Framing Youth Smoking: A case analysis and media audit of the truth® campaign and
Campaign for Tobacco Free Kids.
By Divya Baliga
April 29, 2013
A Capstone Project
Presented to the Faculty of the AU School of Communication in Partial Fulfillment of the
Requirements for the Degree of Master of Arts in Public Communication
Supervisor: Professor Caty Borum Chattoo
April 29, 2013
Acknowledgements
I want to say a HUGE thank you to Professor Chattoo for helping me through this entire
process. You saw that I was panicked from day one, but you helped me to realize that I
really can accomplish what I set my mind to. Thank you for not only guiding us through our
capstone class, but also providing us with much needed laughter during stressful times and
life advice whenever necessary. You really know how to help your students find success
and I will be forever grateful for your calming words and encouragement. I also have to say
thank you to my salon group for putting up with my frantic questions, always giving me
suggestions and helping me keep a positive attitude.
1
Abstract
This capstone aims to discover how U.S. print news media frame different approaches to
anti-smoking campaigns. A case study of two anti-smoking campaigns, truth® and The
Campaign for Tobacco Free Kids, helps readers to understand how two different
approaches can work together to compliment and shape the future of smoking policy in the
United States. The time frame for this paper focuses on the years 1997 through 2003,
which the CDC identified as the years when smoking had the sharpest decline. These were
also the years when both campaigns were extremely active. Media audits and case studies
of the two campaigns revealed the impact of each campaign. The research shows that the
campaigns tactics were not always covered as heavily, but that smoking culture in the
United States has changed since both campaigns began.
2
Table of Contents
Introduction
4
Literature Review
6
History and Overview of Youth Smoking in the United States
Tobacco Industry Marketing in the United States
Behavior Change Communications
Framing: Explaining the Theory
Framing: Uses in Public Health
Framing: Uses in Smoking Campaigns
Agenda Setting: Explaining the Theory
Agenda Setting: Uses in Public Health
Methods
18
Campaign Overviews
20
Results
21
Media Audit
25
Discussion
32
Conclusion
34
Works Cited
36
Appendixes
41
Appendix A: Samples truth articles
Appendix B: Sample The Campaign for Tobacco Free Kids articles
Appendix C: Sample truth and The Campaign for Tobacco Free Kids
articles
3
Introduction
In 1982, the Surgeon General of the United States declared cigarette smoking to the
be the single major cause of cancer deaths in the country (American Cancer Society,2012 ).
Though this statement was made more than 25 years ago, it remains true today (American
Cancer Society,2012 ). In the United States each day, around 3,800 young people under the
age of 18 smoke their first cigarette (SAMHSA ,2011). The risks associated with the habit
become increased for youth smokers because they began earlier than those who started
smoking as adults. Youth smokers have a greater risk of lung cancer, cardiovascular disease
and respiratory diseases (American Legacy Foundation,2012). One third of youth smokers
who continue smoking as adults will die prematurely due to tobacco related diseases. The
risks associated with smoking are heightened for those who begin smoking at a young age
and continue into adulthood. Between the years 1997-2003, youth cigarette use in the
United States declined sharply (CDC,2010).
Within this timeframe, two specific organizations began to work deeply into the
area of youth smoking prevention, albeit with two different “business models” designed to
meet the same objective. In 1996, The Campaign for Tobacco Free Kids began. The
Campaign is a non-profit organization that advocates at national, state and local levels for
policies to reduce tobacco use and save lives. Four years later, in 2000, the American
Legacy Foundation launched the “truth® campaign” as a national anti-smoking campaign
for youth. Both organizations had very different tactics, but they were complimentary to
one another. The truth campaign used prevention messages to target youth while The
Campaign for Tobacco Free Kids focused on aggressive advocacy, but it is difficult to
achieve the goal of lowering smoking rates without both.
4
The purpose of this project is to help explain how two very different campaigns –
The Campaign for Tobacco Free Kids and truth – worked together in order to achieve their
goals, and to make conclusions about whether or not they were successful in their tactics.
Not much research has been done to discover ways in which the media covered the tactics
of the two campaigns. This capstone aims to answer these questions: How does the media
frame the tactics and key messages of these campaigns? Does a campaign that emphasizes
the need for prevention and infrastructure change (policy) work better for a public health
issue such as youth smoking? The research in this paper can help future public health
communicators to identify ways in which to successfully integrate policy and prevention in
order to achieve their campaign goals.
This paper begins with an introduction to the history of smoking including the issue
of youth smoking in the United States. In order to fully explore the topic of framing of antismoking campaigns, the literature review for this paper covers a number of different things
that help readers have a better understanding of the topic. The review of the literature
begins with a section on smoking history that highlights the issues of tobacco use among
young adults. The next section covers tobacco industry marketing and previous campaigns
aimed at lower smoking rates. An explanation and discussion of theoretical frameworks
such as behavior change communication, framing and agenda setting is also included in this
paper. This section elaborates on the theories behind the campaigns themselves. The next
portions of the paper focus on the original research undertaken for this project – in-depth
case studies, including an examination of media coverage. The paper concludes with a final
discussion to assess whether or not the truth campaign and The Campaign for Tobacco
5
Free Kids created antismoking campaigns that made a positive impact on youth smoking
rates in the United States.
Literature Review
History and Overview of Youth Smoking in the United States
In order to understand the issue of youth smoking, it is important to have a sense of
the history of smoking in general. In 1913, R.J. Reynolds, one of the world’s largest tobacco
companies, released the Camel cigarette. It was the first modern, mass-produced cigarette.
Cigarettes were initially not seen as dangerous and were even included in rations for
American soldiers during World War I (U.S. National Library of Medicine,2012). While the
addictive products were being spread throughout the world, researchers found out that
cigarettes do have harmful effects. In 1938, researcher Raymond Pearl established that,
based on statistics, smoking shortens life expectancy (U.S. National Library of
Medicine,2012).
Since the U.S. Surgeon General’s report began being issued in 1964, 31 reports have
been tobacco-related. The first report by Surgeon General Luther L. Terry was titled
“Smoking and Health: Report of the Advisory Committee of the Surgeon General of the
Public Health Service.” The report changed the framing of smoking risks from an individual
issue to one of epidemiology and public health (U.S. National Library of Medicine,2012).
One year after the report’s release, Congress mandated health warnings on cigarette packs.
The warning from 1965 read: “CAUTION: CIGARETTE SMOKING MAY BE HAZARDOUS TO
YOUR HEALTH” (RJ Reynolds). Years later the Comprehensive Smoking Education Act of
1984 required that cigarette manufacturers and importers display four different Surgeon
General’s warnings on a quarterly rotating basis. These warnings read as follows:
6
•
“SURGEON GENERAL’S WARNING: Smoking Causes Lung Cancer, Heart Disease,
Emphysema, And May Complicate Pregnancy.”
•
“SURGEON GENERAL’S WARNING: Quitting Smoking Now Greatly Reduces
Serious Risks to Your Health”
•
“SURGEON GENERAL’S WARNING: Smoking By Pregnant Women May Result in
Fetal Injury, Premature Birth, And Low Birth Weight.”
•
“SURGEON GENERAL’S WARNING: Cigarette Smoke Contains Carbon Monoxide”
(RJ Reynolds)
A Gallup Survey conducted in 1958 found that 44 percent of Americans believed smoking
caused cancer. However, ten years later, after the Surgeon General’s warning was released,
that percentage rose to 78 percent (U.S. National Library of Medicine,2012). Though
awareness of smoking risks rose it did not necessarily lead to behavior change.
According to the most recent Surgeon General’s report from 2012, 99 percent of
young adults who smoke started by the age of 26. Federal statistics indicate that most
youth try their first cigarette between grades six through ten (ages 11 to 15-years old)
(Johnston,2008 ). More than one-third of all kids who ever try a cigarette become daily
smokers by the time they leave high school (Khuder,1999). Earlier initiation of smoking
leads to greater potential problems including larger consumption, longer duration of
smoking and stronger nicotine dependence (Khuder,1999) During the 1980s, smoking
rates among adults were steadily decreasing, however young rates remained stagnant
(Johnston,2008 ). In fact in the 1990s, the rate of youth smoking began to rise sharply
(Johnston,2010 ). According to CDC findings, in 1997, 70 percent of high school students
within the United States had tried smoking a cigarette. Of that 70 percent, almost 36
7
percent went on to smoke daily. The Monitoring the Future survey on drug use also shed
light on the issue of youth smoking by pointing out that the rate of smoking among
surveyed 8th and 10th grade students had risen by half between 1991-1996 and the rate
among 12th graders had risen by one third between 1992-1997 (Johnston,2008 ).
The numbers clearly show that youth smoking is high, but it is difficult to determine
exactly what factors cause adolescents to start smoking. The American Lung Association
states a couple of factors that could attribute to youth smoking initiation:
•
•
•
•
•
Family history—their parents or relatives are smokers
Peer Pressure—their friends encourage them to try
Show Independence or Be Rebellious —they see smoking as a way to
defy rules or show independence
Social Norm—they think everyone else is doing it, so they should too
Tobacco Advertising—targeted towards teens (American Lung
Association 2012 )
Smoking is an extremely risky behavior and research shows that there is single
reason why youth decide to smoke. However, the health implications can be detrimental to
a person of any age. Smoking shortens one’s life expectancy by 6.5 years for men and 5.7
years for women (Gruber,2000). It is estimated that youth smoking causes the loss of
between 1.2 and 3.6 million years of life (Gruber,2000). Though tobacco is deadly and
costly, youth continue to start young and continue smoking throughout adulthood. One
major factor, also mentioned by the American Lung Association, which has impacted youth
smoking, is youth- targeted tobacco advertising.
