Influence of a Nationwide Social Marketing Campaign on Adolescent Drug Use

In this study, we examined whether awareness (recall) of the National Youth Anti-Drug Media Campaign (NYADMC) benefited youth by attenuating their drug use. Data were obtained from the National Survey of Parents and Youth (NSPY), an evaluative survey tool designed to monitor campaign progress over 4 years. A growth modeling strategy was used to examine whether change in message recall or campaign brand awareness was related to declining patterns of drug use. Two distinct growth trajectories were modeled to account for growth among younger (12 to 14) versus older (15 to 18) youth. Growth trajectories indicated steady and positive increases in alcohol, cigarette, and marijuana use over time. During the early portion of adolescence, youth reported more “brand” awareness, remembered more of the video clips depicting campaign messages, recalled more media stories about youth and drugs and more antitobacco ads, and reported more radio listening and less television watching. When they were older, these same youth reported declines in these same awareness categories except for specifically recalling campaign ads and radio listening. Models positing simultaneous growth in drug use and campaign awareness indicated mixed findings for the campaign. Overall early levels of campaign awareness had a limited influence on rates of growth, and in a few cases higher levels were associated with quicker acquisition of drug use behaviors. When they were younger, these youth accelerated their drug use and reported increasing amounts of campaign awareness. When they were older, increasing awareness was associated with declines in binge drinking and cigarette smoking. No effects for marijuana were significant but trended in the direction of increased awareness associated with declining drug use. The findings are discussed in terms of how they depart from previous reports of campaign efficacy and the potential efficacy of social marketing campaigns to reach a large and impressionable youthful audience with strategically placed advertisements.     

Confirmed Recall and Perceived Effectiveness of Tobacco Countermarketing Media in Rural Youth

This study was the first to examine rural youth’s responses to ten television and radio tobacco countermarketing ads aired during a 13-week field campaign conducted in a U.S. Northern Plains state. A post-campaign survey of 391 girls and boys aged 12–17 years and including 58 American Indian youth provided information about their confirmed recall (CR) of the ads; and for recalled ads, their ratings of the ads’ perceived effectiveness (PE). Results were that controlling for age and smoking risk, both American Indian and white girls and boys had the highest CR for the television ad Artery and for the radio ad ABC. Artery shows fatty deposits being squeezed from a deceased smoker’s aorta, and ABC presents a former smoker speaking through his electro-larynx. Among the television ads, PE ratings were highest for the ad Artery in both boys and girls. Among the radio ads, boys rated ABC highest, whereas girls rated Joe DoBoer highest—an ad that discusses mouth lesions that developed from using smokeless tobacco. An analysis of race/ethnicity differences in PE for the ad Artery and ABC indicated American Indian and white youth considered these ads equally effective. These findings indicate certain TV and radio ads depicting graphic health harms from tobacco—especially the TV ad Artery and the radio ad ABC—are highly recalled and perceived as effective by both American Indian and white girls and boys from a rural region. Future research is needed to better understand which individual- and media-level factors increase the likelihood that anti-tobacco ads will be effective in reducing youth tobacco use.     

Harnessing Youth and Young Adult Culture: Improving the Reach and Engagement of the truth® Campaign

The national youth and young adult tobacco prevention mass media campaign, truth®, relaunched in 2014 with the goal of creating “the generation that ends smoking.” The objective of this study was to assess whether the strategy of airing truth ads during popular, culturally relevant televised events was associated with higher ad and brand awareness and increases in social media engagement. Awareness of six truth advertisements that aired during popular television events and self-reported social media engagement were assessed via cross-sectional online surveys of youth and young adults aged 15–21 years. Social engagement was also measured using separate Twitter and YouTube metrics. Logistic regression models predicted self-reported social engagement and any ad awareness, and a negative binomial regression predicted the total social media engagement across digital platforms. The study found that viewing a popular televised event was associated with higher odds of ad awareness and social engagement. The results also indicate that levels of social media engagement for an event period are greater than for a nonevent period. The findings demonstrate that premiering advertisements during a popular, culturally relevant televised event is associated with higher awareness of truth ads and increased social engagement related to the campaign, controlling for variables that might also influence the response to campaign messages.     

