ࡱ> egbcd bjbjVV 2<<B0---8eT-q*#4$$$&. (24\52q4q4q4q4q4q4q$towXq96&&66Xq$$q`D`D`D6$$2q`D62q`D`D np$w-=p*qq0q2pNxCxTpp&xpx66`D66666XqXq`D666q6666x666666666 : Effective Health Communication A literature search using the terms Effectiveness / efficacy, health communication, mass media, social marketing and authors Hornik, Snyder, Maibach, Freimuth, Lefevre, Capella within the following databases Medline, Embase, Health Star, PsycInfo, PubMed and internet search engine Google for articles published between 2004 and 2010 that provided summative data or direct information relating to health communication effectiveness resulted in the following collection of articles. NOTE: Pre-/Post percents and percent changes are highlight in yellow throughout the document. The main findings include: Health communication campaigns are effective if planned, implemented and evaluated well. Health communication campaigns have shown increased awareness, attitude and behaviour results. The following collection of articles including abstract summaries and complete reference highlights when available summative findings as well as theory and principals to apply to increase the effectiveness of health communication. The articles have been tagged with the following codes when appropriate as: Meta analysis or systematic review Multiple campaigns or single campaign Theory/Principles and/or Data (Formative, Process, Summative) and Type (Qualitative, Quantitative) Topic (most frequent include tobacco, nutrition, physical activity, substance use). Apply It! The following recommendations have been highlighted throughout this collection of articles including: Develop long-term campaigns to influence change. Develop health communication campaigns within a health promotion strategy that includes policy and supportive environment changes. Conduct audience analysis include gender specific segmentation to inform message development. Apply theory to audience analysis, message develop and placement to enhance success. Ensure adequate exposure to the messages and conduct process evaluation to assess the exposure. Augment paid ads with earned media and donated ads/PSA to increase message exposure. Campaigns with an enforcement component are more effective than those without. Develop and conduct comprehensive evaluation to assess campaign effectiveness. Gather cost-effective data to inform if the type of health communication is the most effective option. Review the literature to inform campaign benchmarks. Table of Contents:  TOC \o "1-3" Noar, S. M. (2006). A 10-year retrospective of research in health mass media campaigns: where do we go from here?. [Review] [109 refs]. Journal of Health Communication, 11, 21-42.  PAGEREF _Toc131097661 \h 5 Abroms, L. C. & Maibach, E. W. (2008). The effectiveness of mass communication to change public behavior. [Review] [93 refs]. Annual Review of Public Health, 29, 219-234.  PAGEREF _Toc131097662 \h 5 Maibach, E. W., Abroms, L. C., & Marosits, M. (2007). Communication and marketing as tools to cultivate the public's health: a proposed "people and places" framework. BMC Public Health, 7, 88.  PAGEREF _Toc131097663 \h 6 Randolph, W. & Viswanath, K. (2004). Lessons learned from public health mass media campaigns: marketing health in a crowded media world. Annu.Rev Public Health, 25, 419-437.  PAGEREF _Toc131097664 \h 7 Hornik, R. & Kelly, B. (2007). Communication and diet: an overview of experience and principles. Journal of nutrition education and behavior [On-line].  PAGEREF _Toc131097665 \h 7 Gordon, R., McDermott, L., Stead, M., & Angus, K. (2006). The effectiveness of social marketing interventions for health improvement: what's the evidence? Public Health, 120, 1133-1139.  PAGEREF _Toc131097666 \h 8 Maddock, J., Maglione, C., Barnett, J. D., Cabot, C., Jackson, S., & Reger-Nash, B. (2007). Statewide Implementation of the 1% or Less Campaign. Health Education & Behavior, 34,953-963..  PAGEREF _Toc131097667 \h 10 Elder, R. W., Shults, R. A., Sleet, D. A., Nichols, J. L., Thompson, R. S., & Rajab, W. (2004). Effectiveness of mass media campaigns for reducing drinking and driving and alcohol-involved crashes: A systematic review. American Journal of Preventive Medicine, 27, 57-65.  PAGEREF _Toc131097668 \h 11 Snyder, L. B. (2007). Meta-Analyses of Mediated Health Campaigns. In R.W.Preiss, B. M. Gayle, N. Burrell, M. Allen, & J. Bryant (Eds.), Mass media effects research: Advances through meta-analysis. (pp. 327-344). Mawah, NJ: Lawrence Erlbaum Associates.  PAGEREF _Toc131097669 \h 11 Snyder, L. B. (2007). Health communication campaigns and their impact on behavior. Journal of Nutrition Education & Behavior, 39, Suppl-40.  PAGEREF _Toc131097670 \h 12 Snyder, L. B., Hamilton, M. A., Mitchell, E. W., Kiwanuka-Tondo, J., Fleming-Milici, F., & Proctor, D. (2004). A meta-analysis of the effect of mediated health communication campaigns on behavior change in the United States. J Health Communication, 9 Suppl 1, 71-96.  PAGEREF _Toc131097671 \h 12 Bauman, A., Smith, B. J., Maibach, E. W., & Reger-Nash, B. (2006). Evaluation of mass media campaigns for physical activity. Evaluation and Program Planning, 29, 312-322.  PAGEREF _Toc131097672 \h 12 Evans, W. D. (2008). Social marketing campaigns and children's media use. Future of Children,18,181-203.  PAGEREF _Toc131097673 \h 13 Graham, D. J. & Graham, J. F. (2008). Improving media campaigns promoting physical activity: The underutilized role of gender. International Journal of Nonprofit & Voluntary Sector Marketing, Special Issue: Social marketing.13, 205-213.  PAGEREF _Toc131097674 \h 14 Peterson, M., Abraham, A., & Waterfield, A. (2005). Marketing Physical Activity: Lessons Learned from a Statewide Media Campaign. Health Promotion Practice, 6, 437-446.  PAGEREF _Toc131097675 \h 15 The Influence of the VERB Campaign on Childrens Physical Activity in 2002 to 2006  PAGEREF _Toc131097676 \h 15 Huhman, M., Potter,L, Nolin, M.J., Piesse, A., Judkins, D., Banspach, S., Wong, F. (2010) The Influence of the VERB Campaign on Childrens Physical Activity in 2002 to 2006. Am J Public Health. 2010; 100:638645  PAGEREF _Toc131097677 \h 15 Maibach, E. (2007). The influence of the media environment on physical activity: looking for the big picture. Am J Health Promot, 21, 353-62, iii. www.activelivingresearch.org/files/Maibach_AJHP_2007.pdf  PAGEREF _Toc131097678 \h 16 Evans, W. D., Blitstein, J., Hersey, J. C., Renaud, J., & Yaroch, A. L. (2008). Systematic review of public health branding. J Health Commun., 13, 721-741.  PAGEREF _Toc131097679 \h 16 Asbury, L.D, Wong, F.L., Price, S.M, Nolin, M.J. (2008) The VERBTM Campaign Applying a Branding Strategy in Public Health Am J Prev Med 2008;34(6S):S183S187)  PAGEREF _Toc131097680 \h 17 Cismaru, M., Lavack, A. M., Hadjistavropoulos, H., & Dorsch, K. D. (2008). Understanding health behavior: An integrated model for social marketers. Social Marketing Quarterly, 14, 2-32.  PAGEREF _Toc131097681 \h 17 Fishbein, M. & Yzer, M. C. (2003). Using theory to design effective health behavior interventions. Communication Theory, 13, 164-183.  PAGEREF _Toc131097682 \h 17 Maddock, J. E., Silbanuz, A., & Reger-Nash, B. (2008). Formative research to develop a mass media campaign to increase physical activity and nutrition in a multiethnic state. Journal of Health Communication, 13, 208-215.  PAGEREF _Toc131097683 \h 18 Evaluating communication campaigns (2008). Robert Wood Johnson Foundation [On-line]. Available: http://www.rwjf.org/pr/product.jsp?id=31711  PAGEREF _Toc131097684 \h 18 Guilkey, D. K., Hutchinson, P., & Lance, P. (2006). Cost-effectiveness analysis for health communication programs. Journal of Health Communication, Special Issue: Cost-effectiveness analysis. 8 11, 47-67.  PAGEREF _Toc131097685 \h 19 Hutchinson, P. & Wheeler, J. (2006). The cost-effectiveness of health communication programs: what do we know?. [Review] [95 refs]. Journal of Health Communication, 11, Suppl-45.  PAGEREF _Toc131097687 \h 19 Wootan, M. G., Reger-Nash, B., Booth-Butterfield, S., & Cooper, L. (2005). The cost-effectiveness of 1% or less media campaigns promoting low-fat milk consumption. Prev.Chronic.Dis., 2, A05. 19 CostUtility Analysis of the National truth Campaign to Prevent Youth Smoking 19 Holtgrave, D.R., Wunderink, K.A, Vallone, D.M, Healton, C.G. (2009) Cost-Utility Analysis of the Nation truth Campaign to Prevent Youth Smoking. Am J Prev Med 2009; 36 (5). 19 Duffy, M. E. & Thorson, E. (NY). Emerging trends in the new media landscape. Parker, Jerry C.; Thorson, Esther (2009), Health communication in the new media landscape, p 93-116. 19 Social marketin listerv email discussion i 20  A 10-year Retrospective of Research in Health Mass Media Campaigns: Where Do We Go From Here?  Noar, S. M. (2006). A 10-year retrospective of research in health mass media campaigns: where do we go from here?. [Review] [109 refs]. Journal of Health Communication, 11, 21-42. Tags: Multiple campaigns, theory/principles,, multiple topics. Adapted from the abstract: In this article the author discusses the importance of health mass media campaigns and raise the question of whether they are capable of effectively impacting public health. As well as provides a review the literature and discusses what we have learned about the effectiveness of campaigns over 10 years. Followed by a discussion of possible avenues for the health campaign literature over the future 10 years. The overriding conclusion presented is that the literature is beginning to amass evidence that targeted, well-executed health mass media campaigns can have small-to-moderate effects not only on health knowledge, beliefs, and attitudes, but on behaviors as well, which can translate into major public health impact given the wide reach of mass media. Such impact can only be achieved, however, if principles of effective campaign design are carefully followed. ********************** Note: The campaign literature is reviewed from 1996-2005. The author concludes the article with the following paragraph: ..the literature is beginning to amass evidence that targeted, well-executed health mass media campaigns can have small-to-moderate effects not only on health knowledge, beliefs, and attitudes, but on behaviors as well. Given the wide reach that mass media is capable of, a campaign with a small-to- moderate effect size that reaches thousands of people will have a greater impact on public health than would an individual or group-level intervention with a large effect size that only reaches a small number of people (see Glasgow, 2002). Thus, large-scale health campaign efforts can be successful in achieving broad public health impact among communities in the United States and across the world, making further inquiry as to the best means to achieve this impact a worthy venture. (Noar, p 36) The Effectiveness of Mass Communication to Change Public Behavior.  