摘要：Objectives . This study examines how the American Legacy Foundation's “truth” campaign and Philip Morris's “Think. Don't Smoke” campaign have influenced youths' attitudes, beliefs, and intentions toward tobacco. Methods . We analyzed 2 telephone surveys of 12- to 17-year-olds with multivariate logistic regressions: a baseline survey conducted before the launch of “truth” and a second survey 10 months into the “truth” campaign. Results . Exposure to “truth” countermarketing advertisements was consistently associated with an increase in anti-tobacco attitudes and beliefs, whereas exposure to Philip Morris advertisements generally was not. In addition, those exposed to Philip Morris advertisements were more likely to be open to the idea of smoking. Conclusions . Whereas exposure to the “truth” campaign positively changed youths' attitudes toward tobacco, the Philip Morris campaign had a counterproductive influence. (Am J Public Health. 2002;92:901–907) In early February 2000, the American Legacy Foundation (Legacy) launched “truth,” a national tobacco countermarketing campaign conducted by an alliance of advertising firms led by Arnold Communications, Legacy staff, and nationwide youths. “truth” targets primarily 12- to 17-year-olds who are susceptible to smoking. 1– 3 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. “truth” TV and print commercials feature what advertising experts call “edgy” youths (i.e., those who are on the cutting edge of trends), promotional items (e.g., T-shirts, stickers), street marketing, and a Web site ( www.thetruth.com ). Although “truth” is a national multiethnic campaign, special components were developed to reinforce its appeal to African Americans, Hispanics, and Asians. While drawing youths to “truth,” the campaign delivers stark facts about tobacco and tobacco industry marketing practices, rather than sending directive “just say no” messages such as those used in the Philip Morris Company's “Think. Don't Smoke.” campaign, which began in 1998. Specifically, many of the “truth” advertisements are based on historical statements from the industry itself that reveal its youth marketing and obfuscation of tobacco's health effects. In unmasking these practices, “truth” seeks to replace the attractive identity portrayed by tobacco advertising with a “truth” alternative identity. 4 The “truth” brand builds a positive, tobacco-free identity through hard-hitting advertisements that feature youths confronting the tobacco industry. This rebellious rejection of tobacco and tobacco advertising channels youths' need to assert their independence and individuality, while countering tobacco marketing efforts. For example, one well-known “truth” commercial, known as “Body Bags,” features youths piling body bags outside of a tobacco company's headquarters and broadcasting loudly via megaphones that these represent the 1200 people killed daily by tobacco. Empirical evidence for the potential benefits of the national “truth” campaign's approach comes from the dramatic decline in youth tobacco use associated with the Florida 5, 6 and Massachusetts 7 campaigns, as well as from other studies that have found campaigns focusing on tobacco industry practices to be effective. 8– 10 Legacy's model is that “truth” will change youths' attitudes toward smoking, and that this in turn will change their smoking behavior, prevent them from initiating smoking, or both. 11 Thus, attitude shifts are an intermediate outcome on the path to changing smoking behavior. A telephone survey of youths in Florida and nationwide demonstrated that attitudes toward tobacco changed dramatically among Florida youths compared with youths in the rest of the United States after the first year (1998) of Florida's “truth” campaign, compared with a national sample of youths whose attitudes remained relatively constant. 12 The accompanying change in smoking prevalence was at first statistically nonsignificant, but results from the Florida Youth Tobacco Survey showed drops in smoking among middle-school and high-school students of 18% and 8%, respectively, after year 1 and of 40% and 18% after year 2. 5 Some assert that a portion of this decline can be attributed to the November 1998 $0.45-per-pack price increase. 13 Cigarette prices increased by roughly 30% during 1998, year 1 of the Florida program, and by 7% during year 2. 14 With price increases of this magnitude, economic studies projected a 10% to 20% decline in youth smoking prevalence for 1998 and a 2% to 5% decline for 1999. 15– 17 This suggests that although a significant fraction of the decline in smoking after the first year of Florida's program may have been due to price increases, the price increases alone cannot account for all of the 1998 decline or for the continued decline in smoking in 1999. In the present study, we used the results of 2 national youth surveys to compare exposures to Legacy's “truth” and Philip Morris's “Think. Don't Smoke.” campaigns. We then analyzed changes in youths' attitudes, beliefs, and intentions regarding the tobacco industry and tobacco use 10 months into the “truth” campaign as a function of levels of exposure to each campaign.
