER FOR TOBACCO PRODUCTS

GENERAL MARKET AT-RISK YOUTH TOBACCO PREVENTION CAMPAIGN

WAVE 3: CREATIVE CONCEPTS FOR QUALITATIVE TESTING

LUNG – UNHAPPILY EVER AFTER

What if key characters in well-known stories had smoked as teens? Their stunted lungs would have stood in their way, and the tales we tell would be much different.

TV/VIDEO: WALK OF SHAME :30

Open on the Big Bad Wolf walking. He’s looking down, dejected, as a sad song plays in the background.

Camera zooms out to reveal he’s walking through a city made entirely of straw and inhabited by pigs.

The pigs aren’t scared of the Big Bad Wolf at all. Most pay him no mind, but here and there a few mock him. One points him out to his friends, and they laugh. A child in a stroller sticks his tongue out at him.

The Big Bad Wolf sighs, and it’s implied that he lights a cigarette.

AVO: Smoking as a teen can permanently stunt your lungs, taking the air out of even the biggest and baddest. (USDHHS Consumer Booklet 2012, p. 6).

Know The Real Cost

TV/VIDEO: TRASH TALK :30

Open on Grandma in her nightgown, shuffling in the woods and slightly out of breath. She turns around and circles back.

GRANDMA: What you got? I THOUGHT SO. What you got? I’ll tell you what you
got—oh, what SMALL LUNGS you got. WOOOO! Can’t touch this.

Cut to Big Bad Wolf, out of breath, holding on to a tree. Deciding this isn’t worth it, he pulls out a pack of cigarettes and it’s implied that he lights up.

AVO: Smoking as a teen can permanently stunt your lungs. (USDHHS Consumer Booklet 2012, p. 6).

Big ears and big eyes won’t get you anywhere when you run out of breath. (USDHHS Consumer Booklet 2012, p. 7).

Know The Real Cost

TV/VIDEO: THE CHOSEN ONE :30

Open on great hall filled with people. At the front of the room, there’s a long staircase, at the top of which is the Grand Leader giving a speech.

GRAND LEADER: And now, ladies and gentlemen of The City, at long last—I
present to you this year’s Chosen One, Leah Scrimdry!

Crowd cheers as Leah gets up, and starts chanting her name as she makes her way up front.

CROWD: LE-AH! LE-AH! LE-AH! LE-AH!

Crowd continues chanting as Leah starts up the staircase. Halfway up, she runs out of breath and stumbles, and a pack of cigarettes falls out of her pocket. She goes into a panting fit and sits down on the steps to rest, while the crowd stares in stunned silence.

Slowly, someone in the crowd starts chanting another name and the rest join in.

CROWD: TA-MA-RA! TA-MA-RA! TA-MA-RA! TA-MA-RA!

Cut to Tamara, who shrugs, gets up and climbs up the staircase to be welcomed by the Grand Leader. He hands her the Celestial Orb, and she waves at the cheering crowd.

AVO: Smoking as a teen can stunt your lungs (USDHHS Consumer Booklet 2012, p. 6). Don’t eliminate yourself.

Know The Real Cost

TV/VIDEO: VAMPIRE ROMANCE :30

Open on a teenage girl and her vampire lover in a gazebo. They gaze at each other passionately.

ISABEL: Show me your world.

EDDIE: You’ll have to leave all this behind.

ISABEL: All this means nothing without you.

Eddie sweeps Isabel into his arms and takes off running supernaturally fast.

Cut to his POV. He goes at warp speed for a few seconds and then starts to run out of breath. It feels like he’s gone hundreds of miles, but when he stops, we can still see the gazebo in the background and realize he’s only made it down the block.

Eddie puts Isabel down. It’s implied that he lights a cigarette, and he all but collapses onto the curb.

ISABEL: [Perplexed] …This is your world?

