Abstract

A social media-based public health campaign to reduce indoor tanning in high-risk populations

Isabella De Vere Hunt, MD¹, Zhuo Ran Cai, MD¹, Vanessa Nava, BS¹, Natnaelle E. Admassu, MD, MS², Stephanie Bousheri, BS, RN¹, Tiffani Johnson, BS¹, Ellie Cohen³, Anna Tomz⁴, Jessica Thompson, BA¹, Lucy Zhang, BA¹, Sherry Pagoto, PhD⁵, Eleni Linos , MD, MPH, DrPH¹ (1)Stanford University , (2)Memorial Sloan Kettering Cancer Center, (3)University of California, Los Angeles, (4)University of Washington , (5)University of Connecticut

APHA 2022 Annual Meeting and Expo

Indoor tanning beds cause more than 450,000 new skin cancers, including over 10,000 melanomas, each year. Yet, use remains common: 36% of adults and 55% of university students report using a tanning bed on at least one occasion. Social media provides an opportunity for large-scale, targeted health messaging. Our goal was to leverage social media advertising to dissuade indoor tanning and thereby reduce skin cancer incidence long-term.

We developed 36 video and still-image advertisements centered on the following themes: 1.) risk of skin cancer; 2.) risk of accelerated skin aging; 3.) targeting of gay men by the tanning industry; and 4.) celebrity messages encouraging skin protection. We utilized the established theoretical framework the Health Belief Model to inform our messaging. We also partnered with 3 male Instagram ‘influencers’ who disseminated video messages on their own Instagram platforms. Advertisements were directed to two populations, utilizing the detailed targeting function on Meta Ads Manager to select for individuals interested in indoor tanning: 1.) women aged 18-30 living in Kentucky, Nebraska, Ohio or Tennessee; and 2.) men aged 18-45 living in California.

During the 3-week campaign (April 6th-27th 2022), the advertisements appeared on Instagram feeds 9.1 million times, reaching 1.06 million individuals an average of 8.6 times each. Overall, they received 6915 ‘likes’ and were shared 1178 times. We received 7,004 views of our indoor tanning health information landing page, https://pcrt.stanford.edu/stopindoortanning, (average time on page 56s), with 17.6% of people clicking through to one of the 4 subpages: 1.) The tanning industry targets gay men (585 views, average time on page 56s); 2.) Indoor tanning causes cancer (316 views, average time spent 47s); 3.) Indoor tanning speeds up skin aging (181 views, average time on page 29s); 4.) Best ways to protect your skin (149 views, average time on page 77s). The cost of disseminating the advertisements on Instagram was $54,306, and the payments to influencers totaled $14,000. In total, this equates to $64/1000 people reached, and $9.8/view of our tanning health information page.

We demonstrate the feasibility of rapid, social media-based dissemination of tailored public health messages to populations at high-risk of indoor tanning, and that social media advertisements are a successful way to direct people to online health information. Going forward, we will assess foot traffic data to tanning salons in our target regions compared to control regions, to ascertain whether our social media-based public health messages impacted indoor tanning behaviors.

Abstract

Tailoring, perceived targetedness and emotion: Exploring the effectiveness of anti-smoking messages targeting young adult sexual minority women

Sixiao Liu, PhD¹, Ashley Sanders-Jackson, PhD², Dominik Neumann, PhD³, NFN Scout, MA, PhD⁴, Bob Gordon, MPH⁵, Jarvis Chen, ScD⁶, Shoba Ramanadhan, ScD, MPH⁶, Elaine Hanby, MA¹, Brittany Zulkiewicz, MPH¹, Juno Obedin-Maliver, MD, MPH, MAS⁷, Mitchell Lunn, MD, MAS⁸, Kasisomayajula Viswanath, PhD⁹, Jennifer Potter, MD⁶, Andy Tan, PhD., MPH, MBA, MBBS¹ (1)University of Pennsylvania, (2)Michigan State University, (3)Leibniz-Institut für Wissensmedien, (4)National LGBT Cancer Network, (5)California LGBT Tobacco Education Partnership (LGBT Partnership), (6)Harvard University, (7)Stanford University , (8)Stanford University, (9)Harvard University,

APHA 2022 Annual Meeting and Expo

Background:
Perceived message effectiveness (PME) is considered a validated measure to predict the likely success of messages targeting specific demographic groups. This study investigated how LGBTQ-tailored anti-smoking messages impacted PME via the mediation of perceived targetedness (PT) and emotions among young adult sexual minority and heterosexual women.

Method:
This study employed a two (condition: LGBTQ cue present/absent) by six (message) mixed-factorial experimental design. Participants were randomly assigned to view six messages with LGBTQ-tailored cues or control cues (women’s health) out of 28 messages within each condition. PT, emotions, and PME were assessed after each message exposure. We used multilevel generalized structural equation models to examine interactions between condition and sexual orientation in predicting PT, emotions, and PME.