Abroms, L. C. & Maibach, E. W. (2008). The effectiveness of mass communication to change public behavior. [Review] [93 refs]. Annual Review of Public Health, 29, 219-234. Tags: Multiple review articles referenced, theory/principles, data (summative, quantitative), campaign examples include tobacco, seat belt, physical activity, teen pregnancy, family planning, youth mentoring, social capital, From the abstract: This article provides an overview of the ways in which mass communication has been used or can be used -- to promote beneficial changes in behavior among members of populations. We use an ecological perspective to examine the ways in which mass media interventions can be used to influence public behavior both directly and indirectly. Mass media interventions that seek to influence people directly -- by directly targeting the people burdened by the public health problem of concern and/or the people who influence them -- have a long basis in public health history, and recent reviews have clarified our expectations about what can be expected from such approaches. Mass media interventions that seek to influence people indirectly -- by creating beneficial changes in the places (or environments) in which people live and work -- have equal if not greater potential to promote beneficial changes in population health behaviors, but these are currently less explored options. To have the greatest possible beneficial influence on public behavior with the public health resources available, we recommend that public health program planners assess their opportunities to use media to target both people and places in a manner that complements and extends other investments being made in population health enhancement. ************************************* The authors reference many sources to conclude that: mass media interventions, by themselves or in combination with other programs can significantly influence the health behaviors of populations. (Abroms, Maibac, p 221). one important caveat is associated with this conclusion, however; the effects of health communication campaigns are typically only modest in size. (Abroms, Maibac, p 221). effective public health media campaigns typically have two important qualities: They feature well-designed messages, and those messages are delivered to their intended audience with sufficient reach and frequency to be seen or heard and remember. (Abroms, Maibac, p 221). Communication and Marketing as Tools to Cultivate the Public's Health: A Proposed "People and Places" Framework.  Maibach, E. W., Abroms, L. C., & Marosits, M. (2007). Communication and marketing as tools to cultivate the public's health: a proposed "people and places" framework. BMC Public Health, 7, 88. Tags: meta analysis/review articles, theory/principals Adapted from the abstract: In this article we propose a framework--based on contemporary ecological models of health--to explain how communication and marketing can be used to advance public health objectives. The framework identifies the attributes of people (as individuals, as social networks, and as communities or populations) and places that influence health behaviors and health. Communication, i.e., the provision of information, can be used in a variety of ways to foster beneficial change among both people (e.g., activating social support for smoking cessation among peers) and places (e.g., convincing city officials to ban smoking in public venues). Similarly, marketing, i.e., the development, distribution and promotion of products and services, can be used to foster beneficial change among both people (e.g., by making nicotine replacement therapy more accessible and affordable) and places (e.g., by providing city officials with model anti-tobacco legislation that can be adapted for use in their jurisdiction). Public health agencies that use their communication and marketing resources effectively to support people in making healthful decisions and to foster health-promoting environments have considerable opportunity to advance the public's health, even within the constraints of their current resource base. ********************************* Note: the authors reference case studies, meta-analysis and systematic literature reviews concluding that public health communication initiatives are, on the whole effective in changing peoples behavior, but usually only modestly so. (Maiback et al) Lessons Learned from Public Health Mass Media Campaigns: Marketing Health in a Crowded Media World  Randolph, W. & Viswanath, K. (2004). Lessons learned from public health mass media campaigns: marketing health in a crowded media world. Annu.Rev Public Health, 25, 419-437. Tags: Multiple campaigns/articles reviewed, theory/principles, data (quantitative, summative), topics include nutrition, tobacco, physical activity. From the abstract: Every year, new public health mass media campaigns are launched attempting to change health behavior and improve health outcomes. These campaigns enter a crowded media environment filled with messages from competing sources. Public health practitioners have to capture not only the attention of the public amid such competition, but also motivate them to change health behaviors that are often entrenched or to initiate habits that may be new or difficult. In what ways are public health mass media campaigns now attempting to succeed in a world crowded with media messages from a myriad of sources? What are the conditions that are necessary for a media campaign to successfully alter health behaviors and alter outcomes in the long term? To what extent can the successes and failures of previous campaigns be useful in teaching important lessons to those planning campaigns in the future? In this chapter we attempt to answer these questions, drawing from recent literature on public health mass media campaigns. ******************************* The authors provide the following conditions for success on p 421-422: Ensure sufficient exposure. Use social marketing tools to create appropriate messages. Create conditions (such as supportive environment) to support the recommend change. Develop theory-based campaigns. Conduct process analysis assessing exposure to message. Communication and Diet: An Overview of Experience and Principles.  Hornik, R. & Kelly, B. (2007). Communication and diet: an overview of experience and principles. Journal of nutrition education and behavior [On-line]. Tags: Multiple campaigns, theory/principles, limited data (quantitative, summative), topics include nutrition, tobacco, physical activity) From the Abstract: As nutrition officials face the need to address widespread chronic obesity and its associated diseases, many have turned to media campaigns as a strategy for reaching large audiences. In the past, such efforts have had mixed results. Examples of successful and unsuccessful major public health campaigns are presented, including a small number related to diet. One implication of the analysis of those cases is the importance of obtaining high levels of exposure to messages. Several strategies for maximizing exposure are elaborated, including the use of paid advertising, relying on donated time, and earning coverage through media advocacy. *********************************************** Note: Successful campaign results profiled include the following examples: Kentucky Drug Intervention The researchers designed their media buys to reach about 70% of youth, about 3 times per week with their messages. In fact, 85 percent or more of all youth recalled seeing the television ads during the intervention periods. The investigators were studying the effects of one behavior moderator from message theory, called sensation seeking, a personality trait associated with the need for novel, complex, emotionally intense stimuli and the willingness to take risks necessary to obtain them.22 Youth who were low on sensation seeking consistently refrained from using marijuana over time. For the high sensation seekers, however, the likelihood of using marijuana increased until the first campaign, and then the rates started to decrease. In time, the likelihood of using began to increase again in the high sensation seekers. But researchers ran a second campaign, and a second decline followed. Each campaign was associated with a sharp decline in past 30-day use of marijuana only among the high sensation seekers. Using interrupted time series, the authors were able to show that the campaign produced declines in use when it was running and that in the comparison county, where no campaign ran, there were no declines among high sensation seekers during that time. Subsequently, when the campaign was introduced to the comparison community, there were similar declines. (Hornik & Kelly p S7) The Swiss AIDS campaign This national campaign used television, radio, and newspaper advertisements, as well as booklets distributed to all house- holds. The campaign achieved high rates of exposure. One evaluation found that 56% of all households had someone who had read the brochure.23 In 1987, the proportion of 17- to 30-year-olds who said they always used condoms when engaging in casual sex was less than 10%. By 1989, that rate was nearly 50%, and that percentage was maintained (Hornik & Kelly p S7) The California Anti-Tobacco Campaign This program, which ran from 1989 to 1993, used a multi-strategy approach, including raising taxes on cigarettes and a US $15 million per year media campaign. During that time, Californias smoking rates declined at a faster rate than the decline in the rest of the United States.25 Some evidence attributed change to the media campaign specifically, over and above the tax increases. (Hornik & Kelly p S7) The National High Blood Pressure Education Program The program was associated with a change in awareness of the risks of high blood pressure and with a large decline in stroke mortality rates.27 In the 12 years before the start of the campaign, the stroke rate was declining at 1.6% per year. In the 12 years beginning in 1972, stroke declined by 6% per year. (Hornik & Kelly p S7) The CDC Verb Campaign a multiethnic media campaign to increase physical activity in tweens youth aged 9 to 13.28 The results show that the campaign achieved high levels of awareness in the first year and that those who had better recall of the advertisements were also more likely to engage in physical activity. (Hornik & Kelly pS7) 1% or Less Campaign Low-fat milk sales increased from 29% of all milk sales to 46% (52% increase) in the month after the campaign ran. The increase was maintained at the 6-month follow up, and the researchers were also able to show a higher proportion of low-fat milk consumption in their experimental community than in the control. (Hornik & Kelly p S8) 2 Fruit and 5 Veg Every Day Campaign After the first year, reported consumption of produce was significantly increased, and this higher level of consumption seemed to be maintained throughout the course of the study. (Hornik & Kelly pS8) The Effectiveness of Social Marketing Interventions for Health Improvement: What's the Evidence?  