AVO: Smoking as a teen can stunt your lungs (USDHHS Consumer Booklet 2012, pp. 6–7) — for eternity (USDHHS Consumer Booklet 2012, p. 7).

Cut back to Eddie, still panting .

EDDIE: Think you could walk?

END CARD: THE REAL COST

LUNG – Rumor

It’s all about size—and lungs are no exception. After all, being small is a major mojo-killer for anyone.

TV/VIDEO: SHE HEARD :30

Open on two teenage girls sitting at a picnic table in a park.

SHEILA: I hear he’s, you know… small… there.

COLLEEN: Yeah, a girl in my English class actually used the word “stunted.”

Girls giggle cruelly.

SHEILA: It’s kinda too bad. I actually thought he was cute before
I found out.

COLLEEN: Soo not worth it now, though. Just no.

They look over their shoulders and, as the camera comes into focus, we see that the boy in question in the background. It’s implied that he’s smoking.

AVO: Teens who smoke are more likely to have underdeveloped lungs
(USDHHS Consumer Booklet 2012, p. 6). Grow a pair.

Know The Real Cost

TV/VIDEO: HE SAID :30

Open on two teenage boys with BMX bikes at the top of a mountain, near a dirt track. .

TOM: You almost feel sorry for the guy.

ROSS: Yeah. Not being able to finish? Ouch.

They look at someone in the distance, off camera, and shake their heads.

TOM: It can be permanent, too.

ROSS: Oh man, I can’t even imagine going the rest of my life like that.

We see the boy they’re talking about down the mountain a ways, doubled over and panting, unable to get up the slope.

The boy, exhausted, leans against his bike. The boy pulls a pack of cigarettes out of his pocket and it’s implied that he lights one.

AVO: Teens who smoke are more likely to have underdeveloped lungs
(USDHHS Consumer Booklet 2012, p. 6). Grow a pair.

Know The Real Cost

LUNG – LITTLE LUNGS IN A GREAT BIG WORLD

If your lungs have been stunted by smoking, you won’t be able to keep up with the rest of the crew. Poor little you.

TV/VIDEO: SNOWBOARDING :30

Intro jingle: Now it’s time for... “Little Lungs in a great big world” (ding!)

VO: The story of a pair of lungs that smoked as a teen and never grew to normal size.

We open on Little Lungs sitting by a fireplace inside a lodge when a bunch of Larger Lungs walk up to him holding snowboards.

LARGE LUNGS: Hey, aren’t you the one they call Little Lungs? (in a great big world)

LITTLE LUNGS: Sure am!

LARGE LUNGS: Well, whadya say you come snowboarding with us?

LITTLE LUNGS: I’ll give it a try!

Cut to them atop a big mountain as the Larger Lungs all swoop down the slope, riding over jumps and moguls with ease.

LITTLE LUNGS: Look at me!

Little Lungs starts down the hill and seems to be doing OK the first few turns. But soon he’s running out of breath and losing control.

LITTLE LUNGS: My little lungs can’t get enough air!

Soon he’s picked up too much speed and accidentally skis off a gigantic jump, sending him flipping through the air until he lands in the trees, bouncing off multiple branches until he gets speared on a moose’s antlers. Then another moose starts nibbling on him.

LARGE LUNGS: Awww, poor little pair of lungs...
(in a great big world)

Cue jingle again.

SUPER: Smoking as a teen can stunt your lungs (USDHHS Consumer Booklet 2012, pp. 6–7).

THE REAL COST

LOSS OF CONTROL – CRAVINGS

Once you start experiencing cravings, tobacco has started to control your life. You don’t want the kind of hunger that only a cigarette will feed.

TV/VIDEO: ROSEMARY’S CRAVING (CONCERT) :30

Open on Rosemary and a couple of her teen friends at a big concert. They’re dancing around and having the time of their lives as the music and lights blare.

The sound of the music cuts out as we transition to a close-up of Rosemary. She’s stopped dancing and is clutching her head, as if suffering from a sudden migraine. We hear something whimper.