Tobacco Industry Marketing in the United States
Tobacco companies spend about $23 million per day to promote their products. The
industry spends a lot of money on price discounts and promotional allowances, which
make cigarettes cheaper and more affordable. The industry also uses a number of tactics to
8
attract youth to its products, such as in-store displays, product placements and advertising
in magazines with high youth readership (i.e., Glamour, Marie Claire, InStyle, Cosmopolitan
and Vogue) (Schmidt,2012). In 1988, R.J. Reynolds, one of the largest cigarette
manufacturers in the U.S., began advertising its product with a cartoon character named
Joe Camel. Joe Camel appealed to youth more than older audience (Calfee,2000). In an
attempt to create another familiar face among cigarette advertising, Marlboro re-vamped
the Marlboro Man after the creation of Reynolds’ Joe Camel. The original Marlboro Man
emphasize sacrifice, hard work and discipline, which were values with which the youth
audiences did not identify as well (Tobacco Documents Online,1992). In order to change
this, Marlboro created ads that depicted the Marlboro man as laid-back, fun and appealing
to a younger crowd. The new Marlboro man ads displayed someone who was:
“…not only at work, but during leisure time, enjoying benefits of chosen path
(pleasure oriented), shown in charge (dominance) and desirable in magazines
where he could be pictured with a woman (e.g. Playboy, Cosmopolitan)… and more
accessible and less removed (e.g. a smile, a touch, a tip of the hat)” (Tobacco
Documents Online,1992)
Essentially Marlboro was aiming to create a figure that was more appealing to young (1824-year old) audiences and would directly compete with Reynolds’ Camel character.
The figure below shows that among 8th grade smokers in 1998, Marlboro, Newport
and Camel were the three most heavily-consumed brands of cigarettes.
9
(Monitoring the
Future,1998).
Marlboro and Camel both attracted high numbers of Caucasian youth smokers, but
males were more likely to smoke Camels than females. The creation of Joe Camel by R.J
Reynolds could explain the male attraction to this brand. Newport cigarettes were more
likely to be smoked by the Black segment of the underage market (Johnston,1999). African
Americans who smoke are almost 11 times more likely to smoke menthol cigarettes than
10
Caucasians, which can be attributed to heavy tobacco industry targeting of menthol
cigarettes to racial and ethnic minorities and youth
Increased data and awareness of the rise of youth smoking came to the attention of
lawmakers in the late 1990s. It became evident that action needed to be taken in order to
prevent youth from initiating smoking earlier. In 1998 the multi-state Master Settlement
Agreement (MSA) was agreed upon. The MSA was an agreement between the major U.S.
Tobacco companies, 46 states and many U.S. territories. Tobacco companies must pay the
states $246 billion dollars over a 25 year period. The money would go to anti-smoking
programs within the states as well as covering health costs that the states incur due to
patients with smoking-related illnesses. The MSA prohibits “…any action, directly or
indirectly, to target Youth…in the advertising, promotion or marketing of Tobacco
Products” (Schmidt,2012). There are a number of specified regulations within the MSA that
attempt to keep anything youth-focused (i.e. brands, TV show characters, etc.) as separate
as possible from tobacco products.
The year after the MSA, the tobacco companies spent $8.4 billion on advertising and
promotion (Schmidt,2012).This was the highest amount they spent since the Federal Trade
Commission started tracking tobacco industry ad spending in 1970 (Schmidt,2012). The
number of tobacco advertisements in magazines, read by youth audiences, declined by 26
percent from 1997 to 2000 (The University of Chicago Medicine, 2002). However, this has
been attributed to the cost for advertising at the time, but magazine advertising
expenditure also increased by 26 percent during this time (The University of Chicago
Medicine, 2002). Between 1992 and 1997, teens reported that accessibility to cigarettes
was lower than usual which could be attributed to the stricter regulations
11
(Johnston,2008 ). Though the amount spent on advertising have lowered, $8.05 billion in
2010, the amount still remains extremely high, and the tobacco industry continues to
attract youth smokers (Federal Trade Comission,2012).
In order to combat tobacco companies from luring in young smokers, U.S. federal
government, as well as state governments, created prevention campaigns to grab young
consumers’ attention and help them to see the effects of smoking. Notably, the Centers for
Disease Control & Prevention (2012) created the “Tips from Former Smokers campaign” as
a way to show how heavy smoking and exposure to secondhand smoke can cause negative
life-changing impacts. There is a list of dozens of compiled stories with real victims of
smoking who suffer from conditions like Buerger’s Disease (which resulted in limb
amputations for some), cancer, heart disease, stroke and severe asthma (CDC 2012).
Though the campaign is national, it is not youth-focused, and therefore, the messages
within the campaign do not resonate as well with teens.
Behavior Change Communication
Youth smoking prevention campaigns such as truth and The Campaign for Tobacco
Free Kids are both examples of behavior change communications (BCC) campaigns. There
are a number of different theories that can be used within BCC. The three main theories
underlying behavior change communications campaigns are the individual effects model,
social diffusion model, and the institutional diffusion model.
For health campaigns, the Health Belief Model (HBM) was created to understand the
likelihood of a person to perform a health protective behavior. The HBM emphasizes four
factors that help predict the probability of a person to perform a particular behavior:
“(i) the perceived threat against (susceptibility and severity), (ii) the perceived
effectiveness of the preventative behavior (benefits and barriers), (iii) the person’s
12
general health motivation, (iv) cues to action that reflect immediate situation
determinants” (Webb,2010)
The HBM often includes exchange theory and self-efficacy because it depends on the
exchange of a poor behavior for that of the desired as well as the desire for the audience to
learn more and be able to act based on their new knowledge.
First Lady Michelle Obama’s Let’s Move campaign is a prime example of BCC
campaign that emphasizes all of these models. The First Lady announced the campaign on
February 9, 2010 to fight childhood obesity in the United States. The program focuses on
changes within schools and homes to help children learn to live healthier lives. Let’s Move
has five pillars (or goals):
“(i) Creating a healthy start for children, (ii) Empowering parents and caregivers,
(iii) Providing healthy food in schools, (iv) Improving access to healthy, affordable
foods, (v) Increasing physical activity” (Let's Move,2012)
Let’s Move addresses not only individual issues concerning obesity, but turns the
problem into a societal and policy concern for the United States (Political Pounds,2011).
Obama addressed the issue of structural disparities within the nation. She discussed how
23.5 million Americans, which includes 6.5 million children, are currently living in “food
deserts” or areas where they have no access to supermarkets (Political Pounds,2011).
Obama has acknowledged that in order to combat obesity, it will take more than policy
change. It is going to take infrastructural changes within schools and homes by
implementing healthier meal choices. It will take the strength of individuals including
teachers and classmates to encourage children to live healthier lifestyles. The effort must
also be made within communities to change the society they live in into one that is
conscious of their impact on the health of future generations.
13
The Let’s Move campaign has been very successful since its launch in 2009. The
campaign is supported by many partnerships including Wal-Mart, food suppliers, Disney,
the National Football League (NFL) the National Hockey League (NHL) as well as a number
of other celebrities and businesses. Some of these accomplishments include: the Chefs
Move to Schools program where professional chefs help educate kids about healthier food
choices, the Healthy, Hunger-Free Kids Act to increase access to healthier school lunches,
the Presidential Active Lifestyle Award (PALA), Safe Routes to School program, Let’s Move
Cities and Towns and Let’s Move Faith and the Communities. Let’s Move helped to bring
salad bars to over 1,000 schools and partnered with restaurants to improve dining options
for children by including healthier meals and lowering sodium and calories (Curtis,2012 ).
Let’s Move is very similarly structured to the truth campaign because it involves the
three main BCC theories as well as the HBM. The use of these theories helps to form
messages that are most effective among target audiences. In order to reach key audiences,
the media must be used to channel messages directly to consumers. The following sections
explain the role that media-related theories play within not only these two smoking
campaigns, but also health campaigns in general.
Framing: Explaining the Theory
Framing can be widely used and it can be essential for communicators to
understand how their messages are being conveyed and understood by audiences. Entman
(1993) describes framing as:
“to select some aspects of a perceived reality and make them more salient in a
communicating text, in such a way as to promote a particular problem in definition,
casual interpretation, moral evaluation, and/or treatment recommendation for the
item described” (Entman 1993).
14
Frames help audiences to pinpoint a problem, figure out what is causing the
problems, “evaluate casual agents and their effects,” and offer suggestions for fixing the
problem (Entman 1993). “Frames determine whether most people notice and how they
understand and remember a problem, as well as how they evaluate and choose to act upon
it” (Entman 1993).
The way a message is framed is often based on the four previously mentioned
functions because the sender of the message wants to see a certain behavior/attitude
change result from his or her messaging. In order to do this, a messenger highlights certain
aspects of the message, making it more salient, so that receivers are more likely to pay
attention or recall the message presented to them. Framing is “the practice of influencing
how individuals think and feel about issues by encouraging them to think about the issues
in particular ways” (Chang 2010). They will then process the message, weigh their options
and eventually decide whether or not to change their attitude or behavior.
