Prevention Media Campaign Research Articles

Change in attitudes after a suicide prevention media campaign in the Mid-Norway region

BackgroundSuicide prevention media campaigns are one way of reaching people at increased suicide risk who would otherwise not seek help. This is the first study of a Norwegian campaign directed both at individuals at risk for suicide and at their social network.MethodsWe evaluated a media campaign consisting of outdoor posters, feature articles, film clips, and online banners in print, digital, and social media spread across the Mid-Norway region in late autumn 2022. This campaign material consisted of information about how to seek help for suicide thoughts and mental health problems and how to help a friend in similar situations. Before and after this campaign, 1149 adult individuals living in Mid-Norway participated in a survey on attitudes to suicide, mental ill health, and help-seeking.ResultsThere were only marginal changes in attitudes and help-seeking literacy after the campaign. This result was sustained when controlling for age, sex, and campaign visibility. For males, there were a few changes in the negative direction, i.e. lack of willingness to seek help from family and friends, after the campaign.ConclusionWe conclude that the campaign did not seem to have the desired effect and suggest ways of improving future regional Norwegian media campaigns.

"Breaking the Silence" Suicide Prevention Media Campaign in Oregon, April 7-14, 2019.

Background: Between April 7 and 14, 2019, the "Breaking the Silence" media engagement campaign was launched in Oregon. Aims: We aimed to assess the consistency of media content related to the campaign with media guidelines and the quantitative footprint on Twitter (now X) over time. Method: Media items related to the campaign were analyzed regarding focus and consistency with media guidelines for suicide reporting and compared with other suicide-related reports published in the same time frame, as well as with reporting in Washington, the control region. Tweets related to the campaign were retrieved to assess the social media footprint. Results: There were n = 104 media items in the campaign month, mainly in the campaign week. Items typically used a narrative featuring suicide advocacy or policy/prevention programs. As compared to other items with a similar focus, they scored better on several protective characteristics listed in media recommendations. Stories of coping with adversity, however, were scarce. The social media footprint on Twitter was small. Limitations: Inability to make causal claims about campaign impact. Conclusion: Media items from the Breaking the Silence campaign appeared mainly consistent with media guidelines, but some aspects, such as stories of recovery, were under-represented.

"Breaking the silence" suicide Prevention media campaign in Oregon: Evaluation of impact on help-seeking and suicide mortality.

Research has established that suicide-related media can impact suicide rates both positively and negatively, supporting efforts to engage the media in the service of suicide prevention. The goal of the current study is to evaluate the impact of a suicide prevention media campaign implemented April 7-14, 2019 in Oregon. Several indices of help-seeking behavior and suicide risk were employed: suicide-related Google Health API searches, National Suicide Prevention Lifeline (Lifeline) (currently known as the 988 Suicide and Crisis Lifeline) call volume, and state suicide mortality data from April 7, 2016-May 6, 2019. Eight states with similar 2016-2018 average suicide rates were compared with Oregon. Bayesian structural time-series modeling in R was used to test intervention effects. During the 30 days following the start of the campaign, there was a significant increase in Lifeline calls from Oregon area codes (2488 observed vs. 2283 expected calls, p = 0.03). There were no significant changes in suicide mortality or suicide-related Google searches in Oregon. The campaign appeared to increase help-seeking behavior in the form of Lifeline calls, without any indication of an iatrogenic suicide contagion effect. However, the campaign's potential to reduce suicide mortality was unmet.

An Evaluation of the Boys Do Cry Suicide Prevention Media Campaign on Twitter: Mixed Methods Approach.

