Social Marketing Campaigns and Children's Media

Social Marketing Campaigns and Children’s Media Use

W. Douglas Evans

Summary Media-related commercial marketing aimed at promoting the purchase of products and services by children, and by adults for children, is ubiquitous and has been associated with negative health consequences such as poor nutrition and physical inactivity. But, as Douglas Evans points out, not all marketing in the electronic media is confined to the sale of products. Increas- ingly savvy social marketers have begun to make extensive use of the same techniques and strategies used by commercial marketers to promote healthful behaviors and to counter some of the negative effects of conventional media marketing to children and adolescents.

Evans points out that social marketing campaigns have been effective in helping to prevent and control tobacco use, increase physical activity, improve nutrition, and promote condom use, as well as other positive health behaviors. He reviews the evidence from a number of major recent campaigns and programming in the United States and overseas and describes the evaluation and research methods used to determine their effectiveness.

He begins his review of the field of social marketing by describing how it uses many of the strategies practiced so successfully in commercial marketing. He notes the recent development of public health brands and the use of branding as a health promotion strategy. He then goes on to show how social marketing can promote healthful behavior, how it can counter media messages about unhealthful behavior, and how it can encourage discussions between parents and children.

Evans concludes by noting some potential future applications to promote healthful media use by children and adolescents and to mitigate the effects of exposure to commercial marketing. These include adapting lessons learned from previous successful campaigns, such as delivering branded messages that promote healthful alternative behaviors. Evans also outlines a message strategy to promote “smart media use” to parents, children, and adolescents and suggests a brand based on personal interaction as a desirable alternative to “virtual interaction.”

www.futureofchildren.org

W. Douglas Evans is vice president for public health and environment at RTI International.

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ommercial marketing is cen- promote health behavior change. I argue tral to the American, indeed that, like commercial marketers, social the global, economy. Since the marketers create value for target audiences early twentieth century, mar- through their own form of branding—by keting strategies have grown creating positive associations with health Cin reach and influence as media channels have behaviors and encouraging their adoption proliferated and people’s exposure to media and maintenance. Social marketers also use has increased. At its core, marketing is about market research to identify attitudes and an exchange of value between the marketer beliefs among their target audiences that may and consumer. If the marketer can promote support or inhibit the intended behavior a product or service to make the consumer change—increasing exercise or using a perceive sufficient value, the consumer is condom, for example. They apply audience more likely to purchase it. In the past thirty- segmentation techniques to develop targeted five years, marketers have begun to use the (to a group) and tailored (to an individual) same powerful idea in a new way—not to sell messages and promotional activities. products and services but to promote socially beneficial causes and behaviors. A growing Substantial evidence, especially from subject body of evidence shows that marketing is areas such as tobacco control, nutrition and highly effective in this arena as well. physical activity, and HIV/AIDS, suggests that social marketing can change health be- Marketing is perhaps best exemplified by the havior and is a broadly effective social-change strategy of “branding” products, services, strategy that can be applied in other subject organizations, and ideas. Brands, recognition areas as well. Well-funded social marketing of brands, and the relationship between brand campaigns, such as the American Legacy and consumer largely explain the tremendous Foundation’s truth campaign, have demon- success of product advertising and the growth strated robust effect sizes and have had major of the American and global consumer econo- population-level effects on health behavior, my over the past century. Marketers use morbidity, and mortality.2 The challenge for brands to build relationships that enhance the social marketers is to compete successfully value of products and services for consumers. in a media-saturated environment against By providing additional value for consumers, better-funded commercial marketers and brands can instill a sense of loyalty and their often unhealthful commercial mes- identification that causes consumers to sages for products such as junk and fast food, continue purchasing the branded products tobacco, and alcohol. and services over competitors. Brands project a personality with which consumers identify After discussing the evidence that social mar- and seek to associate themselves through keting works, I turn to the question of how owning and using the branded products and it works. As noted, social marketing applies services.1 Very much like reputations, brands the central marketing strategy of building precede the individual or organization and positive relationships with the audience to shape how the world responds. increase the value of promoted behaviors and to encourage exchange in the form of In this article, I examine social marketing and behavior adoption. Many social marketing its use of commercial marketing principles to campaigns have used branding to meet the

182 THE FUTURE OF CHILDREN Social Marketing Campaigns and Children’s Media Use competition head-on. The anti-tobacco use as nutrition and physical activity messages truth campaign, for example, developed promoted by the 1% Or Less milk campaign behavioral alternatives and creative branded and the 5-4-3-2-1 Go! campaign in Chicago, messaging to counter its competition, tobacco have targeted parents to encourage them to industry advertising. The approach used in change the home health environment and truth and other anti-tobacco use campaigns talk to their children about health behaviors.5 is often called “countermarketing.” Counter- These efforts also use relationship-building marketing campaign advertisements provide strategies, and many have used community behavioral alternatives to smoking, such as outreach as well as mass media components rebelling against industry manipulation and for a multi-channel message strategy. expressing independent thinking, thereby outdoing the industry’s own marketing of These strategies have clear applications to cigarettes as hip and cool products. Similar children’s media use and the effects of adver- approaches have been developed in nutri- tising on children’s health behavior. Market- tion, physical activity, and HIV/AIDS social ers have the ability to reach parents of young marketing. children and adolescents with targeted social marketing campaigns aimed at changing social norms about media use. They can pro- Social marketing has also mote “smart”—limited in time and self-aware been used to promote better in terms of influences—media use and a culture of parental involvement with messages parent-child communication that vary by children’s stage of development. and improved family health. At the same time, marketers are able to target adolescents with messages to promote “smart” Social marketing in fields such as these can media use and brand it as socially desirable target not only individual behavior, but also behavior. The evidence suggests that social public policy. Social marketing in tobacco marketers would be most likely to succeed not control, for example, has been used to by demonizing media use but by competing promote policy change and new legislation, with media influences by providing appealing leading to changes in social norms and the behavioral alternatives. Using positive mes- acceptability of smoking.3 Public health orga- sages and imagery, they could promote nizations use branding strategies to promote alternatives to media use—for example, social mobilization and to influence public “branding” direct social interaction as cool and debate and opinion.4 Whether to focus on hip. Such a strategy could lead to a culture of individual behavior or larger policy issues more healthful engagement with, and under- involves a strategic decision by the social mar- standing of, media and its influences. keting campaign based on available resources and competition for public attention. Social Marketing Social marketing uses the principles and Social marketing has also been used to processes of commercial marketing, but not promote behaviors such as better parent- with the aim of selling products and services. child communication and improved family Rather, the goal is to design and implement health. Many social marketing messages, such programs to promote socially beneficial

VOL. 18 / NO. 1 / SPRING 2008 183 W. Douglas Evans behavior change.6 In public health, social a nonsmoker, being physically active, or using marketing attempts to increase healthful be- a condom in an effort to encourage those haviors in a population by using such proven behaviors.7 marketing techniques as market research to understand audience attitudes and beliefs that In this article, I review research on social may affect behavior in response to a health marketing to highlight its potential applica- message. Social marketers analyze their com- tion to counter the flood of often unhealthful petition and use persuasive techniques such commercial media marketing to which as creating social models to engage in the American children and adolescents are promoted behavior. In some cases, market- exposed, explore what is now being done on ers can even create messages tailored for these topics, and outline a future agenda for individuals using information about personal research to enhance the impact of social preferences and behavior just as online and marketing as a protective factor in the lives of direct mail commercial marketers do. In children and adolescents. In the following recent years, social marketers have success- section, I explain how social marketing works. fully branded such health behaviors as being Then I turn to address three main topics:

Table 1. Major Recent Social Marketing Campaigns

Campaign Topic area Research design Location Target audience 1% Or Less 1% milk consumption Observational California Adults, parents, and families 5-4-3-2-1 Go! Nutrition and physical activity Experimental Chicago Parents and families promotion 5-A-Day for Better Health Fruit and vegetable consump- Observational United States Adults, parents, and tion families Florida TRUTH Tobacco countermarketing Quasi-experimental Florida Adolescents and young adults Jalan Sesama Educational entertainment None Indonesia Youth KNOW HIV/AIDS HIV/AIDS awareness and Observational United States Young adults prevention loveLife HIV/AIDS awareness and Observational South Africa Adolescents and young prevention adults Massachusetts anti- Tobacco countermarketing Quasi-experimental Massachusetts Adolescents (preven- tobacco campaign tion) and adults (ces- sation) Parents Speak Up Reproductive health Experimental United States Parents and families Salama HIV/AIDS awareness and Observational Tanzania Adolescents and young prevention adults Sisimpur Educational entertainment None Bangladesh Three- to six-year-olds stand Tobacco countermarketing Quasi-experimental Ohio Adolescents and young adults The TV Boss Children’s media use Observational United States Parents Trust HIV/AIDS awareness and Observational Kenya Adolescents and young prevention adults truth Tobacco countermarketing Quasi-experimental U.S. Adolescents and young adults VERB: It’s What You Do Physical activity promotion Quasi-experimental U.S. Pre-adolescent children

184 THE FUTURE OF CHILDREN Social Marketing Campaigns and Children’s Media Use how social marketing can promote healthful by an advertisement or a larger campaign. behavior, how it can counter media messages For example, the Marlboro Man, so familiar about unhealthful behavior, and how it can in commercials since the 1950s, provided an encourage discussions between parents and appealing social model for the Marlboro ciga- children. rette’s target audience. Of late, social marketers have also made use of models, such as How Social Marketing Works the independent, rebellious youth featured Social marketing has been widely and suc- in the American Legacy Foundation’s truth cessfully used to affect health and other social campaign.11 behaviors related to children and adolescents. Table 1 summarizes many of the major social Imagery can be a powerful marketing tool marketing campaigns conducted over the to help create an idealized social model and past fifteen years. thus promote product purchases and certain kinds of behavior. The Marlboro Man riding Social marketing efforts aimed directly at out on the range, the BMW driver corner- pre-adolescents or adolescents—exhorting ing nimbly on a windy road, the truth cam- them not to start smoking, for example, or to paign young adult confronting the tobacco exercise regularly—have evolved in recent industry—all embody socially desirable, years. During the 1980s and earlier, most idealized characteristics. Research has shown efforts focused on providing young people that such images feed the targeted audience’s with facts and information about health risks. aspirations to realize such an ideal—to be like In tobacco control, school-based programs the Marlboro Man, to own a BMW, to stand aimed to equip adolescents with protective boldly against the tobacco industry.12 Social intrapersonal and interpersonal skills to stay images exemplify socially desirable behavior tobacco-free in a social environment rich in and the attributes of those who engage in a positive imagery encouraging tobacco use.8 behavior—for example, the affluent, sporty, Since the early 1990s, social marketing to sexy BMW driver.13 children and adolescents has begun directly taking on the commercial marketing compe- Because social imagery formation plays an tition, countering unhealthful product important role in determining adolescent marketing and social messages and providing health behaviors, such as smoking, it can be young people with positive behavioral used both to encourage and to discourage alternatives.9 those behaviors. For example, tobacco brand marketing portrays smokers as cool, popular, Social Modeling, Imagery, and and blessed with many friends.14 Because Environment adolescents typically value these traits, they The concept of social modeling has long may be likely to at least experiment with been understood by psychologists and by smoking.15 But, as with the truth campaign, commercial marketers. In the work of Albert social marketers can make their own use of Bandura, for example, social modeling plays social imagery. a central role in social learning and social cognition; that is, the formation of knowl- The social environment, especially the edge, attitudes, and beliefs.10 In marketing, influence of parents among pre-adolescent social models embody the ideals promised children and of peers among adolescents, is

VOL. 18 / NO. 1 / SPRING 2008 185 W. Douglas Evans another powerful influence on health behav- an industry and source of unhealthful be- ior that can be used in social marketing. The havioral choices—in an overarching sense, associations teens form among their immedi- but not necessarily with specific commercial ate social environment, social images, and brands. Douglas Evans, Simani Price, and exposure to marketing can explain adoption Steven Blahut argue that the truth brand of health behaviors. sought to take “market share” away from the tobacco industry.19 In traditional product Competition marketing and branding, taking market share By creating and promoting positive social im- would involve one product, such as Coca- ages of healthful behaviors aimed at counter- Cola, increasing its share of a population, ing unhealthful imagery, social marketers such as soda drinkers or total sales of soda can compete for children’s and adolescents’ among a specific population, at the expense time, attention, and behavioral choices. In of a competitor, such as Pepsi, in that same marketing terminology, social marketing can population. compete with commercial messages by identifying the “frame of reference”—the com- But social marketing efforts in a health do- peting behavioral options in a given social main, such as physical activity, compete with context, such as whether to play outdoors or commercial marketing in that domain as a watch TV—and the “point of difference”— whole by pitting one lifestyle against another. how to portray one behavior as superior to For example, the active lifestyle promoted by another—and developing messages based on VERB represents a range of possible active that analysis.16 behavioral choices, from running, to jumping, to climbing trees, to playing soccer. It is the Social marketers have developed messages general behavior of physical activity that is at to compete both with commercial marketing stake. In this context, “market share” means and with the social norms that promote be- the proportion of individuals who choose one haviors such as smoking, excessive media use behavioral alternative or another. The compe- and other sedentary behavior, or consump- tition is between engaging in an unhealthful tion of junk and fast foods. For example, the behavior, such as being a couch potato or Centers for Disease Control and Prevention’s becoming a smoker, and choosing to engage VERB: It’s What You Do campaign branded in a physically active lifestyle and maintaining children’s play as fun, cool, and socially desir- that choice. able behavior.17 The health campaign por- trayed the competition—excessive sedentary Social marketing can provide children and behavior, such as watching television—as adolescents with reasons and opportunities socially undesirable, dull, and boring for the to engage in healthful alternatives by demon- target audience of tweens (nine- to thirteen– strating behavioral alternatives that tap into year-olds). The VERB brand’s vision was to their wants and needs, just as commercial “free children to play out their dreams.”18 marketers tap into their wants and needs through product promotion. For example, Social marketing messages like VERB and the truth campaign tapped into adolescents’ Legacy’s truth campaign compete with com- need for independence, rebellion, and mercial marketing—TV as a pastime rather personal control through appealing social than active play, or the tobacco industry as images of nonsmoking lifestyle—cool kids

