Public Health Media Campaigns Research Articles

Chest pain presentations to hospital during the COVID-19 lockdown: Lessons for public health media campaigns.

ObjectiveEmergency Department (ED) attendances with chest pain reduced during the COVID-19 lockdown. We performed a service evaluation project in NHS Lothian to explore how and why the COVID-19 pandemic and public health advice had affected chest pain presentations and help-seeking behaviour at an individual patient level using a qualitative interview approach.MethodsWe carried out 28 semi-structured telephone interviews with a convenience sample of patients who presented with chest pain during lockdown and in patients with known coronary heart disease under the outpatient care of a cardiologist in April and May 2020. Interviews were audio recorded and voice files listened to while making detailed notes. Salient themes and issues were documented as verbatim extracts. Interviews were analysed thematically.ResultsPatient interviews revealed three main themes. 1) pandemic help-seeking behaviour; describing how participants made the decision to seek professional healthcare assessment. 2) COVID-19 exposure concerns; describing how the subthemes of perceived vulnerability, wishing to protect others and adding pressure to the health service shaped their decision making for an episode of acute chest pain. 3) hospital experience; describing the difference between the imagined and actual experience in hospital.ConclusionsQualitative interviews revealed how the pandemic shaped help-seeking practices, how patients interpreted their personal vulnerability to the virus, and described patient experience of attending hospital for assessment during this time. As patient numbers presenting to hospital appeared to mirror public health messaging, dynamic monitoring of this messaging should evaluate public response to healthcare campaigns to ensure the net impact on health, pandemic and non-pandemic related, is optimised.

Does Exposure to the Choose Water Campaign Increase Parental Intentions to Promote More Water and Less Sugar-Sweetened Beverage Consumption?

To assess if exposure to the Choose Water public health media campaign increased parents' intentions to promote healthier beverage consumption in their household. A cross-sectional evaluation administered post-campaign. A 2017 internet panel survey in Los Angeles County, California. The survey included 499 parents of young children. The Choose Water media campaign included digital media and out-of-home advertisements (eg, transit shelters, interiors of buses) in both English and Spanish. Dichotomous outcome variables were parental intentions to give child(ren) (1) more water and (2) less sugar-sweetened beverage consumption in their households. The independent variable was campaign exposure, categorized as no exposure, exposed but did not discuss visual, and exposed and discussed visual with someone. Descriptive, bivariate, and multivariable logistic regressions. Among those who were exposed and discussed a campaign visual, the adjusted odds of intending to promote water consumption were 2.82 times greater than for those who reported no exposure (95% confidence interval [CI]: 1.46-5.46). Similar odds to promote less sugar-sweetened beverage consumption were observed for those who were exposed and discussed a campaign visual (adjusted odds ratio: 3.27, 95% CI: 1.76-6.08). Those with the lowest educational attainment discussed the visual(s) less (10.5%). Word of mouth may enhance health messaging by allowing time for intended audiences to process campaign content within their interpersonal network.

Evaluating Correlates of Awareness of the Association between Drinking Too Much Alcohol and Cancer Risk in the United States

Awareness that alcohol consumption is associated with cancer is low in the United States, and predictors of awareness are not well understood. Data from the 2017 Health Information National Trends Survey (HINTS 5 Cycle 1) were used to describe knowledge of the association between drinking too much alcohol and cancer ("Yes," aware of the association; "No"; or "Don't know") among 3,009 adults. Weighted multinomial multivariable logistic regression determined personal characteristics (e.g., demographic characteristics, health-related self-efficacy, cancer beliefs, and information seeking) associated with reporting "Yes" or "Don't know" compared with "No." Thirty-eight percent of the U.S. population believed there was an association (38.36%), 36.17% were uncertain, and 25.47% believed there was no association. People believing that everything causes cancer and people who had ever looked up information about cancer had 1.61 and 1.80 higher odds of reporting "Yes" [95% confidence intervals (CI), 1.08-2.42 and 1.27-2.57, respectively]. Compared with people who were completely confident in their ability to take care of their health, people only somewhat confident had 2.32 higher odds of reporting "Don't know" (95% CI, 1.30-4.14). Younger age was negatively associated with reporting "Don't know." Awareness of the association between alcohol and cancer is low in the United States. Personal characteristics associated with awareness differed between reporting "Yes" and "Don't know," and there were few associations between demographic characteristics and awareness. A significant knowledge gap exists in the population. Broad reaching public health media campaigns, particularly those that increase information seeking, are needed to increase awareness.