Effects of the National Youth Anti-Drug Media Campaign on youths

Objectives. We examined the cognitive and behavioral effects of the National Youth Anti-Drug Media Campaign on youths aged 12.5 to 18 years and report core evaluation results.Methods. From September 1999 to June 2004, 3 nationally representative cohorts of US youths aged 9 to 18 years were surveyed at home 4 times. Sample size ranged from 8117 in the first to 5126 in the fourth round (65% first-round response rate, with 86%–93% of still eligible youths interviewed subsequently). Main outcomes were self-reported lifetime, past-year, and past-30-day marijuana use and related cognitions.Results. Most analyses showed no effects from the campaign. At one round, however, more ad exposure predicted less intention to avoid marijuana use (γ = −0.07; 95% confidence interval [CI] = −0.13, −0.01) and weaker antidrug social norms (γ = −0.05; 95% CI = −0.08, −0.02) at the subsequent round. Exposure at round 3 predicted marijuana initiation at round 4 (γ = 0.11; 95% CI = 0.00, 0.22).Conclusions. Through June 2004, the campaign is unlikely to have had favorable effects on youths and may have had delayed unfavorable effects. The evaluation challenges the usefulness of the campaign.Between 1998 and 2004, the US Congress appropriated nearly $ 1 billion for the National Youth Anti-Drug Media Campaign. The campaign had 3 goals: educating and enabling America''s youths to reject illegal drugs; preventing youths from initiating use of drugs, especially marijuana and inhalants; and convincing occasional drug users to stop.¹ The campaign, which evolved from advertising efforts by the Partnership for a Drug-Free America,² did not expect to affect heavy drug users.The campaign was designed to be comprehensive social marketing effort that aimed antidrug messages at youths aged 9 to 18 years, their parents, and other influential adults. Messages were disseminated through a wide range of media channels: television (local, cable, and network), radio, Web sites, magazines, movie theaters, and several others. Additionally, the campaign established partnerships with civic, professional, and community groups and outreach programs with the media, entertainment, and sports industries. Across its multiple media outlets, the campaign reported buying advertising from September 1999 through June 2004; it was expected that, on average, a youth would see 2.5 targeted ads per week. Sixty-four percent of the gross rating points (GRPs) purchased for the ads were on television and radio. (Within the advertising industry, GRPs are the customary units for measuring exposure to ads. If 1% of the target population sees an ad 1 time, that ad earns 1 GRP).The youth-focused ads, including ads targeted at African American youths and Hispanic youths (in Spanish), fell into 3 broad categories: (1) resistance skills and self-efficacy, to increase youths'' skill and confidence in their ability to reject drug use; (2) normative education and positive alternatives, addressing the benefits of not using drugs; and (3) negative consequences of drug use, including effects on academic and athletic performance. The emphasis on each theme varied across the 5 years of the campaign studied here. To unify its advertising, beginning in 2001, the campaign incorporated a youth brand phrase: “———: My Anti-Drug” (with “Soccer,” for example, filling in the blank). Most campaign ads up to late 2002 did not concentrate on a specific drug, although some ads named marijuana. In late 2002, the campaign introduced the Marijuana Initiative, which altered the ads'' mix of messages to a focus on specific potential negative consequences of marijuana use. In the final 6 months evaluated here, about half of the ads were focused on an “early intervention” initiative, that encouraged adolescents to intervene with their drug-using friends.The campaign involved many institutions. It was supervised by the White House Office of National Drug Control Policy, with overall campaign management by advertising agency Ogilvy and Mather and public relations and outreach efforts by Fleishman Hillard. Most ads were developed on a pro bono basis by individual advertising agencies working with the Partnership for a Drug-Free America. The evaluation, mandated by Congress, was supervised by the National Institute on Drug Abuse and undertaken by Westat and the Annenberg School for Communication at the University of Pennsylvania.We examine the campaign''s effects on youths between September 1999 and June 2004, from its full national launch to 9 months after a major refocusing, partly in response to earlier evaluation results.³ Effects on parents are reported separately.⁴     

