The Birth of "truth"
(and What It Tells Us About the Importance of Horizontal Influence)
Authors:
Catherine Schum, M.A.
Robert J. Gould, Ph.D.
Carrie Schum is a senior vice president, Strategic Planning and Research at Porter Novelli D. Rob Gould is the Managing Director of Porter Novelli's Washington, DC office. They were both core members of the team that launched Florida "truth."
(pdf version)
Abstract
The Florida "truth" anti-tobacco campaign was the first counter-marketing campaign funded with tobacco industry settlement money. Its strategy of undermining conventional attitudes about tobacco use, and showing how the tobacco industry purposely targeted teens, has been widely used by other tobacco prevention programs. This case study describes the strategic decisions that gave rise to the "truth" campaign, and speculates about why "truth" was so effective, with a particular focus on peer-to-peer communication.
Background
The Florida "truth" campaign is often held up as a model of effective social marketing. As the first-ever tobacco counter-marketing program executed with tobacco company money (as a result of the state's settlement with the tobacco industry in August 1997), the program received extensive media coverage and interest from the public health sector. And, most of all, it worked -- tobacco use among Florida middle and high school students declined markedly and rapidly. (Editor's note: Florida's settlement with the tobacco industry preceded the November 1998 multi-state settlement that led to the creation of the American Legacy Foundation, whose legal fight with Lorillard Tobacco over anti-tobacco advertising is profiled in this volume of the journal.)
What isn't as well known is how the program came together, the strategic and operational decisions that made it work so well on the ground. Moreover, with the benefit of hindsight, we now have words to describe what we believe occurred in Florida from 1998 to 2000 - terms, like viral campaign and peer networking, that we see commonly today but that were unknown a decade ago. In many ways, the Florida "truth" campaign was the first horizontal influence campaign, where the horizontal - peer-to-peer - element was just as important as the vertical, top-down professional communications activities.
Porter Novelli served as the public relations agency for the Florida "truth" campaign, executing local and national media relations programs, as well as overseeing youth activism activities and assisting the local grassroots activities of SWAT (Students Working Against Tobacco) chapters.
Tobacco Use Among Florida Youth
It is estimated that 90% of adult smokers began smoking before the age of 18,1 and that one-third of teens who smoke will die prematurely from a tobacco-related disease.2 At the time the campaign launched (in March 1998), about 18% of Florida middle schoolers and 27.4% of high schoolers smoked.3 Nationally, rates of cigarette use among teenagers had risen steadily between 1991 and 1997, from 27.5% in 1991 to 36.4% in 1997.4
Role of Communications in Tobacco Prevention
At the start of the campaign, the communications team conducted a brief literature review of youth-focused tobacco prevention campaigns. Surprisingly, there was little evidence that they had succeeded or should serve as models for the Florida effort. One article,5 however, offered hope that communications that exposed how the tobacco industry manipulated people to entice them into smoking could be effective. The article showcased the state of California's ad campaign, and how it used the tobacco industry's own messages and imagery to de-bunk commonly held perceptions about smoking.
Campaign Strategy
The "truth" campaign was built around the industry manipulation theme. In other words, "truth" messages did not focus on the health effects of smoking; rather, they were designed to show teens the myriad ways in which the tobacco industry targeted them with marketing efforts. "truth" didn't preach to kids, and it didn't even tell them not to smoke. What it did do was give them information to evaluate how smoking was presented to them. It showed them which companies were supporting that messaging, and provided them with new ways to evaluate the advertisements and promotions they saw about smoking.
Distribution
Campaign messages aired widely throughout the state, through television and radio advertising and on billboards. Other campaign communications vehicles included a web site, local events and outreach to television, radio and print media. Each county had a grassroots organization entitled SWAT (Students Working Against Tobacco) designed to develop and implement local outreach and activities. Branded "truth" gear, including t-shirts, lanyards and stickers, were distributed at events and via SWAT.
"truth" was fortunate in that it had substantial money behind it - $25 million in the first year, which meant that paid television advertising formed a core part of the outreach strategy. That kind of money also allowed the state of Florida to hire the best youth-focused creative agencies in the business (Crispin Porter + Bogusky was the advertising and lead agency) so that the advertising was of the same quality as advertisements teens saw for other hip, youth-focused products. In other words, "truth" ads were not just good public health ads - they were good ads, period. Moreover, the funding levels ensured that campaign advertising aired when kids were likely to see it, on the programs they regularly watched and where other youth-focused products were advertising.