Entman (1993) said that “The notion of framing thus implies that the frame has a
common effect on a large portion of the receiving audience, though it is not likely to have a
universal effect on all” (Entman 1993). His description is applicable to the framing of
smoking messages because the way in which the message is presented, or framed, can
affect the way it is processed by the audience. Not all messages are going to be successful,
but it is important to understand why certain frames do or do not work for a target
audience. If a messenger understands his/her audience, it becomes easier to frame
messages in a more appropriate way for them so that the behavior/attitude change desired
is achieved through the messaging.
15
Framing: Uses in Public Health
“Framing is the theoretical basis for the public health model of reporting”
(Coleman,2009). In the case of public health, frames are created to emphasize certain
information that way audiences can get a better understanding of complex medical issues
such as diabetes, AIDS and smoking. It is the job of the communicator to create a message
frame that is likely to derive attention from the target audience. Framing theory implies
that the frame used by the media to cover a certain subject will have a common effect on its
audience (Entman,1993). Public health campaigns in the past have focused on increasing
individual knowledge about health risks, which campaign creators believe will lead to
behavior change (Apollonio,2008). Instead, it would benefit health advocates to use media
campaigns as “exercises in information framing” and not just “exercises in information
provisions” (Apollonio,2008).
Matthew Nisbet stated if researchers pinpointed mental association and cognitive
schema that people associate with complex science, such as medical illnesses, combined
with an effective frame, then complex science becomes more accessible and personally
meaningful for audiences (Nisbet,2009). It is essential to use framing in public health in
order to make the message clearer to the audience. Rather than providing them with
endless facts about a disease or behavior, communicators can focus in on a specific issue
associated with the disease/behavior and emphasize the importance of disease prevention,
treatment, etc. A study by Renita Coleman (2009) found that a public health frame made
readers more supportive of public policy changes and inspired them to change personal
health behaviors; however, it did not make them see the health problem as a societal issue
rather than an individual issue. This research helps to support the point that using a public
16
health frame in the news does encourage public policy change to encourage healthier
lifestyles.
Framing: Uses in Smoking Campaigns
Smoking messages usually contain two different types of audiences: those who are
interested in quitting (cessation) or those who have not yet started smoking (prevention).
It is difficult to connect to both audiences with one message; therefore different types of
messaging can be used for each audience. After reading multiple resources on the types of
messages used by cessation and prevention campaigns, it became apparent that the
framing of the message actually depends more on the person who is being reached and
their dependence on nicotine (Moorman,2006). Therefore message makers must be careful
in defining their audience in order to correctly frame their messages.
Agenda Setting: Explaining the Theory
Agenda setting theory explains that the amount of prominence and coverage that an
issue receives within the media shapes the audiences’ perceptions of its importance
(McCombs,1972). There are two levels of agenda setting, the first is the idea that media
tells audiences what and how to think (Jahng). Second-level agenda setting focuses on how
the media shapes our perceptions of certain issues and can even help us form our opinions
on certain topics (Jahng). Second-level agenda setting is a combination of agenda setting
with framing, which is how it most often used in the public health setting (Jahng).
Agenda Setting: Uses in Public Health
The media in the United State has a great impact on the ways in which Americans
perceive certain issues. Researchers at the American Academy of Pediatrics, led by Colleen
Barry, studied news stories on childhood obesity over the course of ten-years from 200017
2009. Their research found that more coverage was focused on individual, rather than the
institutional, changes that come with combating obesity (Barry,2011) . Individual behavior
change was mentioned more, which means that the media set the agenda as obesity being
an individual problem rather than an epidemic that can be dealt with through policy
change.
Another study by Katherine Chegg Smith and Melanie Wakefield (2006) found that
news coverage of tobacco-control messages were mostly positive and often focused on
local events to reduce youth smoking initiation. The coverage was not very hard-hitting
and did not give much of a call-to-attention which is often necessary with issues such as
smoking. Smith and Wakefield did not believe that the coverage studied “provided strong
support for progressive policy changes or any educative efforts beyond the youth
population” (Smith,2006) The coverage was more “feel good” rather than challenging the
tobacco industry or current policy (Smith,2006). They too found that issues were discussed
at more of an individual level (smokers) rather than tackling the societal problem (tobacco
industry).
Methods
In order to create meaningful research for this project, I used two different research
methods. I performed an in-depth case study on both truth and The Campaign for Tobacco
Free Kids this also included a media audit of articles that resulted from the two campaigns.
The case studies include the tactics used by each campaign as well as target
audiences and successes (as defined by the organizations themselves). I focused on the
campaigns’ activities between 1997 and 2003 because these years incorporate the
18
durations of time in which the campaigns were most active, as well as the timeframe during
which youth cigarette usage in the United States had declined sharply (CDC,2010). The
objective of the case studies is to provide a thorough background about the goals of each
campaign and set the context for the media coverage that was studied through the audit as
well as the explanations given through the discussion section of this paper.
The second method is an audit of approximately 20 articles written about each
campaign that were published between the years 1997 and 2003. This method is used in
order to answer the key research question of this campaign which is: “How do U.S. print
news media frame the tactics and key messages of these campaigns?” The audit uses
articles from two different sources: USA Today and The New York Times. These two sources
were used because these papers were two of the top five highest-circulation papers
between 1999 and 2003 (Advertising Age,2003). They have consistently come in as
numbers two and three between 1999 and 2003 with USA Today as number two and The
New York Times as number three (Advertising Age,2003). I looked at only national
newspapers in order to complete this media analysis because both
campaigns/organizations were run nationally even though they did have local impacts. I
conducted an analysis to identify the key frames in the media coverage and compare these
frames to the messaging, audience and tactics that the campaigns used to try and achieve
their goals. The following search terms were used:
•
•
•
•
•
•
“truth” AND “anti smoking”
“Campaign for Tobacco Free Kids” AND “anti smoking”
“truth” AND “anti-industry”
“Campaign for Tobacco Free Kids” AND “anti-industry”
“truth” AND “counter-marketing”
“Campaign for Tobacco Free Kids” AND “policy”
19
The importance of the media audit is not just to count how many articles covered the
campaigns, but rather to see how the messages and tactics of the campaigns themselves
were framed and covered by the media. Since this paper is not focused on the volume of
coverage, but rather the content, I chose to limit the number of articles that I was
reviewing. I viewed every 5th article within the list of search results. If a search yielded less
than 5 articles, I chose to read the first article listed within the search. Appendixes A,B and
C contain samples of the articles that were chosen for analysis.
Campaign Overviews
“truth campaign”
Prevention messages are often used for youth who have yet to pick up the habit of
smoking or those who are not fully addicted. The truth campaign was created in 2000, by
the anti-smoking organization the American Legacy Foundation (Legacy), to expose the
manufacturing of cigarettes and marketing conducted by tobacco giants. The target
audience for truth is 12 to 17-year olds within the United States and the secondary
audience is 18 to 24-year olds. It is not a campaign that is “anti-smoker, or anti-smoking,
just anti-manipulation” (Legacy 2012). truth counters tobacco messaging and helps teens
to make informed decisions by giving them “control” and emphasizes the downfalls of
rebelling through tobacco use.
The Campaign for Tobacco Free Kids
The Campaign was created in 1996 as a non-profit organization that accepts no
government or tobacco industry funding. It is one of the only non-profits that attempts to
tackle youth tobacco use in the United States and abroad. The campaign is an advocate for
20
policies that prevent youth smoking, help smokers quit, and protect people from
secondhand smoke (Campaign for Tobacco Free Kids,2012). Its mission is to:
•
•
•
•
•
•
Promote public policies proven to reduce tobacco use and exposure to
secondhand smoke. These include higher tobacco taxes, comprehensive smokefree laws, well-funded tobacco prevention and stop-smoking programs, and
tough regulation of tobacco products and marketing.
Expose and counter tobacco industry efforts to market to children and mislead
the public.
Strengthen tobacco control efforts in the United States and worldwide by
providing support and information to our many partners.
Mobilize organizations and individuals to join the fight against tobacco.
Empower a tobacco-free generation by fostering youth leadership and activism.
Inform the public, policy makers and the media about tobacco’s devastating
consequences and the effectiveness of the policies we support. (Campaign for
Tobacco Free Kids,2012)
Results
truth campaign
truth aims to “encourage youth to develop positive beliefs about not smoking” by
emphasizing the deception of tobacco companies (Evans 2005). The campaign gave teens
the power of knowledge to help them make their own decisions about smoking. Rather
than framing smoking as a negative, truth chose to positively frame not smoking, which
was done through advertising and marketing. truth was emphasized as a brand, like Nike
or Apple, which teens could connect to. The campaign also heavily relied on the sharing of
truth values among peers (Evans 2005). The brand was essentially framed in a positive
manner which led teens to desire to be “truth” teens (Evans 2005). A “truth” teen was
someone who was in charge of their own life and did not rely on cigarettes or smoking as a
form of rebelling (Evans 2005). Many studies show that messages that emphasize the
deception and negative practices of tobacco companies are more well-heard (Dunlop
2011).
21
Chang and Lee (2010) argue that negatively framed messages tend to “arouse
viewers’ self-relevance, consciousness and sympathy regarding the serious consequences if
no action is taken.” Though their research is in regards to charitable donations, this
statement can also be applied to smoking cessation. Negatively framed messages tend to
evoke a sense of fear in viewers.
