In a press release issued last week, the American Legacy Foundation touted new research which it says demonstrates the effectiveness of its national "truth" campaign in reducing youth smoking initiation. The Foundation cited a new paper published in the International Journal of Environmental Research and Public Health. In addition, it cited three other recently-published papers: two in the American Journal of Preventive Medicine and one in Ethnicity and Health.
According to the press release: "A growing body of research continues to demonstrate the effectiveness of truth®, the nation’s largest youth smoking prevention campaign not directed by the tobacco industry. A recent study published in the online edition of the International Journal of Environmental Research and Public Health (IJERPH) found that the truth® campaign increased antismoking beliefs among teens, decreased their intent to smoke, and lowered the rates of teens starting to smoke."
The press release acknowledges that the "research was conducted by a team from RTI International, Columbia University and Legacy." No information is provided on who funded the study.
The American Legacy Foundation also touted the results from three other studies:
"'This is the fourth study to be released in the last few weeks that validates the truth® campaign’s efforts,' said Dr. Cheryl G. Healton, President and CEO of the American Legacy Foundation®. ... Last week, three other new research papers found that truth® remains highly effective as well as cost-efficient in its mission to prevent the youth of America from beginning to smoke:
The first paper found that truth® was directly responsible for keeping 450,000 teens from starting to smoke during its first four years.
A second study led by Johns Hopkins found that the campaign not only paid for itself in its first two years, but also saved between $1.9 and $5.4 billion in medical care costs to society. ...
A third paper appearing in the February issue of Ethnicity and Health showed that youth exposed to the truth® campaign were more likely to have anti-tobacco beliefs and attitudes."
No further information is provided on who conducted and funded these three other studies.
The Rest of the Story
The press release provides the impression that the research being reported is independent research which happens to confirm the effectiveness of the "truth" campaign. However, this is far from the "truth."
The IJERPH research, which Legacy acknowledges was conducted by a team from RTI International, Columbia, and Legacy, was funded by...
...the American Legacy Foundation!
Moreover, the researchers from RTI International and Columbia have a history of funding from the Legacy Foundation and in fact are Legacy-funded consultants. The author from Columbia University is not some sort of independent researcher, but is in fact a self-acknowledged "consultant for the American Legacy Foundation."
Thus, the American Legacy Foundation has failed to disclose that the research it touts as showing the effectiveness of its "truth" campaign was in fact funded by itself -- that is, by the American Legacy Foundation.
The press release provides no information on the authorship or funding of the other three studies, other than that the second study was "led by Johns Hopkins." This clearly gives the impression that these were independent studies.
However, once again, this is far from the truth.
The first paper, far from being independent, was written by authors who acknowledged that they "have received financial support from the American Legacy Foundation to conduct evaluation activities in support of the truth® campaign."
The second paper, far from being an independent paper from Johns Hopkins, was funded by the American Legacy Foundation and was co-authored by Dr. Cheryl Healton, the president and chief executive officer of the American Legacy Foundation. Researchers from Legacy participated in the study. In fact, other than one author from Johns Hopkins, the other three authors of the study were all from the American Legacy Foundation.
The third paper, far from being independent, was co-authored by a researcher from the American Legacy Foundation and was authored by a researcher at RTI who has received financial support from Legacy to conduct evaluation activities in support of the "truth" campaign.
To make matters worse, this is not the first time this has happened. Just a month ago, the American Legacy Foundation touted the results of the three previous studies, but failed to disclose that the first and third studies were not independent.
Here is what that press release said about the first study: "The first study, titled “The Influence of the National truth® Campaign on Smoking Initiation” was conducted by researchers at RTI International. Lead author Matthew Farrelly and his team found a direct correlation between the level of truth® advertising to which teens were exposed and a decrease in the amount of teens who began smoking. According to the study, “approximately 450,000 fewer adolescents and young adults initiated smoking as a result of the truth® campaign from 2000 to 2004.” The full results of the paper can be found at www.ajpm-online.net/current."