Communication
While advertising was the cornerstone of the communications program, it was seamlessly woven together with public relations and grassroots events. They were united not only by the "truth" brand name, but with episodic themes that focused on various elements of tobacco industry promotion. For example, during the Reel "truth" initiative, which focused on depictions of tobacco use in films, one advertisement was created to look like a trailer for a horror movie (revealed to be entitled "Tobacco" in the final frame). The coordinating public relations effort focused on increasing awareness of inaccurate depictions of tobacco in movies, such as action heroes who smoked throughout a film but nevertheless were able to run and leap without ever suffering from shortness of breath. Public relations also promoted grassroots events designed to gather signatures from Hollywood stars on a pledge for the responsible use of tobacco. Each element played an important, distinct role, yet they worked together in support of a coherent, strategic objective.
Results
Within six months of the campaign launch, awareness of the campaign among the target teen audience reached 92%.6 By February 1999, one year after campaign launch, smoking among middle school students declined by 19.4% and smoking among high school students declined by 8%.7 In total, it was estimated that 29,000 fewer Florida teens smoked. The decline was cited by the Centers for Disease Control and Prevention (CDC) as "the largest annual reported decline observed in the nation since 1980."8 The decline was attributed in large part to the activities of the Florida Tobacco Pilot Program.
Analysis
The results of and the specific communication elements used in "truth" have been widely cited, and often discussed. We feel, however, than an important part of the story - a part that has only become clear to us in retrospect - has not yet been told. Our belief is that the distinguishing element of "truth" is not simply that youth were involved in its creation, but that they embraced and multiplied its messages on their own.
Youth were involved in tobacco summits where campaign plans were developed; participated in campaign review boards; and helped guide advertising creative development. At the time, this in and of itself was a breakthrough, and this youth-guided model has been adopted to varying degrees by other youth-focused social marketing campaigns.
But what was not apparent at the time - simply because we didn't have the words to express it - is what we believe to be the true reason for the success of the "truth" youth involvement model, what we call horizontal influence. "truth" wasn't successful simply because we got great feedback from kids and used it in the program's communication products and activities. Rather, it was that kids themselves talked to each other about "truth." It became a true viral movement among them.
Of course, the professional products - advertising, media relations and events - were central to mobilizing and focusing this youth activism. But the core of truth was that it was a real youth movement, one that was using the best communications vehicles available at the time to allow teens to communicate with each other. "truth" gave teens the vernacular to use in talking about smoking in a way that was reflective of how they really felt, rather than in public health jargon. "truth" didn't put words in kids' mouths, it gave them the means to express the concerns of teens everywhere - to rebel, to express themselves and to fit in with their peers - without using smoking as the stand-in for all those feelings and emotions.
It is worth highlighting several elements of "truth" that presaged today's horizontal campaigns:
1) Real-World Celebrities.
The stars of "truth" ads included real Florida kids, from participants in the youth summits to members of the youth advisory board. These same teens served as the public voice of the campaign, hosting press conferences, and appearing in television and radio interviews. Real teens - and their real passion for the issue became synonymous with the "truth" campaign.
It may seem unbelievable today, but in 1998, this type of celebrity simply didn't exist. There was no American Idol or Survivor - reality TV as we now know it hadn't been invented. There were celebrities, and there were real people, and the two didn't usually overlap. Today, of course, just the opposite is true, as the chance for ordinary people to become celebrities is the driving force not only behind reality TV shows but behind bloggers like Perez Hilton and the video junkies of YouTube. Ironically, even advertisers have gotten on the bandwagon, soliciting entries from ordinary people in highly promoted contests, with the winners receiving national exposure on the 2007 Super Bowl broadcast.
2) Peer Endorsement
There's a reason that brand loyalty developed early in life creates a lifelong customer. Teens are notoriously brand loyal, and brands serve an essential role for them, functioning as shorthand for qualities they want to project. Smoking, of course, is itself a brand, telegraphing rebellion and coolness, aided by the iconic labels of Marlboro and others. Branding "truth" was an important element of its success, for a highly visible counter-brand, holding the same brand iconography of rebellion and cool as smoking did, held a great deal of appeal for many teens. Moreover, "truth" signaled additional brand values that smoking could never hope to hold, such as independence and understanding. The singular brand message had important marketing values, allowing the campaign to quickly build awareness and leveraging campaign dollars for maximum effect.
But the visible brand - the iconographic "truth" logo, the t-shirts, lanyards, stickers and other gear - served a purpose far beyond the marketing goals its achieved. In an age before peer ratings - the ubiquitous stars that guide us on web sites from Amazon to Macy's, YouTube and beyond - the "truth" brand served as a visible peer rating.
"truth" showed that you were in the know, that you were a leader, an insider. Even more than cigarette brands, which are generally used by adults, after all, "truth" was a teen brand and the brand iconography reinforced that visually and unforgettably for other teens. In the best way possible, "truth" was a visual identity for positive peer pressure, one that gave teens tacit approval to publicly declare that they didn't smoke - and still be deemed "cool" by their peers.
