Program Goals, Target Population, and Program Components
The truth® campaign is a national smoking prevention campaign that uses advertisements with anti-tobacco messages targeted at youths ages 12 to 17 who are most at risk of smoking. Young adults ages 18 to 24 are an important secondary audience. The truth® campaign is based on the tobacco-prevention program launched by the Florida Department of Health in 1998. The Florida program known as “truth” includes television advertisements that deglamorized smoking and portrayed youths confronting the tobacco industry. The marketing portion of the campaign was developed by a team of advertising and public relations firms but was driven by grassroots advocacy. The theory behind the campaign is that “truth” will change youths’ attitudes toward smoking, and that, in turn, will change their smoking behaviors, prevent them from initiating smoking, or both.
The truth® campaign was launched nationally in 2000. It is run by the American Legacy Foundation, which was founded under the terms of the Master Settlement Agreement between the U.S. tobacco companies and 46 U.S. states and 5 territories. The core strategy of the campaign is to market its message as a brand, like other youth brands (e.g., Nike®, Sprite®) to appeal to youths most at risk of smoking. The TV and print commercials feature “edgy” youths (i.e., those who are on the cutting edge of trends), promotional items (T-shirts, stickers), street marketing, and a Web site. Although “truth” is a national multiethnic campaign, special components were developed to reinforce its appeal to African Americans, Hispanics, and Asians.
The objective of the campaign is to allow youths to make informed choices about tobacco use by giving them facts about the tobacco industry and its products. The messages of the truth® campaign focus on smoking addiction, death and disease attributed to smoking, ingredients in cigarettes, and the social consequences of smoking. They feature historical statements from the tobacco industry’s dubious marketing tactics and its efforts to obscure the health effects of tobacco. Rather than use obvious and directive messages that tell teens not to smoke, campaign advertisements use graphic images that depict stark facts about the consequences caused by tobacco use. For example, a well-known commercial titled “Body Bags” showed youths piling 1,200 body bags outside the headquarters of a major tobacco company to illustrate the daily death toll from tobacco use.
12 to 17
Users should interpret these outcomes with some caution based on the methodological limitations to the studies’ designs (for an explanation of the limitations, please see the Evaluation Methodology section).
The descriptive data from the Monitoring the Future surveys showed a large decline in current youth smoking prevalence overall and for each grade between 1997 and 2002 in the Farrelly and colleagues’ 2005 study. Among all grades combined, the current smoking prevalence decreased by 36 percent. Eighth grade students exhibited the largest percentage decline at 45 percent, whereas 12th grade students showed the smallest decline at 27 percent. The annual decline of smoking prevalence for all grades was significantly greater in the post–truth® campaign time period (2000–02) than the pre–truth® campaign time period (1997–99), with a 3.2 percent decline before the campaign launched compared with a 6.8 percent decline after the campaign launched.
The results showed a statistically significant dose–response relationship, meaning that youths with greater exposure to the truth® campaign were less likely to be current smokers (odds ratio = 0.78, p<.05). The dose–response relationship was significant even when controlling for potentially confounding variables, such as median household income and the percentage of the population who were college graduates. The results also showed the increasing effects of the relationship between overall youth smoking prevalence and the campaign as it strengthened over time. For instance, in 2000, a few months after the campaign launch, the truth® campaign showed little effect. But by 2001 the effect of the campaign on youth smoking prevalence was statistically significant (odds ratio = 0.66, p<.05).
The results also showed that the prevalence of smoking among students in all grades combined would have declined by only 5.7 percentage points to 19.6 percent instead of the actual decline of 7.3 percentage points to 18.0 percent had the campaign not existed. Therefore, about 22 percent of the total decline in youth smoking prevalence between 1999 and 2002 is attributable to the truth® campaign. By 2002, smoking rates overall were 1.5 percentage points lower than they would have been in the absence of the campaign, which translates to roughly 300,000 fewer youth smokers (based on 2002 U.S. Census population statistics).
The outcome results of Farrelly and colleagues (2009) showed that exposure to the truth® campaign is associated with a decreased risk of smoking initiation. An increase in cumulative campaign exposure of 10,000 GRPs is associated with a 20 percent decrease in the risk of initiation (relative risk=0.80, p=0.001).
As part of the analysis, the authors calculated the proportion of the sample who had initiated smoking by age and the estimated proportion of the sample who would have initiated smoking in the absence of the truth® campaign. The difference between the two proportions represents the difference attributable to the truth® campaign. For example, 6.8 percent of 20-year-olds initiated smoking (among those who had not previously initiated). The analysis found that in the absence of the truth® campaign, this percentage would have been higher—at 8.5 percent. The difference translates to roughly 73,000 fewer adolescents initiating smoking nationwide. This amounts to approximately 456,281 fewer smokers attributable to the truth® campaign from 2000 through 2004.
Several other factors were associated with a decreased risk of smoking initiation, including high school graduation, African American race, Hispanic ethnicity, and living with both parents at baseline. Factors associated with an increased risk of smoking initiation included ever being suspended from school at baseline, baseline income, and highest parental education of college graduate.
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