The Theory of “truth”: How Counterindustry Media Campaigns Affect Smoking Behavior Among Teens James C. Hersey, Jeff Niederdeppe, W. Douglas Evans, and James Nonnemaker RTI International Steven Blahut American Institutes for Research—Prospect Center Debra Holden RTI International Peter Messeri and M. Lyndon Haviland American Legacy Foundation 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. Keywords: media campaigns, countermarketing campaigns, beliefs and attitudes, theory of reasoned action, social inoculation theory, antismoking campaigns In February 2000, the American Legacy Foundation launched the national “truth” tobacco countermarketing campaign aimed at reducing tobacco use among adolescents. Campaign messages alert youth to tobacco industry marketing practices in promoting cigarettes as glamorous and socially appealing without mentioning the addictive nature and the negative health effects of tobacco use. In addition, the truth campaign seeks to build a positive, tobacco- free identity that counters tobacco influences with hard-hitting ads that feature youth involved in efforts to confront the tobacco industry. Research evidence supports the efficacy of the counterindustry approach. Florida’s counterindustry campaign contributed to a reduction in the likelihood of smoking initiation among teens (Sly, Hopkins, Trapido, & Ray, 2001). Early evaluation results indicate that truth has been successful in changing tobacco-related beliefs, attitudes, and intentions to smoke among teens nationwide (Far- relly et al., 2002). However, little is known about how truth and similar counterindustry campaigns operate to influence teen cog- nition and behavior. The truth campaign differs markedly from traditional health education approaches and shifts blame for smoking onto a third party: the tobacco industry. Campaign proponents hope that alert- ing teens to the deceptive tactics of the tobacco industry can channel their youthful need to assert their independence while inoculating them against the tobacco industry’s glamorous por- trayal of smoking (D. Evans, Wasserman, Bertolotti, & Martino, 2002). Existing theory provides insight into the mechanisms through which counterindustry campaigns may affect smoking behavior. The theory of reasoned action (Fishbein & Ajzen, 1975) posits that beliefs about the consequences of a behavior and the evalua- tion of these consequences influence one’s attitude toward that behavior. Attitudes toward a behavior are among the strongest predictors of intentions to perform a behavior, which in turn predict behavior itself. Although the theory makes no predictions on the basis of beliefs and attitudes toward a third party, such as the tobacco industry, it is consistent with the theory to expect that attitudes toward an object (i.e., the tobacco industry) are influ- enced by salient beliefs about that object (Eagly & Chaiken, 1993). Because beliefs are “the essence of what [campaign] messages address” (Hornik & Woolf, 1999, p. 36), beliefs about tobacco James C. Hersey, Jeff Niederdeppe, W. Douglas Evans, James Nonne- maker, and Debra Holden, RTI International, Washington, DC; Steven Blahut, American Institutes for Research—Prospect Center, Silver Spring, Maryland; Peter Messeri and M. Lyndon Haviland, American Legacy Foundation, Washington, DC. This study was conducted at RTI International with support from the American Legacy Foundation. Although the American Legacy Foundation sponsored the truth campaign, they contracted with RTI International to conduct an independent evaluation. The authors of this study had no financial interest in the campaign and were not involved in campaign development. Correspondence concerning this article should be addressed to James C. Hersey, RTI International, 1615 M Street, Northwest, Suite 740, Washing- ton, DC 20036 –3209. E-mail: hersey@rti.org Health Psychology Copyright 2005 by the American Psychological Association 2005, Vol. 24, No. 1, 22–31 0278-6133/05/$12.00 DOI: 10.1037/0278-6133.24.1.22 22