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This article presented a new product development tool for adults with intellectual and developmental disabilities (IDD) developed by the Centers for Disease Control and Prevention (CDC). People with IDD who also have extreme low literacy (ELL) have unique communication needs; public health communicators often face challenges developing effective communication materials for this audience. To support CDC communication specialists with the development of communication products for adults with IDD/ELL, CDC, with its partners RTI International and CommunicateHealth, created a product development tool for this audience through literature review, expert input, and interviews with adults with IDD/ELL and caregivers of adults with IDD/ELL. To build evidence around the principles described in the tool, RTI conducted interviewer-administered surveys with 100 caregivers who support people with IDD/ELL. During the interviews, we presented caregivers with stimuli (portions of a communication product) that either did or did not apply a single principle and asked which would be easier for the person they support to understand. Across all 14 principles tested, the caregiver respondents indicated that the principle-based version would be easier for the person they support to understand compared with the non-principle-based version(s). These findings provide additional evidence to support the principles included in CDC’s Tool for Developing Products for People with IDD/ELL.

Objectives: How Right Now (HRN) is an evidence-based, culturally responsive communication campaign developed to facilitate coping and resilience among US groups disproportionately affected by the COVID-19 pandemic. To inform the development of this campaign, we examined patterns in emotional health, stress, and coping strategies among HRN’s audiences, focusing on differences among racial and ethnic groups. Methods: We used a national probability panel, AmeriSpeak, to collect survey data from HRN’s priority audience members in English and Spanish at 2 time points (May 2020 and May 2021). We conducted statistical testing to examine differences between time points for each subgroup (Hispanic, non-Hispanic Black, and non-Hispanic White) and differences among subgroups at each time point. Results: We found disparities in COVID-19–related mental health challenges and differences in coping strategies. Non-Hispanic Black respondents were more likely than non-Hispanic White respondents to report challenges related to the social determinants of health, such as affording food and housing (26.4% vs 9.4% in May 2020) and experiencing personal financial loss (46.6% vs 29.2% in May 2020). In May 2021, 30.6% of Hispanic respondents reported being unable to meet basic food or housing needs versus 8.2% of non-Hispanic White respondents, and 51.6% reported personal financial loss versus 26.5% of non-Hispanic White respondents. Conclusions: Our study further illuminates what is needed to build emotional well-being pathways for people who historically have been economically and socially marginalized. Our findings underscore the need for public health interventions to provide culturally responsive mental health support to populations disproportionately affected by COVID-19 during the pandemic and into the future, with a focus on racial and ethnic disparities.

The How Right Now communication initiative (HRN) was developed to facilitate resilience amid the COVID-19 pandemic in the United States. HRN was designed as a conduit for promoting mental health and addressing feelings of grief, worry, and stress experienced during this time. This article provides an overview of the rapid, mixed-method, culturally responsive formative research process undertaken to inform the development of HRN. Specifically, it describes how HRN's disproportionately affected audiences (adults aged 65 and older and their caregivers, adults with preexisting physical and mental health conditions, adults experiencing violence, and adults experiencing economic distress) describe and discuss emotional resilience, what they need to be resilient, and what factors contribute to the perceptions of their ability to "bounce back" from the conditions caused by the COVID-19 pandemic. Data collection methods included an environmental scan (n >= 700 publications), social listening (n >= 1 million social media posts), partner needs-assessment calls (n = 16), partner-convened listening sessions with community members (n = 29), online focus groups (n = 58), and a national probability survey (n = 731), all in English and Spanish. Results revealed that HRN's audiences have diverse perceptions of what constitutes resilience. However, common factors were identified across populations to support resilience amid the COVID-19 pandemic, including informal and formal social support and access to services to meet basic needs, including food and housing resources. Stress, anxiety, depression, and experience with stigma and discrimination were also linked to resilience. Understanding the perspectives and experiences of disproportionately affected populations is vital to identifying supports and services, including the engagement of community stakeholders. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Responding to an emerging health threat often requires rapid deployment of behavior change communication. Health communication best practices include developing and testing draft messages and materials to ensure that they resonate with and inspire priority groups to act. However, when faced with an emergency health threat, the timeline for these activities can be compressed from months to weeks. This article discusses the rapid development and implementation of a Zika virus prevention campaign for pregnant women in Puerto Rico. The goal of the campaign was to increase knowledge among and motivate pregnant women, their partners and family members, and the community to follow Zika virus prevention recommendations. The steps in campaign development include environmental scanning, concept development and testing, and message testing to ensure development of campaign materials that resonated with and were well- received by key audience groups. The materials adhere to principles of behavior change communication, and offer our insights for development of future campaigns when under time constraints.