186 THE FUTURE OF CHILDREN Social Marketing Campaigns and Children’s Media Use living without tobacco.20 The social marketing behaviors and that the associations individuals objective is to get the target audience, in the form with these brands, such as truth or case of truth adolescents and young adults VERB campaign brands, mediate the rela- aged twelve to twenty-four, to do other things tionship between social marketing messages besides smoking. By doing other things— and health behaviors such as remaining a taking action against the tobacco industry, nonsmoker or exercising.24 joining a social movement against tobacco use—adolescents aspire to the nonsmoking Factors such as brand loyalty, identification lifestyle promised by the campaign. with brand characteristics, and the perception of positive brand personality traits, among others, operate as cognitive and emo- Social marketing can provide tional mechanisms in the minds of the audience that brand marketers use to promote children and adolescents with consumer behavior.25 These factors can be reasons and opportunities to measured as both immediate effects of brand exposure on consumers, and, consequently, engage in healthful alterna- influences on consumer behavior, that form tives by demonstrating behav- the basis for individual-level brand research and evaluation. For example, if I am exposed ioral alternatives that tap into to BMW marketing, I may form positive their wants and needs. perceptions of the BMW personality (affluent, sporty, sexy). Forming these personality associations makes me more likely to buy a Public Health Branding BMW in order to attain the social benefits it By marketing a coherent set of behavioral promises (idealized imagery in the brand pro- alternatives, public health marketing cam- motion). Individual-level factors such as loy- paigns also can “brand” a healthful lifestyle by alty, identification, and personality are among creating and maintaining social models of that the constructs underlying brand equity, the lifestyle through advertising and promotional higher-order construct (that is, composed activities similar to those used by commercial of individual-level factors) that captures the marketing.21 In the commercial world, brands effects of commercial brands on consumers represent products and services.22 Commer- and public health brands on individual health cial marketers seek to build strong relations behaviors.26 (positive associations, brand identification, and loyalty) between customers and product Like commercial brands, public health and service brands such as BMW, Nike, and brands present a call to action—and give Crest toothpaste. Public health brands the targeted audience a voice in making represent health behaviors or lifestyles that informed decisions about their health and embody multiple health behaviors.23 The society’s well-being. For example, tobacco hypothesis underlying public health branding countermarketing calls on adolescents to join as a social marketing strategy is that adopting a social movement against tobacco use, to live branded “healthful lifestyles” increases the a nonsmoking lifestyle, and to take action to probability that individuals will engage in promote a nonsmoking society.27 All brands health-promoting and disease-preventing make a “promise”—that the individual will

VOL. 18 / NO. 1 / SPRING 2008 187 W. Douglas Evans realize value by associating with the brand which afford opportunities for rigorous evalu- and that the exchange for that value will ation and intervention research. Smaller-scale benefit the individual.28 The state of Ohio’s social marketing, such as tailored commu- tobacco countermarketing brand, called nication for individuals or small groups, is stand, promises, “Make a difference in the growing in popularity and has substantial lives of important people around you by applications using the Internet and handheld Standing Up against tobacco use.”29 devices.32 However, tailored health com- munications is a new field and has not yet been widely applied to prevention and health The final element of public promotion, and there is limited evidence of health brands, and one that its effectiveness in these applications. helps to distinguish them from Evaluations of Social Marketing Campaigns Unlike commercial marketing, where unpub- commercial brands, is the lished proprietary research is the norm, social notion that they “vaccinate” marketing is generating a large and growing research and evaluation literature. Much of or “inoculate” adolescents the research on outcomes of social marketing against unhealthful lifestyles. campaigns, especially mass media campaigns, are effectiveness studies conducted in real time, in the media markets or communities in The final element of public health brands, which messages are delivered. For example, a and one that helps to distinguish them from national evaluation of the truth campaign was commercial brands, is the notion that they based on a quasi-experimental design—that “vaccinate” or “inoculate” adolescents against is, it included a treatment group and a control unhealthful lifestyles. The truth campaign group, but the groups were not randomly provided arguments, both rational and emo- assigned, as they are in a true experimental tional, for choosing a nonsmoking lifestyle.30 design— in which campaign exposure was Adolescents and young adults who accept measured both from environmental measures those arguments—who associate with the and self-reported “confirmed awareness” of brand—thereby have rational and emotional campaign ads.33 tools to resist being influenced by tobacco industry arguments. This view reflects the In many instances, however, such evaluations well-known Elaboration Likelihood Model are impractical or impossible, thus limiting and the view that individuals who engage in a opportunities to advance the state of health process of elaboration of persuasive messages communication research and the knowledge are more likely to accept and act on them base on effective campaign strategies, mes- as intended.31 sages, and channels. In the case of paid media campaigns, funds may be too limited for the How Social Marketing Can campaign to reach a wide enough audience Influence Health Behavior to detect campaign effects using population The best evidence of social marketing survey methodologies. Logistical constraints effectiveness comes from studies of mass, such as campaign implementation timelines population-level communication campaigns, may also preclude collection of pre-campaign

188 THE FUTURE OF CHILDREN Social Marketing Campaigns and Children’s Media Use survey data. In the case of unpaid media, found that the average campaign accounted or public service announcements (PSAs), for about 9 percent of the variation in health the campaign reach in any given designated risk behavior outcomes, but with varying market area is typically low. For example, results.35 The subset of “non-coercive” television PSAs typically run late at night or campaigns—that is, those that simply deliver on midweek afternoons, when audiences are health information instead of attempting to small. Thus it is difficult to detect campaign persuade and advocate for a behavior— effects because of low statistical power. accounted for about 5 percent of observed variation, as compared with 9 percent for all As a result of practical limits facing many forty-eight campaigns reviewed. social marketing campaign evaluations, much of the research in this field is either quasi- A study of seventeen recent European media experimental, like the truth campaign evalua- campaigns on a range of topics including tion, or observational—that is, with no control promotion of HIV testing, myocardial infarc- group. With the help of several colleagues, tion hospital admissions, immunizations, I reviewed evaluations of social marketing and cancer screenings found similar effects campaigns that used branding strategies in the range of 5–10 percent.36 Like previ- and found that only three out of thirty-three ous research, this study shows that single or studies used a randomized experimental few-time behaviors can be easier to promote design, the gold standard for evaluations. Five than behavior requiring repetition and main- reported outcomes from quasi-experimental tenance over time.37 Some behaviors that do designs. Twenty-five of the studies were based not require long-term maintenance, such on observational designs. as breastfeeding and Vitamin A promotion, and switching to 1 percent milk, have shown Evidence of the Effectiveness of greater effect sizes and generally appear to Social Marketing have higher rates of success.38 Other recent reviews of social marketing evidence, including campaigns that were not One example of social marketing to promote explicitly “branded,” indicate that mass media a broad range of healthful behaviors that has social marketing through television, radio, not, as yet, been widely evaluated is “edutain- outdoor and print advertising, and the Inter- ment” programming, such as adaptations of net is effective in changing health behaviors the Sesame Street series sponsored by the on a population level. In general, these studies Sesame Workshop. show that social marketing has successfully changed health behavior such as smoking, Edutainment: The Sesame Workshop physical activity, and condom use, as well as Edutainment (sometimes called “educational behavioral mediators such as knowledge, at- entertainment” or “entertainment-education”) titudes, and beliefs related to these behaviors. is another form of social marketing that Most of these studies, however, have shown has been widely used to reach children and effect sizes of less than 10 percent.34 adolescents for the purpose of informing and changing health and social behaviors. In their widely cited study of forty-eight U.S. Edutainment seeks to instruct or socialize social marketing campaigns based on mass its audience by embedding lessons in some media, Leslie Snyder and Mark Hamilton familiar form of entertainment: television

