United States Government Accountability Office

GAO Report to the Subcommittee on 

Transportation, Treasury, the Judiciary, 

Housing and Urban Development, and 

Related Agencies, Committee on 

Appropriations, U.S. Senate 

ONDCP MEDIA 

CAMPAIGN 

Contractor’s National 

Evaluation Did Not 

Find That the Youth 

Anti-Drug Media 

Campaign Was 

Effective in Reducing 

Youth Drug Use 

August 2006 

 

GAO-06-818 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

August 2006

ONDCP MEDIA CAMPAIGN 

Contractor’s National Evaluation Did Not 

Find That the Youth Anti-Drug Media 

Campaign Was Effective in Reducing 

Youth Drug Use 

Highlights of GAO-06-818, a report to the 

Chairman and Ranking Member,

Subcommittee on Transportation, Treasury, 

the Judiciary, Housing and Urban

Development, and Related Agencies, 

Committee on Appropriations, U.S. Senate 

Between 1998 and 2004, Congress 

appropriated over $1.2 billion to 

the Office of National Drug Control

Policy (ONDCP) for the National

Youth Anti-Drug Media Campaign.

The campaign aimed to prevent the

initiation of or curtail the use of 

drugs among the nation’s youth. In 

2005, Westat, Inc., completed a

multiyear national evaluation of the 

campaign. 

GAO has been mandated to review 

various aspects of the campaign, 

including Westat’s evaluation

which is the subject of this report. 

Applying generally accepted social

science research standards, GAO 

assessed (1) how Westat provided

credible support for its findings

and Westat’s findings about 

(2) attitudes, beliefs, and behaviors 

of youth and parents toward drug 

use and (3) youth self-reported 

drug use. 

What GAO Recommends

Given that Westat’s evaluation 

stated the campaign did not reduce

youth drug use nationally,

Congress should consider limiting 

appropriations for the campaign,

beginning in the 2007 fiscal year

budget until ONDCP provides 

credible evidence of a media 

campaign approach that effectively

prevents and curtails youth drug

use. ONDCP’s written comments 

on our report generally disagreed 

with the findings. Specifically, 

ONDCP does not believe the 

Westat findings reflect the 

campaign’s effectiveness. We 

believe the Westat study is sound. 

GAO’s review of Westat’s evaluation reports and associated documentation 

leads to the conclusion that the evaluation provides credible evidence that 

the campaign was not effective in reducing youth drug use, either during the 

entire period of the campaign or during the period from 2002 to 2004 when 

the campaign was redirected and focused on marijuana use. By collecting

longitudinal data—i.e., multiple observations on the same persons over 

time—using generally accepted and appropriate sampling and analytic

techniques, and establishing reliable methods for measuring campaign 

exposure, Westat was able to produce credible evidence to support its 

findings about the relationship between exposure to campaign 

advertisements and both drug use and intermediate outcomes. In particular, 

Westat was able to demonstrate that its sample was not biased despite 

sample coverage losses, maintained high follow-up response rates of 

sampled individuals to provide for robust longitudinal analysis, established 

measures of exposure that could detect changes in outcomes on the order of 

magnitude that ONDCP expected for the campaign and that could reliably 

measure outcomes, and used sophisticated statistical methods to isolate 

causal effects of the campaign. 

Westat’s findings on the effects of exposure on intermediate outcomes—

theorized precursors of drug use—were mixed. Specifically, although 

sampled youth and parents’ recall of campaign advertisements increased 

over time, they had good impressions of the advertisements, and they could 

identify the specific campaign messages, exposure to the advertisements 

generally did not lead youth to disapprove of using drugs and may have 

promoted perceptions among exposed youth that others’ drug use was 

normal. Parents’ exposure to the campaign led to changes in beliefs about 

talking about drug use with their children and the extent to which they had 

these conversations with their children. However, exposure did not appear 

to lead to increased monitoring of youth. Moreover, the evaluation was 

unable to demonstrate that changes in parental attitudes led to changes in 

youth attitudes or behaviors toward drug use. 

Westat’s evaluation indicates that exposure to the campaign did not prevent 

initiation of marijuana use and had no effect on curtailing current users’ 

marijuana use, despite youth recall of and favorable assessments of 

advertisements. Although general trend data derived from the Monitoring the 

Future survey and the Westat study show declines in the percentage of youth 

reportedly using marijuana from 2002 to 2004, the trend data do not 

explicitly take into account exposure to the campaign, and therefore, by 

themselves, cannot be used as evidence of effectiveness. In Westat’s 

evaluation of relationships between exposure and marijuana initiation the 

only significant finding was of small unfavorable effects of the campaign 

exposure on marijuana initiation during some periods of data collection and 

in some subgroups. 

www.gao.gov/cgi-bin/getrpt?GAO-06-818.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Laurie 

Ekstrand, (202) 512-8777, 

ekstrandl@gao.gov. 
Contents 

Letter 1

Results in Brief 5 

Background 8

Westat’s Evaluation Design, Use of Generally Accepted and

Appropriate Sampling and Analytic Techniques, and Reliable 

Methods for Measuring Campaign Exposure Produced Credible 

Evidence to Support Its Findings 22 

The Phase III Evaluation Provided Mixed Evidence of the 

Campaign’s Effectiveness on Intermediate Outcomes, but It 

Found No Effect of the Campaign on Parental Monitoring of 

Youth 32

The Phase III Evaluation Found No Significant Effects of Exposure 

to the Campaign on Youth Drug Use Outcomes Other than 

Limited Unfavorable Effects on Marijuana Initiation 37 

Conclusions 42

Matter for Congressional Consideration 44 

Agency Comments and Our Evaluation 44 

Appendix I Westat’s Methods for Addressing Evaluation

Implementation Issues 52 

Appendix II Comments from the Office of National Drug Control 

Policy 65 

Appendix III GAO Contacts and Staff Acknowledgments 72 

Tables 

Table 1: Appropriations for the National Youth Anti-Drug Media 

Campaign, Fiscal Years 1998 through 2006 10 

Table 2: NSPY Survey Rounds and Response Rates, Sampled and 

Surveyed Youth 56 

Figures 

Figure 1: Data Collection Rounds and Waves of the NSPY 15 

Page i GAO-06-818 Youth Anti-Drug Media Campaign
Abbreviations: 

CPS Current Population Survey 

GRP gross rating points 

MTF Monitoring the Future 

NIDA National Institute on Drug Abuse 

NIP National Immunization Program 

NIS National Immunization Survey of Children 

NLSY National Longitudinal Survey of Youth 

NSDUH National Survey on Drug Use and Health 

NRC National Research Council 

NSPY National Survey of Parents and Youth

OMB Office of Management and Budget 

ONDCP Office of National Drug Control Policy 

PART Performance Assessment Rating Tool

PATS Partnership for a Drug Free America’s Attitude Tracking Survey 

PDFA Partnership for a Drug Free America 

PME Performance Measures of Effectiveness 

YRBSS Youth Risk Behavior Surveillance System 

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This is a work of the U.S. government and is not subject to copyright protection in the 

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Page ii GAO-06-818 Youth Anti-Drug Media Campaign
United States Government Accountability Office

Washington, DC 20548 

August 25, 2006 

The Honorable Christopher Bond 

Chairman 

The Honorable Patty Murray 

Ranking Member 

Subcommittee on Transportation, Treasury, the Judiciary, 

Housing and Urban Development, and Related Agencies 

Committee on Appropriations 

United States Senate 

Congressionally mandated under the Treasury and General Government 

Appropriations Act of 1998,1

 the National Youth Anti-Drug Media 

Campaign had the primary goals of preventing the initiation of drug use—

particularly the use of entry-level drugs marijuana and inhalants—among 

the nation’s youth and stopping youth that have begun using drugs from 

continuing their use. Administered through the Office of National Drug 

Control Policy (ONDCP) and implemented in three phases, the campaign 

featured as its centerpiece a paid advertising effort in which campaign 

funds were used to purchase media time and space for advertisements that 

delivered anti-drug messages to the campaign’s target audience—youth 

aged 9 to 18 and their parents—through strategic placement of anti-drug 

advertisements on television and radio and in print media. In addition to 

the advertising, the campaign included community outreach, work with 

the entertainment industry to encourage the accurate depiction of the 

consequences of drug use, outreach to faith-based organizations, and work 

with youth organizations. The campaign’s first two phases, which ran from

January 1998 through the summer of 1999, were pilot phases that focused 

primarily on informing the planning and development for phase III and 

included a 12-city pilot (phase I) and nationwide advertising (phase II). 

Phases I and II aimed to increase public awareness of anti-drug messages. 

Phase III of the campaign, which began in mid-1999, continued the 

nationwide advertising campaign begun during phase II and integrated the 

advertising with outreach efforts. From fiscal year 1998 through fiscal year 

2006, Congress appropriated over $1.4 billion to support the campaign. For 

fiscal year 2007, the President’s budget requested $120 million for the 

campaign, an increase over the fiscal year 2006 appropriation, to purchase 

 1

Pub. L. No. 105-61, 111 Stat. 1272. 

Page 1 GAO-06-818 Youth Anti-Drug Media Campaign
additional media time and space to increase the reach and frequency of 

the campaign’s messages, which would restore appropriations to their 

fiscal year 2005 level. 

Congress first authorized funding for the campaign in fiscal year 1998 with 

the expectation that demonstrable changes in youth drug behaviors would 

be apparent within 3 years, and Congress required ONDCP to assess 

whether the campaign’s efforts have been effective in changing the drug 

use behaviors of America’s youth. ONDCP also indicated that it 

anticipated that it would take 2 to 3 years for the campaign to affect drug

use behavior, although ONDCP also indicated that it was with the 

implementation of phase III of the campaign, beginning in mid-1999, that 

ONDCP expected to see improvements in anti-drug attitudes that would 

lead to decreases in youth drug use within 3 years. We previously reported 

that ONDCP’s evaluations of the first two phases of the campaign 

produced inconclusive results because of various evaluation 

implementation problems and limitations of the analyses used to support 

findings about effects during these pilot phases.2

 In particular, we noted 

that the impact evaluations of phases I and II did not adequately gauge the 

overall level of anti-drug awareness generated by the campaign—the 

principal outcome measure for these two phases—and we identified site 

selection problems, unknown parent response rates, low school response 

rates, and data analysis issues contributing to the inconclusive results. 

To implement the phase III evaluation, ONDCP entered into an 

interagency agreement with the National Institute on Drug Abuse (NIDA), 

which in turn awarded contracts to Westat, Inc., through June 2005 for 

$42.7 million to conduct the evaluation. Westat subcontracted with the 

Annenberg School for Communication at the University of Pennsylvania,

and staff from Westat and Annenberg were coprincipal investigators for 

 2

See: GAO, Anti-Drug Media Campaign: ONDCP Met Most Mandates, but Evaluations of 

Impact Are Inconclusive, GAO/GGD/HEHS-00-153 (Washington, D.C.: July 31, 2000). We

also reported on ONDCP’s use of consultants in the campaign in GAO, Anti-Drug Media 

Campaign: An Array of Services Was Provided, but Most Funds Were Committed to 

Buying Media Time and Space, GAO-05-175 (Washington, D.C.: Mar. 31, 2005). We also 

described the phase III evaluation in GAO, Program Evaluation: Strategies for Assessing 

How Information Dissemination Contributes to Agency Goals, GAO-02-923 (Washington,

D.C.: Sept. 30, 2002). 

Page 2 GAO-06-818 Youth Anti-Drug Media Campaign
the study.3

 Westat’s phase III evaluation covered the period from

September 1999 through June 2004 and studied the impact of the 

effectiveness of the nationwide campaign in reaching its target audience; 

affecting youth beliefs, attitudes, intentions, and behaviors with regard to

drug use; and affecting their parents’ beliefs and attitudes toward drug use 

and affecting parents’ behaviors associated with interacting with their 

children and monitoring their activities. 

Westat evaluated the campaign using a longitudinal panel survey—the 

National Survey of Parents and Youth (NSPY)—that aimed to measure the 

campaign’s effectiveness by assessing changes in various outcomes within 

individuals over time in relation to their exposure to campaign messages. 

Westat’s evaluation assessed the effect of exposure to the campaign on 

youth drug use and on several key intermediate outcomes—such as youth

and parent attitudes toward and beliefs about drug use and parental 

involvement with their children—that were believed to influence youth

drug use. In conducting the evaluation, Westat submitted several interim 

reports that were used in part to inform decisions about the direction of 

the campaign. Westat submitted a draft of the final evaluation report to 

NIDA in February 2005.4

 

Both Congress and ONDCP recognized the need for a separate evaluation 

of the campaign, because of limitations associated with existing national

surveys of drug use. Congressional conferees acknowledged their 

intention to rely on the evaluation to gauge the impact of the campaign, 

and also indicated that if the campaign failed to show its effectiveness, 

they would be compelled to reevaluate the use of taxpayer money to 

support it. ONDCP acknowledged that existing national surveys of drug 

use would not be able to answer the critical question of whether changes 

in drug use behavior and attitudes were the result of the campaign. These 

surveys do not ask respondents about their exposure and reactions to the 

messages of the campaign that can then be linked to their drug-related 

attitudes and behavior. For example, in a 2001 report on youth drug use 

and the campaign, ONDCP officials noted that while national surveys of 

 3

Hereafter, we refer to the contractor as “Westat,” and this implicitly includes Annenberg.

In addition, a second subcontractor, the National Development and Research Institutes, 

Inc., provided expertise in developing drug use questions and assisted in preparing the first 

special topics report on trends in drug use. 

4

Westat and Annenberg jointly submitted to NIDA all evaluation reports except for the final

report, which was submitted by Westat only. 

Page 3 GAO-06-818 Youth Anti-Drug Media Campaign
youth drug use showed flattening or declining youth marijuana use in 1999 

and 2000 and these trends suggested that the campaign may be having the 

desired impact, it was necessary to await the results of the campaign’s 

independent evaluation before drawing any definitive conclusions 

regarding the campaign’s contribution to changes in youth drug use. 

In a committee report for the fiscal year 2004 appropriations cycle, the 

Senate Appropriations Committee directed us to review how consultants 

were used in support of the media campaign. 5 This is the second of two 

reports responding to this mandate.6

 The first report provided information 

concerning ONDCP’s use of consultants in the campaign.This second 

report addresses three questions related to Westat’s evaluation of phase III 

of the media campaign: (1) How did Westat ensure that it could report 

credible results in its evaluation of the campaign? (2) What did the 

evaluation find about the effect of exposure to the campaign on key 

intermediate outcomes that were intended to lower youth drug use? 

(3) What did the evaluation find about the effect of exposure to the 

campaign on youth drug use? 

In addressing our objectives, a team of GAO social scientists reviewed and 

assessed materials related to Westat’s phase III evaluation, applying 

generally accepted social science research standards, including such 

elements as when and how the sample data were collected, adjustments 

made to the sample to address nonresponse, how program effects were 

isolated (i.e., the use of statistical controls), and the appropriateness of 

outcome measures. The materials reviewed included interim and final 

evaluation reports, documentation and analyses provided by Westat to us 

in response to several sets of questions that we submitted about the details 

of its methodology, documentation pertaining to meetings of scientific 

panels that provided guidance on the evaluation, and documentation 

prepared by ONDCP about the design and implementation of the 

campaign. We conducted our work in accordance with generally accepted 

government auditing standards from October 2005 through June 2006. 

 5

Senate Report No. 108-146, at 143 (2003). 

6

See GAO-05-175 for our review of ONDCP’s use of consultants in the campaign. 

Page 4 GAO-06-818 Youth Anti-Drug Media Campaign
By collecting longitudinal data—i.e., multiple observations on the same 

persons over time—using generally accepted and appropriate sampling 

and analytic techniques, and establishing reliable methods for measuring 

campaign exposure, Westat was able to produce credible evidence to 

support its findings about the relationship between exposure to campaign 

advertisements and both drug use and intermediate outcomes. In 

implementing the study, Westat encountered problems that are common to 

large-scale longitudinal studies, and it addressed those using methods that 

are generally recognized as appropriate approaches for the study 

implementation challenges Westat faced. Challenges that Westat 

encountered were (1) lack of baseline data, which precluded Westat from 

comparing postprogram outcomes to preprogram conditions, and the 

redirection of the campaign; (2) sampling concerns, particularly ensuring 

the coverage of eligible households with youth in the targeted age range 

and ensuring that attrition over successive survey cycles did not result in 

insufficient sample size to detect campaign effects or in systematic bias 

within the sample; (3) establishing measures that would allow for both the 

sufficient detection of and the reliable measurement of exposure to the 

campaign on NSPY survey respondents; and (4) disentangling causal 

effects of exposure and drawing meaningful comparisons in the absence 

of ability to employ an experimental design where NSPY respondents 

would have been randomly assigned to various levels of exposure— 

the generally preferred approach for assessing program effects, where 

possible. Our examination of Westat’s evaluation report and related 

documentation leads us to conclude that it addressed each of these 

challenges sufficiently to allow it to report credible findings about the 

effect of campaign exposure on drug use and intermediate variables 

believed to be precursors to drug use. Specifically, (1) several factors 

suggest that the lack of baseline data was not fatal to the evaluation’s 

findings, and Westat was able to generate statistically significant findings 

related to the redirected campaign; (2) Westat found no evidence of bias in 

the NSPY estimates despite sample coverage losses, and it also maintained

high follow-up response rates of sampled individuals to provide for robust 

longitudinal analysis; (3) the NSPY sample could be used to detect 

changes in outcomes that were on the order of magnitude of changes that

ONDCP expected for the campaign, and Westat demonstrated that its 

measures of exposure were valid and could reliably predict outcomes, 

whether results of the associations between exposure and outcomes were 

favorable or unfavorable to the campaign; and (4) using sophisticated 

statistical methods, Westat matched respondents on their underlying 

propensity to be exposed to campaign advertisements and, by comparing 

differences in outcomes among groups with different levels of exposure 

Results in Brief 

Page 5 GAO-06-818 Youth Anti-Drug Media Campaign
resulting from its matching methods, isolated the effects of the campaign 

from other variables. (See appendix I for further details.) 

