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Communications:

A Strategy for Prevention Practitioners

Developed by
CSAP’s Northeast Center for the Application of
Prevention Technologies (CAPT)

  

We are pleased to welcome you to CSAP’s Northeast Center for the Application of Prevention Technologies (CAPT). Since 1997 we have been working with six New England and five mid-Atlantic States, to effectively transfer knowledge to the local level and strengthen their capacity to prevent and reduce alcohol and other drug use in youth ages 12–17.

 

The Center for Substance Abuse Prevention (CSAP) in the Substance Abuse and Mental Health Services Administration is the nation’s lead agency for substance abuse prevention. In addition to funding studies to test research-based models, CSAP spreads the word about proven program interventions that will enhance the efforts of prevention practitioners, policymakers, and evaluators. We hope you will visit the CSAP website at http://prevention.samhsa.gov. CSAP’s Decision Support System (DSS) promotes scientific methods and programs for substance abuse prevention for use within communities and state prevention systems. To learn more about CSAP’s DSS, visit their website at http://preventionplatform.samhsa.gov.

This series includes documents on Policy, Enforcement, Collaboration, Communications, Education, Early Intervention, and Alternatives. Special thanks to Dan Finkelstein at CSAP’s Northeast CAPT for his assistance in creating this module.

Funded by the Center for Substance Abuse Prevention (CSAP), Substance Abuse and Mental Health Services Administration Grant #UD1-SPO8999-01.

© Copyright 2001 Education Development Center, Inc. All rights reserved.

 

COMMUNICATIONS:

One of Seven Science-Based Prevention Strategies

WHAT WORKS IN PREVENTION?

Researchers at the national level are making great strides toward answering this important question. In recent years, they have distilled effective strategies and principles from the many programs that seek to prevent and reduce substance abuse. Now, across the country, more and more practitioners are coming to understand how critical it is to identify and use science-based strategies that are likely to be effective in meeting the needs of the people they serve.

For the Center for Substance Abuse Prevention (CSAP), Gardner and Brounstein have identified principles of effective substance abuse prevention.¹ From these, CSAP’s Northeast CAPT has specified seven effective prevention approaches. (See chart before endnotes.) They are:

• Policy
• Enforcement
• Collaboration
• Communications
• Education
• Early Intervention
• Alternatives

Communications can be used to influence community norms, increase public awareness about specific issues and problems related to substance abuse, attract community support for other program efforts, reinforce other program components, and keep the public informed about the program’s progress. Communications strategies include the following:

• Public education
• Social marketing
• Media advocacy
• Media literacy

As communities around the country are learning, the key to effective prevention is to use multiple strategies, in multiple settings, toward one common goal. Communities should examine their local situations, identify their specific needs, and look for ways to combine seven strategies that have proven effective: policy, enforcement, collaboration, communications, education, early intervention, and alternatives.

Multiple strategies, in multiple settings, toward one common goal.

WHAT IS COMMUNICATIONS?  

Mass media is a powerful influence in our society. For most youth, the media provides a great deal of information (accurate and inaccurate, healthy and unhealthy) that teaches them about the world in which they live. Estimates show that television viewing by youth occupies more time per week than any other non-school activity.² Young people also pick up influential messages from music, magazines, billboards, and the Internet. All this media exposure plays a very important role in shaping a young person’s attitudes, values, and behaviors.

Accordingly, the voice of prevention needs to be heard as well. We need prevention messages that are effective, clear, and memorable. Community leaders working to prevent and reduce substance abuse can benefit from knowing how to use a variety of communications tools.

Communications can be broadly defined as "purposive attempts to inform, persuade, or motivate behavior changes in a relatively well-defined and large audience."³ The tools it offers—public education, social marketing, media advocacy, and media literacy—can be used by prevention practitioners to promote young people’s involvement in positive activities, while diminishing media’s negative influence in fostering unhealthy behaviors, such as the use of alcohol, tobacco, and other drugs.

For many years, prevention practitioners’ use of media was limited to large-scale information campaigns, often national in scope, designed to educate the public and increase awareness about the causes of health problems. These information-based communications campaigns (such as Smokey Bear® and McGruff the Crime Dog®) were effective in reaching large numbers of people, but they were not so effective at reducing unhealthy activities.

In recent years, however, prevention professionals have become more strategic in their communications goals and savvier in their approach to using media. Prevention leaders now develop public education campaigns that advance people’s understanding of pressing health issues. Through techniques known as social marketing, practitioners use advertising principles to change social norms and promote healthy behaviors. Through strategic media efforts known as media advocacy, practitioners shape public debate and change public policies. Through media literacy, they teach children how to analyze the media messages children encounter and to create their own prevention messages.

PUBLIC EDUCATION

Public education attempts to increase the public’s knowledge and awareness of a particular health issue; in turn, this awareness can often support the development and success of programs and policies that address the problem. A public information campaign can communicate information about personal risk factors or publicize new laws or programs that promote safe, healthy behaviors that protect people from risk.⁴ It can also target a wide range of people, including youth, parents, teachers, and others involved in the lives of youth.

Public Education: An Illustration

In 1997, the Portland Press Herald in Maine published a week-long series entitled "The Deadliest Drug," which described the human and financial costs of alcohol abuse in the State of Maine.⁵ The series presented statistics on alcohol abuse and its connection to the high rates of traffic accidents and mental health problems throughout the State. The series also presented individual accounts of the tragic effects of alcohol on families in Maine.

Readers responded very strongly to the series. It raised people’s awareness of the widespread negative impact of alcohol abuse, and it raised concern and interest in finding ways to address the issue. Staff at the Portland Press Herald recognized the strong community response. In the months that followed, the newspaper worked with local community leaders to organize 70 focus groups in communities throughout the entire State, an initiative called the Maine Communities Face Alcohol (MCFA) program. The focus groups discussed the problem of alcohol abuse in their respective communities and developed local action plans. In addition, the governor of Maine formed a task force of legislators to examine Maine’s approach to substance abuse prevention and to develop a plan to address gaps in services. The task force reviewed a program report, and a select group of legislators attended an organized summit that took place at the conclusion of the month-long MCFA focus groups.⁶

"I think the biggest impact that the series had was to serve as a catalyst for a lot of people who are already working in this field. Suddenly they had something that provided real data about the problem and the scope of the problem. Not only that, it was readable, it was a teaching tool, and, within a few weeks, it became clear that this series, in a reprinted form, was going to be valuable for a lot of organizations that work against substance abuse."