VOL. 18 / NO. 1 / SPRING 2008 189 W. Douglas Evans programs, computer and video games, films, educational objective from one of the follow- music, websites, multimedia, and so on. ing developmental domains: physical (including physical development, health, and safety); Sesame Workshop, a nonprofit educational cognitive (including such areas as cognitive media producer, has created a series of development, language arts, mathematics, adaptations of the long-running children’s and science); emotional (identifying, express- educational program, Sesame Street. Sisimpur, ing, and managing emotions); social skills to for example, the Bangladeshi adaptation of get along with peers and adults; aesthetic (ap- Sesame Street, is designed to meet the preciating art forms, creativity, and culture); learning needs of three- to six-year-olds across and moral (moral principles and integrity, social classes and different regions of the honesty, fairness, and manners). country. The series features unique Bangla- speaking Muppets such as Ikri Mikri, an imaginative three-year-old who encourages The Sesame Workshop young girls to have a limitless sense of possi- adaptations and others like bility. Original music and locally produced live-action and animated segments reflect the them have successfully rich artistic heritage of Bangladeshi culture. integrated multiple health, With a curriculum defined by Bangladeshi educators, the series emphasizes literacy, educational, and social math, and science and also helps foster values topics into a single program, such as self-respect, empathy, and coopera- tion. Other key objectives include improving or series of programs, educational opportunities for young girls; thus addressing multiple promoting good nutrition, hygiene, and safety; and encouraging appreciation of the shared risk factors. cultural heritage of diverse segments of Bangladeshi society. Edutainment, many examples of which span the spectrum of health, education, and social Another recent adaptation by Sesame issues, has several major advantages as a form Workshop is Jalan Sesama, a television series of social marketing. First, as commercial created by local producers and educators to programs, edutainment can reach a wider meet the needs of Indonesian children aged audience than many other social marketing three to six. Jalan Sesama promotes age- campaigns.39 Second, edutainment combines appropriate and culturally relevant academic the benefits of branding, through characters and life skills. Like its counterpart in the and story lines, with knowledge- and skills- United States, the television program has a building through health information delivery. “magazine” format comprising short anima- Finally, in a program format, the Sesame tions, live action (documentary film) pieces, Workshop adaptations and others like them and studio segments featuring puppets, have successfully integrated multiple health, affording opportunities to present an array educational, and social topics into a single of educational experiences that enhance and program, or series of programs, thus ad- expand children’s knowledge and skills. Each dressing multiple risk factors. This approach segment of Jalan Sesama addresses a specific has significant potential for social marketing

190 THE FUTURE OF CHILDREN Social Marketing Campaigns and Children’s Media Use aimed at protecting children from the effects Lois Biener analyzed longitudinal data from of commercial media and marketing. the Massachusetts countermarketing campaign and found that adolescents who were How Social Marketing Can Counter aged twelve to thirteen years at the study’s Media Messages about Unhealthful outset and who reported exposure to televi- Behavior sion antismoking advertisements were As noted, social marketing campaigns have significantly less likely to progress to estab- been notably successful in three areas: pre- lished smoking than their peers who did not venting tobacco use, promoting diet and physi- report exposure.42 The study, however, found cal activity, and preventing HIV/AIDS. In each no effect on progression to established area, messages promote healthful behavior smoking among adolescents aged fourteen to and counter the effects of media messages that fifteen as the study began and no effects of glamorize or otherwise encourage risky behav- exposure to radio or outdoor advertisements. iors. These three areas have seen the largest number of effective branded campaigns.40 Countermarketing campaigns have been found effective in influencing specific, tar- Tobacco Countermarketing Campaigns geted attitudes and beliefs to affect smoking One of the most successful social marketing behavior. A longitudinal study of the Florida efforts has been tobacco countermarketing TRUTH campaign (the state campaign that campaigns aimed at preventing youth from preceded, and was the model for, the national starting to smoke. For example, campaigns truth campaign) found that teenagers with such as the American Legacy Foundation’s high levels of anti-tobacco industry attitudes truth campaign have successfully reduced were four times less likely to initiate smoking smoking initiation and progression to estab- and more than thirteen times less likely to lished smoking. Matthew Farrelly and several become established smokers than their peers colleagues showed that from 1999 to 2002, with low levels of such attitudes.43 James U.S. youth smoking prevalence declined from Hersey and several colleagues found that state 25.3 percent to 18.0 percent and that truth countermarketing campaigns using an anti- accounted for approximately 22 percent of tobacco industry message prime, or make that decline.41 more salient, negative perceptions about tobacco industry practices.44 Jeffrey Nieder- Although the effect size of the truth campaign deppe, Matthew Farrelly, and M. Lyndon is small by clinical standards, the campaign Haviland confirmed that TRUTH reduced shows that social marketing can have a big smoking among Florida teens and found spe- impact on population-level health. In the case cifically that adoption of two counterindustry of truth, the campaign-attributable decline in beliefs central to the campaign were associ- youth smoking equates to some 300,000 fewer ated with lower teen smoking rates.45 youth smokers and thus millions of added life years as well as tremendous reductions in Diet and Physical Activity Countermar- health care and other social costs. keting Campaigns Social marketing’s success in the arena of State-funded countermarketing campaigns nutrition and physical activity promotion and have also been effective in preventing and obesity prevention has provided insights to controlling tobacco use. Edward Siegel and help inform future nutrition campaigns.46

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Several effective branded nutrition campaigns, world, especially Africa, presents a different such as the National Cancer Institute’s (NCI) kind of social marketing challenge. Sexual 5-A-Day for Better Health, are widely known imagery, sexualization of children, and to the public. In a workshop on diet and com- normalization of early sexual debut among munication sponsored by NCI in July 2005, adolescents are pervasive in both contempo- researchers examined the potential for diet rary media and commercial marketing and and communication fields to work collabora- represent a major risk factor.52 Having sex is tively and develop more effective social mar- often seen as a rite of passage of youth, and keting strategies.47 The workshop confirmed the peer pressure and social desirability of previous research on poor nutrition as a being sexually active may be stronger than serious and growing risk factor for children’s they are in the case of smoking or other risk health and highlighted social marketing’s behaviors. Social marketing campaigns must promise in protecting children and promot- consider these factors when developing ing better nutritional health.48 messages and setting behavior change objectives. One of the most successful diet and nutrition efforts has been the 1% Or Less campaign, The Henry J. Kaiser Family Foundation which encouraged adults and children older partnered with media giant Viacom to launch than age two to drink milk with a fat content KNOW HIV/AIDS, a comprehensive public of 1 percent or less, instead of whole or 2 education campaign in the United States in percent milk.49 Designed by the Center for 2003.53 The effort built on the existing part- Science in the Public Interest, a nonprofit nership between the Kaiser Family Founda- group dedicated to improving the nation’s tion and Black Entertainment Television health through better nutrition, this campaign (BET, whose parent company is Viacom), has been carried out at many sites since 1995. which promoted HIV/AIDS prevention and The campaign includes news stories and awareness through the targeted Rap It Up advertisements on television, radio, bill- campaign beginning in 1998.54 The campaign boards, and in newspapers; milk taste-tests at reports that it has produced 131 rights-free a variety of community sites; supermarket (that is, non-copyrighted) messages, totaling a shelf labeling to draw attention to low-fat media value commitment of more than $600 milk; and school activities. The California million.55 Adolescent Nutrition and Fitness (CANFit) program found that after its 1% Or Less KNOW HIV/AIDS has five aims: to increase campaign in East Los Angeles, whole milk awareness about HIV/AIDS and how to purchases had dropped from 66 percent to 24 prevent it, to encourage dialogue between percent of overall sales and that the share of partners and with health care providers about all low-fat milk sold had more than doubled.50 sexual health issues, to encourage and pro- Although it was not a goal of the campaign, mote testing, to address the role that stigma overall milk purchases had increased by and discrimination play in spreading the 30 percent.51 disease, and to promote safer sex behaviors.56 The campaign uses partnerships with media, HIV/AIDS Countermarketing Campaigns commercial businesses, government, and HIV/AIDS prevention in the United States, community-based groups and contributions other developed nations, and the developing of air time, community outreach, and similar

