Index

Corresponding Author:
John McCracken, Cactus, 2128 15th Street, Denver, CO 80212

Suggested citation: : : Conrad, J, McCracken, J, and Phelan, K. 'Own Your C' - Colorado's Youth Tobacco Prevention and Cessation Campaign. Cases in Public Health Communication & Marketing. 2009; 3:219-241. Available from: www.casesjournal.org/volume3.

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Abstract

In Colorado, the State Tobacco Education & Prevention Partnership (STEPP) at the Colorado Department of Public Health and Environment (CDPHE) initiated a strategic plan to decrease tobacco use and encourage healthy behavior among teens. In 2006, STEPP partnered with Cactus, a Denver-based advertising agency, to create an integrated public education campaign that would be highly relevant to teens. The campaign, called "Own Your C", uses integrated digital media to empower teens to own their choices around tobacco and other risk behaviors. Own Your C campaign has gained traction among Colorado's youth, generating 47,000 visitors to ownyourC.com, reaching 4.5 million Colorado teens with TV spots and, conducting more than 430 events in each of Colorado's 64 counties reaching more than 75,000 students. More importantly, Colorado youth are receptive to the campaign and have actively engaged in the online community to converse about health-related topics, including tobacco. The average visitor spends six and a half minutes or more on the site and views 27 pages per visit. Furthermore, teens have thanked campaign leaders for being "refreshing" and "non-preachy."

Introduction

More than 92,000 of Colorado's youth will die an early, preventable death because of decisions they are making right now in their daily lives ¹. Every year, approximately 5,600 Colorado teens and pre-teens become new daily smokers ². In fact, almost 80 percent of adult smokers report that they began using tobacco products before high school graduation ³. Since research indicates that health behavior patterns developed in adolescence can form the basis for future health, teen tobacco prevention and cessation programs are instrumental in educating about tobacco use, preventing tobacco initiation and promoting tobacco cessation among Colorado's youth.

Colorado's youth, along with the rest of the nation's, has benefited from these programs. Since 1997, the national youth smoking rate has plummeted from 36.4 percent to its current 21.9 percent ⁴. But there is still work ahead. After a 10-year decline in youth smoking among high school students nationally, including Colorado teens, the Centers for Disease Control and Prevention (CDC) reported in July of 2006 that the decline had come to a standstill ⁵. This is no surprise given the billions of dollars that the tobacco industry allocates to its marketing efforts in Colorado and across the county. In Colorado alone, the tobacco industry continues to spend an astounding $3.6 million per week in its marketing efforts ⁶.

In Colorado, the State Tobacco Education & Prevention Partnership (STEPP) at the Colorado Department of Public Health and Environment (CDPHE) initiated a strategic plan to breakthrough the tobacco industry's hold and encourage healthy behavior among teens.

In 2006, STEPP partnered with Cactus, a Denver-based advertising agency, to create an integrated public education campaign that would be highly relevant, engaging and socially significant to all teens - not just those who smoke. Established under the premise that risk behaviors are connected and tobacco use is just one risky choice that teens make on a daily basis, the campaign was intentionally crafted to connect with a longer list of tough, intricately woven behaviors including alcohol, delinquency, diet, drugs, relationships and sex.

Rather than preach, the aggregated campaign was built on honest, two-way dialogue. The result is a campaign that empowers teens to make educated choices and to recognize the consequences of those choices - to own their "C" (see Figure 1). Own Your C's communication objectives are to build teen life skills in choice-making (helping teens identify choices in their lives), normalize positive choice-making behavior, and promote making smart, healthy choices by preventing tobacco use, improving nutrition and encouraging physical activity.

Background Research

In order to understand the complex, socially spirited and ever-changing world of teens, both tobacco and non-tobacco related, a variety of primary and secondary research methods were employed. Ultimately, the goal was to find a campaign message that resonated universally with teens of all ages, ethnicities, genders, geographic locations and income levels.

The background research took place in three parts. First, a literature review was conducted to discover which public education campaigns had been successful in changing behavior and, specifically, reducing teen smoking levels. Second, the social environment teens inhabit was dissected to understand how they socialize and communicate within that environment. Third, through innovative primary research, teens' attitudes toward risky behavior were analyzed to understand the decision-making dynamic surrounding their choices.