ROSEMARY: [To herself] Oh no.

There’s something under the skin of her forehead, pulsating. Rosemary clutches it as she runs toward the back.

As she sprints through the crowd, a monstrous mouth opens up in her forehead and emits a dark cry. She bursts out of the arena.

Cut to Rosemary in the parking lot. She pulls out a pack of smokes and a long tongue darts out of the mouth to grab a cigarette from it. Cut to a view of her from behind, smoke rising.

AVO: It can take just a few cigarettes for cravings to show their ugly face. Don’t let tobacco control you (Ursprung & DiFranza 2010; Doubeni et al. 2010).

END CARD: THE REAL COST

BRAIN CHANGE – Flerg and Blerg

Zombies know firsthand that nicotine changes brains. Meet Flerg and Blerg, two not-exactly-dead guys going about their post-apocalyptic lives.

TV/VIDEO: TRADESIES :30

Zombies Flerg and Blerg are chowing down on a pile of remains.

FLERG: Braiiiiins...

BLERG: Brains...

Flerg picks up a brain and bites into it. He grimaces and spits it out. We see Flerg get an idea in his head.

He smiles to himself.

FLERG: [Overenthusiastically] Ooh! This brain sooo yum! Tradesies?

Blerg looks suspicious.

BLERG: Brain yum?

Flerg nods enthusiastically, and they trade brains. Blerg takes a bite, then spits it out in disgust. Flerg laughs at him.

BLERG: [Brandishing the brain] Argh! Brain yuck! You give me smoker brain!
Cigarette change brain. (Ursprung & DiFranza 2010; Doubeni et al. 2010; USDHHS Consumer Booklet 2010, p. 4). Give back!

Cut to shot of corpse from which the brain in question came. We see a cigarette pack in its jacket pocket.

Blerg grabs for the fresh brain. Flerg dodges and stuffs it into his mouth, eating the rest of it as quickly as possible, barely fitting it in. He smiles through puffed-out cheeks. Blerg shakes his head.

Cut to TRC logo over black.

BLERG: [Over super] Cigarette change brain.

VO: Smoking changes the brain, causing you to crave nicotine.
(USDHHS Consumer Booklet 2010, p.4;).

END CARD: See more at youtube.com/flergandblerg

TV/VIDEO: BIG SAVINGS :30

Open on a zombie supermarket. It sells brains, and all the staff and customers are zombies. Flerg is pushing the cart, Blerg is putting items into it. They arrive at a bin marked “SMOKER BRAINS - 90% OFF”.

BLERG: Big savings!

FLERG: Big risk. Smoke make different, brain yuck ( Ursprung & DiFranza 2010; Doubeni et al. 2010).

BLERG: It fine. You worrier. Me warrior!

Cut to later, in their bathroom. Flerg is holding Blerg’s hair as the latter vomits.

FLERG: Who warrior now?

Blerg retches again. A handful of his hair comes off in Flerg’s hand as his head thunks into the toilet.

Cut to TRC logo over black.

BLERG: [Over super] Cigarette change brain.

VO: Smoking changes the brain, causing you to crave nicotine.
(USDHHS Consumer Booklet 2010, p.4;)

END CARD: See more at youtube.com/flergandblerg

BRAIN CHANGE – Hacking

It only takes 10 seconds for nicotine to reach your brain. Don’t want your brain to get hacked? Don’t smoke.

TV/VIDEO: HACKER :30

We see a teen outside on her mobile device. We hear an ominous voiceover from a voice that’s being digitally disguised.

VOICE: I don’t need your password to hack your identity. I have direct access to the most powerful server, hardware and software known to humankind. Your brain.

The girl exhales smoke.

VOICE: And when I’m there, I’ll rewire your brain to crave more, just the way I like it. I’m nicotine. A few cigarettes and I’m already taking over.
That’s the real cost of tobacco. (Ursprung & DiFranza 2010; Doubeni et al. 2010; USDHHS Consumer Booklet 2010, p. 4).

