by Nedra Weinreich | Nov 7, 2006 | Blog, Research, Social Marketing
Authors of a study just published by the American Journal of Public Health (available online now and in the Dec. issue of AJPH) say that youth anti-smoking television ads funded by tobacco companies are ineffective, and that the spots intended for parents may even have harmful effects. Among 10th and 12th graders, they say, higher exposure to the parent-targeted ads was associated with lower perceived harm of smoking, stronger approval of smoking, stronger intentions to smoke in the future, and a greater likelihood of having smoked in the past 30 days.
“Of course,” I can hear you saying to yourself, “we all know that Philip Morris is intentionally sabotaging the ad campaign so that it ends up bringing in more future smokers, or at least is just burnishing its reputation with this campaign as window-dressing.” I would have thought so myself. Except that in looking into the campaign, I found out that an old friend and colleague, Cheryl Olson, is on the advisory board for Philip Morris USA’s Youth Smoking Prevention initiative.
Cheryl and I met in grad school, and we have since worked on various projects together, including evaluating tobacco prevention programs. She, along with her husband, psychologist Larry Kutner (who is also the chair of the advisory board), founded and co-direct the Center for Mental Health and Media at the Harvard Medical School. I know that Cheryl is no tobacco industry patsy, and that she would not compromise her integrity if she suspected there were any nefarious strategies behind this campaign.
I got in touch with Cheryl and asked her for her take on the research results that were just published. She, not surprisingly, had a lot to say about why this study is flawed and may just be showing what the researchers wanted to find. I invited her to send me her thoughts to post on the blog, which I’ve reprinted here:
For the past couple of years, I have consulted to Philip Morris USA on smoking cessation and prevention. I had primary responsibility for the content of the QuitAssist cessation guide, and also review and contribute to materials aimed at parents from the Youth Smoking Prevention group.
I work with a group of researchers and clinicians who are affiliated with various universities and hospitals. (We do this work independently from our institutions.) Part of our mandate is to oversee the quality of material content and evaluation, and be vigilant for any unintended negative effects.
Collaborating with a tobacco company can be an awkward and uncomfortable experience for a public health researcher who worked in tobacco control. But since Philip Morris USA is voluntarily committing 100s of millions of dollars to prevention and cessation – going well beyond the requirements of the Master Settlement Agreement – it’s important that a group of independent researchers and clinicians be part of this process to ensure that the resulting materials are honest, research-based, and effective.
My work has included: interviewing parents and former smokers and choosing quotes to use in print and web materials; incorporating research and advice from experts (selected by me) who work with smokers and parents; writing print and web content; and observing focus groups to help formulate and test content (including groups of Spanish speakers with simultaneous translation). I am proud of the brochures and guides I’ve helped develop. Their quality is apparent to anyone who reads them – which may explain why I have received at most a half-dozen phone calls or emails from academics, health workers or reporters asking why I got involved in this.
It is also exciting to be part of a project with such a huge reach. To date, PMUSA has distributed 70 million parent brochures, and hundreds of thousands of QuitAssist guides. The main role of the guide is to encourage smokers to connect with useful government and nonprofit cessation resources; I have heard that the PMUSA web site is the most visited cessation site in the US, and refers more traffic to government web resources than any other source.
I am not involved in developing PMUSA’s TV, radio or magazine ads on smoking cessation or prevention. But I do have some concerns about the article in December’s AJPH. There are some serious flaws in this study’s methodology that make it hard to draw any conclusions about the effects of the ads in question. To describe just two:
1) The “Talk, They’ll Listen” campaign that supposedly harmed children (the one aimed at parents) is based on an estimated exposure to an average of 1.13 thirty-second ads over a four-month period. Let’s take a closer look at this measure of ad exposure.
According to the recent Kaiser Family Foundation national survey, kids between the ages of 8-18 spend an average of 3 hours and 4 minutes per day watching broadcast television. Let’s call it three hours for simplicity’s sake.
There are 122 days in a 4-month period. So kids watch an average of 366 hours or 21,960 minutes of television in a 4-month period. A parent-oriented commercial lasts 30-seconds – or 1/43,920 of their viewing time. If they see 1.13 parent-oriented commercials in 4 months, that means that the commercials comprise 0.000026 (twenty-six one-millionths) of their television viewing content and time. Does it make sense to assume that such an extremely rare event would have the levels of influence on behaviors and attitudes that the authors claim? Based on this exposure issue alone, it’s hard to take the article seriously.
