Spare Change

making a difference with social marketing
by Nedra Kline Weinreich

I hope that when the International Olympic Committee meets in its cushy offices on the shores of Lake Geneva to do its postmortem of this year's games, they have the honesty to admit that the choice of Beijing as Olympic host was a huge mistake (they won't, of course). While the Chinese people certainly have the Olympic spirit running through their veins (and the Chinese athletes have probably had an IV drip in place since they were seven), the Chinese government did exactly what many human rights activists feared. I've already written about all the reasons why China should not have been awarded the games, so on the heels of the Olympic closing ceremony, let's look at the results.

After enduring what seemed like plagues of Biblical proportions in the months running up to the Olympics (the earthquake, locusts, tons of algae covering the Olympic sailing venue, choking pollution and more), China overcame them all to put on a blockbuster show for the world. The opening ceremony dazzled fans and critics alike, but the "One World" theme would have been profoundly more meaningful if China would actually let its citizens join the rest of the world rather than surrounding them with firewalls.

Every aspect of the Olympic production was carefully orchestrated to show that China deserves to stand alongside the other nations of the world, and to showcase what China has to offer. Unfortunately, this $40 billion spectacle was created on the backs of the Chinese citizens, who the government spared no opportunity to repress in the interest of global PR. Whether it was the thousands of dissidents who were preemptively arrested prior to the influx of outside reporters, the hundreds of thousands of Beijing residents who were displaced to make way for Olympic venues without compensation, or the "undesirables" -- the homeless, beggars, and street vendors -- who were rounded up and sent to detention centers, I cannot look at the beautiful stadiums without thinking about the price extracted by the government to erect them.

The Chinese Olympic Committee provided assurances that things would change if they were awarded the games. They would open more access to the internet, offer opportunities for protest, allow outside reporters to have freedom in what they reported. This resulted in temporary access to some Western media sources online, which has now been clamped closed. The protest zones were empty, not because everybody was suddenly happy, but because the government arrested everyone who applied for a permit to demonstrate, including two elderly Chinese women, who were sentenced to a year in a labor camp, and at least eight American bloggers and activists sentenced to 10 days in detention. If anything, the iron fist of the government tightened during the Olympics rather than loosened.

Along the way, though, the Chinese government's carefully constructed PR facade started showing some chinks in its armor (pun definitely NOT intended!). It was revealed that the opening ceremony's technically amazing fireworks display included some CGI effects. A picture perfect girl was actually lip-synching to the beautiful voice of another girl, who had been deemed too unattractive to represent China. The children representing the 56 ethnic groups in China were all from the Han majority. Many sold-out events were played in front of half-filled stands to prevent the gathering of large uncontrollable crowds. And the question remains whether the Chinese government issued passports to underage gymnasts so they could compete on behalf of the country.

All this is not to say that the Olympics themselves were defective. To the contrary, the athletes that gathered from all over the world to compete exemplified the best of Olympic values, and bear no complicity in the shameful activities of the Chinese government's preparations for the games.

Now it's back to business as usual for China -- though with a shiny new veneer of acceptability by many of the world's citizens. We can hope that the brief encounter that the Chinese people had with the free world will be a catalyst for change from within. But none of the world's leaders -- including President Bush, who attended the opening ceremony in Beijing -- have said much to counter the PR cover-up. The athletes who joined Team Darfur, or others who might have felt free to make a political statement in any other country, avoided any controversial statements, worried that, like Joey Cheek, their visas would be revoked and they would not be allowed to compete.

China definitely got what it wanted out of the deal. And the rest of us got a spin job.

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Continuing the sum-up of my experience at the CDC's 2nd National Conference on Health Communication, Marketing and Media (Part 1 here), here are the key points from the sessions I attended on the second day...

  • Jack Wakshlag, Chief Research Officer, Turner Broadcasting Systems - Countering the prevailing wisdom that today's media consumers are watching less and less television, he provided some statistics that surprised me. TV viewing has been rising from 2002-2007, and the average person spends 47% of their media hours with a television on. Network viewing (ABC, CBS, NBC, Fox) is at an all-time low, but cable channels are at a high. Even people with broadband internet are watching more TV now than five years ago, not replacing it with online video (which are more like "snacks," averaging 2 min 12 sec, rather than longer-format programming). Even teens are watching more TV, though less than adults.

