Background. Mass communication is one component of effective public health program implementation. It includes paid media advertising, social and digital media, and news story coverage (“earned media”). From 2014 to 2017, the Centers for Disease Control and Prevention (CDC) funded 88 communities through two initiatives—Racial and Ethnic Approaches to Community Health (REACH) and Partnerships to Improve Community Health (PICH). CDC asked funded programs to use mass communication to support program objectives and share program messages, activities, and successes among the populations they served.

Methods. We interviewed communication leads and program managers from six REACH- and PICH-funded community health programs in small- to mid-sized nonmetropolitan regions. Interviews focused on experiences with implementing mass communication to support obesity prevention program objectives. We identified common themes after conducting interviews.

Results. Across six programs, staff reported that conducting mass communication in smaller communities presents unique opportunities. Programs described special considerations that are required when selecting channels in these settings. Several programs emphasized the importance of cultural competencies when designing communication activities. Audience research allowed programs to develop mass communication for priority populations. Program perceptions of the value and role of mass communication grew over the project period.

Conclusions. Small- to mid-sized public health programs may initially be unsure of the feasibility of using mass communication in program activities. However, these six programs successfully used mass communication strategies to support program efforts. Programs with dedicated funding and technical assistance can strengthen internal capacity for mass communication to reach priority populations.

Few adults know how to assist someone experiencing a tonic-clonic epileptic seizure (Kobau & Price, 2003). As part of a larger media strategy to raise awareness about seizures and first aid, the Epilepsy Foundation collaborated with a major television network to air content online and on television. Developers recorded 9.3 million impressions in Philadelphia for a 2017 “Share My Seizures” (SMS) campaign and 11.2 million impressions in Philadelphia, Chicago, and Atlanta in 2019 for a suite of seizure first aid commercials.

How successful were the efforts in raising viewers’ awareness, attitudes, and knowledge? Evaluators measured the effectiveness of the SMS campaign by surveying 1,562 residents where the commercials aired and did not air (Philadelphia and Baltimore, respectively) and interviewed survey respondents who saw the campaign. While few attitudinal differences emerged between survey respondents who viewed (n = 216) and had not viewed (n = 1,346) the campaign, viewers were more likely to report being able to provide seizure first aid and to visit the Foundation’s website (p < .05). Focus group respondents did not know the recommended steps for administering seizure first aid.

To better assess the effectiveness of the seizure first aid campaign, evaluators conducted a representative, large-scale pre/post survey in the three aforementioned cities. New challenges emerged with the data besides securing a desirable post-test response rate. Presenters will describe their methods, successes, and areas that remained challenging for establishing evidence that media campaigns affect knowledge and skills.

Background. Multiple groups have funded numerous obesity-prevention campaigns. Research shows the potential of mass-media campaigns to change behavior, but advertisements’ characteristics have not been comparatively evaluated to identify what is most effective. This study established a list of ad characteristics typical of obesity-prevention ads and tested their relationship to perceived ad effectiveness (PAE).

Methods. Using obesity-prevention ads in CDC’s State and Community Health Media Center, we conducted individual-level evaluations (n1 = 7,770) and tested for PAE associated with ad characteristics at the ad level (n2 = 118). Respondents answered 4 questions to measure PAE (Davis et al., 2011). Items were measured on a scale from 1 (“strongly disagree”) to 5 (“strongly agree”), (M = 15.17, SD = 0.79; Cronbach’s α= .90). Ad characteristics were systematically identified and coded by construct (n=10) (e.g., food, drink, and physical activity; emotional appeal, framing; use of theory-based constructs and statistics; imagery features, specific types of food shown; obesity-related factors/behaviors/actions/consequences; call to action). After construct-level data reduction, OLS multiple linear regression analysis was conducted, controlling for media type.

Results. Of the 10 ad characteristic constructs, variables in three were associated with PAE (R2= .39). Specific variables contributing equally to PAE included risk avoidance content (β = .37, p = .000), shock/surprise appeals (β = .17, p = .027), and showing food (β = .18, p = .038).

Conclusions. This novel study demonstrates the number and complexity of ad characteristics used in obesity-prevention advertising. Findings demonstrate what characteristics are likely to be effective in obesity-prevention ads.

The Ohio Supplemental Nutrition Assistance Program – Education (SNAP-Ed) social marketing campaign, Celebrate Your Plate (CYP), began in 2016. CYP has the long-term goal of improving the diet quality of low-income populations: individuals at or below 185% of the Federal Poverty Level.

