Truth (anti-tobacco campaign)
Truth (stylized as truth) is a national campaign aimed at curbing youth smoking in the United States. The "truth" campaign is produced and funded by the American Legacy Foundation, a public health nonprofit organization established in 1999 under the Master Settlement Agreement between U.S. tobacco companies, 46 U.S. states, the District of Columbia, and five territories. "truth" produces television and online content to promote anti-tobacco messages. In August 2014, "truth" launched "Finish It", a redesigned campaign encouraging youth to be the generation that ends smoking.
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Florida Tobacco Pilot ProgramEdit
The American Legacy Foundation’s "truth" campaign was modeled after a campaign developed by the Florida Tobacco Pilot Program, which ran from 1998 to 1999. Governor Lawton Chiles and a group of more than 600 youth attending the Governor’s Teen Summit on Tobacco Education established four primary goals for the Tobacco Pilot Program: change youth attitudes about tobacco use, empower youth communities, reduce the availability of tobacco products, and reduce youth exposure to secondhand smoke. To achieve these goals, the program was divided into five components for implementation and evaluation. The marketing and communication component of the program worked to establish an advertising campaign to raise awareness for the program among Florida youth.
Through their marketing campaign, the Tobacco Pilot Program set out to drive a wedge between the tobacco industry's advertising and a youth audience. The program not only assembled a team of advertising and public relations firms, but also collaborated with Floridian youth to develop a campaign that would effectively speak to their generation. Youth articulated their frustrations with the manipulative marketing tactics used by the tobacco industry, and described their ideal campaign as one that would give them facts and the truth about tobacco. From this emerged the concept of uniting youth in a movement against tobacco companies promoted through grassroots advocacy and a youth-driven advertising campaign.
In March 1998, student delegates at a summit sponsored by Florida's Office of Tobacco Control voted to change the theme of the campaign to "truth, a generation united against tobacco." In April 1998, Florida launched a $25 million advertising campaign that included 33 television commercials, seven billboards, eight print ads and four posters. With a target audience of youth aged 12–17, the Florida "truth" campaign modeled their approach after commercial marketing to teens, and used messages that "attacked the [tobacco] industry and portrayed its executives as predatory, profit hungry, and manipulative." The ads re-framed tobacco as an addictive drug promoted by the adult-establishment, and tobacco control as a hip, rebellious, youth-led movement. The grassroots effort of the campaign involved real teenagers taking on the tobacco industry as part of the 13-day "Truth Train" tour across the state.
An evaluation of the "truth" campaign was conducted by Florida State University (FSU). Using four cross-sectional, telephone based surveys of 12- to 17-year-olds in Florida, FSU assessed youth awareness of the Florida "truth" campaign, as well as youth attitudes and smoking-related behaviors. Their findings showed 57% of youth surveyed were aware of the "truth" campaign, 87% were aware of specific "truth" messages, and 47% believed tobacco companies used deceptive practices in their advertising. Despite these positive results, reduced funding for the program, among other factors, ultimately led to the demise of Florida’s "truth" campaign.
American Legacy FoundationEdit
The American Legacy Foundation is a nonprofit organization established and funded in 1999 under the Tobacco Master Settlement Agreement (MSA). The MSA was announced in 1998, after 46 U.S. states, the District of Columbia, and five territories sued the four largest U.S. tobacco companies to recover state Medicaid and other costs from caring for sick smokers. The tobacco industry agreed to provide the states with billions of dollars in perpetuity, making the MSA the largest civil litigation settlement in U.S. history. The states decided a portion of the money received from the tobacco industry should be used to establish a national public health foundation dedicated to tobacco control: the American Legacy Foundation.
Legacy receives the majority of its funding from payments made to the National Public Education Fund established under the MSA. The MSA called for payments to the fund for five years and thereafter for years in which the tobacco companies participating in the agreement collectively have a 99.05% market share. The foundation received what is likely the last payment in 2003. The participating manufacturers’ share does not currently meet the threshold and is not expected to in the foreseeable future.