    After the session, I asked Mr. Wakshlag what I thought was the elephant in the room, which he hadn't addressed. Increased TV viewing is great for people working in entertainment education, working to get their issues depicted on TV programming. But clearly the key reason why he is promoting the continued domination of television is to make the case for advertising when many advertisers are defecting to other media - but are people still paying attention to the commercials? With the advent of Tivo and DVRs, many have the ability to bypass the ads. He conceded that only about 50% of viewers watch the commercials, though I suppose the numbers are still big enough to make it worth it.
  • J. Walker Smith, President, Yankelovich, Inc. - Our relationships with brands are changing in a couple of different key ways. First, the culture of "dis-ownership" means that we no longer have to own something to have it (e.g., leasing, swapping, fractional ownership, piracy, etc.). Second, the culture of "responsibility" has come about from an increased emphasis on values that companies should be green, socially responsible, community-focused and purpose-driven. People see their purchases as a way of sending a message and influencing companies' business practices. This can only happen with increased information availability, but in a pinpointed way. Enabling "narrow engagement," with just the key pieces of information that people need to make decisions without overwhelming them, is going to be the key to making this happen.
Building Our Understanding of Health Messages Targeting Women
(I was moderating this session and didn't take as many notes as I should have!)
  • Samantha Nazione, Michigan State University - In a study looking at breast cancer-focused websites, she found that there is not much targeting done in terms of ethnicity or language. In general, the website reading levels were too high. Websites tailored for minorities were more likely to use first-person stories about breast cancer.
  • Patrice Chamberlain, San Francisco State University - Mothers are a huge target of advertising, with 80.5 million mothers controlling 80% of household spending ($1.6 trillion purchasing power). After the internet, magazines are the second most important source of information for moms for purchasing decisions. This study looked at food and beverage ads in the top parenting publications in the US, and analyzed them in terms of the appeals they used. The most common appeals were about the healthfulness and taste of the products. Many also promised things like more family time, improved relationships with the kids, ways for moms to "do it all." She contrasted the images with some of the nutrition-related social marketing ads that are out there, which often focus more on deficiencies or fear and guilt; we need to learn better from those with the most experience how to appeal to moms.
  • Christy Ledford, George Mason University - In looking at the websites that pharmaceutical companies have used to promote their contraceptive products, they had several common factors. Rather than promoting effectiveness as the key benefit, most touted things like convenience, other physiological benefits (e.g., reduced acne, no periods), and relative risk compared to other brands. The risks were always in tiny text at the bottom of the page, and only one site out of the ten presented the "black box" warning that was required in other media. The sites did not make clear that they were advertising, often appearing to be educational, with the pharmaceutical company or division's name in an obscure location. And the URLs usually consisted of a message, rather than the product's name (e.g., While there is currently no regulations regarding online direct-to-consumer advertising, most of these sites violate current DTC regulations for other media.
Health Marketing Strategies: Segmentation, Tailoring and Targeting
(Unfortunately, I missed the first speaker in this panel.)
  • Leslie Snyder, University of Connecticut - A meta-analysis of interventions that tailored their communications to audience members found (not surprisingly) that tailored interventions were more effective in bringing about health behavior change than non-tailored interventions. She gave an example of tailored calendars to promote childhood immunizations, which included a picture of the child and his/her name, along with key dates like his/her birthday, required shots based on the birthdate, and the phone number of the nearest clinic to their house. Tailored interventions have a similar effect size to media campaigns, and because the effect declines over time should have a "booster activity" done at about three months post-intervention. Did you know that the University of Connecticut has a Center for Health Communication and Marketing? I didn't.
  • Adam Barry, Texas A&M University - This was a very exploratory study (only 13 participants) regarding how college students interpret the message to "drink responsibly," since there is no universally accepted definition of responsible drinking. With responses like no drinking and driving, knowing your limits, pacing your drinking, and planning ahead, there is a lot of room for negative consequences. For example, the students said you can't know your personal limits until you go past them, and as long as you don't black out or throw up, you are within the limits. In monitoring your drinking, by the time you notice the effects, your judgment is already gone. If you pace your drinking (e.g., one drink/hour) you can still get drunk because your body does not metabolize one drink an hour. Even the designated driver concept often gets ignored because it's like a "punishment" for the one who is not allowed to drink. We have to be careful in the messages we put out there, because some can be dangerous if misinterpreted or misapplied.
Peer-to-Peer Communications
  • Scott Shamp, University of Georgia (and others) - For National HIV Testing Day, UGA's New Media Institute, along with partners Verizon, CDC, Danya International and Nokia, recruited 23 students from universities in the Southeast to come together to create what they called "Personal Public Service Announcements" (PPSAs). These were short videos created on cell phones all in the course of one day. Guided by experts, the students learned about HIV/AIDS, about filmmaking and how to use the technology. After coming up with their plans and having them approved by a CDC panel for accuracy, they were divided into remote teams, who shot the footage and then immediately sent it back to the producers who edited it into short videos. They shot 22 videos, and eight of them were used in the final set. They were distributed online in places like YouTube, MySpace, and blogs (e.g., Osocio), as well as on cell phone networks. They all included the KNOWIT SMS code, to which viewers could text their zip code to receive the testing location nearest them.
  • Sarah Diamond, The Institute for Community Research - The Xperience project trained vocal artists ages 14-25 about drug and alcohol prevention, while also helping them create and record a song, rap or spoken piece about the issue. These pieces were then compiled into a CD and performed at a concert. In research to determine the effect of these peer-created messages on the listeners, she found that when the lyrics were "loss-framed" (e.g., negative effects of drugs), males and females related better to the same-sex artists, and the males responded more in general. The "gain-framed" lyrics (e.g., "you can do it," "things will be better") appealed to both genders.
Unfortunately, I was not able to stay for the third day of the conference, but perhaps others have posted their notes for other sessions on the Ning group created for the conference. As with many conferences, though, the personal connections made with old and new friends were even more of a highlight than the sessions themselves.