2) The authors should have used a 99% confidence interval (not 95%) with such a big data set [n=103,172]. That is a standard approach to avoid getting significant results just due to a large sample size. The use of 95% CIs raises questions about the odds ratios.
This is pretty disappointing. It’s hard not to think that the authors were determined to find something negative to say. The dramatic statements in the abstract are hedged a lot in the actual paper text, but the abstract is all that many researchers – and most journalists – will read.
This could have been an opportunity to get some useful lessons that could be applied to future media campaigns, and to model state-of-the-art methods for evaluating media-based behavior change materials – methods that could be used by academics and industry alike.
Among other things, it’s too bad that the authors lumped together ads aimed at youth from two companies that used very different approaches. This doesn’t tell us anything about what aspects might have been particularly helpful or harmful.
Given their well-documented past behavior, tobacco companies (and their anti-smoking media materials) must receive ongoing scrutiny from the public health community. But that shouldn’t mean checking our common sense at the door.
Cheryl raises several important points. As much as many of us would like to pillory the tobacco industry, we can’t let that cloud our desire for the truth (as best we can find it statistically). When you see (or do) research that confirms your preconceptions, you still need to look at it critically and make sure that you are not letting your assumptions guide your conclusions.
Thanks to Cheryl for taking the time to share her valuable perspective. I would love to see research on whether parents who have seen the ads and read PMUSA’s materials have spoken with their children about not smoking and whether their kids are less likely to smoke as a result. But even if that part of the campaign were found to be effective, I have a feeling there are many who would not believe it in any case.
Technorati Tags: smoking, philip morris, ajph, tobacco, advertising, youth
by Nedra Weinreich | Nov 1, 2006 | Blog, Social Marketing, Technology
There’s nothing very unusual about two red-headed women chatting in the headquarters of a Federal agency…unless one of the women is actually a man, and the headquarters actually exists on a server somewhere in Linden Lab. That man is John Anderton, who is responsible for bringing the U.S. Centers for Disease Control and Prevention (CDC) into Second Life. I met John’s avatar, Hygeia Philo (pictured on left talking to my avatar, Sheva Weeks), when I happened to see an announcement of a CDC Health Fair listed in New World Notes and decided to find out more about what the CDC is up to in Second Life.
John first started exploring Second Life last March, and by July he had convinced the powers-that-be at the CDC to let him establish an agency outpost there, which he built with his own virtual hands. John seems to be the CDC’s go-to guy for their health communications “Special Forces” missions, having been detailed to work on public health crises like the CDC’s response to the anthrax scares, the flu vaccine shortage and setting up new communications offices in various parts of the agency. He currently (at least until next week) is working in the Office of the CDC Director with the charge of exploring how social media can be used to promote public health, and he plans to continue to serve as the CDC’s virtual face in Second Life.
When we met, John graciously agreed to do an interview, which we conducted by e-mail, phone and in Second Life.
Can you tell me about the Center at the CDC where you work, and what your role is there?
I am presently on detail to the Office of the CDC Director, Office of Enterprise Communications. I am the lead for Project Fulcrum; an initiative to advance public health using new media, to recruit new persons into public health careers, and to reinvigorate old public health brands that have fallen by the wayside. Before this assignment, I have served for the last five years as Associate Director for Communications Science in the Center at CDC that deals with HIV, STDs and TB (called NCHSTP, for short). In that role, I was charged with lead responsibility for managing campaigns, media, special projects, contracts, issues management, exhibits, and clearance of communications products and materials for the Center. I have worked at CDC in a variety of communications positions, in several areas. I have a PhD in Health Promotion and Behavior, and a Masters degree in Public Administration.
How widespread within the CDC is knowledge and interest in internet-based applications like Second Life and other social media?