That’s the real cost of tobacco.

Cut to end card.

CARD: THE REAL COST

TV/VIDEO: PASSCODE :30

A super that says “ENTER PASSCODE:” is over the following action:

SUPER: ENTER PASSCODE

We see a kid being offered a cigarette. He looks unsure but then accepts it nervously.

The password begins to crack, numbers, symbols and letters rotating in each square, locking in one by one.

Finally, the password is cracked. The boy exhales smoke.

AVO: Don’t get hacked. A couple of cigarettes and nicotine can rewire your brain to crave more. (Ursprung & DiFranza 2010; Doubeni et al. 2010; USDHHS Consumer Booklet 2010, p. 4).

Cut to end card.

END CARD: THE REAL COST

Appearance-related health risks – Don’t retouch your face with cigarettes

Teens live in an age where image is everything, and every image they consume has been retouched. But what they don’t know is that when they smoke, they’re letting the effects of cigarettes retouch their face.

TV/VIDEO: PARTY :30

We see a group of friends at a party. As they’re chatting, it’s implied they are smoking cigarettes – they exhale smoke. Everything pauses, frozen in place. The camera rotates around the friends, pushing in closer on a girl’s face. Retouching tools appear.

VO: Smoking makes your skin age (Ortiz & Grando 2012; Just et al. 2007; Urbanska et al. 2012).

The tools add a wrinkle next to her eye, then another, and another. The camera moves past a plume of smoke and the tools start adding wrinkles to a guy’s forehead and mouth area.

VO: It causes gum disease (USDHHS, 2012).

We move in toward another girl, smiling widely, where computer tools begin darkening areas of her gums and start cloning out pieces of her gum line.

VO: And may stain your teeth (Watts & Addy 2001).

The tools also begin recoloring her teeth to a shade of yellow.

VO: It can even make your skin look grayish (Ortiz & Grando 2012).

The camera pulls out and color-shifts everyone’s skin tone to a gray shade. The camera rotates back to where it began and now we see everyone with wrinkles, yellow teeth and grayer skin… it’s not very flattering.

SUPER: DON’T RETOUCH YOUR FACE WITH CIGARETTES.

Transition to end card.

END CARD: THE REAL COST

Appearance-related health risks – The gift that smoking gives YOU

Smoking has some pretty nasty stuff planned for your appearance if you keep it up. So we’ll portray this by having unexpected gifts show up at teens’ houses containing various cosmetic “alterations” inside, as if we’re in some sort of bizarre Twilight Zone world.

TV/VIDEO: GIFT :30

Open on an ordinary house in Middle America where a generic UPS-style delivery man approaches a house. A teen answers the door. There’s a puff of smoke floating away as he opens it, like he’s just finished a smoke.

DELIVERY MAN: Package for James McCoy?

TEEN: That’s me. Who’s it from?

DELIVERY MAN: Doesn’t say.

The teen sees there’s no return address and accepts it with a mix of curiosity and suspicion. When he opens it up, it’s a lovely gift-wrapped box with a red bow on top. But inside, it’s a set of yellow-stained teeth (Watts & Addy 2001), with a tiny note saying:

Enjoy your new teeth!

Thanks for smoking, Cigarettes

The teen is horrified when he realizes what cigarettes are doing to him.

VO: Once you start smoking, the consequences aren’t far behind. Cigarettes may leave you with stained teeth, wrinkled skin and more (Ortiz & Grando 2012; Just et al. 2007; Urbanska et al. 2012; Watts & Addy 2001).

Know The Real Cost.

Each spot will feature a different teen receiving a different “gift.”

E-CIG – BRAIN HACK, HACKER
(E-CIG VERSION)

We see a teen outside immersed in her mobile phone. We hear an ominous voice-over from a voice that’s being digitally disguised.