For intermediate outcome measures thought to influence the ultimate 

target of the campaign, youth drug use—for example, recall and 

identification of campaign messages, youth anti-drug attitudes, and 

parents’ beliefs and behaviors—Westat found favorable effects for some 

measures and subgroups, as well as unfavorable effects and no significant

effects for others. In general, both youth and parents’ recall of specific 

campaign messages increased over the life of the campaign. In addition, 

NSPY trend data showed some increasing trends in anti-drug attitudes and 

beliefs as well as the proportion of youth who reported never intending to 

try marijuana. However, cross-sectional and longitudinal analysis provided 

no evidence that these trends resulted from campaign exposure. Westat’s 

analysis also indicated that among current, non-drug-using youth, 

exposure to the campaign had unfavorable effects on their anti-drug 

norms and perceptions of other youths’ use of marijuana—that is, greater

exposure to the campaign was associated with weaker anti-drug norms 

and increases in the perceptions that others use marijuana. Data for 

parents in the NSPY on five intermediate measures show some favorable 

effects of campaign exposure on parents’ behaviors and beliefs. However, 

for a major aim of the campaign, affecting parental behaviors regarding 

monitoring their children’s whereabouts, activities, and friends, Westat 

found no evidence of a significant effect. Moreover, where the data 

showed favorable relationships between campaign exposure and parental

beliefs and behaviors, Westat did not find that these effects on parents 

ultimately lead to corresponding changes in their children’s beliefs and 

behaviors. 

Westat’s evaluation found no significant favorable effects of campaign 

exposure on marijuana initiation among non-drug-using youth or cessation 

and declining use among prior marijuana users. Westat’s NSPY data did 

show some declining trends in self-reported lifetime and past-month use of 

marijuana by youth over the period from 2002 to 2004 and declining trends

in youth reports of offers to use marijuana. Declining drug use trends in 

the NSPY were consistent with trends in other national surveys of drug use 

over these years. However, Westat cautioned that because trends do not 

account for the relationship between campaign exposure and changes in 

self-reported drug use, trends alone should not be taken as definitive 

evidence that the campaign was responsible for the declines. ONDCP has 

also acknowledged the limitation of drug use trends for the purpose of 

demonstrating a causal link between campaign exposures and declines in

drug use trends. Westat’s analysis of the relationship between exposure to

Page 6 GAO-06-818 Youth Anti-Drug Media Campaign
campaign advertisements and youth self-reported drug use in the NSPY 

data for the entire period covered by its evaluation—assessments that 

used statistical methods to adjust for individual differences and control for 

other factors that could explain changes in self-reported drug use— 

showed no significant effects of exposure to the campaign on initiation of 

marijuana by prior nonusing youth. Westat’s analysis found significant 

unfavorable effects—that is, a relationship between campaign exposure 

and higher rates of initiation—during one round of NSPY data and for the 

whole period of the campaign among certain subgroups of the sample 

(e.g., 12 1⁄2- to 13-year-olds and girls). Westat found no effects of campaign 

exposure on rates of quitting or use by prior users of marijuana. 

In light of the fact that the phase III evaluation of the media campaign 

yielded no evidence of a positive outcome in relation to teen drug use and 

congressional conferees’ indications of their intentions to rely on the 

Westat study, Congress should consider limiting appropriations for the 

National Youth Anti-Drug Media Campaign beginning in the fiscal 2007 

budget year until ONDCP is able to provide credible evidence of the 

effectiveness of exposure to the campaign on youth drug use outcomes or 

provide other credible options for a media campaign approach. In this 

regard we believe that an independent evaluation of the new campaign 

should be considered as a means to help inform both ONDCP and 

Congressional decision making. 

We provided a draft of this report to the Director of ONDCP for comment.

In response, ONDCP provided written comments (reproduced in appendix

II), which stated that ONDCP was puzzled that we did not make 

recommendations to it about how to improve the campaign. However, the 

main purpose of our report was to assess Westat’s evaluation rather than 

to comment on how to improve the media campaign. In so doing, we 

focused on Westat’s methods. Our role was to inform Congress about the 

reliability of Westat’s evaluation so that Congress could decide the extent 

to which it will continue to fund the campaign. 

ONDCP expressed a number of concerns about our assessment of Westat’s 

evaluation and its implications concerning the effectiveness of the 

campaign. Most importantly, it stated that the Westat study is ill suited to 

assess impact and the study’s findings are of limited relevance. Our 

extensive review of the Westat study does not support ONDCP’s 

conclusion. Westat successfully addressed implementation challenges and 

used sophisticated analytic techniques to develop its findings. Another 

major issue ONDCP presents in its comments deals with the fact that the 

campaign has made major changes since the Westat data collection, 

Page 7 GAO-06-818 Youth Anti-Drug Media Campaign
rendering the study’s findings irrelevant. Neither we nor ONDCP has 

factual data upon which to base an assessment of the effectiveness of the 

current campaign. However, other major efforts to substantially change 

the campaign during the time frame of the Westat data collection did not 

yield positive results. ONDCP raised a number of other issues that are 

generally related to the issues discussed above. These are addressed in the 

Agency Comments and Our Evaluation section of this report. 

As part of the Treasury and General Government Appropriation Act of 

1998,

7

 the Drug Free Media Campaign Act of 1998 required, among other 

things, the Office of National Drug Control Policy to conduct a national 

media campaign for the purpose of reducing and preventing drug abuse 

among young people in the United States.8

 The National Youth Anti-Drug 

Media Campaign may be the most visible federal effort devoted to 

preventing drug use among the nation’s youth. It aims to educate and 

enable America’s youth to reject illegal drugs; to prevent youth from 

initiating use of drugs, especially marijuana and inhalants; and to convince 

occasional users of these and other drugs to stop using drugs. 

Administered by ONDCP, and implemented in three phases, the campaign 

has as its centerpiece a paid advertising effort in which campaign funds 

were used to purchase media time and space for advertisements that 

delivered anti-drug messages to the campaign’s target audiences—youth 

aged 9 to 18 and their parents and adult caregivers—through strategic 

placement of anti-drug advertisements on television and radio and in 

print media. 

Background 

The National Youth AntiDrug Media Campaign 

The campaign’s first two phases were pilot phases that had as their 

objectives developing advertising concepts, creating limited 

advertisements, testing public awareness of the advertisements in 

12 metropolitan areas, and eventually extending the pilot program 

nationwide. Phase III of the campaign, which began in mid-1999, continued 

the nationwide advertising campaign begun during phase II and integrated

 7

Pub. L. No. 105-61, 111 Stat. 1272. 

8

Drug Free Media Campaign Act of 1998, 21 U.S.C. § 1801 et. seq. 

Page 8 GAO-06-818 Youth Anti-Drug Media Campaign
the advertising with outreach efforts. In addition to the advertising, the 

fully integrated phase III campaign included community outreach, work 

with the entertainment and media industries to encourage the accurate 

depiction of the consequences of drug use, outreach to faith-based 

organizations, and work with youth organizations. 

During phase III, ONDCP had overall responsibility for developing and 

implementing the campaign, and to do so, it enlisted the support of 

nonprofit organizations, trade associations, private businesses, and federal 

agencies. Appropriated media campaign funds were to be used to cover 

the costs of actually making the advertisements as well as the costs for 

planning of purchase of media time and space. The campaign also 

included public outreach and specialized communications efforts. The 

purpose of public outreach and communications was to extend the reach

and influence of the campaign through nonadvertising forms of marketing 

communications. Examples of these nonadvertising forms of 

communication included submitting articles related to key campaign 

messages such as effective parenting or the effects of marijuana on teen 

health to newspapers and magazines; building partnerships and alliances,

for example, coordinating positive activities for teens with local schools 

and community groups; creating Web sites and exploring alternative media 

approaches; and entertainment industry outreach. 

According to the campaign’s communications strategy, youth aged 9 to 

18 were segmented into three school and age risk-level categories: late 

elementary school adolescents, aged 9 to 11; middle school children, aged 

11 to 13; high school youth, ages 14 to 18. The campaign originally targeted 

youth aged 9 to 18 with a focus on middle school age adolescents (roughly 

11-to 13-year-olds); its secondary focus was on high school-aged youth 

(approximately 14 to 18 years of age). In 2001, the campaign shifted its 

creative focus to 11- to 14-year-olds in order to more effectively reach 

youth at the time they are most at risk for trying drugs. In 2002, the

campaign altered its target age group to focus primarily on 14- to 

16-year-olds. For all age groups, the communications strategy identified 

the primary focus of the campaign as at-risk nonusers and occasional 

users of drugs. For all groups, it was designed to give consideration to 

differences arising from gender, race, ethnicity, and regional and 

population density factors. 

From fiscal year 1998 through fiscal year 2004, Congress appropriated 

$1.225 billion to support the campaign (table 1). 

Page 9 GAO-06-818 Youth Anti-Drug Media Campaign
Table 1: Appropriations for the National Youth Anti-Drug Media Campaign, Fiscal 

Years 1998 through 2006 

Fiscal year Final appropriations (in millions of dollars)

1998 $195

1999 $185

2000 $185

2001 $185

2002 $180

2003 $150

2004 $145

2005 $120

2006 $100

Total, 1998 through 2006 $1,445

Total, 1998 through 2005 $1,345

Total, 1998 through 2004 $1,225

Sources: Appropriations Acts from various years. 

Note: Appropriated amounts are prerescission amounts. For example, rescissions were 0.38 percent 

in fiscal year 2000, 0.22 percent in fiscal year 2001, 0.65 percent in fiscal year 2003, and 0.59 

percent in fiscal year 2004. 

For fiscal year 2007, the President’s budget requested $120 million for 

campaign activities. The 2007 request represents an increase of $21 million 

above the fiscal year 2006 budget authority. The additional resources were 

requested to help to purchase additional media time and space to increase 

the reach and frequency of the campaign’s messages. 

Planning and the 

Underlying Logic of the 

Campaign 

According to ONDCP, its planning for the campaign’s communications 

strategy included reviews of published studies on the etiology and 

prevention of adolescent drug use, drug prevention campaigns, other 

public health campaigns, and general consumer marketing campaigns 

targeting youth and their parents. ONDCP also supplemented its research 

evidence with an extensive expert consultation process that included 

input from over 200 experts in academia, civic and community 

organizations, government agencies, and the private sector. A campaign 

design expert panel that included experts in the fields of drug use and 

prevention, public health communication, advertising, market research, 

consumer marketing, and public policy met over a 4-day period during the 

fall of 1997 and played a key role in integrating diverse sources of 

Page 10 GAO-06-818 Youth Anti-Drug Media Campaign
information and guiding the development of the communications strategy

for the campaign. 

The planning process resulted in a statement of ONDCP’s communications 

strategy for the campaign, which described the premises of the campaign.

Among these were the following: First, that the media can influence 

people in a variety of ways, such as informing and alerting them to 

important developments and shaping subsequent actions; satisfying leisure 

time needs, thereby influencing individuals’ views and beliefs about the 

world; and stimulating interest in commercial goods and services, thereby 

influencing where and how people shop. Second, that media messages 

have more potential to reinforce rather than to alter existing attitudes and 

beliefs. Third, to the extent that youth attitudes, beliefs, and intentions 

toward drug use vary with their age, the potential of a media campaign to 

influence drug use may be directly related to the age of the youth. Fourth, 

the campaign had to be sustained over time and to have a significant 

media presence, and its central messages have to be repeated often and in

a variety of ways. Citing research showing that attitudinal and behavioral

change took time to occur, ONDCP reported that it expected to observe 

“improvements in anti-drug attitudes that would lead to decreases in youth 

drug use within three years” of the implementation of phase III of the 

campaign. Fifth, as parents and adult caregivers play a vital role in youth

drug use behaviors, and by also targeting parents, the campaign would aim 

to affect the nature of their interaction with their children, thereby 

strengthening their children’s capacity to resist using illicit drugs. 

The campaign focused on primary prevention—that is, preventing those 

who did not use drugs from starting to use drugs. According to ONDCP, a 

media campaign that focused on primary prevention targets the underlying

causes of drug use and therefore has the greatest potential to reduce the

scope of the problem over the long term. Further, a primary prevention 

campaign also has greater potential to affirm and reinforce anti-drug 

attitudes of nonusers than to persuade experienced users to change their

behaviors, and a primary prevention campaign would also, over time, 

lessen the need for drug treatment services. With a focus on young, nondrug-using adolescents, an expectation underlying the campaign’s 

potential success was that as these young, non-drug-using adolescents 

aged, the campaign’s messages would intervene, retard the development of 

more pro-drug attitudes, and enable adolescents to continue to maintain 

their preexisting anti-drug attitudes. By maintaining these attitudes, or 

preventing the development of pro-drug sentiments, the campaign would 

affect drug use rates by lowering the rate at which youth initiated drug 

use, particularly the use of marijuana or inhalants.

Page 11 GAO-06-818 Youth Anti-Drug Media Campaign
The campaign was designed to have a significant and sustained media 

presence. During planning, ONDCP acknowledged that the campaign 

would have to be sustained for a period of time sufficient to bring about a 

measurable change in the beliefs and behaviors of youth in the target 

audience. On the basis of the experiences of successful social marketing 

campaigns, ONDCP reported that it expected that changes in awareness or 

recall of the campaign would be detectable within a few months of the 

start of the campaign, that changes in perceptions and attitudes would be 

detectable within 1 to 2 years of the start of the campaign, and that 

changes in behavior would be detectable within 2 to 3 years.

Campaign Activities during 

Phase III 

From mid-1999, the start of phase III, through June 2004, the end of the 

phase III evaluation, campaign activities included extensive media 

dissemination of campaign messages to a national audience of youth and 

parents; an interactive media component, which involved using contentbased Web sites and Internet advertising; use of experienced individuals 

and organizations with expertise in marketing to teens, advertising and 

communications, behavior change, and drug prevention to inform the 

campaign strategy and implementation; use of multicultural initiatives that 

focused on sufficiently exposing campaign messages to African 

Americans, Asian Americans, Pacific Islanders, Hispanic Americans, 

American Indians, and Alaskan Natives; and the implementation of the 

integrated social marketing and public health communications campaign

through the creation of partnerships with civic, professional, and 

community groups and outreach to media, entertainment, and sports 

industries. Through the partner organizations, the campaign attempted to 

strengthen local anti-drug efforts, and through outreach, it encouraged the 

news media to run articles that conveyed campaign messages. Youth and 

parent exposure to campaign messages could come from the direct, paid 

and donated advertising or from content delivered by news media and

entertainment industries through the outreach efforts. Additional 

opportunities for exposure to anti-drug messages could be enhanced 

through personal involvement with organizations that became partners as

a result of campaign outreach or by interaction with the campaign’s Web 

site. Further, youth exposure to anti-drug messages could also occur 

through interactions with friends, peers, parents, or other adults that 

occurred directly from either campaign ads or outreach efforts. 

Page 12 GAO-06-818 Youth Anti-Drug Media Campaign
Campaign messages for both youth and their parents and caregivers were

to focus on common transitions—such as the transition from elementary 

to secondary school—and common situations—such as the amount of 

time spent in settings without adult supervision—that were believed to 

heighten adolescents’ vulnerability to drug use initiation. In addition, 

messages were to focus on altering mediating variables—such as beliefs 

and intentions—that were known to have a significant impact on 

adolescent drug use. Finally, campaign messages were designed to create 

a “brand identity” in the minds of target audience members and through 

brand identity position campaign messages as credible and important. 

Throughout phase III, themes such as parents as “The Anti-Drug” and the 

“My Anti-Drug” theme for youth were designed to promote identification 

and positive associations with the campaign’s messages. 

Campaign Themes and 

Messages 

While they evolved throughout the campaign, the central strategic 

messages or themes for youth focused on resistance skills and self-efficacy 

to refuse drugs, normative education and positive messages, negative 

consequences of drug use, and early intervention. Resistance skills and 

self-efficacy advertisements were designed to enhance the personal and 

social skills of youth that promote lifestyle choices and to help build 

youth’s confidence that they could resist drugs. Normative education 

themes attempted to instill the beliefs that most young people do not use 

drugs or convey messages that “cool people don’t use drugs,” while 

positive message themes reinforced the idea of positive uses of time as 

alternatives to illicit drugs. Negative consequences themes aimed to 

enhance youth perceptions that drug use is likely to lead to a variety of 

negatively valued consequences, such as loss of parental approval, 

reduced performance in school, and negative social, aspirational, and 

health effects. Negative consequences themes were the primary focus of 

the Marijuana Initiative, which was introduced during 2002. An early 

intervention theme sought to motivate youth to intervene with friends who 

they perceived as having problems with drugs or alcohol and tried to 

convince youth of their ability to take action and to give them the tools 

and skills they needed to intervene. 

For parents, the campaign’s themes included messages that every child, 

including their own, was at risk of doing drugs; that they can learn 

parenting skills to help them help their children avoid drugs; that they 

need to be aware of the harmful effects of drugs including marijuana and

inhalants; and, as part of the Early Intervention Initiative, that it was 

important that they intervene at the earliest possible opportunity in their 

child’s life if their child was using drugs or alcohol. 

Page 13 GAO-06-818 Youth Anti-Drug Media Campaign
ONDCP recognized the need for a separate evaluation of the campaign and 

for ongoing reporting of evaluation results. The need for a separate 

evaluation stemmed in part from the limitations of existing national 

surveys that monitor drug use, such as Monitoring the Future, which 

provides data on drug use by high school students, the National Household 

Survey on Drug Abuse,9

 and the Youth Risk Behavior Survey, which 

addresses health risk behaviors including drug use. These recurring 

surveys provide very little information with which to evaluate the impact

of the campaign, because they were not designed to evaluate it. As ONDCP 

has written, these surveys contain no questions about target audience 

exposure and response to the campaign, and as a result, any changes in 

attitudes, beliefs, and behaviors toward drug use could not be associated

directly with the campaign. By comparison, ONDCP acknowledged that it 

was using the Westat evaluation to assess the extent to which changes in 

anti-drug attitudes and beliefs or drug-using behavior can be attributed to

the campaign, as opposed to other socioeconomic factors. In addition, 

ONDCP indicated that for the campaign, data from Westat’s evaluation 

would enable ONDCP to assess whether the campaign is working. 

Design of the Evaluation, 

Interim Evaluation 

Reports, and Redirection 

of the Campaign 

The primary tool of the Westat evaluation was the National Survey of 

Parents and Youth. The NSPY is a longitudinal panel study of children and 

their parents’ exposure and response to the campaign. The NSPY was 

designed to collect initial and follow-up data from nationally 

representative samples of youth aged 9 to 18 and from the parents of these 

youth. The sample was designed to represent youth living in homes in the 

United States and their parents. Data collection began in November 1999 

and was conducted over four rounds—each of which was about 1 year 

apart from the next round—in nine waves of interviews. An interview 

wave refers to the fielding of a survey round to a specific subsample in the 

NSPY. An interview round refers to the completion of interviews with the

entire sample. Data for each of the nine waves were collected using a 

laptop computer and a combination of computer-assisted interview 

technologies. To collect sensitive data, audio computer-assisted selfinterview technology was used, allowing respondents to self-administer 

the questionnaire in total privacy. The final wave of data collection was 

completed in June 2004 (fig. 1). Eligible youth and parents were to be 

interviewed four times. 