Knowledge and Awareness of Added Sugar in Cigarettes.

Sugars naturally occur in tobacco leaf but are also commonly added to cigarettes by tobacco companies. Added sugar increases levels of toxic chemicals in cigarette smoke. Little is known about smokers' knowledge of added sugar in cigarettes and awareness of its effects. Adult cigarette smokers were recruited through Amazon Mechanical Turk to participate in an online experiment on electronic cigarette advertising. After completing the experiment, participants (N = 4351) answered two items assessing knowledge and awareness of added sugar in cigarettes. Participants had the option of providing open-ended comments about the overall study, and two reviewers read and independently coded comments pertaining to the sugar items. Only 5.5% of participants responded "yes" to the question: "Is sugar added to cigarettes?", and only 3.8% of participants indicated being aware that added sugar increases toxins in cigarette smoke. Forty-eight participants mentioned the sugar items when asked to comment about the overall questionnaire. Fifty-two percent of these comments expressed an interest in obtaining more information about added sugar, and 23% described the sugar items as interesting or informative. Three participants commented that learning about added sugar motivated them to quit or cut down on smoking. Among a large sample of smokers, few reported knowledge of added sugar in cigarettes and awareness of its effects. Further, several smokers expressed an interest in learning more about added sugar. Messages about added sugar in cigarettes may be a promising new angle for campaigns to discourage smoking. Few American smokers are aware that sugar is added to cigarettes, and some participants expressed a desire to learn more about this additive. Given such low awareness, the interest among smokers, and increased popular concerns about added sugar in foods and beverages, messaging about added sugar in cigarettes should be developed and tested for inclusion in public health media campaigns.

Evidence of the Real-World Effectiveness of Public Health Media Campaigns Reinforces the Value of Perceived Message Effectiveness in Campaign Planning

Evidence of the Real-World Effectiveness of Public Health Media Campaigns Reinforces the Value of Perceived Message Effectiveness in Campaign Planning

Peeling lead paint turns into poisonous dust. Guess where it ends up? A media campaign to prevent childhood lead poisoning in New York City.

Successful public health media campaigns promote messages, increase awareness, engage the public, and encourage behavior change. Between 2004 and 2006, the Lead Poisoning Prevention Program of the New York City Department of Health and Mental Hygiene conducted a media campaign grounded in social learning theory and the social marketing model to increase parents' awareness of childhood lead poisoning, ways to protect their children, and property owners' legal responsibility to fix peeling lead paint safely, and increase awareness of regulatory changes and encourage enforcement of New York City's Local Law 1 of 2004. Campaign materials were focus group tested and the campaign was refined annually. The campaign ran city-wide and in targeted high-risk neighborhoods. Neighborhoods and media venue (bus, train, kiosk, and store) changed annually, based on population risk factors and venue availability. Exposure to the campaign, campaign-related knowledge, and behavior were assessed using pre- and postcampaign street intercept surveys. Results showed that campaign reached the targeted population, and had an impact on knowledge of lead poisoning prevention measures as evidenced by increased knowledge of lead paint exposures sources in one year and increased knowledge of preventive behaviors in another year; these improvements were observed for both genders and most ethnic, primary language, educational attainment, and age groups in each year. Lessons learned indicate that well-targeted media campaigns, designed with audience participation, can reach parents through various venues, and improve key knowledge areas. Evaluation challenges faced include high levels of knowledge at baseline, competing media messages, and balancing between program needs and evaluation design.

Noncombustible Tobacco Product Advertising: How Companies Are Selling the New Face of Tobacco