Note that the press release does not mention the fact that this paper was written by authors who acknowledged that they "have received financial support from the American Legacy Foundation to conduct evaluation activities in support of the truth® campaign."
Here is what the press release said about the third study: "In the third study, “The Impact of the 'Truth' Campaign on Beliefs, Attitudes, and Intent to Smoke by Race/Ethnicity,” researchers from RTI International set out to “examine racial/ethnic differences in the association between exposure to the 'truth' antismoking campaign and youth's beliefs and attitudes about cigarette companies and their intent to smoke.” Lead author AJ Cowell and his team write that the data from the research “indicates that exposure to the truth® campaign was positively associated with increased anti-tobacco beliefs and attitudes among youth overall.” The study underscores that different truth® campaign messages appealed to youth based on their race/ethnicity, an issue that should be considered when developing future campaigns to reach youth with behavior change messages."
Note that the press release does not mention the fact that this research was co-authored by the American Legacy Foundation. In fact, the press release is explicitly misleading if not inaccurate because it states that this study was conducted by researchers from RTI International. It omits the fact that Legacy also participated in the research. Unfortunately, this creates the appearance that Legacy is intentionally deceiving the public by hiding its role in this research and trying to create the appearance that this work is independent when in fact it is not.
The rest of the story is that the American Legacy Foundation is publicly touting research which it says demonstrates the effectiveness of the "truth" campaign and is implying that much of this research is independent, but is failing to disclose the truth: that this research is all non-independent, in that every single one of these studies was either conducted by the American Legacy Foundation, co-authored by the American Legacy Foundation, and/or authored by researchers who are Legacy consultants and have received funding from Legacy to conduct evaluations "in support" of the "truth" campaign.
The fact that in one of its press releases, Legacy disclosed authorship and funding information about one of the three studies mentioned and that in the other release, it disclosed authorship but not funding information on the fourth study makes it difficult to believe that the failure to reveal the truth about the non-independent nature of this research is a simple oversight. Instead, it creates the appearance that the American Legacy Foundation is trying to deceive the public into thinking that this research is at least somewhat independent when it truly is not independent at all.
While I want to make it clear that I support the "truth" campaign and I have in fact called for a major national legislative proposal (in lieu of the FDA tobacco legislation) that would provide funding for expansion of the national "truth" campaign as well as for similar campaigns in all 50 states, I do not support the failure to disclose the institutional affiliations and funding of research articles that evaluate the effectiveness of these campaigns.
There are two problems with this failed disclosure. One is strategic and the other is ethical.
The strategic problem is that by failing to disclose the non-independent nature of this research, the American Legacy Foundation is actually undermining the work. Why? Because when the public does discover that it has been deceived, it is going to assume that Legacy is trying to hide the truth for a reason. It is going to undermine the public's acceptance of the findings of the research. Strategically, the best approach is to be up front about the nature of the research and then once that is out of the way, it will not detract from the findings themselves.
The ethical problem is that I believe is it unethical to deceive the public into believing that research on the effectiveness of a public policy program is independent when in fact it is not. In fact, this is something which we criticize the tobacco industry for all the time. The tobacco industry has often used research that it has itself conducted, co-authored, or funded in order to create credibility for its scientific findings by deceiving the public into believing that these findings are independent ones. It seems hypocritical for tobacco control organizations to criticize the tobacco industry and then to use the same tactics themselves.
It is also unethical for an organization which prides itself upon exposing the "truth" and criticizing the tobacco companies for failing to reveal the truth to itself fail to disclose the truth. It actually undermines the very campaign which the American Legacy Foundation is trying to support with this research.
By the way, I should make it clear that I am not arguing here that there is anything wrong with a foundation conducting and/or funding research to evaluate its own programs. Ideally, there would be a truly independent evaluation of the program, but with a paucity of available funding, it is reasonable to expect that foundations will conduct and fund evaluations of their own programs. There's no problem with that.
The problem comes in failing to disclose, in public communications, that the research was in fact authored and/or funded by the foundation.
If we want the public to embrace a "truth" campaign, then we must first embrace the disclosure of the "truth" ourselves.