Primordial Prevention of Cardiovascular Disease among African-Americans: A Social Epidemiological Perspective

Background. The primordial prevention of cardiovascular disease (CVD) among African-Americans represents a formidable challenge for public health. This paper discusses the nature of this challenge, highlighting the role that economic and cultural factors play in shaping the distributions of major CVD risk factors among African-Americans. The paper concludes with specific suggestions for research.Methods. Data from recent national health surveys on black/white differences in major CVD risk factors like hypertension, obesity, cholesterol, cigarette smoking, and physical inactivity were reviewed for the purpose of identifying promising avenues for primordial prevention research among African-Americans.Results. Cigarette smoking has a delayed onset among African-Americans compared to whites. Black/white differences in “vigorous” leisure-time physical activity (e.g., social dancing and team sports) are not apparent until around age 40. These findings have relevance for primordial prevention work in black communities since they suggest the existence of broad-based, health-relevant cultural norms which could support primordial prevention programs, such as regular physical activity, across the life cycle.Conclusions. CVD primordial prevention programs among African-Americans must be grounded in an understanding of how cultural values as well as economic conditions shape CVD risk factor distributions in this population. Ultimate success will depend on the strength of the partnerships that public health researchers, primary care providers, and community residents are able to build.     

Evaluation of a mass-media campaign for the primary prevention of alcohol-related problems

A quasi-experimental design was used to evaluate an alcohol-relatedproblem prevention programme. The study compared two citiesexposed to a mass-media campaign with two cities which receivedthe same mass-media campaign and also participated in communityorganization. Two comparable reference cities received no interventionprogramme. The objectives of the community organization campaignincluded an increase in support for alcohol policies and themass-media campaign aimed to change attitudes about alcoholuse. A process evaluation illustrated the difficulties a problem-preventionprogramme such as this is likely to encounter. Vested interestgroups involved in the production, sale and promotion of alcoholhad a significant adverse effect on the running of the campaign.The process evaluation also documented that the way in whicha public health agency chooses to manage controversies is anintegral part of the health promotion campaign. Attitudes towards alcohol use were affected by the mass-mediacampaign but the combined approach of mass-media and communityaction showed a slightly greater impact. The mass-media campaignalso had an effect on public support for alcohol policies eventhough this was not the target of the campaign. Over all, the results suggest that the mass-media campaign,despite having a focus on individual drinking behaviour, servedthe function of keeping alcohol problems on the public agendaand maintaining support for healthy public policies.     

Developing and implementing a targeted health-focused climate communications campaign in Ontario—#MakeItBetter

SettingPublic health practitioners are called to effectively communicate with the public on climate change. The climate crisis requires swift action that starts with public awareness of climate-related health impacts and leads to public support for individual, community and systemic actions to mitigate and adapt to climate change.InterventionThis paper discusses learnings about public opinion research and communication strategies and how a health-focused climate communication campaign—#MakeItBetter—could help to increase awareness and engage new audiences, including public health partners, in conversations about climate change in order to reduce climate-related health impacts for current and future generations. The #MakeItBetter campaign was grounded in evidence-informed messaging, being sensitive to health inequities. Emerging research and pre-campaign testing suggest that framing climate change as a health issue is a promising practice.OutcomesThe #MakeItBetter campaign appeals to parents/caregivers to learn more about climate-related health impacts, take protective action for children and support multi-level climate action. The campaign launch secured 89 news stories, including multicultural media coverage. Longer-term evaluation is required to determine the campaign’s effectiveness in building public support for climate action.ImplicationsAn innovative approach to climate communication that draws on the intersections between behavioural and climate sciences and engages in multi-sectoral collaboration can spur both climate action and health protection, aiding public health practitioners and partners in effectively communicating the urgency for climate action. More work is needed to support communication on climate change as an inequity multiplier and promote climate action and community resilience for health equity co-benefits.     

