‘Truth’ ads, which crushed teen smoking, focus on opioids
This ad depicts a true story. It begins: A young man walks around his car, which is up on a jack. He says in voice-over: “I got some Oxy after I hurt my neck. First I took them to feel better. Then I kept taking them. I didn’t know they’d be this addictive. I didn’t know how far I’d go to get more.”
Here’s how far he’d go: He lies down under the car. Then he kicks out the jack.
You see the car fall, hear a crunch. “Joe S. from Maine broke his back to get more prescription opioids,” the screen says. And then a voice-over: “Opioid dependence can happen after just five days. Know the truth, spread the truth.”
A similar ad shows a woman taking off her seatbelt and deliberately crashing her car. In another, a man breaks his hand with a hammer. In another, a man slams his arm in a door. Together, those comprised the first national ad campaign in America aimed at preventing opioid misuse.
They came from the Truth Initiative, the organization that was behind truth ads that helped bring about one of the most important public health victories in American history: In 1996, 34 percent of high school seniors had smoked a cigarette in the previous month — the same as in 1975. But by 2019, less than 6 percent smoked.
Now truth ads are being focusing on opioid abuse. There’s a relationship: More than 70 percent of opioid users also smoke, and there is evidence that smoking can prime the brain for other addictions.
Can the strategy work again? Let’s look at what the group did right in its antismoking campaign.
Before the truth ads, antismoking ads for teenagers were created by public health experts who, not surprisingly, emphasized that cigarettes can kill you.
That threat works well to encourage adults to quit smoking. But it doesn’t prevent teens from starting. For many adolescents, the danger is a lure; they smoke to rebel against preachy adults. To them, the consequences are decades away, and teens are immortal.
In the 1990s, Florida and California hired advertising agencies that didn’t know about public health, but did know about selling to teens. They created ads to redirect teenage rebellion against the manipulations of the tobacco industry. Some examples:
One California advertisement portrayed
An ad shows a woman taking off her seatbelt and deliberately crashing her car. In another, a man breaks his hand with a hammer. In another, a man slams his arm in a door. Those comprised the first national ad campaign in America aimed at preventing opioid misuse.
tobacco executives in a smoke-filled room, cackling maniacally as they plot to replace 1,100 customers who quit smoking every day — “Actually, technically, they die,” one says.
Another ad showed rappers attacking Big Tobacco for targeting African-Americans with menthol cigarettes. It ended, “We used to pick it; now they want us to smoke it.”
In Florida, teenagers created ads for a campaign they named “truth.” One showed girls making prank phone calls to tobacco ad executives. “What is the lucky part about Lucky Strike cigarettes?” a girl asks. “It is because (pause) I might live?”
That was in 1998. Over the next two years, teen smoking in Florida fell by 17.5 percent.
Of course, truth ads were only one part of this victory. States and cities raised their cigarette taxes. Indoor smoking vanished. But the ads were crucial.
All this is useful for anti-opioid campaigns. “There’s a lot of crossover in terms of strategy for reaching your target audience of youth,” said Matthew Farrelly, senior director of the Center for Health Policy Science and Tobacco Research at RTI International in North Carolina. “The variety of tactics for getting in front of teens is nearly identical.”
Surveys about the truth ads show that 80 percent of teenagers recognize the brand. And the organization knows what works. A review of published studies in 2014 concluded, “Youth are more likely to recall and think about advertising that includes personal testimonials; a surprising narrative; and intense images, sound and editing.” That’s Joe S. from Maine, all right.
Anti-opioid ads can use the antismoking template, but the message must be different. “Nobody needs education on the fact that tobacco is really bad for you,” said Robin Koval, president and chief executive of the Truth Initiative. “With opioids, we found out how little people know.”
Adolescents know about the misery of addiction — and addiction and overdose at 20 are scary in a way lung cancer at 60 is not. “But there is a lack of understanding and awareness of how easily you can become addicted,” Koval said.
“The hardest thing to go up against is nobody believes they’re going to become addicted to opioids,” Koval said. “We had to reverse this notion of otherness. And we have to combat the stigma that says: This is a moral failing and therefore I can’t believe it would happen to me or anybody we know.”
The Joe S. ad is part of a campaign that began in July 2018, in collaboration with the White House Office of National Drug Control Policy and the Ad Council. Facebook, Google, Turner, Amazon and Vice donated advertising time or space.
Last year, a truth video titled “Treatment Box: Rebekkah’s Story,” won an Emmy. In it, Rebekkah, then 26, started using opioids at 14 after a cheerleading injury. The ad showed her detoxing — minute by minute. The video was projected into a clear glass bedroom-size box in Times Square. Passers-by watched Rebekkah’s pain.
A new ad series, “Best Day,” has a relatable “it could be you” message, said Margie Skeer, associate professor at Tufts University School of Medicine. It’s graduation day, or signing day for college sports, or a basketball awards assembly — but the happy teens explain that on their best day, they see their futures as bleak: that the pain of adult stress or a sports injury will lead them to opioids, then addiction, and finally to overdosing. “My mom will bury me with my cleats,” one girl says.
It’s too soon to know if these ads reduce youth opioid misuse. A test of the Joe S.-style ads found that people who saw them were significantly more likely to agree that someone like them could become dependent on prescription opioids.
“It’s maybe not quite as elaborate and creative as the truth campaign,” said Dr. Farrelly. “But if their goal is to raise awareness of risk, it might not be a bad strategy.”