 9

The survey is now known as the National Survey on Drug Use and Health. 

Page 14 GAO-06-818 Youth Anti-Drug Media Campaign
Figure 1: Data Collection Rounds and Waves of the NSPY 

Phase of data 

collection

Survey 

round 

Survey 

wave 

Data 

collection 

period 

Cohorts (groups) of youth and parents 

interviewed in specific survey waves 

Wave 1 11/99–5/00 Group A, 

recruitment interview 

Wave 2 17/00–12/00 Group B, 

recruitment interview 

Recruitment phase Round 1 

Wave 3 11/01–6/01 Group C,

recruitment interview 

Round 2 Wave 4 17/01–12/01 Group A,

first follow-up 

interview

Wave 5 11/02–6/02 Group B,

first follow-up 

interview

Group C, 

first follow-up 

interview

Round 3 Wave 6 17/02–12/02 Group A,

second follow-up 

interview

Wave 7 11/03–6/03 Group B,

second follow-up 

interview

Group C, 

second follow-up 

interview

Round 4 Wave 8 17/03 – 12/03 Group A, 

third follow-up 

interview

Follow-up phase 

Wave 9 11/04–6/04 Group B,

third follow-up 

interview

Group C, 

third follow-up 

interview

Source: Adopted from Westat, 2005, Vol. 2: Appendices. 

The evaluation aimed to assess whether exposure to the campaign 

affected the self-reported knowledge, attitudes, beliefs, and drug use of 

youth. Because the campaign reached out to all youth nationwide, the 

evaluators could not assess its effects using experimental methods, in 

which some subjects are randomly assigned to the intervention and others

are randomly assigned to control groups that were not exposed to the 

intervention. Westat’s evaluation was designed to take into account the 

variation in self-reported exposure to the campaign messages and to 

assess how this variation in exposure was correlated with outcomes that 

the campaign intended to affect. To attribute changes in drug use attitudes 

and behaviors to the campaign, the evaluation was designed to assess 

exposure to the campaign and to compare differences in outcomes for 

groups of persons that were exposed to varying levels of the campaign’s 

Page 15 GAO-06-818 Youth Anti-Drug Media Campaign
messages, and to use statistical controls to account for individual-level 

differences among survey respondents. 

Westat’s evaluation assessed youth self-reported drug use and 

intermediate outcomes—such as youth and parent attitudes and beliefs 

toward drug use and parental involvement with their children—that were 

believed to influence youth drug use. The evaluation of phase III 

addressed issues related to (1) whether the campaign was reaching its 

target populations, (2) whether the desired outcomes moved in favorable 

or unfavorable directions, (3) whether the campaign was influencing 

changes in the desired outcomes, and (4) what could be learned from the 

overall evaluation to support ongoing decision making for the campaign.

These issues led to the five major objectives for the evaluation: 

• to measure changes in drug-related knowledge, attitudes, beliefs, and 

behavior in youth and their parents; 

• to assess the relationship between changes in drug-related knowledge, 

attitudes, beliefs, and behavior and self-reported measures of media 

exposure, including the salience of the measures; 

• to assess the association between parents’ drug-related knowledge, 

attitudes, beliefs, and behavior and those of their children; 

• to assess changes in the association between parents’ drug-related 

knowledge, attitudes, beliefs, and behavior and those of their children 

that may be related to the campaign; and 

• to compare groups of people with high exposure to other groups with 

low exposure. 

Westat submitted semiannual and special topic reports to NIDA, as the 

findings from these interim evaluation reports were to be used to support 

ongoing decision making for the campaign. Westat submitted the first 

semiannual report in November 2000. By December 2003, Westat had 

submitted six additional reports, four of which were labeled as semiannual 

reports, and the other two included a special report on historical trends in

drug use and a 2003 report of findings.10 Westat submitted its first draft of 

its final report to NIDA in February 2005. 

In addition to Westat’s evaluation of the relationship between exposure 

and outcomes, Westat also prepared a report on the environmental 

 10All of these reports were submitted jointly by Westat and Annenberg. 

Page 16 GAO-06-818 Youth Anti-Drug Media Campaign
context of the campaign.

11 In May 2002, Westat reported findings from this 

qualitative study of views of representatives from major national 

organizations and state prevention coordinators about the messages 

conveyed by the campaign and the role of the campaign as an organizing 

partner in helping to bolster local substance abuse prevention efforts. 

According to Westat, representatives felt that the campaign’s messages 

reinforced their own messages that encouraged youth to find healthy 

alternatives to drug use and to raise public awareness of the issue of illicit

drugs among youth. Westat also reported that representatives were less 

enthusiastic about the role of the campaign as an organizational partner in 

helping with local substance abuse prevention efforts. 

In November 2002, Westat submitted its fifth semiannual report to NIDA. 

In it, Westat reported that it found little evidence that the campaign had 

direct, favorable effects on youth self-reported drug use between 2000 and 

2002. Specifically, Westat reported: 

“There is little evidence of direct favorable Campaign effects on youth. There is no 

statistically significant decline in marijuana use to date, and some evidence for an

increase in use from 2000 to 2001. Nor are there improvements in beliefs and 

attitudes about marijuana use between 2000 and the first half of 2002. Contrarily, 

there are some unfavorable trends in youth anti-marijuana beliefs. Also there is no 

tendency for those reporting more exposure to Campaign messages to hold more

desirable beliefs.”12

Westat further reported that there were unfavorable delayed effects of 

campaign exposure on subsequent intentions to use marijuana and on

other beliefs. By delayed effects, Westat referred to the relationship 

between exposure to the campaign measured in one survey round having

an effect on intentions or beliefs outcomes at a subsequent survey round.

For parents, Westat reported that the evidence was consistent with 

favorable campaign effects, as it found that there were favorable changes 

for three of five parents’ belief and behavior outcome measures. However, 

Westat also reported that it found no evidence for favorable indirect 

 11Westat, “Environmental Context of the National Youth Anti-Drug Media Campaign: 

Findings from In-Depth Discussions with Representatives of National Organizations and 

State Prevention Coordinators.” Report delivered to National Institute on Drug Abuse, 

National Institutes of Health, Rockville, Maryland, May 2002. 

12Hornik, Robert, et al. Evaluation of the National Youth Anti-Drug Media Campaign:

Fifth Semi-Annual Report of Findings, (Rockville, Maryland: Westat, November 2002), 

p. xi. 

Page 17 GAO-06-818 Youth Anti-Drug Media Campaign
effects on youth behavior as the result of their parents’ exposure to the 

campaign. 

Congressional appropriators expressed concerns about the findings of 

Westat’s fifth semiannual report. In the conference report for fiscal year 

2003 omnibus appropriations, the conferees reported that they were 

“deeply disturbed by the lack of evidence that the National Youth AntiDrug Media Campaign has had any appreciable impact on youth drug 

use.”13 The conferees further acknowledged that while the evaluation 

conducted under NIDA’s auspices showed “slight and sporadic impact on 

the attitudes of parents, it has had no significant impact on youth 

behavior.” The conferees further acknowledged that while other surveys 

of youth drug use—such as Monitoring the Future, a survey of high school 

youth—showed recent declines in drug use, “the NIDA study was 

undertaken to measure the specific impact of the Media Campaign, not 

simply to gauge general trends,” and the conferees stated that they “intend 

to rely on the scientifically rigorous NIDA study to gauge the ultimate 

impact of the campaign” and to reevaluate the use of taxpayer money to 

support the campaign if the campaign continued to fail to demonstrate its 

effectiveness. 

In 2002, the strategy for the campaign was redirected. In the spring, the 

target age group of the campaign became 14- to 16-year-olds—youth who 

have higher rates of marijuana initiation than younger youth—from its 

original targeting of 11- to 13-year-olds. The shift to teens in the 14- to 

16-year-old range aimed to allow the campaign to more effectively reach 

youth during the time at which they are most at risk for trying drugs. 

ONDCP also required more rigorous copy test procedures of all television 

advertisements before they were aired, and ONDCP increased its oversight 

in guiding the development and production of advertisements. In October 

2002, ONDCP launched a new initiative called the Marijuana Initiative. 

This initiative contained more focused advertising to address youth 

marijuana use. In a hearing before the House Committee on Government 

Reform, ONDCP announced that it would reverse the ratio of campaign 

advertising expenditures directed to adults and youth, respectively. 

Previously, about 60 percent of expenditures were directed to adults and 

40 percent toward youth. Finally, during February 2004, it expanded the 

campaign’s communications goals to include the Early Intervention 

Initiative. This intervention was targeted toward both parents and teen

 13Conference Report No. 108-10, at 1345 (2003). 

Page 18 GAO-06-818 Youth Anti-Drug Media Campaign
friends, and ONDCP intended to use parental and peer pressure to stop 

drug and alcohol use among teens. 

Assessment of the 

Campaign by the Office of 

Management and Budget 

and ONDCP’s Current 

Approach 

To strengthen the linkages between resources and performance 

envisioned in the Government Performance and Results Act of 1993 

(GPRA),

14 the Office of Management and Budget (OMB) developed the 

Program Assessment Rating Tool (PART) to bring performance 

information into the executive budget formulation process. PART is 

designed to determine the strengths and weaknesses of federal programs 

by drawing upon available program performance and evaluation data so 

that the federal government can achieve better results. The PART 

therefore looks at factors that affect and reflect program performance, 

including program purpose and design; performance measurement, 

evaluations, and strategic planning; program management; and program 

results. Because the PART includes a consistent series of analytical 

questions, it allows programs to show improvements over time and allows 

comparisons between similar programs. 

OMB’s PART rating of the campaign addressed issues related to its 

purpose and design, strategic planning, program management, and 

program results and accountability. OMB indicated that the purpose was 

clear—giving ONDCP a 100 percent score on this factor—and it rated the 

campaign’s planning and management with scores of 67 percent and 

70 percent, respectively. In its assessment of ONDCP’s strategic planning,

OMB noted that in response to its 2002 PART review, ONDCP revised the 

campaign’s logic model and significantly changed its long-term and annual 

performance measures. 

However, OMB’s assessment rating for the campaign was “results not 

demonstrated.” OMB indicated that its assessment of the campaign’s 

progress toward both the long-term goals and annual performance goals

will be reviewed against the results of the NIDA-managed evaluation. OMB 

noted that while there is no federal program closely comparable to the 

campaign, evaluations of other health behavior change efforts found shortterm effects after exposure to media. While acknowledging that a final

assessment of the effects of the campaign awaited the final report from the 

NIDA-managed evaluation, OMB also indicated that “outcome data from 

the evaluation suggest little or no direct positive effect on youth behavior 

 14Pub. L. No. 103-62, 107 Stat. 285 (1993). 

Page 19 GAO-06-818 Youth Anti-Drug Media Campaign
and attitudes attributable to the campaign to date. Perhaps some positive 

effect on parental attitudes/behavior but that has not yet translated into an

effect on youth.” 

ONDCP has credited the campaign, along with a variety of collective 

prevention efforts, with contributing to “significant success in reducing 

teen drug use, as evidenced by the 19 percent decline from 2001 to 2005.”

It has introduced a new youth brand approach to connect youth with 

aspiration themes. ONDCP also has indicated that while it awaits our 

formal assessment of the evaluation, that it will use existing national 

surveys to evaluate the campaign and suspend its request for proposals for 

a new evaluation contract. Specifically, ONDCP indicated that it would use 

the MTF survey to track improvements in perception of the risk of drug 

use—a predictor of lower drug use by youth—and it would use a special

analysis of the PATS survey—the Partnership for a Drug-Free America’s 

Attitude Tracking Survey—data on anti-drug messages. According to the 

2005 data from MTF, there were no significant 1-year declines in marijuana 

use for youth in any grade levels, and while gradual declines in the upper 

grades continued, declines halted for youth in the 8th grade. Additionally, 

for 8th graders, perceived risk of marijuana use held steady, while for 

youth in 10th and 12th grade, there was an increase in perceived risk of 

marijuana use. 

Recent Research on the 

Effects of the Campaign in 

Local Settings 

Two recently released studies have reported that exposure to the 

campaign was associated with changes in past-month marijuana use under 

certain conditions for certain groups of students exposed to the campaign.

In one of the studies,15 45 South Dakota high schools and their middleschool feeder(s) were randomly assigned to three groups: (1) a basic 

prevention curriculum, (2) a group given this curriculum with booster 

lessons, and (3) a control group. All schools were exposed to the 

campaign during the fall of 1999 and spring of 2000. This permitted the 

researchers to test for a synergistic effect between exposure to the 

campaign’s anti-drug messages and participation in the school-based drug

prevention curriculum. The sample of about 4,100 youth were asked how 

often they had seen anti-drug advertisements in recent months in five 

media outlets that were used by the campaign, and the researchers 

 15Longshore, Douglas, et al., “National Youth Anti-Drug Media Campaign and School-Based 

Drug Prevention: Evidence for a Synergistic Effect in ALERT Plus,” Addictive Behaviors, 

Vol. 31, (2006) pp. 496-508. 

Page 20 GAO-06-818 Youth Anti-Drug Media Campaign
measured exposure to the campaign that indicated whether or not the 

adolescents reported seeing ads at least one to three times per week in any 

of the five media outlets. Consistent with Westat’s fifth interim report, the 

evaluation of the South Dakota drug prevention curriculum found no 

direct effects of exposure to the campaign on its sample of adolescents’ 

use of illegal drugs. However, the evaluation also found that marijuana use 

in the past month was significantly less likely among adolescents who 

received both the curriculum with booster lessons and weekly exposure to 

the campaign’s messages. In other words, neither the enhanced curriculum 

nor the campaign alone had a substantial effect on marijuana use in the 

absence of the other. In addition, this evaluation’s measure of exposure 

was based on weekly exposure, suggesting that the synergistic effect of 

the campaign observed in these South Dakota schools was based on the 

delivery of repeated messages. 

The second study used monthly random samples of 100 youth from the 

enrollment lists of 4th to 8th graders in the public schools in the spring of 

1999 in two moderate-sized communities—Fayette County (Lexington), 

Kentucky, and Knox County (Knoxville), Tennessee—over 48 months from

April 1, 1999, through March 31, 2003.16 The study period included 

advertisements aired under the campaign’s Marijuana Initiative. Students 

in the samples aged over time and were 13 to 17 years of age at the 

beginning of the Marijuana Initiative. Youth in the samples were measured 

on marijuana use during the past 30 days, as well as on their attitudes 

toward marijuana. Exposure to television and radio advertisements was 

measured by self-reported past-month exposure. The study found that 

among high-sensation-seeking youth—that is, youth who desire novel, 

complex, and intense sensations and experiences and who are willing to 

take social risks to obtain them—exposure to the first 6 months of the 

campaign’s Marijuana Initiative led to reductions in marijuana use. The 

study’s authors reasoned that the effects that they found for the Marijuana 

Initiative were consistent with an approach termed SENTAR (for 

sensation-seeking targeting), in which high-sensation-seeking youth are 

targeted with high sensation value messages to prevent risky behaviors. 

 16Palmgreen, Philip, et al., “Effects of ONDCP’s Marijuana Initiative Campaign on High 

Sensation-Seeking Youth.” Paper presented to the American Public Health Association, 

Philadelphia, Pennsylvania, December 2005. 

Page 21 GAO-06-818 Youth Anti-Drug Media Campaign
Westat was able to produce credible evidence to support its findings about 

the relationship between exposure to campaign advertisements and both 

drug use and intermediate outcomes by employing a longitudinal panel 

design—i.e., collecting multiple observations on the same persons over 

time—using generally accepted and appropriate sampling and analytic

techniques and establishing reliable and sufficiently powerful measures of 

campaign exposure. Westat encountered various challenges and threats to 

validity that are commonly associated with large-scale longitudinal 

studies, including lack of an opportunity to use experimental methods, 

lack of baseline data, and changes in campaign focus that were not timed 

with data collection; issues with ensuring adequate sample coverage and 

controlling for sample attrition over time; establishing measures that were 

sufficient to detect and reliably measure campaign effects; and 

disentangling causal effects without being able to employ an experimental 

design where subjects would have been randomly assigned to different 

levels of exposure. Our review of Westat’s evaluation report and 

associated documentation leads us to conclude that the design and 

methodology used in its evaluation responded appropriately to these 

challenges, resulting in credible findings. 

The nationwide scope of the campaign precluded Westat from using 

experimental methods or obtaining baseline data, and the timing of the 

introduction of some new campaign initiatives limited some of the data 

available to evaluate them. However, Westat’s longitudinal panel survey 

design provided a framework for developing strong evidence of withinrespondent changes in outcomes over time as a result of exposure to the 

campaign. The consensus of a scientific panel convened by NIDA in 

August 2002 to review the evaluation was that Westat’s use of a national

probability sample to study change arising from the campaign was 

preferable as the “gold standard” to a study based on other alternatives, 

such as in-depth community-based studies of the mechanisms of change 

and campaign effects. Additionally, the theoretical underpinnings of 

behavioral change through advertising, along with statistically significant 

outcomes in some but not all groups, suggest that the absence of baseline 

data and introduction of new campaign initiatives did not invalidate the 

evaluation’s findings. Finally, despite the introduction of new campaign 

initiatives that were not timed with data collection cycles, Westat was able 

to assess change in the NSPY data and generate statistically significant 

findings using these data. 

Westat’s Evaluation 

Design, Use of 

Generally Accepted 

and Appropriate 

Sampling and Analytic 

Techniques, and 

Reliable Methods for 

Measuring Campaign 

Exposure Produced 

Credible Evidence to 

Support Its Findings 

Although Elements of the 

Campaign Limited Choices 

of Evaluation Designs and 

Affected Data Collection, 

Westat’s Design Was 

Rigorous and Provided a 

Means to Test for 

Campaign Effects 

Westat’s longitudinal panel design was based on the premise that effects of 

exposure to the campaign on outcomes could be measured and detected 

Page 22 GAO-06-818 Youth Anti-Drug Media Campaign
within individuals over time, after controlling for various other factors that 

could have influenced outcomes. The design called for measuring the 

same respondents up to four times to assess how the natural variation in 

exposure to the campaign correlated with campaign outcomes. Westat’s 

approach—an exposure (or dose)-response model—is based upon a 

premise that respondents’ recall of advertisements (exposure or dose) is 

related to outcomes (response). In two recent studies of the effects of the 

campaign on specific groups of youth in local areas, an exposure-response 

approach has been shown to be an effective method for detecting effects 

of the campaign in reducing youth drug use in local settings. One of the 

studies reported a synergistic effect of exposure to the campaign and a 

classroom-based drug prevention curriculum among 9th grade students in 

45 South Dakota high schools. The other study reported reductions in drug 

use during the period of the redirected campaign among high-sensationseeking youth in schools in Knoxville, Tennessee, and Lexington, 

Kentucky. To assess the possibility of preexisting differences between 

groups of exposed youth and parents that might explain both the variation

in exposure to the campaign and variation in outcomes, Westat included in

the NSPY structured interview many questions on personal and family 

history, and it used the responses to control statistically for differences in

attributes of respondents in order to attempt to isolate the relationship 

between exposure to the campaign and outcomes. 