Under the MSA, Legacy’s objectives are to support research and interventions that reduce youth tobacco use and prevent tobacco-related disease in the U.S. Today Legacy affirms they continue this mission "to reduce tobacco use through public education, research, and community engagement" with a focus on youth and young adults.
Legacy's truth campaignEdit
As Florida’s "truth" campaign diminished as a result of decreased funding, Legacy adopted in large parts its successful strategy to convert into a national campaign. Generally consistent with Florida's campaign, Legacy’s version of "truth" featured hard-hitting messages highlighting the deceptive practices of tobacco companies, and stark facts about the deadly effects of tobacco.
Campaign strategy and styleEdit
In its "truth" campaign fact sheet, Legacy states: "truth’s objective is to change social norms and reduce youth smoking." In building a strategy to accomplish this goal, "truth" campaign designers looked to marketing and social science research, evidence from other successful campaigns, and engaged in conversations with teen audiences. This research revealed that although youth were aware of the deadly nature of cigarettes, they were attracted to smoking as a tool for rebellion and empowerment. The "truth" campaign designers wanted to counter the appeal of cigarettes by encouraging teens to rebel against the duplicity and manipulation exhibited by tobacco companies.
Accordingly, "truth" strives to be a brand youth can identify with. In stark contrast to the heavy "life or death" tone adopted by many anti-tobacco campaigns, the strategy behind "truth" is to emphasize the facts about tobacco products and industry marketing practices, without preaching or talking down to its target audience. The resonating theme underlying "truth" is one of tobacco industry manipulation. With hard-hitting advertisements featuring youths confronting the tobacco industry, "truth" built a brand focused on empowering youth to construct positive, tobacco-free identities. Above all, the campaign avoids making directive statements telling youth not to smoke, and instead encourages them to make up their own minds about smoking and the tobacco industry. "truth" channels youths’ rebellious nature and need to assert their independence towards tobacco control efforts. The campaign positions "truth" as a counter brand to the lies marketed by tobacco companies. For example, the iconic "truth" advertisement "1200" portrays a mass of youth walking up to a major tobacco company building, then suddenly collapsing as if dead while a single youth remains standing with a sign that reads, "Tobacco kills 1200 people a day. Ever think about taking a day off?" In addition to exposing industry marketing practices, many of the advertisements produced for "truth" focus on facts about the ingredients in cigarettes and the consequences of smoking, including addiction, disease, and death.
All of the lies exposed in "truth" advertisements were pulled from real tobacco industry documents that were made publicly accessible following the Master Settlement Agreement. The Legacy Tobacco Documents Library, created in 2002 and managed by the University of California, San Francisco, Library and Center for Knowledge Management, houses millions of formerly secret tobacco industry internal corporate documents. As summarized on the Library’s homepage, "these internal documents give a view into the workings of one of the largest and most influential industries in the United States."
To get the attention of youth audiences in an increasingly media-saturated world, "truth" utilizes cutting-edge marketing tactics, and distributes its content through multiple forms of media. Since the launch of "truth" in 2000, the campaign asserts it has "utilized many different forms of media and evolved its tactics to ensure it reached the teen audience most effectively." Arguably the most recognized media produced for "truth" are its television advertisements. One notable example is the "truth" "Body Bags" commercial; with a gritty filming style, the ad features youths piling body bags on the sidewalk outside of a tobacco company’s headquarters. One youth steps forward with a megaphone to shout up at the workers in the building, "do you know how many people tobacco kills every day? This is what 1200 people actually looks like." Another "truth" advertisement, "Singing Cowboy", portrays a cowboy who has a breathing stoma (opening) in his neck singing, "you don’t always die from tobacco, sometimes you just lose a lung", and other similar lyrics. A third commercial, "1 out of 3", uses "fantasized scenes such as an exploding soda can" to convey the message that tobacco is the only product that prematurely kills one out of three users. Other edgy "truth" advertisements with various themes were produced between 2000 and 2014, including "Connect truth", "Shards o’ Glass", "The Sunny Side of truth", "Unsweetened truth", "Ugly truth", and more. "truth" embraces an "in-your-face" and "hard-hitting" marketing style because, through social media feedback and focus group testing, "truth" designers state learned teens respond best to "up-front and powerful messages that display courage and honesty in a forceful way."