192 THE FUTURE OF CHILDREN Social Marketing Campaigns and Children’s Media Use methods to increase campaign exposure. It geted high-risk groups including young peo- promotes messages through paid and unpaid ple aged fifteen to twenty-four, commercial targeted television, radio, and outdoor PSAs; sex workers, and rural populations, but it also HIV-themed television and radio program- operated on the principle that young people ming (primarily through partners Viacom and are susceptible to messages about behavior BET); print media; online and other elec- change. Salama relied heavily on community tronic media; and public outreach.57 outreach such as concerts, cultural shows, mobile video units, and sport tournaments. The 2004 survey of African Americans reported by Victoria Rideout revealed that 82 The loveLife campaign was the most compre- percent of all respondents and 94 percent of hensive of the three. It aimed to reduce by young adults aged eighteen to twenty-four re- half the rate of HIV infection among fifteen- called at least one campaign advertisement or to twenty-year-olds, as well as to reduce other program component, and 70 percent recalled sexually transmitted diseases and the inci- seeing two specific advertisements. Brand dence of teenage pregnancy. It promoted a awareness for the Rap It Up campaign was lifestyle choice valuing abstinence, delayed also high, with 58 percent of all respondents initiation of sexual activity, fewer sexual and 92 percent of young adults reporting partners among already sexually active awareness. Approximately 30 percent of all teenagers, and condom use. It was supported respondents and young adults demonstrated by nationwide adolescent-centered reproduc- recall of the KNOW HIV/AIDS brand.58 tive health services in government clinics and a network of youth outreach and support. Respondents who reported exposure to one or more campaign component said that the Studies show that each of the campaigns campaign had influenced their plans for the increased adolescent and young adult aware- future, including visiting a doctor or getting ness of these HIV/AIDS prevention brands tested for HIV, and were more likely than and also increased awareness of HIV/AIDS respondents who were not aware of campaign health risks and intentions to use condoms.61 components to indicate they planned to en- Effects of the campaigns included delayed gage in these behaviors. However, one major onset of sexual activity and increased condom study did not show a link between exposure use among those with repeated exposure to and intentions or sexual behavior.59 these brands. No comparable interventions, however, have been conducted in the United Three branded HIV/AIDS prevention social States. marketing campaigns that illustrate strategies for reaching adolescents and young adults How Social Marketing Can have recently been conducted in Africa: Trust Encourage Discussions among in Kenya, Salama in Tanzania, and loveLife Parents and Children in South Africa.60 Trust, conducted by the Social marketing campaigns can also help U.S.-based Population Services International parents influence their children’s behaviors. (PSI), promoted the social desirability of con- Three examples stand out. The first is a dom use to make using a condom seem cool. traditional public service announcement, an Special events such as concerts were part of unpaid (that is, air time was provided free by the campaign. Salama, also led by PSI, tar- media outlets) mass media campaign called

VOL. 18 / NO. 1 / SPRING 2008 193 W. Douglas Evans the TV Boss campaign sponsored by the The TV Boss is a good example of the use of Ad Council. The second is a multi-channel, branding to reduce media use and limit mixed community- and media-based cam- children’s exposure to specific content. The paign aimed at reducing childhood obesity, campaign has virtually all the major elements in part through reduced screen time and of public health branding.63 First, it seeks to increased exercise, called 5-4-3-2-1 Go! develop a relationship with the target audience sponsored by the Consortium to Lower by depicting parents in the same situation that Obesity in Chicago Children. The third is the audience members likely would be (need to Parents Speak Up national campaign, a U.S. protect kids, lots of negative TV characters out Department of Health and Human Services there), modeling their concerns, and showing campaign to promote parent-child communi- them being strong and taking control by cation about delaying sexual activity. blocking negative content. The campaign adds value for audience members by providing tools Each of these examples highlights different and information and builds on positive norms ways that social marketing can possibly of parental involvement and control that tap protect children from effects of exposure to into parents’ needs with respect to their commercial media and marketing, either children, especially adolescents. directly through messages to them or indi- rectly through messages to parents and To date, no evaluation data on The TV Boss family. Lessons learned from these examples have been published. But this and other cam- may be instructive to future social marketing paigns that are directly aimed at behaviors to efforts in this arena. protect children and adolescents from inap- propriate TV content are a promising social The TV Boss Campaign marketing strategy and should be evaluated. In The Ad Council has created a TV Boss particular, it will be important to compare the website and a public service announcement effectiveness of parentally oriented campaigns campaign in collaboration with major spon- and those targeting children directly using risk sors such as the Motion Picture Association factor and behavior change messages. of America, the National Cable and Telecom- munication Association, the National Associa- The 5-4-3-2-1 Go! Campaign tion of Broadcasters, and others.62 The stated The Consortium to Lower Obesity in Chicago purpose of the campaign is to “give parents Children (CLOCC) developed a public health the tools and information they need to guide education initiative to bolster ongoing local their child’s television consumption.” efforts addressing Chicago’s childhood obesity epidemic through healthful eating and physi- The campaign is a “direct influence” effort to cal activity. A citywide coalition of groups rep- raise parents’ knowledge and build their skills resenting virtually all social sectors developed to control children’s TV and media use. the 5-4-3-2-1 Go! social marketing initiative, Recognizing that motivation will be impor- which involves community youth and partners tant to encourage parental action, the cam- across Chicago in developing and disseminat- paign uses themes such as parental control ing the core messages. After completing a over negative media influences, depicting training process, youth ambassadors (known knowledgeable parents “blocking” potentially as Go! Teams) deliver these messages through risqué or violent characters in PSA spots. community outreach activities. The campaign

194 THE FUTURE OF CHILDREN Social Marketing Campaigns and Children’s Media Use

Table 2. 5-4-3-2-1 Go! Delivery Channels

Channels Aim Strategy Tactics Effects Go! Teams Create 5-4-3-2-1 Go! Teams Engage Chicagoans who are Create a team of high Brand the look of the Go! to provide a “for us, by us” social models and embody school student leaders Team to guarantee recog- element to the program so the values of living a health- (the Go! Team) from nition and visual appeal. that the targeted Chicago ful lifestyle, such as high diverse ethnic back- children, adolescents, and school sports stars, political grounds who can serve families will relate to it. leaders, sports, TV and as positive role models movie personalities. for younger kids and, at the same time, serve as living mascots who build awareness for the 5-4-3-2-1 Go! brand. Earned media Raise public awareness and CLOCC has more than 500 Go! Teams work through Awareness of the exis- coverage promote support for 5-4-3-2-1 community partners, many in community partners to tence of 5-4-3-2-1 Go! will through com- Go! and involvement in 5-4- the six target communities. reach community-level increase, as measured by munity media 3-2-1 Go! activities through Working with partners, 5-4- newspapers published response to 5-4-3-2-1 Go! and events advocating for and drawing 3-2-1 Go! will promote news in English and Spanish. awareness and specific attention to the campaign, media attention to its activi- questions about exposure leading to news media ties using media advocacy to news media coverage of coverage. techniques such as staging 5-4-3-2-1 Go! events. Website www. Create a 5-4-3-2-1 Go! web- The site contains detailed Drive traffic to the site The website becomes a clocc.net/ site (www.clocc.net/) featur- and practical information by coordinating with trusted health informa- ing information in English and based on key messages and Chicago Park District, tion source for community Spanish as an effective way is updated weekly. It features Chicago Public Schools, members. They receive to disseminate information upcoming events and how to Mayor’s Office of Spe- more detailed information about the campaign 24 hours participate, prizes and how cial Events, and other on the 5-4-3-2-1 Go! mes- a day/7 days a week. to win them, photos, and partners to establish sage and specific informa- games to test kids’ nutrition a hyperlink back to the tion about how to access and fitness knowledge. site. Promote the site community resources, how CLOCC works with Chicago through Go! Teams. to make more healthful schools to direct traffic to the food choices, and where site and make it a “favorite” to get nutritious foods (for on all elementary school example, local farmers’ computers. markets and the produce- mobile). is based on a simple 5-4-3-2-1 healthful eating communities that inhibits healthful lifestyles.65 and active living message for children: con- The campaign also responds to the complex sume five or more fruits and vegetables, four and potentially reciprocal relation among servings of water, and three servings of low-fat characteristics of the physical environment, dairy a day; spend no more than two hours social capital, and physical activity. For watching television or engaging in a similar example, highly walkable, mixed-use sedentary behavior; and get at least one hour neighborhoods have been associated with of physical activity a day. increased physical activity in the form of more walking for transportation.66 The 5-4-3-2-1 Go! campaign uses a healthful- lifestyles branding strategy aimed at improv- The social marketing strategy behind the ing family food choices and increasing use of campaign is culturally relevant and true to community physical activity resources.64 It community norms and values. Its healthful- targets six vanguard community areas that are lifestyles brand uses a name and logo-treat- linked to census boundaries in Chicago and is ment that embodies the brand essence: in part a response to the “obesigenic” environ- “Eating right and being healthy is as easy as ment, both social and physical, in those 5-4-3-2-1 Go!” It communicates positive