The absence of baseline data—that is, precampaign data on outcomes—

was beyond Westat’s control, as phase III of the campaign began before 

the first wave of data collection for the phase III evaluation began. The lag 

between the start of phase III of the campaign in mid-1999 and the 

completion of the evaluation’s first round of data collection—around mid2001—leaves open the possibility that there were effects of the campaign

that occurred very early on in the campaign, prior to when Westat began 

data collection. Several factors suggest that the absence of pre-phase III 

baseline data was not fatal to the evaluation’s findings. First, if there were 

effects of the campaign that could not be detected because of the absence

pre-phase III baseline data, those effects must have occurred very rapidly 

and then endured throughout the remainder of the campaign, from 1999 

through 2004. However, rapid changes in youth drug use were not 

observed in MTF data; rather, the overall trend in MTF past year drug use 

was flat between 1998 and 1999. Second, rapidly occurring effects were 

not expected by ONDCP in designing the campaign. As we reported in 

2000, and as ONDCP wrote in 2001, ONDCP believed that it would take 

Page 23 GAO-06-818 Youth Anti-Drug Media Campaign
2 to 3 years for changes in drug use to be evident as a result of the 

campaign.17

Another campaign design factor that affected Westat’s evaluation was the 

implementation of new campaign initiatives, such as the Marijuana 

Initiative, which were implemented at times that officials at ONDCP 

considered to be important, and therefore they may not have coincided 

with planned data collection for the evaluation, nor should they 

necessarily have done so. For example, the Marijuana Initiative was 

implemented in October 2002, and the NSPY data available to evaluate

outcomes during it were limited to three complete survey waves. For its 

longitudinal analysis of change during the Marijuana Initiative, Westat was 

limited to data from two survey waves. Despite these limitations, the 

evaluation produced data that enabled Westat to detect effects during the 

period of the Marijuana Initiative. 

Sample Coverage Issues 

Did Not Invalidate Westat’s

Assessment of the 

Effectiveness of Exposure 

to the Campaign on 

Intermediate and Drug Use 

Outcomes 

During the enrollment phase of the NSPY, Westat experienced sample 

coverage problems, in that it enrolled—or rostered—a smaller percentage

of households with youth in the targeted age range than would be 

expected based on comparable Current Population Survey (CPS) 

estimates—the data that Westat used to develop its expectations about the 

percentage of households having youth in the targeted age ranges. 

Coverage refers to the extent to which a sample is representative of the 

intended population on specified characteristics, and it is important 

because the omission of segments of the intended population from a 

sample—or undercoverage—can lead to biased results, in that omitted 

segments may differ in some important respect from those segments 

included. Westat estimated the extent of undercoverage in the NSPY to be

about 30 percent as compared to the CPS estimates, and according to 

Westat and NIDA, the undercoverage arose during the stage of sampling in 

which Westat was developing rosters of households that were believed to

contain youth in the target age range. At this stage, the survey rostering 

process required entry into the household, which may have led 

respondents in potentially eligible households to refuse to participate. 

Our review of Westat’s documentation leads us to conclude that there was 

no evidence of biased results due to undercoverage and that the sample 

was sufficiently reliable both for the purposes of estimating changes over 

 17GAO/GGD/HEHS-00-153, (Washington, D.C.: July 31, 2000), p. 68. 

Page 24 GAO-06-818 Youth Anti-Drug Media Campaign
time in individual outcomes and for assessing the effectiveness of 

exposure to the campaign on outcomes. Westat’s comparisons of the 

estimated population characteristics of the NSPY—such as race and 

ethnicity of head of household and race and ethnicity of youth in 

households—with the estimated population characteristics from the CPS 

show that they are generally similar. That is, the distributions of 

characteristics of eligible households with youth included in the NSPY 

were broadly consistent with a variety of corresponding distributions from 

the 1999 CPS. These comparisons suggest that the NSPY estimated 

population by race and ethnicity was similar to that of CPS. Westat also 

used multivariate modeling techniques to develop weighting adjustments, 

and it developed weights to adjust its sample for nonresponse that were 

reasonably effective in reducing nonresponse bias. 

An additional test for bias in a sample is to compare estimates derived 

from it with estimates on the same variable derived from another sample. 

If the NSPY results were biased, then one would expect that estimates 

derived from it would differ from estimates derived from unbiased 

samples. For example, if eligible households refused to participate in the 

NSPY because they contained teens with drug issues and as a result 

avoided participation at a higher rate than did households containing teens 

without drug issues, then these higher refusal rates by households 

containing teens with drug issues would lead to NSPY estimates of the 

percentage of youth reporting that they used drugs that were lower than

those obtained from other, comparable national surveys. According to 

data provided by NIDA officials and our review of Westat’s final report, 

estimated self-reported drug use rates from the NSPY are comparable to 

estimates derived from other major surveys of drug use, such as the 

National Survey on Drug Use and Health. For example, in the NSPY, rates 

of past-month marijuana use among 12- to 18-year-olds were 7.2 percent in 

2000, 8 percent in 2001, 8.9 percent in 2002, and 7.9 percent in 2003. These 

rates were similar to those reported for 12- to 17-year-olds in the National

Survey on Drug Use and Health (NSDUH) of 7.2 percent in 2000, 8 percent 

in 2001, 8.2 percent in 2002, and 7.9 percent in 2003. If youth with known 

drug use problems consistently opted out of both the NSPY and the 

NSDUH—a hypothesis that is not testable with the available data—then 

the estimates from both the NSPY and the NSDUH of the true prevalence 

of youth drug use would be biased underestimates. 

Page 25 GAO-06-818 Youth Anti-Drug Media Campaign
As the NSPY was a longitudinal survey—in which eligible sample 

respondents were re-interviewed up to three times after their enrollment 

interviews—attrition was a concern with which Westat had to contend. If

comparatively large numbers of sample respondents were not retained 

across successive rounds of the survey, the capacity of the NSPY to 

provide data to assess changes in outcomes in response to exposure over 

time would be greatly diminished. Further, if attrition was specific to 

certain groups, then the NSPY estimates would also be biased. 

For the purpose of estimating within-respondent changes in outcomes in 

response to changes in exposure across sample periods—the main use of

the NSPY data—Westat achieved follow-up longitudinal response rates of 

between 82 percent and 94 percent for waves 4 through 9, the follow-up 

waves to the first three enrollment waves. The longitudinal response rate 

consists of two elements: (1) the percentage of prior survey respondents 

that are tracked and for whom eligibility is determined and (2) the 

percentage of those eligible that actually complete an interview. Across 

the three follow-up survey rounds, Westat tracked and determined the 

eligibility to participate in a follow-up survey of between 92 percent and

96 percent of the youth and parents who completed a survey in the prior 

round. Of these, Westat obtained consent and completed extended 

interviews with between 94 percent and 96 percent of youth and parents 

for whom eligibility for a follow-up survey had been determined. 

In our view, Westat’s follow-up response rates resulted in a sample that 

was sufficient to provide reliable findings about the effects of exposure on

outcomes. In addition, Westat’s nonresponse adjustment methodology 

compensated for effects of differential response rates related to the 

percentage of persons in certain age groups, of certain races and 

ethnicities, of those that owned homes versus rented, those that were 

U.S. citizens versus noncitizens, and those with incomes below the 

poverty level. 

The NSPY sample could be used to detect changes in outcomes that were 

on the order of magnitude of changes expected by ONDCP for the 

campaign, and its measures of exposure were valid and reliably predicted

outcomes. In early meetings on the design of the evaluation of the media

campaign, ONDCP officials reported that it had a specific Performance 

Measures of Effectiveness system and that the campaign was embodied 

within the first goal of the National Drug Strategy, which was to “educate

and enable America’s youth to reject illegal drugs as well as the use of 

alcohol and tobacco.” Under this goal, ONDCP’s proposed targets for 

Sample Attrition across 

NSPY Interview Rounds 

Was Sufficiently Low to 

Allow for Reliable 

Assessments of the Effect 

of Campaign Exposure on 

Outcomes 

The NSPY Data Could Be 

Used to Detect Reasonably 

Small Effects, and Westat’s

Measurement of Exposure 

and Outcomes Were Valid 

and Could Detect Effects, 

if They Occurred 

Page 26 GAO-06-818 Youth Anti-Drug Media Campaign
reducing the prevalence of past-month use of illicit drugs and alcohol 

among youth from a 1996 base year—by 2002, reduce this prevalence by 

20 percent, and by 2007, reduce it by 50 percent. ONDCP officials 

identified other specific targets, again from the base year 1996—by 2002, 

increase to 80 percent the proportion of youth who perceive that regular 

use of illicit drugs, alcohol, and tobacco is harmful; and by 2002, increase 

to 95 percent the proportion of youth who disapprove of illicit drug, 

alcohol, and tobacco use. To achieve a goal of 80 percent of 12th grade 

youth who perceive that regular use of marijuana is harmful would require 

increasing the 1996 baseline percentage of youth perceiving marijuana as

harmful from 60 percent, as measured by MTF, or by about 3.3 percentage 

points per year from 1996 to 2002. Westat’s sample could be used to detect 

this amount of annual change in youth attitudes. 

In order to detect changes in outcomes due to exposure to the campaign,

it also was necessary that Westat accurately measure and characterize 

exposure to the campaign. Westat provided evidence for the validity of its 

measures of self-reported exposure, and the evidence suggests that the 

measure of exposure was both valid and reliable. To measure exposure to

the campaign for both youth and parents, NSPY interviewers asked 

respondents about their recall of anti-drug advertisements (general 

exposure) and their recognition of specific current or very recent 

television and radio advertisements (specific exposure).18 To facilitate 

measures of recall, respondents viewed television and radio 

advertisements on laptop computers. Youth and parents were only shown 

or listened only to advertisements targeted to their respective groups. In 

addition, both youth and parents were asked some general questions about 

their recall of advertisements seen or heard in various media, including 

television, radio, newspapers, magazines, movie theaters, billboards, and

the Internet. 

Westat’s assessments of the validity of its measure of exposure to 

campaign advertisements confirm that the NSPY data were able to 

measure exposure. First, Westat examined respondents’ recall of 

campaign advertisements using “ringer” television advertisements—

advertisements that never had appeared. According to Westat’s analysis of 

ringer advertisements, youth were more likely to recognize an

advertisement as a campaign advertisement when presented with an 

 18Each respondent was presented ads that had been broadcast nationally in the 2 calendar

months prior to the interview.

Page 27 GAO-06-818 Youth Anti-Drug Media Campaign
actual campaign advertisement than a bogus one. For example, a far lower 

percentage of respondents (11 percent) claimed to have seen a ringer, or

bogus, advertisement than the percentage who claimed to have seen the

broadcast advertisements (45 percent), particularly the advertisements 

that were delivered with high frequency. The result held for youth and for

parents. 

Second, comparing data on advertisement time purchases with selfreported exposure to these advertisements in the NSPY, Westat found a 

high correlation between advertising and exposure. Specifically, on the 

basis of analysis of individual advertisements’ gross rating points (GRP)— 

a measure of the underlying reach and frequency of each advertisement—

and self-reported exposures by respondents, Westat found a high 

correlation between GRPs purchased by the campaign and self-reported 

exposure to advertisements among youth. The correlation for parents was 

somewhat smaller, but was also significant. Third, Westat also compared 

self-reported exposure with recall of the correct brand phrase and found a 

strong association between self-reported exposure and correct recognition 

of the brand phrase. This is further evidence for the validity of its 

measures of self-reported exposure.

Westat measured a variety of outcomes for youth and parents and took 

steps to ensure that the measures were consistent with existing research. 

The youth questionnaires included numerous questions that were designed 

to measure exposure to the campaign advertisements and other anti-drug 

messages. The youth question areas included exposure propensity to 

media; current and past use of tobacco, alcohol, marijuana, inhalants, and 

Ecstasy; past discussions with and communication of anti-drug messages 

from parents and friends; expectations of others about respondent’s drug 

use; knowledge and beliefs about the positive and negative consequences 

of drug use; exposure to campaign messages; family and peer factors; 

personal factors; and demographic information. Westat used separate 

questionnaires for youth of different ages; one questionnaire was used for 

children (aged 9 to 11) and another one was used for teens (aged 12 to 18). 

Page 28 GAO-06-818 Youth Anti-Drug Media Campaign
In it analysis, Westat used three types of evidence to draw inferences 

about the effects of the campaign: (1) trend data—data that describe 

increases or decreases in drug use and other outcomes over time; 

(2) cross-section analysis—measures of association between exposure to 

campaign messages and individual drug use beliefs, intentions, and 

behaviors, at the time data were collected; and (3) longitudinal analysis—

measures of association, for youth and parents who were observed at two

points in time, between exposure to campaign messages at the earlier time 

on outcomes at the later time.19 Westat indicated that trends over time, by 

themselves, could not be used to provide definitive support for campaign

effects. Rather, the trends needed to be supported by measures of 

association. Westat also indicated that measures of association, whether 

cross-sectional or longitudinal, needed to control for variables that could 

influence outcomes independently of the campaign or otherwise confound

the association between exposure and outcomes. Cross-section 

association between exposure and outcomes measured at the same time 

would provide stronger evidence of campaign effects than would trend 

data alone, provided that controls for other variables were introduced into

the associational analyses. However, even if cross-section associations 

between exposure and outcomes hold after controlling for the effects of

other variables, as Westat pointed out, there may remain an alternative 

explanation for cross-section associations: For example, an outcome—like 

perceptions of others’ use of drugs—may be the cause of exposure rather 

than an effect of it. Westat’s longitudinal analysis attempts to address the 

ambiguities that exist with cross-sectional associations. With longitudinal 

data, if, after controlling for other confounding variables, exposure 

measured at an earlier time is associated with an outcome at a later time, 

the inference made is that the causal direction is from exposure to 

outcome, since an effect cannot precede a cause in time. 

Westat’s Analytic Methods 

Aimed to Isolate Causal 

Effects of the Campaign 

and Did So Using 

Sophisticated Techniques 

That Enhanced the 

Strength of Its Findings 

As the campaign was implemented nationally and it was therefore not 

possible to assign youth and their parents randomly to treatment and 

control groups, a major threat to the validity of the conclusions from the 

evaluation is that the observed correlations between exposure to the 

campaign and self-reported attitudes and behaviors could reflect 

preexisting differences among individuals in their underlying susceptibility 

to campaign messages. The evaluation’s associations between exposure to

the campaign and self-reported initiation of marijuana use took into 

account statistically the individual differences in attributes among youth 

 19Westat also called its longitudinal analysis a “delayed effects” analysis. 

Page 29 GAO-06-818 Youth Anti-Drug Media Campaign
who were exposed to various levels of campaign messages, and they 

adjusted for the influence of other variables that could determine 

marijuana initiation—called confounder variables. As such, Westat’s 

evaluation of the associations between campaign exposure and marijuana 

initiation have accounted for individual differences among youth and can 

be viewed as comparisons of outcomes for statistically similar individuals. 

Further, the statistical test Westat used in assessing the relationship 

between exposure and initiation did not rely upon assumptions of linearity 

between levels of exposure and initiation. Instead, it tests for an ordered 

relationship between exposure and an outcome such as marijuana use 

initiation. 

Westat used statistical methods to address the possibility that preexisting 

differences between individuals could have caused both reported levels of

exposure and respondent outcomes, and its use of these methods 

contributed to the validity of its findings about the effects of the campaign

on outcomes. If, independently of the campaign, individuals differed in 

their underlying tendencies to accept and recall campaign messages, and if 

the individuals who were more likely to recall advertisements also were 

those who were more likely to respond to advertisements, then, absent 

efforts to address this confounding factor, the findings about the 

evaluation would be questionable. This type of bias is often called a 

selection effect. If selection effects occurred in the campaign, then both 

exposure and reported changes in attitudes and behaviors could reflect 

underlying beliefs that were not affected by the campaign, despite the 

presence of statistical correlations between self-reported exposure and 

changes in attitudes and behaviors. 

To control for selection effects and the many factors that could have 

influenced both exposure and outcomes independently of, or in 

conjunction with, the campaign, Westat used propensity scoring methods. 

These methods limit the influence of preexisting differences among 

exposed groups by controlling for a wide range of possible confounding 

variables. Propensity score methods are used to create comparison groups 

that are similar on measured and potentially confounding variables but 

that differ on their levels of treatment. In the evaluation of the campaign,

the comparison groups were similar on confounding variables but differed 

on their level of exposure to campaign messages. Propensity score 

methods replace a set of confounding variables with a single function of 

these variables, which is called the propensity score. In Westat’s analysis,

an individual’s propensity score is considered to represent an individual’s 

probability of being assigned to a particular level of exposure to the 

campaign, conditional upon the individual’s values of the confounding 

Page 30 GAO-06-818 Youth Anti-Drug Media Campaign
variables. By including relevant, potentially confounding variables and 

matching individuals on their propensity scores, Westat was able to 

minimize bias due to selection effects. The comparison groups that Westat 

created by using propensity score methods can be considered as statistical 

analogues to randomly assigning individuals to different levels of 

exposure. After creating these groups, Westat then analyzed outcomes 

among the groups having different propensities to be exposed to campaign 

messages. 

