Estimating the Pathways of an Antitobacco Campaign



      This study examined mechanisms through which the truth campaign, a national mass media antismoking campaign, influences smoking-related attitudes, and progression of tobacco use over time in youth and young adults.


      Structural equation modeling tested causal pathways derived from formative research and behavioral theory with a nationally representative longitudinal sample of 15–21-year-olds (n = 8747) over 24 months. Data were collected from 2014 to 2016, and analyses were conducted in 2017.


      Greater ad awareness predicted strengthening of attitudes targeted by the campaign (i.e., feelings of independence from tobacco, antitobacco industry sentiment, decreasing acceptance of social smoking, and decreasing acceptance of smoking imagery), and attitude changes were significantly associated with greater support for an antitobacco social movement (e.g., agreement to the item “I would be part of a movement to end smoking”). Greater social movement support predicted a slower rate of progression on smoking intensity after two years of the campaign.


      Findings suggest that engaging youth and young adults in a cause-based social movement for promoting health can be a powerful strategy to drive positive behavior change. Messages targeting attitudes that resonate with values important to this age group, including independence and connectedness, are particularly effective. Investments in national antitobacco public education campaigns are key policy interventions which continue to help prevent tobacco use among youth and young adults.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • National Cancer Institute
        The role of the media in promoting and reducing tobacco use.
        Bethesda, MD2008 (Tobacco Control Monograph No. 19)
        • Wakefield MA
        • Loken B
        • Hornik RC
        Use of mass media campaigns to change health behaviour.
        Lancet. 2010; 376: 1261-1271
        • Johnston LD
        • O'Malley PM
        • Miech R
        • et al.
        Monitoring the future national survey results on drug use, 1975–2016: Overview, key findings on adolescent drug use.
        Institute for Social Research, The University of Michigan, Ann Arbor2017
        • U.S. Department of Health and Human Services
        The health consequences of smoking: 50 years of progress. A report of the surgeon general.
        U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA2014
        • Vallone D
        • Cantrell J
        • Bennett M
        • et al.
        Evidence of the impact of the truth FinishIt campaign.
        Nicotine Tob Res. 2017; 20: 543-551
        • Hornik R
        • Woolf KD
        Using cross-sectional surveys to plan message strategies.
        Soc Market Q. 1999; 5: 34-41
        • Vallone D
        • Smith A
        • Kenney T
        • et al.
        Agents of social change: A model for targeting and engaging Generation Z across platforms: How a nonprofit rebuilt an advertising campaign to curb smoking by teens and young adults.
        J Adv Res. 2016; 56: 414-425
        • DiClemente RJ
        • Santelli JS
        • Crosby RA
        Adolescent health: Understanding and preventing risk behaviors.
        John Wiley & Sons, 2009
        • Melucci A.
        The new social movements: A theoretical approach.
        Information (Int Soc Sci Council). 1980; 19: 199-226
        • Duryea EJ
        Principles of non‐verbal communication in efforts to reduce peer and social pressure.
        J School Health. 1991; 61: 5-10
        • Brehm SS
        • Brehm JW
        Psychological reactance: A theory of freedom and control.
        Academic Press, 2013
        • Ajzen I
        The theory of planned behavior.
        Organ Behav Hum Decision Process. 1991; 50: 179-211
        • Hersey JC
        • Niederdeppe J
        • Evans WD
        • et al.
        The theory of “truth”: How counterindustry campaigns affect smoking behavior among teens.
        Health Psychol. 2005; 24: 22
        • Fahimi M
        Post-stratification of pooled survey data.
        in: Proceedings of the American Statistical Association, survey research methods section. 1994
        • Hair E
        • Pitzer L
        • Bennett M
        • et al.
        Harnessing youth and young adult culture: Improving the reach and engagement of the truth® campaign.
        J Health Commun: Int Perspect. 2017; 22: 568-575
        • Cantrell J
        • Hair EC
        • Smith A
        • et al.
        Recruiting and retaining youth and young adults: Challenges and opportunities in survey research for tobacco control.
        Tob Control. 2017; 27: 147-154
        • Duke JC
        • Davis KC
        • Alexander RL
        • et al.
        Impact of a US antismoking national media campaign on beliefs, cognitions and quit intentions.
        Health Educ Res. 2015; 30: 466-483
        • Terry‐McElrath YM
        • O'Malley PM
        Trends and timing of cigarette smoking uptake among US young adults: survival analysis using annual national cohorts from 1976 to 2005.
        Addiction. 2015; 110: 1171-1181
        • Saddleson M
        • Kozlowski L
        • Giovino G
        • et al.
        Assessing 30-day quantity-frequency of US adolescent cigarette smoking as a predictor of adult smoking 14 years later.
        Drug Alcohol Depend. 2016; 162: 92-98
        • Orzechowski W
        • Walker R
        The tax burden on tobacco.
        Hist Compil. 2011; 46
        • Huang J
        • Chaloupka F
        State-level per capita tobacco control expenditures.
        Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, 2011 (Unpublished Data)
      1. American Nonsmokers' Rights Foundation. Clean air laws in ANRF's U.S. Tobacco Control Laws Database., Unpublished Data;. 2018.

        • Agaku IT
        • King BA
        • Dube SR
        Current cigarette smoking among adults-United States, 2005-2012.
        Morb Mortal Wkly Rep. 2014; 63: 29-34
      2. Mplus Version 7.4 [computer program]. Los Angeles, CA: Muthén & Muthén; 2012.

        • Enders CK
        Applied missing data analysis.
        Guilford Press, 2010
        • Farrelly MC
        Association between the real cost media campaign and smoking initiation among youths—United States, 2014–2016.
        MMWR Morb Mortal Wkly Rep. 2017; 66
        • McAfee T
        • Davis KC
        • Alexander RL
        • et al.
        Effect of the first federally funded US antismoking national media campaign.
        Lancet. 2013; 382: 2003-2011
      3. Costanza-Chock S. Youth and Social Movements: Key lessons for allies. 2012.

        • Bryan CJ
        • Yeager DS
        • Hinojosa CP
        • et al.
        Harnessing adolescent values to motivate healthier eating.
        Proc Natl Acad Sci. 2016; 113: 10830-10835
        • Farrelly MC
        • Healton CG
        • Davis KC
        • et al.
        Getting to the truth: Evaluating national tobacco countermarketing campaigns.
        Am J Public Health. 2002; 92: 901-907
        • Siegel M
        • Biener L
        The impact of an antismoking media campaign on progression to established smoking: Results of a longitudinal youth study.
        Am J Public Health. 2000; 90: 380
        • Bauman A
        • Bowles HR
        • Huhman M
        • et al.
        Testing a hierarchy-of-effects model: Pathways from awareness to outcomes in the VERB™ campaign 2002–2003.
        Am J Prev Med. 2008; 34: S249-S256
        • Luxenberg MG
        • Greenseid LO
        • Depue J
        • et al.
        A comparison of two methods for assessing awareness of antitobacco television advertisements.
        Tob Control. 2016; 25: 301-306