—Kurt Hazlet, Managing Editor, Portland Press Herald

How Can a Public Education Campaign Be Used to Support Prevention in My Community?

Public education can support other prevention strategies by publicizing a community-based program, raising awareness and support for enforcement efforts, and galvanizing support for a new public policy. Public education campaigns are most effective when they are developed in conjunction with other community strategies to address public health problems, such as underage drinking or drinking and driving.

Increase awareness and impart information about a health issue
A public education campaign can raise people’s awareness about a problem—such as drunk driving, marijuana use, or teen smoking—and place it on the public agenda. It can present recent scientific findings about risk factors and unhealthy behaviors, which can prompt people to evaluate their personal risk and consider possible action for themselves or as part of a collective effort.⁷ Looking at the series published by the Portland Press Herald, it is evident that communicating information resulted in raising people’s concern and their level of involvement in addressing how alcohol was affecting their community.

"As a journalist, you can hope that you go into this business because you want to be a watchdog; you want to take a look at the community and hold a mirror up and say, ‘Hey, guess what, there’s some problems here,’ and let those citizens look at it and say, ‘Well, should we do something?’ And you hope that when you do write about these projects that people will care, and they’ll say, ‘Hey, we’ve got to do something.’"

—Barbara Walsh, Reporter, Portland Press Herald

Increase awareness about a new or existing law
Campaigns can be effective in increasing awareness of a new law that was recently passed or an existing law that is not being enforced. Campaigns have been used to educate the public about new laws related to drinking and driving and existing laws that govern the illegal sales of cigarettes to youth.⁸

In the late 1980s, an aggressive six-month effort was instituted to reduce the illegal sale of cigarettes to youth in Santa Clara County, California, and a community-wide public education campaign was a key component of this strategy.⁹ Mass media, small media, and presentations to community groups were used to make Santa Clara County aware of the problem of tobacco availability to youth.

Before the campaign began, compliance checks were conducted at stores throughout the county. In compliance checks, pseudo-patrons who cannot legally purchase a product try to do so, and vendors who sell to them are penalized. The results were released at a well-publicized press conference.

Then, several Public Service Announcements (PSAs), including one by former U.S. Surgeon General C. Everett Koop, were created and released on local radio and television stations. In addition, in a direct merchant education effort, prevention practitioners contacted store managers to explain the project and give them a merchant education kit. They also contacted CEOs of chain stores to ask the companies to take action to address the problem of illegal tobacco sales. Finally, numerous presentations were made to local community groups.

Overall, public education played a key role in informing the public about the pressing nature of illegal tobacco sales to youth and in garnering community support for this project. Following the public education campaign, many community leaders wrote letters of support, and many local organizations passed formal resolutions in support of the project. Research on the impact of this multifaceted campaign showed that over-the-counter sales to minors decreased significantly in communities that were targeted by the campaign.

Publicize a community-based program
A campaign can be particularly effective in promoting awareness of prevention activities and events taking place within a community. A campaign can be used to publicize a new or existing program, recruit new participants, win financial support, gain the endorsement of important community leaders, and/or solicit volunteers. In Michigan, a large-scale community campaign set out to raise awareness among urban women, adolescents, and pre-adolescents about the risks of smoking, and to encourage them to call a hotline to seek information about quitting. As a result of this campaign, the hotline experienced a significant increase in the number of calls from women expressing an interest in quitting smoking.¹⁰

Reinforce instruction taught in schools or community-based organizations
A campaign can also be used to strengthen and reinforce prevention messages that youth receive in school and other settings. A community in South Carolina produced PSAs in conjunction with a school-based alcohol education program. The combination of the PSA campaign and classroom instruction was shown to increase students’ knowledge of the risks of drinking, the effects of alcoholism on family members, alternatives to drinking, community resources, and other related information.¹¹

"I think the best way for an organization to get attention from a newspaper is to provide the newspaper with what it needs to see that there is a story. Don’t try to persuade them necessarily with just words. Provide facts."

—Kurt Hazlet, Managing Editor, Portland Press Herald

Evaluate the impact of public education
Since considerable resources go into any public education effort, it is important to be able to show how effective it was; therefore, you will need to conduct an evaluation. Whenever possible, an evaluation should include both process and outcome components to monitor your progress and demonstrate the effects of your effort.¹² Process measures document the implementation of the campaign’s activities, whether the campaign was conducted as planned, what obstacles or problems were encountered, and how these obstacles were addressed. A process evaluation asks the following types of questions: Is the campaign using as many media messages as intended? How many times and over what period are the messages being disseminated? How many people are being exposed to the campaign?¹³ This information enables you to determine whether the campaign is succeeding in implementing the activities contained in the original plan and to make mid-course corrections if it appears that your efforts are not working as intended.¹⁴

Outcome measures assess the impact of a campaign on the target population or the social environment in which the target audience exists.¹⁵ For example, did young people’s knowledge about the risks associated with tobacco use increase? What effect did the campaign have on their attitudes toward tobacco use, if any? Did rates of use of alcohol and other drugs change? Were there fewer alcohol-related crimes committed within the community? These types of questions help you to determine whether a campaign achieved its intended results.¹⁶

How Do I Know that This Strategy Works?

Evaluation studies have shown that public education campaigns alone can be effective in increasing the public’s awareness about a health issue. In conjunction with other strategies, they have also contributed to changes in people’s behaviors. For example:

• Public education has been shown to be effective at publicizing newly available services, such as smoking cessation programs.¹⁷

• Free and paid PSA campaigns alone have been effective in reducing drinking and driving behaviors.¹⁸

• Public education campaigns combined with enforcement efforts have been shown to reduce the illegal sales of tobacco to youth.¹⁹

SOCIAL MARKETING

In the commercial world, products are developed and sold through market research and skillful use of the media. Social marketing uses media messages and images in the same way, but for a different purpose—to encourage favorable changes in social values and individual behavior. These campaigns try to convince the public to adopt a new behavior by showing them the benefit they will receive in return. Social marketing campaigns have been used in a variety of social service and public health settings to address such issues as underage drinking, cigarette smoking, and cardiovascular health.