In addition to its television advertisements, "truth" produces billboards, maintains an online presence, employs guerrilla "on-the-street" marketing, and sends a team of "truth tour riders" to popular music and sporting events across the country every summer. Tour riders are enthusiastic young people in their early 20s who connect with teens from their home base, the "truth" truck, while on tour at events like the Vans Warped Tour. The tour is the primary way "truth" connects with teens on a peer-to-peer level and allows youth to interact with the campaign firsthand.
Prior to the launch of the Food and Drug Administration’s "Real Cost" campaign in February 2014, "truth" was the only national youth tobacco prevention campaign not sponsored by the tobacco industry.
In August 2014, "truth" launched the "Finish It" campaign with a new strategy and style to appeal to the next generation of youth.
Evaluation and effectivenessEdit
Rigorous evaluation studies of "truth" have been published in the peer-reviewed literature since the launch of the campaign in 2000. To evaluate the effectiveness of "truth", the American Legacy Foundation employs an internal Research and Evaluation team. Its efforts include evaluation of televised truth ads as well as digital, gaming and grassroots campaign components. Between 1999 and 2004, Legacy conducted a nationally-representative Media Tracking Survey of youth aged 12–17 to inform its "truth" campaign evaluation. The Legacy Media Tracking Survey (LMTS) measured tobacco-related attitudes, beliefs, and behaviors, exposure to smoking influences including "truth", sensation seeking, and openness to smoking. Data from eight waves of the LMTS have been used extensively by both Legacy’s Research and Evaluation team and external researchers to investigate the impact of "truth".
With the nationally representative LMTS data collected by Legacy, the majority of studies evaluating "truth" have been cross-sectional. Early cross-sectional studies on the effectiveness of the "truth" campaign provided convincing evidence that the campaign "had a significant impact on tobacco industry-related attitudes, beliefs, and other behavioral precursors, as well as a significant impact on youth smoking prevalence in the United States." One such study, conducted by Farrelly et al. in 2002, used data from the LMTS to evaluate the reach and impact of "truth". The study found that 10 months after the campaign’s launch, 75% of youth had seen at least one advertisement, indicating that the campaign resonated with youth. In addition, exposure to "truth" campaign messages was significantly associated with stronger anti-tobacco industry attitudes and beliefs such as, "taking a stand against smoking is important". Exposure to "truth" was also associated with a statistically significant reduction in nonsmokers’ intentions to smoke in the future. However, because a quasi-experimental cross-sectional study design based on self-report was utilized, no causal inferences can be drawn. In 2008, Farrelly et al. released a follow-up study showing that youth awareness of "truth" and anti-tobacco attitudes continued to increase over the first three years of the campaign.
Another study of "truth" from 2000 to 2004 examined whether campaign awareness and receptivity differed for youth across socioeconomic backgrounds. The researchers found females had lower campaign awareness compared to males, and youth who lived in lower education zip codes were less likely to have confirmed campaign awareness compared to youth in higher education zip codes. This demonstrates that the effectiveness of the "truth" campaign could be improved through strategies to increase awareness for females and youth from lower education zip codes.