With declining cigarette sales, increasing restrictions, and recent Food and Drug Administration (FDA) regulation of cigarettes, there has been a dramatic rise in the marketing of noncombustible tobacco products (NCPs). However, little is known about how NCPs are advertised and to whom. Two full-service advertising firms were used to systematically collect all U.S. advertisements for NCPs (e-cigarettes, snus, dissolvables, and chew/dip/snuff,) running between June 1 and September 1, 2012. The advertisement and associated metadata (brand, media channel, observations, spend, and estimated reach) were examined. Attributes of print advertisements were examined relative to target demographics of the publications in which they ran. Over 3 months, almost $20 million was spent advertising NCPs. Although the greatest amount spent was on the promotion of smokeless (~$8 million) and snus (~$10 million), e-cigarette advertisements were the most widely circulated. Print advertisements, the majority of which were e-cigarettes and chew/dip/snuff, were heavily tailored to middle-aged White males. Many e-cigarette print ads suggested harm reduction and use when one cannot smoke (poly-use), while chew/dip/snuff focused on masculinity. Robust ongoing surveillance of NCP advertising is critical to inform the FDA and to protect public health. Both commercial advertising and public health media campaigns must ensure that content is not misleading and that it educates consumers about harm based on the available science. The way messages are framed have the potential to decrease tobacco use by promoting rather than undermining cessation of combusted products and/or by encouraging exclusive use of less harmful NCPs rather than poly-use of combusted and NCPs.

Fighting obesity or obese persons? Public perceptions of obesity-related health messages

This study examined public perceptions of obesity-related public health media campaigns with specific emphasis on the extent to which campaign messages are perceived to be motivating or stigmatizing. In summer 2011, data were collected online from a nationally representative sample of 1014 adults. Participants viewed a random selection of 10 (from a total of 30) messages from major obesity public health campaigns from the United States, the United Kingdom and Australia, and rated each campaign message according to positive and negative descriptors, including whether it was stigmatizing or motivating. Participants also reported their familiarity with each message and their intentions to comply with the message content. Participants responded most favorably to messages involving themes of increased fruit and vegetable consumption, and general messages involving multiple health behaviors. Messages that have been publicly criticized for their stigmatizing content received the most negative ratings and the lowest intentions to comply with message content. Furthermore, messages that were perceived to be most positive and motivating made no mention of the word 'obesity' at all, and instead focused on making healthy behavioral changes without reference to body weight. These findings have important implications for framing messages in public health campaigns to address obesity, and suggest that certain types of messages may lead to increased motivation for behavior change among the public, whereas others may be perceived as stigmatizing and instill less motivation to improve health.

Turning negative into positive: public health mass media campaigns and negative advertising

Literature suggests that 'negative advertising' is an effective way to encourage behavioral changes, but it has enjoyed limited use in public health media campaigns. However, as public health increasingly focuses on non-communicable disease prevention, negative advertising could be more widely applied. This analysis considers an illustrative case from tobacco control. Relying on internal tobacco industry documents, surveys and experimental data and drawing from political advocacy literature, we describe tobacco industry and public health research on the American Legacy Foundation's "truth" campaign, an example of effective negative advertising in the service of public health. The tobacco industry determined that the most effective advertisements run by Legacy's "truth" campaign were negative advertisements. Although the tobacco industry's own research suggested that these negative ads identified and effectively reframed the cigarette as a harmful consumer product rather than focusing solely on tobacco companies, Philip Morris accused Legacy of 'vilifying' it. Public health researchers have demonstrated the effectiveness of the "truth" campaign in reducing smoking initiation. Research on political advocacy demonstrating the value of negative advertising has rarely been used in the development of public health media campaigns, but negative advertising can effectively communicate certain public health messages and serve to counter corporate disease promotion.

Check Out That Body: A Community Awareness Campaign in New York City

The authors evaluate the effectiveness of the small media campaign in raising community awareness about the importance of going for a health check up. Data were collected over time from 535 respondents ages 15-30 years using cross-sectional surveys in two low-income, predominantly African-American communities in New York city. Regression analyses indicated campaign material recognition at 15 months was significantly higher in the intervention community relative to the comparison community. There were no significant changes in social norms, attitudes, or beliefs. Media campaigns aimed at adolescents and young adults on a community-wide level are an effective means of gaining material recognition. Editors' Strategic Implications: This research illustrates the effect of a public health media campaign on awareness, but it also serves as a reminder to public health officials that awareness is not necessarily sufficient to promote attitudinal or behavioral health changes.

