Women's knowledge of the leading causes of cancer death.

This paper describes adult women's knowledge of the leading causes of cancer mortality among women. Exposure to antismoking advertisements or media messages also is examined as a potentially effective mechanism for changing inaccurate beliefs. We used data from the 2002 and 2003 American Smoking and Health Survey (ASHES), a national telephone survey of adults, to measure women's knowledge about cancer mortality. Logistic regression models were used to estimate the likelihoods of women indicating either breast or lung cancer as the leading cause of cancer mortality among women. The independent influence of individual characteristics such as race, smoking status, education, and awareness of antismoking messages or advertising on women's knowledge of cancer mortality was assessed. Overall, 66.7% of women inaccurately indicated breast cancer as the leading cause of cancer death among women, whereas 29.7% of women correctly indicated lung cancer. Black women were 43% less likely than White women to indicate lung cancer as the leading cause of cancer mortality among women. Current smokers were 35% less likely than noncurrent smokers to state that lung cancer is the leading cause of cancer mortality among women. Awareness of antismoking messages or advertisements was associated with a higher probability of correctly indicating lung cancer as the leading cause of cancer mortality among women. Our evidence suggests that antismoking media messages may help to correct inaccurate beliefs about the leading causes of cancer death among women.

Do tobacco countermarketing campaigns increase adolescent under-reporting of smoking?

This study assesses whether a national anti-tobacco campaign for youth could create a social context that would elevate social desirability response bias on surveys, as measured by an increase in under-reporting of smoking. This could give rise to data that falsely suggest a campaign-induced decline in youth smoking, or it could exaggerate campaign effects. Data were obtained from a national sample of 5511 students from 48 high schools that were matched to schools sampled for the 2002 National Youth Tobacco Survey (NYTS). Self-reported smoking was compared with biochemical indicators of smoking, measured using saliva cotinine. The rate of under-reporting detected was 1.3%. Level of truth exposure was not related to under-reporting. This study suggests that for high school students, anti-tobacco campaigns are not an important cause of social desirability responses on surveys, and that in general under-reporting smoking is not a major source of error in school-based surveys.

Are menthol cigarettes a starter product for youth?

This study assessed the relationship between menthol use and nicotine dependence. Data from the National Youth Tobacco Survey indicated that menthol cigarette use was significantly more common among newer, younger smokers. Additionally, youth who smoked menthol cigarettes had significantly higher scores on a scale of nicotine dependence compared with nonmenthol smokers, controlling for demographic background and the length, frequency, and level of smoking. The study suggests that menthol cigarettes are a starter product that may be associated with smoking uptake by youth.

Evidence of a dose-response relationship between "truth" antismoking ads and youth smoking prevalence.

OBJECTIVES: In early 2000, the American Legacy Foundation launched the national "truth" campaign, the first national antismoking campaign to discourage tobacco use among youths. We studied the impact of the campaign on national smoking rates among US youths (students in grades 8, 10, and 12). METHODS: We used data from the Monitoring the Future survey in a pre/post quasi-experimental design to relate trends in youth smoking prevalence to varied doses of the "truth" campaign in a national sample of approximately 50000 students in grades 8, 10, and 12, surveyed each spring from 1997 through 2002. RESULTS: Findings indicate that the campaign accounted for a significant portion of the recent decline in youth smoking prevalence. We found that smoking prevalence among all students declined from 25.3% to 18.0% between 1999 and 2002 and that the campaign accounted for approximately 22% of this decline. CONCLUSIONS: This study showed that the campaign was associated with substantial declines in youth smoking and has accelerated recent declines in youth smoking prevalence.

The theory of "truth": how counterindustry campaigns affect smoking behavior among teens.

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.

Will the master settlement agreement achieve a lasting legacy?

This article outlines the mission and activities of the American Legacy Foundation (Legacy)-the public charity created by the Master Settlement Agreement (MSA) between 46 states attorneys general and the tobacco industry. Payments to Legacy are made by the 46 settling states. Legacy has achieved much in its short 5-year tenure and has faced and continues to face challenges. These include the "sunset" clause of the MSA that may terminate payments to Legacy's public education fund-the source of funds for most of Legacy's public education campaigns and grant making, a unique set of MSA provisions intended to rein in the activities of Legacy and rising public expectations in the context of sharply reduced resources. The inextricable link between Legacy, state tobacco control, and the politics of tobacco are discussed.

Measurement properties of a nicotine dependence scale for adolescents.

