Journal Issue: Children and Electronic Media Volume 18 Number 1 Spring 2008
How Social Marketing Can Counter Media Messages about Unhealthful Behavior
As noted, social marketing campaigns have been notably successful in three areas: preventing tobacco use, promoting diet and physical activity, and preventing HIV/AIDS. In each area, messages promote healthful behavior and counter the effects of media messages that glamorize or otherwise encourage risky behaviors. These three areas have seen the largest number of effective branded campaigns.40
Tobacco Countermarketing Campaigns
One of the most successful social marketing efforts has been tobacco countermarketing campaigns aimed at preventing youth from starting to smoke. For example, campaigns such as the American Legacy Foundation's truth campaign have successfully reduced smoking initiation and progression to established smoking. Matthew Farrelly and several colleagues showed that from 1999 to 2002, U.S. youth smoking prevalence declined from 25.3 percent to 18.0 percent and that truth accounted for approximately 22 percent of that decline.41
Although the effect size of the truth campaign is small by clinical standards, the campaign shows that social marketing can have a big impact on population-level health. In the case of truth, the campaign-attributable decline in youth smoking equates to some 300,000 fewer youth smokers and thus millions of added life years as well as tremendous reductions in health care and other social costs.
State-funded countermarketing campaigns have also been effective in preventing and controlling tobacco use. Edward Siegel and Lois Biener analyzed longitudinal data from the Massachusetts countermarketing campaign and found that adolescents who were aged twelve to thirteen years at the study's outset and who reported exposure to television antismoking advertisements were significantly less likely to progress to established smoking than their peers who did not report exposure.42 The study, however, found no effect on progression to established smoking among adolescents aged fourteen to fifteen as the study began and no effects of exposure to radio or outdoor advertisements.
Countermarketing campaigns have been found effective in influencing specific, targeted attitudes and beliefs to affect smoking behavior. A longitudinal study of the Florida TRUTH campaign (the state campaign that preceded, and was the model for, the national truth campaign) found that teenagers with high levels of anti-tobacco industry attitudes were four times less likely to initiate smoking and more than thirteen times less likely to become established smokers than their peers with low levels of such attitudes.43 James Hersey and several colleagues found that state countermarketing campaigns using an anti- tobacco industry message prime, or make more salient, negative perceptions about tobacco industry practices.44 Jeffrey Niederdeppe, Matthew Farrelly, and M. Lyndon Haviland confirmed that TRUTH reduced smoking among Florida teens and found specifically that adoption of two counterindustry beliefs central to the campaign were associated with lower teen smoking rates.45
Diet and Physical Activity Countermarketing Campaigns
Social marketing's success in the arena of nutrition and physical activity promotion and obesity prevention has provided insights to help inform future nutrition campaigns.46 Several effective branded nutrition campaigns, such as the National Cancer Institute's (NCI) 5-A-Day for Better Health, are widely known to the public. In a workshop on diet and communication sponsored by NCI in July 2005, researchers examined the potential for diet and communication fields to work collaboratively and develop more effective social marketing strategies.47 The workshop confirmed previous research on poor nutrition as a serious and growing risk factor for children's health and highlighted social marketing's promise in protecting children and promoting better nutritional health.48
One of the most successful diet and nutrition efforts has been the 1% Or Less campaign, which encouraged adults and children older than age two to drink milk with a fat content of 1 percent or less, instead of whole or 2 percent milk.49 Designed by the Center for Science in the Public Interest, a nonprofit group dedicated to improving the nation's health through better nutrition, this campaign has been carried out at many sites since 1995. The campaign includes news stories and advertisements on television, radio, billboards, and in newspapers; milk taste-tests at a variety of community sites; supermarket shelf labeling to draw attention to low-fat milk; and school activities. The California Adolescent Nutrition and Fitness (CANFit) program found that after its 1% Or Less campaign in East Los Angeles, whole milk purchases had dropped from 66 percent to 24 percent of overall sales and that the share of all low-fat milk sold had more than doubled.50 Although it was not a goal of the campaign, overall milk purchases had increased by 30 percent.51
HIV/AIDS Countermarketing Campaigns
HIV/AIDS prevention in the United States, other developed nations, and the developing world, especially Africa, presents a different kind of social marketing challenge. Sexual imagery, sexualization of children, and normalization of early sexual debut among adolescents are pervasive in both contemporary media and commercial marketing and represent a major risk factor.52 Having sex is often seen as a rite of passage of youth, and the peer pressure and social desirability of being sexually active may be stronger than they are in the case of smoking or other risk behaviors. Social marketing campaigns must consider these factors when developing messages and setting behavior change objectives.
