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Context: Media messaging matters for public opinion and policy, and analyzing patterns of campaign strategy can provide important windows into policy priorities., Methods: The authors used content analysis supplemented with keyword-based text analysis to assess the volume, proportion, and distribution of media attention to race-related issues in comparison to gender-related issues during the general election period of the 2022 midterm campaigns for federal office in the United States., Findings: Race-related mentions in campaign advertising were overwhelmingly focused on crime and law and order, with very little attention to racism, racial injustice, and the structural barriers that lead to widespread inequities. In stark contrast to mentions of gender, racial appeals were less identity focused and were competitively contested between the parties in their messaging, but they were much more likely to be led by Republicans., Conclusions: The results suggest that discussions of race and gender were highly polarized, with consequences for public understanding of and belief in disparities and policies important to population health., (Copyright © 2024 by Duke University Press.)

Aims: To test whether showing spectators counter-advertisements exposing alcohol harms alone, or exposing alcohol harms and alcohol sponsorship, before watching an alcohol-sponsored sporting event promotes less favourable post-event attitudes and intentions towards alcohol sponsor brands and alcohol in general., Design: On-line between-subjects experiment., Setting: Australia., Participants: A sample of Australian adults aged 18-49 years who planned to watch an alcohol-sponsored National Rugby League (NRL) State of Origin series game was recruited through an online panel., Interventions: Participants were randomly assigned to one of three counter-advertising conditions: control (neutral advertisement); counter-advertisement exposing alcohol harms; and counter-advertisement exposing alcohol sponsorship and harms, to view at least four times during the week before watching the alcohol-sponsored sporting event., Measurements: Participants (n = 1932) completed a pre-test questionnaire a week before the sporting event. Within 4 days of watching the sporting event, participants completed post-test measures assessing sponsor brand awareness, attitudes and preferences towards the brand, as well as knowledge, attitudes and intentions for alcohol in general (n = 1075)., Findings: Compared with the control advertisement, the counter-advertisement exposing alcohol sponsorship and harms promoted higher (6-13%) awareness of sponsor brands, less favourable attitudes towards sponsor brands and drinking beer, lower purchase intentions for sponsor brands (Cohen's d = 0.15, 0.31, 0.27, respectively) and perceived less image-based similarity and fit between the sporting event and sponsor brands (Cohen's d = 0.20 and 0.56). Both counter-advertisements promoted lower perceptions of the appropriateness of consuming alcohol while watching sport (Cohen's d = 0.22 and 0.34), higher awareness of alcohol harms (6-34%) and higher intentions (8-13%) to reduce alcohol consumption than the control advertisement., Conclusions: At alcohol-sponsored sporting events, counter-advertisements addressing alcohol harms may promote knowledge of harms and intentions to drink less. Counter-advertisements that additionally expose and critique alcohol sponsorship may detract from perceptions of sponsor brand image and intentions to purchase the sponsor's products., (© 2023 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Background: Exposure to alcohol advertising and sponsorship through elite sport is associated with harmful use of alcohol. Owing to strong financial and cultural ties between alcohol and sport in Australia, policy action to restrict alcohol sport sponsorship is unlikely to occur without strong public support for change. This study tested whether exposure to counter-advertising exposing industry marketing of harmful products-a technique shown to be effective in tobacco control-promotes higher support for policy change and less favourable beliefs about the alcohol industry among sport spectators., Methods: A sample of 1,075 Australian adults aged 18-49 years who planned to watch an National Rugby League (NRL) State of Origin series game, featuring prominent alcohol sponsorship, was recruited through an online panel and randomly assigned to one of three conditions: control (neutral advertisement); counter-advertisement exposing alcohol harms; counter-advertisement exposing alcohol sponsorship and harms. Participants completed a pre-test questionnaire and viewed their assigned counter-advertisement multiple times in the 5-7 days before the NRL game. Within four days of watching the game, participants completed post-test measures., Results: Compared to both the control advertisement and the counter-advertisement exposing alcohol harms, participants who viewed the counter-advertisement exposing alcohol sponsorship and harms were significantly more likely to indicate support for each of four policies aimed at restricting sports-related alcohol marketing, including the complete removal of alcohol sponsorship from sport (51% vs. 32% and 37%). They were also significantly less likely to agree with statements such as "alcohol companies should be allowed to sponsor sport since their products are legal" (39% vs. 63% and 60%) and significantly less likely to report liking alcohol companies in general (38% vs. 59% and 54%). There were no significant differences in policy support or industry beliefs between participants who saw the counter-advertisement exposing alcohol harms and those who saw the control advertisement., Conclusion: Counter-advertising employing messages that expose and critique the intent and impact of pervasive alcohol sponsorship in sport has potential to bolster public support for policies targeting alcohol sport sponsorship, diminish beliefs supportive of alcohol industry marketing strategies and enhance negative views of alcohol companies and their marketing practices., (© 2023. The Author(s).)