Since the campaign gives people facts, it emphasizes the importance for them to
make their own decision about whether or not they want to quit or avoid smoking instead
of relying on peer pressure or industry advertising pressure. Its tactics used countermarketing strategies that emphasized that smoking is “following orders” because that is
exactly what the tobacco industry wants young people to do, instead not smoking or
quitting would be considered rebellious (truth,2013). The campaign relied heavily on TV
advertising and showed 30-second advertisements that were shocking and informative,
such as the “body bags” ad created by Arnold Worldwide.
(Arnold Worldwide). The ad
shows 1,200 body bags piled up in front of a tobacco company office in New York City to
22
represent the 1,200 people who die every day from tobacco. Other ads created by truth
display the harsh effects of smoking
Research on truth shows that the campaign resulted in almost 300,000 fewer youth
smokers between 2000 and 2008 (Cami 2008). truth is associated with a 20 percent
decrease in smoking initiation which results in approximately 73,000 fewer smokers from
2000 to 2004 (Farrelly 2009). This campaign was able to use gain framing because its
audience was most susceptible to a positive message. truth had to highlight the positives
associated with not smoking in order for teens to choose not to rebel, where as a negative
framed message may have inspired them to rebel more. Though its Master Settlement
Agreement (MSA) funding ended in 2003, the truth campaign continues to spread its
lifesaving messages across multiple platforms such as an online site, music and gaming
tours and an interactive mobile game (Cami 2008).
Campaign for Tobacco Free Kids
The Campaign for Tobacco Free Kids tends to take a different approach than truth
to address smoking issues within the United States. The Campaign actually works outside
of international barriers to fight against big tobacco overseas where marketing is often
heavier and more targeted. Rather than focusing on consumers, the Campaign aims to fight
big tobacco through policy changes. Where truth aimed to reach kids and impact their own
personal thoughts and behavior, the Campaign tried to reach a step further by targeting
lawmakers. It aggressively pursued lawmakers to adopt policies that would restrict
tobacco companies and their efforts to market to youth. A press release from January 1997
titled “Tobacco Wars 1997 Preview Upcoming Battles at Federal and State Levels,” gives a
highlight of what was to come for the federal and state governments in terms of tobacco
23
regulations. In order to get the word out about these issues, the Campaign held a media
briefing to cover
“Bills introduced by Rep. Bart Gordon (D-TN) and Sen. Wendell Ford (D-KY) to
undermine the FDA rule scheduled to go into effect Feb. 28; The effect that
Appropriations Committee funding may have on the FDA; The status of the Attorney
General lawsuits suing tobacco companies to recoup medical costs; An overview on
major anti-tobacco legislation being introduced in state legislatures.”
(The Campaign for Tobacco Free Kids,1997)
It basically gave the media chance to hear everything that is doing on in the tobacco-control
world in one sitting. This also provided the Campaign with the opportunity to promote its
opinions about tobacco control and policy into the public sphere by sharing its
organizational beliefs to media outlets that would hopefully cover its efforts.
Though The Campaign for Tobacco Free Kids is focused on policy changes, it does
have programs to help kids gain more knowledge about smoking and its harsh effects on
one’s body. In 1997, the Campaign held the second annual “Kick Butts Day.” Thousands of
young people, in over 50 cities, organized anti-tobacco events within their community. The
events usually took place at the state capitol and included activities such as “burning
tobacco industry merchandise, lobbying for stronger anti-tobacco measures in their
schools and communities and asking teen role models to quit smoking” (The Campaign for
Tobacco Free Kids,1997 ). In 1998, the number of participants in “Kick Butts Day” nearly
tripled. In Jackson, Mississippi, participants spoke with Attorney General Mike Moore to
discuss findings of their 10-city undercover buying operation to help discover if businesses
were complying with new laws restricting the sale or transfer of tobacco products to
minors (The Campaign for Tobacco Free Kids,1998). In March 2013, the Campaign held its
18th annual Kick Butts Day in which nearly 1, 3000 events took place across the country.
Though the Campaign for Tobacco Free Kids is taking a more consumer-based approach
24
with the Kick Butts Day effort, most of its work is still focused on enacting smoking
decreases through policy changes that prohibit marketing targeted towards youth, creating
stricter smoking bans and raising the taxes on cigarettes and other tobacco products. The
Campaign also emphasizes the issue of states cutting anti-smoking programs and not using
even the minimum levels of funding as recommended by the Center for Disease control. In
2003, it released a statement regarding to the 2002 results of the National Youth Tobacco
Survey. The survey stated that cigarette-smoking rates among youth (grades 9-12) had
declined by around 18 percent (The Campaign for Tobacco Free Kids,2003). The Campaign
attributed this decline to Legacy’s truth campaign as well as increased cigarette prices (due
to settlement-related pricing). The Campaign also stated that if states continued to cut
funds or cancel tobacco-related education, the problem of youth smoking would only
increase (The Campaign for Tobacco Free Kids,2003).
Media Audit
In order to get a better understanding of how the truth campaign was assessed by
the media, I chose to use a media audit as an additional research method. The media audit
is a great way to understand the volume of coverage and to get a more broad
understanding of how the tactics and messages of the campaign are coming through, or not
coming through, in the media. The table below illustrates the overall breakdown of each
campaign within the media audit.
truth
Campaign for Tobacco Free Kids
Time period covered
January 1, 1997-December 31, 2003
January 1, 1997-December 31, 2003
USA Today
29
62
25
The New York Times
37
79
Total Articles:
66
141
Total Articles Examined:
13
28
The list below is an overview of how many articles (from USA Today or The New York
Times) mentioned each of the following search terms within the same article:
•
•
•
•
•
•
•
“truth” AND “anti-smoking”
o The NY Times: 25
o USA Today: 23
“Campaign for Tobacco Free Kids” AND “anti-smoking”
o The NY Times: 40
o USA Today: 38
“truth” AND “anti-industry”
o The NY Times: 1
o USA Today: 0
“Campaign for Tobacco Free Kids” AND “anti-industry”
o The NY Times: 0
o USA Today: 0
“truth” AND “counter-marketing”
o The NY Times: 0
o USA Today: 1
“Campaign for Tobacco Free Kids” AND “policy”
o The NY Times: 28
o USA Today: 19
“truth” AND “Campaign for Tobacco Free Kids”
o The NY Times: 11
o USA Today: 4
I chose to use these terms because they are incorporated within the key messages
and/or tactics of the campaign, but they are simple enough that they could be used within
news media coverage rather than a research or policy paper.
26
truth campaign
Overall, the amount of media coverage for truth was relatively low over the sevenyear period that I examined. Though the volume of coverage as low, the content of the
coverage stayed true to the values of the campaign.
The first search terms used were “anti-smoking” AND “truth” which yielded a high
number of results between both newspapers. Legacy made a big move in 2002 to possibly
air a truth commercial or public service announcement during Super Bowl XXXVI even
after threats of lawsuit came from tobacco giant Lorillard. The article mentions two truth
ads from the previous year’s Super Bowl that were “equally hard-hitting” (McCarthy,2002 )
The Body Bags ad was highly covered in 2000 when it first aired. One article highlighted
the involvement of other teens, which is another staple of truth because it is a brand that
teens can recognize and approve based on the involvement of their peers. The teens
involved agreed that the campaign’s “in- your-face messages work best to convince young
audiences.” (Santiago,2000) The Chief Executive Officer and President of Legacy, Dr. Cheryl
Healton, is often quoted in news stories. This is yet another way for the truth message to
be spread because it allows Dr. Healton to give an exact explanation of what the truth
campaign is all about such as "The campaign is based on changing the social norms around
tobacco and encouraging young people to rebel against the concept of becoming addicted
to tobacco” (Founation, 2001).
When searching the terms “anti-industry” AND “truth,” only one article was found.
This article discussed how tobacco companies believe that Legacy’s truth campaign was
vilifying tobacco company employees through their shocking ads. The article does highlight
the tactics of truth through quotes from experts.
27
“Rather than spotlighting the ill effects of cigarettes, the ads are focusing on the
supposed evils of the tobacco industry.” Susan Moses, the deputy director of the
Tobacco Project at the Harvard School of Public Health, said, "Kids need a common
enemy, and kids hate more than anything to be lied to, and hate to be manipulated.
"THE "truth" campaign is doing just that, telling teenagers that if they smoke,
they're playing into the hands of Big Tobacco.” (Tugend,2002)
Though the article is discussing the feud between truth and tobacco companies, there are
still several mentions of truth tactics such as the shocking advertisements with body bags,
dying rats and dog urine in cigarettes. The coverage is positive for truth because there are
multiple points of praise mentioned by experts of the campaign’s effective anti-industry
messaging.
truth and its connection to declining smoking rates is also very important to
emphasize the success of the campaign. One article links the University of Michigan’s
“Monitoring the Future” survey to the anti-smoking campaigns and quotes Dr. Healton as
attributing the declining teen smoking rates to truth ads that “seem to have resonated
among teenagers” (Fountain,2001).