Media advocacy for alcohol policy support: results from the New Zealand Community Action Project

Media advocacy has been described as the strategic use of massmedia for advancing a social or public policy initiative. Thispaper describes an attempt to use media advocacy to increasepublic awareness and support for public health policies on alcoholin a demonstration project. The New Zealand Community ActionProject (CAP) was an evaluated alcohol problem prevention programmewhich compared cities exposed to a mass media campaign with,and without, community organization, against reference cities.Media advocacy was an element in both a community organizationstrategy and in a print media advertising campaign. Major objectivesof CAP were to increase the level of support for alcohol policiesin the general population and to increase the amount of alcohol-relatedmaterial (excluding liquor industry promotion) in the localprint media. Evaluation of the media advocacy strategies are reported froman analysis of alcohol-related material in the local print media,from a general population survey conducted in the six cities,a complementary qualitative key informants interview study,and a street interview survey. The results indicated that inthe four cities where. mass media only or intrusive intervention(mass media and community organization) were employed, therewas increased newspaper coverage of alcohol-related materialon the focus areas of moderation and social policy. Resultsfrom the general population survey, the key informants interviewstudy and the street interview survey suggested a positive effectof the programme both in the media only, and in the intensiveintervention cities, compared with the reference cities.     

Bridging the gap: Translating research into policy and practice

Effective physical activity interventions do not achieve their full potential if they are not applied beyond their original testing in research studies. Potentially effective interventions can be adopted in community settings through the efforts of numerous agencies, organizations, and individuals. This paper highlights the important roles of public health practitioners and policy makers, who differ in their decision-making processes. To enhance the uptake of evidence-based interventions, several steps are needed to: build the science by moving upstream, increase the understanding of practice-based evidence, move beyond the “what” to the “how,” re-frame the dissemination challenges, place greater emphasis on workforce development, and make research more accessible for policy audiences. The most effective strategies to bridge the gap between research and practice, will have at their heart, effective academic-practice-policy maker partnerships.     

People and money matter: investment lessons from the Ontario Heart Health Program, Canada

Resource allocation is a critical issue for public health decision-makers. Yet little is known about the level and type of resources needed to build capacity to plan and implement comprehensive programs. This paper examines the relationships between investments and changes in organizational capacity and program implementation in the first phase (1998-2003) of the Ontario Heart Health Program (OHHP)--a province-wide, comprehensive public health program that involved 40 community partnerships. The study represents a subset of findings from a provincial evaluation. Investments, organizational capacity of public health units and implementation of heart health activities were measured longitudinally. Investment information was gathered annually from the provincial government, local public health units and community partners using standard reports, and was available from 1998 to 2002. Organizational capacity and program implementation were measured using a written survey, completed by all health units at five measurement times from 1994 to 2002. Combining provincial and local sources, the average total investment by year five was $1.66 per capita. Organizational capacity of public health units and implementation of heart health activities increased both before and during the first 2 years of the OHHP, and then plateaued at a modest level for capacity and a low level for implementation after that. Amount of funding was positively associated with organizational capacity, yet this association was overpowered by the negative influence of turnover of a key staff position. Regression analysis indicated that staff turnover explained 23% of local variability in organizational capacity. Findings reinforce the need for adequate investment and retention of key staff positions in complex partnership programs. Better accounting of public health investments, including monetary and in-kind investments, is needed to inform decisions about the amount and duration of public health investments that will lead to effective program implementation.     

Collaborative partnerships at the state level: promoting systems changes in public health infrastructure.

Reforms in the public health infrastructure such as those called for in recent Institute of Medicine reports require stakeholder engagement on different levels than traditional grass-roots community work. The Turning Point Initiative, funded by The Robert Wood Johnson Foundation, involves 21 state-wide partnerships established for systems change and focused in specific areas of public health innovation and policy development. These partnerships represent a different model of strategic alliances and relationship-building than has been previously described in the literature on community-level and health-promotion collaborations. This article utilizes qualitative data to illustrate the ways in which state-level partnerships for systems change both confirm and extend previous models. Findings indicate that state-level public health partnerships share many of the challenges and opportunities of locally-based and health-promotion-oriented partnerships. Collaboration at the state level, however, involves more attention to organizational alliances, coordination of institutional change, and strategic responses to political changes. These partnerships depend on a combination of interpersonal skills, material resources, and organizational savvy to manage complex planning and implementation processes. Influencing policy development and organizational redesign in public health systems requires nuanced understanding of the opportunities provided by various kinds of organizational partners.     