Gordon, R., McDermott, L., Stead, M., & Angus, K. (2006). The effectiveness of social marketing interventions for health improvement: what's the evidence? Public Health, 120, 1133-1139. Tags: Review article, theory/principles, data (quantitative, summative), topics include nutrition, physical activity, tobacco, substance use) Adapted from the abstract: This article describes three reviews of systematic reviews and primary studies that evaluate social marketing effectiveness. All three reviews used pre-defined search and inclusion criteria and defined social marketing interventions as those which adopted six key social marketing principles. The reviews provide evidence that social marketing interventions can be effective in improving diet, increasing exercise, and tackling the misuse of substances like alcohol, tobacco, and illicit drugs. There is evidence that social marketing interventions can work with a range of target groups, in different settings, and can work upstream as well as with individuals. Social marketing provides a very promising framework for improving health both at the individual level and at wider environmental and policy-levels. Problems with research design, lack of conceptual understanding or implementation are valid research concerns. ****************************************** Note: Successful campaign results profiled include the following examples: Nutrition Interventions: Of the 18 studies that sought to increase fruit and vegetable intake, 10 had a positive overall effect, six had mixed or moderate effects, one had no effect, and one was counter productive. Of the effective studies, for example, one used an education-based social marketing intervention to pro- duce a mean increase in daily fruit and vegetable consumption of 0.56 servings among low-income women in Maryland, USA.16 Another study reported significant improvements in the fruit and vegetable consumption of primary school children in England and Wales following the implementation of a rewards-based peer modeling intervention.17 Overall, these results provide strong evidence that social marketing can improve fruit and vegetable consumption. (Gordan et al p 1135-36) Eighteen studies sought to reduce fat intake. Of these, eight had a positive overall effect, seven had mixed or moderate effects and three produced no change. For example, the CATCH school-based program implemented in the US reported a significant reduction in fat intake among students in intervention schools compared with control schools (p<0.001), and also successfully lowered the percentage of calories from total fat in school meals (Gordan et al p 1136) Of the 11 studies that sought to improve dietary knowledge, nine reported a positive overall effect. For example, a 5-a-Day program with low- income women (comprising nutrition sessions, printed materials and direct mail) significantly increased their knowledge of the recommendation to eat five or more fruits and vegetables a day (p<0.001). 16 (Gordan et al p 1136) Thirteen out of 17 studies had a positive effect on at least one psychosocial variable. For example, a badge-based intervention with Boy Scouts in Houston, Texas brought about significant improvements in boys preferences for fruit, juice and vegetables as well as their perceptions of positive outcomes associated with healthy eating (p = 0.01 for fruit and p = 0.0001 for vegetables). 20 (Gordan et al p 1136) The evidence for effects on physiological variables is less convincing. Only three out of the 13 studies that examined this had a positive effect on at least one physiological variable; though positive changes were seen for blood pressure and cholesterol none were reported for body mass index (BMI) in any of the studies. (Gordan et al p 1136) Physical Activity Interventions Of the interventions that sought to change behavioural outcomes, eight out of 21 had a positive effect overall... Of the effective studies, for example, Nieger22 implemented a workplace intervention designed to increase physical activity among employees and reported significant improvements on two measures of activity: with participants significantly more likely to participate in moderate physical activity and less likely to be involved with mild physical activity. (Gordan et al p 1136) All four studies that sought to improve exercise related knowledge reported positive effects. (Gordan et al p 1137) Eleven studies sought to influence psychosocial variables such as self-efficacy or perceived social support to exercise regularly. Six of these studies found a positive effect on at least one variable.. (Gordan et al p 1137) Fourteen studies reported physiological outcome results using a range of measures including BMI, CVD (cardiovascular disease) rates, cholesterol level and blood pressure. In terms of impact, only four studies reported positive effects. (Gordan et al p 1137) Six of the social marketing physical activity interventions aimed to effect policy or environmental changes. Measurable outcome data was not reported due to the difficulties in measuring policy and environmental change. (Gordan et al p 1137) Substance Misuse Interventions: Of the interventions that were aimed at smoking prevention, 13 out of 18 studies had a positive effect overall (Gordan et al p 1137) Of the substance misuse interventions that dealt with alcohol prevention and harm minimization, eight out of 13 had a positive effect overall (Gordan et al p 1137) Twelve interventions dealt with illicit drug use prevention and, of these, eight had a positive effect overall. (Gordan et al p 1138) For smoking cessation, two of the nine interventions had a positive effect overall. (Gordan et al p 1138) Finally, three of studies reported increases in policy adoption over the intervention period and there was modest evidence from four of the studies of increases in retailer compliance. (Gordan et al p 1138) Statewide Implementation of the 1% or Less Campaign.  Maddock, J., Maglione, C., Barnett, J. D., Cabot, C., Jackson, S., & Reger-Nash, B. (2007). Statewide Implementation of the 1% or Less Campaign. Health Education & Behavior, 34,953-963.  HYPERLINK "http://heb.sagepub.com/cgi/content/abstract/34/6/953" http://heb.sagepub.com/cgi/content/abstract/34/6/953 Tags: Single campaign, data (quantitative,summative), nutrition From the abstract: The 1% or Less Campaign is an effective research-tested program for reducing saturated fat intake by encouraging individuals to switch to low-fat milk. All published studies have been conducted in small communities with mostly White populations. The 6-week intervention included a media campaign, public relations, and taste tests. Campaign effectiveness was measured using sales data and cross-sectional telephone surveys. Survey results showed a significant increase in low-fat milk consumption from 30.2% to 40.8% of milk drinkers (p < .001) with a reduced yet sustained increase at 3 months. This translates to approximately 65,000 people switching to low-fat milk during the campaign with a sustained effect of approximately 32,000 people three months post-campaign. Sales data show an increase of low-fat milk sales from 32.7% to 39.9%. Results are similar to smaller community initiatives, indicating the program is effective in promoting population behavior change but may need booster sessions for sustained effects. Effectiveness of Mass Media Campaigns for Reducing Drinking and Driving and Alcohol-Involved Crashes: A Systematic Review.  Elder, R. W., Shults, R. A., Sleet, D. A., Nichols, J. L., Thompson, R. S., & Rajab, W. (2004). Effectiveness of mass media campaigns for reducing drinking and driving and alcohol-involved crashes: A systematic review. American Journal of Preventive Medicine, 27, 57-65. Tags: Systematic review, data (quantitative, summative), alcohol From the abstract. A systematic review of the effectiveness of mass media campaigns for reducing alcohol-impaired driving (AID) and alcohol-related crashes was conducted for the Guide to Community Preventive Services (Community Guide). In eight studies that met quality criteria for inclusion in the review, the median decrease in alcohol-related crashes resulting from the campaigns was 13% (inter-quartile range: 6% to 14%). Economic analyses of campaign effects indicated that the societal benefits were greater than the costs. The mass media campaigns reviewed were generally carefully planned, well executed, attained adequate audience exposure, and were implemented in conjunction with other ongoing prevention activities, such as high visibility enforcement. According to Community Guide rules of evidence, there is strong evidence that, under these conditions, mass media campaigns are effective in reducing AID and alcohol-related crashes. *************************************** Note: The inclusion criteria for the campaigns reviewed included articles from peer-reviewed journal articles and technical reports that had to 1) be primary research published in English before December 31, 2001; (2) provided objective data on one or more outcomes related to AID; and (3) meet minimum quality criteria for study design and execution. (Elder et al p.58) Meta-Analyses of Mediated Health Campaigns  Snyder, L. B. (2007). Meta-Analyses of Mediated Health Campaigns. In