The campaign’s signature tactic of counter-marketing was only mentioned in one
article in either newspaper between 1997 and 2003. When the term is used, it is not
actually in reference to the truth campaign in Florida. The article emphasizes that "[the
ads] speak to teens in teens' own voice" and they are more effective because they are not
the typical ads that preach to kids about not smoking for health-related reasons. Though
truth is heavily hovered in the article, the emphasis of the story is not to celebrate the
success of truth. Its intention is to highlight that only 8 percent of the initial payments from
the $250 billion Master Settlement Agreement are being used to fun anti-tobacco programs
(DeBarros,2001).
28
Overall, the coverage of truth was positive and emphasized the tactics of the
campaign. However, not all teens were swayed by truth. Jefferson Graham, of USA Today,
explains that truth is hard-hitting and shows graphic and sickening detail of how tobacco
can do to your body. However, he also stated that though it’s a site for teens by teens, his
son was not convinced because he had not “heard of anyone looking like that after
smoking” (Graham,2000). Though truth graphics may be bold and frightening, they may
not always get the message across to teens that do not have first-hand experience with the
horrors of tobacco-related cancer.
The Campaign for Tobacco Free Kids
The Campaign for Tobacco Free Kids also takes aggressive action against tobacco to
stop kids from smoking. However, The Campaign focuses on how laws and policies affect
smoking behavior among kids. The news coverage of The Campaign for Tobacco Free Kids
was higher in volume than truth. The coverage of The Campaign contained many more
statements from The Campaign for Tobacco Free Kids officials (i.e. reactions to tobacco
company statements and tobacco policy changes) than truth.
In 1998, President Bill Clinton aimed to create policies that would reduce the
number of youth smokers. Republican Senator John McCain chaired a bill that would
significantly increase taxes on tobacco products. The Campaign was mentioned in multiple
articles centered around the debate on whether or not taxes should be raised to $1.50 per
pack over the course of 10 years (Broder,1997). The Campaign for Tobacco Free Kids
President, Matthew Myers, was included in the White House discussions on what course of
action was best to take. This mention of Myers at the meeting emphasizes The Campaign’s
importance in the tobacco control world.
29
In 2002, The National Basketball League (NBA) and Lorillard were forced to end
their partnership for Hoop-It-Up, a popular youth basketball tournament. NBA League
Commissioner David Stern made the decision to end Lorillard’s sponsorship after urged to
do so by The Campaign for Tobacco Free Kids, American Cancer Society, the American
Heart Association, and the American Lung Association. The article explained how antismoking sponsors are also being kept out of the tournament. It ends with a quote that
expanded on where the Lorillard anti-smoking program has sponsored events. The article
was not completely one-sided, but placed more of an emphasis on the actions of the
tobacco company rather than the anti-smoking groups.
The most highly covered topic among The Campaign for Tobacco Free Kids news
media was the lawsuit between the federal government and tobacco companies that
followed the Master Settlement Agreement. The Bush administration decided to seek
settlement rather than pursuing the lawsuit against the tobacco companies that had been
vigorously pursued by the Clinton administration. The Campaign’s President, Matthew L.
Myers, is quoted as being worried by this decision and letting administration officials know
that their discouraging sentiment towards to lawsuit was not appreciated. The article even
highlighted one senator who was one of the most responsible for blocking anti-smoking
legislation to create more rigid smoking legislation and raise cigarette prices and exposed
the Republican Party on its acceptance of tobacco company donations. According to the
article, “antismoking groups accused the Bush administration of repaying the tobacco
industry for its campaign contributions. Statistics compiled by antismoking organizations
stated that tobacco companies donated more than $8 million during the last election, more
than 80 percent of it to Republican candidates” (Johnston,2001).
30
Another major theme throughout the coverage was that The Campaign for Tobacco
Free Kids was revered a source for meaningful research and knowledge that shed greater
light on tobacco issues. Four articles within the search results for “Campaign for Tobacco
Free Kids” and “anti-smoking” mentioned how The Campaign conducted research that
displayed how tobacco funds were not being used properly or explained how public
opinion of politician’s ability to protect children’s health changed based on whether or not
the politician accepted tobacco funding (Meier,1999). Another article, concerning Nicotine
Water (Nico Water), quotes only a Federal Drug Administration (FDA) official and Myers
instead of including someone from American Cancer Society, which teamed with The
Campaign to petition the FDA to review the safety of Nico Water(Koch,2002).
Though most of the coverage on The Campaign for Tobacco Free Kids was related to
public policy and shifts in lawmaking, there were articles that mentioned the Campaign’s
efforts to implement consumer-friendly tactics (Pearson,2003). One article mentioned Kick
Butt’s Day and another spoke to how the Campaign supports anti-smoking ads, even if they
were not produced by their own organization.
Coverage on The Campaign shows that they were a big player in the game when it
came to regulating tobacco through governmental means. The Campaign’s bold and forceful
actions towards politicians definitely made a statement within the news coverage.
Campaign President, Matthew Myers, or other Campaign officials were often quoted in
articles to give the Campaign’s take on a situation which allowed them to get their
messages out to the public. This coverage is useful in spreading the ideas of the Campaign
because it was not necessarily a household name since it was not a consumer-focused
campaign like truth.
31
truth and The Campaign for Tobacco Free Kids
In total, there were 15 articles that mentioned both truth and The Campaign for
Tobacco Free Kids between 1997 and 2003. However, in most of the articles I examined,
the two campaigns were referenced but the articles did not discuss their connection or
significance together. One article explained truth more in depth in terms of its tactics and
funding, but does mention that The Campaign for Tobacco Free Kids played a role in
tobacco control by providing research about tobacco companies spending and activities.
In 1998, The New York Times published an article by Mireya Navarro that described
how the original Florida truth program aimed to create a campaign that included fun,
consumer-based tactics such as advertisements and rock concerts with more serious
measures such as the Teen Smoking Court. The Teen Smoking Court punished children who
smoked before the age of 18. The program allowed officers to give citations to kids under
18 who were found smoking or possessing tobacco products. They were then brought to
court, in Broward County, and tried. The penalties came in the form of fines or community
service. When the Florida truth campaign was born, Myer commented on how “attempting
different things at once with a well-financed campaign, Florida may help design an effective
model for other efforts to reduce smoking by the young” (Navarro,1998). He also stated
that truth might not work perfectly, but is would be a good learning experience and help
create efforts that are even more successful (Navarro,1998).
Discussion
Both truth and The Campaign for Tobacco Free Kids had relatively low amounts of
coverage over the eight-year period of the media audit. However, the media coverage did
32
help give greater insight into how these campaigns’ tactics and messages were covered
within news articles at the time.
There were a number of articles that mentioned the Florida truth campaign because
it was the basis for the national campaign. In 1997, the Florida truth program was still an
active program, which explains why articles about this topic were included within the
search results. Within six months of the campaign’s Florida launch, 92 percent of teens
were aware of the campaign (Schum,2013). This immediate success made it evident to
truth creators that it had the potential to be a successful national campaign. Therefore
coverage explaining the meaningfulness and success of the Florida campaign are beneficial
and help explain the strategies of truth since the Florida campaign is where the national
campaign got its foundation.
Overall, the shock and outrageousness factor of the truth ads were highly covered
by media outlets. However, almost all articles covering truth tactics and messaging also
covered the struggle between tobacco companies and Legacy over the campaign’s bold
advertisements. truth did not aim to engage its target audience through the media which
could help explain why there was not as much coverage about this campaign. Instead, they
focused on reaching kids through counter-marketing. The campaign brought grassroots
tactics together with public relations efforts in order to create meaningful messages among
teens.
Rather than focusing on pitching their stories to the media, truth used knowledge
and activity-based tactics to gain the attention of their target audience. truth created a
brand that was intriguing to teens. There was something for every teen to relate to—
rebellion, music, fun—but it also brought teens the information they needed in order to
33
help them make more informed decisions on smoking. The knowledge was always
presented in a fun way, whether that be through seeing an ad on their favorite TV channel
or playing games with truth marketers in the “truth zone” at Vans Warped Tour.
The Campaign for Tobacco Free Kids created much more coverage within the
national news from 1997 to 2003. The Campaign pushed heavily for coverage as a tactic of
the campaign. In order to gain more awareness among audiences, The Campaign needed
the media to spread their message of change. If it could catch the attention of the public,
then it would be more likely to bring the issue of tobacco control to their local politicians
who would then make the impactful decisions within the government. The main reason
why The Campaign reached out to consumers was to ask them to help fight for changes to
governmental policies. For example, Kick Butts Day is mentioned in some articles, but the
language and information within the stories describes how The Campaign encouraged
people to organize their own petitions against tobacco policies, not about how The
Campaign is focused on consumers themselves.
In general, the stories about The Campaign for Tobacco Free Kids shed a positive
light on The Campaign’s hard work to overcome issues within tobacco control policy that
are negatively affect youth.
Conclusion
The objective of this paper was to understand the differences in tactics between two
anti-smoking campaigns and figure out how they were successful. It also aimed to discover
how the media coverage surrounding these campaigns was framed in order to get a better
understand how the media explained the tactics and messaging of these campaigns. While
to two campaigns had very different tactics and were framed in different ways, both
34
ultimately worked together to accomplish their goal of lowering youth smoking in the
United States.