This article discusses the social marketing planning process and strategies used to design a preconception health campaign, Show Your Love, launched in February 2013. Developing a social marketing strategy for preconception health is a challenging endeavor, in part because preconception health represents a set of diverse behaviors and the audience for the campaign is quite large, encompassing all women of childbearing age whether they intend to become pregnant or not. The network of organizations implementing the campaign, the National Preconception Health Consumer Workgroup, required a broad audience segmentation strategy; therefore, two large audiences were selected. This commentary describes the two primary audiences selected for the campaign based on the Transtheoretical Model—intenders (those in contemplation, preparation, and action) and nonintenders (precontemplators)—and explores how levels of knowledge, motivations, the campaign product, and the campaign goals are distinct for each audience. Additionally, the authors describe potential extensions to the segmentation strategy that could offer finer grained approaches for social marketers who may be building on the Show Your Love campaign or designing other programs in this area.

To inform the development of a preconception health (PCH) social marketing plan, we conducted qualitative research with prospective consumers.We present formative findings based on the four Ps of social marketing: product, price, promotion, and place.We conducted focus groups with 10 groups of women in Atlanta, Georgia, in fall 2010.We classified women aged 18 to 44 into five groups based on their pregnancy plans, and then further segmented the groups based on socioeconomic status for a total of 10 groups.The focus group guide was designed to elicit participants' responses about the product, price, promotion, and placement of PCH. We used NVivo 9 software to analyze focus group data.Women planning a pregnancy in the future had different perspectives on PCH as a product than women not planning a pregnancy. Barriers to PCH included lack of social support, addiction, and lack of awareness about PCH. Participants preferred to think of PCH behaviors as "promoting" a healthy baby rather than preventing an unhealthy birth outcome. Many women in the focus groups preferred to hear PCH messages from a health care provider, among other channels.The results from this research will inform the development of a social marketing plan for PCH and the development of concepts that will be tested with consumers to determine their viability for use in a national campaign.

To understand couples' notions of preconception health (PCH) and to inform the development of social marketing plans focused on PCH. APPROACH/DESIGN: We used a social marketing perspective to understand how couples considered PCH as a product, its potential price, how it should be promoted, and in what type of places it should be promoted. These variables are typically referred to as the four social marketing P's.Telephone interviews with couples recruited from a national database.A total of 58 couples (116 individuals) were segmented by five couple segments based on pregnancy planning intention and current parental status in which the wife or partner was 18 to 44 years of age. The five segments were combined into three categories: couples who were planning pregnancies, couples who were not planning pregnancies, or couples who were recent parents (interconception).Couple-based structured interviews lasting approximately 45 to 60 minutes were conducted via telephone. Questions inquired about couples' experience with PCH and the four social marketing P's.Commonalities existed across the four social marketing P's for the different couple segments. Notable couple-related themes that emerged included the importance of couple communication, support, and relationship quality. PCH was more relevant for couples planning a pregnancy, but nonplanning couples understood the benefits of PCH and related behaviors.Couples may be an important target audience when considering social marketing approaches for PCH. Many couples perceived the relevance of the issue to important aspects of their lives, such as health, family, and their relationships.