CDC is always looking into better ways to understand its audiences and the public, and to communicate its messages in timely, credible, and relevant ways. An internal blog was started recently, and podcasts began last month for outside audiences. The internal newswebsite is in its second year of daily publication, and it featured a story about CDC in Second Life a few weeks ago, so I think the knowledge of what we are doing internally is growing. I have presented on it a dozen times to various internal constituencies to build inertia around expanding our presence in world. I started looking into Second Life (SL) last March, when only 175,000 persons were in-world, as a way to advance the CDC mission using this new medium, for this specialized audience. We acquired our avatar formally in July, and introduced the space in August. The SL presence has been continuously evolving since that time.
How did you personally become involved as a CDC representative within Second Life? Are there others who are doing work in-world from your Center or other divisions of the CDC?
I began exploring YouTube as a means of disseminating CDC health content, and ran across a machinima presentation on Second Life, in March, 2006. Intrigued, I wrote a white paper to make the case to management for CDC to enter SL, and was authorized to explore and begin involvement. I created an avatar with purpose; Hygeia was the Greek muse of health, and the last name of Philo means ‘lover of,’ thus a CDC av with the metaphoric moniker of Hygeia Philo (lover of health) seemed perfectly appropriate. I waited until July 13 (CDC’s 60th anniversary) for her to formally enter Second Life for the reason that birthdays are rites of passage (drivers license, voting, etc.) and her birthday into the new world, as CDC celebrated maturity in the real world, also seemed appropriate. Everyone I meet has been congenial and both surprised and pleased to see CDC in the SL space. I have been working in SL on a daily basis, part time, for almost 8 months now. As far as others at CDC – the National Center for Environmental Health is exploring how to educate about toxic waste in SL, and the Strategic National Stockpile is exploring training issues in SL. The Injury Center is also thinking about how to get involved, too.
I love the thinking behind Hygeia’s name. If it’s not too personal a question, how does it feel to be a man in real life but use a female avatar?
I think of working with the CDC space and Hygeia Philo like hosting a trade show booth with a colleague. I am there to represent CDC in the best way possible, professionally and personally. The Juwangsan address [the location in Second Life] and the avatar in SL are both parts of that image. The gender discrepancy between myself and my role in SL doesn’t bother me, and I don’t get much grief at CDC either, as I tend to thoroughly explain why the avatar was chosen before explaining my role. I don’t see Hygeia Philo as an alternate John Anderton, rather I see her more as the face of the Agency that I am working with to disseminate health information. More of a partner than a puppet, and I do not hide my true identity when asked, interviewed by the press, or during discussions. When I attended the Second Life Community Conference in San Francisco this past August, the distinction between myself and Hygeia caused a little amusement for a few people, but no apparent consternation.
Please tell me about how the CDC’s presence in Second Life came about. How much resistance did you encounter from others at the CDC to the idea of building a virtual office?
I met with Randy Moss, at the American Cancer Society to learn about how the ACS was raising money with the in world Relay for Life, and then attended the Second Life Community Conference in San Francisco to continue studying how people were playing, interacting, transacting, and studying the possibilities of SL. Both contact experiences were transformative; I came to see this as neither a fad nor a game, but as a social movement and a glimpse into the future of social interaction, learning, and even being. The blended reality aspect of real and virtual worlds is fascinating to me. I wanted to build a space that could both educate and foster/enable dialogue. I routinely change up what is offered, based on interactions with residents who stop by, or whom I meet when I am exploring. The transience of the space is also marvelous; one can change on a dime, if something new presents itself. The day the E. coli scare occurred, I posted a “Real Life Health Alert” in the space for persons to learn about what was going on, and what to do about it. To those who saw it, it was very favorably commented upon; as a bridge builder between real life health threats and virtual education opportunities.
Everyone at CDC has been saying “Go go go!” there is not internal resistance; rather a chorus of support that is also a little agitated that I cannot go even faster! In world, after an interview with the Metaverse Messenger [a Second Life-focused newspaper downloaded by almost 50,000 people each month], the Editor responded favorably to my request to publish health info in her pub, so I have contributed a weekly column to this news outlet for the last 5 weeks. That has been great too, as a learning tool about virtual media, and the intersection with real world media.
I found out about the CDC in Second Life during a “health fair” you were offering there. How often do you do those, and are there any other virtual activities in which the CDC is involved?
