From Salt to Stroke-Evaluation of a Media Campaign for Sodium Reduction in Philadelphia.

Ann C Klassen,Michelle Shuster,Jared Stokes,Amber Summers,Andrea Mccord,Jessica P Lopez,Suruchi Sood,Amanda Wagner,Udara Perera,Joann White

doi:10.3389/fpubh.2020.619261

Abstract

Excess dietary sodium contributes to the burden of chronic disease, including cardiovascular disease and stroke. Media-based health education campaigns are one strategy to raise awareness among populations at greater risk for stroke, including African Americans. During 2014–2015, the Philadelphia Department of Public Health conducted a health education campaign using radio, print news, and transit ads, to promote awareness of the link between dietary sodium, hypertension and stroke, and encourage reduced consumption of high sodium foods. Using a repeated cross-sectional design, street intercept surveys were conducted with ~400 Philadelphia residents representing the campaign's priority audience (African Americans ages 35–55) before and 6–13 weeks after the campaign, to evaluate both process (campaign exposure) and impact (recall of key health messages). Thirty percent of post-campaign respondents reported familiarity with one of the most engaging radio spots, and 17% provided accurate unaided recall of its key content, with greater recall among older respondents and frequent radio listeners. Forty-one percent of post-campaign respondents named stroke as a consequence of excess salt consumption, compared to only 17% of pre-campaign respondents, with greater awareness of the salt-stroke connection among those accurately recalling the radio spot from the campaign. Results suggest that priority populations for sodium reduction can be effectively reached through radio and transit campaigns. From a pragmatic perspective, street intercept surveys may offer one low resource strategy for evaluating public health education campaigns conducted by local health departments, especially among urban populations.

Highlights

Strategies to address the burden of non-communicable diseases have a growing focus on dietary behavior change, including recommendations from the World Health Organization [1] to limit sodium consumption to 2 grams per day
No formal denominator and response rate can be calculated for intercept surveys, 53% (1,106/2,098) of those approached completed screening, and 98% (804/817) of screened and eligible respondents completed the survey, yielding an overall response rate of 38% among all persons approached
Over 90% of respondents were in the target age range [35–55], a small proportion stated during initial screening that they met age criteria, but disclosed that they were slightly younger or older when asked demographic information at the end of the survey

Summary

INTRODUCTION

Most Americans consume far more than the recommended level of salt [2], and almost everyone would benefit from reducing dietary sodium to decrease risk for chronic diseases, including hypertension and stroke [3, 4]. To address excess sodium and related stroke risk in Philadelphia, a city with substantial chronic disease burden and health disparities, the Philadelphia Department of Health created and carried out a salt reduction media campaign during 2014–2015. Participants knew the connection between salt and hypertension, few connected excess dietary sodium to stroke risk These findings informed the development of a media campaign by a professional media partner. He offers her “cheesesteaks and fries” if she wins, but she responds with cautions about high sodium meals, his hypertension and its link to stroke (audio and print images available from the authors on request)

Evaluation Design

EVALUATION RESULTS

DISCUSSION AND LIMITATIONS

CONCLUSION

ETHICS STATEMENT