Objectives: During a public health emergency, public health officials issue directives with actions people need to take to protect themselves. Past research has shown that adherence to these directives depends on individual beliefs and circumstances. This report presents new research about the effects of community factors on adherence.Methods: A random digit-dial survey of 936 residents in the St Louis, Missouri, area was conducted in 2008 to assess barriers to and facilitators of adherence to directives issued in response to a hypothetical scenario involving the intentional release of the bacterium that causes plague. Community factors were assessed using characteristics of census tracts for individual respondents. Multilevel modeling was used to understand how individual and community factors contributed to the likelihood of adherence.Results: The majority of participants indicated that they would adhere to 3 distinct directives. Community poverty and ethnic homogeneity as well as individual-level barriers were negatively associated with adherence to a 6-day quarantine. Having children younger than 18 years and being away from home when the directive was called were negatively associated with adherence to a 10-hour quarantine. Logistical concerns were negatively associated with visiting a point of dispensing for prophylactic antibiotics.Conclusions: Our findings establish an empirical basis for the influence of community factors on adherence to public health directives. The influence of community and individual factors on adherence varies across directives. Consequently, communication strategies to disseminate directives and organizational strategies to support them must vary according to the nature of the directives.(Disaster Med Public Health Preparedness. 2012;6:253–262)

The objective of this study was to explore pregnant and recently pregnant women's perceptions of influenza vaccine and antivirals during the 2009 H1N1 pandemic. We conducted 18 focus groups with pregnant and recently pregnant women in three US cities in September 2009. Participants were segmented into groups by insurance status (no or public insurance vs. private insurance), vaccine attitudes (higher vs. lower likelihood of acceptance of any vaccines, not only influenza vaccines), and parity (first child vs. other children in the home) based on information they provided on the screening questionnaire at the time of recruitment. We found that women are not well informed about influenza vaccinations and antiviral medicine and have significant concerns about taking them during pregnancy. An interest in their infant's well-being, however, can be strong motivation to adopt preventive recommendations, including vaccination. A woman's health care provider is a highly trusted source of information about the 2009 H1N1. Pregnant women have unique communication needs for influenza. Messages directing pregnant women to adopt public health recommendations, particularly for vaccination or prophylactic medication should include a detailed description of the benefits or lack of risk to the fetus and the safety of breastfeeding. Additionally, messages should recognize that pregnant women are taught to be selective about taking medication and provide a clear rationale for why the medicine or vaccine is necessary.

Pregnant women and their newborn infants are at increased risk for influenza-associated complications, based on data from seasonal influenza and influenza pandemics. The Centers for Disease Control and Prevention (CDC) developed public health recommendations for these populations in response to the 2009 H1N1 pandemic. A review of these recommendations and information that was collected during the pandemic is needed to prepare for future influenza seasons and pandemics. The CDC convened a meeting entitled "Pandemic Influenza Revisited: Special Considerations for Pregnant Women and Newborns" on August 12-13, 2010, to gain input from experts and key partners on 4 main topics: antiviral prophylaxis and therapy, vaccine use, intrapartum/newborn (including infection control) issues, and nonpharmaceutical interventions and health care planning. Challenges to communicating recommendations regarding influenza to pregnant women and their health care providers were also discussed. After careful consideration of the available information and individual expert input, the CDC updated its recommendations for these populations for future influenza seasons and pandemics.

To better understand the knowledge, attitudes, and behaviors of providers regarding influenza infection and vaccination in pregnancy, fourteen focus groups were conducted among 92 providers in Atlanta, GA; Dallas, TX; and Portland, OR in late 2009. NVivo 8.0 was used for analysis. Most providers had no experience with pregnant women severely affected by influenza. Many perceived the 2009 H1N1 pandemic to be limited and mild. Providers knew that pregnant women should receive the 2009 H1N1 vaccine and reported plans to vaccinate more patients than the previous season. Most knew CDC guidelines for antiviral treatment and prophylaxis, but some reported hesitancy with presumptive treatment. Although awareness of influenza's potential to cause severe illness in pregnant women was observed, providers' experience and comfort with influenza prevention and treatment was suboptimal. Sustained efforts to educate prenatal care providers about influenza in pregnancy through trusted channels are critical.

