Assistant Professor of Social and Behavioral Sciences
Jennifer Cantrell, DrPH, MPA is Assistant Professor in the Department of Social and Behavioral Sciences. She earned her DrPH from Columbia University’s Mailman School of Public Health and her MPA from Columbia University School of International and Public Affairs. She completed postdoctoral training in the National Institute of Drug Abuse’s (NIDA) program for Behavioral Science Training in Drug Abuse Research at National Development Research Institutes in New York, NY.
Dr. Cantrell’s research focuses on the impact of policies and population-level interventions, including communications, media and messaging, on health risk behaviors for tobacco use and opioid use. With a primary focus on tobacco use, Dr. Cantrell’s research examines the ways that pro- and anti-tobacco marketing, digital media, tobacco regulatory policies, and community processes shape youth tobacco prevention, adult cessation and tobacco-related disparities. She also conducts research on the development of novel cessation interventions for groups that experience disparities in smoking. Dr. Cantrell has published over 50 scientific articles, co-authored a chapter on “Communication, Marketing and Tobacco-related Disparities” in the National Cancer Institute’s (NCI) Monograph 22: A Socioecological Approach to Tobacco-related Disparities, and received national and international media coverage for her work. Her research has been funded by NIDA, the National Institute on Minority Health and Health Disparities (NIMHD), Truth Initiative, the Centers for Disease Control and Prevention and NYU’s Vice Provostial Mega-Grants Initiative.
Prior to joining NYU GPH, she was a Managing Director and Research Investigator at Truth Initiative, a national non-profit research and education organization focused on tobacco use prevention and cessation, where she evaluated and conducted research on national anti-smoking mass media efforts, including the award-winning truth® campaign and the Centers for Disease Control’s Tips for Former Smokers campaign. As part of this work, she led the development of the winning proposal for the 2017 Berreth Award for Excellence in Public Health Communication. She has received the NIH Loan Repayment Program award for health disparities research from NIMHD and serves on multiple advisory committees.
Alcohol, Tobacco and Driving PoliciesBehavioral ScienceHealth DisparitiesPopulation HealthPublic Health PolicySocial BehaviorsSocial epidemiology
History and Current Trends in the Electronic Cigarette Retail Marketplace in the United States: 2010-2016Cantrell, J., Huang, J., Greenberg, M., Willett, J., Hair, E., & Vallone, D.
Journal titleNicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
Page(s)843-847INTRODUCTION: The US market for electronic nicotine delivery systems (ENDS) has grown rapidly in the last decade. There is limited published evidence examining changes in the ENDS marketplace prior to the US Food and Drug Administration's (FDA) deeming rule in 2016. This study describes US ENDS retail market trends from 2010 to 2016. METHODS: National data were obtained from Nielsen retail scanners for five product types: (1) disposables, (2) rechargeables, (3) cartridge replacements, (4) e-liquid bottle refills, and (5) specialty vapor products. We examined dollar sales, volume, price, brand, and flavor. RESULTS: Adjusted national sales increased from $11.6 million in 2010 to $751.2 million in 2016. The annual rate of sales growth rapidly increased before slowing through 2015. The rate of growth spiked in 2016. Market share for menthol products and other assorted flavors increased from 20% in 2010 to 52.1% by 2016. NJOY's early market dominance shifted as tobacco industry brands entered the market and eventually captured 87.8% of share by 2016. Rechargeables and accompanying products comprised an increased proportion of total volume sold over time while disposable volume declined. Specialty vapor products appeared at retail in 2015. CONCLUSIONS: Findings show strong early growth in the ENDS retail market followed by considerable slowing over time, despite a slight uptick in 2016. Trends reflect shifts to flavored products, newer generation "open-system" devices, lower prices, and tobacco industry brands. This study provides a baseline against which to compare the impact of FDA's 2016 deeming rule and future actions on the ENDS marketplace. IMPLICATIONS: This study uses market scanner data from US retail outlets to describe trends in the ENDS retail market from 2010 to 2016, providing a baseline against which to compare the impact of FDA's 2016 deeming rule and future actions on the ENDS marketplace. Understanding historical market trends is valuable in assessing how future regulatory efforts and advances in ENDS technology may impact industry response and consumer uptake and use.
Impact of e-cigarette and cigarette prices on youth and young adult e-cigarette and cigarette behaviour: Evidence from a national longitudinal cohortCantrell, J., Huang, J., Greenberg, M. S., Xiao, H., Hair, E. C., & Vallone, D.