In 2005, an article was published in the American Journal of Public Health that used a pre/post quasi-experimental design to relate changes in national youth smoking prevalence to exposure to the "truth" campaign over time, controlling for secular trends in smoking prevalence and other confounding influences. The study, conducted by researchers from RTI International, Columbia University, and Legacy, analyzed data from Monitoring the Future, collected from students between 1997 and 2002. As the Monitoring The Future survey did not specifically ask about exposure to the "truth" campaign, the study grouped participants based on television markets to analyze the effect of the campaign. The study’s statistical analyses showed that smoking rates among youth in the U.S. declined at a faster rate after the launch of the "truth" campaign: there was a 3.2% decline in smoking before the campaign launch (1997–1999), compared to a 6.8% decline after the campaign launch (2000–2002). Overall, smoking rates were "1.5 percentage points lower than they would have been in the absence of the campaign", which equates to approximately 300,000 fewer youth smokers in the U.S. by 2002. The study also concluded that, while there was no statistically significant relationship between overall youth smoking prevalence and the campaign in 2000 (just a few months after the campaign began), there was a statistically significant effect during 2001.
A similar study published in the American Journal of Preventative Medicine in 2009 used advanced quasi-experimental methods to investigate the association between changes in youth smoking initiation and differing levels of exposure to the "truth" campaign over time and across 210 U.S. media markets. The study found a direct association between youth exposure to "truth" messaging and a decreased risk of taking up smoking. Results demonstrated that during its first four years (2000–2004), the "truth" campaign prevented approximately 450,000 youth nationwide from initiating smoking. The authors conclude that the study "strengthens the available evidence for anti-smoking campaigns as a viable strategy for preventing youth smoking."
Economically, a 2009 study examined whether the $324 million investment in the "truth" campaign could be justified by its effect on public health outcomes. The researchers found that even using conservative estimates of the campaign’s positive health impact, the campaign was economically efficient because it saved between $1.9 and $5.4 billion in medical care costs to society between 2000-2002. In this way, the authors argue "truth" is a cost-effective public health intervention.
Litigation and criticismEdit
A "truth" campaign radio ad prompted Lorillard Tobacco Company to pursue litigation against the American Legacy Foundation. The dispute ran from July 2001 until its resolution in July 2006. The "truth" campaign ran a radio ad called "Dog Walker" during June and July 2001. In the ad, an actor who identified himself as a dog walker placed a phone call to Lorillard, offering to sell Lorillard the urine from his dogs. The "truth" advertisement states urine and tobacco both contain urea.
Initially, Lorillard accused the ad agency of violating the laws regarding the taping of telephone conversations and threatened to refer them to the criminal authorities. In October 2001, Lorillard filed a Motion for a Declaratory Ruling with the Federal Communications Commission (FCC), asking the FCC to rule that the radio stations’ broadcast of the ad violated an FCC regulation regarding broadcasting of telephone conversations. In November 2001, Lorillard notified the American Legacy Foundation of their intent to litigate against the organization and its ad agency for defamation. Lorillard stated that it would not sue if the foundation agreed to a series of demands. Accordingly, the foundation entered into discussions with Lorillard to attempt an out-of-court resolution. However, on January 18, 2002, Lorillard abandoned discussions and advanced a new claim that portions of the "truth" campaign violated the Master Settlement Agreement's prohibition against "vilification" or "personal attacks."
Cases were filed in both Delaware and North Carolina. The matter was resolved by the Delaware Supreme Court on July 17, 2006. They ruled unanimously that the "truth" campaign did not violate the Master Settlement Agreement.
In a 2002 editorial in the Columbia Spectator, commentator Jaime Sneider contended that "truth" attempts "to create the illusion of a racist conspiracy perpetrated by 'Big Tobacco'." Sneider notes that some "truth" commercials claim that "tobacco gives black males 50% more lung cancer than white males." Sneider argues, "obviously, tobacco itself hasn't been engineered to increase the health risk for blacks; therefore, the sentence would more accurately read, 'Black males are 50% more likely than white males to contract lung cancer from tobacco.'"
Sneider states that the "truth" campaign avoids this phrasing because "the focus of the sentence would then be removed from their object of contempt, and placed on the very people who choose to smoke," despite differences in tobacco-related cancer deaths.