Measuring Exposure to Pro- and Anti-tobacco Marketing Among Adolescents: Intercorrelations Among Measures and Associations With Smoking Status

Exposure to tobacco - related marketing has been implicated as one of the risk factors for tobacco use among adolescents. However, tobacco - related marketing exposure has been measured in different ways in different studies, including per ceived pervasiveness, receptivity, recognition, recall, and affect. It is not known whether these measures represent one or more underlying constructs and how these underlying constructs are associated with adolescent smoking status. This study analyzed data from 5, 870 eighth - grade students in California, collected in 1996- 1997 as part of the Independent Evaluation of the California Tobacco Control , Prevention, and Education Program . An exploratory factor analysis of multiple measures of tobacco - related marketing exposure revealed four distinct factors: per ceived pervasiveness of protobacco marketing, perceived pervasiveness of anti tobacco marketing, recognition of specific antitobacco advertisements, and receptivity to protobacco marketing. Receptivity to protobacco marketing showed the strongest association with smoking status; higher levels of receptivity were associated with higher levels of smoking. Two measures of exposure to antitobacco marketing (perceived pervasiveness of antitobacco marketing and recognition of spe cific antitobacco ads) were highest among established smokers and lowest among susceptible nonsmokers. The same pattern was evident for perceived pervasiveness of protobacco marketing. Results suggest that exposure to tobacco - related market ing is a multidimensional construct, and each dimension may have a unique contribution to the process of smoking initiation. Because adolescents are exposed to numerous pro - and antitobacco messages, it is important to develop antitobacco media campaigns that can successfully counter protobacco marketing efforts. Potential strategies include targeting the susceptible nonsmokers who are at high risk for smoking and developing messages to decrease receptivity.     

Health Communications in Rural America: Lessons Learned from an Arthritis Campaign in Rural Arkansas

CONTEXT: Lack of awareness about diseases and associated risk factors could partially account for some rural health disparities. Health communications campaigns can be an effective means of increasing awareness in these areas. PURPOSE: To review findings and lessons learned from a rural health communications campaign. METHODS: The health communications campaign titled "Physical Activity. The Arthritis Pain Reliever," developed by the Centers for Disease Control and Prevention, was implemented in a rural Arkansas county to promote awareness about arthritis and the beneficial effects of physical activity among residents 45-64 years of age with arthritis. The campaign was implemented through radio spots, print ads in local newspapers, and distribution of brochures and posters. A survey of 193 residents with arthritis assessed the reach of the campaign.Findings:Whereas 86% of respondents reported having seen or heard the messages related to arthritis during the 13-week period of the campaign, only 11% recalled messages from the "Physical Activity. The Arthritis Pain Reliever" campaign. Challenges faced during campaign implementation included limited fiscal resources, distrust, and staff and time constraints. CONCLUSION: Challenges to health communications campaigns in rural areas can decrease campaign reach and effectiveness. If resource constraints exist, leveraging partnerships and building trust among residents of the community are important for achieving campaign success.     

Efficacy of a Randomized Trial of a Community and School-based Anti-violence Media Intervention Among Small-town Middle School Youth

In a community randomized controlled trial, intervention middle school students from small towns were exposed to a community and school-based anti-violence intervention ("Resolve It, Solve It"). The primary intervention was a media campaign in which local high school students served as models in print, radio, and television PSAs and spearheaded local school and community activities. The media campaign was supported with school and community events that reinforced campaign messages. Tests of recognition and recall indicated widespread exposure to the media intervention. Multiple group latent growth models indicated that relative to control students, intervention students reported significant differences in rates of growth for intent for violence, physical assault against people, verbal victimization, and perceived safety at school. No differences were found for verbal assault, physical assault against objects, physical victimization, or self-efficacy for avoiding violence. When examined by sex, it was determined that results for physical assault against people were obtained only among female students, and changes in verbal victimization and perceived school safety were observed only among male students. These results suggest that a media and reinforcing community intervention led by older peers can alter rates of growth for some measures of violence and associated factors among small-town youth. Further research is indicated to determine how different campaign messages influence students by sex.     