Context: Understanding the role of drug-related issues in political campaign advertising can provide insight on the salience of this issue and the priorities of candidates for elected office. This study sought to quantify the share of campaign advertising mentioning drugs in the 2012 and 2016 election cycles and to estimate the association between local drug overdose mortality and drug mentions in campaign advertising across US media markets., Methods: The analysis used descriptive and spatial statistics to examine geographic variation in campaign advertising mentions of drugs across all 210 US media markets, and it used multivariable regression to assess area-level factors associated with that variation., Findings: The share of campaign ads mentioning drugs grew from 0.5% in the 2012 election cycle to 1.6% in the 2016 cycle. In the 2016 cycle, ads airing in media markets with overdose mortality rates in the 95th percentile were more than three times as likely to mention drugs as ads airing in areas with overdose mortality rates in the 5th percentile., Conclusions: A small proportion of campaign advertising mentioned drug-related issues. In the 2016 cycle, the issue was more prominent in advertising in areas hardest hit by the drug overdose crisis and in advertising for local races., (Copyright © 2021 by Duke University Press.)

Context: Prior research suggests the potential for political campaign advertisements to increase psychological distress among viewers. The current study tests relationships between estimated exposure to campaign advertising and the odds of respondents reporting that a doctor told them they have anxiety, depression, insomnia, or (as a negative control) cancer., Methods: A secondary analysis of U.S. data on televised campaign ad airings from January 2015 to November 2016 (n = 4,659,038 airings) and five waves of a mail survey on television viewing patterns and self-reported medical conditions from November 2015 to March 2017 (n = 28,199 respondents from n = 16,204 unique households in the U.S.)., Findings: A 1 percent increase in the estimated volume of campaign advertising exposure was associated with a 0.06 [95% CI 0.03-0.09] percentage point increase in the odds of a respondent being told by a doctor that they have anxiety in the past 12 months. We observed this association regardless of the political party of the ad sponsor, the political party of the respondent, or their statistical interaction. We also observed this association for both Presidential campaign ads and non-Presidential (including local, state, and U.S. congressional election) campaign ads, providing evidence that these relationships were not driven by the unique divisiveness of the race between Donald Trump and Hilary Clinton. Some topic-specific models offered additional evidence of association between estimated volume of campaign advertising exposure and the odds of being told by a doctor that they have depression or insomnia, but these patterns were less consistent across models that utilized different categories of campaign exposure. Campaign ad exposure was not associated with cancer, which served as a negative control comparison., Conclusions: There was a consistent positive association between the volume of campaign advertising exposure and a reported diagnosis of anxiety among American adults., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Aims: To estimate the volume of past-year televised alcohol advertising exposure by product category and demographic group among adults living in the United States and test associations between estimated alcohol advertising exposure and past 30-day drinking behavior., Design: Secondary analysis of data from two national-level US data sets: Kantar data on appearances of televised alcohol advertisements and data from the Simmons National Consumer Survey (NCS), a large national mail survey on television viewing patterns and consumer behavior., Setting: United States., Participants: A total of 54 671 adults, aged 21 years and older, who were randomly selected to participate in the Simmons NCS., Measurements: Estimated exposure to televised advertisements for beer, wine and spirits, self-reported alcohol use in the past year and number of drinks consumed in the past 30 days., Findings: The average respondent was exposed to an estimated 576 [95% confidence interval (CI) = 570-582] televised alcohol advertisements in the year preceding their survey. Exposure was higher among males versus females and African Americans versus whites. A 1% increase in the estimated volume of advertisement exposure was associated with a 0.11 (95% CI = 0.08-0.13) percentage point increase in the odds of having at least one drink in the last 30 days and, among past 30-day drinkers, a 0.05 (95% CI = 0.04-0.07) per cent increase in the number of alcoholic drinks consumed. Associations were consistent across product categories and demographics., Conclusions: There appears to be a small but consistent positive association between alcohol advertising exposure and drinking behavior among American adults., (© 2020 Society for the Study of Addiction.)