Journal titleTobacco control
Page(s)374-380Introduction Understanding the impact of prices for tobacco and nicotine products is critical for creating policies to prevent use among young people. This study examines the impact of electronic cigarette (e-cigarette) and cigarette prices on current e-cigarette and cigarette use among youth and young adults. Methods Data were from a national probability-based sample aged 15-21 collected in 2014 and followed every 6 months for 2.5 years through 2016. We conducted separate conditional likelihood logistic regression models with past 30-day e-cigarette use and past 30-day cigarette use outcomes on the sample of individuals who participated in at least two survey waves (n=11 578) with linked Nielsen market-level price data for rechargeable e-cigarettes and cigarettes. Models controlled for time-varying variables at the individual and state policy levels, and fixed effects at the individual, wave and market levels. Results Higher cigarette prices were associated with increased past 30-day e-cigarette use, indicating e-cigarettes may serve as a substitute for cigarettes. We did not find a statistically significant relationship between rechargeable e-cigarette prices and past 30-day e-cigarette use; neither did we find a significant relationship between rechargeable e-cigarette prices and past 30-day cigarette smoking. Conclusion This is the first study to examine e-cigarette and cigarette prices on e-cigarette and cigarette behaviour longitudinally among young people. Findings suggest the need for better measuring the costs associated with e-cigarette use among this population, as well as a careful assessment of price and tax policies that takes into account cross-product impact to sufficiently discourage e-cigarette and cigarette use among young people.
Sociodemographic disparities in the tobacco retail environment in Washington, DC: A spatial perspectiveAnesetti-Rotherme, A., Herman, P., Bennett, M., English, N., Cantrell, J., Schillo, B., Hair, E. C., & Vallone, D. M.
Journal titleEthnicity and Disease
Page(s)479-488Objective: Studies assessing sociodemographic disparities in the tobacco retail environment have relied heavily on non-spatial analytical techniques, resulting in potentially misleading conclusions. We utilized a spatial analytical framework to evaluate neighborhood sociodemographic disparities in the tobacco retail environment in Washington, DC (DC) and the DC metropolitan statistical area (DC MSA). Methods: Retail tobacco availability for DC (n=177) and DC MSA (n=1,428) census tract was assessed using adaptive-bandwidth kernel density estimation. Density surfaces were constructed from DC (n=743) and DC MSA (n=4,539) geocoded tobacco retailers. Sociodemographics were obtained from the 2011-2015 American Community Survey. Spearman's correlations between sociodemographics and retail density were computed to account for spatial autocorrelation. Bivariate and multivariate spatial lag models were fit to predict retail density. Results: DC and DC MSA neighborhoods with a higher percentage of Hispanics were positively correlated with retail density (rho = .3392, P = .0001 and rho = .1191, P = .0000, respectively). DC neighborhoods with a higher percentage of African Americans were negatively correlated with retail density (rho = -.3774, P = .0000). This pattern was not significant in DC MSA neighborhoods. Bivariate and multivariate spatial lag models found a significant inverse relationship between the percentage of African Americans and retail density (Beta = -.0133, P = .0181 and Beta = -.0165, P = .0307, respectively). Conclusions: Associations between neighborhood sociodemographics and retail density were significant, although findings regarding African Americans are inconsistent with previous findings. Future studies should analyze other geographic areas, and account for spatial autocorrelation within their analytic framework.
Examining differences in cigarette smoking prevalence among young adults across national surveillance surveysMesseri, P., Cantrell, J., Mowery, P., Bennett, M., Hair, E., & Vallone, D.
Journal titlePloS one
Issue12Accurate smoking prevalence data is critical for monitoring, surveillance, and evaluation. However, estimates of prevalence vary across surveys due to various factors. This study examines smoking prevalence estimates for 18–21 year olds across six U.S. national telephone, online and in-person surveys for the years 2013 and 2014. Estimates of ever smoking ranged from 35% to 55%. Current smoking ranged from 16% to 30%. Across the three modalities, household surveys were found to yield the highest estimates of smoking prevalence among 18 to 21 year olds while online surveys yielded the lowest estimates, and this was consistent when stratifying by gender and race/ethnicity. Assessments of the joint effect of gender, race/ethnicity, educational attainment and survey mode indicated that the relative differences in the likelihood of smoking were consistent across modes for gender and education groups. However, the relative likelihood of smoking among minority groups compared with non-Hispanic Whites varied across modes. Gender and racial/ethnic distributions for most surveys significantly differed from the U.S. Census. Over and underrepresentation of certain demographic subpopulations, variations in survey question wording, and social desirability effects may explain modality differences in smoking estimates observed in this study. Further research is needed to evaluate the effect of survey mode on variation in smoking prevalence estimates across national surveys, particularly for young adult populations.