The former Campaign for Tobacco Free Kids president William D. Novelli said, "The
academics are right; the best way to do public education is not media alone." This quote
highlights that consumer-based behavior change campaigns and advocacy-based
campaigns must be combined in order to create greater change. To create a campaign that
is successful at declining smoking rates, there must be a balance between consumer-based
tactics such as peer-to-peer learning and tough anti-tobacco policies that are highlighted
through media coverage. If cigarettes are easily accessible to teens, they will continue to
smoke. However, a study predicted that for each 10 percent that tobacco prices are raised,
the rate of teens you start to smoke declines by three to five percent (Campaign for
Tobacco Free Kids,2011).
Though the efforts of both campaigns were not fully covered in the media articles
reviewed through this research it must be stated that these campaigns started when the
culture of smoking was very different. The culture of smoking has changed greatly. When
these campaigns began, cigarette manufacturers were just starting to have regulations in
terms of advertising towards youth. The campaigns set out to accomplish very difficult
mission, but ended up successful in many ways. The ultimate goal of each campaign was to
lower smoking rates among young adults. The rate of smoking among teens has decreased
since the campaigns began. Both The Campaign for Tobacco Free Kids and the truth
campaign continue to run throughout the United States. In 2012, youth smoking rates in
the United States dropped to a record low of almost 11 percent according to the Monitoring
the Future survey (Campaign for Tobacco Free Kids 2012). This is the lowest that the
35
smoking rates have been in the 38 years since the survey began. Therefore in many ways,
though they made not have caused the exact change, they have ultimately been able to get
closer to accomplishing their goal of eliminating youth smoking in the US.
Works Cited
Advertising Age (,2003). ""Top 50 Newspapers by Circulation" ". Retrieved March 23, 2013,
2013, from http://adage.com/datacenter/datapopup.php?article_id=106784.
American Cancer Society (,2012 ). "Cigarette Smoking ".
American Legacy Foundation (,2012). "Youth and Smoking Fact Sheet ". Retrieved February
17, 2013, from
http://www.legacyforhealth.org/PDFPublications/Factsheet_youthandsmoking_Final.pdf.
American Lung Association (2012 ). "Why Kids Start." Retrieved March 17, 2013, from
http://www.lung.org/stop-smoking/about-smoking/preventing-smoking/why-kidsstart.html.
Apollonio, D. E., Malone, R.E. (,2008). "Turning negative into positive: public health mass
media campaigns and negative advertising." Health Education Research 24(3): 483-495.
Arnold Worldwide. ""truth Body Bags" ". from
http://www.arnoldworldwidepartners.com/creative/work/body-bags.
Barry, C. J., Marian. Grob, Rachel. Schlesinger, Mark. Gollust, Sarah. (,2011). "News Media
Framing of Childhood Obesity in the United States From 2000 to 2009."
Broder, J. (,1997). "Clinton Will Seek Tougher Proposals To Rein In Smoking". The New
York Times
Calfee, J. E. (,2000). "The Historical Significance of Joe Camel " Journal of Public
Policy&Marketing.
Cami, A. (2008). "The Future of Children: Chidlren and Electronic Media." 18(1).
36
Campaign for Tobacco Free Kids (2012). "New Survey Shows U.S. Youth Smoking Rates Fell
to Record Lows in 2012." Retrieved April 10, 2013, from
http://www.tobaccofreekids.org/press_releases/post/2012_12_19_survey.
Campaign for Tobacco Free Kids (,2011). ""RAISING CIGARETTE TAXES REDUCES
SMOKING, ESPECIALLY AMONG KIDS (AND THE CIGARETTE COMPANIES KNOW IT)"."
Retrieved April 6, 2013, from
http://www.tobaccofreekids.org/research/factsheets/pdf/0146.pdf.
Campaign for Tobacco Free Kids (,2012). "Who We Are- Campaign for Tobacco Free Kids ".
from http://www.tobaccofreekids.org/who_we_are/.
CDC (,2010). "Cigarette Use Among High School Students- United States, 1991-2009 "
Morbidity and Morality Weekly Report 59 (27). Retrieved February 2, 2013, 2012, from
http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.h
tm.
CDC, C. f. D. C. a. P. (2012, October 19, 2012). "Leading Causes of Death ". Retrieved
November 29, 2012, from http://www.cdc.gov/nchs/fastats/lcod.htm.
Chang, C. L., Y. (2010). "Effects of message framing, vividness congruency and statistical
framing on responses to charity advertising." International Journal of Advertising 29(2):
195-220.
Coleman, R. T., E., and Wilkins, L. (,2009). Testing the Impacts of Public Health Gramind and
Rich Sourcing International Communication Association 1-24.
Curtis, C. (,2012 ). "Let's Move: Two Years of Healthy Changes for our Nation's Kids ".
Retrieved February 21, , 2013, from http://www.whitehouse.gov/blog/2012/02/08/letsmove-two-years-healthy-changes-our-nations-kids.
DeBarros, A. (,2001). Anti-smoking funds sparse Despite a $250 billion tobacco lawsuit
windfall, only a few states are using the money to fight teen smoking. However, those that
try are coming up big. USA TOday NEWS, Pg 1A: 1.
Dunlop, S. M. (2011). "Talking "truth": Predictors and Consequences of Conversations
about a Youth Antismoking Campaign for Smokers and Nonsmokers " Journal of Health
Communication: International Perspectives 16(7): 708-725.
Entman, R. (1993). "Framing: Toward Clarification of a Fractured Paradigm." Journal of
Communication 43(4): 51.
Entman, R. (,1993). ""Framing: Toward Clarification of a Fracture Paradigm" " Journal of
Communication 43(4): 51.
37
Evans, D., Simani Price, Steven Blahut (2005). "Evaluating the truth®." Journal of Health
Communication 10: 181-192.
Farrelly, M. C., Nonnemaker, J., Davis, K., Hussin, A. (2009). "The Influene of the National
truth® Campaign on Smoking Initation." American Journal of Preventitive Medicine 36(5):
379-384.
Federal Trade Comission (,2012). FTC Releases Report on Cigarette Adveritising and
Promotion
Fountain, J. (,2001). "Study Finds Teenagers Smoking Less; Campaign Is Cited The New
York TImes. Section A; column 1; National Desk.
Graham, J. (,2000). "Awful truth online helps kids say no to smoking" USA Today.
Gruber, J., Zinman, Johnathon. (,2000). "Youth Smokin gin the U.S.: Evidence and
Implications." MIT.
Jahng, M. "Second-level agenda setting in health public service announcements: How the
PSA influence the public agenda on teen perscription drug abuse issue " University of
Missouri- Columbia, School of Journalism
Johnston, D. (,2001). "IN SHIFT, U.S. OPENS EFFORT TO SETTLE TOBACCO LAWSUIT". The
New York TImes Washington, DC
Johnston, L. (,2010 ). Monitoring the Future: National Results on Adolescent Drug Use
1975-2007 Diane Publishing Co. .
Johnston, L., et al (,2008 ). "Monitoring the Future National Results on Drug Use, 19752007 " NIH Publication I(No. 08-6418A).
Johnston, L., PM O'Malley, JG Bachman, JE Schulenerg (,1999). "Cigarette brands smoked by
American teens: One brand predominates; three account for nearly all of teen smoking. ."
University of Michigan News and Information Services: Ann Arbor, MI.
Khuder, S. (,1999). ""Age at smoking onset and its effect on smoking cesstion" " Addictive
Behaviors 24(5): 673-677.
Koch, W. (,2002). "Nicotine water for smokers could hook kids, critics say" USA Today.
NEWS: 1A.
Legacy (2012). "truth." Retrieved December 8, 2012, from
www.legacyforhealth.org/28.aspx
Let's Move (,2012). "About Let's Move ". Retrieved February 21, 2013, from
http://www.letsmove.gov/about.
38
McCarthy, M. (,2002 ). "Anti-smoking ads stirs up Super Bowl" USA Today
McCombs, M. a. D. S. (,1972). "The Agenda-Setting Function of Mass Media." Public Opinion
Quarterly 36(2): 176-187.
Meier, B. (,1999). "Tobacco Windfall Begins Tug-of-War Among Lawmakers". The New York
Times
Monitoring the Future (,1998). Grade 8: Brands Usually Smoked by Current Smokers. F. 1.
Moorman, M., van den Putte, B. (,2006). "The Influence of Message Framing, Intention to
Quit Smoking, and Nicotine Dependence on Persuasiveness of Smoking Cessation Messages
" International Communications Association: 1-22.
Navarro, M. (,1998). "Florida Gives Teen-Age Smokers a Day in Court. The New York tImes.
Nisbet, M. C. (,2009). "Communicating Climate Change: Why Frames Matter for Public
Engagement." Environment 51(2): 12-23.
Pearson, P. (,2003). Focus on helping smoking-addicted teens quit USA Today.
Political Pounds (,2011). Political Pounds: A critical Evaluation of the Let's Move Initiative
International Communication Association: 1-30.
RJ Reynolds. "Making Decisions Regarding Tobacco Use." Retrieved February 17 2013,
from http://www.rjrt.com/pubhealth.aspx.
SAMHSA ( ,2011). "Results from the 2010
National Survey on Drug Use and Health: Summary of National Findings."
Santiago, F. (,2000). Body bags pile up for anti-smoking ad aimed at teens USA Today.
Schmidt, L. (,2012). "Trends in Tobacco Industry Marekting ". Retrieved February 21, 2013,
from http://www.tobaccofreekids.org/research/factsheets/pdf/0156.pdf.