Media and community campaign effects on adult tobacco use in Texas

The present study reports on the effects on adult tobacco cessation of a comprehensive tobacco-use prevention and cessation program in the state of Texas. Differences in cessation rates across treatment conditions were measured by following a panel of 622 daily smokers, recruited from the original cross-sectional sample, from baseline to follow-up. The adult media campaign combined television, radio, newspaper and billboard advertisements featuring messages and outreach programs to help adults avoid or quit using tobacco products. The ads also promoted quitting assistance programs from the American Cancer Society Smokers' Quitline, a telephone counseling service. The cessation component of the intervention focused on increasing availability of and access to cessation counseling services and pharmacological therapy to reduce nicotine dependence. Both clinical and community-based cessation programs were offered. Treatment areas which combined cessation activities with high level media campaigns had a rate of smoking reduction that almost tripled rates in areas which received no services, and almost doubled rates in areas with media campaigns alone. Analyses of the dose of exposure to media messages about smoking cessation show greater exposure to television and radio messages in the areas where high level media was combined with community cessation activities than in the other areas. Results also show that exposure to media messages was related to processes of change in smoking cessation and that those processes were related to the quitting that was observed in the group receiving the most intensive campaigns.     

Impact of an Australian mass media campaign targeting physical activity in 1998.

BACKGROUND: Physical activity is now a public health priority, but there is only limited evidence on the effectiveness of mass-reach campaigns. INTERVENTION: Paid and unpaid television and print-media advertising, physician mail-outs, and community-level support programs and strategies. SETTING/PARTICIPANTS: A mass-media statewide campaign to promote regular moderate-intensity activity was conducted during February 1998. The target group was adults aged 25 to 60 who were motivated but insufficiently active. DESIGN: Cohort and independent-sample, cross-sectional representative population surveys, before and after the campaign. The intervention was conducted in the state of New South Wales, with the other states of Australia as the comparison region. MEASURES: Telephone survey items on physical activity, media message awareness, physical activity knowledge, self-efficacy, and intentions. RESULTS: Unprompted recall of the activity messages in the campaign state increased substantially from 2.1% to 20.9% (p<0.01), with small changes elsewhere in Australia (1.2% to 2.6%). There were large changes in prompted awareness from 12.9% to 50.7% (p<0.0001), much larger than changes elsewhere (14.1% to 16%, p=0.06). Knowledge of appropriate moderate-intensity activity and physical activity self-efficacy increased significantly and only in the campaign state. Compared to all others, those in the target group who recalled the media message were 2.08 times more likely to increase their activity by at least an hour per week (95% confidence interval = 1.51-2.86). CONCLUSIONS: This integrated campaign positively influenced short-term physical activity message recall, knowledge, and behavior of the target population, compared to the population in the region who were not exposed.     

Peer Reviewed: Changes in Youth Cigarette Use Following the Dismantling of an Antitobacco Media Campaign in Florida

We examined the association of the termination of a successful youth-targeted antitobacco media campaign ("truth") and changes in smoking rates among youths aged 12-17 years in Florida. Six telephone-based surveys were completed during the active media campaign (1998-2001), and 2 postcampaign surveys were completed in 2004 and 2006 (each n ~1,800). Prevalence of current smoking among youth observed during the campaign continued to decrease in the first postcampaign survey; however, by the second follow-up survey, youth smoking rates had increased significantly for youth aged 16 years or older. Our findings support the need for consistent antitobacco messaging to reduce the prevalence of youth smoking.     