A multidisciplinary approach to health campaign effectivenessRath, J. M., Greenberg, M., Ganz, O., Pitzer, L., Hair, E. C., Xiao, H., Cantrell, J., & Vallone, D.
Journal titleJournal of Public Health Research
Page(s)87-91Campaign costs are rising, making ad execution testing more critical to determine effectiveness prior to media spending. Premarket testing occurs prior to messages’ airing while in-market testing examines message attributes when messages are aired within a real-world setting, where context plays an important role in determining audience response. These types of ad testing provide critical feedback to help develop and deploy campaigns. Due to recent changes in media delivery platforms and audience tobacco use behavior, this study analyzes two nationally representative youth samples, aged 15-21, to examine if pre-market ad testing is an indicator of in-market ad performance for public health campaigns, which rely on persuasive messages to promote or reduce health behaviors rather than selling a product. Using data from the Truth® campaign, a national tobacco use prevention campaign targeted to youth and young adults, findings indicate strong associations between pre-market scores and in-market ad performance metrics.
Cost and threshold analysis of the finishit campaign to prevent youth smoking in the United StatesWeir, B. W., Cantrell, J., Holtgrave, D. R., Greenberg, M. S., Kennedy, R. D., Rath, J. M., Hair, E. C., & Vallone, D.
Journal titleInternational journal of environmental research and public health
Issue8In 2014, Truth Initiative launched the national FinishIt campaign to prevent smoking initiation among youth and young adults. The significant changes in the communications landscape requires further analysis to determine resource requirements for public education campaigns relative to their impact. This analysis estimates the cost of the FinishIt campaign based on data from expenditure records and uses published estimates of the lifetime treatment costs and quality-adjusted life years associated with smoking. The total cost of the FinishIt campaign for 2014–2016 was $162 million. Under assumptions associated with the pessimistic base-case (no medical care costs saved through prevention), 917 smoking careers would need to be averted for the campaign to be cost-effective. Assuming smoking leads to increased medical care costs, 7186 smoking careers would need to be averted for the campaign to be cost-saving. Given these thresholds (917 and 7186) and the estimate of the impact of the previous truth campaign, the investments in the Truth Initiative’s FinishIt campaign are likely warranted for preventing smoking careers among youth and young adults.
Effects of the truth FinishIt brand on tobacco outcomesEvans, W. D., Rath, J. M., Hair, E. C., Snider, J. W., Pitzer, L., Greenberg, M., Xiao, H., Cantrell, J., & Vallone, D.
Journal titlePreventive Medicine Reports
Page(s)6-11Since 2000, the truth campaign has grown as a social marketing brand. Back then, truth employed branding to compete directly with the tobacco industry. In 2014, the launch of truth FinishIt reflected changes in the brand's strategy, the tobacco control environment, and youth/young adult behavior. Building on a previous validation study, the current study examined brand equity in truth FinishIt, as measured by validated multi-dimensional scales, and tobacco related attitudes, beliefs, and behavior based on two waves of the Truth Longitudinal Cohort data from 2015 and 2016. A fixed effects logistic regression was used to estimate the change in brand equity between panel survey waves 3 and 4 on past 30-day smoking among ever and current smokers. Additional models determined the effects of brand equity predicting tobacco attitudes/use at follow up among the full sample. All analyses controlled for demographic factors. A one-point increase in the brand equity scale between the two waves was associated with a 66% greater chance of not smoking among ever smokers (OR 1.66, CI 1.11–2.48, p < 0.05) and an 80% greater chance of not smoking among current smokers (OR 1.80, CI 1.05–3.10, p < 0.05). Higher overall truth brand equity at wave 3 predicted less smoking at wave 4 and more positive anti-tobacco attitudes. Being male, younger, and non-white predicted some of the tobacco related attitudes. Future research should examine long-term effects of brand equity on tobacco use and how tobacco control can optimize the use of branding in campaigns.