Rationale and Objective: Unhealthy, energy-dense nutrient-poor foods and beverages are heavily promoted through sport sponsorship. This naturalistic trial assessed whether exposing young adult spectators to various types of counter-advertising (CA) before watching an unhealthy food sponsored elite sporting event could diminish sponsorship effects and increase support for restrictions on sponsorship., Method: Young adults (ages 18-29 years) who planned to watch the Australian Football League (AFL) Grand Final were recruited through an online panel and randomly assigned to one of four conditions: (A) control (neutral advertisement); (B) anti-industry CA (critiquing unhealthy food industry sponsorship of sport); (C) anti-product CA (critiquing the association of sports stars with unhealthy food); or (D) negative health effects CA (highlighting negative health consequences of unhealthy food consumption). Participants (N = 1316) completed a pre-test questionnaire and viewed their assigned CA online 1-3 days before watching the 2017 AFL Grand Final, which featured unhealthy food sponsorship., Results: Participants who reported watching the AFL Grand Final (n = 802) answered post-test measures within five days of the event. Results indicated that participants found the anti-industry CA more believable, attention-grabbing, reassuring and encouraging than the anti-product CA. The anti-industry CA promoted less favourable attitudes to sponsor brands, the anti-product CA promoted reduced intentions to purchase the fast-food sponsor brand, and the negative health effects CA reduced preferences for fast food in general compared to the control condition., Conclusions: Anti-industry CA may detract from favourable attitudes to unhealthy food sponsor brands and negative health effects CA may detract from intentions to consume fast food in the face of unhealthy food sponsorship exposure. Such interventions may require higher dosage levels than applied in the present study to bolster spectators' resistance to the surfeit of unhealthy food sport sponsorship., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Messaging about the Affordable Care Act (ACA) has seemingly produced a variety of outcomes: millions of Americans gained access to health insurance, yet much of the US public remains confused about major components of the law, and there remain stark and persistent political divides in support of the law. Our analysis of the volume and content of ACA-related media (including both ads and news) helps explain these phenomena, with three conclusions. First, the information environment around the ACA has been complex and competitive, with messaging originating from diverse sponsors with multiple objectives. Second, partisan cues in news and political ads are abundant, likely contributing to the crystallized politically polarized opinion about the law. Third, partisan discussions of the ACA in political ads have shifted in volume, direction, and tone over the decade, presenting divergent views regarding which party is accountable for the law's successes (or failures). We offer evidence for each of these conclusions from longitudinal analyses of the volume and content of ACA messaging, also referencing studies that have linked these messages to attitudes and behavior. We conclude with implications for health communication, political science, and the future outlook for health reform., (Copyright © 2020 by Duke University Press.)

Latinx adults, especially immigrants, face higher uninsurance and lower awareness of the Affordable Care Act's (ACA) provisions and resources compared to other racial/ethnic groups. Television advertising of ACA health plans has directed many consumers to application assistance and enrollment, but little is known about how ads targeted Latinx consumers. We used Kantar Media/CMAG data from the Wesleyan Media Project to assess Spanish- vs. English-language ad targeting strategies and to assess which enrollment assistance resources (in person/telephone vs. online) were emphasized across three Open Enrollment Periods (OEP) (2013-14, 2014-15, 2015-16). We examined differences in advertisement sponsorship and volume of Spanish- versus English-language ads across the three OEPs. State-based Marketplaces sponsored 47% of Spanish-language airings; insurance companies sponsored 55% of English-language airings. The proportion of Spanish-language airings increased over time (8.8% in OEP1, 11.1% in OEP2, 12.0% in OEP3, p <.001). Spanish-language airings had 49% lower (95%CI: 0.50,0.53) and 2.20 times higher odds (95%CI: 2.17,2.24) of mentioning online and telephone/in-person enrollment assistance resources, respectively. While there was a significant decrease in mention of telephone/in-person assistance over time for English-language airings, these mentions increased significantly in Spanish-language airings. Future research should examine the impact of the drastic federal cuts to ACA outreach and marketing.