Evidence of the dose effects of an antitobacco counteradvertising campaign

OBJECTIVE: The objectives were to assess the cumulative effects of exposure to multiple antitobacco advertisements shown over a 22-month period on smoking uptake, and determine if there is evidence of a dose effect and how this effect operates through response to the campaign's major message theme and antitobacco attitudes. METHODS: A follow-up telephone survey of persons ages 12-20 years was conducted after 22 months of the Florida "truth" antitobacco media campaign. Logistic regression analyses were used to estimate adjusted odds ratios for the likelihood that time-one nonsmokers would remain nonsmokers at time two by levels of confirmed advertisement awareness, self-reported influence of the campaign's message theme, and anti-tobacco industry manipulation attitudes. Separate cohorts are analyzed and controls include gender and time-one susceptibility. RESULTS: The likelihood of nonsmokers remaining nonsmokers increases as the number of ads confirmed, the self-reported influence of the campaign's major message theme, and the level of antitobacco attitudes increases. The pattern to these relationships holds within cohorts of young and older youth and for a cohort that has aged into the early young adult years. Considering all variables simultaneously suggests that ad confirmation operates through its effects on the influence of the message theme and antitobacco industry manipulation attitudes. CONCLUSIONS: There is evidence of a dose effect; however, considering only ad confirmation underestimates this. Antitobacco campaigns that target youth can have effects at least through the early young adult ages. The uniqueness of the Florida campaign may limit the generalization of reported results.     

Do Mass Media Affect Medicare Beneficiaries’ Use of Diabetes Services?

BACKGROUND: Appropriate secondary preventive care for people with diabetes can reduce complications and premature death, yet many people with diabetes do not get these services. Mass media may influence individual health behavior. METHODS: In 1999, the West Virginia Medical Institute (WVMI) began a long-term radio and television campaign to educate West Virginia Medicare beneficiaries with diabetes about the importance of foot exams, eye exams, HbA1c testing, and influenza and pneumonia immunizations using messages with an "Ask your doctor about..." formula. To assess campaign efficacy, WVMI commissioned a telephone survey of 1500 randomly selected beneficiaries likely to have diabetes in two groups of counties with differing exposure to the messages. The survey asked whether the beneficiary had heard the messages and responded to them, by message topic. RESULTS: Nearly everyone (90%) in both survey groups said they had seen or heard the diabetes ads. However, high-exposure group members were about 1.2 times more likely to recall hearing most messages than low-exposure group members, and were 1.2 to 1.8 times more likely to say that they did what the messages suggested. CONCLUSIONS: Media campaigns with preventive health messages targeted to Medicare beneficiaries with diabetes can reach them and may induce appropriate responses.     

The Effects of Smoking-Related Television Advertising on Smoking and Intentions to Quit Among Adults in the United States: 1999–2007