VOL. 18 / NO. 1 / SPRING 2008 195 W. Douglas Evans messages that resonate across different ethnic The campaign’s primary means of communi- communities and builds on local community cation is paid and unpaid public service pride in being Chicago residents. Table 2 announcements designed for a general summarizes the delivery channels used to mar- audience. The campaign also supports three ket key messages and their hypothesized outreach centers—African American, His- effects. panic, and American Indian—to get help with research, message development, creative Parents Speak Up National Campaign development, support building, and message In 2005, Congress authorized up to $10 mil- penetration in these communities. Finally, lion for the Administration on Children and the campaign uses outdoor advertising Families to carry out the Parents Speak Up (billboards), bus media, posters, Web national campaign, a national public educa- banners, and media kits. tion campaign to promote delayed sexual debut by teenagers. The national multimedia Parents Speak Up also includes a 4Parents.gov campaign encourages parents to talk “early website and associated parent and adolescent and often” to their pre-adolescent and ado- guides. The website provides information lescent children aged ten to fourteen about (as opposed to motivational messages) for delaying the onset of sexual activity. The parents about how to talk with their preteen purpose is to increase parent-child commu- or teen about waiting to have sex, about the nication as a proximal behavioral outcome accuracy of social norms among teens, and leading to delayed onset of sexual activity. about related topics such as parent-child The strategy of aiming messages promoting relationship quality and setting goals for parent-child communication at this target the future.68 audience has been used on a smaller scale in school- and community-based interven- There is also an ongoing impact evaluation tions, but never on a national scale in a mass to measure reactions and changes associated communication campaign. The campaign was with exposure to Parents Speak Up messages publicly released in June 2007. and ad executions. The evaluation will be The campaign applies many of the principles the first of its kind of a national campaign to of marketing. In particular, it uses a theory- increase parent-child communication about based behavior-change model that hypoth- sexual activity. The primary evaluation study is esizes increased parent-child communication a randomized controlled trial of mothers and will result from positive reactions to the fathers of children aged ten to fourteen, the public service advertising. It also develops a campaign’s target audience. Parents are ran- credible and likeable “argument” for delaying domly assigned to control, treatment (expo- initiation of sexual activity by communicating sure to a core set of campaign messages), and personal (social, educational, career-related) treatment plus booster (core plus additional advantages of abstinence. The campaign uses and more frequent campaign messages) con- strategies such as promoting self-efficacy and ditions. The different groups will be surveyed appealing to fear to communicate the health at baseline (before message exposure) and at risks of early sexual debut, the individual’s four follow-up time points, four weeks, ability to delay sexual debut, and the benefits six months, twelve months, and eighteen of waiting.67 months later.

196 THE FUTURE OF CHILDREN Social Marketing Campaigns and Children’s Media Use Conclusions and Recommendations behavioral determinants. Tobacco counter- Social marketing has been successful at marketing campaigns like truth, for example, changing a wide range of health behaviors, have developed innovative public health especially in the domains of tobacco use, nu- brands and created messages based on an trition and physical activity, and HIV/AIDS. adolescent “consumer” orientation.70 At the Social marketers have become increasingly same time, truth engaged communities and adept at using commercial marketing strate- advocated for state and national tobacco gies to craft competing messages and reduce policy changes, such as clean indoor air laws the percentage of children and adolescents and cigarette tax increases.71 responding to commercial messages. In some cases, despite their relatively small budgets Future efforts to limit children’s media use and slender resources, social marketers have should draw on lessons learned from past been successful at taking market share away efforts: know the audience and target mes- from the commercial sector.69 sages appropriately; use creative marketing and promotional strategies such as branding healthful lifestyle choices; use multiple chan- The competition between nels to increase exposure; and address public industry and social marketing policy in addition to individual behavior. brands is far from even. How There are several potentially fruitful avenues for future messages and campaigns. For can social marketing succeed pre-adolescent children, parents are a in the long run given this powerful social influence and have substantial opportunities to limit media use and market- comparative disadvantage? ing exposure. Social marketers should conduct formative research with parents to Unlike more heavily funded commercial mar- understand the home and family media keters, however, social marketers can rarely environment and parents’ role in regulating maintain public exposure to health messages children’s media use. Amy Jordan and several at high levels. Given the importance of expo- colleagues conducted research along these sure, social marketers thus often operate at lines, though not aimed at designing a social a significant disadvantage to the commercial marketing campaign, that could serve as a sector. The competition between industry starting point.72 and social marketing brands is far from even. How can social marketing succeed in the long Based on findings of this and related re- run given this comparative disadvantage? search, a campaign targeting possibly two distinct groups—parents of preschool (aged The answer to date has been threefold: two to five) and elementary school (aged six develop more socially powerful and persua- to eleven) children—could be developed. sive competing messages; use multiple Messages would be crafted specifically for channels including media, community each group with the aim of informing each outreach, and mobilization and develop social about what constitutes appropriate media use movements; and focus on social and health (for example, two or fewer hours of screen policies that affect individual behavior and time a day) and raising awareness of the