SNAP-Ed diet quality improvement campaigns are required by their funders, the Food and Nutrition Service (FNS) branch of the USDA, to use behavioral change as their sole reported outcome measure. This is problematic because most SNAP-Ed social marketing campaigns don’t achieve market saturation or continue for a length of time necessary to achieve significant behavior change. Millions of dollars are spent on social marketing campaigns each year and they yield overwhelmingly poor results because they are only exploring behavior change as an outcome measure.

To address this issue, Slater’s stages of change model has been combined with Fishbein & Yzer’s Integrative Model of Behavioral Prediction to create a hybrid framework. This framework was used to suggest outcome evaluation metrics that could more accurately evaluate campaign efficacy, particularly in the early stages of the campaign, than behavior change. The CYP outcome evaluation for the first half of the campaign was analyzed in the context of this hybrid framework and alternatives to behavior change including knowledge gains, intent to change, and self-efficacy were identified. These alternate outcome metrics will be integrated into the outcome evaluation for the second half of the CYP campaign and compared with behavior change metrics from the first half of the campaign.

Background: The CDPH Nutrition Education and Obesity Prevention Branch conducted a three-year Be Better social marketing campaign to promote three healthy behaviors among California’s ethnically diverse, SNAP-eligible population, specifically drinking water, engaging in physical activity (PA), and eating fruits and vegetables (FV). Here, we describe and evaluate the 2018 Be Better campaign, focusing on associations between advertising recognition and maternal behaviors that support children’s health.

Methods: SNAP-eligible Latina, African-American, and White mothers (N=816) were randomly sampled from California’s Medi-Cal Eligibility Data System and recruited for two telephone interviews (prior to the campaign, 3-4 months later), administered in English and Spanish. Generalized Estimating Equations were used as the overall analytic approach, examining associations among maternal ad recognition, ad type, and child maternal support.

Results: Overall, the campaign successfully reached the target audience, with 84% of mothers recognizing at least one campaign ad. Ad recognition was positively associated with various supportive behaviors. Television ad recognition was associated with maternal support for children’s FV consumption, limits on unhealthy snacks, and children’s PA. Radio ad recognition was associated with limits on sugar-sweetened beverages (SSBs) and with replacement of SSBs with water. Billboard ad recognition was associated with children’s FV consumption, limits on unhealthy snacks, and family PA. Finally, digital ad recognition was associated with limits on children’s unhealthy snacks and SSBs.

Conclusions: CDPH’s SNAP-Ed social marketing approach successfully reached its target audience and was positively associated with supportive maternal behaviors. The Be Better campaign demonstrates the effectiveness of a social marketing, health communication approach.

background: Community often refers to people living in one place, but with the Internet this can expand beyond a geographical location. Social media has shattered physical boundaries by connecting people through a virtual platform. This evolution has created online communities and more opportunities for public health outreach.

objective: To evaluate the use of social marketing health campaigns to reach an online community.

methods: Eight social marketing health campaigns on various health topics were administered at different intervals from June 2018 to Nov 2019 via social media and online resources. These campaigns included social media posts, Facebook advertisements, health webinars, and online blog articles.

results: From June through December 2018, three social marketing health campaigns were delivered, reaching over 115,000 people via social media and online resources. Facebook posts reached 52,929 with 76,011 impressions. Facebook advertisements reached 45,306 unique users. Online blogs and health webinars reached over 20,000 people. The remaining five social marketing health campaigns are in progress and the results will be included in the presentation.

public health implications: As public health practitioners, it is essential to engage with people in their communities. The internet and online communities can greatly influence health behaviors. Understanding the impact of social marketing via online resources is important to determine if online health messages and communication can change social norms and attitudes on various health topics.

conclusion: Social media and online resources show promise for reaching an online community. Establishing a large network of followers will improve outreach and engagement of health campaigns.

Background: Young adults face increasing risks for HIV infection, and online campaigns can reach them effectively. Virality metrics, displayed as the number of online shares, are used to quantify the campaign reach. However, it remains unclear whether the metrics can further impact how young people perceive the campaign messages.

Methods: We conducted an online experiment involving 245 young adults aged 18 to 35 recruited from Survey Sampling International in 2018. Participants were randomly assigned to view an HIV prevention campaign video accompanied by one of four levels of virality metrics (i.e., high, medium, low, and no metric) on a social media site. They then answered questions assessing perceived effectiveness and credibility of the message and condom use behavior-related constructs.

Results: Virality metrics generated significant differences in perceived message effectiveness (p<.001), perceived message credibility (p=.022), perceived risk for HIV (p=.008), injunctive norm supporting condom use (p=.029), and descriptive norm regarding condom use (p=.004). Post hoc analyses showed the high metric condition significantly increased the five measurements in comparison to the no metric condition. A structural equation model showed the high metric condition increased condom use intention through increasing perceived message effectiveness (b=.161, p=.004) and injunctive norm (b=.527, p<.001), in comparison to the no metric condition.