Evaluating the Effects of a Youth Health Media Campaign

This article examines the impact of a socially oriented public health media campaign that aims to influence social indicators among adults as a means to advances in youth health outcomes. Hierarchical regression analyses are conducted on telephone survey data from 18 weekly telephone surveys of adults in Kansas. Media campaign exposure was positively associated with two outcome measures: beliefs about youth development and behaviors toward youth development. In addition, these two outcome measures increased significantly over time, with the dissemination of the campaign's television and newspaper advertisements. Furthermore, these over-time increases were present only among respondents who were exposed to the media campaign. These findings offer support for the campaign's influence on the two social indicators, which would, per other research, be expected to influence improvements in youth health. Findings are discussed in reference to previous research in the areas of public health and mass communication, with implications made for practitioners and researchers.     

A Public Health Achievement Under Adversity: The Eradication of Poliomyelitis From Peru, 1991

The fight to achieve global eradication of poliomyelitis continues. Although native transmission of poliovirus was halted in the Western Hemisphere by the early 1990s, and only a few cases have been imported in the past few years, much of Latin America’s story remains to be told. Peru conducted a successful flexible, or flattened, vertical campaign in 1991. The initial disease-oriented programs began to collaborate with community-oriented primary health care systems, thus strengthening public–private partnerships and enabling the common goal of poliomyelitis eradication to prevail despite rampant terrorism, economic instability, and political turmoil. Committed leaders in Peru’s Ministry of Health, the Pan American Health Organization, and Rotary International, as well as dedicated health workers who acted with missionary zeal, facilitated acquisition of adequate technologies, coordinated work at the local level, and increased community engagement, despite sometimes being unable to institutionalize public health improvements.During the past few decades, immunization has evolved into a crucial health intervention in developing countries, and advocates of both vertical, disease-oriented programs and horizontal, community-oriented primary health care (PHC) defend its relevance.1 In addition, immunization campaigns have been viewed recently as tests for coveted public–private partnerships, the integration of health relief efforts into permanent health institutions, and community engagement in public health initiatives.2 The international campaign against poliomyelitis (also known as infantile paralysis) launched in the late 1980s by the World Health Organization (WHO) continues to be a major undertaking of international health. Although historians of medicine have described the history of polio eradication in developed countries, mainly achieved before the WHO initiative,3,4 only a few studies have analyzed in detail how the fight against polio proceeded in less-developed countries in the late 20th century.5–7We examined a portion of this campaign that many experts consider a success: the elimination of poliomyelitis from Peru, despite adverse conditions, through national immunization days and a house-to-house vaccination strategy. The events surrounding the discovery of three-year-old Luis Fermín Tenorio Cortez, the last polio victim in the Americas, embodied the heart of the eradication achievement. He was found by Roger Zapata in Pichanaki, a remote Andean town in the Central Andes, in August 1991. Following this discovery, an energetic campaign supported by the Peruvian Ministry of Health, the Pan American Health Organization (PAHO), and Rotary International (RI), among other agencies, “mopped up” the 890 districts surrounding Pichanaki, vaccinating more than two million children in two weeks.8 For several years, poliomyelitis joined smallpox as the only diseases eliminated from the Western Hemisphere.The Peruvian campaign against wild poliomyelitis was remarkable for its success under adverse conditions. The late 1980s and early 1990s were years of economic hyperinflation and political violence in Peru. This turmoil encompassed the rise and fall of the Shining Path terrorist group, a crumbling democratic system, human rights violations perpetrated by the military and terrorists, and finally the emergence of an authoritarian regime under Alberto Fujimori.Our investigation contributes to an emerging body of literature on the history of immunization, particularly polio control and eradication.9–11 It also illuminates some crucial issues in Latin American public health, such as the relationship between vertical and horizontal programs and immunization in underdeveloped health care systems and the possibility for broad alliances between public and private agencies for humanitarian health goals.The history of Peru’s fight to eliminate polio falls into two periods: the early 1960s until 1985, before the full implementation of an eradication campaign, and the design and enforcement of the campaign from 1985 to 1994, when eradication of wild poliomyelitis from the Americas became an official goal.5-7 We searched library archives, unearthed rare publications, and conducted interviews in Lima between 2004 and 2005 to examine the Peruvian political context, human resources, available technology, and public attitudes toward immunization in each of these periods.Open in a separate windowRoger Zapata examines Luis Fermín Tenorio Cortez in rural Pichanaki, Peru. 1991. Courtesy of Roger Zapata.     