In most countries, men are more likely to die by suicide than women. Adherence to dominant masculine norms, such as being self-reliant, is linked to suicide in men in Western cultures. We created a suicide prevention media campaign, "Boys Do Cry," designed to challenge the "self-reliance" norm and encourage help-seeking in men. A music video was at the core of the campaign, which was an adapted version of the "Boys Don't Cry" song from "The Cure." There is evidence that suicide prevention media campaigns can encourage help-seeking for mental health difficulties. We aimed to explore the reach, engagement, and themes of discussion prompted by the Boys Do Cry campaign on Twitter. We used Twitter analytics data to investigate the reach and engagement of the Boys Do Cry campaign, including analyzing the characteristics of tweets posted by the campaign's hosts. Throughout the campaign and immediately after, we also used Twitter data derived from the Twitter Application Programming Interface to analyze the tweeting patterns of users related to the campaign. In addition, we qualitatively analyzed the content of Boys Do Cry-related tweets during the campaign period. During the campaign, Twitter users saw the tweets posted by the hosts of the campaign a total of 140,650 times and engaged with its content a total of 4477 times. The 10 highest-performing tweets by the campaign hosts involved either a video or an image. Among the 10 highest-performing tweets, the first was one that included the campaign's core video; the second was a screenshot of the tweet posted by Robert Smith, the lead singer of The Cure, sharing the Boys Do Cry campaign's video and tagging the campaign's hosts. In addition, the pattern of Twitter activity for the campaign-related tweets was considerably higher during the campaign than in the immediate postcampaign period, with half of the activity occurring during the first week of the campaign when Robert Smith promoted the campaign. Some of the key topics of discussions prompted by the Boys Do Cry campaign on Twitter involved users supporting the campaign; referencing the original song, band, or lead singer; reiterating the campaign's messages; and having emotional responses to the campaign. This study demonstrates that a brief media campaign such as Boys Do Cry can achieve good reach and engagement and can prompt discussions on Twitter about masculinity and suicide. Such discussions may lead to greater awareness about the importance of seeking help and providing support to those with mental health difficulties. However, this study suggests that longer, more intensive campaigns may be needed in order to amplify and sustain these results.

Innovative perception analysis of HIV prevention messaging for black women in college: a proof of concept study

BackgroundBlack women in college are disproportionately affected by HIV, but have not been a population of focus for HIV prevention campaigns. This study used content from a preexisting HIV media campaign to assess its relevancy and acceptability among Black women in college.MethodsMedia viewing and listening sessions were convened with Black women enrolled at an HBCU (n = 10) using perception analyzer technology—hardware and software tools that are calibrated to gather and interpret continuous, in-the-moment feedback. Matched pre-and-post-test responses from focus groups were obtained from the perception analyzer data. Descriptive statistics and t-tests were used to characterize the data.ResultsStudents were more likely to personally identify with media content that included profound statements, along with memorable people and actors [95% CI: 1.38, 2.27]. In over half of the vignettes, participants reported that content representing students’ society, culture, or interests was missing.ConclusionsHIV prevention media campaigns may offer potential in increasing HIV awareness and risk perceptions; further research is needed to evaluate optimal content tailoring for both cultural and climate relevancy.

Development of the UNC Perceived Message Effectiveness Scale for Youth

PurposeTobacco prevention media campaigns are an important tool to address youth tobacco use. We developed a theory-based perceived message effectiveness (PME) Scale to use when vetting messages for campaigns.MethodsParticipants were...

Evaluating the actual and perceived effectiveness of E-cigarette prevention advertisements among adolescents