Mass media campaigns are one of the most effective population-level interventions for the prevention of tobacco use. However, accurately evaluating the effectiveness of these campaigns presents several challenges, particularly as campaign delivery becomes increasingly fractured across media platforms. There are a number of weaknesses associated with traditional, individual-level measures of campaign exposure in an increasingly socially networked, digital media ecosystem. This study evaluated the national truth® campaign using a novel method to measure campaign exposure through an aggregate weekly exogenous measure of awareness. We generated this exogenous measure from a continuous, cross-sectional tracking survey to predict intentions to smoke and current tobacco use among youth in the United States. Results from multi-level models indicated that weeks with aggregate campaign awareness greater than 65% were associated with lower odds of current tobacco use. We conclude with a discussion of implications and practical considerations for using this method for media campaign evaluation.

Exposure to cigarette advertising can increase the likelihood of youth smoking initiation and may encourage people who already smoke to continue. Requiring prominent, graphic warning labels could reduce these effects. We test whether graphic versus text-only warning labels in cigarette advertisements influence cognitive and emotional factors associated with youth susceptibility to smoking and adult intentions to quit. We conducted two randomized, between-subjects experiments with middle-school youth (n = 474) and adult smokers (n = 451). Both studies employed a two (graphic or text-only warnings) by two (advertisements with social cues or brand imagery) factorial design with a fifth, offset control group (social cue advertisements with the current US Surgeon General's Warning). Graphic warnings outperformed text-only warnings in reducing visual attention to the advertisement, generating visual attention to the warning and arousing more negative affect. Graphic warnings also reduced the appeal of cigarette brands among youth relative to social cue advertisements with the Surgeon General's warnings. None of the warnings (graphic or textual) influenced health risk beliefs. Graphic warning labels on cigarette advertisements appear to have effects similar to those observed on cigarette packs in previous work, with an added benefit of reducing cigarette brand appeal among youth.

Television advertising has been a primary method for marketing new health plans available under the Affordable Care Act (ACA) to consumers. Data from Kantar Media's Campaign Media Analysis Group were used to analyze advertising content during three ACA open enrollment periods (fall 2013 to spring 2016). Few advertisement airings featured people who were elderly, disabled, or receiving care in a medical setting, and over time airings increasingly featured children, young adults, and people exercising. The most common informational messages focused on plan choice and availability of low-cost plans, but messages shifted over open enrollment cycles to emphasize avoidance of tax penalties and availability of financial assistance. Over the three open enrollment periods, there was a sharp decline in explicit mentions of the ACA or Obamacare in advertisements. Overall, television advertisements have increasingly targeted young, healthy consumers, and informational appeals have shifted toward a focus on financial factors in persuading individuals to enroll in marketplace plans. These advertising approaches make sense in the context of pressures to market plans to appeal to a sufficiently large, diverse group. Importantly, dramatic declines over time in explicit mention of the law mean that citizens may fail to understand the connection between the actions of government and the benefits they are receiving., (Copyright © 2018 by Duke University Press.)

The effectiveness of health insurance advertising has gained renewed attention following the Trump administration's decision to reduce the marketing budget for the federal Marketplace. Yet there is limited evidence on the relationship between advertising and enrollment behavior. This study combined survey data from the 2014 National Health Interview Survey on adults ages 18-64 with data on volumes of televised advertisements aired in respondents' counties of residence during the 2013-14 open enrollment period. We found that people living in counties with higher numbers of ads sponsored by the federal government were significantly more likely to shop for and enroll in a Marketplace plan. In contrast, people living in counties with higher numbers of ads from political sponsors opposing the Affordable Care Act (ACA) were less likely to shop or enroll. These findings add to the evidence base around advertising in the ACA context.

The launch of the Affordable Care Act was accompanied by major insurance information campaigns by government, nonprofit, political, news media, and private-sector organizations, but it is not clear to what extent these efforts were associated with insurance gains. Using county-level data from the Census Bureau's American Community Survey and broadcast television airings data from the Wesleyan Media Project, we examined the relationship between insurance advertisements and county-level health insurance changes between 2013 and 2014, adjusting for other media and county- and state-level characteristics. We found that counties exposed to higher volumes of local insurance advertisements during the first open enrollment period experienced larger reductions in their uninsurance rates than other counties. State-sponsored advertisements had the strongest relationship with declines in uninsurance, and this relationship was driven by increases in Medicaid enrollment. These results support the importance of strategic investment in advertising to increase uptake of health insurance but suggest that not all types of advertisements will have the same effect on the public., (Project HOPE—The People-to-People Health Foundation, Inc.)