You came on the first day of the first CDC health fair. Events drive interest among SL residents, and I had marveled at how concerts and fashion shows rivaled presentations by the Lindens [the staff of Linden Labs] as both entertainment and information dissemination opportunities. Rather than a big press conference (which we will do later, when we expand), I decided to go the highly localized route of a community health fair. In the real world this is a nice, local platform to display health information, to educate on specific issues while building community and establishing credibility of source. I was delighted at the attendance, and content of discussions. It was surprising to me to be at the top of the list in Rik’s Picks, in New World Notes, and kind of exciting to receive coverage from the Second Life News Network on the Fair. I’m not sure if that is due to the novelty of the event, an interest in what CDC is doing, or some other factor, but the interest has been wonderful. CDC is ramping up a variety of offerings, and will require us to expand and complicate the space a bit, but I don’t have a timetable for these upcoming developments.
The CDC’s National Center for Health Marketing’s director Jay Bernhardt is one of the first I know of in a Federal health agency to write a blog. While it is not updated very often, I think it is still a significant milestone and an indicator of the CDC’s desire to use the latest tools to communicate with its audience. Are there any other examples of how the CDC is using newer internet/social media or other tools (e.g., mobile phones) to reach its audiences beyond just offering a static website?
I would suggest that you contact Jay with that question – I’m not in a place to be able to answer that effectively.
What has been the response of SL residents to the CDC’s outreach in-world?
Almost without exception, I have been warmly greeted by old and new SL residents. People are kind of amazed that CDC would treat it seriously, and that we are not there for profit. I hope that CDC can continue to grow and evolve in the SL space, as it grows and changes itself. With such rapid development, it forces us to stay on our toes!
Are there specific health issues that you tend to focus on that are more prevalent among Second Life residents because of their demographics and behavioral risk factors?
I would like to gradually introduce the topic of sexual health into the space, as a way to promote discussion about the links between what one says and does in Second Life, and then one’s actions in real life. Liaisons in real life, foreshadowed and even pre-enacted though virtual spaces have led to documented disease transmission, and discussion about this seems generally absent from SL. On the demographic side, there are all kinds of opportunities to introduce topics relevant to persons in their 30s about screenings, health and emergency preparedness, childhood milestones, and other topics. On the behavioral side, there is also plenty of room for talk about good eating, active lifestyles, eye strain, and other health topics relevant to persons who spend significant amounts of time sedentary in front of a monitor. The possibilities are hard to count, there are so many.
How do you see Second Life fitting into an organization’s overall social marketing strategy?
Second Life joins the list of audiences, interests, and channels that link the American public with their public health infrastructure. Given that half of residents are international, it also broadens and deepens the CDC communications portfolio into addressing wider audience needs and concerns. I suppose that it is a tactic, and not a strategy in itself, but one that suggests that attention to new media requires constant vigilance, and willingness to experiment. If SL fails, for some reason, the movement of persons into online congregate social settings will probably continue to expand, and understanding how to reach these audiences will continue to be important.
For people at other agencies or organizations who may be considering establishing a presence in Second Life, what advice would you offer?
Do it. Now. In my career at CDC, which spans a short 15 years, four new technologies have emerged and merged with mainstream communications. My first business card had my name, title, address and phone number on it. Then came a fax machine number, then an email address, a website, and most recently, a metaverse designation and avatar. These are all ways that I can receive contact from the world and matriculate therein. They have gone from slow, to fast, to real time. One must be in all of these modes to communicate effectively with the audiences with whom we participate, and to understand the places they inhabit. Galileo reminded us that one sees farther if one stands on the shoulders of giants. There are plenty of giants out there to partner with, in this new medium, and most of them are friendly. Also, and importantly, establish excellent relationships with the IT department; with all of the updates coming from Linden, internal firewalls, network up and downtime, and corporate/governmental IT security issues will cause frequent calls for assistance.
Have you hooked up with any groups of nonprofits that are working on how best to integrate their causes into SL like TechSoup.org?
No, other than the American Cancer Society and some exchanges with the New Media folks, I have not begun to run with the big dogs. I am still studying how to best interact with persons, groups, and constituencies to best participate in this wondrous landscape. I hope to continue to learn, evolve and adapt to the space in fruitful ways, and if it goes really well, to lead trends.
Is there anything else you’d like to add that we haven’t touched on yet?