This paper reports on the measurement properties of a scale intended to measure nicotine dependence in adolescents using data from the American Legacy Longitudinal Tobacco Use Reduction Study. The Nicotine Dependence Scale for Adolescents (NDSA) is a simple linear sum of items associated with behaviors to avoid withdrawal and items associated with experiences of craving. An exploratory factor analysis indicated that the items formed a single scale. The reliability of the scale was assessed by estimating Cronbach's alpha for the scale items. The estimated alpha reliability was.81. The scale's validity was assessed by estimating the correlation between the scale and measures of smoking and quitting behaviors. As hypothesized, the scale was positively correlated with lifetime number of cigarettes smoked (r=.44, p<.001), days smoked in the past 30 days (r=.66, p<.001), cigarettes smoked per day on days smoked (r=.61, p<.001), and number of quit attempts (r=.10, p<.001) and negatively correlated with the length of the quit attempt (r=-.22, p<.001). We also examined the measurement properties of the NDSA separately for middle and high school students and by gender and race or ethnicity. We found no meaningful differences in the measurement properties of the NDSA across these groups. The six-item self-report NDSA had good measurement properties in our sample.

Confirming "truth": more evidence of a successful tobacco countermarketing campaign in Florida.

This study provides additional evidence that Florida's "truth" tobacco countermarketing campaign was successful in reducing smoking among Florida teens. Smoking rates were substantially lower among Florida teens between fall 2001 and spring 2002, whereas previous studies found that smoking rates were comparable before the launch of "truth." Florida teens had higher levels of "truth" campaign awareness and were more likely to agree with campaign-targeted beliefs; 2 of these beliefs were the only items associated with current smoking.

Progression to established smoking among US youths.

OBJECTIVES: Our study presents national estimates of the proportion of youths in each of 7 stages of smoking and investigates the associations between risk/protective factors and progression to established smoking. METHODS: We analyzed data from the 1999 and 2000 National Youth Tobacco Surveys. RESULTS: In 1999 and 2000, 48.6% of US adolescents had at least experimented with tobacco, and 7.8% were established smokers. Important correlates of progression to established smoking included parental advice not to smoke, antismoking lessons in school, susceptibility to tobacco industry advertising and promotion, peer smoking, and exposure to smoking at home. CONCLUSIONS: Interventions to stop adolescent progression to established smoking should target susceptible never smokers and early experimenters as well as those in later stages of smoking.

The effects of state counterindustry media campaigns on beliefs, attitudes, and smoking status among teens and young adults.

OBJECTIVES: This study sought to identify the pathways through which state-funded counterindustry media campaigns influence beliefs and attitudes regarding tobacco industry practices and smoking status. METHODS: A national random-digit-dial telephone survey of 6875 youths 12 to 24 years old was conducted in Winter 1999-2000. Exploratory and confirmatory factor analysis investigated the structure underlying beliefs and attitudes toward the tobacco industry. Structural equation modeling tested whether the data were consistent with a theoretically based causal model of campaign effects from exposure to an aggressive counterindustry campaign, mediated by beliefs about tobacco industry practices and attitudes toward the tobacco industry, to smoking status. RESULTS: Exploratory and confirmatory factor analysis indicated that two dimensions underlie perceptions of the tobacco industry: beliefs about tobacco industry practices and attitudes toward the industry. Structural equation models provided strong support for the hypothesized model: youth living in states with aggressive counterindustry media campaigns had more negative beliefs about tobacco industry practices, which led to negative attitudes toward the industry and less progression along a continuum of smoking intentions and behavior. CONCLUSIONS: Media campaigns using counterindustry messages show promise in reducing smoking behavior among teens and young adults by changing beliefs about industry practices.

Getting to the truth: evaluating national tobacco countermarketing campaigns.

OBJECTIVES: This study examines how the American Legacy Foundation's "truth" campaign and Philip Morris's "Think. Don't Smoke" campaign have influenced youths' attitudes, beliefs, and intentions toward tobacco. METHODS: We analyzed 2 telephone surveys of 12- to 17-year-olds with multivariate logistic regressions: a baseline survey conducted before the launch of "truth" and a second survey 10 months into the "truth" campaign. RESULTS: Exposure to "truth" countermarketing advertisements was consistently associated with an increase in anti-tobacco attitudes and beliefs, whereas exposure to Philip Morris advertisements generally was not. In addition, those exposed to Philip Morris advertisements were more likely to be open to the idea of smoking. CONCLUSIONS: Whereas exposure to the "truth" campaign positively changed youths' attitudes toward tobacco, the Philip Morris campaign had a counterproductive influence.