Muévete Bogotá: promoting physical activity with a network of partner companies

In 1998 the mayor's office and the District Institute for Sports and Recreation created Muévete Bogotá, a physical activity and health promotion programme for the capital city of Colombia. Muévete means to move or to be active, and this campaign to promote physical activity was designed to improve the health and quality of life of the citizens of Bogotá through regular physical activity. The programme is based on the 1995 recommendations on physical activity of the U.S. Centers for Disease Control and Prevention and the American College of Sports Medicine (Pate el al, 1995), and was developed in close consultation with the Agita S?o Paulo programme in Brazil (Matsudo el al., 2003). Muévete Bogotá couples a mass media campaign with programmes targeted to change physical activity behaviour. The interventions, which are conducted at work sites, schools, health care centers and in community settings rely on partnerships created among professionals in areas of education and health, business officials and personnel, and community members, to deliver the programmes in each of these settings and populations. Like many developing countries, Colombia suffers from a growing epidemic of chronic diseases. In 1993 35.7% of total mortality in the city of Bogotá was due to chronic diseases (Espinosa, 1993). In 2002 cardiovascular diseases accounted for 40.3% of mortality among the population aged 60 years or older and 26.8% for persons 45 to 59 years of age. (Cardona, 2002) Bogotá has implemented extensive physical and social environmental changes over the last decade, which has increased opportunities for physical activity, but sedentary lifestyle continues to be a significant public health problem in the city. Programmes such as Muévete Bogotá that educate and motivate the population to become more physically active appear to be needed to complement the underlying environmental and policy changes. Muévete Bogotá provides an example of successful implementation of a comprehensive multi-sectoral approach to physical activity promotion in a large metropolitan area. This model may be used as an exemplary effort elsewhere in Latin America and in urban areas in developing countries around the world.     

“Live, Learn and Play”: Building strategic alliances between professional sports and public health

Public–private partnerships allow communities and corporate entities to pool resources to address a mission of relevance to their common constituency or consumer base. Collaborations between public health and professional sports may present unique opportunities to improve health outcomes related to physical activity since athletes are fitness icons, both for adults and children. There are many “win–win” opportunities, as sports venues regularly host huge numbers of spectators, offering food and entertainment, providing hours of exposure, and introducing new ideas for engaging fans in order to remain a competitive draw. In 2008, the San Diego Padres embarked on a communitywide fitness initiative, FriarFit, including incorporating 10-minute Instant Recess™ breaks during their Sunday homestand pre-game shows. Many lessons have been learned that may be useful to others mounting such initiatives, such as: there is more at stake in cost-benefit and risk-benefit assessment for sports executives, requiring greater caution and circumspection than is typical for public health projects; the core business of the corporate entity must be accommodated without undermining the health objectives; and health aims must be addressed in a way that is financially viable and delivers tangible value for profit-making concerns, in terms of marketing, revenues or brand enhancement.     

Planning and implementing a community-based public health advocacy campaign: a transport case study from Australia

Facilitating community action is a key goal of health promotion. This paper describes a public health advocacy framework. It then presents a case study of its application for planning community action by a community alliance concerned about increased heavy traffic on roads through a small regional city in the South West region of Western Australia. The case study illustrates defining the public health problem, the solution and the target for action; and the implementation of a comprehensive range of strategies including a media advocacy strategy to attract public attention, to reframe media messages, and to provide a policy alternative to government and industry. The campaign was evaluated in terms of process and outcomes, and was successful in putting pressure on key stakeholders and achieving the alliance's two main goals. The case study demonstrates the value of a well-planned campaign and including public health advocacy in public health practice, as an important strategy to facilitate the creation of healthy environments through healthy public policy.     

