The industry manipulation attitudes of smokers and nonsmokers

Tobacco industry denormalisation as a tobacco control intervention: a review

OBJECTIVE

To conduct a review of research examining the effects of tobacco industry denormalisation (TID) on smoking-related and attitude-related outcomes.

METHODS

The authors searched Pubmed and Scopus databases for articles published through December 2010 (see figure 1). We included all peer-reviewed TID studies we could locate that measured smoking-related outcomes and attitudes toward the tobacco industry. Exclusion criteria included: non-English language, focus on tobacco use rather than TID, perceived ad efficacy as sole outcome, complex program interventions without a separately analysable TID component and non peer-reviewed literature. We analysed the literature qualitatively and summarised findings by outcome measured.

RESULTS

After excluding articles not meeting the search criteria, the authors reviewed 60 studies examining TID and 9 smoking-related outcomes, including smoking prevalence, smoking initiation, intention to smoke and intention to quit. The authors also reviewed studies of attitudes towards the tobacco industry and its regulation. The majority of studies suggest that TID is effective in reducing smoking prevalence and initiation and increasing intentions to quit. Evidence is mixed for some other outcomes, but some of the divergent findings may be explained by study designs.

CONCLUSIONS

A robust body of evidence suggests that TID is an effective tobacco control intervention at the population level that has a clear exposure-response effect. TID may also contribute to other tobacco control outcomes not explored in this review (including efforts to 'directly erode industry power'), and thus may enhance public support and political will for structural reforms to end the tobacco epidemic.

Collecting health data with youth at faith-based institutions: lessons learned

Faith-based organizations (FBOs) are ideal for health promotion but can present unique challenges in data collection. The present initiative included 6 years of awards to mostly small, rural, predominantly African American FBOs to conduct tobacco prevention lessons for youth in Grades 4-6 while they were attending summer Vacation Bible School. In 2005, these awards included $1,500 disbursed to 64 geographically diverse FBOs who had never before received this funding. Lessons learned include the following: Plan for evaluation in every aspect of the project; pilot-test everything; use reminders judiciously; make backup plans at every step; personally collect data in a nonthreatening way; and safeguard data entry. Evaluation requires extensive time, money, and effort; so, in both the intermediate and the long run, this extra work is worth it.

Using classification trees to profile adolescent smoking behaviors

The purpose of this study was to explore the interactive nature of various predictor variables in profiling adolescent smoking behaviors characterized by intention to smoke, current, situational, and established smoking using classification trees. The data (n = 3610) were obtained from cross-sectional telephone surveys of the Florida Anti-Tobacco Media Evaluation Program. Three classification trees were constructed, namely, intention versus no intention to smoke among non-smokers, current smokers versus non-smokers, and established versus situational smokers. The tree model for the intention model revealed that social and health risks are important in the context of peer smoking. Certain variables such as peer smoking and alcohol consumption retained their relative importance across the tree classifiers demonstrating that smoking intention may be predictable using some of the same variables as in current or more dependent smoking.

The impact of anti-tobacco industry prevention messages in tobacco producing regions: evidence from the US truth campaign

BACKGROUND

Adolescents who live in tobacco producing regions may not respond favourably to anti-industry ads.

OBJECTIVE

To examine whether state level involvement in tobacco production appears to limit the effectiveness of anti-industry ads to prevent tobacco use among adolescents in the USA.

DESIGN

Time trend analyses were done using repeated cross sectional data from six waves of the Legacy Media Tracking Survey, which were collected between 1999 and 2003.

SETTING AND PARTICIPANTS

28,307 adolescents, ages 12-17 years, were classified as living in: tobacco producing states (TPS) (n = 1929); non-tobacco producing states (non-TPS) with low tobacco control funding comparable to TPS (n = 5323); non-TPS with relatively high funding (n = 15,076); and non-TPS with established anti-industry ad campaigns (n = 5979).

MAIN OUTCOME MEASURES

Reactions to anti-industry ads; strength of anti-industry attitudes/beliefs; changes in anti-industry attitudes/beliefs over time.

RESULTS

Ad reactions did not differ by state type. Multivariate adjusted time trend analyses indicated significant, comparable increases in anti-industry attitudes/beliefs since the onset of the truth campaign, in both TPS and non-TPS. Mediation analyses indicated that these increases were due, in part, to campaign exposure.

CONCLUSIONS

Adolescents who live in tobacco producing regions appear to be as responsive to anti-industry ads as their counterparts in non-tobacco producing regions. This study provides further evidence for the effectiveness of such ads.

Outcomes of a statewide anti-tobacco industry youth organizing movement

PURPOSE

To outline the design and present select findings from an evaluation of a statewide anti-tobacco industry youth organizing movement.

DESIGN

A telephone survey was administered to teenagers to assess associations between exposure to anti-industry youth organizing activities and tobacco-related attitudes and behaviors. A group-level comparison between areas high and low in youth organizing activities was planned. Methodological obstacles necessitated a subject-level analytic approach, with comparisons being made between youth at higher and lower levels of exposure.

SETTING

Six rural areas (comprising 13 counties) and two urban regions of Minnesota were selected for survey.

SUBJECTS

The study comprised 852 youth, aged 15 to 17 years old, randomly selected from county-specific sampling frames constructed from a marketing research database.

