1. truth® campaign Mike Kendall Catherine Montoya James Montoya Carmelita Parraz John Sampson Natalie Skogerboe

2. Vintage Smoking Advertisements

3. 1964 Surgeon General Report Focus on the link between smoking and lung cancer 1965 Federal Cigarette Labeling and Advertising Act Required Surgeon General Warning label printed on cigarette packs 1967 – 70 Fairness Doctrine Act Required TV Networks to balance anti and pro smoking ads 1984 Comprehensive Tobacco Education Act (Public Law 98- 474) Interagency Committee on Smoking and Health 1989 National Cancer Institute Use activists to impact public opinion on smoking CDC booklet entitled Tips for Kids stated smokers were second class citizens 1994 Clinton takes on kids smoking Post War History of Anti Smoking

4. truth® campaign was based on the Florida Truth campaign, which reduced youth smoking rates In 1998 Florida Department of Health launched a tobacco prevention program that featured a mass media campaign known as truth ( Farrelly et al, 2005). Florida Truth Campaign

5. A telephone survey of youths demonstrated that attitudes toward tobacco changed amongst Florida youth compared with youths in the rest of the United States after the first year. Florida Youth Tobacco Survey 18% and 8% among middle-school and high-school students after year one After year two 40% and 18% Florida Truth Campaign

6. truth® campaign Launched in 2000 by the American Legacy Foundation (Legacy) 1 st year had a budget of more than $100 million

7. Market its message as a brand, like other youth brands (e.g., Nike, Sprite) Truth TV and print commercials feature what experts call edgy youths, promotional items, street marketing, and a Web site (www.thetruth.com)www.thetruth.com (Farrelly, 2002). Deliver stark facts about tobacco and tobacco industry marketing practices Core Strategy of the truth® campaign

8. …You wont see statistics about the toll of tobacco, Farrelly. Emphasizing the long-term consequences of smoking is not as effective as addressing the more immediate problems, said Howard Willard, senior vice president of youth smoking at Philip Morris (Grand Rapids Press, 2002). In comparison to Philip Morris ads

9. Only national youth smoking prevention program in the U.S. not sponsored by the tobacco industry ( Holden, D. & Zimmerman, M., 2009, p. 124) Advertising spots in major metropolitan demographic market areas (DMAs) truth® Campaign

10. In December 1999, Legacy Media Tracking Survey (LMTS) fielded - primary evaluation tool 2000-2003 In 2000, LMTS targeted specific racial and ethnic groups, 12-17 year olds Continuous tracking-benefited media contractors, creative directors, and other stakeholders 2nd wave of LMTS 10 months after launch of Truth found 75% exposure Telephone surveys

11. Exposure and recall Message reactions and receptivity Behavioral determinants (knowledge, attitudes, and beliefs) Behavioral outcomes Media Evaluations Measure 4 key process and outcome dimensions ( Holden, D. & Zimmerman, M., 2009, p. 125)

12. 3 critical elements for successful youth tobacco prevention media Teen focused counter-marketing Talk to teens on their level, i.e. do not talk down to teens Highlight tobacco industrys failure to highlight addictiveness and health effects ( Columbia Marketing Panel, 1996; McKenna, Gutierrez, & McCall, 2000)

13. Process evaluations Media Evaluations Outcome evaluations Assess if the teens heard the Truth Campaign Determine effects on health behavior Did children react favorably Were children less likely to smoke? Creates Formative Feedback

14. Expose youth to truth® messages and promote positive reactions to these messages Change attitudes and beliefs towards tobacco use Reduce tobacco use among youth Three Main Objectives

15. Overall looking at marketing campaigns To promote or change consumer behavior Health communication Affect consumer health behavior Social Marketing Incorporating business and social objectives Influence social behavior To benefit target market & society as whole E.g. CDC or American Cancer Society Media Evaluation

16. For Immediate Formative Feedback to enhance the campaign efforts Process and Outcome data must happen simultaneously Looking at 4 key areas: 1.Exposure & recall 2.Message reactions & receptivity 3.Behavioral determinants 4.Behavioral outcomes Why Need to Evaluate?

17. Relationship between evaluators, advertisers, and marketers Evaluation design and measurement Environmental factors external to campaign Difficulty to isolate and assess effects of Truth Challenges in Evaluation

18. 1)Expose youth to Truth & get positive reactions 2)Change attitudes & beliefs towards tobacco use & companies 3)Reduce tobacco use among youth 3 Primary Objectives of truth®

19. For Objectives 1 & 2 (telephone): LMTS (Legacy Media Tracking Survey) For Objective 3 (in-school survey): ELM (Elaborate Likelihood Model) NYTS (National Youth Tobacco Survey) MTF (Monitoring the Future) Types of Evaluations Used

20. No control or comparison market - implemented nationally rather quickly Therefore rely on quasi experimental comparison (dose of Truth) Many states built own campaigns Tobacco control in prices & taxes Philip Morris campaign - tobacco industry Evolving campaign & multiple stakeholders More Challenges

21. Pre- truth® vs. During truth®

22. % Change from Baseline to 10-Month Surveys

23. Tobacco more prominent in minds of youth truth® campaign resonates more with youth than Think. Dont Smoke. even though that campaign aired more than 12 months prior to truth® Findings

24. Did the truth® reach its Objectives? OBJECTIVE 1 Expose youth to truth® and get positive reactions -Exposure and Recall -Message Reactions and Receptivity -75% of 12-17yr old survey respondents recalled the ads YES!

26. Did the truth® reach its Objectives? OBJECTIVE 2 Change Attitudes and Beliefs Toward tobacco use AND tobacco companies -Behavioral Determinants -Significant changes in knowledge, attitudes and beliefs related to truth® messages YES!

27. Did the truth® reach its Objectives? OBJECTIVE 3 Reduce tobacco use among youth -Behavioral outcomes -How can these be attributed to the truth® campaign? YES!?

28. SOURCE: Figure 6.2 in Holden & Zimmerman (2009) A Practical Guide to Program Evaluation Planning

29. Evaluators were able to survey a large number of youth because of the high levels of exposure to the campaign No opportunity for experimental control Campaign messages and evaluation tools changed over time Could impact time series Requires decisions along the way as to which variables should stay and go Evaluators came up with creative ways to analyze dose- response relationships Conclusions

30. More discussion around what populations were of primary concern (i.e. geographic locations or ethnic groups with higher prevalence rates etc.) Also, how the messages were adapted to address those populations Cost savings resulting from the reductions in youth smoking Truth ads should expand its target groups to include: existing smokers, age groups (18-24), and youth who reside in non-urban locations. Group Reflections

31. Anti Smoking Ads

32. Anti Smoking Ad Survey