Objectives. We sought to better understand the challenges of communicating with the public about emerging health threats, particularly threats involving toxic chemicals, biological agents, and radioactive materials.Methods. At the request of the Centers for Disease Control and Prevention, we formed an interdisciplinary consortium of investigative teams from 4 schools of public health. Over 2 years, the investigative teams conducted 79 focus group interviews with 884 participants and individual cognitive response interviews with 129 respondents, for a total sample of 1013 individuals. The investigative teams systematically compared their results with other published research in public health, risk communication, and emergency preparedness.Results. We found limited public understanding of emerging biological, chemical, and radioactive materials threats and of the differences between them; demand for concrete, accurate, and consistent information about actions needed for protection of self and family; active information seeking from media, local authorities, and selected national sources; and areas in which current emergency messaging can be improved.Conclusions. The public will respond to a threat situation by seeking protective information and taking self-protective action, underlining the critical role of effective communication in public health emergencies.

Results from a national survey indicated that most persons would follow public health officials’ guidelines., We report the results of a national survey conducted to help public health officials understand the public’s response to community mitigation interventions for a severe outbreak of pandemic influenza. Survey results suggest that if community mitigation measures are instituted, most respondents would comply with recommendations but would be challenged to do so if their income or job were severely compromised. The results also indicate that community mitigation measures could cause problems for persons with lower incomes and for racial and ethnic minorities. Twenty-four percent of respondents said that they would not have anyone available to take care of them if they became sick with pandemic influenza. Given these results, planning and public engagement will be needed to encourage the public to be prepared.

The development and publication of this supplement of the American Journal of Health Promotion have provided an opportunity to connect with new partners in the field of preconception health education, assess the current state of the science on this topic, and note gaps in research that we hope readers will consider filling. As guest editors, we appreciate our colleagues who submitted articles for consideration, the guest reviewers for their time and willingness to serve, and the journal staff for their flexibility and support throughout the process. This supplement serves as a platform to elevate contributions made in the context of preconception health promotion since 2006 as well as to issue a call to action to expand the work being done in this important arena. Six years ago, in partnership with over 35 national organizations and hundreds of partners, a select panel of experts on preconception health issued a series of 4 goals, 10 recommendations, and over 40 action steps focused on improving the health and well-being of women and men of childbearing age. The recommendations addressed a number of domains, including consumer education, clinical care, advocacy and policy, research, and public health and community interventions. A complete list of the recommendations and action steps is included in the online version of this article (http://www.cdc.gov/mmwR/preview/ mmwrhtml/rr5506a1.htm). Four national workgroups were created to move this agenda forward based on these different domains. To catalyze action in the context of consumer education and health promotion, the National Preconception Health Consumer Workgroup was formed. A main charge of the consumer workgroup continues to be to improve the knowledge, attitudes, and behaviors of men and women related to preconception health by using information that is relevant across various age groups, literacy levels, and cultural and ethnic groups. This journal issue on preconception health focuses mainly on women’s preconception health and is one example of the consumer workgroup’s efforts. In the context of women, preconception health refers to the health of a woman of childbearing age prior to or between pregnancies. The purpose of preconception care is to identify and modify biomedical, behavioral, and social risks to a woman’s health in order to maximize her health as well as that of any babies she may have in the future. Increasing awareness, knowledge, and engagement in preconception health practices among women and their partners are important objectives. Data suggest that pregnancy intentions can improve birth outcomes. Given the high infant mortality rates in the United States, particularly as compared to 28 other countries with better birth outcomes, this work is essential. Preconception health is unique as it is comprised of numerous components, including lifestyle (i.e., healthy weight, physical activity, smoking, drinking, substance use), screenings and vaccination (i.e., sexually transmitted infections, human immunodeficiency virus, rubella), and chronic disease management (i.e., diabetes, hypertension), along with family planning and exposure to teratogens, to name a few. Mass communication and clinician intervention about preconception health are challenging because of the volume of health topics within this issue and in light of the fact that half of all pregnancies are unplanned. Ultimately, a key task of the preconception health movement is to change social norms about the importance of the health of women and men and the impact it can have on their future reproductive goals. Formative research, education campaigns, and interventions on single health topics among women of childbearing age are well documented in the literature. However, less is known about how to effectively bundle and deliver a preconception health ‘‘package’’ to consumers in a way that resonates with them and motivates them to take action. One goal of this supplement is to inform this dialogue. In soliciting the content for this issue, we were particularly interested in preconception health audience research, advances in message development and dissemination strategies, and innovations in public and private partnerships, as well as insight into improving the preconception health of at-risk populations. A critical step in the process of developing and disseminating health promotion messages is to conduct audience Elizabeth W. Mitchell, PhD, is with the National Center on Birth Defects and Developmental Disabilities, Division of Birth Defects and Developmental Disabilities, Prevention Research Branch, National, Atlanta, Georgia. Sarah Verbiest, DrPH, MSW, MPH, is with the Center for Maternal and Infant Health, University of North Carolina at Chapel Hill.