VOL. 18 / NO. 1 / SPRING 2008 197 W. Douglas Evans health risks of excessive media use and the desired goals. Media use—“it’s cool but don’t potential risks of marketing exposure. An- let it rule (your life).” other aim would be to modify parent attitudes and practices about children’s media Five new strategies now being developed and use, following other successful campaigns by used within social marketing campaigns may portraying an active healthful lifestyle as help in future messages and campaigns. The socially desirable. The overarching goal first such strategy is improved audience seg- would be to change the social norm about mentation. For example, social marketers can media use from one of permissiveness to one use market research data, such as that used of parental involvement and management of by commercial marketers, to identify more the home and family media environment. refined behavioral predictors and related message strategies. The second strategy is to For adolescents (aged twelve to seventeen), develop tailored messages for very specific and potentially also a secondary audience groups, such as adolescents who visit certain of young adults (aged eighteen to twenty- websites. The third strategy is co-branding. four), separate formative research should Like the commercial marketers, social mar- be conducted on their knowledge, attitudes, keters can link their branded messages to beliefs, and practices related to media use other trusted brands, such as by co-branding and how they use their time with media, a nutrition social marketing message with the including television, music, and new media, Sesame Workshop. The fourth strategy is to as compared with other pursuits. The goal make full use of technology. The Internet, of this campaign would be to brand limited handheld devices, and other media offer media use as socially desirable, as the new, social marketers opportunities to compete hip, and cool way to live. Media use would with industry using low-cost word-of-mouth not be demonized, but placed in the context marketing (so-called viral marketing). The of a larger, socially desirable lifestyle in which fifth and final strategy is social networking. television, the Internet, and other media Social marketers can place messages in media devices are part of a wide array of pursuits— used by children and adolescents to network living a physically active, outgoing, socially and take advantage of potential social diffu- engaged lifestyle—in which hip young people sion effects (for example, through MySpace, want to engage. Messages would be aimed at Facebook, and iPods). changing social norms about media use, raising consciousness of the limitations of media- Innovations such as these are no panacea. multitasking, and increasing awareness of the The task facing social marketing is daunt- value of interpersonal interaction in balance ing in the face of the rising tide of children’s with human-media interaction. Advertising to media use and large and growing commercial promote the brand would use social model- marketing efforts and budgets. These ap- ing by portraying hip, edgy, cool kids using proaches, however, would continue the so-far media in moderation or balancing media use successful trends in social marketing demon- and multitasking with popularity among peers strated in tobacco control, diet and physical and direct (not online) social interaction as activity, and HIV/AIDS prevention.

198 THE FUTURE OF CHILDREN Social Marketing Campaigns and Children’s Media Use Endnotes

1. D. Aaker, Building Strong Brands (New York: Simon & Schuster Inc., 1996).

2. M. C. Farrelly and others, “Evidence of a Dose-Response Relationship between ‘truth’ Antismoking Ads and Youth Smoking,” American Journal of Public Health 95, no. 3 (2005): 425–31.

3. W. D. Evans and others, “The ASSIST Newspaper Tracking System,” in Evaluation of Project ASSIST: A Blueprint for State-Level Tobacco Control, edited by F. Stillman and W. Trochim (Bethesda, Md.: National Cancer Institute, 2006).

4. M. Haider, “Branding of International Public Health Organizations: Applying Commercial Marketing to Global Public Health,” in Public Health Branding: Applying Marketing for Social Change, edited by W. D. Evans and G. Hastings (Oxford University Press, 2008.)

5. W. D. Evans and others, “The 5-4-3-2-1 Go! Intervention: Social Marketing for Nutrition,” Journal of Nutrition Education and Behavior 39, no. 2, S.1 (2007): S55–S59; B. Reger, M. Wootan, and S. Booth- Butterfield, “Using Mass Media to Promote Healthful Eating: A Community-Based Demonstration Project,” Preventive Medicine 29 (1999): 414–21; B. Reger and others, “1% or Less: A Community-Based Nutrition Campaign,” Public Health Reports 113, no. 5 (1998): 410–19.

6. W. D. Evans, “How Social Marketing Works in Health Care,” British Medical Journal 322 (2006):1207–10.

7. W. D. Evans and others, “Systematic Review of Public Health Branding,” Journal of Health Communica- tion (forthcoming).

8. G. J. Botvin and others, “Effectiveness of Culturally-Focused and Generic Skills Training Approaches to Alcohol and Drug Abuse Prevention among Minority Youths,” Psychology of Addictive Behaviors 8 (1994): 116–27.

9. W. D. Evans, S. Price, and S. Blahut, “Evaluating the truth® Brand,” Journal of Health Communication 10, no. 2 (2005): 181–92.

10. A. Bandura, Social Foundations of Thought and Action: A Social Cognitive Theory (Englewood Cliffs, N.J.: Prentice Hall, 1986).

11. W. D. Evans and others, “Branding Behavior: The Strategy behind the truth® Campaign,” Social Market- ing Quarterly 8, no. 3 (2002): 17–29.

12. W. D. Evans and others, “Social Imagery, Tobacco Independence, and the truth® Campaign,” Journal of Health Communication 9, no. 5 (2004): 425–41.

13. L. Chassin and others, “Self-Images and Cigarette Smoking in Adolescence,” Personality and Social Psychology Bulletin 7 (1981): 670–76.

14. P. A. Aloise-Young and K. M. Hennigan, “Self-Image, the Smoker Stereotype, and Cigarette Smoking: Developmental Patterns from Fifth through Eighth Grade,” Journal of Adolescence 19 (1996): 163–77.

15. D. Burton and others, “Image Attributions and Smoking Intentions among Seventh Grade Students,” Journal of Applied Social Psychology 19 (1989): 656–64.

16. A. Tybout and B. Sternthal, “Brand Positioning,” in Kellogg on Branding, edited by A. Tybout and T. Calkins (New York: John Wiley and Sons, Inc., 2005).

VOL. 18 / NO. 1 / SPRING 2008 199 W. Douglas Evans

17. M. Huhman and others, “Effects of a Mass Media Campaign to Increase Physical Activity among Children: Year-1 Results of the VERB Campaign,” Pediatrics 116 (2005): e247–54.

18. M. Huhman, S. Price, and L. Potter, “Branding Play for Children: VERB™ It’s What You Do,” in Public Health Branding: Applying Marketing for Social Change, edited by W. D. Evans and G. Hastings (London: Oxford University Press, 2008).

19. Evans, Price, and Blahut, “Evaluating the truth® Brand” (see note 9).

20. Ibid.

21. W. D. Evans and G. Hastings, “Public Health Branding: Recognition, Promise, and Delivery of Healthy Lifestyles,” in Public Health Branding: Applying Marketing for Social Change, edited by Evans and Hastings (London: Oxford University Press, 2008).

22. Aaker, Building Strong Brands (see note 1).

23. Evans, Price, and Blahut, “Evaluating the truth® Brand” (see note 9); W. D. Evans and others, “System- atic Review of Public Health Branding” (see note 7).

24. Evans, Price, and Blahut, “Evaluating the truth® Brand” (see note 9); Huhman and others, “Effects of a Mass Media Campaign” (see note 17); Farrelly and others, “Evidence of a Dose-Response Relationship” (see note 2).

25. K. L. Keller, “Branding Perspectives on Social Marketing,” Advances in Consumer Research 25 (1998): 299–302.

26. Evans and Hastings, “Public Health Branding” (see note 21); Evans, Price, and Blahut, “Evaluating the truth® Brand” (see note 9).

27. Farrelly and others, “Evidence of a Dose-Response Relationship” (see note 2).

28. T. Calkins, “The Challenge of Branding,” in Kellogg on Branding, edited by Tybout and Calkins (New York: John Wiley and Sons, Inc., 2005).

29. W. D. Evans and others, “Prevention Effects of an Anti-tobacco Brand on Adolescent Smoking Initiation,” Social Marketing Quarterly 13, no. 2 (2007): 19–38.

30. J. C. Hersey and others, “The Theory of truth®: How Counterindustry Campaigns Affect Smoking Behavior among Teens,” Health Psychology 24, no. 1 (2005): 22–31.

31. R. E. Petty and J. T. Cacioppo, Communication and Persuasion: Central and Peripheral Routes to Attitude Change (New York: Springer-Verlag, 1986).

32. M. Kreuter and others, Tailored Health Messages: Customizing Communication with Computer Technology (Mahwah, N.J.: Lawrence Erlbaum Associates, 2000).