MEASURES

Exposure index scores were developed for two types of activities designed to involve youth in the anti-industry program: branding (creating awareness of the movement in general) and messaging (informing about the movement's main messages). Attitudinal outcomes measured attitudes about the tobacco industry and the effectiveness of youth action. Behavioral outcomes included taking action to get involved in the organization, spreading an anti-industry message, and smoking susceptibility.

RESULTS

Branding index scores were significantly correlated with taking action to get involved (p < or = .001) and spreading an anti-industry message (p < or = .001). Messaging index scores were significantly correlated with all five attitudinal constructs (all associations, p < or = .001), taking action to get involved (p < or = .001), and spreading an anti-industry message (p < or = . 01). The hypothesized association between messaging scores and susceptibility was not significant.

CONCLUSION

A youth organizing effort, in combination with an intensive countermarketing media campaign, can be an effective strategy for involving youth in tobacco prevention and generating negative attitudes about the industry.

The effectiveness of state-level tobacco control interventions: a review of program implementation and behavioral outcomes

In 2001, nearly one billion dollars will be spent on statewide tobacco control programs, including those in California, Massachusetts, Arizona, and Oregon, funded by cigarette tax revenues, and the program in Florida, funded by the state's settlement with the tobacco industry. With such large expenditures, it is imperative to find out whether these programs are working. This paper reviews the effectiveness of the statewide tobacco control programs in California, Massachusetts, Arizona, Oregon, and Florida. It focuses on two aspects of process evaluation--the funding and implementation of the programs and the tobacco industry's response, and four elements of outcome evaluation--the programs' effects on cigarette consumption, adult and youth smoking prevalence, and protection of the public from secondhand smoke. The paper formulates general lessons learned from these existing programs and generates recommendations to improve and inform the development and implementation of these and future programs.

Evidence of the dose effects of an antitobacco counteradvertising campaign

OBJECTIVE

The objectives were to assess the cumulative effects of exposure to multiple antitobacco advertisements shown over a 22-month period on smoking uptake, and determine if there is evidence of a dose effect and how this effect operates through response to the campaign's major message theme and antitobacco attitudes.

METHODS

A follow-up telephone survey of persons ages 12-20 years was conducted after 22 months of the Florida "truth" antitobacco media campaign. Logistic regression analyses were used to estimate adjusted odds ratios for the likelihood that time-one nonsmokers would remain nonsmokers at time two by levels of confirmed advertisement awareness, self-reported influence of the campaign's message theme, and anti-tobacco industry manipulation attitudes. Separate cohorts are analyzed and controls include gender and time-one susceptibility.

RESULTS

The likelihood of nonsmokers remaining nonsmokers increases as the number of ads confirmed, the self-reported influence of the campaign's major message theme, and the level of antitobacco attitudes increases. The pattern to these relationships holds within cohorts of young and older youth and for a cohort that has aged into the early young adult years. Considering all variables simultaneously suggests that ad confirmation operates through its effects on the influence of the message theme and antitobacco industry manipulation attitudes.

CONCLUSIONS

There is evidence of a dose effect; however, considering only ad confirmation underestimates this. Antitobacco campaigns that target youth can have effects at least through the early young adult ages. The uniqueness of the Florida campaign may limit the generalization of reported results.

The Florida "truth" anti-tobacco media evaluation: design, first year results, and implications for planning future state media evaluations

OBJECTIVES

To outline the design and present selected findings from the evaluation of a state counter-advertising, anti-tobacco media campaign. The appropriateness of the design for states developing media evaluations is discussed.

DESIGN

Four cross sectional, telephone surveys of the 12--17 year old population were used to track and monitor advertising and campaign awareness, confirmed awareness, and receptivity. The Florida baseline and one year surveys were used with two parallel national surveys in a quasi-experimental design to assess attitude and smoking related behaviour change attributable to the campaign.

MEASURES

Awareness was measured by self report, confirmed awareness by unaided description, and receptivity by self reports of how well advertisements were liked, talked to friends about, and made one think about whether or not to smoke. Eleven attitude and three smoking behaviour items for Florida (treatment) and a national (control) population were compared at baseline and after 12 months.

RESULTS

Significant increases in ad specific awareness, confirmed, receptivity, and campaign awareness, and confirmed awareness were reached by the sixth week. They continued to rise through the first year. No attitude and only minor behaviour differences were noted between the treatment and comparison populations at baseline. By the end of the first year, Florida youth had stronger anti-tobacco attitudes and better behaviour patterns than the comparison population.

CONCLUSIONS

The industry manipulation strategy used in the Florida campaign resulted in high rates of recall, significant changes in attitudes/beliefs, and reduced rates of smoking behaviour among youth.

Influence of a counteradvertising media campaign on initiation of smoking: the Florida "truth" campaign

OBJECTIVES

The purpose of this study was to assess the short-term effects of television advertisements from the Florida "truth" campaign on rates of smoking initiation.

METHODS

A follow-up survey of young people aged 12 to 17 years (n = 1820) interviewed during the first 6 months of the advertising campaign was conducted. Logistic regression analyses were used to estimate the independent effects of the campaign on smoking initiation while other factors were controlled for.

RESULTS

Youths scoring at intermediate and high levels on a media effect index were less likely to initiate smoking than youths who could not confirm awareness of television advertisements. Adjusted odds ratios between the media index and measures of initiation were similar within categories of age, sex, susceptibility, and whether a parent smoked.

CONCLUSIONS

Exposure to the "truth" media campaign lowered the risk of youth smoking initiation. However, the analysis did not demonstrate that all such media programs will be effective.