R.W.Preiss, B. M. Gayle, N. Burrell, M. Allen, & J. Bryant (Eds.), Mass media effects research: Advances through meta-analysis. (pp. 327-344). Mawah, NJ: Lawrence Erlbaum Associates. Tags: Meta-Analysis, data (quantitative, summative), multiple topics, multiple settings Adapted from the chapter abstract: Campaigns are often created to battle the actual causes of death--the lifestyle and behaviors that contribute to the leading diseases, such as heart disease and cancer. Many of the most common actual causes of death--tobacco use, poor diet, physical inactivity, alcohol consumption, microbial agents, toxic agents, and motor vehicles (National Center for Chronic Disease Prevention and Health Promotion, 2004)--can be battled through health campaigns. Given the societal need to communicate with large numbers of people about health recommendations, it is important to understand the efficacy of communication campaigns. The present chapter reviews the synthesized evidence on mediated health campaign effects. ****************************************** Note: Successful campaign principals profiled include the following: Campaigns for some health topics have been more effective than campaigns for other topicsseatbelt campaigns were the most effective, and youth substance abuse prevention campaigns were the least effective. (Snyder p 332) Health topics can also be groups by whether then goal of the campaign is to promote a new behavior or substitute a new behavior for an old one, discourage and old behavior, or prevent a new behavior that is undesirable from the standpoint of public health.to estimate potential campaign effects for new topics.new behavior is easier to achieve than cessation or prevention (r=.12 vs r=.05, r=.06 respectively (Synder p 333) Health Communication Campaigns and Their Impact on Behavior  Snyder, L. B. (2007). Health communication campaigns and their impact on behavior. Journal of Nutrition Education & Behavior, 39, Suppl-40. Tags: Theory/Principles, Meta analysis/research syntheses, topics include campaign on nutrition, physical activity, tobacco, substance use, HIV, family planning & reproductive health From the abstract: The objective is to review the evidence for the effectiveness of health communication campaigns to inform future nutrition campaigns. The review drew on existing meta-analyses and other literature. The average health campaign affects the intervention community by about 5 percentage points, and nutrition campaigns for fruit and vegetable consumption, fat intake, and breastfeeding, have been slightly more successful on average than for other health topics. The factors affecting success rates are discussed. The conclusion is that nutrition campaigns that pay attention to the specific behavioral goals of the intervention, target populations, communication activities and channels, message content and presentation, and techniques for feedback and evaluation should be able to change nutrition behaviors. A Meta-Analysis of the Effect of Mediated Health Communication Campaigns on Behavior Change in the United States.  Snyder, L. B., Hamilton, M. A., Mitchell, E. W., Kiwanuka-Tondo, J., Fleming-Milici, F., & Proctor, D. (2004). A meta-analysis of the effect of mediated health communication campaigns on behavior change in the United States. J Health Communication, 9 Suppl 1, 71-96. Tags: Meta-Analysis, data (quantitative, summative), multiple topics, Adapted From the abstract: A meta-analysis was performed of studies of mediated health campaigns in the United States in order to examine the effects of the campaigns on behavior change. Mediated health campaigns have small measurable effects in the short-term. Campaign effect sizes varied by the type of behavior: greatest effect in order of seat belt use, oral health, alcohol use reduction, heart disease prevention, smoking, mammography and cervical cancer screening, and sexual behaviors. Campaigns with an enforcement component were more effective than those without. To predict campaign effect sizes for topics other than those listed above, researchers can take into account whether the behavior in a cessation campaign was addictive, and whether the campaign promoted the commencement of a new behavior, versus cessation of an old behavior, or prevention of a new undesirable behavior. Given the small campaign effect sizes, campaign planners should set modest goals for future campaigns. The results can also be useful to evaluators as a benchmark for campaign effects and to help estimate necessary sample size. Evaluation of Mass Media Campaigns for Physical Activity  Bauman, A., Smith, B. J., Maibach, E. W., & Reger-Nash, B. (2006). Evaluation of mass media campaigns for physical activity. Evaluation and Program Planning, 29, 312-322. Tags: Review article, theory/principles, physical activity In this article the authors focus on steps for evaluating campaigns that target physical activity. The authors note that Mass media efforts are part of effective, integrated approaches to increase physical activity in the community. They need sufficient time and resources, and appropriate levels of planning and formative message development. (Buaman, p. 321) The authors note that, Evaluations to date have, however, focused on the short-term effects of campaigns, so little is know about what types of combinations of interventions will have longer-term effects and potentially influence health status. (Buaman, p. 313). The article references Snyder and Hamiltons 2002 articles that suggests short-term health behavioral changes in the 5-9% range might result from exposure to mass media campaigns (Buaman, p. 313). The article outlines evaluation techniques and stresses that Comprehensive process evaluation is essential for all campaigns, to determine if the message reached the target group, and was planned in concert with other community-wide campaign elements (Buaman, p. 321). The authors stress that Effective physical activity campaigns require consistent messages and sustained communications over years to decades. Shorter-term campaigns do not represent a comprehensive public health investment in this area, and may not demonstrate sustain physical activity changes at the population level. (Buaman, p. 321) Social Marketing Campaigns and Children's Media Use. Future of Children.  Evans, W. D. (2008). Social marketing campaigns and children's media use. Future of Children,18,181-203. Tags: Multiple campaign examples (tobacco, nutrition, physical activity, HIV/AIDS), theory/principles, data (summative, quantitative) Adapted from the abstract: Increasingly savvy social marketers have begun to make extensive use of the same techniques and strategies used by commercial marketers to promote healthful behaviors and to counter some of the negative effects of conventional media marketing to children and adolescents. Evans points out that social marketing campaigns have been effective in helping to prevent and control tobacco use, increase physical activity, improve nutrition, and promote condom use, as well as other positive health behaviors. He reviews the evidence from a number of major recent campaigns and programming in the United States and overseas and describes the evaluation and research methods used to determine their effectiveness. He begins his review of the field of social marketing by describing how it uses many of the strategies practiced so successfully in commercial marketing. He notes the recent development of public health brands and the use of branding as a health promotion strategy. He then goes on to show how social marketing can promote healthful behavior, how it can counter media messages about unhealthful behavior, and how it can encourage discussions between parents and children. Evans concludes by noting some potential future applications to promote healthful media use by children and adolescents and to mitigate the effects of exposure to commercial marketing. *************************** Note: Evan highlights an number of studies that present evidence of the effectiveness of social marketing: In general, these studies show that social marketing has successfully changed health behavior such as smoking, physical activity, and condom use, as well as behavioral mediators such as knowledge, attitudes, and beliefs related to these behaviors. Most of these studies, however, have shown effect sizes of less than 10 percent.34 (Evans, p10) In their widely cited study of forty-eight U.S. social marketing campaigns based on mass media, Leslie Snyder and Mark Hamilton found that the average campaign accounted for about 9 percent of the variation in health risk behavior outcomes, but with varying results.35 The subset of non-coercive campaignsthat is, those that simply deliver health information instead of attempting to persuade and advocate for a behavior accounted for about 5 percent of observed variation, as compared with 9 percent for all forty-eight campaigns reviewed. (Evans, p 10) A study of seventeen recent European media campaigns on a range of topics including promotion of HIV testing, myocardial infarction hospital admissions, immunizations, and cancer screenings found similar effects in the range of 510 percent.36 Like previous research, this study shows that single or few-time behaviors can be easier to promote than behavior requiring repetition and maintenance over time.37 Some behaviors that do not require long-term maintenance, such as breastfeeding and Vitamin A promotion, and switching to 1 percent milk, have shown greater effect sizes and generally appear to have higher rates of success.38 (Evans p. 10) One of the most successful social marketing efforts has been tobacco counter marketing campaigns aimed at preventing youth from starting to smoke. For example, campaigns such as the American Legacy Foundations truth campaign have successfully reduced smoking initiation and progression to established smoking. Matthew Farrelly and several colleagues showed that from 1999 to 2002, U.S. youth smoking prevalence declined from 25.3 percent to 18.0 percent and that truth accounted for approximately 22 percent of that decline.41(Evans, p 12) Counter marketing campaigns have been found effective in influencing specific, targeted attitudes and beliefs to affect smoking behavior. A longitudinal study of the Florida TRUTH campaign (the state campaign that preceded, and was the model for, the national truth campaign) found that teenagers with