Social Marketing: An Illustration

A good example of a large-scale social marketing campaign is the Stanford University Heart Disease Prevention Program in California. This project sought to bring about a change in people’s behavior in order to reduce their risk of cardiovascular disease. Face-to-face instruction was combined with newspaper stories, television, and print materials that disseminated information about the causes of heart disease and encouraged changes in tobacco use, diet, exercise, and other habits. The campaign marketed a lifestyle that could improve blood pressure, weight, cholesterol levels, and other physical factors associated with heart disease. At the conclusion of the intervention, members of the target group had a 15 percent lower risk of heart disease than a control group not exposed to the program.²⁰

How Can a Social Marketing Campaign Be Used to Support Prevention in My Community?

A social marketing campaign will be more likely to influence people to change their health habits if the messages resonate with a group’s values, interests, and lifestyle needs and if people see the benefits of making lifestyle changes.

Exchange a behavior for a benefit
A social marketing campaign offers an exchange to a targeted audience. In this exchange, practitioners communicate a message: "You will get this benefit if you change this behavior." However, in order to change the behavior, a person needs to "pay a price" in the form of money, time, effort, or convenience. The goal of a social marketing campaign is to convince an audience that a behavior has benefits that make it worth the price, which means explicitly showing the benefits of such actions as quitting smoking, wearing seat belts, or participating in a community coalition. For example, one social marketing campaign tried to persuade teenage girls to wear seat belts. Past campaigns have communicated to youth that not wearing a seat belt can put them at risk for horrible bodily harm. Research for this campaign, however, showed that teenage girls were less concerned with jeopardizing their safety than with facial disfigurement. As a result, a campaign was developed to communicate the message that wearing a seatbelt can protect people from facial disfigurement.²¹

Understand your target audience
The key to developing effective social marketing campaigns is answering one question: "What does our target audience want?" Social marketing campaigns only succeed when they appeal to the existing values, attitudes, and motivations of the target audience. Practitioners can get this information by conducting formative research. Using surveys, interviews, and focus groups, practitioners can gain clues to the kinds of messages that will appeal to the interests and concerns of the group they are trying to influence.²²

Adolescents and young adults tend to take good health for granted, and campaigns that target a younger audience must keep that in mind. Research shows that messages based on long-term consequences of alcohol, tobacco, or other drug use have a limited effect on the behaviors of young people.²³ What does get their attention are messages that highlight short-term negative consequences (for example, that smoking causes body and mouth odor, discoloration of the teeth, and a deterioration in physical performance.) The "Nic (a teen)" program of the Office of Smoking and Health in the Centers for Disease Control and Prevention (CDC) emphasizes the fact that smoking makes people unattractive to members of the other sex. Research also shows that campaigns based on fear are difficult to carry out effectively. If the threat is too mild, then people will not be motivated by it; if it is too strong, people may tune it out, refuse to believe it, or adopt a fatalistic attitude.²⁴

Find the right channels
It is critical that practitioners figure out which channels will work best in getting their message to the target audience. Channels include television and radio spots, print ads, the Internet, community events, poster contests, giveaways of products or coupons for services, toll-free hotlines for counseling and referrals, or classes offered in the community.²⁵ Research and pre-testing can help you identify the most appropriate channels. For example, is television the best way to reach members of your target audience, or will they be more likely to pay attention to articles in your local newspaper? When choosing communications channels, prevention practitioners should ask themselves three questions:

• Which channels are most appropriate for my message and the problem it addresses?
• Which channels are most likely to be credible and accessible to my target audience?
• Which channels are feasible, considering my schedule and budget?²⁶

Check-in during a campaign
It is critical to check in with a target audience at several points throughout a campaign to find out how well your effort is working. This enables you to obtain information about whether the message is understandable, able to motivate an audience, and likely to achieve its intended goal. Good methods for checking in include focus groups, individual interviews, and intercept interviews, (on-the-spot, informal interviews at a location frequented by your target population).²⁷

The importance of checking in is illustrated by the experience of an anti-smoking campaign sponsored by CDC’s Office for Prevention in the early 1990s. Based on formative research, staff concluded that they would focus on teenagers’ desire to gain control over their lives by using a counter-advertising strategy to expose the predatory marketing techniques of the tobacco industry. Draft print advertisements and a television commercial were developed that featured such theme lines as "You get an image. They get an addict." Subsequent testing indicated that this concept of manipulation by the industry did not communicate clearly; in fact, 38 percent of those who viewed the rough TV spot believed that the main message promoted smoking!²⁸

Evaluate the impact
The evaluation component of a social marketing campaign is similar to the evaluation of a public education campaign. Whenever possible, it should include both process and outcome evaluation components to monitor progress and assess the effects of your effort.²⁹ An outcome evaluation of a social marketing campaign should look at changes in beliefs, attitudes, and self-reported behaviors. Keep in mind, though, that some researchers express concern about self-reports, especially around such socially undesirable behaviors as drinking and drug use, because respondents may give socially acceptable answers.³⁰

People’s answers can also change over time, as the behavior in question becomes more or less socially acceptable. However, there are ways to minimize these concerns. One is to construct questions carefully so that all the possible responses appear equally acceptable. Another is to assure respondents that their responses are anonymous or will be treated as confidential; research shows this will increase the validity of their responses.³¹ Strategies that incorporate this concern include intercept interviews where a written questionnaire is completed in private and random telephone surveys of youth and adults.³² Also, you can ask the same question in a variety of ways.

How Do I Know that This Strategy Works?