Estimating the Pathways of an Antitobacco CampaignHair, E. C., Cantrell, J., Pitzer, L., Bennett, M. A., Romberg, A. R., Xiao, H., Rath, J. M., Halenar, M. J., & Vallone, D.
Journal titleJournal of Adolescent Health
Page(s)401-406Purpose: This study examined mechanisms through which the truth campaign, a national mass media antismoking campaign, influences smoking-related attitudes, and progression of tobacco use over time in youth and young adults. Methods: Structural equation modeling tested causal pathways derived from formative research and behavioral theory with a nationally representative longitudinal sample of 15–21-year-olds (n = 8747) over 24 months. Data were collected from 2014 to 2016, and analyses were conducted in 2017. Results: Greater ad awareness predicted strengthening of attitudes targeted by the campaign (i.e., feelings of independence from tobacco, antitobacco industry sentiment, decreasing acceptance of social smoking, and decreasing acceptance of smoking imagery), and attitude changes were significantly associated with greater support for an antitobacco social movement (e.g., agreement to the item “I would be part of a movement to end smoking”). Greater social movement support predicted a slower rate of progression on smoking intensity after two years of the campaign. Conclusions: Findings suggest that engaging youth and young adults in a cause-based social movement for promoting health can be a powerful strategy to drive positive behavior change. Messages targeting attitudes that resonate with values important to this age group, including independence and connectedness, are particularly effective. Investments in national antitobacco public education campaigns are key policy interventions which continue to help prevent tobacco use among youth and young adults.
Evidence of the impact of the truth finishit campaignVallone, D., Cantrell, J., Bennett, M., Smith, A. A., Rath, J. M., Xiao, H., Greenberg, M., & Hair, E. C.
Journal titleNicotine and Tobacco Research
Page(s)543-551Introduction: Over the past decade, public education mass media campaigns have been shown to be successful in changing tobacco-related attitudes, intentions, and behaviors among youth and young adults. In 2014, the national truth® campaign re-launched a new phase of the campaign targeted at a broad audience of youth and young adults, aged 15-21, to help end the tobacco epidemic. Methods: The study sample for this analysis is drawn from the Truth Longitudinal Cohort (TLC), a probability-based, nationally representative cohort designed to evaluate the relationship between awareness of truth media messages and changes in targeted attitudes, beliefs, and behaviors over time. The sample for this study was limited to those with data at baseline and three subsequent follow-up surveys (n = 7536). Results: Logistic regression models indicate that truth ad awareness is significantly associated with increases in targeted anti-tobacco attitudes as well as reduced intentions to smoke over time, holding constant baseline attitudes and intentions. Results also suggest a dose-response relationship in that higher levels of truth ad awareness were significantly associated with higher likelihood of reporting agreement across all five attitudinal constructs: anti-smoking imagery, anti-social smoking sentiment, anti-tobacco social movement, anti-tobacco industry sentiment, and independence. Conclusions: Longitudinal results indicate a significant dose-response relationship between awareness of the new phase of the truth campaign and campaign-targeted attitudes and intentions not to smoke among youth and young adults. Implications: Findings from this study confirm that a carefully designed anti-tobacco public education campaign aimed at youth and young adults is a key population-level intervention within the context of an expanding tobacco product landscape and a cluttered media environment. As tobacco use patterns shift and new products emerge, evidence-based public education campaigns can play a central role in helping the next generation to reject tobacco. Public education mass media campaigns are a key component to changing tobacco use attitudes and behavior, particularly among youth and young adults.
Examining perceptions about IQOS heated tobacco product: Consumer studies in Japan and SwitzerlandHair, E. C., Bennett, M., Sheen, E., Cantrell, J., Briggs, J., Fenn, Z., Willett, J. G., & Vallone, D.