Objective: Pharmaceutical direct-to-consumer advertising (DTCA) is widely prevalent on US television. This study tests the relationship between estimated exposure to DTCA for statin drugs, which often feature mixed messages about the efficacy of diet and exercise in reducing risk of cholesterol and heart disease, and guilty feelings regarding food and exercise., Methods: A series of repeated cross-sectional surveys of the US population between 2001 and 2007 (N=106,859 adults aged 18 and older) were combined with data on the frequency of DTCA appearances on national, cable, and local television during the same time period., Results: Adjusting for potential confounders with ordinary least squares (OLS) regression, increased potential exposure to statin DTCA was associated with increased food guilt (in a dose-response pattern) and exercise guilt (in a threshold pattern)., Conclusion: This study provides new evidence that DTCA has potential to influence emotional well-being as well as direct behavioral responses emphasized in previous academic research., Practice Implications: Health practitioners should be prepared to encounter and counsel patients who are prompted by DTCA to feel guilty about their food and exercise behaviors, feelings which may impact the likelihood of adherence to prescribed behavioral modification for weight management., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

The authors conducted an experiment among U.S. college students (N = 115) to assess the effects of anger- and sadness-framed television antismoking advertisements on viewers' emotional response, impressions of the speaker, source likability, and empathy toward the speaker. The study was based on the fundamental assumptions of discrete emotions and was operationalized using the principles of universal facial expressions. The authors also constructed a path model to investigate how these variables predicted one's attitude toward smoking, attitude toward the tobacco industry, and intentions to smoke. Supporting study hypotheses, the anger-framed message increased the perceived dominance of the speaker relative to the other conditions. Perceived dominance, in turn, was negatively associated with smoking attitudes and, indirectly, smoking intentions. Contrary to study hypotheses, the sadness-framed message did not increase sad emotional responses, source likability, or empathy relative to the no emotion-framed message. The anger-framed message unexpectedly appeared to decrease these outcomes. Empathy and source likability were associated with positive attitudes toward the tobacco industry, but these attitudes did not predict intentions to smoke. The authors discuss the implications of these findings.

Background: While statin drugs are recommended for secondary prevention of coronary heart disease (CHD), there is no medical consensus on whether or not a statin should be added to lifestyle change efforts for primary prevention of CHD. Previous research suggests that exposure to direct-to-consumer advertising (DTCA) increases drug demand among those at comparatively low risk. Research has yet to examine whether individual-level DTCA exposure may influence statin use among men and women at high, moderate, or low risk for future cardiac events., Objective: To determine the relationship between estimated exposure to DTCA for statin drugs and two clinical variables: diagnosis with high cholesterol and statin use., Design: We used logistic regression to analyze repeated cross-sectional surveys of the United States population, merged with data on the frequency of DTCA appearances on national, cable, and local television, between 2001 and 2007., Participants: American adults (n=106,685) aged 18 and older., Main Measures: Levels of exposure to statin DTCA, based on ad appearances and TV viewing patterns; self-reports of whether or not a respondent has been diagnosed with high cholesterol, and whether or not a respondent took a statin in the past year., Key Results: Adjusting for potential confounders, we estimate that exposure to statin ads increased the odds of being diagnosed with high cholesterol by 16 to 20 %, and increased statin use by 16 to 22 %, among both men and women (p<0.05). These associations were driven almost exclusively by men and women at low risk for future cardiac events. There was also evidence of a negative association between DTCA exposure and statin use among high-risk women (p<0.05) CONCLUSIONS: This study provides new evidence that DTCA may promote over-diagnosis of high cholesterol and over-treatment for populations where risks of statin use may outweigh potential benefits.