Evaluation studies suggest that social marketing campaigns, in conjunction with other prevention strategies, can play an important role in changing people’s behavior:

• Combining a social marketing campaign with a classroom intervention can be effective in increasing high school students’ knowledge about alcohol use and its effects.³³
• Combining a social marketing campaign and a classroom intervention can increase anti-smoking attitudes in elementary, middle, and high school students.³⁴
• Combining a social marketing campaign and a classroom intervention can be effective in increasing students’ social resistance skills and, at the middle school level, decreasing the amount that they smoked.³⁵

MEDIA ADVOCACY

A media advocate’s job is to shape the way social issues are discussed in the media and to use media outlets to build support for changes in public policy. By working directly with local newspapers, television, and radio, trying to change both the amount of coverage the media provide and the content of that coverage, media advocates hope to influence the way people talk and think about a social or public policy.

Media Advocacy: An Illustration

A good example of media advocacy took place in San Jose, California, when a grass-roots group called the Association for Responsible Alcohol Control (ARAC) used this strategy to promote the enforcement of laws that limited the density of alcohol outlets within the city.³⁶ ARAC focused on certain Latino neighborhoods where there were many alcohol outlets and high arrest rates for alcohol-related offenses among Latinos. ARAC wanted to create a policy that could reduce the number of outlets selling alcohol and give residents some say in these decisions. It developed and promoted a potential citywide ordinance that would require new businesses to apply for a conditional-use permit in order to be allowed to make off-site alcohol sales. The group attracted media coverage and took part in community events to increase public support for these permits and promote awareness of the problems associated with alcohol outlets, especially among San Joses’ Latino population. As a result of ARAC’s efforts, the San Jose city council voted unanimously in favor of implementing the conditional-use permit law.

How Can Media Advocacy Be Used to Support Prevention in My Community?

Practitioners can use media coverage to reframe the issue of substance abuse prevention by focusing on the larger environment that contributes to young people’s use of alcohol, tobacco, and other drugs. A media advocate will try to get reporters to cover issues and community events, which can dramatically increase an organization’s impact and which may not receive adequate coverage otherwise.³⁷ For example, while local news media may report on how many young people are using alcohol or drugs, they do not often report on the role that some local merchants may play in enabling youth to access alcohol. A media advocate might encourage the local newspaper to write a story on how police have caught local liquor stores selling alcohol to underage youth, who in turn are selling to other youth.

Identify the appropriate contact person
By carefully reading local papers and viewing local television and cable stations, you can usually find out which reporters are most likely to be interested in your topic or event. Health section reporters will often cover prevention issues; you may also be able to interest metro or even living/features section reporters in covering a community event. When in doubt, you can contact the section assignment editor, who can forward your information to the appropriate person. The operator at the media outlet may also be able to direct calls to the proper person.

Cultivate relationships with reporters
Reporters need information for their stories. Once you’ve identified the appropriate person, you need to introduce yourself. There are several ways to go about this. Because reporters are almost always pressed for time, one of the best options is a short note. However, because of the volume of mail large news outlets receive, regular mail may get overlooked or even thrown away before your potential contact gets a chance to see it. (Smaller papers tend to be more responsive to mail.) To avoid this risk, you could fax or e-mail your target person, or you could even call him or her directly. In each case, explain why your project/event/issue is relevant to the paper’s readers, and suggest some potential story ideas. You might also suggest some experts on the issue who could be interviewed in conjunction with the piece. Reporters will be more likely to listen to you if they believe you are pitching a good story rather than trying to get some publicity for your organization. By developing a working relationship with two or three members of the media, you stand a greater chance of getting your ideas heard. Media advocates can serve as an important source by offering expertise, credibility, and timely information. Advocates can also contact a reporter with story ideas that move beyond personal vignettes to include policy solutions. Finally, they can offer feedback about how a story was reported, including important facts that were not included in the story or background material for future stories.³⁸

Present information effectively
Reporters and editors are swamped with press releases and other demands on their attention, so you should present your information as clearly and succinctly as possible. Some media personnel prefer to receive a brief outline of your information, story idea, or media release via fax, with a phone call to follow up; others dislike the follow-up calls. It is best to ask each individual how he or she prefers to receive information.

Help the media "tell the story right"
A media advocate will try to influence the way the media report an event or issue and on which aspects of an event or issue they focus their attention.³⁹ Often, the media report health-related stories by focusing on personal tales that easily engage readers and viewers, while ignoring the broader community and social contexts that shape health-related behavior. The personal story is, at first glance, more compelling and easier to read and report, but by itself does not usually lead to solutions. For example, in covering a drunk driving incident, the media may profile the person who committed the crime without looking at the State’s lax approach to enforcing drunk driving laws. The media advocate’s job is to get the media to cover the "back story" as well. Practitioners can directly influence which stories are covered by writing letters to the editor or "op-ed" pieces, planning media events with good visual images for television, and speaking on radio talk shows.⁴⁰

Look for opportunities to create news
Advocates look for opportunities to create news on public health issues that the media will find worthy of reporting. Public health stories are often newsworthy because they concern large numbers of people, touch on broad community issues, and frequently involve conflict, controversy, or injustice.⁴¹ Good times to promote a story to the media include during a news-breaking event (such as an alcohol-related automobile crash), the announcement of a new project, the passing of a new law, or the anniversary of a major event.⁴²

Use paid advertising
By paying for coverage, media advocates can present a message exactly the way they want, at the exact time they want, and to a desired target audience. This is more costly than other methods, but it has obvious advantages. Not all paid ads are prohibitively expensive. Radio ads, for example, can be fairly inexpensive and can be used to reach large numbers of people during commuting hours. Anti-smoking ads on teen music stations are part of many State and local community strategies.⁴³

Evaluate the impact
As with public education and social marketing, it is important to conduct a process and outcome evaluation of your media advocacy efforts. This feedback is important in determining whether your efforts had an impact, whether your results were worth the effort, and what effective strategies for future advocacy efforts might be.⁴⁴ Three questions should frame your evaluation: Did you gain the type of media coverage you were seeking? Did your story appear in the outlets you wanted to use to reach your target audience? Were you able to have the story told the way that you hoped?

Media advocacy is often used to advance a new policy through the legislative process. An evaluation can look at whether a policy was successfully implemented or not. Finally, in the long term, it is also useful to examine whether your organization has become a source for key reporters in your community.⁴⁵

How Do I Know that This Strategy Works?