VOICE: I don’t need your password to hack your identity. I have direct access to the
most powerful server, hardware and software known to humankind. Your brain.

The girl exhales e-cigarette aerosol, which billows up.

VOICE: And when I’m there, I’ll rewire your brain to crave more, just the way I like it. I’m nicotine. Before you know it, I’m in control.

VO: Don’t get hacked. E-cigs can contain nicotine, just like cigarettes, which can lead to addiction (Vansickel & Eissenberg 2013; Hecht et al. 2014; Adriaens et al. 2014; Etter 2014).

Know the real cost of e-cigs.

Cut to end card.

END CARD: THE REAL COST

SUPER: KNOW THE REAL COST OF E-CIGS

E-CIG – E-SNAKE

Open in an urban park. A handful of teens are hanging out, talking. A girl walks up to them with a snake hanging calmly around her neck, as if it’s her pet. The others take a step back, afraid.

GIRL: Relax guys, it’s just an E-snake.

GUY: E-snake?

GIRL: Yeah, it’s harmless. Here, pet it.

One of the teens strokes its skin, but it recoils angrily. We hear its tail make a scary, electronic-sounding “rattle.” The girl’s eyes suddenly open wide in fear.

E-SNAKE: (robotic voice) Dispensing venom in 3, 2, 1…

The snake starts to raise its head to strike, as the teens all start to freak out and run for it. The girl tries to pull the snake off, but it starts coiling around her neck, tightly.

ALL TEENS: (screaming)

VO: Just because it’s electronic doesn’t mean it’s harmless.

She finally yanks the snake off and sends it flying. The snake crashes into the ground and breaks to dozens of metal and clear e-cig pieces with nasty liquids. A super appears over the pile and we hear VO.

VO: Inhaling from an e-cig could mean inhaling chemicals like acrolein and nicotine. (Cheng, 2013; Goniewicz, 2014; Williams et al. 2013).

Cut to end card.

END CARD: THE REAL COST

SUPER: KNOW THE REAL COST OF E-CIGS

STRATEGIC CONCEPTS

Don’t vape your way to addiction

E-cigarettes are often promoted as being better for you than regular cigarettes. But most e-cigs contain nicotine (Vansickel & Eissenberg 2013; Hecht et al. 2014; Adriaens et al. 2014; Etter 2014)– the addictive chemical in cigarettes that makes quitting so difficult for those who smoke (USDHHS 2004, p.616; USDHHS Consumer Booklet 2010, p.8). If you vape, you may end up addicted to nicotine, just like a regular smoker.

E-cig flavoring may damage your lungs

Chocolate. Caramel. Toffee. These flavorings may lead you to think there’s nothing harmful about e-cigs. But although they may be safe to eat, when inhaled, they can cause irreversible obstructive lung disease (Barrington-Trimis JL et al. 2014). Just because something is safe to eat doesn't mean it’s safe to inhale.

What’s in an e-cig?

If I gave you a mysterious bottle containing an unknown liquid and asked you to drink it, would you? Probably not. But if you’re using an e-cigarette, you’re basically doing the same thing. Do you know what’s in an e-cig?

E-cigarettes and cigarettes have a lot in common

E-cigarettes may not seem much like regular cigarettes. But most e-cigs contain nicotine and other harmful chemicals (Goniewicz et al. 2014; Cheng 2014) found in cigarette smoke (USDHHS 2010, p. 229). Maybe e-cigs and regular cigarettes have more in common than you know.

Don’t think of vaping as “safe smoking”

Some young people who wouldn’t consider smoking a cigarette are open to using e-cigs. But some of the same harmful chemicals in cigarette smoke can also be found in e-cig aerosol, including acrolein (Goniewicz et al. 2014; Cheng 2014), and nicotine (Vansickel & Eissenberg 2013; Hecht et al. 2014; Adriaens et al. 2014; Etter 2014). If you wouldn’t smoke regular cigarettes, why would you use e-cigs?

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