Literature review of tobacco prevention campaign effectiveness
Secondary research, data and supporting documents were studied to discover which public education campaigns had been successful in reducing teen smoking levels. It was discovered that a precedent had been set for successful advertising in regard to reducing teen smoking levels.

A study published in 2005 measuring students in 75 major media markets with varying levels of state-sponsored anti-tobacco TV ads found that students from markets with higher advertising levels were significantly less likely to have smoked in the past 30 days; more likely to perceive great harm from smoking; and, more likely to report that they would not be smoking in five years ⁷. Additionally, a study measuring the effectiveness of the national "truth" campaign reported that 22 percent of the nation's overall youth smoking decline between 1999 and 2002 could be directly attributed to the campaign8.

While the counter-industry premise (anti-Big Tobacco) was successful in the past and tested well in the late 1990's and early 2000's, some recent studies have shown that this strategy may be overused. According to a recent study in the American Journal of Public Health, nearly two-thirds of all state campaigns used counter-industry messaging9. Additional studies have found that ads graphically portraying the effects of living or suffering from the afflictions of tobacco use (as opposed to dying from) ranked high in getting youth to "stop and think" about tobacco use. However, researchers cautioned against using messages that inflict fear. Images and messages that employ fear tactics are more likely to be rebelled against, don't break-through teens' invincibility barrier, and potentially only enhance the idea of tobacco as the "forbidden fruit" ¹⁰.

Communicating with teens
Teens' consumption and interactions with media place them at the vanguard of the digital revolution. Gone are the days when a single television program would aggregate 75 percent of the teen audience. ¹¹ Today, a popular show would be lucky to get 12 percent. Teens have turned much of their attention to the Internet where they access a world of information, entertainment and social groups. More than 93 percent of teens use the Internet. ¹² Teens' reactions to advertising and brands have evolved significantly over the past decade. Teens have become more accepting of advertising and now see brands as a way to help define themselves, a sharp contrast to previous generations' anti-establishment tendencies ¹³. This new dynamic was important in creating a campaign with which teens would both identify and embrace (see Figure 2).

It was imperative to understand how teens socialize today and how new communication technologies impact their relationships. While talking on the phone was still the preferred communication method of choice (when not hanging out in person) ¹⁴, teens' communication patterns were heavily driven by their increased use of new media. Online forums (Instant Message (IM), social networks, etc.) have become fundamental ingredient of teens' increasingly complicated social lives. This shift to digital communication and expression has changed the social dynamics of teen relationships.

Dr. Henry Jenkins of Massachusetts Institute of Technology notes that teens' online social interactions are characterized by the natural formation of "informal mentorships" whereby information, expertise and advice are disseminated organically throughout the group ¹⁵. This new peer-to-peer learning dynamic allows participants to feel like experts while tapping the expertise of others ¹⁶.

To better understand what brands are effectively communicating their messages to teens, it was crucial to understand not only which brands are "in" versus "out," which is constantly evolving with the fickle youth audience, but what makes a brand relevant, albeit fleeting, in the minds of teens today. Overwhelmingly, brand theorists point out that, for teens, a brand is no longer a badge of quality or insurance of a safe choice as it is with older generations ¹⁷; a brand is a means for teens to define themselves, to express who they believe they are, or want to be outwardly, to their peers, family and strangers. It is an interesting juxtaposition of self-expression, while concurrently enhancing connectedness to other like-minded teens.

A recent global brand study showed that several U.S. brands are losing favor with teens to more innovative, international brands ¹⁸. Experts argue that the brands losing teen relevance are those that try to impose images on teens, rather than reflecting teens' perceptions of themselves. Overall, teens are aware of marketing and are very much "hip to the hype." Teens need to feel in control and believe that they are discovering brands on their own. Teens want and need to feel as if they are part of the brand story. Additionally, according to researcher Dr. Hye-Jin Paek ¹⁹, "Anti-smoking ads have the greatest impact on smoking attitudes and behavior when adolescents think that their peers are listening to those messages." Hence, teens interpret media based on the perception of their close peers.