Media advocacy is most effective when is it is used in combination with policy and collaboration strategies (i.e., community coalition building, inter-agency and intra-agency collaboration). Research shows that media advocacy has played an effective role in three important areas:

Increasing public support for changes in alcohol- and tobacco-related policies⁴⁶

• Enacting new laws related to advertising and sales of alcohol and cigarettes⁴⁷
• Increasing public awareness about policy issues and results of baseline surveys, and stimulating public support and involvement⁴⁸

MEDIA LITERACY

Increasingly, the media are our teachers. It has been reported that youth spend more hours watching television, listening to music, and surfing the Internet than they spend in the classroom. A central question, then, is whether young people have the skills to be critical about what they watch, hear, and read.

Media literacy programs teach young people how to analyze and understand media messages and seek to empower them to make better decisions, using these skills. Young people are taught how programs and advertisements are developed, the strategies that producers use to make media messages more persuasive, the commercial sources for advertisements, and the ideas and beliefs expressed in commercial and news media.⁴⁹ Students learn to ask five key questions:

• Who created this message, and what is its purpose?
• What techniques are being used to attract my attention?
• What lifestyles, values, and points of view are represented?
• How is this message intended to influence me?
• How and why did they choose what to include and what to leave out of this message?⁵⁰

Media Literacy: An Illustration

The MediaSharp curriculum, developed by the American Academy of Pediatrics, CDC, and CSAP, is a two-part media literacy education resource guide for educators and community leaders who work with middle school and high-school age-youth; it can easily be integrated into existing classroom English, social studies, or health curricula, or adapted to community youth programs. It consists of an 80-page guide and a 7-minute video that feature activities and interactive learning. It can fulfill national health education standards and school health education guidelines, while the critical-thinking and communications skills it emphasizes makes it useful for interdisciplinary courses for middle and high school students.⁵¹

How Can Media Literacy Be Used to Support Prevention in My Community?

Media literacy instruction can occur in many settings. Classroom lessons and courses in this topic increasingly appear in K–12 curricula. After-school and religious education programs are integrating media literacy lessons for youth of all ages. In addition, parent-teacher organizations and other parent groups are learning about media literacy through expert presentations and programs sponsored by such groups as the National Cable Television Organization.⁵² Clearly, community prevention professionals can benefit from learning about media literacy as a prevention tool and should look for opportunities to partner with schools and community organizations.

Teach young people to analyze and use media
Media literacy activities generally teach students two important skills:⁵³

• Media analysis: Students learn to analyze and understand media messages, and recognize the way that the media normalize and glamorize unhealthy behaviors. For example, students examine models in cigarette ads and identify characteristics that the tobacco manufacturers want an audience to associate with the activity of smoking (e.g., glamour, independence).

• Media production: Students learn to create messages that deglamorize unhealthy activities like drinking alcohol and smoking. Students produce their own messages and advertisements, and thus demonstrate mastery of media literacy skills and ideas.

Partner with parents
Effective media literacy initiatives involve parents in the process of protecting young people from the media’s negative influence. Parents who are encouraged to become more literate about the mass media can be directly involved in children’s media use in two important ways:

• Structuring children’s media use: Parents can structure their children’s television, Internet, and video game use, by setting limits on how much children can watch or play, when they can do so, and which programs are consistent with the family’s values.⁵⁴

• Co-viewing: Parents can watch television, use the Internet, and listen to music with their children, and share their views about the content. Referred to as "co-viewing" or "parental mediation," this practice can shape children’s attitudes and behaviors toward the media they use

Connect with the community
Media literacy initiatives have the flexibility to operate in multiple settings—a characteristic of good prevention. A community-wide approach could involve, for instance, lessons in the schools’ curricula, presentations to parent groups, materials promoted at libraries, and a special series that examines media literacy approaches in print and broadcast media. Toward this end, here are two suggestions:

• Partner with other school and community organizations: It is best to involve multiple groups in presenting media literacy activities to young people. This enables your community to promote these skills without depending too much on one person or organization.⁵⁵ Appropriate groups might include the Boys and Girls Clubs, Boy Scouts, Girl Scouts, school parent-teacher organizations, and local chapters of MADD and SADD. These groups can also work to integrate media literacy into their activities.

• Involve health care providers: Involving pediatricians in your efforts can be very effective, since they are concerned about the overall health and well- being of children and adolescents, and are knowledgeable about substance use. Pediatricians are also increasingly concerned with the environmental aspects of child development and can offer useful media information during regular visits with families, or by speaking at school, community, or parent groups. Through the leadership of the American Academy of Pediatrics, many physicians are already calling attention to the harmful aspects of media on developing children through newspaper editorials, electronic mailing lists, and speaking engagements.

Evaluate the impact
A process evaluation of your media literacy efforts should document the activities that you conducted and who was exposed to them. Your outcome evaluation should attempt to examine how the audience’s skills, attitudes, and knowledge changed over the course of your activities. Did they acquire skills for critically evaluating advertisements? Did they develop more critical attitudes toward alcohol and tobacco use? Did they develop an accurate understanding of the prevalence of adult drinking and smoking? These are some important questions to answer.

How Do I Know that This Strategy Works?

Research suggests that media literacy efforts can help make young people less vulnerable to negative aspects of media exposure. Studies have shown that such programs in schools have successfully achieved the following outcomes:

• Developed elementary school students’ skills in more critically evaluating television program and advertising content⁵⁶
• Increased students’ knowledge around alcohol and tobacco advertising⁵⁷
• Reduced students’ alcohol use expectancies and their intention to drink⁵⁸

As a home-based intervention, research has demonstrated that adults who watch television with their children and offer comments and observations about the shows can have a significant positive effect on their children’s attitudes and behaviors toward television viewing.⁵⁹

COMMUNICATIONS RESOURCES

General Resources

Print Materials

The Journal of Health Communication is a peer-reviewed quarterly that publishes the latest developments in the field of health communication, including research in social marketing, shared decision making, communication (from interpersonal to mass media), psychology, government, policymaking, and health education around the world. Call (800) 821-8312, ext. 1117, for more information.