high levels of anti-tobacco industry attitudes were four times less likely to initiate smoking and more than thirteen times less likely to become established smokers than their peers with low levels of such attitudes.43 (Evans p. 12) The California Adolescent Nutrition and Fitness (CANFit) program found that after its 1% Or Less campaign in East Los Angeles, whole milk purchases had dropped from 66 percent to 24 percent of overall sales and that the share of all low-fat milk sold had more than doubled.50 Although it was not a goal of the campaign, overall milk purchases had increased by 30 percent.5 (Evans p. 13) Studies show that each of the campaigns increased adolescent and young adult awareness of these HIV/AIDS prevention brands and also increased awareness of HIV/AIDS health risks and intentions to use condoms.61 Effects of the campaigns included delayed onset of sexual activity and increased condom use among those with repeated exposure to these brands. (Evans, p 14) Improving Media Campaigns Promoting Physical Activity: The Underutilized Role of Gender  Graham, D. J. & Graham, J. F. (2008). Improving media campaigns promoting physical activity: The underutilized role of gender. International Journal of Nonprofit & Voluntary Sector Marketing, Special Issue: Social marketing.13, 205-213. Tags: Review articles referenced, summative data; Single campaign example profiled (CDC VERB Physical Activity), Theory/principles, formative qualitative & quantitative data Adapted from the abstract: Drawing on facets of consumer behavior, psychology, and public policy, this work represents a cross-disciplinary theoretical analysis suggesting that the effectiveness of media-based campaigns promoting physical activity could be enhanced by making use of gender-specific advertising. Research is reviewed suggesting that gender differences in information processing styles and values lead to gender-specific responses to media campaigns. Recommendations are made to help practitioners improve physical activity campaigns by crafting advertisements that specifically appeal to the unique preferences of each gender. *********************************** The authors reference review papers: Marcus and colleagues (1998) reviewed 28 media based interventions and concluded that message recall following these campaigns is generally high, but with minimal impact on physical activity behaviour beyond the short term. Finlay and Faulkner (2005) examined 17 national and community media campaigns promotion physical activity conducted between 1998 and 2004. Each of the campaigns employed television advertisements and most campaigns used other media outlets as well (e.g. radio or print). These campaigns demonstrate that media advertisements can effectively increase knowledge regarding the benefits of physical activity and may increase short-term physical activity behaviour among some population subgroups. (Graham & Graham, p 206) Wolins (2003) meta-analysis of 76 papers covering gender issues in advertising provides strong evidence that males and females tend to process advertising messages differently. (Graham & Graham p 208) Marketing Physical Activity: Lessons Learned from a Statewide Media Campaign  Peterson, M., Abraham, A., & Waterfield, A. (2005). Marketing Physical Activity: Lessons Learned from a Statewide Media Campaign. Health Promotion Practice, 6, 437-446. Tags: Single campaign, theory/principals, data: summative (qualitative & quantitative), physical activity (Get up and do something campaign). From the abstract: Steps taken to create, implement, and initially assess a statewide physical activity social marketing campaign targeted to 18- to 30-year-olds are presented. Included is a summary demonstration of the application of the associative group analysis in formative market research and message development. Initial post campaign questionnaire (n = 363) results indicated that 39.1% of respondents had seen the television ad, of which 31.2% indicated they intended to be more active, and 62.5% of respondents had been exposed to either the television or outdoor media ads. Lessons learned through the social marketing process including media channel effectiveness, message development and assessment, and marketing firm relationships are provided. ******************************************** Note: This article provides audience analysis information using associative group analysis (AGA). The AGA was an innovative and effective way to identify and measure market segment perceptions, attitudes and group norms toward physical activity. (Peterson et al p 444). The Influence of the VERB Campaign on Childrens Physical Activity in 2002 to 2006  Huhman, M., Potter,L, Nolin, M.J., Piesse, A., Judkins, D., Banspach, S., Wong, F. (2010) The Influence of the VERB Campaign on Childrens Physical Activity in 2002 to 2006. Am J Public Health. 2010; 100:638645 Tags: Single campaign, suumative data (quantitative), physical activity Adapted from the abstract: Evaluated physical activity outcomes for children exposed to VERB, a campaign to encourage physical activity in children, across campaign years 2002 to 2006. Examined the associations between exposure to VERB and (1) physical activity sessions (free time and organized) and (2) psychosocial out- comes (outcome expectations, self-efficacy, and social influences) for 3 nation- ally representative cohorts of children. Outcomes among adolescents aged 13 to 17 years (cohort 1, baseline) and children aged 9 to 13 years from cohorts 2 and 3 were analyzed for doseresponse effects. Propensity scoring was used to control for confounding influences. Awareness of VERB remained high across campaign years. In 2006, reports of children aged 10 to 13 years being active on the day before the survey increased significantly as exposure to the campaign increased. Psychosocial out- comes showed doseresponse associations. Effects lessened as children aged out of the campaign target age range (cohort 1, baseline), but doseresponse associations persisted in 2006 for outcome expectations and free-time physical activity. VERB positively influenced childrens physical activity out- comes. Campaign effects persisted as children grew into their adolescent years. The Influence of the Media Environment on Physical Activity: Looking for the Big Picture  Maibach, E. (2007). The influence of the media environment on physical activity: looking for the big picture. Am J Health Promot, 21, 353-62, iii.  HYPERLINK "http://www.activelivingresearch.org/files/Maibach_AJHP_2007.pdf" www.activelivingresearch.org/files/Maibach_AJHP_2007.pdf Tags: Review articles referenced (data: summative: quantitative), theory/principals, formative (data quantitative) physical activity Adapted from the abstract: In this article the author suggests opportunities to influence the media environment for the purposes of promoting physical activity. A research agenda focused on media consumption, media content, commercial considerations, promoting physical activity through the media, partnerships with industry, positioning, dissemination of proven methods, and environmental change is proposed. Note: the author references two studies that provide favourable campaign results: Cavill and Bauman recently reviewed the peer-reviewed evaluations of 15 mass media physical activity campaigns published between 1970 and 2002 that met certain methodological criteria (i.e., a minimum of a pre-post evaluation design and population sampling).64 Despite many caveatsincluding a lack of information about the intensity of the campaign and inconsistent evaluation measures and methodsthey found that among the 13 campaigns that measured behavior, five produced significant increases in physical activity, several by 20% or more. Since 2002, two additional campaign evaluations meeting Cavills criteria have been published; both produced significant increases in physical activity.65,66 (Maibach p 357-8) The Guide to Community Preventive Services currently states that there is insufficient evidence to recommend media campaigns as a means to promote physical activity.67 However, the Guide cites strong evidence to support community-wide campaigns, which are characterized as large-scale, intense, highly-visible community-wide campaigns with messages directed to large audiences through different types of media accompanied by other community-based behavior change components. The Guide also recommends point-of-decision prompts (e.g., posters in elevator lobbies that suggest taking the stairs rather than the elevator), which can also be characterized as media-based. Taken together, these studies and guidelines suggest that there is considerable potential to use media to promote increases in exercise and other forms of physical activity. (Maibach p 357-8) The author also provides the implication of this information for practitioners and researchers ((Maibach p 360): It is clear that there are two sides of the media environment and physical activity coin. Americans ever increasing consumption of media appears to be displacing time they would otherwise spend being more active, even if only slightly more active. Conversely, there are at least five possibilitiesall of which are currently largely untapped through which we may be able to influence the media environment to promote physical activity. To reverse the long, slow erosion of (non-exercise) physical activities from American life, it would be helpful for practitioners to focus their creative energies on exploring these possibilities, and for researchers to support practitioners by developing answers to the long list of important currently unanswered questions presented in this paper. Systematic Review of Public Health Branding  Evans, W. D., Blitstein, J., Hersey, J. C., Renaud, J., & Yaroch, A. L. (2008). Systematic review of public health branding. J Health Commun., 13, 721-741. Tags: Systematic review, theory/principles, multiple topics Adapted from the abstract: Brands build relationships between consumers and products, services, or lifestyles by providing beneficial exchanges and adding value to their objects. Brands can be measured through associations that consumers hold for products and services. Public health brands are the associations that individuals hold for health behaviors, or lifestyles that embody multiple health behaviors. Branded health messages typically are theory based, and there is a body of evidence on their behavior change effectiveness, especially in nutrition, tobacco control, and HIV/AIDS. More rigorous research is needed, however, on how branded health messages impact specific populations and behaviors The VERBTM Campaign Applying a Branding Strategy in Public Health  Asbury, L.D, Wong, F.L., Price, S.M, Nolin, M.J. (2008) The VERBTM Campaign Applying a Branding Strategy in Public Health Am J Prev Med 2008;34(6S):S183S187) Tags: Single campaign, theory/principals, formative data (qualitative), physical activity From the abstract: A branding strategy was an integral component of the VERBTM Youth Media Campaign. Branding has a long history in commercial marketing, and recently it has also been applied to public health campaigns. This article describes the process that the CDC undertook to develop a physical activity brand that would resonate with children aged 913 years (tweens), to launch an unknown brand nationally, to build the brands equity, and to protect and maintain the brands integrity. Considerations for branding other public health campaigns are also discussed. Understanding Health Behavior: An Integrated Model for Social Marketers.  