Teen decision-making
We conducted our own research to better understand nuances of teen social environments. Recognizing the importance of digital media to teens, a two-pronged primary research strategy was employed: online and offline. After conducting ethnographic research through the profiles and blogs of Colorado teens on sites such as Myspace and Xanga, a virtual research space called Youth Ruckus was created and monitored. The site became a hub for direct interaction with teens on their turf and on their terms, and provided valuable insight.

In the online environment, teens were willing to share their experiences and emotions around risky behaviors and smoking. It was substantiated that teens face enormous peer pressure to fit in and, as such, remain constantly aware of their social dynamic.

In addition, a schedule of face-to-face research interviews, one-on-ones via Instant Messaging sessions and focus groups provided comprehensive insight for message and tactical development. From these, it became clear that the most difficult and salient issue for teens was finding a way to be in control of their own lives. Teens were transitioning from doing what others told them, to experimenting with their own judgment - making their own choices. Being in control of choices meant being able to express oneself, despite the pressure to do otherwise.

The following key findings from primary and secondary research were instrumental in campaign development:

• Teens do think about their choices and approach them rationally (but assess value and benefits differently than adults).
• Teens believe themselves to be media immune, but are especially attuned to the attitudes and behaviors of their peers.
• Teens' online social interactions are a source of peer-driven learning.
• Teens are pack-oriented and experience self-inflicted pressure to belong.
• Teens desire to be in control of their lives.
• Teens are concerned with their future, but their notion of future does not extend beyond college.
• Teens are surrounded by negative messages and want to see things that reflect their optimism.
• Teens have high aspirations and respect brands that reflect this idealized version of themselves.
• Teens' adoption of tobacco is closely intertwined with milestones where teens achieve increased independence (graduating from middle to high school, earning their driver's license and the freedom to go off-campus, graduating high school).

Execution Methods

The campaign strategy aims to recognize youth's desire to assert independence through their choices and empower them to seek out information and take responsibility for the outcomes of those choices. This campaign empowers teens to make choices to implement change in their own lives (see Figure 3). It provides them with an environment to learn and discover what making smart, health choices means to them. This strategy yielded a powerful and impactful youth tobacco prevention and cessation campaign coined, "Own Your C" (Own Your Choices).

"Choice" was selected as the message anchor because all youth, regardless of age, ethnicity, gender, geographic location, income or sexual orientation, must make difficult choices in their daily lives. Choice is relevant to all teens because it also connects to them on an emotional level. Own Your C was developed as the brand to embody the empowerment strategy and choice message. This theme fit well with a common vernacular among young adults, "own it", which means to step-up and take accountability for your own actions.

To breakthrough the advertising clutter in a teen's world and be relevant to their lives, a bona fide youth-relevant brand was created from the ground up. The Own Your C brand competes not just against other public health messages, but other youth brands. Campaign elements were designed to work with and complement current fashions and trends of the youth culture (see Figure 4).

Own Your C is a holistic campaign that engages teens from multiple touch points and integrates the digital platform in a way never before seen. The result is a campaign that truly empowers teens to own their choices - not just choices about tobacco use, but important inter-related choices teens are confronted by every day. The campaign recognizes the influencers of youth behavior and the ways in which youth assert their choices. The goal isn't to tell teens what to do; rather, it is to encourage teens to make educated choices and to recognize the consequences of those choices.

ownyourC.com
Own Your C needed more than a campaign. It needed a community - an immersive community that invites teens to share their choices, connect with their peers and influence the conversation. The online environment invites users in, encourages exploration, dialogue and, above all, debate. Teens are encouraged to educate each other because the same power of peer influence that might cause a teen to smoke in the first place, also has the power to inspire positive change when put to constructive use. Teens, speaking to one another in an open and honest environment, authentically sharing their experiences, have more power than any spokesperson in impacting behavior change.

ownyourC.com gives teens what they want most- a soapbox to express themselves. It is a rich, online community that allows teens to share their opinions about the choices they face each and every day. We start the process by posting a statement with which teens can agree or disagree (see Figure 5). By starting with a statement, we provide teens with an easy entry point into the conversation and have a central topic to guide the discussion. New topics are posted each week to represent the range of choices that teens face in their lives, from smoking and alcohol, to relationships and education. As long as the topic allows teens to take a firm position and has the potential to spark a dialog, it qualifies.