Training

CSAP’s Northeast CAPT is developing a series of trainings, with videos, that will build practitioners' capacity to incorporate each of the seven prevention strategies into their efforts.

Web Resources

CSAP’s Decision Support System (DSS) at https://prevention.samhsa.gov promotes scientific methods and programs for substance abuse prevention for use within communities and State prevention systems. You can use this site to learn how to assess your needs, gain insight into how to further develop your agency capacity, and choose among effective prevention programs.

Public Information and Education

Print Materials

National Cancer Institute (1992). Making health communications programs work: A planner’s guide. Bethesda, MD: National Cancer Institute. The full text is available online at http://cancer.gov/pinkbook or by writing to the Information Projects Branch, Office of Cancer Communications, National Cancer Institute, Building 31, Room 4B43, Bethesda, MD 20892.

Media Advocacy

Print Materials

Wallace, L., Dorfman, L., Jernigan, D., and Themba, M. (1993). Media advocacy and public health: Power for prevention. Newbury Park, CA: Sage Publications. This book, which is well suited for community groups and prevention practitioners, provides a framework for understanding and using media advocacy, and tools for strategically using the media to advocate for policy changes by key decision-makers.

Social Marketing

Print Materials

• Jaker, J. (2000). Early and often: How social marketing of prevention can help your community. Published by the Minnesota Institute of Public Health, this document can be obtained by calling (800) 782-1878.
• Weinreich, N. (1999). Hands-on social marketing: A step-by-step guide. Thousand Oaks, CA: Sage Publications. This book provides readers with the practical skills needed to develop a social marketing program. Designed for local practitioners, it takes into account the challenges faced by organizations with small budgets and little experience with the development and implementation of this type of program. The book is equally suited for individuals working at the State, national, and international levels.
• Zimmerman, R. (1997). Social marketing strategies for campus prevention of alcohol and other drug problems. Washington, DC: U.S. Department of Education, Higher Education Center for Alcohol and Other Drug Prevention. The full text of this document is available online at http://www.higheredcenter.org/services/publications/social-marketing-strategies-campus-prevention-alcohol-and-other-drug-problems

Websites

• The Social Marketing Network website http://www.hc-sc.gc.ca/hppb/socialmarketing/ contains resources, a forum, and a network for those interested in social marketing.

• A comprehensive social marketing resource is available online at http://www.social-marketing.com/. It contains general information on this strategy as well as news of upcoming conferences, job listings, and a chat room.

Organizations

The Social Marketing Institute is an excellent resource for those seeking to learn more about this strategy. Contact Alan Andreasen, Social Marketing Institute, 1825 Connecticut Avenue NW, Suite S-852, Washington, DC 20009, or visit the organization online at http://www.social-marketing.org.

Electronic Mailing Lists

To join the Social Marketing Institute’s electronic mailing list, send an e-mail to listproc@listproc.georgetown.edu. Type "subscribe soc-mktg" in the message body. You will receive confirmation of your subscription shortly after sending your subscription message.

Media Literacy

Print Materials

• Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, The Office on Smoking and Health, Centers for Disease Control and Prevention, The American Academy of Pediatrics, and National Education Association Health Information Network. (1997). MediaSharp: Analyzing tobacco and alcohol messages. Atlanta, GA: Centers for Disease Control and Prevention. This five-module curriculum, jointly developed by CSAP, SAMHSA, CDC’s Office on Smoking and Health, the American Academy of Pediatrics, and the National Education Association Health Information Network, addresses advertising, promotions, media mapping, and the analysis of pro-health messages.

• Burke, K. (1995). Flash point: Life skills through the lens of media literacy. Salem, MA: Eastern District Attorney’s Office. Using media literacy as a teaching strategy, participants are challenged to examine their attitudes regarding violence and substance abuse in the media.

Organizations and Websites

• The Media Awareness Network http://www.media-awareness.ca/english/index.cfm is a clearinghouse of information on media education and media violence, established under the auspices of the National Film Board of Canada in 1995.

• The Center for Media Literacy http://interact.uoregon.edu/medialit/MLR/home is a Los Angeles-based national advocacy organization that distributes educational materials and develops training programs for promoting critical thinking about the media in school classrooms, after-school programs, parent education, and religious and community centers, as well as in the home.

• The Media Literacy OnLine Project is located in the Center for Advanced Technology in Education at the University of Oregon’s College of Education. This project works with educators, producers, students, and parents to make resources available related to the influence of media in the lives of children, youth, and adults. The website http://interact.uoregon.edu/MediaLit/HomePage has archived articles, bibliographies, and other resources of value in the study of mass media.

Electronic Mailing Lists

To subscribe to the Media-L list, send an e-mail to listproc@nmsu.edu. In the body of the message, on one line, write Subscribe Media-L, your name, your title, and the name of your organization. It is important that it all fit on one line, so abbreviate if necessary. You will receive confirmation of your subscription shortly after sending your subscription message.

CSAP’s Northeast CAPT	CSAP
Policy	Environmental Approaches
Enforcement	Environmental Approaches
Collaboration	Community-Based Processes
Communications	Information Dissemination
Education	Prevention Education
Early Intervention	Problem Identification & Referral
Alternatives	Alternatives

ENDNOTES

1 Gardner, S. E., and Brounstein, P. J. (2001). Science-Based Prevention Practices. Principles of Substance Abuse Prevention. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention, Division of Knowledge Development and Evaluation. Available online: http://captus.samhsa.gov/northeast/PDF/gardner/gardner-cover2.cfm

