Problem/Objective: The national “truth” campaign has exposed U.S. youth to tobacco countermarketing messages since 2000. Tobacco industry sponsored campaigns, such as “Think. Don't Smoke,” (TDS) have also aired nationally. Cross-sectional evidence suggests that “truth” has impacted youths' tobacco beliefs, intentions, and behaviors. However, there are no longitudinal studies showing similar associations. This study examines the effects of the “truth” and TDS campaigns using an in-school longitudinal survey of youth.

Methods: We used a 3-wave longitudinal survey of 15,700 middle and high school youth in 7 communities in the U.S. Using logistic regressions, we estimated the effects of low, medium, and high “truth” and TDS exposure on changes in tobacco beliefs, intentions, and smoking initiation. Analyses controlled for age, race, gender, and a comprehensive set of other potential confounders.

Results: “Truth” was associated with increased agreement with anti-tobacco beliefs among youth who held baseline pro-tobacco beliefs. Among youth who held baseline anti-tobacco beliefs, “Truth” was associated with lower odds of developing pro-tobacco beliefs. “Truth” was also associated with decreased intentions to smoke and lower odds of smoking initiation among baseline nonsmokers. Effects were greater at higher levels of “truth” exposure, indicating a dose response. TDS was not associated with study outcomes.

Conclusions: The “truth” campaign was associated with changes in key tobacco outcomes. These effects appear to be uniform across high and low risk youth at baseline. Our findings offer new longitudinal evidence that branded tobacco countermarketing campaigns targeted to at-risk youth are effective in changing key tobacco-related beliefs, intentions, and behaviors.