Conclusion: Virality metrics enhanced message evaluation and indirectly increased preventative behavior intention only when the metric was relatively large. This suggests designing strategies to increase online shares of campaign messages can significantly boost the campaign efficacy beyond enhancing its reach.

Every child in school deserves to be healthy, safe, engaged, supported, and challenged -- the focus of the Whole School, Whole Community, Whole Child (WSCC) model. The purpose of this project was to develop interactive and digital WSCC materials for CDC-funded education agencies. Materials were focused on HIV, STD and pregnancy prevention among students.

To illustrate how the WSCC model supports HIV, STD and pregnancy prevention, a coordinated system of products were developed—interactive web pages, animated videos, digital flipbook and fact sheet. Products emphasized the relationship between education and health while integrating CDC’s school-based prevention efforts using WSCC model components. Usability testing was conducted among target audiences to gain feedback on user experiences, product functionality/utility, website navigability and ease of use, and comprehension of the content. These visual translations specific to CDC's use of the WSCC model were developed into products for engaging education agencies around strategic adolescent health priorities.

WSCC products were posted on CDC's Healthy Youth website in October 2018. In one month, the interactive web pages generated nearly 5,000 page views; related products were downloaded over 870 times; and the video was viewed over 800 times. Products were shared on social media during November 2018. WSCC tweets generated nearly 10K impressions, accounting for 20% of overall impressions for the month. A video gif image generated 498 media views. WSCC tweets had an above average engagement rate of 3.7%. This project included a variety of visually dynamic, multi-formatted WSCC products tailored for use by education audiences in their efforts to teach students and strive to create a healthier nation.

Background: Over the past decade, the number of mobile applications to assist in health management (mHealth) has grown exponentially. Most mHealth apps are developed for disease or chronic condition management (e.g., diabetes, cancer) or healthy lifestyle promotion (e.g., diet, meditation). Like many technological tools, the effectiveness of mHealth apps assumes user engagement. Thus, mHealth app development may benefit from a theoretically driven behavioral science framework that supports sustained use, desired behaviors, and health goals.

Methods: A review of existing literature revealed a paucity of behavioral science models/frameworks that can be applied mHealth apps. The field has primarily relied on technology adoption models, which generally do not elucidate: 1) how people interact with technology in real-time or 2) applicable social/cognitive concepts promoting sustained use.

Results: We identified behavior constructs either lacking (e.g., time distortion, cognitive load) or poorly described (e.g., self-efficacy, motivation) within technology adoption literature. Further, we identified stages of mHealth app engagement where behavioral constructs may be applied: 1) download; 2) welcome/onboarding, 3) initial use; and 4) sustained use. We developed a unified framework that identifies where different behavioral constructs can be leveraged. This approach recognizes that each stage of engagement presents different behavioral/cognitive challenges for both users and developers.

Conclusion: This framework details how behavioral science constructs can be best applied throughout the mHealth app lifecycle. We hope this work can facilitate a scientific discussion regarding the benefits of a theoretically driven approach to mHealth app development, improved user experience, and health outcomes.

Background: Underserved populations lack access to integrative health services and tools. The University of Arizona Center for Integrative Medicine developed the My Wellness Coach (MWC) app to promote behavior change in seven core areas of health (Movement, Nutrition, Spirituality, Resilience, Relationships, Sleep, and Environment). MWC applies health coaching and motivational interviewing principles and goal setting strategies. In 2018, we conducted a preliminary evaluation in collaboration with community clinics and agencies. Methods: Users were recruited using clinic tabling, staff referrals, flyers, and word of mouth. Users either used MWC in a weekly group (n=5) or individually with support from a study coordinator (n=36). Baseline and 3-month surveys assessed outcomes tied to the seven core areas of health. Users completed the Mobile App Rating Scale at 5 weeks and 3-months. User goal setting data were also analyzed. Results: Among 36 users, significant (P<0.05) pre-post changes were documented for several health outcomes, including eHealth literacy, overall wellbeing, global physical health, BMI, and vigorous physical activity. Majority of users (78%) set at least one goal and 73% created action steps toward their goals. Most goals were created in the Movement and Nutrition areas. About 37% of the goals were achieved. Most users (75-91%) gave the app high ratings for impact on behavior change, help seeking, intent to change, attitudes, knowledge and awareness. Conclusion: Users benefited from using the MWC in a group or individually. Future directions include the development of the app in Spanish and Android system to facilitate broader dissemination to underserved communities.