Our assessment of Westat’s methods leads us to conclude that Westat took

reasonable steps to develop valid propensity models, and as a result of its 

models, its analysis identified the effects of the campaign, net of other 

factors included in its propensity score models. First, rather than simply 

compare individuals who were exposed to campaign messages with those 

who were not exposed, Westat estimated and compared groups of 

individuals with different levels of exposure, where the number of 

exposure groups was measured alternatively as a three- or four-level 

variable—e.g., low, medium, or high exposure.20 Second, for the results of 

propensity methods to be valid, it is important that the propensity scoring 

models include all relevant variables that could otherwise explain 

differences in both exposure and outcomes, as evaluators can adjust only 

for confounding variables that are observed and measured. If an important 

variable is omitted from the propensity model, the results of analyses may 

be affected. Westat’s models included many relevant and potentially 

confounding variables. For example, in the youth models, the propensity 

score models included measures of demographic attributes, educational 

attainment and educational aspiration, family and parent background, 

parental consumption of television and other media, income and 

employment, reading habits, Internet usage, location of residence in an 

urban area, among other variables. Third, for propensity models to remove 

the effects of confounding variables from the association between 

exposure and response, it is necessary that the population means of the 

confounder variables not vary across exposure levels. If a confounder is 

successfully balanced, then it will have the same theoretical effect across 

all exposure levels. After estimating models, Westat also assessed and 

demonstrated the balance of variables in its propensity models. 

 20Propensity score methods have been demonstrated to be robust against bias associated 

with the specification of incorrect functional forms—e.g., linear rather than quadratic— 

of variables. 

Page 31 GAO-06-818 Youth Anti-Drug Media Campaign
Westat reported mixed evidence about the effectiveness of the campaign 

on intermediate outcome measures—such as recall and identification of 

campaign messages, youth anti-drug attitudes, and parents’ beliefs and 

behaviors—that were thought to be causal factors influencing youth drug 

use, the ultimate target of the campaign. Most parents and youth recalled 

exposure to campaign anti-drug messages, and for both groups, recall 

increased during the September 1999 to June 2004 period covered by the

phase III evaluation. For current, non-drug-using youth—whose resistance 

to initiating marijuana use the campaign intended to affect—although 

NSPY data showed some favorable trends in anti-drug attitudes and beliefs 

and in the proportion of youth who said that they would definitely not try 

marijuana, there was no evidence that exposure to the campaign 

influenced these trends. Conversely, among current, non-drug-using youth,

evidence suggested that exposure to the campaign had unfavorable effects 

on their anti-drug norms and perceptions of other youths’ use of 

marijuana—that is, greater exposure to the campaign was associated with

weaker anti-drug norms and increases in the perceptions that others use 

marijuana. On three of five parent belief and behavior outcome 

measures—including talking with children about drugs, doing fun 

activities with children, and beliefs about talking with children—the 

evidence pointed to a favorable campaign effect on parents. However, 

while there was mixed evidence on the effect of the campaign on parents’ 

beliefs and attitudes about monitoring children’s behaviors, there was no 

evidence to support a claim that the campaign actually affected parents’ 

monitoring behaviors—an area of the campaign’s focus for parents—and 

there was little evidence for favorable indirect effects on youth behavior 

or beliefs as the result of parental exposure to the campaign. 

According to Westat, the campaign purchased enough advertising time 

over the 58-month period from September 1999 to June 2004 to achieve an

average exposure of 2.5 youth-targeted ads per week for youth and an 

average of 2.2 parent-targeted advertisements per week for parents. 

Westat’s estimates include campaign advertisements intended for either all 

youth or all parents, but they do not include exposure of youth to parent 

advertisements or parents to youth advertisements, nor do they account 

for separate advertising targeted to specific race- or ethnicity-defined 

audiences. 

Using exposure indexes, Westat measured trends in general and specific 

exposure to campaign advertisements. The general exposure index was 

based on questions that asked about exposure to anti-drug messages in 

recent months through a variety of channels, including movies, television,

The Phase III 

Evaluation Provided 

Mixed Evidence of the 

Campaign’s

Effectiveness on 

Intermediate 

Outcomes, but It 

Found No Effect of 

the Campaign on 

Parental Monitoring 

of Youth 

Youth and Parents’ Recall 

of Campaign 

Advertisements Increased 

over Time, Their 

Impressions of the 

Advertisements Were 

Favorable, and They Could 

Identify the Campaign 

Brand 

Page 32 GAO-06-818 Youth Anti-Drug Media Campaign
radio, and billboards, and was not limited to campaign advertisements.21

The specific exposure index was based on recall of specific 

advertisements broadcast during the 60 days prior to the respondent’s 

interview, and was limited to advertisements that targeted the respondent.

For example, for youth, only youth advertisements were sampled to 

measure specific exposure. Youth aged 121⁄2 to 18 and their parents 

reported increasing levels of recall of specific but not general exposure to 

campaign advertisements over time. For both parents and youth, there was 

a sharp increase over time in the recall of specific exposure of television

ads across the campaign. Westat speculated that the increase in specific 

recall may have arisen from better-placed, more memorable, or longeraired advertisements rather than only to an overall increase in television 

advertisements. However, recall of all general anti-drug advertising was 

fairly stable over time, as there was no overall detectable change in 

reported general exposure over the course of the campaign.

Beginning in 2001, when the evaluation started to measure brand phrase 

recall, and continuing through 2004, the evidence indicates that youth, in

particular, exhibited increases in brand phrase recall. Advertising 

campaigns may use a brand phrase to provide a recognizable element, and 

to the extent that the brand is recognized and positively regarded, its 

familiarity may lead to a positive response to a new advertisement or 

increase the perception that each advertisement is part of a larger 

campaign. The campaign included both a parent and a youth brand. Brand 

messages may have involved a series of phrases or the portrayal of an

activity or lifestyle as positive (e.g., participating in team sports) to set up 

the brand phrase of “The Anti-Drug.” Westat reported that the evidence 

from the NSPY shows that the greater the exposure to media campaign 

advertising, the more likely respondents were to recall the brand phrase. 

In addition, the more that respondents recalled specific ads, the more 

likely they were to recognize the brand phrase, although over time even 

those with less exposure had learned the brand phrase. 

Overall, youth reported favorable impressions of the subset of campaign 

television advertisements that they were asked to evaluate, and their 

favorable impressions increased over time. Responses to the 

advertisements—whether they were attention getting, convincing, or said 

 21According to Westat, the reference period for the general exposure index, is “in recent 

months,” and this wording was chosen to maintain equivalence to the wording used in the 

Monitoring the Future surveys in its questions about anti-drug advertising. 

Page 33 GAO-06-818 Youth Anti-Drug Media Campaign
something important to the respondent—were positive among both youth 

and their parents. Parents’ evaluations of the advertisements were 

generally more positive than those of youth, and parents’ positive views 

also increased over time. 

In addition to distributing messages directly in media advertisements, the 

campaign aimed to reach its target audiences indirectly through other 

institutions and routes, such as community groups, in-school and out-ofschool anti-drug education, and discussions among youth and parents, and 

youth and friends, concerning drug use and the drug advertisements. The 

NSPY data indicated that the campaign’s messages were not accompanied 

by similar increases in exposure to messages from other sources. Both 

youth and parents reported receiving anti-drug messages from other 

sources, but they did not consistently report increases in exposure to 

messages from these sources. For example, from the 2000 to 2004 samples, 

the percentages of youth reporting receiving in-school drug education 

messages and attending out-of-school drug education both declined. 

Westat Found That the 

Campaign Generally Had 

No Effect on the Attitudes 

of Youth Not Using 

Marijuana toward Its Use 

but That Exposure to the 

Campaign Was Associated 

with Unfavorable Effects 

on Youth Perceptions of 

Others’ Use of Marijuana 

Westat generally found no significant effects of campaign exposure on the 

cognitive outcomes of adolescent nonusers of marijuana— 

i.e., development of anti-drug attitudes and beliefs. For current nonusers, 

the evaluation reported on four cognitive measures and a fifth measure of 

their perceptions of others’ use of marijuana. Three of the four measures—

attitudes and beliefs about the consequences of marijuana use; perceived

social norms or pressures from parents, friends, and peers about 

infrequent or regular marijuana use; and perceived self-efficacy to avoid 

using marijuana, or their confidence to turn down use of marijuana under 

various circumstances—were premised to affect the fourth—youth 

intentions to use marijuana at all during the next year. The fifth outcome, 

perceptions of other youths’ use of marijuana,22 was included to examine 

whether exposure to the campaign was leading to increased perception 

among youth that others use marijuana, and whether this perception, in 

turn, affected their own behaviors. 

Westat reported that the evidence from the analysis of trend data from 

2000 to 2004 for two of the youth cognitive measures—attitudes and 

beliefs about the consequences of marijuana use and intentions to use 

marijuana—showed significant increases in youth believing that marijuana 

 22This was measured as the “Percent perceiving few other kids regularly use marijuana.” 

Page 34 GAO-06-818 Youth Anti-Drug Media Campaign
use had negative consequences and significant increases in the percentage 

of youth that reported that they had no intention to use marijuana. 

However, evidence from both cross-section and longitudinal associations 

between exposure and these two cognitive outcomes did not substantiate 

that the favorable trends arose from exposure to the campaign.

Specifically, the cross-sectional associations between both general and

specific exposure to the campaign and intentions not to use marijuana 

show no significant favorable effects of exposure on this outcome. None 

of the cross-section associations between either general or specific 

exposure and intention to use marijuana are significant, and none of the 

longitudinal associations between specific exposure and intentions are 

significant. Two of the longitudinal associations between general exposure 

and intentions are significant, but the direction of the effect is unfavorable, 

in that greater exposure led to declines in intentions not to use marijuana. 

The evidence from the associational analyses between exposure and 

attitudes and beliefs about the consequences of marijuana use generally

did not show an effect of the campaign. While there was one significant 

cross-section association between general exposure and attitudes and 

beliefs about consequences during the final two waves of survey data, 

there were no significant cross-section associations between specific 

exposure and attitudes and beliefs about consequences, nor were there 

any significant longitudinal associations with either general or specific 

exposure. 

The associational analysis also produced some evidence of unfavorable 

effects of exposure on social norms—i.e., social pressures from parents, 

peers, and other important persons about marijuana use. Westat’s crosssection associations showed no significant effects of exposure on social 

norms, but its longitudinal associations showed that across all survey 

rounds, there was a significant relationship between specific exposure and 

weaker social norms. Westat’s analysis of associations between exposure 

and perceptions of others’ use of marijuana also produced significant 

results. Cross-section associations between specific exposure and 

perceptions of others’ use were significant, as were longitudinal 

associations of this relationship. In other words, among youth who 

reportedly did not use marijuana at the time of their interview, there was a

significant effect of specific exposure on the perception that others used 

marijuana, and the direction of the effect was unfavorable—that is, those 

reporting higher exposure to anti-drug ads were more likely to believe that 

their peers used marijuana regularly. A significant and unfavorable 

relationship between specific exposure and perceptions of others’ use of 

marijuana was obtained for the data covering the entire period of the 

Page 35 GAO-06-818 Youth Anti-Drug Media Campaign
evaluation as well as for the period of the redirected campaign, from 

2002 to 2004. 

A theme of the campaign was to encourage parents to engage with their 

children to protect them against the risk of drug use, and parent skills 

were a focus of parent advertising almost since the start of the campaign.

The campaign encouraged parents to monitor their children’s behavior by

knowing where they were and with whom, and to make sure that they had 

adult supervision. It also encouraged parents to talk with their children 

about drugs and to a lesser degree to engage in fun activities with their 

children. The evaluation observed five outcomes for parents, and for four 

of the five found significant and favorable effects of exposure to the 

campaign. For three outcomes—parent-child conversations about drugs 

(talking behavior), parents’ beliefs and attitudes about talking with their 

children about drugs (talking beliefs), and parents’ engagement with their 

children in in-home and out-of-home activities (fun activities)—both crosssection and longitudinal associations between exposure and outcomes 

were generally significant and favorable to the campaign. For parents’ 

beliefs and attitudes toward monitoring their children’s behaviors, Westat 

reported favorable trend and cross-sectional associations but no 

significant overall longitudinal effects of either general or specific 

exposure on this outcome. For the fifth outcome, parent monitoring 

behaviors—that is, parents’ knowing or having a pretty good idea about

what their child was doing or planned to do—the evidence did not support 

a finding of an effect of the campaign. There were no significant favorable

trends in parents’ reports of monitoring behaviors, and there were no 

significant cross-section or longitudinal associations of either general or 

specific exposure on monitoring behaviors. 

Despite evidence of some favorable parental outcomes for the campaign,

Westat found no significant evidence for the overall evaluation that these 

favorable parent outcomes affected youth attitudes and behaviors toward

drug use. Specifically, for the entire period covered by the evaluation, 

Westat found no evidence of overall, indirect campaign effects on parents 

leading to changes in marijuana use, intentions to use marijuana, social

norms, self-efficacy, or cognitions among youth who were not marijuana 

users. Westat found that there were some significant indirect effects of 

parental specific exposure on some youth outcomes for some subgroups. 

For example, parental specific exposure was favorably associated with 

intentions to use marijuana for 14- to 18-year-olds and for boys, and it was 

also associated favorably with attitudes and beliefs about the 

The Evaluation Reported 

Favorable Effects of the 

Campaign on Three Parent 

Outcomes but Not on 

Parental Monitoring 

No Evidence of Favorable 

Effects of the Campaign on 

Youth Outcomes through 

Campaign Effects on 

Parental Outcomes 

Page 36 GAO-06-818 Youth Anti-Drug Media Campaign
consequences of marijuana use for Hispanics. Westat also found 

significant but unfavorable indirect effects of parents’ general exposure on 

subgroups of youth in other youth outcomes. For example, parental 

general exposure was unfavorably associated with youth social norms for 

14- to 16-year-olds and for girls. 

Westat reported that the NSPY data showed some declines in self-reported 

lifetime and past-month use of marijuana by youth over the period from 

2002 to 2004, and these trends in NSPY were consistent with trends in 

other national surveys of drug use over these years. Westat also reported 

that the NSPY data showed declining trends in youth reports of offers to 

use marijuana. However, Westat cautioned that because trends do not 

account for the relationship between campaign exposure and changes in 

self-reported drug use, drug use trends alone should not be taken as 

definitive evidence that the campaign was responsible for the declines. On

the basis of the analysis of the relationship between exposure to campaign 

advertisements and youth self-reported drug use in the NSPY data—

assessments that used statistical methods to adjust for individual 

differences and control for other factors that could explain changes in selfreported drug use—for the entire period covered by its evaluation, Westat 

found no significant23 effects of exposure to the campaign on initiation of 

marijuana by prior nonusing youth. The only significant effect indicated in 

Westat’s analysis of the relationship between campaign exposure and selfreported drug use was an unfavorable effect of exposure on marijuana 

initiation—that is a relationship between campaign exposure and higher

rates of initiation—for one round of NSPY data and similar unfavorable 

effects of campaign exposure on marijuana initiation among certain 

subgroups of the sample (e.g., 121⁄2- to 13-year-olds and girls). Westat found 

no effects of campaign exposure on rates of quitting or use by prior users 

of marijuana. 

The Phase III 

Evaluation Found No 

Significant Effects of 

Exposure to the 

Campaign on Youth 

Drug Use Outcomes 

Other than Limited 

Unfavorable Effects 

on Marijuana 

Initiation 

 23In discussing Westat’s findings, any references to significance refers to statistical 

significance. 

Page 37 GAO-06-818 Youth Anti-Drug Media Campaign
Westat tracked trends in self-reported use of marijuana by youth and 

trends in youth reports of offers to use marijuana for the period from 

2000 to the first half of 2004 to determine if there were significant declines. 

Westat also assessed these trend data for changes occurring since 2002, 

or during the period of the redirected campaign. Westat’s trend analysis 

was designed to provide supportive but not definitive evidence for 

campaign effects. 

In its trend analysis, Westat compared trends in self-reported drug use—

lifetime, past year, and past month—in the NSPY with trend data on selfreported drug use from three other nationally representative surveys of 

drug use—Monitoring the Future, the Youth Risk Behavior Surveillance 

System (YRBSS), and the National Survey on Drug Use and Health.24 Both 

MTF and YRBSS are school-based surveys, and NSDUH is a household 

survey that provides estimates of drug use by the civilian, 

noninstitutionalized population of the United States aged 12 years and 

older. Methodological differences between the school-based surveys—

MTF and YRBSS—and the household surveys—NSPY and NSDUH—have 

been shown to account for the some of the differences in estimates of 

marijuana use. 

Westat Tracked Trends in 

Marijuana Use from 

Several Sources and 

Reported That the Trend 

Data by Themselves Were 

Insufficient to 

Demonstrate Effects of 

Exposure to the Campaign 

According to Westat’s analysis, the surveys of self-reported marijuana use 

show some similarities and differences in trends depending upon the 

measure, age group, or subperiod covered within the longer 2000 to 2004 

period. For example, the MTF data generally show declines in lifetime, 

past-year, and past-month self-reported drug use for 8th, 10th, and 

12th graders over the years from 2000 to 2004, although only some of the 

year-to-year differences in the MTF self-reported drug use data were 

statistically significant. Nonetheless, for the subperiod from 2002 to 2004, 

MTF data show statistically significant declines in past-year and pastmonth use for 8th graders and past-year use for 10th graders, and the 

NSPY data also show statistically significant declines in past-month use 

from 2002 to 2004 for youth aged 121⁄2 to 18 years old and for 14- to 18-yearolds. On the other hand, the MTF data suggest a decline in past-year and

past-month use by 10th graders from 2000 to 2002, but the NSPY data 

suggest an increase in past-month marijuana use during this period.25

Further, the data from NSDUH for 2000 and 2001 also show statistically 

 24This survey was formerly known as the National Household Survey on Drug Abuse. 

25Westat points out, however that the MTF decline in use among 10th graders between 

2001 and 2002 was within the statistical confidence limits of NSPY. 

Page 38 GAO-06-818 Youth Anti-Drug Media Campaign
significant increases in lifetime, past-year, and past-month marijuana use 

among youth aged 12 to 17, statistically significant increases in lifetime 

and past-year marijuana use for youth aged 16 to 17, and a statistically 

significant increase in past year use for youth aged 14 to 15. The pattern of 

increase in NSDUH data from 2000 to 2001 is consistent with the 2000 to

2002 increases in past-month use in NSPY, but they differ from the MTF 

trends over this period. 

All four surveys generally show declines in marijuana use beginning in 

2002, but not all of the declines are statistically significant. Both MTF and 

NSPY show some statistically significant declines since 2002, and while 

NSDUH and YRBSS show declines, the declines were not statistically 

significant. These declines starting in 2002 coincide with the redirected 

campaign and the introduction of the Marijuana Initiative. 