BackgroundThe efficacy of e-cigarette prevention ads among adolescents has seldom been studied. We examined the impact of ads from the The Real Cost vaping prevention media campaign on what adolescents think and believe about vaping. We also sought to test whether perceived message effectiveness (PME) served as a proxy for ad impact. MethodsParticipants were 543 U.S. adolescents ages 13–17. In an online experiment, we randomized participants to either: 1) persuasive e-cigarette prevention video ads from the Food and Drug Administration's The Real Cost campaign that was targeted to adolescents or 2) information-only e-cigarette harms control videos (control condition). Participants in each condition viewed 2 videos in a random order. After ad exposure, the survey assessed PME (message and effects perceptions), risk beliefs about vaping, attitudes toward vaping, and intentions to vape. ResultsThe FDA’s The Real Cost ads led to higher beliefs about the harms of vaping (p < .001), more negative attitudes toward vaping (p < .001), and lower intentions to vape (p < .05) compared to the control videos. The Real Cost ads also scored higher on both message perceptions (p < .001) and effects perceptions (p < .001) compared to control videos. Effects perceptions were associated with all three outcomes (all ps < 0.001, adjusting for both types of PME and covariates), but message perceptions did not offer additional predictive value. ConclusionsExposure to The Real Cost vaping prevention ads gave adolescents a more negative view of vaping and lowered their intentions to vape compared to control videos. Effects perceptions may be superior to message perceptions as a proxy for e-cigarette prevention ad impact.

675-P: Final Outcomes of a Four-Year Effort to Support, Scale, and Sustain the National Diabetes Prevention Program

CDC’s State and Local Public Health Actions 1422 Cooperative Agreement funded 17 states and 4 large cities for four years to develop and sustain the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) by implementing comprehensive environmental, health system, and community-clinical linkage strategies for populations at high-risk for type 2 diabetes. Objectives: (1) Describe health system and community-clinical linkage strategies implemented; (2) share findings from baseline to year 4, and (3) highlight key facilitators and barriers to scale and sustain the National DPP. Qualitative and quantitative data were analyzed from awardees’ annual performance reports and health impact statements. Performance measure data from baseline to year 4 were analyzed to determine year-to-year percent change. Qualitative data from awardees were analyzed to identify barriers and facilitators to implementing activities, and understand how barriers were overcome. Recipients and sub-awardees worked with partners across key sectors to implement evidence-based strategies and increase coverage and referral policies to promote engagement in CDC-recognized LCPs. Outcomes from baseline to year 4 will be shared on reach of diabetes prevention media campaigns, the number of people in health systems identified as having prediabetes, the number of health systems engaging community health workers, and the total number of people enrolled in CDC-recognized diabetes prevention programs. Barriers and facilitators to implementation of the National DPP will also be shared. Key lessons learned from SLPHA-1422 include the importance of leveraging existing programs and infrastructure (i.e., SPHA-1305 resources) to scale and sustain the National DPP, establishing strong partnerships across sectors, providing on-going training and technical assistance to recipients and prioritizing enrollment of participants in CDC-recognized LCPs. Disclosure Y. Mensa-Wilmot: None. A. Mensa-Kwao: None. K.D. Farris: None. S. Bowen: None. S. Thummalapally: None. M.D. Murphy: None. G.E. Rutledge: None.

Lessons on Addiction Messages From “The Real Cost” Campaign

A key strategy in reducing the public health burden of cigarette smoking is preventing youth from ever becoming addicted to cigarettes in the first place. However, there is limited research exploring youth responses to addiction messages. This study assesses youths' responses to the U.S. Food and Drug Administration's "The Real Cost" campaign messaging depicting addiction as a "loss of control." Between 2013 and 2016, three focus group studies and four copy testing studies were conducted to assess reactions to advertising concepts and near-final videos. Participants were aged 12-17 years and ethnically and geographically diverse. Researchers conducted a thematic secondary analysis of focus group transcripts and open-ended survey questions from the copy testing studies. Data analysis for this study took place in 2017. Youth responded favorably to loss of control messages showing real, often short-term, consequences of addiction, such as choosing to spend money on cigarettes instead of going to a movie, and depictions of scenarios that were relatable to youth. Youth also responded favorably to messages describing how nicotine changes the brain. A portion of youth remained skeptical, stating they felt the consequences depicted were unrealistic. This study shows that by framing addiction as a loss of control and tying that loss of control to short-term health and social consequences, addiction becomes more concrete and understandable, and the consequences feel more relatable and relevant to youth. This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.