Second Life is part of one’s first life; not separate from it. Even the immersionists have to sleep, eat, and interact with the Real World. If one can merge good health practices in real life with the fun and play of Second Life, then physical and psychological realms can be enlightened and good habits enacted, to personal benefit. If this happens collectively, then public benefits are achieved, and public health becomes a reality, in virtual and actual ways. Thanks for the chance to talk about these issues.
Thank you to John for providing such an insightful and compelling glimpse into the process he has gone through to keep the CDC in the position of leading trends among Federal agencies. I hope that when other organizations and agencies see that even the CDC, with all its bureaucracy and generally slow uptake of new technology, is taking Second Life and other social media seriously, that they should too. I predict that the CDC’s entry into SL will open the floodgates for other people working on health and social issues.
If you are in Second Life and would like to visit the CDC’s virtual offices, you can click here to teleport directly. If you are not already in Second Life, you can first download the software and get a free account.
Technorati Tags: cdc, second life, public health, npsl
by Nedra Weinreich | Oct 18, 2006 | Blog, Social Marketing
A few weeks ago, I wrote about a community forum (“Selling Us to Ourselves: Is Social Marketing Effective HIV Prevention?) in New York that would be discussing recent HIV/AIDS prevention social marketing campaigns that have been criticized by the gay community for using stigmatizing messages and images. CHAMP, which was one of the sponsors, has now posted a report from the forum that summarizes the speaker presentations.
And last week, another forum was held in Los Angeles to discuss a new campaign by the LA Gay and Lesbian Center that states “HIV is a gay disease. Own it. End it.” Richard Kearns of aids-write.org attended the forum and posted his notes and reactions, along with a powerful poem about the use of stigma in these recent social marketing campaigns. He calls the effects of this approach “friendly fire,” which I thought was a quite apt description. While trying to shoot down the “enemy” — AIDS — these social marketing campaigns also cause some collateral damage by either reinforcing negative stereotypes or creating an environment that makes people not want to acknowledge that they are at risk.
By saying that HIV is a “gay disease” (75% of people with HIV in LA are gay), the campaign undoes decades of hard work to get the point across that anyone can become infected if they engage in risky behaviors. While I understand that the point is to get the gay community to re-engage and take ownership of the solution for ending AIDS, this statement in one fell swoop both implies that all gays have HIV and that everyone with HIV is gay. If this campaign were only visible to the gay community (maybe using gaydar vision?), then perhaps it would be justifiable if it were shown to be effective, to get people talking and empowered to take action. But they cannot ignore the effects of the campaign on the general population, who may form negative opinions about gays or people with HIV as a result.
Steve Simon, the LA City AIDS coordinator, spoke on the panel and said that he had received phone calls 20 to 1 complaining about the ad. He felt that “this is undermining messages we’ve been putting out for a long time.” He was contemplating creating a series of ads to balance out the “HIV is a gay disease” theme, with messages like “HIV is a Latino disease,” “… a black disease,” “…a woman’s disease,” etc.
Les Pappas, whose company Better World Advertising created the campaigns, spoke at both forums. At the New York forum, he said this about the approach they took with the HIV (not fabulous) campaign:
Change can come in different ways. It can come from attracting people (getting them on the bandwagon), but it also comes through disturbing them or causing them discomfort (so they’re challenged in some way to move to make a change). We like it when it makes us “feel good” but we don’t like it when it confronts our reality, shocks us, airs our dirty laundry, or makes us think too much. But why do we think that we have to like or approve or agree with social marketing? Ultimately, what is the role of controversy? We need to leverage the scarce resources we have, and we need to get people’s attention. The first hurdle is getting people’s attention; then, you can gauge people and deal with other hurdles…
…Now what about campaigns that people don’t like so much? What about campaigns that make people feel bad? For example, we launched the HIV (not fabulous) campaign. We had a gentleman with facial wasting, we had a gentleman in a diaper because of chronic diarrhea, and we had a gentleman with a bloated belly. People thought it was stigmatizing people with HIV, but what I can speak for is the e-mails that we received about the ads. We had a lot of people complaining, but we also had a lot of people who had no idea that HIV was so bad. Young gay men in Los Angeles woke up with this campaign—it gave them a reality check and changed their behavior in terms of protecting themselves.