After visitors agree or disagree with the statement, the community's results are revealed (see Figure 6). The survey results can be easily manipulated to allow teens to view others' responses based on the age, gender and location of each registered user. Each response becomes its own thread, providing teens the opportunity to dive deeper. They can express their own point-of-view through video, image or text - empowering a highly customized interaction within the community (see Figure 7). They can use the filtering feature to seek out responses that are most relevant to them, view others' responses and begin a dialog with others through these responses.

Own Your C has professed that teens' choices define them, and through this site, that concept is brought to life. Users can choose to form connections and create a community with other teens who are defined by the choices they make and the opinions they share on the site.

As Own Your C is targeted to 13 to 17 year-olds, age appropriate content for this audience is mandatory. Yet, in order for the online community to work without feeling censored and controlled, we employed a unique approach to moderating the site. To fulfill teens' desire for instant gratification, their posted content appears live on only their local computer. A moderator receives notice of new content, views it and, if deemed appropriate, it's pushed live for the rest of the world to see. If content is rejected, teens are notified on why it is inappropriate and are allowed the opportunity to revise and post something constructive to the community. More than 80 percent of those teens edit and resubmit their content. Teens respect brands that are authentic and honest, so we are transparent about our process for moderating content. Since the Web site's launch, teens have taken the initiative to moderate content themselves, demonstrating their ownership of the culture and content of the site. Our official Own Your C moderator fulfills the role more akin to a curator now, encouraging discussion, providing new information and offering resources.

A site like ownyourC.com will only work if people are participating. The following tactics represent the integrated campaign developed to drive traffic to the Web site and encourage participation.

Online Advertising and Facebook Connect
The online strategy includes a blend of paid placements using banner ads and word-of-mouth promotion using social media. A series of interactive, rich-media banner ads was designed to pique teens' interest and encourage them to join the community at ownyourC.com (see Figure 8). However, this Web site offers depth and value that cannot be described within the constraints of a banner advertisement. It requires a referral and endorsement from a credible source, so social media channels were tapped. Central to this strategy is the site's utilization of Facebook Connect. By linking ownyourC.com and Facebook, we provide teens an opportunity to bring their existing network of Facebook friends into their ownyourC.com connections. In addition, Facebook Connect enables teens to seamlessly post ownyourC.com responses simultaneously on their Facebook profile. Any choice they make on ownyourC.com becomes an invitation to their connected Facebook friends to respond to within ownyourC.com and Facebook.

TV Spots
The 2008 television campaign features a series of eight eclectic television spots that drive home the message that choices define you. The first three, "Genie", "C-Tree" and "Boomerang" (see Figures 9 and 10) are visually stunning reminders to consider the consequences of your choices, who influences your choices and the empowering outcome that owning your choices has on your life. The second set, created through stop-motion photography, are engaging, if sometimes bizarre, visual metaphors for the community created by the ownyourC.com (see Figure 11). They encourage teens to sign on to share, connect and influence their opinions on the Web site.

Youth Outreach
A branded ice cream truck, the C-Ride serves as a "C" brand ambassador, building buzz and generating excitement at schools and youth-oriented events in urban, rural and mountain communities statewide (see Figure 12). The truck features a back-lit chrome "C" hood ornament, air-ride suspension and custom rims, custom lighting and sound, and a freezer for distributing ice cream and treats. A U.K. artist popular for his offbeat character illustrations was commissioned to design the truck's exterior. The C-ride is equipped with a street team that invites teens to share their choices through the online community via video interviews and encourages teens to enroll in an online quitting program called FixNixer, uniquely developed for this audience. The team uses large displays to engage teens in topics from the Web site and show related videos.

For promotional items, artists from around the world were commissioned to express what "owning your C" means to them. Choice-inspired designs from artists in Thailand to the U.K. and across the U.S. have been parlayed into jump-drives, magnets, stickers, t-shirts and winter hats that are distributed by the C-Ride street team (see Figure 13).