33. Farrelly and others, “Evidence of a Dose-Response Relationship” (see note 2). The environmental measures were gross rating points, or GRPs, derived from designated market areas, or DMAs.

34. R. C. Hornik, ed., Public Health Communication: Evidence for Behavior Change (Mahwah, N.J.: Lawrence Erlbaum, 2002).

35. L. B. Snyder and M. A. Hamilton, “Meta-analysis of U.S. Health Campaign Effects on Behavior: Emphasize Enforcement, Exposure, and New Information, and Beware the Secular Trend,” in Public

200 THE FUTURE OF CHILDREN Social Marketing Campaigns and Children’s Media Use

Health Communication: Evidence for Behavior Change, edited by Robert C. Hornik (Hillsdale, N.J.: Lawrence Erlbaum Associates, 2002), pp. 357–83.

36. R. Grilli, C. R. Ramsay, and S. Minozzi, Mass Media Interventions: Effects on Health Services Utilisation, Cochrane Database of Systematic Reviews, Issue 1 (2002): Art. Number: CD000389, DOI:10.1002.14651858.CD000389.

37. Evans, “How Social Marketing Works in Health Care” (see note 6).

38. R. C. Hornik, “Public Health Education and Communication as Policy Instruments for Bringing about Changes in Behavior,” in Social Marketing, edited by M. Goldberg, M. Fishbein, and S. Middlestadt (Mahwah, N.J.: Lawrence Erlbaum, 1997).

39. R. C. Hornik, ed., Public Health Communication: Evidence for Behavior Change (Mahwah, N.J.: Lawrence Erlbaum, 2002).

40. Evans and others, “Systematic Review of Public Health Branding” (see note 7).

41. Farrelly and others, “Evidence of a Dose-Response Relationship” (see note 2).

42. M. Siegel and L. Biener, “The Impact of an Antismoking Media Campaign on Progression to Established Smoking: Results of a Longitudinal Youth Study,” American Journal of Public Health 90 (2004): 380–86.

43. D. F. Sly, E. Trapido, and S. Ray, “Evidence of the Dose Effects of an Antitobacco Counteradvertising Campaign,” Preventive Medicine 35 (2002): 511–18.

44. J. C. Hersey and others, “How State Counter-Industry Campaigns Help Prime Perceptions of Tobacco Industry Practices to Promote Reductions in Youth Smoking,” Tobacco Control 14 (2005): 377–83.

45. J. Niederdeppe, M. C. Farrelly, and M. L. Haviland, “Confirming ‘truth’: More Evidence of a Successful Tobacco Countermarketing Campaign in Florida,” American Journal of Public Health 94, no. 2 (2004): 255–57.

46. L. Snyder, “Health Communication Campaigns and Their Impact on Behavior,” Journal of Nutrition Education and Behavior 39, no. 2, S. 1 (2007): S32–40.

47. W. L. Johnson-Taylor and others, “What Can Communication Science Tell Us about Promoting Optimal Dietary Behavior?” Journal of Nutrition Education and Behavior 39, no. 2, S. 1 (2007): S1–S4.

48. A. F. Subar and others, “Dietary Sources of Nutrients among U.S. Children, 1989–1991,” Pediatrics 102 (1998): 913–23.

49. Reger, Wootan, and Booth-Butterfield, “Using Mass Media to Promote Healthy Eating” (see note 5); Reger and others, “1% or Less: A Community-Based Nutrition Campaign” (see note 5).

50. CANFit, “CANFit’s Latino 1% Milk Social Marketing Campaign,” CANFit Connection (www.canfit.org/ assets/images/Newsletter_-_Fall_2000.PDF [August 10, 2007]).

51. Reger, Wootan, and Booth-Butterfield, “Using Mass Media to Promote Healthy Eating” (see note 5).

52. S. Villani, “Impact of Media on Children and Adolescents: A 10-Year Review of the Research,” Journal of the American Academy of Child and Adolescent Psychiatry 10, no. 4 (2001): 392–401.

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53. The Henry J. Kaiser Family Foundation, “About Viacom: KNOW HIV/AIDS” (www.kff.org/entpartnerships/ viacom/index.cfm [August 10, 2007]).

54. V. Rideout, “Assessing Public Education Programming on HIV/AIDS: A National Survey of African Americans” (Washington, D.C.: Kaiser Family Foundation, 2004).

55. The Henry J. Kaiser Family Foundation, “KNOW HIV/AIDS: Learn about the Campaign” (www.know hivaids.org/learn_about.html [August 10, 2007]).

56. Rideout, “Assessing Public Education Programs on HIV/AIDS” (see note 54).

57. Kaiser Family Foundation, “About Viacom: KNOW HIV/AIDS” (see note 53).

58. Rideout, “Assessing Public Education Programs on HIV/AIDS” (see note 54).

59. Ibid.

60. W. D. Evans and M. Haider, “Public Health Brands in the Developing World,” in Public Health Branding: Applying Marketing for Social Change, edited by W. D. Evans and G. Hastings (London: Oxford University Press, 2008).

61. S. Agha, “The Impact of a Mass Media Campaign on Personal Risk Perception, Perceived Self-Efficacy, and Other Behavioral Predictors,” Aids Care 15, no. 6 (2003): 749–62; P. M. Eloundou-Enyegue, D. Meekers, and A. E. Calves, “From Awareness to Adoption: The Effect of AIDS Education and Con- dom Social Marketing on Condom Use in Tanzania (1993–1996),” Journal of Biosocial Science 37 (2005): 257–68; J. Stadler and L. Hlongwa, “Monitoring and Evaluation of loveLife’s AIDS Prevention and Advocacy Activities in South Africa, 1999–2001,” Evaluation and Program Planning 25 (2002): 365–76.

62. The Ad Council, “Parents: The TV Boss” (www.thetvboss.org/ [July 9, 2007]).

63. Evans and others, “Systematic Review of Public Health Branding” (see note 7).

64. W. D. Evans and others, “The 5-4-3-2-1 Go! Intervention: Social Marketing Strategies for Nutrition” (see note 5).

65. J. O. Hill and J. C. Peters, “Environmental Contributions to the Obesity Epidemic,” Science 280 (1998): 1371–74; J. O. Hill and others, “Obesity and the Environment: Where Do We Go from Here?” Science 299 (2003): 853–55.

66. L. D. Frank and others, “Linking Objectively Measured Physical Activity with Objectively Measured Urban Form: Finding from SMARTRAQ,” American Journal of Preventive Medicine 28 (2005): 117–25.

67. P. Slovic and others, “Risk as Analysis and Risk as Feelings: Some Thoughts about Affect, Reason, Risk, and Rationality,” Risk Analysis 24, no. 2 (2004): 311–22; K. Witte, “Putting the Fear Back into Fear Appeals: The Extended Parallel Process Model,” Communication Monographs 59 (1992): 329–49.

68. U.S. Department of Health and Human Services (http://4parents.gov/ [October 29, 2007]).

69. Evans and Hastings, “Public Health Branding” (see note 21).

70. Evans, Price, and Blahut, “Evaluating the truth® Brand” (see note 9); Evans and others, “Systematic Review of Public Health Branding” (see note 7).

202 THE FUTURE OF CHILDREN Social Marketing Campaigns and Children’s Media Use

71. D. Holden and others, “Modeling Psychological Empowerment among Youth Involved in Local Tobacco Control Efforts,” Health Education and Behavior 32, no. 2 (2005): 264–78.

72. A. Jordan and others, “Reducing Children’s Television-Viewing Time: A Qualitative Study of Parents and Their Children,” Pediatrics 118, no. 5 (2006): 1303–10.

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