The Henry J. Kaiser Family Foundation partnered with media giant Viacom to launch KNOW HIV/AIDS, a comprehensive public education campaign in the United States in 2003.53 The effort built on the existing partnership between the Kaiser Family Foundation and Black Entertainment Television (BET, whose parent company is Viacom), which promoted HIV/AIDS prevention and awareness through the targeted Rap It Up campaign beginning in 1998.54 The campaign reports that it has produced 131 rights-free (that is, non-copyrighted) messages, totaling a media value commitment of more than $600 million.55
KNOW HIV/AIDS has five aims: to increase awareness about HIV/AIDS and how to prevent it, to encourage dialogue between partners and with health care providers about sexual health issues, to encourage and promote testing, to address the role that stigma and discrimination play in spreading the disease, and to promote safer sex behaviors.56 The campaign uses partnerships with media, commercial businesses, government, and community-based groups and contributions of air time, community outreach, and similar methods to increase campaign exposure. It promotes messages through paid and unpaid targeted television, radio, and outdoor PSAs; HIV-themed television and radio programming (primarily through partners Viacom and BET); print media; online and other electronic media; and public outreach.57
The 2004 survey of African Americans reported by Victoria Rideout revealed that 82 percent of all respondents and 94 percent of young adults aged eighteen to twenty-four recalled at least one campaign advertisement or program component, and 70 percent recalled seeing two specific advertisements. Brand awareness for the Rap It Up campaign was also high, with 58 percent of all respondents and 92 percent of young adults reporting awareness. Approximately 30 percent of all respondents and young adults demonstrated recall of the KNOW HIV/AIDS brand.58
Respondents who reported exposure to one or more campaign component said that the campaign had influenced their plans for the future, including visiting a doctor or getting tested for HIV, and were more likely than respondents who were not aware of campaign components to indicate they planned to engage in these behaviors. However, one major study did not show a link between exposure and intentions or sexual behavior.59
Three branded HIV/AIDS prevention social marketing campaigns that illustrate strategies for reaching adolescents and young adults have recently been conducted in Africa: Trust in Kenya, Salama in Tanzania, and loveLife in South Africa.60 Trust, conducted by the U.S.-based Population Services International (PSI), promoted the social desirability of condom use to make using a condom seem cool. Special events such as concerts were part of the campaign. Salama, also led by PSI, targeted high-risk groups including young people aged fifteen to twenty-four, commercial sex workers, and rural populations, but it also operated on the principle that young people are susceptible to messages about behavior change. Salama relied heavily on community outreach such as concerts, cultural shows, mobile video units, and sport tournaments.
The loveLife campaign was the most comprehensive of the three. It aimed to reduce by half the rate of HIV infection among fifteen- to twenty-year-olds, as well as to reduce other sexually transmitted diseases and the incidence of teenage pregnancy. It promoted a lifestyle choice valuing abstinence, delayed initiation of sexual activity, fewer sexual partners among already sexually active teenagers, and condom use. It was supported by nationwide adolescent-centered reproductive health services in government clinics and a network of youth outreach and support.
Studies show that each of the campaigns increased adolescent and young adult awareness of these HIV/AIDS prevention brands and also increased awareness of HIV/AIDS health risks and intentions to use condoms.61 Effects of the campaigns included delayed onset of sexual activity and increased condom use among those with repeated exposure to these brands. No comparable interventions, however, have been conducted in the United States.