In other CDC-related news, make sure you sign up for the upcoming Web Dialogue on Web 2.0 and Health Marketing co-sponsored by CDC's National Center for Health Marketing and WestEd. It will be a one-day asynchronous discussion on September 16th about how to use social media technologies in social marketing and public health. I will be a panelist, along with Fard Johnmar and Craig Lefebvre (so far). I can see by those who have already registered to participate that many of my very smart online friends will be there, so it should be a rollicking good time where we'll all learn from each other. Make sure you sign up too!

And another piece of exciting news comes from Jay Bernhardt, the director of the NCHM:
The CDC National Center for Health Marketing is developing a national network of leaders dedicated to applying the power of marketing, communication, and partnerships to improve the health of individuals, families, and communities in the US and throughout the world. This network of individual leaders and organizations, called the Health Marketing Leadership Roundtable will strive to advance the field of health marketing science and practice, educate and inform partners and stakeholders on the value of health marketing for improving people’s health, and receive key updates on health marketing activities from CDC and others throughout the field of public health.
Whatever gets us closer to formalizing ways to advance the social marketing field and brings practitioners together is a good thing. I look forward to seeing where this goes!
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I can't attend humongous conferences like the American Public Health Association monstrosity; although there are an incredible number of sessions, only a small percentage actually apply directly to my own interests. Last week at the CDC's 2nd National Conference on Health Communication, Marketing and Media, I had the opposite problem. So many sessions were scheduled, and nearly every one was spot-on as to the topics I want to learn about, that it was hard to choose which ones to attend. (Disclosure: I was on the conference planning committee, but can't really claim credit for how the actual end product turned out. And I unfortunately did not try hard enough to change the theme -- "Engage and Deliver" -- which Adam Ant sang over and over in my head throughout the conference.)

I had to miss the last day of the conference, but still filled an entire notepad with my notes from each session. Aside from the plenary sessions, the panels were comprised primarily of research-based presentations. Despite some inevitably dry deliveries, I'm glad our field has evolved to the point where we have so much research to share. Here are some of the key points I thought were worth highlighting:

  • James Surowiecki, author of The Wisdom of Crowds, talked about how, under the right conditions, a group's decisions can be smarter than those of the smartest person in the group. He used examples like Google's pagerank algorithm, racetrack betting and Best Buy's yearly gift card sales. His point is that if you can devise a way to aggregate individual predictions simultaneously, and to do this within a diverse group of people with different perspectives and ways of approaching problems, the random errors will cancel each other out and you will end up with the closest approximation to the correct answer.