Journal titleTobacco control
Page(s)s70-s73Objective To examine consumer perceptions, attitudes and behaviours regarding the heated tobacco product, IQOS, as well as to document the product's marketing strategies to determine its potential for appealing to youth and young adults. Method Truth Initiative, in collaboration with Flamingo, collected qualitative data via: (1) expert interviews, (2) semiotic analysis of IQOS packing and marketing materials, and (3) 12 focus groups with adults in Switzerland (ages 19-44 years; June 6-9, 2016) and Japan (ages 20-39 years; June 22-24, 2016) (n=68 for both groups). Results Expert interviews and IQOS packing and marketing analyses revealed the product is being marketed as a clean, chic and pure product, which resonated very well in Japan given the strong cultural values of order, cleanliness, quality and respect for others. Focus groups results indicated Japanese IQOS users used the product for socialising with non-smokers. Focus group participants in both Japan and Switzerland reported lower levels of satisfaction with the product relative to combustible cigarettes, although many found the product packaging to be appealing. While participants identified several benefits and barriers related to IQOS, few reported any potential health benefits of use compared with combustible tobacco products. Conclusion IQOS was marketed as a sophisticated, high tech and aspirational product. Because youth and young adults are more interested in such product positioning, this approach raises some concern about youth appeal. This research shows cultural factors appeared to affect the appeal of this messaging, indicating that prevalence and uptake data will likely not be similar from country to country.
It's getting late: improving completion rates in a hard-to-reach sampleCantrell, J., Bennett, M., Thomas, R. K., Rath, J. M., Hair, E. C., & Vallone, D.
Journal titleSurvey Practice
Patterns in first and daily cigarette initiation among youth and young adults from 2002 to 2015Cantrell, J., Bennett, M., Mowery, P., Xiao, H., Rath, J., Hair, E., & Vallone, D.
Journal titlePloS one
Issue8This study’s objective was to describe long-term trends and patterns in first cigarette use (cigarette initiation) and daily cigarette use (daily initiation) among youth and young adults in the U.S. We used cross-sectional survey data from the National Survey on Drug Use and Health, 2002–2015, to estimate annual incidence of first cigarette use (N = 270,556) and first daily cigarette use (N = 373,464) for each year by age groups, race/ethnicity and gender, examining trends over time and the average annual change in initiation for each group. Several clear patterns emerged: 1) cigarette initiation and daily initiation significantly decreased over time among those aged 12–14 and 15–17 and these trends were consistent among nearly all racial/ethnic and gender subgroups; 2) among 18–21 year olds, cigarette initiation sharply increased through 2009, surpassing rates among 15–17 year olds, and sharply declined through 2015 while remaining higher than rates among the younger group, and this trend was consistent for almost all racial/ethnic subgroups; 3) daily initiation for those aged 18–21 significantly declined, and this was significant among most subgroups 4) there was no change in cigarette initiation and daily initiation for 22–25 year olds overall and most subgroups; 5) there was a significant increase in cigarette initiation for 22–25 year old Hispanics males and daily initiation for 22–25 year old males. This study provides a comprehensive look at trends in cigarette and daily initiation among U.S. youth and young adults. Despite notable declines in smoking initiation among youth and young adult populations over the last two decades, targeted prevention and policy efforts are needed for subgroups at higher risk, including young adults and Hispanic males.
Recruiting and retaining youth and young adults: Challenges and opportunities in survey research for tobacco controlCantrell, J., Hair, E. C., Smith, A., Bennett, M., Rath, J. M., Thomas, R. K., Fahimi, M., Dennis, J. M., & Vallone, D.
Journal titleTobacco control
Page(s)147-154Introduction Evaluation studies of population-based tobacco control interventions often rely on large-scale survey data from numerous respondents across many geographic areas to provide evidence of their effectiveness. Significant challenges for survey research have emerged with the evolving communications landscape, particularly for surveying hard-to-reach populations such as youth and young adults. This study combines the comprehensive coverage of an address-based sampling (ABS) frame with the timeliness of online data collection to develop a nationally representative longitudinal cohort of young people aged 15-21. Methods We constructed an ABS frame, partially supplemented with auxiliary data, to recruit this hard-to-reach sample. Branded and tested mail-based recruitment materials were designed to bring respondents online for screening, consent and surveying. Once enrolled, respondents completed online surveys every 6 months via computer, tablet or smartphone. Numerous strategies were utilized to enhance retention and representativeness Results Results detail sample performance, representativeness and retention rates as well as device utilization trends for survey completion among youth and young adult respondents. Panel development efforts resulted in a large, nationally representative sample with high retention rates. Conclusions This study is among the first to employ this hybrid ABS-to-online methodology to recruit and retain youth and young adults in a probability-based online cohort panel. The approach is particularly valuable for conducting research among younger populations as it capitalizes on their increasing access to and comfort with digital communication. We discuss challenges and opportunities of panel recruitment and retention methods in an effort to provide valuable information for tobacco control researchers seeking to obtain representative, population-based samples of youth and young adults in the U.S. as well as across the globe.