Objectives. We investigated whether state-sponsored antitobacco advertisements are associated with reduced adult smoking, and interactions between smoking-related advertising types.Methods. We measured mean exposure to smoking-related advertisements with television ratings for the top-75 US media markets from 1999 to 2007. We combined these data with individual-level Current Population Surveys Tobacco Use Supplement data and state tobacco control policy data.Results. Higher exposure to state-sponsored, Legacy, and pharmaceutical advertisements was associated with less smoking; higher exposure to tobacco industry advertisements was associated with more smoking. Higher exposure to state- and Legacy-sponsored advertisements was positively associated with intentions to quit and having made a past-year quit attempt; higher exposure to ads for pharmaceutical cessation aids was negatively associated with having made a quit attempt. There was a significant negative interaction between state- and Legacy-sponsored advertisements.Conclusions. Exposure to state-sponsored advertisements was far below Centers for Disease Control and Prevention–recommended best practices. The significant negative relationships between antismoking advertising and adult smoking provide strong evidence that tobacco-control media campaigns help reduce adult smoking. The significant negative interaction between state- and Legacy-sponsored advertising suggests that the campaigns reinforce one another.Cigarette smoking remains the leading cause of preventable death in the United States. State tobacco control programs rely heavily on paid television advertising to promote tobacco control messages, with the goals of influencing attitudes and beliefs about tobacco use, and reducing population smoking. The California Tobacco Control Program, launched in 1990, is the largest and longest-running state-sponsored antismoking media campaign in the United States.1 Massachusetts introduced a campaign in 1994, Arizona in 1997, and Oregon and Florida in 1998.2,3 Between 1998 and 2002, at least 30 other states started antismoking media campaigns. Cigarette excise taxes and earmarked funds from the 1998 Master Settlement Agreement (MSA) have financed the majority of such campaigns4; in recent years, however, many of these state campaigns have been significantly cut, or even eliminated. The American Recovery and Reinvestment Act of 2009 allocated $650 million toward the Communities Putting Prevention to Work initiatives, many of which included significant tobacco control media campaigns.5 This recent infusion of funding represents the largest expansion of state and regional tobacco control media campaigns since 1998. In addition, the US Food and Drug Administration has announced its own sizable tobacco control media campaign scheduled in 2012.6State-sponsored antitobacco advertisements are not the only smoking-related messages seen on television in the United States in recent years. Since 1996, when nicotine replacement therapies were approved for over-the-counter distribution, pharmaceutical companies have used television advertising extensively to promote smoking cessation aids.7 Also as a result of the MSA, the American Legacy Foundation (Legacy) was formed in 1999, and in 2000 introduced “truth,” its national antismoking advertising campaign. In addition, Philip Morris and Lorillard each launched media campaigns in 1998, which included television advertising with putatively antismoking messages.8Early evidence has suggested that public investments in antismoking media campaigns contributed to reductions in smoking among youths.9 Research on the relationship between antismoking advertisements and adult smoking behavior is encouraging but less conclusive.4,10 Most studies have focused on individual media campaigns within a single state or country, and have not controlled for other smoking-related advertising or other tobacco control policies, such as cigarette excise taxes or clean indoor air regulations, which also influence smoking.11 For example, a recent Australian study showed that higher levels of televised antismoking advertising was associated with reduced adult smoking, with control for important concurrent tobacco control policies.12 One multistate study of the relationship between antismoking advertisements and adult smoking in the United States showed that smokers with higher levels of awareness of antismoking media campaigns were more likely to quit, even after control for other tobacco control policies in the 9 states studied.13 However, that study did not explore the impact of other antitobacco or cessation-related advertising, such as Legacy’s truth campaign or advertisements for pharmaceutical cessation aids. Adults in the United States received substantial levels of exposure to ads for pharmaceutical cessation aids, as well as to Legacy’s predominantly youth-targeted antitobacco media campaign.7 Exposure to either or both of these smoking-related messages may therefore have had important effects on adult smoking. To date, there has been no research on the relationship between smoking among US adults and concurrent exposure to smoking-related advertisements produced by various sponsors, or potential interactions among advertising produced by various sponsors.We examined the relationships between US adults’ smoking behaviors and their exposure to smoking-related television advertisements sponsored by state health departments, the American Legacy Foundation, tobacco companies, and pharmaceutical companies promoting their cessation products. We hypothesized that higher levels of exposure to state-sponsored antitobacco advertisements would be associated with reduced smoking. Our models controlled for individual characteristics, as well as state tobacco control policies and, therefore, overcame the limitations of previous research on the effects of antismoking advertising on smoking among adults.     

Using Aggregate Temporal Variation in Ad Awareness to Assess the Effects of the truth® Campaign on Youth and Young Adult Smoking Behavior

Mass media campaigns are one of the most effective population-level interventions for the prevention of tobacco use. However, accurately evaluating the effectiveness of these campaigns presents several challenges, particularly as campaign delivery becomes increasingly fractured across media platforms. There are a number of weaknesses associated with traditional, individual-level measures of campaign exposure in an increasingly socially networked, digital media ecosystem. This study evaluated the national truth® campaign using a novel method to measure campaign exposure through an aggregate weekly exogenous measure of awareness. We generated this exogenous measure from a continuous, cross-sectional tracking survey to predict intentions to smoke and current tobacco use among youth in the United States. Results from multi-level models indicated that weeks with aggregate campaign awareness greater than 65% were associated with lower odds of current tobacco use. We conclude with a discussion of implications and practical considerations for using this method for media campaign evaluation.     