Inverse Association between Canned Fish Consumption and Colorectal Cancer Risk: Analysis of Two Large Case–Control Studies

Fish is among the foods exerting favourable effects on colorectal cancer (CRC), but the possible role of canned fish has been insufficiently investigated. We aimed to investigate the relationship between canned fish consumption and CRC risk. We analysed data from two case–control studies conducted between 1992 and 2010 in several Italian areas, comprising a total of 2419 incident cases and 4723 hospital controls. Canned fish consumption was analysed according to the weekly frequency of consumption as <1 serving per week (s/w) (reference category), 1 < 2 s/w, and ≥2 s/w. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional logistic regression models, adjusting for several recognised confounding factors. Overall, canned fish consumption was lower among cases than among controls (23.8% vs. 28.6%). An inverse association was found between canned fish consumption and CRC risk with a significant trend in risk (OR = 0.81, 95% CI: 0.71–0.92 for intermediate consumption and OR = 0.66, 95% CI: 0.51–0.85 for the highest one), which was consistent across strata of several covariates. This study is the first to offer a basis of support for canned fish consumption as a component of a healthy diet, and it has relevant public health implications given the high ranking of CRC in incidence and mortality worldwide.     

A Culture-Centered Community-Grounded Approach to Disseminating Health Information among African Americans

ABSTRACT

This study highlights the role of local communities in creating culturally rooted health information resources based on comparative effectiveness research (CER), depicting the role of culture in creating entry points for building community-grounded communication structures for evidence-based health knowledge. We report the results from running a year-long culture-centered campaign that was carried out among African American communities in two counties, Lake and Marion County, in Indiana addressing basic evidence-based knowledge on four areas of cardiovascular disease (CVD). Campaign effectiveness was tested through an experimental design with post-test knowledge of CER among African Americans in these counties compared to CER knowledge among African Americans in a comparable control county (Allen). Our campaign, based on the principles of the culture-centered approach (CCA), increased community CER knowledge in the experimental communities relative to a community that did not receive the culturally centered health information campaign. The CCA-based campaign developed by community members and distributed through the mass media, community wide channels such as health fairs and church meetings, postcards, and face-to-face interventions explaining the postcards improved CER knowledge in specific areas (ACE-I/ARBs, atrial fibrillation, and renal artery stenosis) in the CCA communities as compared to the control community.     

Using cocreated visually informed community mental health education in low‐ and middle‐income countries: A case study of youth substance misuse in Assam,India

IntroductionOur aim is to evaluate the visually informed community mental health education materials cocreated in our research on youth substance misuse in Assam, India, and to reflect on what we might learn for similar initiatives in low‐ and middle‐income countries.MethodsMaterials consist of: (i) images participants brought to the interview; (ii) 30 posters cocreated by participants to convey key messages from their interview; (iii) six short films on the implications of addiction, and (iv) an animation of our Pathways to Recovery model. We also created a community education package that incorporated these materials. We analyse feedback from three groups of events and a social media campaign, which drew variably across our materials and engaged a range of audiences.ResultsOutcomes indicate the cocreation process and focus on the visual was successful in promoting young people''s voice, increasing awareness and has potential for stigma reduction. Our educational package was deemed useful in increasing awareness and has potential for prevention and treatment.ConclusionsOur case study offers insights into community mental health education in low‐ and middle‐income countries, confirming the importance of cocreation, the usefulness of visual materials and the potential of social media campaigns while acknowledging the importance of local context in health messaging, particularly for stigmatized topics.Patient or Public ContributionService users were involved in the cocreation of the materials evaluated in this study and contributed as presenters in one of the events reported. Members of the public took part in events in which the materials were shared and provided us with the feedback analysed in this article.     