Fear and Humor Appeals in “The Real Cost” Campaign: Evidence of Potential Effectiveness in Message Pretesting

In tobacco prevention campaigns, fear-appeal messages are widely used and generally shown to be effective, whereas the utility of humor appeals is less clear. This study compares the potential effectiveness of fear and humor ads developed for "The Real Cost" campaign. Adolescents (N=1,315) aged 13-17 years who were either experimenting with smoking or susceptible to smoking initiation were randomized to view either a single ad (of three fear and two humor ads in total) or nothing (control condition). Those in the ad viewing condition completed measures on fear, amusement, and perceived ad effectiveness. All participants completed measures on smoking attitudes and risk perceptions. Data were collected in 2014 and 2015. Analysis was performed in 2016. Compared with control, both fear and humor ads produced greater risk perceptions (p<0.001). Fear ads also produced more negative smoking attitudes (p=0.001); humor ads had a similar effect on attitudes that approached significance (p=0.07). Fear ads scored higher on perceived ad effectiveness and fear, and lower on amusement than humor ads (p<0.001). In regression models, fear was a stronger predictor of perceived ad effectiveness, smoking attitudes, and risk perceptions than amusement for fear ads, whereas amusement was a stronger predictor of these outcomes than fear for humor ads. Both fear and humor appeals have potential to be effective in "The Real Cost" campaign. Concurrent employment of these message strategies should help to diversify messaging and consistently recapture the target audience's attention. This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.

Finding Pete and Nikki: Defining the Target Audience for “The Real Cost” Campaign

Successfully reaching at-risk teens aged 12-17 years with smoking-prevention messages capable of changing their knowledge, attitudes, and beliefs about cigarette smoking requires a multifaceted approach to understand the target audience's unique demographic, environmental, behavioral, interpersonal, and intrapersonal characteristics. This paper explores the initial target audience segmentation and insights development approach used to create the underlying message strategy for "The Real Cost" youth smoking prevention media campaign-a public education effort responsible for preventing nearly 350,000 U.S. youth aged 11-18 years from initiating smoking from 2014 to 2016. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.

“The Real Cost”: Reaching At-Risk Youth in a Fragmented Media Environment

In 2014, the U.S. Food and Drug Administration launched its first youth smoking prevention media campaign, "The Real Cost," with the goal of preventing cigarette smoking among at-risk youth aged 12-17 years in the U.S. This paper examines how the paid media strategy was developed, implemented, and refined between 2013 and 2016. Specifically, this paper discusses how research and best practices informed the media targeting strategy used to implement a multifaceted national campaign that successfully reached and influenced thousands of teens at risk for cigarette smoking. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.

The Case and Context for “The Real Cost” Campaign

Discussion of how the creation of the Center for Tobacco Products at the U.S. Food and Drug Administration, youth trends in cigarette smoking, and effectiveness of mass media interventions served as the foundation for the development of "The Real Cost" youth smoking prevention media campaign. The success of the campaign demonstrates that a comprehensive regulatory approach that includes public education can reduce the public health burden of tobacco use. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.

Bringing “The Real Cost” to Life Through Breakthrough, Evidence-Based Advertising

Building on the success "The Real Cost" campaign has already achieved requires the constant development of new audience insights, novel ideas, and unconventional ways of bringing the campaign to life. This article provides a high-level overview of the campaign's approach to developing and testing breakthrough advertising that has proven effective in preventing smoking initiation among a skeptical, hard-to-reach, at-risk youth audience. This approach is informed by evidence-based communication best practices for youth behavior change campaigns; insights from published literature and subject matter experts with decades of experience in youth health marketing and tobacco prevention; and findings from formative research studies conducted as part of the campaign development process. The paper also explores two campaign advertisements to showcase the research-based creative development process in action. This article is a collaboration between federal government officials, campaign managers, ad agency creatives, and researchers, and thus provides a unique, multidisciplinary examination into the research and creative processes that go into creating a national health communication effort. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.