2 Comstock, G. (1993). The medium and the society: The role of television in American life. In G. L. Berry and J. K. Asamen (Eds.),Children and television. Newbury Park, CA: Sage Publications; National Institute on Media and the Family.
3 Rice, R. E. and Atkin, C. K. (Eds.) (1989). Public communication campaigns, 2^nd Edition. Newbury Park, CA: Sage Publications; Rogers, E. M. and Storey, D. (1987). Communication campaigns. In C. Berger and S. Chaffee (Eds.), Handbook of communication science. Newbury Park, CA: Sage Publications.
4 DeJong, W. and Winsten, J. A. (1998). The media and the message: Lessons from past public service campaigns. Washington, DC: The National Campaign to Prevent Teen Pregnancy.
5 Portland Press Herald (October 1998). The deadliest drug.
6 Maine Task Force on Substance Abuse (1998). The largest hidden tax: Substance abuse in Maine; Kathleen Alfiero (May, 2000). Personal correspondence.
7 DeJong, W. and Winsten, J. A. (1998). The media and the message: Lessons from past public service campaigns.
8 Altman, D. G., Rasenick-Douss, L., Foster, V., and Tye, J. B. (1989). Reducing the illegal sale of cigarettes to minors. Journal of the American Medical Association, 261, 80–83; Ross, H. L. (1992). Confronting drunk driving social policy for saving lives. New Haven, CT: Yale University Press.
9 Altman, D. G., Rasenick-Douss, L., Foster, V., and Tye, J. B. (1989). Reducing the illegal sale of cigarettes to minors.
10 Center for Health Promotion, Michigan Department of Public Health (1990). The 1989 Michigan Smoking Prevention Media Campaign: An evaluation report. Detroit, MI.
11 Collins, D. and Cellucci, T. (1991). Effects of a school-based alcohol education program with a media prevention component. Psychological Reports, 69(1), 191–197.
12 Lau, R., Kane, R., Berry, S., Ware, J., and Roy, D. (Spring, 1980) Channeling health: A review of the evaluation of televised health campaigns. Health Education Quarterly, 7, 56–89; Wallack, L. (1984). Drinking and driving: Toward a broader understanding of the role of mass media. Journal of Public Health Policy, 5, 471– 496; DeJong, W. and Winsten, J. A. (1998). The media and the message: Lessons from past public service campaigns.
13 Zimmerman, R. (1997). Social marketing strategies for campus prevention of alcohol and other drug problems. Washington DC: U.S. Department of Education, Higher Education Center for Alcohol and Other Drug Prevention. The full text of this document is available online at http://www.higheredcenter.org/services/publications/social-marketing-strategies-campus-prevention-alcohol-and-other-drug-problems.
14 Arkin, E. B., Denniston, R., and Romano, R. M. (1990). The government perspective. In C. Atkin and L. Wallack (Eds.), Mass communication and public health: Complexities and conflicts. Newbury Park, CA: Sage Publications; DeJong, W. and Winsten, J. A. (1998). The media and the message: Lessons from past public service campaigns.
15 Zimmerman, R. (1997). Social marketing strategies for campus prevention of alcohol and other drug problems.
16 Zimmerman, R. (1997). Social marketing strategies for campus prevention of alcohol and other drug problems.
17 Center for Health Promotion, Michigan Department of Public Health, 1990.
18 Murry, J. P., Stam, A., and Lastovika, J. L. (1993). Evaluating an anti-drinking and driving advertising campaign using a sample survey and time series intervention analysis. Journal of the American Statistical Association, 88(421), 50–56; Murry, J. P., Stam, A., and Lastovika, J. L. (1996). Paid versus donated-media strategies for public service announcement campaigns. Public Opinion Quarterly, 60(1), 1–29; Barber, J. G., Bradshaw, R. and Walsh, C. (1989). Reducing alcohol consumption through television advertising. Journal of Consulting and Clinical Psychology, 57(5), 613–618.
19 Altman, D. G., Rasenick-Douss, L., Foster, V., and Tye, J. B. (1989). Reducing the illegal sale of cigarettes to minors.
20 Farquar, J., Maccoby, N., Wood, P. et al. (1976). Community education for cardiovascular health. Lancet, 1192–1195; Zimmerman, R. (1997). Social marketing strategies for campus prevention of alcohol and other drug problems.
21 Kotler, P. and Roberto, E. L. (1989). Social marketing: Strategies for changing public behavior. New York: Free Press.
22 Zimmerman, R. (1997). Social marketing strategies for campus prevention of alcohol and other drug problems.
23 Atkin, C. (1979). Research evidence on mass-mediated health communication campaigns. In D. Nimmo (Ed.), Communication yearbook (Volume 3). New Brunswick, NJ: Transaction.
24 Zimmerman, R. (1997). Social marketing strategies for campus prevention of alcohol and other drug problems.
25 Weinreich Communication (1999). Available online: http://www.social-marketing.com/building.html.
26 Zimmerman, R. (1997). Social marketing strategies for campus prevention of alcohol and other drug problems.
27 Zimmerman, R. (1997). Social marketing strategies for campus prevention of alcohol and other drug problems.
28 McKenna, J. W. and Williams, K. N. (1993). Crafting effective tobacco counter-advertisements: Lessons from a failed campaign directed at teenagers. Public Health Reports, 108(1), 85–89.
29 Lau, R., Kane, R., Berry, S., Ware, J., and Roy, D. (Spring, 1980) Channeling health: A review of the evaluation of a televised health campaigns; Wallack, L. (1984). Drinking and driving: Toward a broader understanding of the role of mass media; DeJong, W. and Winsten, J. A. (1998). The media and the message: Lessons from past public service campaigns.
30 Wallack, L. (1986). Mass media, youth and the prevention of substance abuse: Towards an integrated approach. In S. Griswold-Ezekoye, K. Kumpfer, and W. Bukowski (Eds.), Childhood and chemical abuse: Prevention and intervention. New York: Haworth Press; DeJong, W. and Winsten, J. A. (1998). The media and the message: Lessons from past public service campaigns.
31 Rouse, B., Kozel, N., and Richards, L. (Eds.) (1985). Self-report methods of estimating drug use: Meeting current challenges to validity. Rockville, MD: U.S. Department of Health and Human Services, National Institute on Drug Abuse; DeJong, W. and Winsten, J. A. (1998). The media and the message: Lessons from past public service campaigns.
