Social imagery, tobacco independence, and the truthSM campaign

Objectives: This study investigated relationships among exposure to the truth(sm) campaign, differences in social imagery about not smoking and related measures, and smoking behavior. We asked, "How does truth(sm) work? Through what psychological mechanisms does it affect smoking behavior?" We developed a framework to explain how receptivity to truth(sm) ads might influence youth cognitive states and subsequent effects on progression to established smoking. The main hypotheses were that social imagery about not smoking and related beliefs and attitudes about tobacco use mediate the relationship between truth(sm) exposure and smoking status. Methods: The study was based on data from the Legacy Media Tracking Survey (LMTS), waves I-III, which were conducted at three time points from 1999 through 2001. A nationally representative sample of 20,058 respondents aged 12-24 from the three time points was used in the analysis. We developed a structural equation model (SEM) based on constructs drawn from the LMTS. We investigated the model and tested our hypotheses about the psychological and behavioral effects of campaign exposure. Results: We tested our constructs and model using a two-stage structural equation modeling approach. We first conducted a confirmatory factor analysis (CFA) to test the measurement model. Our model achieved satisfactory fit, and we conducted the SEM to test our hypotheses. We found that social imagery and perceived tobacco independence mediate the relationship between truth(sm) exposure and smoking status. We found meaningful differences between paths for segmented samples based on age, gender, and race/ethnicity subgroups and over time. Conclusions: The truth(sm) campaign operates through individuals' sense of tobacco independence and social imagery about not smoking. This study indicates that the campaign's strategy has worked as predicted and represents an effective model for social marketing to change youth risk behaviors. Future studies should further investigate subgroup differences in campaign reactions and utilize contextual information about the truth(sm) campaign's evolution to explain changes in reactions over time.