A Secondary Audience's Reactions to “The Real Cost” Advertisements: Results From a Study of U.S. Young Adult Smokers and Susceptible Nonsmokers

Exposure to "The Real Cost" campaign has prevented smoking initiation among its target audience (U.S. youth aged 12-17 years). This study examines reactions to "The Real Cost" advertisements among a potential secondary audience: U.S. young adults. An online convenience sample of young adult (ages 18-29 years) smokers (n=225) and susceptible nonsmokers (n=339) participated in a within-subjects experiment in 2017. Participants viewed three TV ads from "The Real Cost" campaign and reported their past exposure to, conversations about, and reactions to the ads. In 2017, analyses examined message-level and person-level predictors of perceived message effectiveness using multilevel modeling. About half of smokers (47%) and susceptible nonsmokers (51%) had seen at least one of the three ads in the past 3 months. About one in four smokers (23%) and susceptible nonsmokers (24%) had at least one conversation about the ads in the past 3 months. Susceptible nonsmokers rated the ads higher on perceived message effectiveness than smokers (p<0.01), but lower on message relevance and negative affective reactions to the ads (both p<0.05). In both samples, ads that elicited higher negative affective reactions and message relevance, and lower message reactance (i.e., resistance) received higher perceived message effectiveness ratings (all p<0.05). "The Real Cost" ads have reached and generated conversations among a convenience sample of young adult smokers and susceptible nonsmokers. Increasing the perceived relevance and emotional reactions of campaigns may increase their impact. Future studies should examine reactions to "The Real Cost" campaign and effects on smoking behavior using nationally representative samples of young adults. This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.

Adolescents’ Neural Response to Tobacco Prevention Messages and Sharing Engagement

Interpersonal communication can reinforce media effects on health behavior. Recent studies have shown that brain activity in the medial prefrontal cortex during message exposure can predict message-consistent behavior change. Key next steps include examining the relationship between neural responses to ads and measures of interpersonal message retransmission that can be collected at scale. Neuroimaging, self-report, and automated linguistic measures were utilized to investigate the relationships between neural responses to tobacco prevention messages, sharing engagement, and smoking-relevant belief changes. Thirty-seven adolescent nonsmokers viewed 12 ads from the U.S. Food and Drug Administration's "The Real Cost" campaign during a functional magnetic resonance imaging scan session (2015-2016). Data were analyzed between 2016 and 2017. The extent that participants talked in detail about the main message of the ads, or sharing engagement, was measured through transcripts of participants' subsequent verbal descriptions using automated linguistic coding. Beliefs about the consequences of smoking were measured before and after the main experiment using surveys. Increased brain activation in self- and value-related subregions of the medial prefrontal cortex during message exposure was associated with subsequent sharing engagement when participants verbally talked about the ads. In addition, sharing engagement was significantly associated with changes in participants' beliefs about the social consequences of smoking. Neural activity in self- and value-related subregions of the medial prefrontal cortex during exposure to "The Real Cost" campaign was associated with subsequent sharing engagement, which in turn was related to social belief change. These results provide new insights into the link between neurocognitive responses to ads, the content of interpersonal sharing, and downstream health-relevant outcomes. This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.

Importance of Messages for a Suicide Prevention Media Campaign.