Cismaru, M., Lavack, A. M., Hadjistavropoulos, H., & Dorsch, K. D. (2008). Understanding health behavior: An integrated model for social marketers. Social Marketing Quarterly, 14, 2-32. Tags: Systematic review, theory/principles, obesity From the abstract: Many effective social marketing campaigns seek to change health-related behavior by utilizing various health-protective behavioral theories. In this article, we review and integrate three such theories: (1) protection motivation theory (PMT), (2) the extended parallel process model (EPPM), (3) and the transtheoretical model (TTM). We highlight how EPPM and TTM can be used to refine PMT by adding insight into the decision-making process involved when consumers consider whether or not to follow a particular recommended health behavior. Specifically, the development of an integrated PMT model can provide insight into the characteristics of people more or less likely to change, what happens when persuasion fails, and what can be done to increase persuasion. Developing an integrated PMT model opens new avenues of research that have the potential to increase our understanding of behavior and assist in creating more persuasive social marketing campaigns. ****************************************** Note: The topic of obesity is applied as a practical example for using this integrated model on p.24 Using Theory to Design Effective Health Behavior Interventions.  Fishbein, M. & Yzer, M. C. (2003). Using theory to design effective health behavior interventions. Communication Theory, 13, 164-183. Tags: Theory/principles, formative qualitative and quantitative data, multiple topics From the abstract: This article demonstrates the usefulness of two theories for the development of effective health communication campaigns. (1)The integrative model of behavioral prediction focuses on changing beliefs about consequences, normative issues, and efficacy with respect to a particular behavior. (2) Media priming theory focuses on strengthening the association between a belief and its outcomes, such as attitude and intention toward performing the behavior. Both the integrative model of behavioral prediction and media priming theory provide guidance with respect to the selection of beliefs to target in an intervention. The article describes the theories, shows how they can be applied to the selection of target beliefs, and, for each theory, defines the criteria for belief selection. The two theories as well as their appropriate analytic strategies are complementary rather than conflicting. ******************************* From the conclusion: It is clear that theory is an important tool for the development of effective communication campaigns that aim to change peoples intention to engage in a health behavior. (Fishbein and Yzer p 181) Formative Research to Develop a Mass Media Campaign to Increase Physical Activity and Nutrition in a Multiethnic State.  Maddock, J. E., Silbanuz, A., & Reger-Nash, B. (2008). Formative research to develop a mass media campaign to increase physical activity and nutrition in a multiethnic state. Journal of Health Communication, 13, 208-215. Tags: theory/principals, data: formative (qualitative & quantitative), physical activity & nutrition Adapted from the abstract: Successful mass media campaigns should have a formative research base that includes conducting preproduction research with the target audience, using theory as a conceptual foundation of the campaign, segmenting the audience into meaningful subgroups, and using a message approach that is targeted to and likely will be effective with the audience segment. Evaluating Communication Campaigns  Evaluating communication campaigns (2008). Robert Wood Johnson Foundation [On-line]. Available:  HYPERLINK "http://www.rwjf.org/pr/product.jsp?id=31711" http://www.rwjf.org/pr/product.jsp?id=31711 Tags: theory/principals, multiple topics From the abstract: As the Robert Wood Johnson Foundation has expanded the use of communication campaigns to spark social change, effective evaluation of such campaigns has become crucial. Examples of recent RWJF campaigns include Cover the Uninsured Week, the Campaign for Tobacco-Free Kids and the Back to School Campaign. In September 2007, RWJF hosted a conference convening evaluators, RWJF staff and staff from other foundationsthe Annie E. Casey Foundation, Lumina Foundation and the Pew Charitable Truststo discuss successful strategies to evaluate communication campaigns. Robert Hornik, Ph.D., discussed evaluation of public health communication programs, including an examination of special problems, major principles of communication evaluation and alternative evaluation designs. Lawrence R. Jacobs, Ph.D., provided an overview of policy communication evaluations, outlining effective strategies and lessons learned. Julia Coffman presented the differences between evaluating advocacy and evaluating programs or services. Coffman also shared a composite logic model to facilitate advocacy evaluation design. ******************************* Note: This article highlighted the following considerations: Although Hornik has conducted many summative evaluations (which are designed to present conclusions about the merit or worth of a program at the end of the program activities) for communication programs, he suggested that there are better ways to use research resources. Determining causality for communication programs is expensive and difficult. (p 3) Most communication programs need an evaluation that will show how to improve the program or adapt it for a different audience. Formative research to test message strategies or choose communication channels and monitoring research to test message recall and movement of cognition are often a better use of research money than a summative evaluation. (p.3) Cost-effectiveness Analysis for Health Communication Programs  Guilkey, D. K., Hutchinson, P., & Lance, P. (2006). Cost-effectiveness analysis for health communication programs. Journal of Health Communication, Special Issue: Cost-effectiveness analysis. 8 11, 47-67. Tags: theory/principals From the abstract: This article describes methods for analyzing the cost-effectiveness of health communication programs, focusing in particular on estimating program effectiveness with econometric methods that address experimental and quasi-experimental designs (and their absence), national or sub-national program coverage, and endogenously targeting of programs. Experimental designs provide a gold standard for assessing effectiveness but are seldom feasible for large-scale health communication programs. Even in the absence of such designs, however, fairly simple methods can be used to examine intermediate objectives, such as program reach, which in turn can be linked to program costs to estimate cost effectiveness. When moving beyond program reach to behavioral or other outcome measures, such as contraceptive use or fertility, or when faced with full-coverage national programs, more elaborate data and methods are required. We discuss data requirements and assumptions necessary in each case, focusing on single-equation multiple regression models, structural equations models, and fixed effects estimators for use with longitudinal data, and then describing how cost information can be incorporated into econometric models so as to get measures of the cost-effectiveness of communication interventions. The Cost-Effectiveness of Health Communication Programs: What Do We Know?  Hutchinson, P. & Wheeler, J. (2006). The cost-effectiveness of health communication programs: what do we know?. [Review] [95 refs]. Journal of Health Communication, 11, Suppl-45. Tags: theory/principals, review articles referenced, topics include mental health, smoking cessation, family planning, HIV/AIDS, Sexually transmitted infections (STIs), diabetes, cholesterol, and substance abuse From the abstract: While a considerable body of evidence has emerged supporting the effectiveness of communication programs in augmenting health, only a very small subset of studies has examined also whether these programs are cost-effective, that is, whether they achieve greater health gains for available financial resources than alternative interventions. In this article, we examine the available literature on the cost-effectiveness of health behavior change communication programs, focusing on communication interventions involving mass media, and, to a lesser extent, community mobilization and interpersonal communication or counseling. Our objective is to identify the state of past and current research efforts of the cost-effectiveness of behavior change communication programs. This review makes three principal conclusions. First, the analysis of the cost-effectiveness of health communication programs commonly has not been performed. Second, the studies reviewed here have utilized a considerable diversity of methods and have reflected varying levels of quality and adherence to standard cost-effectiveness methodologies. This leads to problems of transparency, comparability, and generalizability. Third, while the available studies generally are indicative of the cost-effectiveness of communication interventions relative to alternatives, the evidence base clearly needs to be expanded by additional rigorous cost-effectiveness analyses. The Cost-Effectiveness of 1% or Less Media Campaigns Promoting Low-Fat Milk Consumption.  