Improvements in General Practitioner Beliefs and Stated Management of Back Pain Persist 4.5 Years After the Cessation of a Public Health Media Campaign

Quasi-experimental, nonrandomized, nonequivalent, parallel group-controlled study involving before-after mailed surveys of general practitioners. To measure the magnitude of any sustained change in general practitioner beliefs and stated behavior about back pain 4.5 years after cessation of a media campaign designed to alter population back pain beliefs. A media campaign providing simple advice about back pain carried out in Victoria, Australia between September 1997 and December 1999 resulted in significant improvements in physicians' beliefs and stated management. Mailed surveys of general practitioners in Victoria and the adjacent control state, New South Wales, were performed before, immediately after, and 4.5 years after the Victorian campaign. We elicited knowledge and attitudes about back pain by asking respondents to indicate their level of agreement with a set of statements. We also elicited their likely management by presenting 2 hypothetical scenarios. A total of 635 Victorian and 511 NSW GPs completed the latest survey. There were sustained improvements over time in Victorian physicians' beliefs about back pain and their stated behavior: e.g., at Survey 3, compared with baseline, Victorian physicians were 2.0 (95% confidence interval [CI], 1.3-3.0) times as likely as their NSW counterparts to know that patients with low back pain need not wait to be almost pain free to return to work; 1.78 (95% CI, 1.27-2.49) times as likely not to order tests for acute low back pain and 0.47 (95% CI, 0.33-0.69) times as likely to order lumbosacral radiographs. They were also 0.49 (95% CI, 0.34-0.73) times as likely to prescribe bed rest and 1.62 (95% CI, 1.19-2.22) times as likely to advise work modification. A population-based strategy to shift societal views about back pain has had a sustained effect on GP beliefs and stated behavior 4.5 years after its cessation.

The Impact of a Health Campaign on Health Social Capital

Referring to literature in sociology, mass communication, and public health, we conceptualize and operationally define “health social capital” and “individual health social capital” and then posit and test a model for its development in response to a public health media campaign. The campaign evaluated here was designed to stimulate behaviors that would provide a more supportive social environment for children and youth, an environment which we consider to be richer in aggregate health social capital. The association model of advertising was employed to explain the development of individual health social capital measures of awareness, attitude, and behavior. With cross-sectional data (1998, n = 614; 1999, n = 1,087; 2000, n = 1,388), we examine the results for changes in awareness, attitude, and behavior over time and the significant links between these dependent variables and media campaign exposure. The results show significant increases in awareness and attitude, but not in behavior. Structural equation modeling revealed different patterns of influence for newspaper and TV campaign exposure.

Dialogic voices in talk about drinking and pregnancy

Alcohol use during pregnancy poses a significant risk of fetal alcohol syndrome. This study presents the interpretive findings of the formative research phase of a funded grant to develop a community‐based public health media campaign on the topic of drinking during pregnancy. In the initial wave of data collection, 50 rural women were recruited from four Women, Infants, and Children (WIC) clinics in southeastern Iowa to participate in semi‐structured interviews. In the second wave, 10 additional WIC clients were interviewed for member‐checking purposes. Findings revealed two competing discourses that organized these women's attitudes, beliefs, and behaviors surrounding drinking and pregnancy: the discourse of individualism and the discourse of responsible motherhood. These two discourses offer opposing normative guidelines for talk among their close female relatives and friends. The implications of these findings for designing a community‐based media campaign are discussed.

Influence of Interpersonal and Mass-Mediated Interventions on Injection Drug and Crack Users: Diffusion of Innovations and Hiv Risk Behaviors

Evaluation research of public health media campaigns to influence behavior change often bemoans the lack of relevance to target audience and an absence of integrated interpersonal and mass-mediated communication channels. The assumption that illegal drug users are disconnected from mass-mediated communication may account for this absence of media interventions. The authors used cross-tabulation, chi-square, and regression analyses to demonstrate that many out-of-treatment drug users in an HIV-prevention research project are media consumers and that participants who recalled seeing or hearing media interventions reported greater levels of positive behavior change than participants who did not recall such messages. Results suggest coordination of human and mass-mediated public health messages relevant to this population to facilitate behavior changes.

Tuned in and turned off: Out‐of‐treatment injection drug and crack users' response to media intervention campaigns

Evaluation research of public health media campaigns to influence behavior change often bemoans the lack of relevance to target audience and an absence of integrated interpersonal and mass‐mediated communication channels. The assumption that illegal drug users are disconnected from mass‐mediated communication may account for this absence of media interventions. The authors used crosstabulation, chi‐square, and regression analyses to demonstrate that many out‐of‐treatment drug users in an HIV‐prevention research project are, indeed, media consumers. Project participants who recalled seeing or hearing media interventions reported greater levels of positive behavior change than participants who did not recall such messages. Results suggest coordination of human and mass‐mediated public health messages relevant to this population to facilitate behavior changes.