Awards and praiseEdit
The "truth" campaign has been praised by a number of leading federal and state public health officials, as well as the U.S. Centers for Disease Control and Prevention, and the U.S. Department of Health and Human Services. The campaign has also been recognized for its achievements in marketing with numerous awards in advertising efficacy. "Shards o’ Glass" and "found.thetruth.com" won Emmy awards in 2005 and 2006. More recently, "Ugly truth", "Poop vs. Pee", and 7 other "truth" advertisements won Clio Healthcare awards. The campaign has also won multiple Effie awards including "Ugly truth" in 2014, "Unsweetened truth" in 2012, and a Grand Effie in 2003. Legacy affirms "truth" has been featured in a variety of academic marketing and communications textbooks to educate the next generation of public health and social marketing leaders.
In 2007, the Institute of Medicine (IOM) released a landmark report, partially funded by Legacy, titled Ending the tobacco problem: A blueprint for the nation. The report reviewed effective tobacco control policies and interventions to present specific recommendations to Congress. The history and success of the "truth" campaign are detailed in Chapter 5 of the report, as evidence to support IOM’s fifteenth recommendation: "a national, youth-oriented media campaign should be funded on an ongoing basis as a permanent component of the nation’s strategy to reduce tobacco use."
In 2008, the Monitoring the Future (MTF) study, which surveys national samples of over 45,000 youth in grades 8, 10, and 12, reported historically low levels of current cigarette use amongst youth. The findings showed that smoking prevalence since 1996 decreased by two-thirds among 8th graders, by more than half among 10th graders, and by nearly half among 12th graders. In a national press release from MTF investigators, the Master Settlement Agreement and the development of the American Legacy Foundation is cited as the most important governmental response to reduce high rates of teen smoking in the 1990s. The investigators also highlight Legacy’s national anti-smoking ad campaign aimed at youth, "truth", as an important result of the MSA.
Citizens' Commission to Protect the TruthEdit
The Citizens' Commission to Protect the Truth was founded to support continued funding of the American Legacy Foundation and the "truth" campaign. Members of the Commission include former U.S. Secretaries of Health, U.S. Surgeons General, and former Directors of the Center for Disease Control and Prevention.
Finish It campaignEdit
In August 2014, "truth" launched the "Finish It" campaign targeting the next generation of U.S. youth aged 15–21. Along with a revamped campaign design, web presence, and series of ads, Finish It embraces a powerful new campaign theme: be the generation that ends smoking for good.
Designed by Legacy and their ad agency 72andSunny, the campaign is a clear departure from previous "truth" efforts. In research with its target audience, campaign designers discovered today’s teenagers are less interested in protesting against tobacco industry manipulation, and more interested in driving positive collective action. While the original "truth" campaign was designed for a generation of naturally rebellious youth, Finish It was developed to suit this generation’s desire to be agents of social change. The campaign aims to empower the 91 percent of teenage nonsmokers, and the 9 percent of teen smokers, to take an active role in ending the tobacco epidemic. The first campaign ad released, "Finishers", was shot in the style of a video manifesto and tells youth, "We have the power. We have the creativity. We will be the generation that ends smoking. Finish it." The spot encourages youth to get involved in the Finish It movement by superimposing the campaign logo, an "X" in an orange square, onto their Facebook profile picture. This online activism tactic is similar to that used by the Human Rights Campaign when they asked individuals to change their profile pictures in support of marriage equality.
In another series of Finish It ads, "Unpaid Tobacco Spokesperson" and "Unpaid Tobacco Spokesperson Response", the campaign tries to shed light on the way smokers, especially celebrity smokers, give tobacco companies free marketing as "unpaid spokespeople" when their photos are posted. As a response, Finish It asks youth to "think before you post a smoking selfie." The campaign also encourages youth to "erase and replace" cigarettes from photos on social media with various props from the "truth" website.
Through YouTube, Finish It also releases intermittent "progress reports" that detail tobacco control success stories from across the U.S. For example, one progress report states "Florida just recorded its lowest teen smoking rate", while another highlights the fact that CVS Pharmacy stopped selling cigarettes.
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