Wootan, M. G., Reger-Nash, B., Booth-Butterfield, S., & Cooper, L. (2005). The cost-effectiveness of 1% or less media campaigns promoting low-fat milk consumption. Prev.Chronic.Dis., 2, A05.  HYPERLINK "http://www.cdc.gov/Pcd/issues/2005/oct/pdf/05_0019.pdf" http://www.cdc.gov/Pcd/issues/2005/oct/pdf/05_0019.pdf Tags: theory/principals, single campaign, quantitative data, topics include nutrition. Adapted from the abstract: The purpose of our study was to compare the cost-effectiveness of 3 four strategies using components of 1% Or Less to promote population-based behavior change. 1% Or Less is a mass-media campaign that encourages switching from high-fat (whole or 2%) to low-fat (1% or skim) milk. Using a quasi-experimental design, campaigns were previously conducted in four West Virginia communities using different combinations of 1) paid advertising, 2) media relations, and 3) community-based educational activities. Telephone surveys and supermarket milk sales data were used to measure the campaigns' effectiveness. Using data from the previously completed studies, we analyzed the cost of each campaign. We then calculated the cost per person exposed to the campaign and cost per person who switched from high- to low-fat milk. The combination of paid advertising and media relations was the most cost-effective campaign, with a cost of 0.57 dollars per person to elicit a switch from high- to low-fat milk, and the combination of media relations and community-based educational activities was the least cost-effective campaign, with a cost of 11.85 dollars per person to elicit a switch. Population-based campaigns using a combination of paid advertising and media relations strategies can be a cost-effective way to promote a behavior change in a community CostUtility Analysis of the National truth Campaign to Prevent Youth Smoking  Holtgrave, D.R., Wunderink, K.A, Vallone, D.M, Healton, C.G. (2009) Cost-Utility Analysis of the Nation truth Campaign to Prevent Youth Smoking. Am J Prev Med 2009; 36 (5). Tags: theory/principals, single campaign, quantitative data, topics include tobacco. Adapted from the Abstract: In 2005, the American Journal of Public Health published an article that indicated that 22% of the overall decline in youth smoking that occurred between 1999 and 2002 was directly attributable to the truth social marketing campaign launched in 2000. A remaining key question about the truth campaign is whether the economic investment in the program can be justified by the public health outcomes. Standard methods of cost and cost utility analysis were employed in accordance with the U.S. Panel on Cost-Effectiveness in Health and Medicine; a societal perspective was employed. During 20002002, expenditures totaled just over $324 million to develop, deliver, evaluate, and litigate the truth campaign. The base-case cost utility analysis result indicates that the campaign was cost saving; it is estimated that the campaign recouped its costs and that just under $1.9 billion in medical costs was averted for society. Sensitivity analysis indicated that the basic determination of cost effectiveness for this campaign is robust to substantial variation in input parameters. This study suggests that the truth campaign not only markedly improved the publics health but did so in an economically efficient manner. Emerging Trends in the New Media Landscape.  Duffy, M. E. & Thorson, E. (NY). Emerging trends in the new media landscape. Parker, Jerry C.; Thorson, Esther (2009), Health communication in the new media landscape, p 93-116. Tags: theory/principals From the Chapter Abstract: This chapter introduces the health communication media choice model, a research-based strategy that shows how health communicators can develop effective information programs in the new media landscape. First, we sketch the primary features of today's media world, describing how consumers are using media and technology to fulfill their needs and desires. Second, we briefly review some of the most salient health communication research offering insights into how individuals are seeking and accessing health information in the current environment. Third, we offer a theory and an organizing framework that suggests a communication needs and features-based segmented audience strategy. We link these communication needs and features with the notion of aperture, a window of enhanced opportunity for sending a persuasive and/or informative message at the optimal time. Finally, we outline a research strategy that describes how health communicators can design effective evidence-based campaigns. Mike I've seen several references to the 5% change and was interested in which one you were going to reference. I often referenced the below article, which is worth looking at, but I later realized that it wasn't really saying that (the math was trickier, and it seems someone has borrowed the book from my shelf so I can't look it up right now). It also has a higher average change for campaigns that include a legal enforcement element (such as wearing seat belts). Snyder, Leslie B., Hamilton, Mark A., A Meta-Analysis of U.S. Health Campaign Effects of Behavior: Emphasize Enforcement, Exposure, and New Information, and Beware the Secular Trend. Public Health Communication: Evidence for Behavior Change. Ed. Robert C. Hornik. New Jersey: Several of the meta-analyses in the attached also mention a 5% range..... but note that the type of behavior and the health area seem to effect those averages. Some of these might also look at knowledge, etc but I never looked at them for that particular question. Risha ______________________________________ RISHA HESS Global Marketing & Communications Technical Advisor Population Services International ______________________________________ Whitefield Place | School Lane | Westlands P.O. Box 14355- 00800 | Nairobi | KENYA Tel +254 20 444 0125/8 Mobile +254 738 338 445 | Skype: rishahess  HYPERLINK "http://www.psi.org" www.psi.org Would you deny for others what you demand for yourself? - Crumbs From Your Table, U2  From: Jim Grizzell < HYPERLINK "mailto:jim@healthedpartners.org" jim@healthedpartners.org> To:  HYPERLINK "mailto:soc-mktg@georgetown.edu" soc-mktg@georgetown.edu Sent: Sunday, October 16, 2011 8:19 PM Subject: RE: Realistic Change Percentages In general terms in introductions to social marketing courses or to groups I suggest 3% to 4% per year and 15% to 30% a year or two post-intervention. It would be nice to have some meta-analysis that considers variables related to planning, the behavior to change, target population for that behavior, and the proportion of the population that needs to recall the messages. If program proposers are using big percentages like 75% - 90% maybe they havent done an analysis and synthesis of programs from a literature review. The realistic change percentages I suggest from Bill Reger-Nashs Wheeling Walks and 1% or less, and Health Canadas social marketing campaigns. I put links and some of the results below. To motivate doing the work like mobilizing people and market research to develop effective social marketing interventions I suggest that there could be 3% to 4% per year changes (i.e., Bill and Martin Quit Smoking) or about 15% to 30% (Wheeling Walks and 1% or Less) in a year to 3 years post-intervention. Variables to consider - It seems the social marketing messages need to be designed to and do reach and resonate well enough with the target audience so that a year after implementing the campaign 70% to 90% of the target population needs to be able to recall it. Other variables would be the behavior to be changed and the proportion of the population is already (baseline) doing the desired behavior. To come up with realistic targets for a specific behavior and target audience a literature review ought to help a lot Id list findings as references for Bill Reger-Nashs studies and other articles are at this link (I put results from his Wheeling Walks and 1% or less campaigns below):  HYPERLINK "http://medicine.hsc.wvu.edu/BillRegerNash/Publications" \l "SocialMarketing" http://medicine.hsc.wvu.edu/BillRegerNash/Publications#SocialMarketing Tools of Change (see the Case Studies page, quit smoking results are below)  HYPERLINK "http://www.toolsofchange.com/en/case-studies/" http://www.toolsofchange.com/en/case-studies/ WHEELING WALKS: a media-based intervention to increase walking  HYPERLINK "http://www.walk21.com/papers/Reger.pdf" http://www.walk21.com/papers/Reger.pdf (see page 7 for the results) Actual behavior change, meaning the number of survey participants who reported being insufficiently active at baseline and then walking 30 minutes a day or more after the intervention, was reported by 18% of survey participants in the comparison community and 32% in Wheeling, yielding a 14% net increase (100% increase) in walking immediately-post intervention. 90% of immediate-post telephone survey participants reported knowing about the campaign. Also of interest in this regard, 77% reported seeing the television ads, 81% reported having seen or heard news stories about the campaign, 34% reported having heard radio coverage, and 5% reported hearing about the campaign via their worksite. The Cost-Effectiveness of 1% Or Less Media Campaigns Promoting Low-Fat Milk Consumption  HYPERLINK "http://www.cdc.gov/pcd/issues/2005/oct/pdf/05_0019.pdf" http://www.cdc.gov/pcd/issues/2005/oct/pdf/05_0019.pdf The Clarksburg campaign included paid advertising, media relations, and community-based educational activities, which increased low-fat milk sales from 18% to 41% (Table 2). The low-fat milk sales were still higher (33%) 1 year after the campaign ended. Wheelings campaign involved paid advertising and media relations and increased the low-fat milk sales from 29% to 46%, a change that was sustained at 42% 2 years after the campaign ended. My calculations: 1% or less: a community-based nutrition campaign.  