Quit Kits
Discreet quit kits for teens to quit smoking or chew tobacco were inspired by the research (see Figure 14). The kits are encased in anonymous encyclopedia covers with hollowed interior space to store a quit journal, gum, stress balls and alternative-to-tobacco mint snuff pouches. While the artistic quit journals feature inspirational messages and fashion-forward designs, the copy and content is based on best practices and the latest quit psychology available for youth.

Evaluation

Own Your C campaign has been recognized as a leader among health campaigns and was presented as an exemplar at the 2008 National Conference on Health Communication, Marketing, and Media. It has been recognized by Reuters, Wired, the Los Angeles Times, AdCritic, AdRants, Advertising Age, The Denver Post (see Figure 15) and Rocky Mountain News, to name a few.

More importantly, the campaign is gaining traction among Colorado's youth (see Figure 16). The TV spots have reached 4.5 million Colorado teens and, in the past month, ownyourC.com has generated 47,000 site visitors, adding to the 500,000+ visits over the past two years. Once there, the average user spends six and a half minutes or more on the site, viewing an average of 27 pages per visit. The conversations within health topics are just as heated and engaging as social or pop culture related topics. In fact, four out of five of the most popular discussion topics are health related, including:

• "Kissing a smoker is disgusting."
• "Vegetarians are healthier than meat-eaters."
• "Underage drinking is okay if my parents allow it."
• "Body shape and size is determined by how much I exercise."

Campaign representatives have conducted over 430 events in each of Colorado's 64 counties reaching more than 75,000 students (see Figures 17 and 18). All in all, street teams have distributed 3,400 quit kits, 18,500 quit journals, 18,500 posters and thousands of t-shirts, stickers and more.

Anecdotal feedback from students, teachers and parents has been positive. One student wrote to campaign leaders to thank them for being "refreshing" and "non-preachy." Another young person wrote in to say, "Thanks for not lecturing."

Colorado now boasts the second lowest teen smoking rate in the nation at 14.6 percent, well below the current national average reported by the CDC (20 percent) and already surpassing the CDC's Healthy People 2010 goal of 16 percent. Health officials in at six other states have expressed interest in bringing Own Your C to their communities. The Own Your C movement is born.

Lessons Learned

Based on our experiences with the Own Your C campaign, we offer the following lessons learned that may be useful to other public health communication and marketing initiatives.

• In order to effectively engage teens online via social media, control over the message has to be relinquished. By encouraging youth to participate in the conversation, like on ownyourC.com, the administrator's balance shifts from dictating conversation to curating it. Providing some direction for conversation, being transparent about the rules, and then stepping out of the way can result in dialogue that's authentic, emotional, powerful and relatable.
• Use teens as your messenger if the campaign targets teens. Social cognitive theory suggests that youth are more likely to learn if they closely identify with the messenger. Thus, there is no more credible messenger to teens than their peers. The online environment is very well suited as there is no better vehicle to connect teens across any distance to other teens they find a bond with.
• Cultivate community partnerships. Grass-roots partnerships have been instrumental to Own Your C's success. From schools and community based organizations, to local health agencies and organizations serving disparate populations, statewide alliances enabled Own Your C to be culturally relevant and locally activated and have been invaluable in promoting ownyourC.com and even incorporating it as a resource within their classrooms.
• Honesty goes a long way with media cynical and brand savvy teens. If a campaign, and thus Web site, message is transparent, authentic and ultimately offers something of value, they will listen and participate.

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References

1. Campaign For Tobacco Free Kids. The Tobacco State Settlement: Colorado Page. http://www.tobaccofreekids.org/reports/settlements/state.php?StateID=CO Accessed April 6, 2009.
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Author Information

Joe Conrad is founder, CEO and Strategic Director of Cactus, and has been deeply entrenched in strategic planning, execution and evaluation of the Own Your C campaign since 2006.

John McCracken, is account director for the Own Your C account and has worked closely with the Colorado State Tobacco Education & Prevention Partnership on strategic planning, execution and evaluation of the Own Your C campaign since 2006.

Karen Phelan, MA, is Health Communications and Marketing Director, State Tobacco Education & Prevention Partnership at the Colorado Department of Public Health and Environment. She oversees STEPP's statewide marketing campaigns and is the liaison for program expertise.