Contrast this confrontational in-your-face approach with other more positive and empowering campaigns like Better World’s HIV Stops with Me and We Are Part of You or Oakland’s new I Am Worth It campaign (though I’m not crazy about Kenneth Cole’s anti-stigma We All Have AIDS campaign — it’s too wishy-washy). Unfortunately, there is not much data to show whether the controversial approach has been effective.
So what do you think? Is it worth creating controversy and potentially stigmatizing some of the members of your target audience in order to attract attention to the issue? Is some collateral damage acceptable when dealing with life and death issues? Or should you stay away from those methods even if you find it works to bring about change?
I think an effective social marketing campaign needs to involve members of the target audience in the message development and pretesting to find out whether the approach will shock and awe or completely backfire. If you make people angry with your message, they will dismiss you and the campaign without paying attention to what else you might be saying. Getting their attention is good, but you also need to get them on your side.
Technorati Tags: hiv, aids, social marketing, gay, stigma
by Nedra Weinreich | Oct 10, 2006 | Behavior Change, Blog, Social Marketing
In recent years, college campuses (and other community settings) have increasingly been adopting the social norms marketing approach to reducing things like binge drinking, drug use and smoking by their students. The idea behind this approach is that people will avoid unhealthy activities if they think that most other people around them are doing it too. So, if college students think it’s normal for people to each drink a six-pack of beer at a party, they will be more likely to engage in unhealthy levels of drinking. By publicizing the statistics of how few students at that campus actually do drink that much alcohol in one sitting, showing that the norm is to drink moderately, the model suggests that students will be less likely to binge drink themselves.
This approach has quite a bit of documented success. According to the National Social Norms Resource Center, some examples of the effectiveness of this type of project in addressing high-risk drinking include:
- Hobart and William Smith Colleges — 32% Reduction over 4 years
- Northern Illinois University — 44% Reduction over 9 years
- Rowan University — 25% Reduction over 3 years
- University of Arizona — 27% Reduction over 3 years
- University of Missouri at Columbia — 21% Reduction over 2 years
- Western Washington University — 20% Reduction in the first year
But what if there is actually a substantial proportion of the population that does engage in the undesirable behavior? You could still say that “a majority of West Knippenquad University students do not smoke pot,” if 51% say they abstain. But is that a meaningful statement? Even if only 20% of the population uses drugs, that is still one out of five people — not an insignificant figure. Among certain subgroups, the percentage might be much higher.
A recent study published in the Journal of Health Communication backs up these concerns. Not surprisingly, the study found that friends have a greater influence on students’ drinking behavior or beliefs about drinking on campus than social norms campaigns. The social norms messages are not believable if they do not square with what students have observed in their own experience among their friends and acquaintances.
A survey of 277 college students at a northeastern university found that nearly 73 percent did not believe the norms message that most students drink “0-4” drinks when they party. Of that group, nearly 53 percent reported they typically drank five or more drinks at one sitting. To illustrate the influence of social networks, 96 percent of the 5-plus-drink group said their friends drank a similar amount and believed that “other students” on campus drank a similar amount.
“Disbelief in the campaign message may have resulted from the behavior observed by students among their friends and acquaintances, which contrasted with the 0-4 message,” said co-author Ann Major, professor of communications and director of the Jimirro Center for the Study of Media Influence at Penn State. “Also, some students may discount social norms campaigns as an attempt by university administrators to control their behavior.”
Perhaps the social norms approach works among those students who are on the fence about engaging in an unhealthy behavior, and just need a little reinforcement to help them do what they would be inclined to do otherwise. Other types of approaches — social marketing, policy enforcement, or counseling — might be necessary to reach the more diehard partiers who already have set expectations for what is appropriate.
I am also made more skeptical about this approach with the announcement of the establishment of the National Social Norms Institute at the University of Virginia with a $2.5 million grant from the Anheuser-Busch Corporation. I’m glad that many campuses have had success with social norms marketing, but I do hope that it will not be seen as the magic bullet across all subgroups — especially for those most in need of some type of intervention.
Technorati Tags: social norms, marketing, social marketing, alcohol, college
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Nedra helps nonprofits and public agencies create positive change on health and social issues through social marketing and transmedia storytelling strategies at Weinreich Communications since founding the company in 1995. She helps organizations make a difference for the populations they serve by strategically designing programs that draw on state-of-the-art behavior change techniques, digital media approaches and the power of stories. 