Schum, C. a. G., Robert. (,2013). "The Birth of "truth" (and What It Tells Us About the
Importance of Horizontal Influence)." George Washington University Cases in Public Health
Communication and Marketing.
Smith, K. W., M. (,2006). "Newspaper Coverage of Youth and Tobacco: Implications for
Public Health " Health Communication 19(1): 19-28.
The Campaign for Tobacco Free Kids (,1997). "Press Release: "Tobacco Wars 1997 Preview
Upcoming Battles at Federal and State Levels"
39
." Retrieved March 31, , 2013, from
http://www.tobaccofreekids.org/press_releases/post/id_0119.
The Campaign for Tobacco Free Kids (,1997 ). "Press Release: "Thousands of Youth
Activists "Kick Butts" on April 10th: Students in Over 50 Cities Organize Anti-Tobacco
Events" ". Retrieved March 31, , 2013, from
http://www.tobaccofreekids.org/press_releases/post/id_0110.
The Campaign for Tobacco Free Kids (,1998). ""America’s Kids ‘Kick Bitts’ On April 2"."
Retrieved March 31, , 2013, from
http://www.tobaccofreekids.org/press_releases/post/id_0070.
The Campaign for Tobacco Free Kids (,2003). "Press Release: "New Survey Showing Large
Decline in High School Smoking Is Proof that Tobacco Prevention Measures Work" ". from
http://www.tobaccofreekids.org/press_releases/post/id_0709.
The University of Chicago Medicine (, 2002). "Cigarette ads target youth, violating $250
billion 1998 settlement ". Retrieved March 4, 2013, from
http://www.uchospitals.edu/news/2002/20020312-tobacco.html.
Tobacco Documents Online (,1992). "The Viability of the Marlboro Man Among the 18-24
Segment." Retrieved March 17, 2013, from
http://tobaccodocuments.org/youth/AmCgPMI19920300.St.html.
truth (,2013). ""About"." Retrieved March 23, 2013, from www.thetruth.com/about/.
Tugend, A. (,2002). "Business; Cigarette Makers Take Anti-Smoking Ads Personally".
The New York Times
U.S. National Library of Medicine (,2012). "The Reports of the Surgeon General ". Retrieved
February 17, 2013, from http://profiles.nlm.nih.gov/ps/retrieve/Narrative/NN/p-nid/58.
Webb, T. L., Sniehotta, Falko, Michie, Susan (,2010). "Using theories of behaviour change to
inform interventions for addictive behaviours. ." Addiction 105(11).
This paper reviews a set of theories of behaviour change that are used outside the
field of addiction and considers their relevance for this field. Methods Ten theories
are reviewed in terms of (i) the main tenets of each theory, (ii) the implications of
the theory for promoting change in addictive behaviours and (iii) studies in the field
of addiction that have used the theory. An augmented feedback loop model based on
Control Theory is used to organize the theories and to show how different
interventions might achieve behaviour change. Results Briefly, each theory
provided the following recommendations for intervention: Control Theory: prompt
behavioural monitoring, Goal-Setting Theory: set specific and challenging goals,
Model of Action Phases: form 'implementation intentions', Strength Model of SelfControl: bolster self-control resources, Social Cognition Models (Protection
Motivation Theory, Theory of Planned Behaviour, Health Belief Model): modify
40
relevant cognitions, Elaboration Likelihood Model: consider targets' motivation and
ability to process information, Prototype Willingness Model: change perceptions of
the prototypical person who engages in behaviour and Social Cognitive Theory:
modify self-efficacy. Conclusions There are a range of theories in the field of
behaviour change that can be applied usefully to addiction, each one pointing to a
different set of modifiable determinants and/or behaviour change techniques.
Studies reporting interventions should describe theoretical basis, behaviour change
techniques and mode of delivery accurately so that effective interventions can be
understood and replicated. [ABSTRACT FROM AUTHOR]
APPENDIXES
APPENDIX A
Sample truth articles
The New York Times
October 27, 2002 Sunday
Late Edition - Final
Business;
Cigarette Makers Take Anti-Smoking Ads Personally
BYLINE: By ALINA TUGEND
SECTION: Section 3; Column 1; Money and Business/Financial Desk; Pg. 4
LENGTH: 1438 words
BODY bags. Dying rats. Dog urine.
These are some of the images used in state and nationwide anti-smoking commercials that
are sounding a contentious theme. Rather than spotlighting the ill effects of cigarettes, the
ads are focusing on the supposed evils of the tobacco industry.
The commercials, which run on youth-oriented television and radio stations, rotate every
few months. Among the most vivid are ones that depict body bags piled up in front of the
headquarters of Philip Morris, gasping rats to dramatize that cigarettes include the same
ingredient -- ammonia -- as rat poison, and a dog walker offering to sell dog urine to
tobacco companies because cigarettes contain urea.
Anti-smoking advocates and tobacco companies agree that the campaign has been highly
effective. But while smoking-prevention groups say that such campaigns resonate,
especially with teenagers, industry officials argue that in some cases they do little more
than vilify cigarette companies and their employees.
The battle between these groups has intensified lately, largely because of the American
Legacy Foundation, set up after the $206 billion master settlement four years ago between
46 states and the major tobacco companies.
As the foundation's campaigns have become ever more focused on cigarette makers,
tobacco companies are fighting back. The Lorillard Tobacco Company, a unit of the Loews
Corporation that makes brands like Newport and Kent, is suing the foundation in a North
Carolina court. Other companies have used letters, phone calls and e-mail messages to
41
make it known that they are not pleased.
"We need to communicate positive messages about why youth should not smoke," said
Steven C. Watson, a Lorillard spokesman. "It's wrong to attack our company."
But anti-smoking advocates say attacking the industry is exactly the right thing to do.
"What we learned very early on is that 'Please don't smoke; it's not good for your health'
doesn't work for kids," said Colleen Stevens, a spokeswoman for the tobacco control
section of California's Department of Health Services.
What works, she said, is telling teenagers "how the industry manipulates you."
Preventing teenagers from smoking has been the focus of intense campaigns because a vast
majority of adults who smoke started when they were under 18.
Even though youth smoking has declined in recent years, health officials say anti-smoking
advocates cannot afford to be complacent. The decline, experts agree, results from higher
cigarette prices -- brought about by price increases and state taxes -- and the anti-tobacco
programs.
States like California, Florida and Massachusetts had been financing tough anti-smoking
campaigns for years. But it was the foundation, through its "truth" campaign, that took the
anti-industry approach nationwide two years ago.
Past anti-tobacco ads "were very authoritarian -- they said, 'Don't smoke,' " said Jeff Hicks,
the president of the Crispin, Porter & Bogusky advertising firm in Miami. But that message
backfired, he said, because young people tend to do exactly what they are told not to.
"Smoking is not about cigarettes, but about rebellion," said Mr. Hicks, whose company has
created many anti-tobacco ads for Florida and for the foundation.
"Kids know smoking is something your parents prefer you wouldn't do, so a cigarette is the
ultimate statement of autonomy -- 'I'm willing to put my life in jeopardy.' "
Susan Moses, the deputy director of the Tobacco Project at the Harvard School of Public
Health, said, "Kids need a common enemy, and kids hate more than anything to be lied to,
and hate to be manipulated."
THE "truth" campaign is doing just that, telling teenagers that if they smoke, they're
playing into the hands of Big Tobacco.
Cheryl Healton, the foundation's chief executive, says that her group's campaign can be
chiefly credited with the decline in teenage smoking -- and that the tobacco companies'
efforts have been largely ineffective.
Under the settlement, the foundation is financed by payments from the tobacco companies
of $250 million in 1999 and about $300 million each year from 2000 to 2003.
Tobacco company officials argue that their own programs, like Philip Morris's "Think. Don't
Smoke." and Lorillard's "Tobacco Is Whacko if You're a Teen," have contributed to the
decline.
"We're not saying there's only one way that works, as they seem to claim," Mr. Watson of
Lorillard said.
Tobacco executives also say that aggressiveness is fine, but that lying and degrading
employees is not. In Lorillard's lawsuit, against both the foundation and the state attorneys
general who were party to the 1998 master settlement, Lorillard says a radio commercial
that was broadcast on more than 100 stations nationwide in 2001 did just that.
In the commercial, an actor calls Lorillard, asking if the company would be interested in
buying dog urine, because, he says, urea is added to its tobacco. The ads stopped running
last year as part of the normal rotation, foundation officials said.
42
The lawsuit asserts, among other things, that the foundation taped a Lorillard employee
without his knowledge and lied about Lorillard adding urea. Lorillard says urea is a natural
component of its tobacco. The suit also says the foundation personally attacked and vilified
a tobacco company and that such attacks are banned by the settlement.
"Once again you have chosen an approach of deception, vilification and untruth," Mr.
Watson wrote to Dr. Healton in July 2001. "We have watched this pattern unfold through
shameless ads" in the past, he said, but added that recent ones have "reached new heights
of deception."
"It appears that the American Legacy Foundation continues to be content with taking an
approach in its advertisements that seeks to vilify the tobacco industry," he said, "rather
than serve to educate the public."
Individual attorneys general have sued tobacco companies under the settlement, but
Lorillard's is the first suit brought by a tobacco company.
Lorillard is asking not for money but for a clarification of the settlement, Mr. Watson said.