Despite the concurrence of the trend data from all sources for the 2002 to 

2004 period, Westat concluded that the existence of declining trends in 

self-reported drug use by themselves do not provide definitive evidence 

that the campaign caused the declines because factors other than the 

campaign also could affect behavior. For example, changes in high-school 

completion rates among youth could affect drug use behaviors, as high 

school dropouts may have more involvement with drugs than youth who 

stay in school. Additionally, declines in self-reported drug use that began 

before the initiation of phase III of the campaign could not have been 

caused by the campaign. The declines reported in MTF began prior to the 

start of phase III of the campaign; therefore, factors other than the 

campaign had to have been responsible for the start of the decline 

occurring in these data. Further, ONDCP also has acknowledged the 

limitations of trends in the national surveys for determining whether 

changes in drug use were the result of the campaign. ONDCP’s Office of 

Programs, Budget, Research and Evaluation wrote about the MTF, YRBSS, 

and NSDUH:26

“They provide policy makers with broad indicators of the success of 

policy...However, they will not be able to answer the critical question of whether 

these changes were the result of the Media Campaign. These surveys do not ask 

 26At the time that ONDCP prepared this document, NSDUH was still known as the National 

Household Survey on Drug Abuse, or NHSDA. 

Page 39 GAO-06-818 Youth Anti-Drug Media Campaign
respondents about their exposure and reactions to the messages of the Media 

Campaign that can then be linked to their drug-related attitudes and behavior.”27

Westat Reported That 

Trends in Marijuana Offers 

Declined over Time, but 

Factors Other than the 

Campaign Contributed to 

Changes in Offers 

Westat assessed trends in youth reports of receiving offers of marijuana—

whether anyone had ever offered youth marijuana and the frequency of 

offers within the past 30 days. Marijuana offers are closely related to 

marijuana use, and the campaign aired messages that encouraged 

resistance to offers of marijuana. Over the 2000 to 2004 period, Westat 

found significant increases in the percentage of youth reporting that they 

had never received offers, and it also found significant decreases in the 

percentage of youth reporting that they had received offers in the prior 

month. Westat also found significant changes in offers over 2002 to 2004, 

during the period of the redirected campaign, and these changes were 

generally consistent with the trends for the overall 2000 to 2004 period. 

Further, on the basis of longitudinal analysis of the relationship between

offers in one period and marijuana use in the subsequent period among 

youth who were nonusers in an initial survey round—an analysis that 

assesses whether offers precede use or are simply a correlate of it—

Westat found that youth who reported having received a marijuana offer at 

one period were much more likely—between three and seven times more 

likely, depending upon age group—to have initiated marijuana use at a 

following period than nonusing youth who reported never having received 

such an offer. However, as Westat reported, while the findings on offers 

are favorable, they cannot be ascribed to the campaign because they may 

be caused by other factors, as the analysis of the relationship between 

offers and use did not take into account other factors that could affect use. 

 27Office of Programs, Budget, Research and Evaluation, Office of National Drug Control

Policy, “Youth Drug Use and the National Youth Anti-Drug Media Campaign,” February,

2001 (Washington, D.C.: Executive Office of the President), p. 16. 

Page 40 GAO-06-818 Youth Anti-Drug Media Campaign
From its longitudinal analysis of associations between exposure and 

initiation of marijuana use, Westat found no evidence that increased 

exposure to the campaign reduced youth’s initiation of marijuana use. 

Westat’s longitudinal analysis assessed the effects of exposure at one 

survey wave on marijuana initiation at a subsequent survey wave, 

controlling for potential confounding variables that could affect the 

exposure initiation relationship. Westat assessed the effects of two types 

of exposure on initiation of marijuana use—general exposure and specific 

exposure. General exposure represents the sum of recalled exposure to 

anti-marijuana advertising in four types of sources of advertisements—

television and radio, movies and videos, print media including newspapers 

and magazines, and outdoor media. Specific exposure represents the sum 

of recalled exposure to youth-targeted individual campaign television 

advertisements that had been aired in the 60 days prior to an interview. 

On the Basis of Its Analysis 

of the Association between 

Exposure and Drug Use 

Outcomes, Westat Found 

No Evidence That 

Exposure to the Campaign 

Affected Initiation or 

Cessation of Marijuana 

Use 

Westat found no significant effects of the level of general exposure on 

marijuana use initiation, either over the entire period of the campaign or 

between subperiods as defined by survey rounds.28 Westat also found no 

overall effects of levels of specific exposure on marijuana initiation during 

the entire period of the campaign, but it found one significant association 

between specific exposure and marijuana use initiation that occurred in 

the data from wave 7 and its wave 9 follow-up, or during the period of the 

Marijuana Initiative. Wave 7 was the first complete survey wave covering 

exposure to the Marijuana Initiative. The significant association from this 

analysis was that higher levels of specific exposure were associated with 

higher levels of initiation of marijuana use among previously nonusing 

youth. 

Westat also examined the longitudinal relationships between exposure 

and initiation for nine subgroups of youth (two sexes, three race/ethnicity 

groups, two risk groups, and two nonoverlapping age groups). For several 

subgroups, it found significant associations between specific exposure and 

marijuana initiation. These associations were in a direction that was 

unfavorable to the campaign, in that greater specific exposure was 

associated with higher levels of initiation. The subgroups for which these 

unfavorable associations were most pronounced included 121⁄2- to 13-yearolds, girls, African Americans, and lower risk youth. 

 28Westat’s assessed the exposure-initiation relationship using data from survey rounds 

1 and 2, survey rounds 2 and 3, and within survey round 4; it assessed the exposureinitiation relationship between waves 6 and 8 and waves 7 and 9.

Page 41 GAO-06-818 Youth Anti-Drug Media Campaign
On cessation and reduction of marijuana use, Westat assessed two 

outcomes among current marijuana users: the rate at which they quit using 

marijuana and their frequency of use. The frequency of use measure 

allowed for campaign effects to be observed if users did not quit but 

reduced their use of marijuana. Westat estimated that the quit rate—the 

percentage of prior-year users reporting that they no longer used 

marijuana—among prior-year users of marijuana was 24.8 percent. 

However, it found no statistically significant association between general 

exposure and quitting or between specific exposure and quitting. It also 

found that among adolescent marijuana users, the frequency of use—

increase, decrease, or no change—was not affected by exposure to the 

campaign. 

A well-designed and executed multiyear study of the impact of the ONDCP 

anti-drug media campaign on teen initiation of drug use, or cessation of 

drug use, shows disappointing results for the campaign. The study 

provides no evidence that the campaign had a positive effect in relation to

teen drug use, and shows some indications of a negative impact. Some 

intermediate outcomes, such as parents talking with children about drugs, 

and doing fun activities with their children, showed positive results in that 

the media campaign encouraged parents to adopt these behaviors. 

However, other intermediate outcomes, such as parents’ monitoring of 

their children’s behavior, were not shown to be affected by the campaign.

Moreover, the evaluation did not provide evidence that intermediate 

outcomes that showed positive results translated into greater resistance to

drugs among the teenage target population. 

Conclusions 

Unfavorable preliminary findings from the evaluation were reported by 

Westat in 2002. Beginning in 2002, ONDCP took a number of steps that 

were intended to strengthen the power of the campaign to achieve positive 

results. These steps included more rigorous ad copy testing and a 

concentration on anti-marijuana messages. However, the post-2002 results 

yielded no evidence of positive impacts and some evidence of negative and 

unintended consequences in relation to marijuana use. Specifically, 

exposure to advertisements during the redirected campaign was 

associated with higher rates of marijuana use initiation among youth who

were prior nonusers of marijuana. 

Most parents and youth recalled exposure to the campaign messages and,

further, they recognized the campaign brand. Thus, the failure of the 

campaign to show positive results cannot be attributed to a lack of 

recognition of the messages themselves. This raises concerns about the 

Page 42 GAO-06-818 Youth Anti-Drug Media Campaign
ability of messages such as these to be able to influence teen drug 

attitudes and behaviors. It raises questions concerning the understanding 

of the factors that are most salient to teens’ decision making about drugs 

and how they can be used to foster anti-drug decisions. 

Westat’s evaluation is centered on this particular configuration of a media 

campaign as it was presented from 1999 to 2004, and its results pertained 

to the campaign nationwide. It cannot be construed to mean that a media 

campaign that is configured differently from this one cannot work. Nor 

should its results be construed to mean that in some locations, for some 

groups of youth, the campaign did not have an effect on drug use. 

However, substantial effort and expertise were brought to the task of 

designing the advertisements from the outset, and the 2002 redirection of

the campaign placed even greater emphasis on copy testing and enhanced 

ONDCP oversight. This casts some doubt on the notion that a better media 

campaign can lead to positive results. 

It is also important to note that two recent smaller studies in three 

locations have provided evidence of a limited effect of the campaign for 

some youth, and it is quite possible that additional analyses of the NSPY 

data using different methods or measures may find other effects of the 

campaign, at least for some adolescents, than have been produced by

Westat’s evaluation team. The data from the evaluation have only recently 

been made available to academic and other researchers, and while the 

analyses undertaken by Westat are, as we have noted elsewhere, 

appropriate and thorough, they are not exhaustive. 

It is heartening that surveys intended to measure teen drug use, such as 

Monitoring the Future, are showing declines in marijuana use in recent 

years. Indeed, NPSY also shows some evidence of a decline in drug use 

among teens. However, Monitoring the Future and other surveys of teens 

concerning drug use are not linked to exposure to the media campaign, 

and NPSY shows no relationship between anti-drug media campaign 

exposure and favorable drug outcomes for teens. This seems to indicate 

that other unidentified factors, other than the anti-drug media campaign, 

are affecting drug use decisions among teens. 

Although ONDCP has pointed to declines in teen drug use and credited the 

campaign along with other prevention efforts as contributing to significant 

success in reducing teen drug use, trend data derived from the Monitoring 

the Future survey that show declines in teen marijuana use from 2001 to 

2005 do not explicitly take into account exposure to the campaign, and 

therefore, by themselves, cannot be used as evidence of effectiveness. 

Page 43 GAO-06-818 Youth Anti-Drug Media Campaign
ONDCP has indicated in the past, and we concur, that because these 

surveys cannot link their results with the media campaign, they do not 

measure campaign effectiveness. The evaluation of the media campaign

reinforces the lack of linkage between the media campaign and teen drug 

use behavior. 

It is important to note that virtually all social science research is 

imperfect. Attempting to systematically observe and document human 

behavior in real-world settings is a daunting task given the extremely wide 

variation in both humans and settings. We believe that the evaluation of 

the ONDCP media campaign is credible in that it was well designed given 

the circumstance of the campaign, and appropriately executed. 

In light of the fact that the phase III evaluation of the media campaign 

yielded no evidence of a positive outcome in relation to teen drug use and 

congressional conferees’ indications of their intentions to rely on the 

Westat study, Congress should consider limiting appropriations for the 

National Youth Anti-Drug Media Campaign beginning in the fiscal 2007 

budget year until ONDCP is able to provide credible evidence of the 

effectiveness of exposure to the campaign on youth drug use outcomes or 

provide other credible options for a media campaign approach. In this 

regard we believe that an independent evaluation of the new campaign 

should be considered as a means to help inform both ONDCP and 

Congressional decision making. 

We provided a draft of this report to the Director of the Office of National 

Drug Control Policy for comment on July 31, 2006. ONDCP provided us 

with written technical comments on the report, which we incorporated 

where appropriate. In addition, ONDCP provided written comments about 

our report in which it raised a question about our matter for congressional 

consideration and outlined a number of concerns that it had with our 

report on Westat’s findings. These written comments are reproduced in 

appendix II. In our evaluation of ONDCP’s written comments, we address 

each of the other concerns in the order ONDCP presented them. 

ONDCP comments that Westat’s evaluation is ill suited to judge the impact 

of an advertising campaign in part because Westat attempted to establish a 

causal relationship between exposure and outcomes, and this, ONDCP 

indicates, is something that major marketers rarely attempt because of its 

difficulty. ONDCP writes, “we take issue with the fundamental method 

Matter for 

Congressional 

Consideration 

Agency Comments 

and Our Evaluation 

Westat Evaluation’s Role in 

Judging the Impact of the 

Advertising Campaign 

Page 44 GAO-06-818 Youth Anti-Drug Media Campaign
pursued by Westat and GAO, and therefore, believe that the study’s 

findings are deeply flawed.” We find this response surprising for a number 

of reasons. First, ONDCP is on record as stating that the evaluation 

conducted by Westat would be the means to assess the impact of the 

campaign. Indeed, in February, 2001, in the ONDCP publication entitled 

Youth Drug Use and the National Youth Anti-Drug Media Campaign, 

ONDCP states: 

“ONDCP, on the other hand, is measuring the impact of the Media Campaign with 

a thorough, rigorous, and independent evaluation. The nationally representative 

evaluation is being conducted for ONDCP by the National Institute on Drug Abuse 

(NIDA)....The evaluation is a 4-year longitudinal study of parents’ and their

children’s exposure and response to the Media Campaign....ONDCP will be able 

to assess the extent to which changes in anti-drug attitudes and beliefs or drug 

using behavior can be attributed to the Media Campaign.”29

ONDCP officials had opportunities during the evaluation to raise concerns 

about Westat’s design and its efforts to establish a link between exposure 

to the campaign and outcomes, but we are not aware of their having done 

so. However, we are aware of ONDCP’s participation in a NIDA-sponsored 

expert panel review of Westat’s evaluation that was held in August 2002. 

Our review of the minutes of that meeting reveals that while an ONDCP 

official raised concerns about issues such as assessing the nonadvertising 

components of the campaign and the number of interim reports, ONDCP 

officials did not at that time raise concerns that the evaluation was 

fundamentally flawed. The consensus of the expert panel was that 

Westat’s evaluation was “pretty impressive” given the challenges presented 

by the absence of baseline data and of an experimental design. Panel 

members also asserted that Westat’s use of propensity score models to 

isolate the effects of the campaign was termed both “sensible” and “stateof-the-art.” 

ONDCP further states that major advertisers evaluate the success of their 

campaigns by rigorously testing advertisements prior to airing and by 

developing correlations between messages and consumer attitudes and 

behavior. While we do not dispute whether this is a commonly used 

approach among major advertisers, we believe that in assessing the 

 29Office of Programs, Budget, Research and Evaluation, Office of National Drug Control

Policy, “Youth Drug Use and the National Youth Anti-Drug Media Campaign,” February,

2001 (Washington, D.C.: Executive Office of the President), p. 3. 

Page 45 GAO-06-818 Youth Anti-Drug Media Campaign
expenditure of public funds researchers should attempt, where feasible, to 

establish causal relationships or use research designs that attempt to 

isolate the effects of federally funded interventions. While we 

acknowledge that establishing causal relationships is difficult, we maintain 

that Westat used sophisticated and appropriate statistical methods that 

aimed to isolate the effects of recalled exposure to the campaign on youth 

drug use. Further, adopting a methodology that relies upon correlations 

between advertising messages and an outcome, such as reductions in 

youth drug use, without attempting to take into account many of the other 

factors that could affect drug use allows for too many post hoc 

explanations of findings. Westat’s analysis included socioeconomic 

factors, parent characteristics, television viewing habits, risk of using 

drugs, and sensation-seeking tendencies to be able to determine whether 

exposure was related to drug use net of the influences of these factors. We 

conclude, on the basis of our assessment of Westat’s methods, that 

exposure to campaign messages generally did not influence youth drug 

use net of these other influences. 

ONDCP notes that correlational findings have been used to assess antitobacco advertising campaign results. We have not reviewed the antitobacco campaign and cannot comment on its relationship to youth 

smoking prevalence. We notice, however, that in ONDCP’s comments on 

“Consequences of Further Budget Cuts,” it appears to contradict its 

statements about establishing causal relationships to determine the effect

of advertising campaigns. ONDCP writes, “Previous studies have 

established a relationship between exposure to anti-tobacco messages and 

smoking rates among teens.” ONDCP goes on to draw an analogy between 

anti-smoking messages and anti-drug messages to write, “We should 

expect similar results for illicit drug use if anti-drug messages decline.” 

These statements emphasize very directly the same kind of causal 

relationships that ONDCP cites as not appropriate in its opening 

comments. 

We also note that ONDCP indicates in its comments that it has made 

multiple refinements to the media campaign on the basis of earlier findings 

from the Westat study. This seems to be inconsistent with a position of 

major concerns with the fundamental soundness of the study.

Finally, the three research papers that ONDCP cites on page 2 of its 

comments on “Conflicting Evidence from Other Research” all use 

exposure-response methodologies that are analogous to Westat’s and all

attempt to isolate the causal effects of exposure either to ONDCP’s 

campaign or to other media campaigns. Thus, it would seem that ONDCP’s 

Page 46 GAO-06-818 Youth Anti-Drug Media Campaign
comment that efforts to isolate causal effects of media campaigns are 

fundamentally flawed would also apply to these three studies. 

ONDCP indicates that it has sought to improve the performance of the 

media campaign by using the results from the Westat study and other data.

We are aware that ONDCP redirected the campaign in 2002 in response to 

Westat’s interim findings that indicated some negative impacts of the 

campaign on youth marijuana use. However, the 2002 to 2004 Westat study 

results also did not show positive outcomes. Westat’s study is the only 

national evaluation of the campaign. Although Monitoring the Future 

provides context regarding general drug trends among youth, as ONDCP 

has stated: 

“These surveys [MTF, the National Household Survey on Drug Use, and the Youth

Risk Behavior Survey] will permit the determination of whether drug use behavior 

and related attitudes and beliefs changed after the launching of Phase III of the 

Media Campaign in mid-1999. However, they will not be able to answer the critical 

question of whether these changes were the result of the Media Campaign. These 

surveys do not ask respondents about their exposure and reactions to the 

messages of the Media Campaign that can then be linked to their drug-related

attitudes and behavior.”30

More recently in late 2005, ONDCP launched a newly designed campaign. 

The impact of this campaign is not known and should be independently 

evaluated. 

ONDCP believes we did not provide adequate discussion of studies that 

report findings contrary to those of Westat. Our report mentions two of 

the three studies that ONDCP identifies—the Longshore and Palmgreen 

studies. Our report does not mention the third study, Slater, because it 

focused on a different anti-drug media campaign approach and not on the 

ONDCP media campaign. Overall, these studies’ findings are not 

necessarily “contrary” to Westat’s findings. Rather, they assess small slices 

of the youth population or particular circumstances (such as other 

programs that could reinforce an anti-drug message) and find some 

positive results. The Westat national findings do not preclude the findings

of positive results for some subpopulations of youth. The Palmgreen study, 

ONDCP Made Campaign 

Changes as a Result of 

Westat Interim Findings 

Other Youth Drug Use 

Findings 

 30Office of Programs, Budget, Research and Evaluation, Office of National Drug Control

Policy, “Youth Drug Use and the National Youth Anti-Drug Media Campaign,” February,

2001 (Washington, D.C.: Executive Office of the President), p. 16. 

