With youth smoking rates showing little decline since the late 1990’s, the state of North Carolina implemented a multi-component initiative focused on teenage tobacco use prevention and cessation. One component of this initiative is Tobacco.Reality.Unfiltered., or TRU, an anti-tobacco media campaign, aimed at North Carolina youth ages 11–17 years. The primary goal of this campaign is to prevent the initiation of tobacco use, especially cigarette smoking, among youth. This research evaluates the progress that the TRU campaign has made in achieving its short term, i.e. campaign awareness and receptivity, and long term, i.e. prevention of tobacco use, goals using a longitudinal telephone survey of North Carolina youth (N = 502). The results indicate that 45% of North Carolina youth had confirmed awareness of at least one TRU ad, with the majority of youth reporting that the ads were convincing, attention-grabbing, and gave good reasons not to smoke. Latent transition analyses indicate that the probabilities at which youth were transitioning into smoking experimentation were not different for youth who were aware of the TRU campaign versus youth who were unaware of the campaign. These results held regardless of whether smoking initiation was measured using a youth’s lifetime smoking behavior or current smoking behavior. A difference did emerge in the transition probabilities for younger and older youth regarding current smoking behavior, with older youth transitioning into smoking experimentation at a higher rate than younger youth.