Swisher Sweets a Artist Project': Using musical events to promote cigarsGanz, O., Rose, S. W., & Cantrell, J.
Journal titleTobacco control
Correlates of cigar use by type and flavor among U.S. young adults: 2011-2015Glasser, A. M., Johnson, A. L., Rose, S. W., Ganz, O., Cantrell, J., Delnevo, C. D., & Villanti, A. C.
Journal titleTobacco Regulatory Science
Harnessing Youth and Young Adult Culture: Improving the Reach and Engagement of the truth® CampaignHair, E., Pitzer, L., Bennett, M., Halenar, M., Rath, J., Cantrell, J., Dorrler, N., Asche, E., & Vallone, D.
Journal titleJournal of Health Communication
Page(s)568-575The national youth and young adult tobacco prevention mass media campaign, truth®, relaunched in 2014 with the goal of creating “the generation that ends smoking.” The objective of this study was to assess whether the strategy of airing truth ads during popular, culturally relevant televised events was associated with higher ad and brand awareness and increases in social media engagement. Awareness of six truth advertisements that aired during popular television events and self-reported social media engagement were assessed via cross-sectional online surveys of youth and young adults aged 15–21 years. Social engagement was also measured using separate Twitter and YouTube metrics. Logistic regression models predicted self-reported social engagement and any ad awareness, and a negative binomial regression predicted the total social media engagement across digital platforms. The study found that viewing a popular televised event was associated with higher odds of ad awareness and social engagement. The results also indicate that levels of social media engagement for an event period are greater than for a nonevent period. The findings demonstrate that premiering advertisements during a popular, culturally relevant televised event is associated with higher awareness of truth ads and increased social engagement related to the campaign, controlling for variables that might also influence the response to campaign messages.
Mobile marketing: An emerging strategy to promote electronic nicotine delivery systemsCantrell, J., Ganz, O., Emelle, B., Moore, R., Rath, J., Hair, E. C., & Vallone, D.
Journal titleTobacco control
Progression to established patterns of cigarette smoking among young adultsHair, E., Bennett, M., Williams, V., Johnson, A., Rath, J., Cantrell, J., Villanti, A., Enders, C., & Vallone, D.
Journal titleDrug and alcohol dependence
Page(s)77-83Background As tobacco control policies have been implemented across the U.S. over the past decade, patterns of smoking cigarettes have significantly changed, particularly among young adults. For many users, the typical daily use pattern of smoking several packs of cigarettes per day has been supplanted by a variety of use patterns, often referred to as light, intermittent, and occasional smoking. Methods The aim of this study was to examine progression to established smoking patterns among a nationally representative, longitudinal sample of young adults (n = 9791). Using repeated measures latent class techniques (RMLCA), we modeled the distribution of cigarette smoking intensity over time and latent class categories. Results Findings demonstrate that young adults fall into three discrete classes that reflect probabilities for never to low use, daily use, and variable cigarette use for progression to established use of cigarettes: 79.3% fall into the class of “never or ever users” of cigarettes (no current use of cigarettes), 11.3% fall into the class of “rapid escalators” or daily users of cigarettes, and 9.4% fall into the “dabbler” class. Smoking patterns were found to be stable by the age of 21. Conclusions Intervening prior to age 21 has the potential to disrupt progression to established smoking and reduce the long-term health consequences of smoking in this age group.
The effect of branding to promote healthy behavior: Reducing tobacco use among youth and young adultsVallone, D., Greenberg, M., Xiao, H., Bennett, M., Cantrell, J., Rath, J., & Hair, E.
Journal titleInternational journal of environmental research and public health
Issue12Policy interventions such as public health mass media campaigns disseminate messages in order to improve health-related knowledge, attitudes, beliefs and behaviors at the population level. Only more recently have campaigns that promote health-related behaviors adopted branding, a well-established marketing strategy, to influence how consumers think and feel about a message. This study examines whether positive brand equity for the national truth® campaign is associated with lower likelihood of cigarette use over time using the nationally representative Truth Longitudinal Cohort of youth and young adults, aged 15-21. Logistic regression models were used to examine the relationship between brand equity and the likelihood of reporting past 30-day smoking over a 12-month period. Respondents who reported positive brand equity were significantly less likely to report past 30-day smoking 12 months later (OR = 0.66, p < 0.05), controlling for covariates known to influence tobacco use behavior. Findings also translate the effect size difference to a population estimate of more than 300,000 youth and young adults having been prevented from current smoking over the course of a year. Building brand equity is a strategic process for health promotion campaigns, not only to improve message recall and salience but also to influence behavioral outcomes.