Page 47 GAO-06-818 Youth Anti-Drug Media Campaign
for example found a positive effect for the media campaign on highsensation-seeking youth, but did not find an effect on non-high-sensationseeking youth in the two moderate size communities in which the study 

was conducted. The distribution of these youth in the nationwide 

population could be consistent with both studies being correct. Our 

objective was to assess the Westat study as a national evaluation of the 

impact of the national campaign. In the Slater study, after being trained in

the use of campaign media materials, leaders in each of eight communities 

that received a media campaign were allowed to develop their own media 

strategies and were able to use whatever materials they chose or 

developed on their own. This approach emphasized the flexibility to adopt

different media strategies deemed appropriate by individual communities 

and not the use of a single national strategy. 

ONDCP expressed concern that we had not discussed Westat’s hypothesis 

concerning why the campaign might have contributed to youth 

experimentation with marijuana. We are unable to draw a conclusion 

about this hypothesis based on Westat’s report, nor do we have additional 

information upon which to base an assessment. ONDCP also faults our 

report for not discussing other potential competing explanations for the 

substantial downturn in teen drug use and increase in anti-drug attitudes.

Although this is beyond the objectives of this report, we note that multiple 

other indicators of youth responsibility also seem to be trending in a 

positive direction at the same time that MTF reports declines in youth drug 

use. For example, from 1991 through 1999, the teen pregnancy rate 

declined by 27 percent and from 1991 through 2002, the teen birth rate fell

30 percent. Similarly, the number of juvenile homicides declined by 

44 percent from 1993 to 2002, and the juvenile violent crime arrest rate fell 

by more than 40 percent from 1994 to 2003. All of these trends—including 

declines in drug use—could be related to broader environmental, familial, 

or other influences. The coincidence of these trends with drug use trends 

indicates that factors other than the campaign could be responsible for the 

decline in drug use and points to the necessity of trying to isolate the 

effects of the campaign, rather than relying upon simple correlations. 

Steps Taken to Remedy 

Potential Problems 

ONDCP states that it has taken extensive “due diligence” steps that are 

briefly acknowledged in our report, but that our report “fails to 

acknowledge the thoroughness of our actions to identify, assess, and 

attenuate any possible negative consequences of the campaign once 

Westat reported the possibility of such an effect.” Apart from those actions 

described in Westat’s evaluation reports, a full discussion of the steps that

ONDCP took in response to Westat’s interim evaluation reports that 

highlighted the possibility of unintended negative consequences of 

Page 48 GAO-06-818 Youth Anti-Drug Media Campaign
exposure to the campaign on youth initiation of marijuana was not salient

to our assessing whether Westat took appropriate steps to address the 

evaluation implementation challenges that it faced. However, Westat’s 

findings for the period from 2002 to 2004 showed that the campaign also 

was not effective after ONDCP took these steps. 

ONDCP states that the campaign is substantially different from what it 

was when the last data were collected by Westat more than 2 years ago.

We are not in a position to comment on ONDCP’s new campaign (“Above 

the Influence”), launched in November 2005, as these current efforts are 

beyond the scope of our report and outside the time frame of the Westat 

data collection. At this time, neither we nor ONDCP have empirical 

information with which to assess this revised campaign. However, 

Westat’s evaluation showed that neither the campaign as initially 

implemented nor the redirected campaign implemented after 2002 was 

effective. Hence, although a new and improved campaign may be effective,

Westat’s findings raise concerns about whether any campaign can affect 

youth drug use, especially since the lack of effect does not seem to be 

related to recognition of campaign ads, but rather to subsequent impact on

attitudes and behaviors. Finally, ONDCP cites the receipt of awards from 

both the advertising and communications industry for its newest 

campaign. While laudable, these awards are not evidence that the new

campaign will change youth drug attitudes and behavior. Only an 

independent evaluation can assess the current campaign’s effectiveness. 

ONDCP stated that there is growing research evidence showing that 

asking people a question about their future behavior influences the 

subsequent performance of the behavior in question. ONDCP then 

indicates that the use of a panel design for the Westat study with repeated

interviews of youth concerning drug attitudes and behaviors might, itself, 

have resulted in increased perceptions that drug use is widely pervasive 

among youth. If, during the course of the Westat study, ONDCP and NIDA, 

who acted as monitor for the study, felt that the study itself—that repeated 

interviews of youth by Westat concerning the campaign and drug attitudes 

and behavior—was resulting in a negative effect, it would have been 

appropriate for them to discontinue the study to avoid potential harm to 

subjects. Although ONDCP raised this issue in its comments to us, neither

ONDCP nor NIDA mentioned this issue in any of our previous meetings 

specific to this engagement. 

ONDCP Cites Major 

Changes in Campaign 

ONDCP Offers an 

Alternative Explanation 

for Counterintuitive 

Results 

Page 49 GAO-06-818 Youth Anti-Drug Media Campaign
ONDCP said that the “long delay” in receiving our assessment of the 

Westat report has prevented it from making progress on the next round of 

evaluation. We note that Westat’s draft final report was not made available 

to us until spring 2005 (not 2 years ago as seems to be indicated in 

ONDCP’s comments). The volume of reports from the 41⁄2-year study, and 

the complexity of the review required a great deal of time from our most 

skilled social scientists and statisticians. Time was required to ensure that 

our review of the Westat study was both comprehensive and correct. 

ONDCP said that our matter for congressional consideration—that 

Congress consider limiting appropriations until ONDCP is able to provide 

credible evidence of the effectiveness of exposure to the campaign on 

youth drug use outcomes—offers insufficient detail concerning how to 

demonstrate satisfactory evidence of progress and that it was puzzled by 

our lack of recommendations to ONDCP for improving the campaign. Our 

mandate was to assess Westat’s evaluation and to draw conclusions about 

the reliability of its findings so that Congress could make decisions about 

funding for the campaign, and developing suggestions for improvements to 

the media campaign itself was beyond our scope. In so doing, we focused 

on Westat’s methods and efforts to address challenges in implementing the 

evaluation. Our matter for congressional consideration was intended to 

allow ONDCP to explore a number of approaches to providing credible 

evidence of campaign effectiveness to Congress. Our report clearly 

indicates that one approach is the one applied in the Westat evaluation,

which is the focus of this report, but we do not want to rule out other 

approaches. At the same time, we acknowledge that providing such 

evidence is not easy. 

ONDCP states that further budget cuts to the campaign could have farreaching and unfavorable consequences in youth drug use. Given that the 

Westat findings show that the campaign was not having a positive impact, 

we found no evidence that a reduction in campaign advertisements would 

have a negative impact. ONDCP cites the 2005 MTF as an indicator of 

media campaign effectiveness by indicating that the reduction in anti-drug 

messages has resulted in a flattening of 8th graders’ perception of risk. 

Again, as ONDCP has indicated, the relationship cannot be assessed with 

MTF because it does not ask respondents about their exposure and 

reactions to the messages of the media campaign that can then be linked

to their drug-related attitudes and behaviors. 

ONDCP Takes Issue with 

the Timing of Our Review 

Points Concerning Our 

Matter for Congressional 

Consideration 

ONDCP Posits 

Consequences of Further 

Budget Cuts 

Page 50 GAO-06-818 Youth Anti-Drug Media Campaign
Failure to continue the media campaign’s efforts, according to ONDCP, is 

“raising a white flag to those who favor drug legalization, with the 

expectation that youth drug use soon would begin to rise, reversing years 

of hard-earned positive news.” In our view, on the other hand, 

continuation of programs that have been demonstrated not to work diverts 

scarce resources from programs that may be more effective. 

We are sending copies of this report to other interested congressional 

committees and the Director of the Office of National Drug Control Policy. 

We will make copies of the report available to others upon request. In 

addition, the report will be available at no charge on GAO’s Web site at 

http://www.gao.gov. 

If you or your staff have any questions about this report, please contact 

either Nancy Kingsbury at 202-512-2700 or by e-mail at 

KingsburyN@gao.gov or Laurie Ekstrand at 202-512-8777 or by e-mail at 

EkstrandL@gao.gov. Contact points from our Offices of Congressional 

Relations and Public Affairs may be found on the last page of this report. 

Key contributors are listed in appendix III. 

Sincerely, 

Nancy Kingsbury, Managing Director 

Applied Research and Methodology 

Laurie E. Ekstrand, Director 

Homeland Security and Justice 

Page 51 GAO-06-818 Youth Anti-Drug Media Campaign
Appendix I: W

Ev

estat’s Methods for Addressing 

aluation Implementation Issues 

Page 52 GAO-06-818

Appendix I: Westat’s Methods for Addressing 

Evaluation Implementation Issues 

This appendix provides additional details about how Westat’s addressed 

evaluation implementation issues related to the coverage of the National 

Survey of Parents and Youth (NSPY), sample attrition, and its analytic 

methods. 

Coverage in the NSPY The NSPY was a nationwide household survey of youth aged 9 to 18 and 

their parents. Westat used a dual-frame sampling frame—or list of the 

members of the population from which the sample was ultimately 

selected. One frame—the area frame—consisted of housing units that had

been built by late 1991; the second frame—the building permit frame—

consisted of building permits issued between January 1990 and December 

1998 for new housing.1

 Combined, these frames constituted an estimated

98 percent of dwelling units nationwide that existed by the end of 1998. 

A household had to meet two criteria in order to be eligible to be included 

in the NSPY sample: It had to (1) contain children within a specified age 

group and (2) be a housing unit that was built before April 1, 1990, was a 

mobile home, or was selected from a roster of building permits for new 

housing units issued between January 1990 and December 1998. To

identify households that met these conditions, Westat drew a sample of 

dwelling units and from this sample it screened households to determine 

their eligibility for inclusion in the NSPY, that is, whether a household 

contained children in a specified age group, where the specified age 

groups were children aged 9 through 13, 12 and 13, or 9 through 18. 

According to estimates provided by Westat, after completing enrollment in 

the NSPY—which occurred during waves 1 through 3—the NSPY sample 

covered more than an estimated 95 percent of occupied dwelling units 

(households) nationwide. From its sample of occupied dwelling units, 

Westat developed rosters of households that were believed to contain 

youth in the target age range. At this second stage of sample enumeration, 

Westat experienced a drop-off in the coverage of households that were 

 1

Housing units built after 1998 had no chance of selection in either sampling frame. Also, a

housing unit had no chance of selection if it had been built during the 1990s in a

jurisdiction where no permit was required. Finally, modular housing built during the 1990s

was inadvertently omitted from the permit sample. Any biases resulting from excluding

housing units built after 1999 are likely to be small, as they constituted a small fraction of 

all housing units in the NSPY sampling frame, and they were accounted for by Westat’s 

poststratification adjustments. For example, housing units built after April 1999 accounted

for an estimated 1.0 percent of all housing units in existence in the time period covered by

the wave 1 sample. 

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believed to be eligible for inclusion in the sample. The number of eligible

households enumerated in the NSPY was 30 percent smaller than the 

number expected from the 1999 Current Population Survey (CPS) data. 

According to Westat, coverage losses in the NSPY could have occurred for 

several reasons: (1) because an interviewer may have decided to classify a 

household as an ineligible household rather than as a nonresponding 

household, (2) because the household respondent took cues from the 

screening questions to avoid selection into the sample by giving an 

incorrect answer, or (3) because the doorstep enumeration process was 

considered to be intrusive. Westat reported that it could not conclusively 

rule out the first explanation for coverage losses. However, it undertook 

sample validation procedures that examined whether ineligible

households in the recruitment waves were misclassified, and it found 

none. Neither Westat nor the National Institute on Drug Abuse reported 

that undercoverage was primarily due to respondents avoiding selection

into the sample by taking cues from the screening questions and giving

incorrect answers as a way to avoid selection into the sample. Overall, 

Westat reported that the main reason for undercoverage was the rostering 

component of the survey, which required actual entry into the home, and 

led to “a great many respondents” asking the interviewer to come back at a 

later date, only to repeat the request when the interviewer reappeared. 

Westat inferred that this represented passive refusal to participate. 

Therefore, according to Westat, most of the coverage losses occurred 

during the doorstep screening process in which simple, focused screening 

questions about the composition of the household were used to identify 

households from which to sample eligible youth.

NSPY and CPS 

Comparisons of 

Distributions on Analyzed 

Variables

In response to questions from us, Westat provided data that indicated that 

the coverage losses in the NSPY did not result in differences in the 

estimated distributions of population characteristics from the NSPY as 

compared with those estimated from the CPS data. In other words, the 

distributions of characteristics of eligible households with youth included 

in the NSPY were broadly consistent with a variety of corresponding 

distributions from the 1999 Current Population Survey. 

The comparisons of NSPY-estimated populations to CPS-estimated 

populations were based on weighted NPSY estimates, where the weights 

adjusted for nonresponse at the doorstep and household enumeration 

(roster) stages, and the weights also reflected the differential probabilities 

of retaining a household for the NSPY depending on the screener group to

which it was applied. These weights were calculated prior to Westat’s 

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poststratification calibration techniques, which brought the estimated 

NSPY population totals into line with the estimated CPS population totals. 

Hence, if upon using the weights based only on the probability of selection 

and nonresponse adjustments, the population characteristics in the NSPY

differed widely from those derived from the CPS, this would constitute 

evidence of potential bias in the NSPY sample due to undercoverage. 

Westat compared NSPY and CPS distributions for each of the three 

enrollment waves of the NSPY (waves 1 through 3) on several variables, 

including the race/ethnicity of the householder and the presence of males 

28 years of age or older, the distribution of eligible households by the age 

of the youth in the household, the age and gender distributions of youth, 

and the age distributions of youth by race and ethnicity. Each of these 

comparisons involved discrete subgroups within the focused 

subpopulation of the NSPY. The largest differences between the NSPY and 

CPS estimates arose in the comparison of the distributions by 

race/ethnicity of household and the presence of a male 28 years of age or

older in the household. Some of these differences could also arise from 

sampling variance, as both the NSPY and CPS estimates are based on 

samples that are subject to sampling errors. Although Westat did not 

provide sampling errors with the estimates that it provided to us, some of 

the differences in distributions could be apparent, as opposed to real,

differences, in statistical terms. 

Undercoverage in the 

NSPY and Other Widely 

Known and Used 

Longitudinal Surveys 

Coverage issues are not an uncommon problem with surveys that focus on

relatively small subpopulations within a larger population, such as 

occurred with the NSPY’s focus on youth aged 9 to 18. The NSPY’s target 

population of households with youth aged 9 to 18 focused on a 

subpopulation that, according to 1999 CPS data, constituted about 

25 percent of the roughly 104 million households in the United States. 

The estimated extent of undercoverage of eligible youth in the NSPY was 

comparable to the extent of undercoverage in other well-known and 

widely used longitudinal surveys. Both the National Longitudinal Survey of

Youth (NLSY)—sponsored by the Bureau of Labor Statistics—and the 

National Immunization Survey of Children (NIS)—sponsored by the 

National Immunization Program (NIP) and conducted jointly by the NIP 

and the National Center for Health Statistics of the Centers for Disease 

Control and Prevention—focus on specific subpopulations, and both 

experienced undercoverage that was comparable to that of the NSPY. The 

1979 NLSY is a nationally representative sample of men and women born 

in the years 1957 to 1964 who were ages 14 to 22 when first interviewed in

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1979. It had a coverage rate of 68 percent. The 1979 NLSY has been widely

used and cited to examine a wide variety of policy issues. As documented

in the National Longitudinal Surveys’ annotated bibliography, about 

3,100 journal articles, working papers, monographs, and other research 

documents have been catalogued as having used the 1979 NLSY data. The

target population for the NIS is children between the ages of 19 and 

35 months living in the United States at the time of the interview, and it 

has been conducted annually since 1994. The survey involves the selection 

of a quarterly probability sample of telephone numbers, and the coverage 

has been about 20 percent lower than estimated by two other benchmark 

surveys. Survey data are used primarily to monitor immunization coverage 

in the preschool population in the nation and to provide national, state, 

and selected urban area estimates of vaccination coverage rates for these 

children. 

Sample Attrition across 

NSPY Interview Rounds 

In the NSPY, respondents initially recruited into the sample were to be 

tracked for three additional survey rounds that covered about a 3-year 

period following the recruitment round. By the final survey round of the 

NSPY, the cumulative response rate—the percentage of youth or parents 

in eligible households that completed all four interviews—reached

between 50 percent and 55 percent. These cumulative response rates after 

four survey rounds were determined largely by the response rates during 

the enrollment waves, as postenrollment, Westat was able to track, 

contact, determine eligibility for reinterview, and complete interviews for 

between 82 percent and 94 percent of previously interviewed respondents 

between two successive interview waves. The response rates achieved for 

the first three survey waves—the enrollment waves—were generally 

similar. Specifically, about 74 percent to 75 percent of the dwelling units 

determined to be eligible for the survey in waves 1 through 3 completed 

the household enumeration (or rostering of youth). After obtaining 

consent to conduct interviews from parents and youth, interviewers 

completed extended interviews—that is, completed the full NSPY 

questionnaire—with about 91 percent of the sampled youth in each of 

waves 1 through 3. Among sampled parents, about 88 percent gave

consent and completed extended interviews in the enrollment waves. 

(See table 2.) 

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Table 2: NSPY Survey Rounds and Response Rates, Sampled and Surveyed Youth 

Rounds and stages of sampling Survey waves 

Round 1: enrollment waves Wave 

1 

Wave 

2 

Wave 

3 

• Percentage of sampled dwelling units for which eligibility was determined 95.1% 95.7% 95.5%

• Percentage of eligible dwelling units completing household roster 74.4% 74.6% 75.3%

• Percentage of youth completing interview 90.3% 91.9% 91.2%

• Cumulative (overall) response rate, enrollment waves 63.8% 65.5% 65.5%

Round 2: first follow-up Wave 4 Wave 5 

• Percentage of dwelling units (from prior wave) refielded for follow-up 94.2% 92.9%

• Percentage of refielded dwelling units for which eligibility was determined 86.8% 93.8%

• Percentage of youth completing interview 93.5% 93.6%

• Cumulative (overall) response rate 54.1% 58.4%

• Follow-up (conditional) longitudinal response rate 82.2% 88.8%

Round 3: second follow-up Wave 6 Wave 7 

• Percentage of dwelling units (from prior wave) refielded for follow-up 85.1% 89.8%

• Percentage of refielded dwelling units for which eligibility was determined 93.1% 92.8%

• Percentage of youth completing interview 94.7% 93.8%

• Cumulative (overall) response rate 53.1% 56.0%

• Follow-up (conditional) longitudinal response rate 93.4% 91.6%

Round 4: third follow-up Wave 8 Wave 9 

• Percentage of dwelling units (from prior wave) refielded for follow-up 78.7% 83.5%

• Percentage of refielded dwelling units for which eligibility was determined 95.9% 94.8%

• Percentage of youth completing interview 94.0% 94.3%

• Cumulative (overall) response rate 50.2% 53.4%

• Follow-up (conditional) longitudinal response rate 92.4% 93.4%

Source: Westat, June 2005. 