Wheeling Walks: a community campaign using paid media to encourage walking among sedentary older adults

BACKGROUND: Mass media may effect communitywide changes in health awareness, attitude, and behavior, but the approach remains unproven for physical activity. METHODS: Wheeling Walks promoted walking among sedentary 50- to 65-year-old adults in a West Virginia city of 31,420 people. This quasi-experimental communication intervention used theory of planned behavior and transtheoretical model constructs to change behavior by promoting 30 min of daily walking through paid media, public relations, and public health activities. Impact was determined by pre- and postintervention telephone surveys with 719 adults in the intervention community and 753 adults in the comparison community and observations of walkers at 10 community sites. RESULTS: Behavior observation showed a 23% increase in the number of walkers in the intervention community versus no change in the comparison community (OR = 1.31, 95% CI = 1.14-1.50). Thirty-two percent (32.2) of the baseline sedentary population in the intervention community reported meeting the CDC/ACSM/Surgeon General recommendation for moderate-intensity physical activity by walking at least 30 min at least five times per week versus 18.0% in the comparison community (OR = 2.12, 95% CI = 1.41-2.24). The intervention community also realized a pre to post increase in positive stage change (P < 0.001). CONCLUSIONS: This theory-based mass media campaign demonstrated increases in those meeting the recommended standard for moderate-intensity physical activity through walking and significant positive stage change.     

Local Newspapers, Community Partnerships, and Health Improvement Projects: Their Roles in a Comprehensive Community Initiative

To understand local media's role in a community health initiative, a content analysis of 1,709 paragraphs from 173 news articles and editorials was undertaken. The articles were from three local newspapers, one in each of three communities. Analyses focused on article content combined with reflective personal interviews with local campaign directors. Results suggest that local campaign staff can be successful using commercial media to achieve objectives. Surprisingly, most coverage was not about projects with observable and easily identifiable benefits for local residents, but rather partnerships among influential residents engaged in decision-making about such projects. We conclude that the politics of resource distribution is more newsworthy to local journalists than tangible topics like access to health information, insurance coverage, and service provision.     

Evaluating the effects of a youth health media campaign

This article examines the impact of a socially oriented public health media campaign that aims to influence social indicators among adults as a means to advances in youth health outcomes. Hierarchical regression analyses are conducted on telephone survey data from 18 weekly telephone surveys of adults in Kansas. Media campaign exposure was positively associated with two outcome measures: beliefs about youth development and behaviors toward youth development. In addition, these two outcome measures increased significantly over time, with the dissemination of the campaign's television and newspaper advertisements. Furthermore, these over-time increases were present only among respondents who were exposed to the media campaign. These findings offer support for the campaign's influence on the two social indicators, which would, per other research, be expected to influence improvements in youth health. Findings are discussed in reference to previous research in the areas of public health and mass communication, with implications made for practitioners and researchers.     

Strengthening the Merci Mon Héros Campaign Through Adaptive Management: Application of Social Listening Methodology

BackgroundBetween 2014 and 2018, the penetration of smartphones in sub-Saharan Africa increased from 10% to 30%, enabling increased access to the internet, Facebook, Twitter, Pinterest, and YouTube. These platforms engage users in multidirectional communication and provide public health programs with the tools to inform and engage diverse audiences on a range of public health issues, as well as monitor opinions and behaviors on health topics.ObjectiveThis paper details the process used by the U.S. Agency for International Development–funded Breakthrough RESEARCH to apply social media monitoring and social listening techniques in Burkina Faso, Côte d’Ivoire, Niger, and Togo for the adaptive management of the Merci Mon Héros campaign. We documented how these approaches were applied and how the lessons learned can be used to support future public health communication campaigns.MethodsThe process involved 6 steps: (1) ensure there is a sufficient volume of topic-specific web-based conversation in the target countries; (2) develop measures to monitor the campaign’s social media strategy; (3) identify search terms to assess campaign and related conversations; (4) quantitatively assess campaign audience demographics, campaign reach, and engagement through social media monitoring; (5) qualitatively assess audience attitudes, opinions, and behaviors and understand conversation context through social media listening; and (6) adapt campaign content and approach based on the analysis of social media data.ResultsWe analyzed posts across social media platforms from November 2019 to October 2020 based on identified key search terms related to family planning, reproductive health, menstruation, sexual activity, and gender. Based on the quantitative and qualitative assessments in steps 4 and 5, there were several adaptive shifts in the campaign’s content and approach, of which the following 3 shifts are highlighted. (1) Social media monitoring identified that the Facebook campaign fans were primarily male, which prompted the campaign to target calls to action to the male audience already following the campaign and shift marketing approaches to increase the proportion of female followers. (2) Shorter videos had a higher chance of being viewed in their entirety. In response to this, the campaign shortened video lengths and created screenshot teasers to promote videos. (3) The most negative sentiment related to the campaign videos was associated with beliefs against premarital sex. In response to this finding, the campaign included videos and Facebook Live sessions with religious leaders who promoted talking openly with young people to support intergenerational discussion about reproductive health.ConclusionsPrior to launching health campaigns, programs should test the most relevant social media platforms and their limitations. Inherent biases to internet and social media access are important challenges, and ethical considerations around data privacy must continue to guide the advances in this technology’s use for research. However, social listening and social media monitoring can be powerful monitoring and evaluation tools that can be used to aid the adaptive management of health campaigns that engage populations who have a digital presence.     