Previous research suggests that direct-to-consumer (DTC) advertisements for pharmaceutical drugs have the potential to influence consumers' perceptions of whether symptoms should be treated medically and/or through behavior change. However, the relative frequency of messages emphasizing these approaches in pharmaceutical advertising remains largely unknown. A content analysis of print and television advertisements for cholesterol management medication between 1994 and 2005 (for print) and between 1999 and 2007 (for television) was conducted. First, the extent to which established theoretical constructs drawn from health communication scholarship are depicted in the content of DTC cholesterol advertisements is quantified. Second, specific claims about behavior change inefficacy when a pharmaceutical alternative is available are identified. Findings indicate that DTC ads offer many mixed messages about the efficacy of diet and exercise in reducing cholesterol and risk of heart disease. Theoretical and practical implications of this work are discussed.

There are large disparities in cigarette smoking rates by socioeconomic status (SES) in many countries. There is mixed evidence about the relative effectiveness of smoking cessation media campaigns in promoting quitting between lower and higher SES populations, and studies suggest that some types of ad content may have differential effects by SES. We analyzed data from five waves of the New York Media Tracking Survey Online (MTSO), a web survey involving over 7000 adult smokers conducted between 2007 and 2009, to assess SES variation in response to smoking cessation ads. Smokers with low levels of education and income less often recalled ads focused on how to quit, and perceived them as less effective, than ads using graphic imagery or personal testimonials to convey why to quit. Contrary to predictions offered by the Stages of Change Model, we found no evidence that variation in readiness to quit smoking explained patterns of response by education. Results offer guidance for theorists and campaign planners in developing campaigns that are likely to promote cessation among less educated populations., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objective: To examine which types of cessation-focused advertisements are associated with perceived advertisement effectiveness among smokers and to assess whether key smoker characteristics (ie, cigarette consumption, desire to quit and past quit attempts) influence perceived effectiveness of different types of cessation ads., Methods: We used data from the New York Media Tracking Survey Online, a web survey of 7060 adult smokers in New York. Participants were exposed to four categories of cessation ads: (1) why to quit--graphic images, (2) why to quit--testimonial, (3) how to quit and (4) anti-industry. Perceived ad effectiveness was measured with a four-item scale assessing the degree to which participants thought the ads made them stop and think, grabbed their attention, were believable and made them want to quit smoking. We categorised smokers based on cigarette consumption, desire to quit and past quit attempts. We used multivariable analyses to examine how smoker characteristics and category of cessation ads predict perceived ad effectiveness., Results: Ads using the 'why to quit' strategy with either graphic images or personal testimonials were perceived as more effective than the other ad categories. Smokers who had less desire to quit or had not tried quitting in the past 12 months responded significantly less favourably to all types of cessation ads tested. Greater cigarette consumption was also associated with lower perceived effectiveness, but this association was smaller in magnitude., Conclusions: Tobacco control programmes that utilise cessation-focus advertising should focus relatively more on ads that adopt the 'why to quit' strategy with either graphic images or personal testimonials.

Evidence strongly suggests that public health communication campaigns can succeed in changing health-related cognitions and behaviors. For many evaluation studies, however, inferences of campaign effects are only valid to the extent that measures of campaign exposure are themselves valid. This study compares the validity of "aided" and "confirmed" ad recall measures in the context of a statewide tobacco countermarketing campaign using data from the Florida Anti-Tobacco Media Evaluation (FAME) surveys. Both aided and confirmed ad recall measures exhibited positive associations with cumulative gross ratings points (GRPs), a measure of the relative availability of specific countermarketing ads on broadcast television. In addition, both recall measures were significant predictors of campaign-targeted beliefs. Confirmed ad recall, however, was not a significantly better predictor of cumulative GRPs or campaign-targeted beliefs than aided ad recall, and the magnitude of association between both recall measures and targeted beliefs was quite small. These findings raise questions about the marginal utility of confirmed ad recall measures, compared with aided ad recall, in public health communication campaign evaluations. Nevertheless, results do provide evidence that both aided and confirmed ad recall measures are valid measures of campaign exposure.

This study used structural equation modeling to test a theory-based model of the pathways by which exposure to the "truth" counterindustry media campaign influenced beliefs, attitudes, and smoking behavior in national random-digit-dial telephone surveys of 16,000 12- to 17-year-olds before, 8 months after, and 15 months after campaign launch. Consistent with concepts from the theory of reasoned action, youth in markets with higher levels of campaign exposure had more negative beliefs about tobacco industry practices and more negative attitudes toward the tobacco industry. Models also provided support for a social inoculation effect, because negative industry attitudes were associated with lower receptivity to protobacco advertising and with less progression along a continuum of smoking intentions and behavior.

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.