Regular articleThe effects of state counterindustry media campaigns on beliefs, attitudes, and smoking status among teens and young adults☆
Introduction
Traditional public health campaigns have structured their approach around “outcome expectancy” theories of behavior change, such as the Theory of Reasoned Action [1] and the Health Belief Model [2], [3], [4]. In this theoretical paradigm, an individual weighs the benefits and risks toward the decision of whether to perform a specific behavior. Early antitobacco media campaigns focused on the health, cosmetic, or social risks of cigarette smoking with mixed results [5], [6], [7], [8]. Although often effective for adults, developmental theory suggests that adolescents may not consider health threats when considering risky behaviors [9]. More recently, several states (including California, Florida, and Massachusetts) and the American Legacy Foundation's national truth campaign have employed strategies that draw attention to negative behavior of the tobacco industry. This paper begins to assess the rationale that underlies such “counterindustry” campaigns.
Counterindustry campaigns alert teens and young adults to tobacco industry marketing practices in promoting cigarettes as glamorous and socially appealing without addressing the addictive nature and negative health consequences associated with tobacco use. These campaigns often highlight the well-funded industry efforts to target teens and minority groups and draw attention to tobacco industry denials about the addictive and harmful nature of their product.
None of the state and national campaigns listed above has used counterindustry messages exclusively. California and Massachusetts have included a variety of advertisements that featured serious long-term illness and death due to smoking and secondhand smoke exposure. Massachusetts has also employed messages with more humorous themes of social acceptability. Florida and the American Legacy Foundation campaign messages have drawn attention to the number of deaths associated with tobacco use. Nonetheless, all of these campaigns used the counterindustry strategy as a major campaign message component.
Focus groups and other qualitative methodologies provide evidence for the appeal of counterindustry messages with youth [10], [11], but it is unclear how well information from these formative research techniques predicts campaign success in practice. Recent evidence indicates that the national truth campaign has been successful in changing industry beliefs, attitudes, and intentions to smoke among teens [12]. Evidence from evaluations in Massachusetts [13] and Florida [14] indicates that exposure to campaigns that used counterindustry themes was successful at preventing youth from smoking experimentation. However, these campaigns were also embedded within larger, statewide initiatives that included increases in cigarette taxes, policy changes, school education, and community interventions. It is uncertain how much of these changes was attributable to media campaigns or how well these effects generalize to the national population of youth. In addition, very little is understood about the theoretical mechanisms that contribute to the apparent success of the counterindustry approach.
Counterindustry campaigns are based on the assumption that messages aimed at changing beliefs about tobacco industry practices can inoculate teens against persuasive cigarette marketing techniques and motivate them to assert their independence against tobacco companies by choosing not to smoke. This contention differs from outcome expectancy theories, which assert that messages targeting specific beliefs about the behavior (e.g., smoking) will lead to subsequent changes in intentions and behavior. These theories make no predictions with regard to beliefs about a third party (e.g., the tobacco industry). Thus, counterindustry messages operate in theoretical territory distinct from that employed in many public health campaigns. However, these theories can inform thinking about potential counterindustry campaign effects.
One of the central premises of the Theory of Reasoned Action is that the effect of media campaigns on attitudes is mediated via beliefs. As Hornik and Woolf [15] note, “beliefs are the essence of what messages address” (p. 35). According to Fishbein [16], beliefs about a concept refer to “the probability that a particular relationship involving the object or concept exists” (p. 260). In other words, beliefs can be thought of as statements dealing with truth or falsity.
Attitudes, on the other hand, are composed of the evaluative implications about the sum of salient beliefs about the attitude object [1], [17]. In the case of counterindustry campaigns, the attitude object is the tobacco industry. By this logic, the evaluative implications of salient beliefs about the tobacco industry should be strongly associated with one's attitude toward the industry. Although we have not measured perceptions about the evaluative implications of beliefs about industry practices, focus group research implies that industry deception and manipulation are evaluated negatively [10].
The Theory of Reasoned Action [1] further posits that one's attitude toward a behavior should be directly associated with intentions to perform a behavior, which in turn predicts behavior itself. We recall, however, that the theory makes no predictions based on attitudes toward a third party, such as the tobacco industry. Proponents of the counterindustry approach, however, theorize that negative attitudes toward the tobacco industry will lead to a lower likelihood of smoking initiation and progression to established smoking through a process of psychological reactance and inoculation from the influence of pro-tobacco marketing [18], [19], [20].
Based on these theoretical perspectives, we hypothesize that the impact of counterindustry campaigns on smoking behavior operates through the following causal mechanism: exposure to counterindustry campaigns engenders negative beliefs about tobacco industry practices, which in turn leads to negative attitudes toward the industry and reduces the likelihood of progression along a continuum of smoking intentions and behavior. This paper tests these relationships, controlling for the impact of cigarette prices and other state tobacco control policies, among a national sample of teens (12 to 17) and young adults (18 to 24) prior to the launch of the national truth campaign.
Section snippets
Data collection
We analyzed data from the first wave of the Legacy Media Tracking Survey (LMTS), a national survey of 6875 U.S. youths aged 12 to 24. The random-digit-dialing telephone survey was conducted between December 6, 1999, and February 6, 2000, prior to the launch of the national truth campaign. We enhanced representation of African-Americans, Asians, and Hispanics or Latinos by oversampling telephone exchanges with high proportions of households of these groups and by randomly selecting from lists of
Counterindustry state residency and smoking status
Table 1 presents weighted and poststratified estimates of smoking status, by age group, in counterindustry states and the rest of the country. We tested for differences by state residence, controlling for age, gender, and race/ethnicity using multinomial logistic regression models. Results indicate that counterindustry state residents exhibit less progression along the smoking status continuum than their national counterparts (P < 0.01).
Scale construction
We continued with an exploratory factor analysis among the
Discussion
These results provide strong support for our hypothesized model of campaign effects. Counterindustry campaign exposure was associated with negative beliefs about industry practices, which in turn led to negative attitudes toward the industry. Industry attitudes, in turn, accounted for variation in smoking status, over and above the influence of other program components. This finding is consistent with the construction of beliefs and attitudes specified in the Theory of Reasoned Action [1]. The
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☆Support for this research was provided by the American Legacy Foundation.