The Relationship between Advertising-Induced Anger and Self-efficacy on Persuasive Outcomes: A Test of the Anger Activism Model Using the Truth CampaignIlakkuvan, V., Turner, M. M., Cantrell, J., Hair, E., & Vallone, D.
Journal titleFamily and Community Health
Page(s)72-80Turner's Anger Activism Model (AAM) contends anger and efficacy interact in a unique way to determine message responses to campaign materials. This study tested the AAM using responses to 2 truth antismoking advertisements collected in August-October 2014 via an online, cross-sectional survey of 15- to 21-year-olds. Those aware of each of the truth advertisements (n = 319 for each) were organized into 4 anger/efficacy groups. Analysis of variance and regressions were conducted to understand group differences in message-related cognitions (persuasiveness, receptivity, conversation). Message cognitions were highest among the high anger/high efficacy group and lowest among the low anger/low efficacy group.
Trajectories of hookah use: Harm perceptions from youth to young adulthoodHair, E., Rath, J. M., Pitzer, L., Emelle, B., Ganz, O., Halenar, M. J., Cantrell, J., & Vallone, D.
Journal titleAmerican Journal of Health Behavior
Page(s)240-247Objectives: Hookah use has increased in United States, especially among young adults. This study investigates the role of harm perceptions of hookah use over a 2-year period in a nationally representative sample of youth and young adults as they transition to young adulthood. Methods: Using a probability-based, nationally representative, longitudinal cohort of youth aged 15-21, we analyzed the 7536 participants who completed all 4 waves. Ordered logit growth models examined changes over time in hookah use, and whether that relationship varies by baseline harm perceptions. Results: Results show that age, sex, parental education, race, and smoking status are significant predictors of hookah use. Additionally, those who perceive hookah as "less harmful" than cigarettes have the highest probability of current hookah use over time, compared to those with more accurate harm perceptions. Conclusions: This study helps confirm the influence of harm perceptions of hookah tobacco on hookah use among youth and young adults. Increased public education efforts aimed at youth and young adults can help shift knowledge, attitudes and beliefs regarding the health consequences of hookah use.
Validity of a Subjective Financial Situation Measure to Assess Socioeconomic Status in US Young AdultsWilliams, V. F., Smith, A. A., Villanti, A. C., Rath, J. M., Hair, E. C., Cantrell, J., Teplitskaya, L., & Vallone, D. M.
Journal titleJournal of Public Health Management and Practice
Page(s)487-495Purpose: Young adulthood is an important period for preventing the establishment of negative health behaviors that can influence trajectories to chronic disease and early death. Given the evolving nature of educational attainment and income variation during this developmental period, identifying indicators of socioeconomic status (SES) remains a challenge. This study examines measures of subjective and objective indicators of SES to predict health risk for young adults. Methods: This study uses data from the Truth Initiative Young Adult Cohort Study from respondents aged 18 to 34 years who completed 3 consecutive surveys between June 2011 and August 2012 (n = 2182). Analyses were conducted to compare a measure of subjective financial situation (SFS) to commonly used SES measures for adults and adolescents. Age-stratified, multivariable logistic regression was used to model the relationship between 5 SES indicators (SFS, household income, respondent education, parental education, and subjective childhood financial situation) and dichotomized versions of 3 health status measures (body mass index, self-reported health status, and quality of life), controlling for gender, race/ethnicity, and region. Results: Findings indicate that SFS is associated with other commonly used SES measures. Prospective associations with health outcomes revealed that SFS is a stronger predictor of health outcomes among young adults aged 18 to 24 years as compared with other SES measures. Conclusion: This study provides evidence that subjective financial situation may be more robust than traditional SES indicators in predicting health outcomes among young adults, particularly for 18- to 24-year-olds, and should be considered a viable candidate measure for assessing SES among this age group.
Agents of social change: A model for targeting and engaging generation Z across platforms: How a nonprofit rebuilt an advertising campaign to curb smoking by teens and young adultsVallone, D., Smith, A., Kenney, T., Greenberg, M., Hair, E., Cantrell, J., Rath, J., & Koval, R.