    Key lessons: 1) When assembling a team to solve a problem, bring in people with many different viewpoints and skills. 2) Encourage disagreement. 3) Limit the amount of back-and-forth dithering, which leads to worse decisionmaking.
New Frontiers in Message Design Theory
  • Karen King, University of Georgia - If you have multiple messages to convey within a campaign, you can bundle up to four together without losing recall. It does not make a difference whether you specify the category that unifies the messages. I found this interesting as I have always thought to be most effective you should limit the number of messages you try to cram into a single communication piece. They were testing this with brochures, but I think other media would have a different maximum number.
  • Michael Rovito, Temple University - For the issue of testicular cancer, he used perceptual mapping to identify four different types of "control identities" related to locus of control (whether people believed control was external or internal) and constructs of whether control is realistic or unrealistic. The four types were: 1) The Fates - unrealistic external; 2) The Herd - realistic external; 3) The Optimals - realistic internal; and 4) The Manipulators - unrealistic internal. Clearly, different types of people need different kinds of messages tailored to their beliefs.
  • Bill Smith, Academy for Educational Development - Bill described a research/decision making technique called "deliberative polling," which was created by James Fishkin and offers another way to think about involving citizens in policy discussions when there is no clear-cut right answer. A randomly selected sample of 800-1500 people, who are first polled by phone, are brought together over two days. During this time they read background documents on the issue, have experts explaining the different options, ask questions of the experts, and break into small groups to discuss and debate what they've learned. This technique can be a good way of involving the public in evaluating competing alternatives and prioritizing public policy issues.
Applying Emerging Theories to Engage the Public
  • Sergey Sotnikov, CDC - By mapping out the relationships between either organizations or people within an organization, you can use network analysis to visualize the key points within the network. You can look at who is most connected overall, who are the go-betweens on specific topics, and who is more isolated. This can help you figure out the best way to spread information within a network.
  • Jennifer Heilbronner, Metropolitan Group - Jennifer spoke about building public will, and how this is a different process from social marketing. She defined it as "a communication approach that builds public support for long-term social change by integrating grassroots outreach methods with traditional mass media tools and connecting an issue to the existing, closely held values of individuals and groups." While I think she was contrasting this process to the too common mass media-focused, short-term campaign blast many people think is social marketing, her description of public will building is much closer to the more comprehensive marketing mix-driven social marketing process to which many of us in the field adhere. You can download her group's Public Will Framework to learn more about their process.
  • Constanze Rossmann, Ludwig-Maximilians-Universitat-Munchen - While I thought it was overkill to start off with a definition of "health flyer" and I loved her pronunciation of the word "anxiety" as "ANKshity" (Yes! It does look like it should be pronounced that way.), this presentation looked at two very important different elements of how we present information. First, do exemplars -- a case study of one person -- affect risk perceptions, attitudes and behaviors more than abstract statistics and generalizations about the population? In her testing of a brochure about obesity, the answer was yes -- but only among people who are already involved with the issue (e.g., worried about their weight, dieting, etc.). Second, what is the effect of fear appeals in graphic images? She tested three different images related to obesity, each of which was either low, moderate or high fear inducing. Interestingly, she found that when it came to building knowledge, the low and high images were more effective. To affect risk perception, attitudes and behaviors, the moderately fear inducing image was more effective. I wonder why that difference - do different types of people react to the images in different ways?
That was Day 1 - I'll sum up the second day in a subsequent post.

In the meantime, you can learn more by checking out the Ning group for the conference that was started by Dana Sheets as a place to share notes. If you're on Facebook, look at the Health Communication, Marketing and Media group that is a central place to exchange ideas related to the conference. Read Craig Lefebvre's summary of a discussion that took place at the conference about the development of a professional network. And if you went to the conference and want to put in your two cents about what you thought, someone at the CDC Chatter message board wants to know if it was "as extravagant and pointless as we all expected it to be." Um, no, Senator Coburn. An embarrassment of riches, perhaps, but extravagant and pointless, not in any way.

UPDATE: Read Part 2 here...
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