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Health campaigns work – sometimes

Effectiveness of mass media campaigns depends on target and method of delivery

Louise Prime

Friday, 08 October 2010

Mass media campaigns to increase ‘healthy’ behaviours and decrease ‘unhealthy’ ones have in many cases been extremely successful – such as promotion of seat-belt use, and sun protection in Australia. But poorly targeted or conducted campaigns have failed or even backfired, such as encouraging marijuana use, say authors of a Review in The Lancet this week.

Dr Melanie Wakefield from Cancer Council Victoria in Melbourne, Australia, and her colleagues found good evidence that mass media campaigns were associated with a decline in young people starting smoking and with an increase in the number of adults stopping. Campaigns were more likely to be successful in stopping young people from smoking when they included schools and/or community programmes. Other strategies such as increasing the level of tobacco taxation and prohibiting smoking in certain places also helped cut smoking.

But, they found, tobacco companies’ own youth-directed anti-smoking campaigns appeared to have actually increased the risk of young people smoking – perhaps because this age group were attracted to something portrayed as an ‘adults-only’ activity.

The authors concluded that on the whole, campaigns encouraging safe alcohol use have been ineffective, which they suggest is because they compete with widespread, unrestricted alcohol marketing and the broad view that drinking is acceptable. The notable exceptions are anti-drink-driving campaigns, which have been successful.

Campaigns aimed at reducing the use of illicit drugs have had mixed results – one, to cut marijuana use in the US, actually appeared to have increased the likelihood of people saying they would try the drug.

Programmes aimed at improving diet and exercise in the US are thought to have worked to some extent, but the benefits did not persist for long beyond the end of the campaigns.

European populations exposed to HIV awareness campaigns failed to reduce their number of sexual partners, although they did increase their use of condoms.

The authors say their review shows that combined strategies work best to improve cancer screening and prevention – for example, sending women reminder letters for cervical and breast screening while at the same ensuring that screening services are present and easily accessible.

They also found that campaigns are more likely to succeed when they are aimed at a single target, such as vaccination uptake, cancer screening or ending aspirin use in children, rather than having a more general or ongoing focus, such as improving diet and physical activity levels.

They argue that commercial marketing of ‘unhealthy’ choices can be a powerful opponent of health campaigns, but on the other hand that “public relations or media advocacy campaigns that shape the treatment of a public health issue by news and entertainment media also represent a promising complementary strategy to conventional media campaigns.”

They conclude: “isolation of the independent effects of mass media campaigns is difficult but in aggregate [studies] yield a substantial body of support for the conclusion that mass media campaigns can change population health behaviours.”

The (unnamed) author of an accompanying Editorial says: “There is considerable evidence that exposure to smoking in films and television is a major contributor to smoking initiation in young people. Teenagers’ alcohol consumption, too, is related to depiction of drinking in the media.

“The messages for governments are clear. Prevent or restrict young people’s exposure to unhealthy behaviours in the media, and use those same channels to promote healthy behaviours.

“Health promotion is undermined while television screens, music videos, or outdoor advertising sites continue to expose young people to images that encourage unhealthy lifestyles. Mass media campaigns to change behaviour can improve health, but often need sustained funding to do so, and are more likely to be effective if complementary policy or legal frameworks are in place.”

How would qualify the communication between primary and secondary care services? (See OnMedica News 20/04)

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