Journal titleJournal of Advertising Research
Page(s)414-425The Truth Initiative strives to protect a new generation of youths who are prime prospects for the tobacco industry, by engaging that audience and reigniting their interest. The current authors oversaw a three-phase study that included recruiting a national cohort sample-believed to be the first of its kind-of more than 10,000 members of Generation Z, ages 15 to 21 years old. The authors’ methods informed a new cross-platform campaign that fueled brand awareness and prompted changes in attitudes against smoking, while generating $88.6 million in earned media value with 78.5 million earned media impressions.
American spirit pack descriptors and perceptions of harm: A crowdsourced comparison of modified packsPearson, J. L., Richardson, A., Feirman, S. P., Villanti, A. C., Cantrell, J., Cohn, A., Tacelosky, M., & Kirchner, T. R.
Journal titleNicotine and Tobacco Research
Page(s)1749-1756Introduction: In 2015, the Food and Drug Administration issued warnings to three tobacco manufacturers who label their cigarettes as "additive-free" and/or "natural" on the grounds that they make unauthorized reduced risk claims. The goal of this study was to examine US adults' perceptions of three American Spirit (AS) pack descriptors ("Made with Organic Tobacco," "100% Additive-Free," and "100% US Grown Tobacco") to assess if they communicate reduced risk. Methods: In September 2012, three cross-sectional surveys were posted on Amazon Mechanical Turk. Adult participants evaluated the relative harm of a Marlboro Red pack versus three different AS packs with the descriptors "Made with Organic Tobacco," "100% Additive-Free," or "100% US Grown Tobacco" (Survey 1; n = 461); a Marlboro Red pack versus these AS packs modified to exclude descriptors (Survey 2; n = 857); and unmodified versus modified AS pack images (Survey 3; n = 1001). Results: The majority of Survey 1 participants rated the unmodified AS packs as less harmful than the Marlboro Red pack; 35.4%-58.8% of Survey 2 participants also rated the modified (no claims) packs as less harmful than Marlboro Red. In these surveys, prior use of AS cigarettes was associated with reduced perceptions of risk (adjusted odds ratio [AOR] 1.59-2.40). "Made with Organic Tobacco" and "100% Additive-Free" were associated with reduced perceptions of risk when comparing the modified versus the unmodified AS packs (Survey 3). Conclusions: Data suggest that these AS pack descriptors communicate reduced harm messages to consumers. Findings have implications for regulatory actions related to product labeling and packaging. Implications: These findings provide additional evidence that the "Made with Organic Tobacco," "100% Additive-Free," and "100% US Grown" descriptors, as well as other aspects of the AS pack design, communicate reduced harm to non-, current, and former smokers. Additionally, they provide support for the importance of FDA's 2015 warning to Santa Fe Natural Tobacco Company on "100% Additive Free" as an unauthorized modified risk claim.
Design and Feasibility Testing of the truth FinishIt Tobacco Countermarketing Brand Equity ScaleEvans, W. D., Rath, J., Pitzer, L., Hair, E. C., Snider, J., Cantrell, J., & Vallone, D.
Journal titleJournal of Health Communication
Page(s)800-808The original truth campaign was a branded, national smoking prevention mass media effort focused on at-risk youth ages 12–17. Today the truth brand focuses on the goal of finishing tobacco (truth FinishIt). There have been significant changes in the tobacco control landscape, leading FinishIt to focus on 15- to 21-year-olds. The present article reports on formative research and media monitoring data collected to pilot test a new truth FinishIt brand equity scale. The goals of this study were to (a) content analyze truth FinishIt mass media ads, (b) assess truth’s social media and followers’ perceptions of truth’s digital brand identity, and (c) develop and feasibility test a new version of the truth FinishIt brand equity scale using data from an existing Truth Initiative media monitoring study. Through factor analysis, we identified a brand equity scale, as in previous research, consisting of 4 main constructs: brand loyalty, leadership/satisfaction, personality, and awareness. Targeted truth attitudes and beliefs about social perceptions, acceptability, and industry-related beliefs were regressed on the higher order factor and each of the 4 individual brand equity factors. Ordinary least squares regression models generally showed associations in the expected directions (positive for anti-tobacco and negative for pro-tobacco) between targeted attitudes/beliefs and truth FinishIt brand equity. This study succeeded in developing and validating a new truth FinishIt brand equity scale. The scale may be a valuable metric for future campaign evaluation. Future studies should examine the effects of truth FinishIt brand equity on tobacco use behavioral outcomes over time.