A suicide prevention media campaign aimed at family members and friends may be one useful population-level suicide prevention strategy for Australia. However, currently there is limited evidence of what messages would be acceptable and appropriate for inclusion. This expert consensus study aimed to identify messages that experts with lived experience of suicide risk and suicide prevention professionals believed were most important to include in such a suicide prevention campaign. Using an online survey method, 127 participants with lived experience (lived experience group) and 33 suicide prevention professionals (suicide prevention professionals group) rated 55 statements, drawn from an earlier Delphi study, from very low priority to very high priority for inclusion in a suicide prevention campaign. There was significant agreement within and between the two participant groups on the most highly rated messages for inclusion. The mostly highly rated messages were that family members or friends should ask directly about suicidal thoughts and intentions, listen to responses without judgment, and tell the person at risk that they care and want to help. We restricted ratings to just one round and may therefore have limited the level of consensus achieved. Use of a predefined set of suicide prevention messages might also have prevented us from identifying other important messages. Lived experience participants were drawn from one source and this might bias their responses through exposure to common suicide prevention messages that influence their points of view. There is substantial agreement between professionals and people with lived experience on the most important messages to include in a suicide prevention campaign. These most highly rated messages could be adopted in a suicide prevention media campaign.

Suicide Prevention Media Campaigns: A Systematic Literature Review

ABSTRACTSuicide prevention media campaigns are gaining traction as a means of combatting suicide. The current review set out to synthesize information about the effectiveness of these campaigns. We searched four electronic databases for studies that provided evidence on the effectiveness of media campaigns. We focused on studies that described an evaluation of the effectiveness of an entire campaign or a public service announcement explicitly aimed at suicide prevention. We identified 20 studies of varying quality. Studies that looked at whether campaign exposure leads to improved knowledge and awareness of suicide found support for this. Most studies that considered whether campaign materials can achieve improvements in attitudes toward suicide also found this to be the case, although there were some exceptions. Some studies found that media campaigns could boost help-seeking, whereas others suggested that they made no difference or only had an impact when particular sources of help or particular types of help-seeking were considered. Relatively few studies had sufficient statistical power to examine whether media campaigns had an impact on the ultimate behavioral outcome of suicides, but those that did demonstrated significant reductions. Our review indicates that media campaigns should be considered in the suite of interventions that might be used to prevent suicide. Evidence for their effectiveness is still amassing, but there are strong suggestions that they can achieve positive results in terms of certain suicide-related outcomes. Care should be taken to ensure that campaign developers get the messaging of campaigns right, and further work is needed to determine which messages work and which ones do not, and how effective messages should be disseminated. There is an onus on those developing and delivering campaigns to evaluate them carefully and to share the findings with others. There is a need for evaluations that employ rigorous designs assessing the most pertinent outcomes. These evaluations should explore the nature of given campaigns in detail – in particular the messaging contained within them – in order to tease out which messages work well and which do not. They should also take into account the reach of the campaign, in order to determine whether it would be reasonable to expect that they might have their desired effect.

Advancing Knowledge About Suicide Prevention Media Campaigns.

Advancing Knowledge About Suicide Prevention Media Campaigns.

Process Evaluation of Cancer Prevention Media Campaigns in Appalachian Ohio.

The purpose of this study is to provide process data from campaigns (2009-2010) to improve colorectal cancer (CRC; intervention) screening and fruit and vegetable (F&V; comparison) consumption in 12 Appalachian Ohio counties. County-specific campaigns included one billboard, posters, and articles for local newspapers. Participants in CRC screening counties who reported seeing CRC screening billboards had greater intention to talk to a doctor/nurse about screening in the next 6 months (odds ratio [OR] = 2.92, 95% confidence interval [CI; 1.71, 4.99]) and had twice the odds of talking to a doctor/nurse about screening in the past year (OR = 2.15, 95% CI [1.29, 3.60]) compared to those who did not see the billboards. Participants in F&V counties who reported seeing F&V billboards had twice the odds (OR = 2.27, 95% CI [1.35, 3.84]) of talking to a doctor/nurse in the past year about F&Vs compared to those who did not see the billboards. Participants who reported campaign exposure lived closer to the billboards compared to those who did not report campaign exposure (mean distance in miles from home to billboard: 8.8 vs. 10.9; p < .01). Most participants reported campaign messages were clear and important. Results suggest that partnering with community members to develop campaign materials is important to ensure cultural appropriateness and that exposure to the intervention components may affect health-related outcomes.