Tobacco use among Massachusetts youth: is tobacco control working?

BACKGROUND: This paper examines whether the Massachusetts Tobacco Control Program is affecting the rates of smoking and smokeless tobacco use among Massachusetts' youth. METHODS: School survey data from the Massachusetts Prevalence Study were analyzed to estimate differences between 1993 and 1996 rates of youth cigarette and smokeless tobacco use, attitudes toward smoking, and awareness of cigarette ads and promotions of antismoking messages. RESULTS: Lifetime and Current Smoking rates declined significantly among middle school males, contrasting with stable national trends. Among girls in this age group, Lifetime and Current Smoking did not change significantly. Hispanic middle school students exhibited a significant decline in Lifetime Use. There were no significant changes in Lifetime or Current Smoking rates among high school students. Lifetime use of smokeless tobacco declined among middle school students while Current Use declined among both middle and high school students. Students reported declines in awareness of cigarette ads or promotions and increases in awareness of antismoking messages. CONCLUSIONS: These results provide evidence for cautious optimism regarding the impact of tobacco control, but indicate that these efforts should begin earlier and that additional research is needed to understand and address the problems of tobacco use by girls.     

Increasing Youths' Exposure to a Tobacco Prevention Media Campaign in Rural and Low-Population-Density Communities

Objectives. We examined the effectiveness of a program to increase exposure to national “truth” tobacco countermarketing messages among youths in rural and low-population-density communities.Methods. A longitudinal survey of 2618 youths aged 12 to 17 years was conducted over 5 months in 8 media markets receiving supplemental advertising and 8 comparison markets receiving less than the national average of “truth” messages.Results. Confirmed awareness of “truth” increased from 40% to 71% among youths in treatment markets while remaining stable in comparison markets. Over 35% of all youths who were unaware of the campaign at baseline became aware of it as a direct result of the increased advertising. Youths living in rural and low-population-density communities were receptive to the campaign''s messages.Conclusions. Through purchase of airtime in local broadcast media, the reach of a national tobacco countermarketing campaign was expanded among youths living in rural and low-population-density areas. This strategy of augmenting delivery of nationally broadcast antitobacco ads can serve as a model for leveraging limited tobacco control resources to increase the impact of evidence-based tobacco prevention campaigns.The national “truth” campaign is a branded smoking prevention campaign designed to reach at-risk youths aged 12 to 17 years, primarily through countermarketing messages that focus on the tobacco industry''s deceptive marketing practices and efforts to deny the health risks of smoking.^1–3 The campaign is grounded in behavior change theory, communication theory, and empirical evidence on the effectiveness of countermarketing strategies in tobacco use prevention.^4–14 It uses messages that resonate with youths who have higher levels of a personality trait called “sensation seeking,” which has been shown to be associated with increased risk for smoking.^15,16Studies have demonstrated the effectiveness of the “truth” campaign.^1,2,17–22 The campaign has generated substantive levels of exposure over time, and confirmed awareness of campaign advertisements has been associated with changes in relevant beliefs and the intention not to smoke.^1,2,17,19 One study demonstrated that youths with greater exposure to the campaign were less likely to be current smokers.² A longitudinal study indicated that exposure to the campaign was associated with a decreased risk of smoking initiation.¹⁸ Research indicates that youths'' affinity for the “truth” brand was associated with greater reductions in smoking initiation as compared with mere campaign awareness.^3,21 The campaign has been shown to be cost-effective.²²Over the course of the national “truth” campaign, the media strategy shifted from airing television advertisements on national broadcast channels to airing advertisements primarily on national cable networks, to maximize resources and further target the intended audience. As a result of uneven cable penetration across the United States, youths in some rural and low-population-density areas of the country were exposed to the campaign''s antitobacco messages less frequently than youths nationwide. This is of particular concern because rural youths are more likely to smoke than those living in urban and suburban areas.²³To address this disparity in “truth” campaign exposure, the American Legacy Foundation (hereafter referred to as “Legacy”) responded to a program announcement from the Centers for Disease Control and Prevention (CDC) to obtain matching funds for a smoking countermarketing initiative targeted at youths. The program, called “ ‘truth’ or Consequences,” proposed to reduce disparities in smoking rates among youths by increasing the dose of “truth” messages in rural and low-population-density communities. The CDC awarded Legacy the program grant in 2006, and in the first year of the program, countermarketing messages were increased to the mean national level of advertising in 18 states across 41 Designated Market Areas, defined as geographical regions where the population receives the same, or similar, television and radio programs. In accordance with the CDC''s recommendations regarding the timeline of expected outcomes for media campaigns,¹² we examined the relationship between increasing levels of paid media messages and confirmed awareness of, and receptivity to, the “truth” campaign in 8 matched media markets from April to September 2007.     