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/9769765?dopt=Abstract" http://www.ncbi.nlm.nih.gov/pubmed/9769765?dopt=Abstract Overall milk sales increased by 16% in the intervention cities following the campaign and remained high at follow-up. Low-fat milk's market share increased from 18% of overall milk sales at baseline to 41% of overall milk sales in the month following the end of the campaign, an increase in market share that was sustained at the six-month follow-up. In the post-intervention telephone survey, 38.2% of those respondents who reported drinking high-fat milk at baseline reported having switched to low-fat milk. Bob and Martin Quit Smoking  HYPERLINK "http://www.toolsofchange.com/en/case-studies/detail/185" http://www.toolsofchange.com/en/case-studies/detail/185 The Bob/Martin campaign proved to be one of Health Canada's most successful social marketing campaigns. First paragraph of the long Results section: Per capita (age 15+) cigarette consumption fell by 7% in 2003. By 2004, prevalence had reached an all time low of 20%. The percentage of Canadians aged 40-54 who smoked had declined from 24% in 2001 to 21% in 2004. My calculations: 3 percentage points / 13% change in 3 years; 1 point / 4% per year. Jim Jim Grizzell, MBA, MA, MCHES, ACSM-HFS, FACHA C - 909-856-3350 E -  HYPERLINK "mailto:jimgrizzell@healthedpartners.org" \t "_blank" jimgrizzell@healthedpartners.org,  HYPERLINK "mailto:jvgrizzell@csupomona.edu" \t "_blank" jvgrizzell@csupomona.edu W -  HYPERLINK "https://experts.csupomona.edu/expert.asp?id=476" \t "_blank" https://experts.csupomona.edu/expert.asp?id=476 W -  HYPERLINK "http://www.linkedin.com/company/2223366" \t "_blank" www.linkedin.com/company/2223366,  HYPERLINK "http://www.csupomona.edu/%7Ejvgrizzell" \t "_blank" www.csupomona.edu/~jvgrizzell,  HYPERLINK "http://www.facebook.com/jimgrizzell3" \t "_blank" www.facebook.com/jimgrizzell3,  HYPERLINK "http://www.twitter.com/jimgrizzell" \t "_blank" www.twitter.com/jimgrizzell  HYPERLINK "http://www.healthedpartners.org/ceu" \t "_blank" Continuing Education Online Self-Study Courses  HYPERLINK "http://www.healthedpartners.org/continuing_education.html" \t "_blank" www.healthedpartners.org/continuing_education.html, NCHEC Provider # MEP3305 $10 to $30 per course, 2 0 to 10.5 Cat 1 CECHs, all include advanced hours NEW National Prevention Strategy (6 CECH, includes 2 advanced; $25) Implement Healthy People 2020 (10.5 CECH, $30) 6 New Courses Using MAP-IT to Mobilize, Assess, Plan, Implement (2 parts) and Track Healthy People 2020 (7.5 - 10 CECH, 2 6.5 advanced, $30 [$5 to CTB] Health Promotion Planning Using the Social Marketing Approach (10.5 CECH, $30) Health Reform II: Be a Health Education Resource on the Laws Passed and Signed (7 CECH, $25) Health Impact Assessment: Is the Proposed Policy, Project or Program Healthy? (6.5 CECH, $25) The New Government Physical Activity Guidelines (6 CECH, $25) Healthy People 2020: Get Ready to Use It (5 CECH, $25) Health Marketing (5 CECH, $25) Understanding Health Reform Bills and the Legislative Process (5 CECH, $19.99) Social Marketing Overview (2 CECH, $10) From:  HYPERLINK "mailto:owner-SOC-MKTG@georgetown.edu" \t "_blank" owner-SOC-MKTG@georgetown.edu  HYPERLINK "mailto:[mailto:owner-SOC-MKTG@georgetown.edu]" \t "_blank" [mailto:owner-SOC-MKTG@georgetown.edu] On Behalf Of Newton-ward, Mike Sent: Friday, October 14, 2011 9:27 AM To: Newton-ward, Mike;  HYPERLINK "mailto:soc-mktg@georgetown.edu" \t "_blank" soc-mktg@georgetown.edu Subject: RE: Realistic Change Percentages Everyone, The basis for my asking this question is that I so often see grant proposals and program plans with wildly hopeful goals of 75-80-95% change in behavior, knowledge and attitudes. I try to counsel people to understand the slowness of change and to be more realistic. So I was hoping that some of you might be aware of target ranges for these. I understand that many variables (e.g., the specific behavior or knowledge, the resources available, audience attributes, the specific environment, to list some that have been offered to me) affect the actual changes we observe. But, my question is how do we determine a range that is realistic to put in our proposals and plans?!?!?! The 3-5%/year rate for change in behavior that I stated is something I heard repeatedly in grant writing workshops in the late 90s, early 2000s and I am sorry, but I don t have a reference. L It has proved to be a useful reference over the years, though. I advise people to look at the experiences of similar programs to determine a realistic percentage for their work. However, I keep being wildly hopeful myself that there is some rule of thumb, some article I have yet to discover, some meta-analysis that provides some grounding for selecting a defensible percentage of change for knowledge and attitudes! How do you determine percent change for goals in your plans and proposals?! Or, are all of us just going for 75-80-95%?! Thanks!! And I will summarize all the responses I get. Mike Mike Newton-Ward, MSW, MPH Social Marketing Consultant North Carolina Division of Public Health/ Social Marketing National Excellence Collaborative 1916 MSC Raleigh, NC 27699-1916 Ph: 919-707-5137 Fax: 919-870-4833 Web Site:  HYPERLINK "http://www.ncpublichealth.com/employees/socialmarketing.htm" \t "_blank" www.ncpublichealth.com/employees/socialmarketing.htm  INCLUDEPICTURE "cid:1.1308040917@web160616.mail.bf1.yahoo.com" \* MERGEFORMATINET   From:  HYPERLINK "mailto:owner-SOC-MKTG@georgetown.edu" \t "_blank" owner-SOC-MKTG@georgetown.edu  HYPERLINK "mailto:[mailto:owner-SOC-MKTG@georgetown.edu]" \t "_blank" [mailto:owner-SOC-MKTG@georgetown.edu] On Behalf Of Newton-ward, Mike Sent: Tuesday, October 11, 2011 10:51 AM To:  HYPERLINK "mailto:soc-mktg@georgetown.edu" \t "_blank" soc-mktg@georgetown.edu Subject: Realistic Change Percentages Dear Colleagues, I have seen from a variety of sources that a realistic average percentage of behavior change is 3 5% a year. What is a realistic percentage change to see in knowledge and in beliefs over a year? Both your experiences and references to literature would be appreciated! Mike Mike Newton-Ward, MSW, MPH Social Marketing Consultant North Carolina Division of Public Health/ Social Marketing National Excellence Collaborative 1916 MSC Raleigh, NC 27699-1916 Ph: 919-707-5137 Fax: 919-870-4833 Web Site:  HYPERLINK "http://www.ncpublichealth.com/employees/socialmarketing.htm" \t "_blank" www.ncpublichealth.com/employees/socialmarketing.htm  INCLUDEPICTURE "cid:1.1308040917@web160616.mail.bf1.yahoo.com" \* MERGEFORMATINET  October 20, 2011 In a recent communications lit review we found the following which might be of interest. They contribute to the evidence base re the % effectiveness of different approaches. These articles are a small extract from the literature review that Sarah Kinsler on our staff conducted under subcontract to EDC for the SAMHSAs CAPT. Derzon, J. and Lipsey, M. (2002). A meta-analysis of the effectiveness of mass-communication for changing substance-use knowledge, attitudes and behaviors. In W Crano and D Burgoon (Eds.), Mass Media and Drug Prevention: Classic and Contemporary Theories and Research (231-258). London and New Jersey: Lawrence Erlbaum Associates, Publishers. Derzon and Lipseys meta-analysis includes media campaigns effect sizes for knowledge, attitudes and behaviors, broken down by media type, message target, substance, and a variety of other variables. This is the best resource I could find for percent change/effect size of interventions on knowledge and attitudes (among what we looked at for the lit review). In addition, Leslie Snyder has authored a number of works, including meta-analyses, looking at the effects of media campaigns/social marketing efforts. Her work is not constrained to ATOD use. However, most of her analyses seem to be focused on behavior. Snyder, L. (2007). Health communication campaigns and their impact on behavior. Journal of Nutrition Education and Behavior, 39 (2): S32-S40. theres a bit about knowledge and attitudes on S34. Snyder, L. and Hamilton, M (2002). A meta-analysis of US health campaign effects on behavior: Emphasize enforcement, exposure and new information, and beware the secular trend. In R.C. Hornik (Ed.), Public Health Communication: Evidence for Behavior Change (pages 357-384). Mahwah, NH: Lawrence Erlbaum. Full text not available online, may not include anything on knowledge or attitudes. Cited in Noar (2006) as the first meta-analysis on the subject. Derzon and Lipsey (2002) and Snyder and Hamilton (2002) are both sited in Noar (2006) folks may find his summaries helpful. Noar, S (2006). A 10-year retrospective of research in health mass media campaigns: Where do we go from here? Journal of Health Communication, 11: 21-46. Kate Perkins MCD Public Health 207.622.7566 x282 207.671.3221 cell  Formative Evaluation: Used in the planning stages of a program to ensure the program is developed based on stakeholders needs and that programs are using effective and appropriate materials and procedures. Formative evaluation includes: needs assessments, evaluability assessment (analysis to determine if your programs intended outcomes are able to be evaluated), program logic models, pre-testing program materials, and audience analysis.  Process Evaluation: It examines the procedures and tasks involved in providing a program. What services are actually being delivered and to whom? Process evaluation includes such things as: tracking quantity and description of people who are reached by the program, tracking quantity and types of services provided, descriptions of how services are provided, descriptions of what actually occurs while providing services, and quality of services provided, implementation evaluation.  Summative Evaluation: Investigates the effects of the program, both intended and unintended. Did the program make a difference?(impact evaluation) Did the program meet its stated goals and objectives?(outcome evaluation). Outcome evaluation can assess both short term outcomes, immediate changes in individuals or participants (such as participation rates, awareness, knowledge, or behaviour) and long term outcomes (some- times referred to as impact evaluation) which look at the larger impacts of a program on a community. An outcome evaluation can also analyze the results in relation to the costs of the program (cost-benefit evaluations).     From Risha Hess on D  4 5 f g : v MNQRɼɱyyyoj_______hc5CJOJQJ hc5hC&xhc>*CJ(jhc0JB*CJOJQJUph!hC&xhcB*CJOJQJph#hC&xhc5>*B*OJQJphh?<5CJOJQJ *h?<5CJOJQJ *h?<h?<5CJOJQJhcB*CJOJQJphhcCJOJQJhC&xhc:CJOJQJ% g ; # o ! u v N & Fgd- 7$8$H$h^h & F & FI]I & Fxxgd?<$&dPa$gdR=>Q5gAMjCq ! 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