What the "truth" campaign elements did, in effect, was make public the social norm, which is that most kids don't smoke. As many studies and articles have shown, peer influence has a tremendous effect on youth risk behaviors.9 Yet effectively communicating such a norm is a difficult and delicate task, which is why simply providing information about the norm often isn't enough to change behavior. After all, telling kids "most kids don't smoke" simply reinforces the idea that it's a behavior that indicates that they are special and unique - all parts of the appeal of smoking for those who pick up the habit.
"truth" publicized the social norm in an extremely subtle way - no one ever talked about who did and didn't smoke, or used words like "social norm." It simply gave teens the tools to figure it out for themselves, and ample evidence of appealing, popular role models carrying the message. In other words, it was hard to believe that you had to smoke to be cool, when there was so much evidence that plenty of cool kids clearly didn't.
3) The Influence of the Few
Thanks to Malcolm Gladwell, author of the book The Tipping Point, the words "maven" and "connector" mean much more now than they did just a few years ago. His premise that reaching the right few could mean you reach the broad many has resonated widely in social psychology and marketing. "truth" undoubtedly benefited from the tremendous amount of paid advertising that ran in Florida. Yet advertising alone can't create a true grassroots movement. And "truth" was undoubtedly that. The teens involved with "truth" cared passionately about it, and they spread the word to their local networks, influencing other teens in their schools and communities. These networks worked powerfully to support the causes the students believed in, most notably when it was proposed that the "truth" budget be slashed. In that case, students stormed the governor's office in protest; a real-life movement that had no support from paid public health agencies or leadership from the Florida Tobacco Pilot Program.
Conclusion
Many reasons have been put forth for the success of the Florida "truth" campaign: the unprecedented funding levels, the media spotlight, the support of statewide elected and public health officials, and the skill of the advertising and public relations firms. In reality, all of these were responsible to one degree or another, but there is one additional element that has not previously been examined: the engagement of teens themselves.
Today, the conventional wisdom is that youth engagement is an outgrowth of the Internet and social media such as blogs and gathering places such as MySpace. But as this case study shows, teens' desire and ability to create social movements were already there. Technology certainly makes it easier for them to act upon this desire, of course, and it also makes the workings of teen networking more transparent to adults. So maybe what's most important about "new media" is that it makes the mechanisms of peer networks more understandable to public health communicators, and increases our ability to reach teens on important social and health issues.
- Campaign for Tobacco-Free Kids, Fact Sheet, "Tobacco Harm to Kids." http://www.tobaccofreekids.org/research/factsheets/pdf/0077.pdf. Calculated from the 2005 National Survey on Drug Use and Health, http://www.oas.samhsa.gov/hsduh.htm.
- Centers for Disease Control and Prevention (CDC), "Projected Smoking-Related Deaths Among Youth - United States," MMWR, 45(44) (November 8, 1996). http://www.ccdc.gov/mmwr/PDF/wk/mm4544.pdf.
- Bauer UE, Johnson TM, Hopkins RS, et al. Changes in youth cigarette use and intentions following implementation of a tobacco control program. Findings from the Florida youth tobacco survey, 1998-2000. JAMA 2000;284:723-728.
- CDC, National Youth Risk Behavior Surveillance Survey, Fact Sheet, "Trends in the Prevalence of Cigarette Use." http://www.cdc.gov/HealthyYouth/yrbs/pdf/trends/2005_YRBS_Cigarette_Use.pdf
- Balbach ED, Glantz SA. Tobacco control advocates must demand high-quality media campaigns: the California experience. Tob Control 1998 Winter; 7(4):397-408.
- Zucker, D, Hopkins RS, et al. Florida’s "truth" Campaign: A Counter-Marketing, Anti-Tobacco Media Campaign. J Public Health Management Practice, 2000, 6 (3), 1-6.
- CDC, Tobacco Use Among Middle and High School Students - Florida, 1998 and 1999. MMWR 48 (12), April 2, 1999; 248-253.
- Ibid.
- Asch, SE. (1951) Effects of group pressure on the modification and distortion of judgments. In H. Guetzkow (Ed.) Groups, leadership and men. Pittsburgh: Carnegie Press.
- Kandel, DB (1980). Drug and Drinking behavior among youth. In A. Inkeles, NJ Smelser, & R. Turner (Eds.) Annual review of sociology, (Vol. 6) Palo Alto, CA: Annual Reviews, Inc.
Kandel, DB (1985). On processes of peer influences in adolescent drug use: A developmental perspective. Adolescence, Advances in Alcohol and Substance Abuse, 4(3/4), 139-163.