32 Strunin, L. and Hingson, R. (1992). Alcohol, drugs, and adolescent sexual behavior. The International Journal of Addictions, 27, 129–146; DeJong, W. and Winsten, J. A. (1998). The media and the message: Lessons from past public service campaigns.
33 Collins, D. and Cellucci, T. (1991). Effects of a school-based alcohol education program with a media prevention component.
34 Flynn, B. S., Worden, J. K, Secker-Walker, R. H., Pirie, P. L., Badger, G. J., Carpenter, J. H., and Geller, B. M. (1994). Mass media and school interventions for cigarette smoking prevention: Effects 2 years after completion. American Journal of Public Health, 84(7), 1148–1150; Flynn, B. S., Worden, J. K, Secker-Walker, R. H., Badger, G. J., and Geller, B. M. (1995). Cigarette smoking prevention effects of mass media and school interventions targeted to gender and age groups. Journal of Health Education, 26(2) Suppl, S45–S51.
35 Flay, B. (1987). Mass media and smoking cessation: A critical review. American Journal of Public Health, 77, 153–160.
36 Neigron, D., Canela, J., and Aguirre-Molina, M. (1997). Giving communities a voice in alcohol sales: The Association for Responsible Alcohol Control. In D. Jernigan and P.A. Wright (Eds.), Making news, changing policy: Case studies of media advocacy on alcohol and tobacco issues. Rockville, MD: Center for Substance Abuse Prevention.
37 Wallack, L., Dorfman, L., Jernigan, D., and Themba, M. (1993). Media advocacy and public health: Power for prevention. Newbury Park, CA: Sage Publications.
38 Wallack, L. and Dorfman, L. (1996). Media advocacy: A strategy for advancing policy and promoting health. Health Education Quarterly, 23(3), 293–317.
39 Wallack, L., et al. (1993). Media advocacy and public health: Power for prevention.
40 Wilbur, P. M. and Stewart, K. (2000). Strategic media advocacy for enforcement of underage drinking laws. Washington DC: Pacific Institute for Research and Evaluation, Office for Juvenile Justice and Delinquency Prevention, U.S. Department of Justice.
41 Kansas Community Toolbox. Available online: http://ctb.ku.edu/en/.
42 Richardson, H. (1994). Raising more voices than mugs: Changing the college alcohol environment through media advocacy. Washington, DC: U.S. Department of Education, Center for Substance Abuse Prevention and U.S. Department of Health and Human Services.
43 Wallack, L. et al. (1993). Media advocacy and public health: Power for prevention.
44 Wallack, L. et al. (1993). Media advocacy and public health: Power for prevention.
45 Wallack, L. et al. (1993). Media advocacy and public health: Power for prevention.
46 Holder, H. D. and Treno, A. J. (1997). Media advocacy in community prevention: News as a means to advance policy change. Addiction, 92(Supplement 2) S189–S199; Russell, A., Voas, R. B., DeJong, W., and Chaloupka, M. (1995). MADD rates the states: A media advocacy event to advance the agenda against alcohol-impaired driving. Public Health Reports, 110(3), 240–245; Robinson, R. G. and Sutton, C. (1997). The Coalition Against Uptown Cigarettes. In D. Jernigan and P. A. Wright (Eds.), Making news, changing policy: Case studies of media advocacy on alcohol and tobacco issues; Rogers, T., Feighery, E. C., Tencati, E. M., Butler, J. L., and Weiner, L. (1997). Community mobilization to reduce point-of-purchase advertising of tobacco products. Health Education Quarterly, 22(4), 427–442; Neigron, D., Canela, J., and Aguirre-Molina, M. (1997). Giving communities a voice in alcohol sales: The Association for Responsible Alcohol Control.
47 Russell, A., Voas, R. B., DeJong, W., Chaloupka, M. (1995). MADD rates the states: A media advocacy event to advance the agenda against alcohol-impaired driving.
48 Rogers et al, (1997). Community mobilization to reduce point-of-purchase advertising of tobacco products; Neigron, D., Canela, J., and Aguirre-Molina, M. (1997). Giving communities a voice in alcohol sales: The Association for Responsible Alcohol Control; Casswell, S. and Gilmore, L. (1989). Evaluated community action project on alcohol. Journal of Studies on Alcohol, 50(4), 339–346; Holder, H. D. and Treno, A. J. (1997). Media advocacy in community prevention: News as a means to advance policy change.
49 Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention, American Academy of Pediatrics, National Education Association Health Information Network, and U.S. Department of Health and Human Services. (1997). MediaSharp: Analyzing tobacco and alcohol messages (Leader's guide). Washington, DC: Centers for Disease Control and Prevention; Simons-Morton, B. G., Donohew, L., and Crump, A. D. (1997). Health communication in the prevention of alcohol, tobacco, and drug use. Health Education and Behavior, 24(5), 544–554.
50 Barry, D. (1999). Communication strategies. Newton, MA: Education Development Center, Inc.
51 Center for Substance Abuse Prevention et al. (1997). MediaSharp: Analyzing tobacco and alcohol messages (Leader's Guide).
52 Center for Substance Abuse Prevention et al. (1997). MediaSharp: Analyzing tobacco and alcohol messages (Leader's Guide).
53 Center for Substance Abuse Prevention et al. (1997). MediaSharp: Analyzing tobacco and alcohol messages (Leader's Guide.)
54 "Media Violence," AAP Committee on Communications, in Pediatrics, Vol. 95, No. 6, June 1995; Myers-Walls, J. (1993). "Suggestions for Parents: Children Can Unlearn Violence," Media and Violence. Part One: Making the Connections. Media & Values (62) 1-24.
55 Centers for Disease Control and Prevention et al. (1997). MediaSharp: Analyzing tobacco and alcohol messages (Leader's Guide).
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57 Graham, J. W. and Hernandez, R. (1993). A pilot test of the AdSmarts Curriculum: A Report to the Scott Newman Center. Los Angeles, CA: Scott Newman Center.
58 Austin, E. W., and Johnson, K. K. (1997). Effects of general and alcohol-specific media literacy training on children’s decision-making model about alcohol. Journal of Health Communication, 2, 17–42.
59 Buerkel-Rothfuss, N., Atkin, C., and Neuendorf, K. (1982). Learning about the family from television. Journal of Communication, 32(3), 191–201.