摘要：Objectives. In early 2000, the American Legacy Foundation launched the national “truth” campaign, the first national antismoking campaign to discourage tobacco use among youths. We studied the impact of the campaign on national smoking rates among US youths (students in grades 8, 10, and 12). Methods. We used data from the Monitoring the Future survey in a pre/post quasi-experimental design to relate trends in youth smoking prevalence to varied doses of the “truth” campaign in a national sample of approximately 50000 students in grades 8, 10, and 12, surveyed each spring from 1997 through 2002. Results. Findings indicate that the campaign accounted for a significant portion of the recent decline in youth smoking prevalence. We found that smoking prevalence among all students declined from 25.3% to 18.0% between 1999 and 2002 and that the campaign accounted for approximately 22% of this decline. Conclusions. This study showed that the campaign was associated with substantial declines in youth smoking and has accelerated recent declines in youth smoking prevalence. Mass media campaigns can be an effective public health strategy to prevent youth smoking. 1– 3 Antismoking television campaigns have emphasized diverse themes to discourage smoking, including highlighting short-and long-term health consequences, deglamorizing its social appeal through humorous and unflattering portrayals, and countering misperceptions that smoking is widespread among teens. A more recent theme, first used by California in the 1990s, focuses on exposing deceptive tobacco industry marketing practices and denials of tobacco’s health and addictive effects. In 1998, the Florida Department of Health launched a tobacco prevention program that featured a mass media campaign known as “truth” that countered industry influences with hard-hitting television advertisements that deglamorized smoking and portrayed youth confronting the tobacco industry. After 2 years, the prevalence of any past 30-day smoking among middle and high school students dropped by 40% and 18%, respectively. 4 In a longitudinal study, Sly et al. 5 linked exposure to the Florida “truth” campaign to declines in youth smoking prevalence. As a result of the Master Settlement Agreement between tobacco companies and 46 states, the American Legacy Foundation (Legacy) initiated the national “truth” campaign in February 2000. From 2000 to 2002, annual funding for the campaign averaged $100 million per year. A national media purchase was employed by the campaign, as opposed to a randomized exposure design, for 2 primary reasons. First, Legacy could not ethically assign some media markets to low or zero exposure, given the documented successes of the Florida “truth” campaign. Second, a national media purchase was roughly 40% cheaper than a market-to-market purchase, which would have been necessary to randomize exposure. Although the “truth” campaign builds upon the experiences of Florida and other state campaigns, no similar large-scale national antismoking effort has occurred since the period of the Fairness Doctrine from 1967 to 1970, when TV networks were required to maintain a balance between anti-and prosmoking ads. The “truth” campaign ads are designed to avoid overt and directive messages that tell teens not to smoke and instead use graphic images depicting stark facts about death and disease caused by tobacco and exposés of manipulative marketing practices. For example, an early commercial, “Body Bags,” showed youths piling 1200 body bags outside a major tobacco company’s headquarters to highlight the daily death toll from tobacco use. This is the first study to evaluate the behavioral outcomes of the campaign. Previous studies have shown that the campaign influenced campaign-related attitudes toward tobacco use and the tobacco industry and that negative attitudes about the tobacco industry are correlated with reduced risk of smoking. 6– 9 The current study assessed whether there was a dose–response relationship between the level of exposure to the campaign and youth smoking prevalence during the first 2 years of the campaign.