Results:
Participants (N=203) were aged between 18 and 30 (M=24.19, SD=3.75) and identified as either sexual minority (N=73, predominantly bisexual) or heterosexual (N=130) cisgender women. Sexual minority women reacted less positively to messages with LGBTQ-tailored cues (β=-.34, [-.65, -.03]). We further identified significant indirect effects via PT and emotions. Sexual minority women reported higher PT than heterosexual women (β=.35, [.03, .68]), which led to heightened positive emotions (β=.25, [.19, .31]) and increased PME (β=.25, [.21, .30]). However, increased PT stimulated decreased negative emotions (β=-.06, [-.65, -.03]), which reduced PME (β=.12, [.07, .17]).

Conclusion:
Sexual minority women perceived messages with LGBTQ-tailored cues as less effective than non-tailored messages. Highlighting the identity of sexual minority women with superficial cues in health messaging may be less beneficial, especially for bisexual women.

Abstract

Evaluating a college HPV vaccination toolkit: insights from an implementation science approach

Marie Barnard, PhD¹, Saara Nasruddin, Pharm.D.¹, Alexcia Carr, B.S.P.S¹, Eric Pittman, Pharm.D.², Hyllore Imeri, M.Pharm.¹, Wesley Sparkmon, M.P.H.¹, Joshua Gatreaux, M.P.J.³, Sarah Vivo, B.S.⁴, Katharine J. Head, Ph.D.⁵ (1)University of Mississippi Department of Pharmacy Administration, (2)University of Mississippi Center for Pharmaceutical Marketing and Management, (3)University of Mississippi Public Health Program, (4)Indiana Immunization Coalition, (5)Indiana University-Purdue University at Indianapolis

APHA 2022 Annual Meeting and Expo

Background: College campuses represent an opportunity to increase HPV vaccination coverage. The Project HPV-Free Collegiate Vaccination Toolkit provides evidence-based comprehensive resources for campuses to implement programming to increase HPV vaccination rates. A program evaluation guided by the Consolidated Framework for Implementation Research (CFIR) is being conducted, as it is critical in the early stages of implementation and dissemination to identify best practices and opportunities for program improvements. The evaluation sought to identify implementation barriers and facilitators, explore metrics for evaluating implementation effectiveness, and identify opportunities to enhance outcomes in diverse campus environments.

Methods: Institutions who had contacted the toolkit developers were invited to participate in an interview. A semi-structured interview guide based on CFIR constructs was developed. Interviews were conducted via Zoom. A framework analysis approach was utilized to analyze transcripts.

Results: Representatives from six institutions planning to implement and two who have implemented the toolkit completed interviews. Challenges identified included vaccination cost, engaging campus partners, and tailoring the content to a diverse population. Facilitating factors included having a student health center, engaging campus partners, and developing community partnership.

Conclusions: Campuses find the toolkit to be useful and report it provides sufficient resources to conduct a campaign. CFIR determinants, particularly inner and out setting factors, are important drivers of implementation planning and success. An implementation science lens offered insight into how the toolkit can be improved, including adding support to tailor campaigns, to identify methods to cover vaccination costs, and to build partnerships.

Abstract

The impact of an electronic health record based patient navigation and outreach program on colorectal cancer screening completion

Luis Rustveld, PhD, Ajeesh Sunny, MS Baylor College of Medicine

APHA 2022 Annual Meeting and Expo

Timely colonoscopy completion is essential for early detection of CRC, especially considering that early stages of CRC often do not manifest symptoms early on. The current project addressed the critical need to improve systems efficiency for navigation and coordination of timely completion of fecal occult blood tests and colonoscopies at two affiliated medical institutions in Harris County, Texas. The project implemented an Electronic Health Record Based (EHR-based) patient navigation and outreach program that included: 1) CRC screening registry in the EHR that brought in age-eligible (age 50-74) and high-risk patients (FOBT positive, iron deficiency anemia, rectal bleeding) targeted for navigation; 2) Patient navigation data, including capturing CRC screening data, and outcomes of patient navigation; 3) CRC screening preparation guide that helped patients prepare for colonoscopies. The quality of colonoscopies was measured with the Boston Bowel Preparation Scale (BBPS). Scores range from 0 to 9, with 0 representing poor and a score of 9 excellent preparation. Means and standard deviations were calculated for all continuous variables and Student’s t-test was used to determine statistically significant differences. A total of 46,081 individuals received dedicated CRC patient navigation services over a three-year period. Out of this total, 29,375 individuals went on to complete CRC screening (FOBTs, n = 14,255; colonoscopies, n = 14,732, sigmoidoscopies, n = 388). Wait time for colonoscopy completion decreased significantly in year 3 of the project, compared to year 1 (31.84 days vs. 48.63 days, p<0.001). Wait time for high-risk patients to receive a diagnostic colonoscopy was also significantly improved in year 3, compared to year 1 (25.23 days vs. 56.73 days, P<0.001). Compared to the year before the start of the project, the BBPS scores improved significantly in year 3 (mean BBPS 8.1 ± 1.45 vs. 7.6 ± 1.5, p = 0.004). A total of 5,507 CRC pre-cancerous polyps were detected with colonoscopies and successfully removed. Results suggest that the EHR-based patient navigation program positively impacted overall CRC screening completion and timely follow-up of those at high risk. The multi-faceted approach taken with the current project provides the patients with individualized patient navigation services that are sensitive to their needs and more likely to result in the successful completion of CRC screening.