The Laugh Model: Reframing and Rebranding Public Health Through Social Media

Objectives. We examined the use of low-cost social media platforms in communicating public health messages and outline the laugh model, a framework through which public health organizations can reach and engage communities.Methods. In August 2014, we developed an online campaign (Web site and social media) to help promote healthy family meals in Utah in conjunction with the state and local health departments.Results. By the end of September 2014, a total of 3641 individuals had visited the Utahfamilymeals.org Web site. Facebook ads reached a total of 29 078 people, and 56 900 people were reached through Twitter ads. The per-person price of the campaign was 0.2 cents, and the total estimated target population reach was between 10% and 12%.Conclusions. There are 3 key takeaways from our campaign: use of empowering and engaging techniques may be more effective than use of educational techniques; use of social media Web sites and online marketing tactics can enhance collaboration, interdisciplinary strategies, and campaign effectiveness; and use of social media as a communication platform is often preferable to use of mass media in terms of cost-effectiveness, more precise evaluations of campaign success, and increased sustainability.Many public health entities continue to use social media simply to broadcast information, much like traditional media, without engaging audiences.1 Although various state and local health departments have begun to use multiple social media platforms, the majority have few followers, minimal if any comments on their posts, and overall low engagement with the public.1,2 This may be attributable to a fundamental mismatch of motivations for social media use and gratification. People are generally motivated to use social media to pass time, to seek or give affection, to be sociable, or to share problems.3,4 Conversely, public health entities attempt to communicate with consumers to gain market insights, establish and promote a brand with consumers, disseminate critical information, expand their reach to include broader and more diverse audiences, and foster public engagement and partnerships with consumers.5To fully engage constituents, public health entities must bridge this motivational gap between people and organizations. Evidence suggests that organizations can reach out and engage constituents through innovative social media campaigns that are beneficial and have a positive effect on behaviors.6–9According to Neiger et al., owing to a lack of evidence supporting the use of social media to broadcast 1-way information as a stand-alone intervention to improve health status, public health entities may need to transition to 2-way communications that engage audiences.2 Social media can be used to facilitate communications that fulfill the social and organizational needs of all parties. Social media marketing leverages existing social networks and encourages people to share content with their respective networks, increasing overall reach and engagement.10 Neiger et al. suggested that engaging people through social media for health promotion purposes can increase

awareness or knowledge of health-related information, feelings of belonging and social connection, and involvement with health promotion programs either as partners who help guide actual program development and implementation or as participants who receive direct services or products.2

