Kathy Crosby is the Director of the Center for Tobacco Products (CTP) Office of Health Communication and Education. This multidisciplinary office contains several specialized divisions and teams, including regulatory communications, public education, research and evaluation, and Freedom of Information Act. Learn how these diverse teams of experts work together to support CTP’s public health mission.
Can you share a little bit of your background? How did it lead you to your work at CTP?
I’ve been in advertising my whole career. I spent the first 10 years in a traditional advertising agency, working on major national clients like US Airways, McDonalds, and Volkswagen. I worked on my agency’s pitch for the Truth Initiative, which was known then as the American Legacy Foundation. We, along with another agency we partnered with, won the Truth Initiative as a client. That was my first foray into behavior change advertising. I found that it allows me to do what I love most, which is advertising, while applying everything I know toward something that really matters. It isn’t selling a product; it’s advertising to help people’s lives.
Then I was recruited to lead the Advertising Council of Washington, D.C., which gave me the opportunity to work on many pressing social issues. That position led me to my job here at FDA. I was recruited to start CTP’s Office of Health Communication and Education, with two primary goals. Develop public education campaigns to reduce tobacco use, especially among youth, and raise awareness among the public about CTP’s actions and why they will benefit public health.
Why do you think that communication is so important to successful tobacco control?
Communication is critical to helping people rethink their relationship with tobacco. People are bombarded with thousands of messages a day, across so many different places and platforms. We have to become experts in all of these platforms to cut through the noise so that our message is heard. It’s also hard to break through the magnitude of information and misinformation that’s out there. As a regulatory agency, we have to compete with a nonstop news cycle, speak in a trusted voice, and clearly articulate what we are doing and why our actions will benefit public health.
CTP’s public education campaigns are unusual for a federal agency. What makes the campaigns so effective?
We are very lucky to have phenomenal resources to dedicate to the best practices of health communication. First, we do comprehensive research on our target audience. Most of our public education campaigns target teens who are vulnerable to tobacco use, though we have another campaign that targets adults who are trying to quit. We must understand the target audience’s current knowledge, attitudes, and beliefs, and learn what their barriers are to taking action. Second, we develop persuasive advertising that’s designed to change the way they think and act toward tobacco use. Third, we laser target the audience we’re trying to reach when we put the advertising in market.
It’s really the combination of doing your research, developing authentic and relevant creative, and then ensuring you’re able to find the person you’re trying to reach so that they see and engage with the ad. We’ve found through our evaluation that the vast majority of teens in the U.S. see our ads. By tracking these same kids over time, we know that we really are changing their attitudes and beliefs about using tobacco products, such that we’re driving down prevalence.
Why is it critical to have social scientists in your communications office?
We are so grateful to have a research team embedded in our communications office. Our expert social scientists help us develop every campaign we work on, starting with the formative research to help us know what messages might have salience and credibility. During the copy testing process, our researchers share the ads with a sample of the target audience to determine if they clearly understand the main message, and if that message is relevant and authentic. We also design the research to discover potential unintended consequences that could shift perceptions in the wrong direction.
Finally, our team performs comprehensive evaluation research to help us understand the impact of the campaign. For example, from its launch in February 2014 to November 2016, FDA’s first smoking prevention campaign, “The Real Cost,” prevented up to 587,000 youth ages 11 to 19 from initiating smoking cigarettes, half of whom might have gone on to become established adult smokers. Ultimately, by preventing these kids from becoming established smokers, the campaign will save them, their families, and the country more than $53 billion by reducing smoking-related costs like early loss of life, costly medical care, lost wages, lower productivity, and increased disability – that’s more than $180,000 in savings for each of the up to 293,500 youth that would likely have become an established smoker.
One of our overarching goals has always been to allow others to apply what we have learned to their own programs. From that perspective, our Research & Evaluation team is really on the cutting edge of behavior change advertising. Not only are we working to build an evidence base for communication science but we’re sharing our findings with the field so other tobacco control organizations can apply our findings to their own programs for their own successes.
How has the research team’s work changed during this time of COVID-19?
Our research team has had to really work differently in light of COVID-19. Integral to our success is traveling to communities across America talking to teens and adults to understand their current attitudes and beliefs toward tobacco products. We share our visual designs and our messages with our target audiences so that they can help us enhance and improve the advertising. With COVID-19, we haven’t been able to do all that in-person research. But we didn’t let that stop us. We found a different way to talk to our audiences through online focus groups and individual interviews. It’s been amazing to see how our social scientists have been able to adapt their research protocol. Our work hasn’t suffered at all because we are still able to glean the insights we need, even without traveling.
What are some of the tobacco regulations you’ve worked on at CTP that could have the greatest public health impact?
Our communications team lets the public know about every regulatory action we take. We explain each action we’re taking, why we’re taking it, and how we believe it will benefit public health. I am very proud that in some instances our office goes above and beyond our core responsibilities to contribute to the policies, rules and regulatory actions that we take.
We’ve had the opportunity to play a significant role in some noteworthy rules. Probably one of the most important is the final rule on cigarette health warnings. Health warnings from the Surgeon General first appeared on cigarette packages in 1966 and were last updated in 1984. Research shows that the warnings were failing to leave a memorable impression because of their unchanged content over the last 35 years, their small size and lack of images. Our communications staff worked hand in hand with our Office of Science to develop 13 new health warnings to promote awareness of some of the health effects of cigarette smoking, such as head and neck cancer, blindness, and diabetes. We also worked on images to occupy the top half of the front and back of the cigarette package. I am very proud that our communications office played a pivotal role developing the actual rule, as well as communicating the action to the public.