Scare' Em or Disgust 'Em: The Effects of Graphic Health Promotion Messages

This study experimentally tested the effects of 2 types of content commonly found in anti-tobacco television messages—content focused on communicating a health threat about tobacco use (fear) and content containing disgust-related images—on how viewers processed these messages. In a 2 × 2 within-subjects experiment, participants watched anti-tobacco television ads that varied in the amount of fear and disgust content. The results of this study suggest that both fear and disgust content in anti-tobacco television ads have significant effects on resources allocated to encoding the messages and on recognition memory. Heart-rate data indicated that putting fear- or disgust-related content into anti-tobacco ads led to more resources allocated to encoding compared to messages without either feature. However, participants appeared to allocate fewer resources to encoding during exposure to messages featuring both fear and disgust content. Recognition was most accurate for messages that had either fear or disgust content but was significantly impaired when these 2 message attributes occurred together. The results are discussed in the context of motivated processing and recommendations about message construction are offered to campaign designers.     

The 2005 British Columbia smoking cessation mass media campaign and short-term changes in smokers attitudes

The effect of the 2005 British Columbia (BC) smoking cessation mass media campaign on a panel (N = 1,341) of 20-30-year-old smokers' attitudes is evaluated. The 5-week campaign consisted of posters, television, and radio ads about the health benefits of cessation. Small impacts on the panel's attitudes toward the adverse impacts of smoking were found, with greater impacts found for those who had no plans to quit smoking at the initial interview. As smokers with no plans to quit increasingly recognized the adverse impacts of smoking, they also increasingly agreed that they use smoking as a coping mechanism. Smokers with plans to quit at the initial interview already were well aware of smoking's adverse impacts. Respondents recalling the campaign poster, which presented a healthy alternative to smoking, decreased their perception of smoking as a coping mechanism and devalued their attachment to smoking. Evidence was found that media ad recall mediates unobserved predictors of attitudes toward smoking.     

A critical perspective on the drug czar's antidrug media campaign

The US government's Office of National Drug Control Policy (ONDCP) launched its new antidrug media campaign in July 1998. The campaign is likely to increase awareness of the youth drug problem, but shortcomings in the campaign's early implementation raise questions about its potential for changing behavior. Shortcomings include: a) The first wave of ONDCP's television advertisements are focused on reinforcing problem awareness but do not model skills or provide other information necessary for behavior change; b) the campaign provides insufficient focus on promoting drug treatment and citizen involvement in local prevention activities, including political action; c) the campaign is being implemented without a major new investment in drug-treatment programs or community-based prevention programs; d) The campaign does not substantively address alcohol and tobacco, which pose a clear threat to health and serve as a "gateway" to illicit drug use; and e) the first wave of television advertisements use exaggerated fear appeals, a strategy shown by research rarely to be successful. Only time will tell whether the ONDCP media campaign will succeed or fail. Using past research as a guide, there is legitimate reason for concern that the campaign will not live up to expectations.