This engagement between public health entities and audiences can lead to program involvement through participation or partnership.11 The #SMMStandards effort, a cross-industry venture designed to simplify and unify social media standards, identified 6 metrics for measuring social media engagement: content and sourcing, reach and impressions, engagement and conversations, influence, opinion and advocacy, and impact and value.12 By employing these standards as a guide for successful marketing, health promotion efforts can achieve broader reach, gain higher levels of engagement, and ultimately improve health by increasing program participation.A handful of studies in the area of public health have measured the overall reach of online, population-based interventions with the intent of evaluating their effectiveness in changing behaviors.13,14 These studies demonstrate the potential for using online marketing in both educating the public and influencing individual behaviors. For example, Gosselin and Poitras used online incentives and quizzes to publicize a health promotion Web site, and more than 100 000 people viewed the site’s content.13 Purdy conducted a viral marketing campaign to promote condom use in Turkey by advertising a “fun” component (messaging that portrayed safe sex as synonymous with fun sex) as a means of driving viral marketing. By using social media platforms effectively, this program increased sales of condoms and generated tens of thousands of clicks.14 Clearly, social media have considerable potential for successful public health marketing.Because of increasing cuts in public funding for preventive health services, public health must increasingly do more with less,15 attempting to elicit participation from communities despite working with fewer resources and personnel. Although advocacy efforts are conducted continuously to increase funding, the advocacy process is long and laborious and generally fails to lead to acquisition of resources in the short term. To address these challenges, new public health marketing efforts must be unique, appeal to the masses, and be able to generate support from communities.16Social media are a viable option for cost-effective campaigns and health promotion in the face of budget constraints and limited resources, but several barriers may exist that prevent health professionals from crafting effective messages on these such platforms, including employers discouraging social media use at work; perceived lack of ease of use, particularly among older professionals; and low performance expectancy levels.17 Given funding constraints, efforts must also be inexpensive and sustainable, a predicament that will force the rising generation of public health professionals to explore innovative techniques for reaching large audiences.18,19The “laugh model” framework, described here, posits that social media and business-like marketing and branding strategies are cost-effective tools through which public health organizations can reach and engage communities.20 The laugh model is based on the success of businesses in using entertainment, engagement of populations, and at times humorous messages to prompt simple actions and connect individuals to programs or communities. In addition to outlining this framework, we present the results of a campaign applying the model. The campaign was implemented during September 2014 in Utah to promote healthy family meals, and the results have implications for public health practice.We propose that the field of public health can achieve an effective viral marketing presence by implementing the laugh model, which is based on a combination of business, social media, and viral marketing concepts and frameworks. The laugh model was labeled as such to convey the importance of prioritizing the use of humor, content virality, and entertainment in health promotion messages disseminated to the public. This framework is unique in the area of public health because it recommends overhauling public service announcements (PSAs), billboards, and educational content (flyers, posters) as a means of message communication in favor of an online business marketing approach in which state-of-the-art social media marketing strategies are used to promote programs and services available to the public.PSAs have been the traditional means of communicating information on issues or abstract concepts such as physical activity, bullying, substance abuse, domestic violence, and good nutrition, whereas businesses use marketing to promote concrete products (e.g., deodorants, cars). The laugh model proposes that public health follow the example of businesses and market concrete products such as programs and services to better reach audiences and drive positive health behaviors. The framework is based on the premise that, just as entertaining, engaging, and even at times irreverent social media material is successful in promoting commercial products, this approach can be an effective means of promoting public health programs and services.Rather than focusing media efforts on messages that are solely educational or designed to influence complex behavioral changes, the laugh model framework suggests using overtly entertaining content to create online health marketing campaigns. Content is developed to drive viewers toward public health programs that are based on sound behavioral principles. This way, the focus shifts from PSAs carrying the responsibility for changing individual behaviors to their merely influencing the “purchasing behavior” of populations, namely, marketing public health programs that are efficacious and based on an understanding of behavioral principles. This approach is supported by 2 recent studies that reviewed PSAs on YouTube with respect to incorporation of health behavior constructs. These studies both showed that PSAs lacked integration of behavioral principles and that the majority of the videos were highly educational and received a small number of views.21,22The laugh model (Figure 1) posits that raising target audiences’ awareness and changing their health behaviors through social media channels are contingent on creating overtly entertaining content and connecting individuals to programs or communities. Connectivity and entertainment are 2 important reasons why individuals use social media and are directly linked to content being shared and having “viral” capacity.16,23Open in a separate windowFIGURE 1—Laugh model framework.