Across the three follow-up rounds of the NSPY, Westat achieved between

an 82 percent and a 94 percent longitudinal response rate. Follow-up 

required that respondents be tracked over time and across places, as 

persons enrolled in the sample could move, and their eligibility for a 

follow-up interview had to be determined. For example, youth who turned 

19 years of age between survey rounds would no longer be eligible for 

reinterview, as they were beyond the target age of the campaign. Efforts to 

track individuals prior to the second survey round included verifying 

address change information with the U.S. Postal Service and obtaining 

location information from a national database company. Westat obtained

updated location information from these sources, and telephone 

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interviewers placed calls to these households to verify the identity of 

respondents. According to Westat, a high proportion of the households 

that moved were contacted and respondents verified their new addresses. 

During the third and fourth survey rounds, Westat used procedures to 

track and verify addresses that were similar to those used to track 

respondents from the first to second survey rounds, although Westat 

modified these procedures as necessary. The key eligibility requirement 

for youth for a follow-up interview was the youth had to be 18 years of age

or younger at the time of the interview. 

For the first follow-up round—waves 4 and 5—Westat located individuals 

and determined eligibility for 92 percent of the youth and 92 percent of the 

parents who completed an initial interview during the first round of the 

survey—that is, in waves 1, 2, and 3, and of these youth who were still 

eligible, 94 percent completed an interview. Among parents from the first 

round who were tracked and determined to be eligible in the second 

round, 92 percent completed a second round interview. In the third and 

fourth survey rounds of the NSPY, between 96 percent and 97 percent of 

the youth and parents who had completed prior round surveys were 

tracked and determined to be eligible, and of these, the youth response 

rates were 96 percent and the parent rates were 95 percent. 

Comparisons of 

Respondents and 

Nonrespondents across 

NSPY Survey Waves 

Even with the relatively high follow-up response rates that Westat 

achieved, it is possible that respondents could differ from nonrespondents 

in follow-up rounds, and if so, the NSPY estimates of the effects of 

exposure on outcomes would be biased. Westat provided data that 

compared nonrespondents to the respondents across the three enrollment 

waves, indicating that with some differences, nonrespondents were 

generally similar to respondents with respect to characteristics that might 

affect survey outcomes. Nonrespondents were compared to respondents 

on gender, age at interview, whether both parents were in the household,

the number of youth in the household, the type of household dwelling, and 

the type of area in which the household was located. For example, apart 

from the three differences below, nonrespondents and respondents were 

similar in characteristics across survey waves: In the three enrollment 

waves, nonrespondents were proportionately older youth than 

respondents; in waves 2 and 3, there were proportionately more youth 

living in cities among nonrespondents than respondents; and in wave 1,

there were proportionately more youth in the building permit sample 

among nonrespondents than respondents. 

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Westat compared estimates of drug-use prevalence from the NSPY data 

with those obtained from other national surveys such as Monitoring the 

Future (MTF). While the NSPY estimates of marijuana use prevalence 

differ over some periods covered by the NSPY from those derived from the 

MTF survey of youth in school, differences between the two surveys’ 

sampling frames and methodologies mean that direct comparisons 

between the two surveys must be made with caution and must take the

methodological differences into account. Specifically, MTF showed a 

decline in marijuana use for some teenage groups during the 2000 to 2002 

period, while the NSPY showed the increases reported above. However, 

the difference in drug use rates reported from the two surveys could 

plausibly arise from differences in the sampling frames. The MTF sampling 

frame covers only youth who are in school and not those who drop out of

school, who are truant on the survey day, or who are 17- and 18-year-olds 

who have graduated from high school. To the extent that high school 

dropouts and truants have more involvement with drugs than those who 

stay in school, the MTF estimates of drug use may underrepresent drug 

use among all youth of high school age. By comparison, the NSPY 

household survey includes youth who are not enrolled in school in its 

sampling frame. To the extent that dropping out of high school is 

correlated with drug use, and given that dropouts are excluded from the 

MTF sampling frame, differences in drug use between MTF and NSPY 

could reflect the fact that youth enrolled in high school reported drug use 

at different rates from all youth in the general population covered by the 

NSPY, which would include dropouts who may be at higher risk of using 

drugs. 

One challenge in designing surveys to evaluate changes in outcomes as the 

result of an intervention lies in selecting a sample with sufficient power to 

detect differences between groups—including the same individuals at two 

points in time—or significant associations among variables, such as 

between levels of exposure to the campaign and outcomes. Sample size is 

a major factor determining a study’s power to detect differences, and 

while larger sample sizes will generally allow researchers to detect smaller 

differences over time, as the size and power of a sample to detect changes

increases, so too generally does its cost. 

Differences in Sampling 

Methodologies between 

NSPY and MTF 

The Capacity of the NSPY 

to Detect Reasonably 

Small Effects 

In consultation with the National Institute on Drug Abuse (NIDA), Westat 

chose to compute power for analyses of annual change in a prevalence 

statistic—that is, change in the percentage of a population that reported an 

outcome. For purposes of its power analysis, Westat chose to assume 

different baseline prevalences for parents and for youth of all ages and to

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assume that the study should be able to detect reliably declines of 

specified sizes. For example, for youth of all ages, Westat assumed a 

baseline prevalence of 10 percent and determined the power of its sample 

for detecting a minimum downswing in an outcome—such as past-month 

drug use—of 2.3 percentage points over a year.2

 The power of the sample 

to detect this difference was well within conventional power criteria.3

As reported above, the sizes of differences that Westat’s sample could 

detect were consistent with the Office of National Drug Control Policy’s 

(ONDCP) goals for the campaign. In early meetings on the design of the 

evaluation of the media campaign, ONDCP officials reported that ONDCP

had a specific Performance Measures of Effectiveness (PME) system and 

that the campaign was embodied within the first goal of the National Drug 

Strategy, which was to “educate and enable America’s youth to reject 

illegal drugs as well as the use of alcohol and tobacco.” Under this goal, 

ONDCP’s PME proposed targets for reducing the prevalence of past-month 

use of illicit drugs and alcohol among youth from a 1996 base year: by

2002, reduce this prevalence by 20 percent, and by 2007, reduce it by 

50 percent. ONDCP officials further identified specific targets for the 

media campaign, again with respect to a base year of 1996: by 2002, 

increase to 80 the percentage of youth who perceive that regular use of 

illicit drugs, alcohol, and tobacco is harmful; and by 2002, increase to 

95 the percentage of youth who disapprove of illicit drug, alcohol, and 

tobacco use. To achieve a goal of 80 percent of youth who perceive that 

regular use of marijuana is harmful would require increasing the 1996

baseline percentage of youth perceiving marijuana as harmful from 

60 percent, as measured by MTF, or by about 3.3 percentage points per 

year from 1996 to 2002. Westat’s sample had sufficient power to detect this 

amount of annual change in youth attitudes. 

The power of the NSPY to detect changes in outcomes due to exposure to

the campaign also presumes that it was possible to accurately measure 

and characterize exposure to the campaign by the reported number of 

advertisements recalled by respondents. While the general question of 

 2

The power to detect differences for upswings in prevalence would depend upon the

baseline level. However, the power to detect an upswing from a baseline of 90 percent of 

youth would be exactly the same as that for detecting a downswing from a 10 percent

baseline.

3

Specifically, the minimum detectable difference for wave-to-wave changes was at least 

80 percent using a one-sided hypothesis test at the 0.05 level. 

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how exposure to advertisements affected respondents was beyond the 

scope of the evaluation, if by exposure is meant a recognition-based 

task—or encoded exposure—then the NSPY measures of exposure can be 

viewed as valid. According to communications researchers, often what is

of interest to campaign planners and evaluators is whether the 

presentation of campaign content generates at least a memory trace in

individuals. At this point, a potential audience member can be said to have 

engaged the campaign’s presentation in a meaningful sense, and this is 

what is meant by encoded exposure. To measure exposure to the 

campaign for both youth and parents, NSPY interviewers asked 

respondents about their recall of specific current or very recent television

and radio advertisements.4

There was variation in recall of advertisements by both youth and parent 

respondents, and this type of variation is needed in order to examine 

associations between levels of exposure and outcomes. For example, for 

the entire campaign, youth reported a median of 12 exposures per month, 

and 76.7 percent reported 4 or more exposures per month. Comparatively 

few youth—about 6 percent—reported less than 1 exposure per month. 

Youth recall of specific exposure also varied, as 41.2 percent of youth 

reported 12 or more television exposures per month throughout the 

campaign while reporting a median of 4.4 exposures to television 

advertisements. Additionally, Westat’s measures of exposure and 

outcomes have demonstrated sensitivity to detect favorable campaign 

effects among parents. 

Westat’s test for associations between exposure and outcomes—the 

gamma coefficient—was an ordinal test statistic for whether two variables 

(e.g., exposure and marijuana use initiation) have a montonic, but not 

necessarily a linear, relationship. Therefore, were there nonlinear 

relationships, its test would have allowed for them. Finally, nonrandom 

measurement error in the measure of exposure is unlikely to have biased 

estimates of campaign effects, as if the nonrandom measurement error 

were constant, it would not affect measures of association, and if it was 

not constant, it would be addressed by Westat’s statistical methods. 

 4

Each respondent was presented ads that had been broadcast nationally in the 2 calendar

months prior to the interview.

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Westat measured a variety of outcomes for youth and parents and took 

steps to ensure that the measures were consistent with existing research. 

The youth questionnaires included numerous questions that were designed 

to measure exposure to the campaign advertisements and other anti-drug 

messages. The youth question domains included exposure propensity to 

media; current and past use of tobacco, alcohol, marijuana, inhalants, and 

Ecstasy; past discussions with and communication of anti-drug messages 

from parents and friends; expectations of others about respondent’s drug 

use; knowledge and beliefs about the positive and negative consequences 

of drug use; exposure to campaign messages; family and peer factors; 

personal factors; and demographic information. Westat used two separate 

questionnaires for youth of different ages; one questionnaire was used for 

children (aged 9 to 11) and another one was used for teens (aged 12 to 18). 

Westat Methods to 

Measure Outcomes 

The NSPY parent questionnaire also included numerous questions that 

were intended to measure parents’ exposure to the campaign’s messages 

and other anti-drug messages. The question domains for parents included 

media consumption; past discussions with child about drug attitudes and 

avoidance strategies; past child monitoring behaviors; self-efficacy of 

discussing drugs with child and monitoring of child’s actions; belief that 

the child is at risk of drug use; belief that drug use has bad consequences; 

exposure to the campaign’s advertising, including brand recognition; 

parent’s own current and past use of tobacco, alcohol, and drugs; and 

demographic information. 

Westat followed generally accepted procedures in developing the survey

instruments for the NSPY by using information from a prototype prepared 

by NIDA and using information from other surveys that addressed youth 

drug use and prevention. Prior to the phase III evaluation, and in 

preparation for the NSPY, NIDA convened an expert panel to assist in the 

development of the youth and parent questionnaires. The panel, which 

consisted of experts in adolescent drug use prevention and parenting 

behaviors, drafted NSPY survey questionnaires for children, teens, and 

parents, and NIDA shared these prototypes with Westat at the beginning of 

Westat’s evaluation contract. In developing the final questionnaire for the

NSPY, Westat created a questionnaire development team consisting of 

evaluation experts. In developing the final NSPY questionnaires, the 

Westat team reviewed NIDA’s prototype and other surveys. 

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Westat measured youth drug use by self-reported data on use. We have 

previously cautioned about limitations associated with self-reported data

on youth drug use.5

 Additionally, the National Research Council (NRC) of 

the National Academy of Sciences also has pointed out limitations 

associated with self-reported drug use in national surveys such as the 

National Survey of Drug Use and Health (NSDUH) and MTF.6

 As NRC has 

pointed out, while self-reported data on drug use may have limitations for 

estimating the actual levels of use at a particular point in time, they may 

not suffer from these same limitations when they are used to assess 

changes in use over time, unless there is reason to believe that attitudes 

about drug use change in ways that affect respondents’ willingness to 

honestly report drug use, or stigma. 

Specifically, if there is a stigma associated with self-reporting drug use, 

that stigma may affect the levels of use reported, as some have argued that 

the propensity of respondents to give valid responses may be affected by 

social pressures. In particular, the incentive to give false negative reports

may increase over time if drug use becomes increasingly perceived as 

harmful or socially unacceptable. Using data from NSDUH and MTF, NRC 

showed an inverse relationship between the percentages of respondents 

who either disapproved of illegal drug consumption or perceived it to be

harmful. Thus, as stigma increased, self-reported drug use decreased. As 

NRC cautioned, one could interpret this relationship as indicating that 

changes in stigma are associated with changes in invalid reporting, or as 

stigma increases, false negative reports increase, rather than necessarily 

indicating that as stigma increases, drug use decreases. 

The NRC analysis leads to two inferences: First, if social stigma remains 

constant over time, changes in the propensity to give valid responses 

would be unaffected and estimates of change in self-reported drug use 

would not be biased by social stigma. For the evaluation results, this 

would imply that its measures of changes in self-reported drug use would 

provide valid measures of changes in use, so long as factors other than 

stigma did not affect the propensity to self-report use. Second, if the social

stigma associated with reporting drug use is inversely related to 

disapproval of illicit drug use or increased perceptions that it is harmful, 

 5

GAO: Drug Use Measurement: Strengths, Limitations, and Recommendations for 

Improvement, GAO/PEMD-93-18 (Washington, D.C.: June 25, 1993). 

6

National Research Council, Informing America’s Policy on Illegal Drugs: What We Don’t 

Know Keeps Hurting Us. National Academy Press, Washington, D.C.: 2001. 

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then the estimates of self-reported drug use are likely to decrease as a 

result of the stigma. According to results from the evaluation, trends in 

youth attitudes and beliefs about illicit drugs changed significantly over 

the entire campaign in a direction that was favorable to the campaign. 

Specifically, the trends in youth attitudes and beliefs about illicit drug use 

meant that youth were more likely to believe, as the campaign went on, 

that use of illicit drugs was likely to have negative consequences. 

Alternatively, the social stigma associated with drug use increased over 

time. If the relationship between stigma and reporting that NRC found 

held and applied to the data in the evaluation of the campaign, this would 

imply that the increased stigma associated with drug use would lead to 

decreases in self-reports of drug use over time. 

To control for the many factors that could have influenced both exposure 

and outcomes independently of, or in conjunction with, the campaign, 

Westat used propensity scoring methods to match individuals based on 

numerous measured attributes and to create groups of individuals who 

differed on their underlying propensity to be exposed to different levels of

campaign advertisements. A propensity score is a weighted sum of the 

individual effects of variables in a model that predicts the likelihood of 

exposure to campaign messages. Westat’s propensity scoring methods 

resulted in the creation of groups of individuals who were statistically 

similar on exposure propensities. These groups can be considered as 

statistical analogues to randomly assigning individuals to different levels 

of exposure. After creating these groups, Westat then analyzed outcomes 

between the groups having different propensities to be exposed to 

campaign messages. 

Westat’s Analytic 

Methods 

Westat used ordinal logit models to estimate the chances of being 

exposed, where exposure was measured alternatively as a three- or fourlevel variable—e.g., low, medium, or high exposure.7

 Westat used a myriad 

of variables to predict exposure levels in both the youth and parent 

models. For example, in the youth models, the propensity score models 

included measures of demographic attributes, educational attainment and

educational aspiration, family and parent background, parent consumption 

 7

Propensity score methods have been demonstrated to be robust against bias associated 

with the specification of incorrect functional forms—e.g., linear rather than quadratic— 

of variables. 

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of television and other media, income and employment, reading habits, 

Internet usage, location of residence in urban areas, among other 

variables. After estimating models, Westat also assessed the balance of 

variables in its propensity models. For propensity models to remove the 

effects of confounding variables from the association between exposure 

and response, it is necessary that the population means of the confounder 

variables not vary across exposure levels. If a confounder is successfully 

balanced, then it will have the same theoretical effect across all exposure 

levels. 

The net result of the propensity scoring models is to provide each 

individual with a score that reflects the individual’s propensity to recall

advertisements based upon a weighted sum of all of the variables in the 

model. Therefore, while two individuals may differ on the likelihood that a 

particular variable affects their chances of being exposed to messages or 

on their levels of a certain variable—such as age or education—they could 

be similar in their overall propensity to be exposed to campaign messages 

if the differential effects of any individual variables sum to the same total 

propensity. 

In order for the results of propensity methods to be valid, it is important 

that the propensity scoring models include all relevant variables that could 

otherwise explain differences in both exposure and outcomes. Propensity 

score models can adjust only for confounding variables that are observed 

and measured. In other words, they are built upon the assumption that all

relevant variables are measured and controlled for. If an important 

variable is omitted from the propensity model, the results of analyses may 

be affected. Westat made reasonable attempts to identify and control for a 

variety of confounding variables, include them in its models, and reduce 

bias. 

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National Drug Control Policy 

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National Drug Control Policy 

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National Drug Control Policy 

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National Drug Control Policy 

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Appendix II: Comments from the Office of

National Drug Control Policy 

Page 71 GAO-06-818 Youth Anti-Drug Media Campaign
Appendix III: GAO

A

 Contacts and Staff 

cknowledgments 

Page 72 GAO-06-818

Appendix III: GAO Contacts and Staff 

Acknowledgments 

Nancy Kingsbury, 202-512-2700 

Laurie E. Ekstrand, 202-512-8777 

In addition to the contacts named above, contributors to this report 

included David P. Alexander, Billy Commons, James Fields, 

Kathryn Godfrey, Mary Catherine Hult, Jean McSween, Karen V. O’Conor, 

Mark Ramage, William J. Sabol, Barry J. Seltser, and Douglas Sloane. 

Youth Anti-Drug Media Campaign

GAO Contacts 

Acknowledgments 

(440408) 
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