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Controlled exposure and naturalistic exposure studies examining the relative effectiveness of different advertising messages for youth. The NCI review of the media and tobacco use described above highlights the difficulty of evaluating the media components of several early quasi-experimental studies of community-based cardiovascular programs because the media elements were combined with other program elements e. However, the evaluations of the overall effects of these programs indicate positive immediate and intermediate effects on smoking levels among youth Vartiainen et al. In contrast, another cardiovascular program aimed primarily at adults, the Stanford Five-City Project, allowed for the examination of the media effects alone and did not show any differences between intervention and control communities in the prevalence of smoking that could be traced to the media component. There was evidence, however, of a strong secular trend that may have reduced the ability to detect effects Winkleby et al.

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