Our communications office also played an important role when FDA authorized the sale of the IQOS tobacco heating system, which is a device that heats tobacco-filled sticks wrapped in paper to create an aerosol that contains nicotine. FDA found that permitting the sale of the product was appropriate for the protection of the public health because it produces fewer or lower levels of some toxins than combustible cigarettes. However, FDA placed strict marketing restrictions to prevent youth access and exposure to the new products. Our communications team took the lead in developing the marketing restrictions, especially restrictions on social media influencers and how ads can be targeted online, to prevent youth from seeing the advertising to the greatest degree possible. Our marketing expertise was essential to putting these restrictions in place.
CTP has an innovative collaboration with Scholastic to create e-cigarette educational materials for students and teachers. What need do these materials fulfill?
We’re very excited about our collaboration with Scholastic. Through our public education campaigns, we’ve been talking with teens for 5 years about the dangers of using tobacco products. However, as schools become the epicenter of youth vaping, we need to make sure that teachers understand what is happening on school grounds. We want to equip teachers with the facts they need to have science-based conversations with the teens in their care in their classrooms. So, in collaboration with Scholastic, we’ve developed multiple rounds of expansive multimedia resources for teachers and school administrators. This includes videos, lesson plans, fact sheets for students and parents, and a wealth of other resources to help adults engage in viable and valuable conversations with students about the dangers of vaping. These resources offer some excellent online learning tools for teachers to rely upon, especially when schools are temporarily closed because of COVID-19.
How do you work with stakeholders to improve public health?
Through our active stakeholder engagement program, we engage in face-to-face outreach at local, state, and national conferences and health fairs, meeting with public health advocates, tobacco consumers, researchers, educators, and many more. Over the last 10 years, we’ve attended conferences with a total of more than 1.3 million attendees, answering questions and providing resources and materials. In addition, our Exchange Lab offers a robust online repository of free FDA-branded public health education materials to educators, retailers, researchers, doctors, and health departments. Since it was created, the Exchange Lab has provided over 263,000 pieces of print material. It also offers syndicated web content with the latest health facts, as well as social media content for tobacco prevention and education efforts.
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We also engage with state and local governments and tobacco retailers by distributing resources like CTP’s retailer education program, “This Is Our Watch,” which provides materials to tobacco retailers to help them understand and follow FDA regulations. We’ve partnered with the state of Virginia to expand our public education campaign, “Fresh Empire,” to help reduce tobacco use in Virginia among African American, Hispanic, and Asian American/Pacific Islander youth who identify with hip-hop culture. We’ve also collaborated with other federal agencies, including a partnership with the Department of Defense’s Operation Live Well to provide more than 70 military base theaters nationwide with “The Real Cost” tobacco public education ads. In addition, we’ve partnered with public health stakeholders to expand our reach into populations that CTP didn’t previously have access to. Those organizations, the National Association of School Nurses, the National Behavioral Health Network, and the National Alliance for Hispanic Health, represent 15 million new potential audience members for CTP.
What role does the Freedom of Information Act (FOIA) team serve in your office?
Our FOIA team plays such a critical role in transparency—allowing the public and stakeholders to understand the actions we take in a way that protects confidential commercial information. Our FOIA team does an amazing job of helping to bring light to our actions through an important and balanced process. They really are unsung heroes. They have to understand FOIA law, they have to understand science, and they have to understand how to protect proprietary information so the requestor can get what they need, but it doesn’t come at the harm of releasing a company’s confidential information. It’s a very delicate balance.
How do you keep up with the quickly evolving issues with youth use of e-cigarettes?
We try to cast a wide net to help us understand what’s happening with youth usage. We talk to thousands of teens every year, through focus groups and longitudinal evaluations, to really understand what’s happening, what teens are seeing, why they’re seeing it, and how it makes them feel. That is one of the best ways we keep on top of youth use of e-cigarettes. Other pivotal tools we use are the major annual surveys, including Monitoring the Future and the National Youth Tobacco Survey. In addition, we have comprehensive data on the tobacco marketplace, social media, and conversations happening online. Those are just a few of the diagnostic tools to look at the marketplace and changing patterns of youth usage. We use a combination of existing surveys, talking directly with teens, looking at social media and sales data, to gain marketing intelligence on youth e-cigarette use.
Which accomplishment over your tenure at CTP are you most proud of?
That’s a hard question because there’s so much to be excited about. But if I need to narrow it down, I’d say one accomplishment is that we’ve developed an absolute world-class team of professionals in our office, from marketing and communication experts to social science authorities, to specialists in transparency to government contracting professionals. I think the results we’ve garnered are really a testament to the people we’ve recruited to work with us on complex and important public health issues. Experts.
The second thing I’m proud of is we were able to create really sophisticated, persuasive advertising and dynamically shape the trajectory of tobacco use in this country. One effort alone prevented almost 600,000 youth, who would have tried cigarettes if they hadn’t seen “The Real Cost,” from initiating smoking. And that means so much, not just for those kids and their families, but for the future health of our nation. I think this tops my bucket list.