The company would like the court to find that the foundation violated the settlement, and
to define the phrase in the agreement that says there will be no "personal attack on, or
vilification of, any person, company or government agency."
The foundation denies the assertions and has countersued in a Delaware state court, saying
it was created by the master settlement but was not a party to it.
LORILLARD is not the only company that has complained. In California, R. J. Reynolds
Tobacco argued in court papers filed last month -- in response to a lawsuit brought against
it and Philip Morris by two private citizens -- that the state has created such a hostile
environment toward cigarette companies that "it has had devastating effects on cigarette
companies' right to a fair trial within California."
The state's tobacco control program developed such an atmosphere, Reynolds argued, by
"shifting the focus of its messages away from products (cigarettes) to persons (cigarette
companies and their trial witnesses)." Reynolds's brands include Camel, Salem and
Winston.
The company tried and failed to move the trial out of California. "All we want is a fair trial
and there have been direct attacks on us and other companies on a personal level," said
Seth W. Moskowitz, a spokesman for Reynolds.
Philip Morris, the largest cigarette maker, has also expressed its disapproval of strong antitobacco ads. In April, company officials wrote to Debra Bodenstine, the director for health
awareness and tobacco at the Florida Department of Health, contending that recent ads -created by Crispin, Porter & Bogusky -- concerning Philip Morris's marketing of cigarettes
overseas were "inaccurate, misleading and false."
Copies of the letter were sent to 28 television stations. In the letter, Philip Morris, which
makes Marlboro and other brands, demanded that the commercials be corrected and
retracted, or that facts substantiating the allegations be provided.
A Florida health department spokesman said the state did not respond to the letter.
Michael Pfeil, a Philip Morris spokesman, said his company has chosen not to sue any state
or the foundation. "Our desire is to engage with them," he said. "We believe we have a role
to play in preventing kids from smoking."
Philip Morris has spent $300 million on youth anti-smoking programs and youth
development programs. Its recent efforts, Mr. Pfeil said, are aimed at encouraging parents
to talk to their children.
43
As for the American Legacy Foundation, he said, "we're going to continue to seek
constructive dialogue."
USA TODAY
January 25, 2002, Friday, FINAL EDITION
Anti-smoking ad stirs up Super Bowl
BYLINE: Michael McCarthy
SECTION: MONEY; Pg. 7B
LENGTH: 426 words
DATELINE: NEW YORK
NEW YORK -- American Legacy Foundation and Lorillard Tobacco are gearing up for a
possible legal battle over the foundation's controversial anti-smoking ad campaign. And to
get its message out, American Legacy is turning to the country's most-watched TV event:
the Super Bowl.
American Legacy will air at least one TV commercial during Fox's Feb. 3 broadcast of Super
Bowl XXXVI, says Kathryn Kahler Vose, interim vice president of communications. But it
hasn't decided whether to use "truth" commercials or other public service announcements,
she says.
The "truth" campaign, launched in February 2000, uses explosive imagery to combat youth
smoking. One spot shows body bags being piled up outside the corporate headquarters of
Philip Morris in New York. A young man on a bullhorn berates the company for its role in
the deaths. American Legacy spends more than $ 100 million a year to support the ads.
The tobacco industry wants the ads toned down. Lorillard sent a letter to the foundation a
week ago threatening to sue. The No. 4 tobacco firm says the ads violate the $ 205 billion
settlement with 46 state attorneys general in 1998, which created the foundation. The ads
break the agreement by "vilifying" tobacco marketers and portraying them as "dishonest"
and "deceitful," says the letter that formally threatens legal action in the next 30 days.
Lorillard also complained to the Federal Communications Commission.
The foundation fired back Tuesday, calling Lorillard's threats "unwarranted and
outrageous." Says Dr. Cheryl Healton, chief executive officer: "They're a smoke screen to
hide the company's real goal, which is to crush the 'truth' campaign because it's working to
stop kids from smoking."
The group aired spots during last year's Super Bowl that were equally hard-hitting. One
showed real-life consumer Rick Stoddard talking about losing his 46-year-old wife, Marie,
to lung disease. "I guess I never thought of 23 as middle-aged," says Rick. The other showed
smoker James Dunne speaking through his electric voice box about the dangers of smoking.
The "truth" ads were created by ad agencies Crispin Porter & Bogusky in Miami and Arnold
Worldwide, Boston. Both declined comment.
Fox has sold only 90% of its in-game commercial slots, although Super Bowl broadcasters
are usually sold out by now. Philip Morris is one of the advertisers and will air an antismoking spot. Lou D'Ermilio of Fox says it's not atypical for a network to enter the final
week with a handful of spots for sale.
The New York Times
44
December 20, 2001 Thursday
Late Edition - Final
Study Finds Teenagers Smoking Less; Campaign Is Cited
BYLINE: By JOHN W. FOUNTAIN
SECTION: Section A; Column 1; National Desk; Pg. 24
LENGTH: 876 words
DATELINE: HARVEY, Ill., Dec. 19
Janel Horton, 17, has been smoking since she was 11, but she admits to being the odd bird
among her friends, many of whom have kicked the habit or never even started.
"They stopped because of the things people told them, like they get cancer and all that
stuff," said Ms. Horton, standing outside Thornton High School here.
Her observation was echoed in a national study released today showing that teenage
smoking has fallen sharply since peaking in 1996.
News of the survey, released by the Department of Health and Human Services and the
University of Michigan Institute for Social Research, was cause for optimism, experts and
opponents of smoking said.
Researchers at the University of Michigan who conducted the study found that from 1996
to 2001, the percentage of eighth graders who were smoking fell to 12 percent, from 21
percent. Among 10th graders, the number fell to 21 percent, down from 30 percent, and
among 12th graders, smoking fell to 30 percent in 2001, down from 37 percent in 1997.
The study's director, Lloyd D. Johnston, attributed the decline to the increased cost of
cigarettes and an aggressive antismoking campaign, both nationally and in some states, as
well as the withdrawal of some tobacco advertising.
Antismoking campaigns, Mr. Johnston said, have diminished the attraction of cigarettes by
emphasizing the hazards of smoking and helping to mold new attitudes.
"There really is an attitudinal shift going on," he said, "with more young people saying that
they see smoking as dangerous, more saying they personally disapprove of smoking, more
saying that their friends would disapprove of their smoking. So the social acceptability of
smoking is changing in some important ways."
Although Ms. Horton continues to smoke, it is not because she is unaware of the risks or
because she has not seen the slick antismoking commercials on television, or that she is not
getting lots of peer pressure from her nonsmoking friends, she said.
"My sister got me doing that, and it's addictive," said Ms. Horton, a junior at Thornwood, in
Chicago's southern suburbs. "I can't stop."
"I believe it," she said of the anti-smoking advertisements. "It's just the fact that when my
nerves go bad and stuff, I just start smoking."
Elsewhere, the news that smoking among teenagers has declined came as a surprise to
students taking cigarette breaks on the steps behind Garfield High School in Seattle.
"That's not true," said Cindy Polkinghorn, 17, a junior, who took her first drag from a
cigarette at 12.
"I don't believe it," added Myra, 16, a sophomore who would not give her last name, but
who said she had smoked for two years.
The girls said that many of their peers smoke, even though "a lot of people think smoking is
disgusting," Myra said.
45
But other teenagers, like Jorge Anaut, 15, of Miami, say they have never tried smoking and
never will.
"I don't like it," Jorge said. "I'm not interested. I know what happens to smokers. I've heard
about it on talk shows, the Discovery Channel and in health class. People explain the
consequences."
Outside Thornton High, Tania Cashaw, 16, a junior, said the antismoking message from
school sank in two years ago. That was when she quit smoking.
Other students said they had noticed the trend.
"Many kids are tired of smoking. They see that people are dying from smoking," said Jason
Clark, 17, a Thornton junior.
Cheryl Healton, president of the American Legacy Foundation, a public health foundation
created as part of the 1998 settlement agreement by the states with tobacco companies,
attributed the decline in teenage smoking partly to American Legacy's Truth Campaign,
which has produced advertisements that seem to have resonated among teenagers.
"The campaign is based on changing the social norms around tobacco and encouraging
young people to rebel against the concept of becoming addicted to tobacco," Ms. Healton, a
professor of public health at Columbia University, said in a telephone interview.
"What I was particularly excited about," she said, "was the changing attitudes of young
people toward tobacco, because attitudinal shifts precede behavioral shifts."
The Michigan study was based on nationally representative surveys of some 44,000
students in Grades 8, 10 and 12. The latest findings are in contrast to the sharp increase in
teenage smoking observed in the early 1990's, Mr. Johnston said.
Despite the good news, Matthew Myers, president of the Campaign for Tobacco-Free Kids,
cautioned against overconfidence.
"The survey is a good news, bad news story," Mr. Myers said. "The sharp declines
demonstrate that higher prices are having a dramatic effect on reductions. The bad news is
that states cannot take this as a signal to cut back on funding for education programs. If
they do, we'll see the declines disappear."
Many observers contend that the war is far from over. In Coral Gables, Fla., Gordie Sacasa,
16, said he started smoking at 11 because his older friends smoked, and he continues to
smoke although most of those friends have since quit. It is not that he has not gotten the
message.
"My mom passed away from lung cancer, so I know the danger," he said, "but I like to
smoke. I think they will find a cure for cancer in a couple years so I don't worry about it."
46