We sought to examine motivators and barriers related to monovalent 2009 influenza A (H1N1) vaccination among pregnant women. We conducted a national poll of pregnant women using a random online sample (237) and opt-in supplement (277). In all, 42% of pregnant women reported getting the vaccine. Vaccination was positively associated with attitudinal factors including believing the vaccine is very safe or benefits the baby, and with provider recommendations. Women in racial/ethnic minority groups, women with less education, and women

It is important to educate both men and women about preconception health (PCH), but limited research exists in this area. This paper examines men’s and women’s awareness of exposure to PCH information and of specific PCH behaviors, PCH planning, and PCH discussions with their partners. Data from Porter Novelli’s 2007 Healthstyles survey were used. Women and men of reproductive age were included in the analysis (n = 2,736) to understand their awareness, planning, and conversations around PCH. Only 27.9% of women and men reported consistently using an effective birth control method. The majority of men (52%) and women (43%) were unaware of any exposure to PCH messages; few received information from their health care provider. Women were more aware than men of specific pre-pregnancy health behaviors. Women in the sample reported having more PCH conversations with their partners than did men. PCH education should focus on both women and men. Communication about PCH is lacking, both between couples and among men and women and their health care providers. PCH education might benefit from brand development so that consumers know what to ask for and providers know what to deliver.

Objectives. The purpose of this article is to look at how prepared people in communities outside the main areas devastated by Hurricanes Katrina and Rita thought they were for those storms and for major hurricanes in the near future, what factors were related to why people did not evacuate, and what concerns people had in communities that took in evacuees from the hurricanes. Methods. Telephone interviews were conducted with randomly selected adults in Baton Rouge, Houston, Dallas, and Mississippi/Alabama (excluding the immediate Gulf Coast) to assess respondents' knowledge, attitudes, and behaviors about hurricane preparedness and response to Hurricanes Katrina and Rita. Results. The surveys found a sizeable proportion of respondents who might not, for a number of reasons, comply with future orders to evacuate. A substantial proportion reported that they were not prepared for another major hurricane and indicated a desire for more information about how to prepare for future hurricanes. In communities that reported taking in large numbers of evacuees, residents expressed concern about the impact of the evacuees on their community. Conclusion. Evacuating communities involves a number of concrete problems that were not adequately addressed in the cases of Hurricanes Katrina and Rita. Responses to these surveys indicate a need for more comprehensive hurricane disaster planning.

A meta-analysis was performed of studies of mediated health campaigns in the United States in order to examine the effects of the campaigns on behavior change. Mediated health campaigns have small measurable effects in the short-term. Campaign effect sizes varied by the type of behavior: r=.15 for seat belt use, r=.13 for oral health, r=.09 for alcohol use reduction, r=.05 for heart disease prevention, r=.05 for smoking, r=.04 for mammography and cervical cancer screening, and r=.04 for sexual behaviors. Campaigns with an enforcement component were more effective than those without. To predict campaign effect sizes for topics other than those listed above, researchers can take into account whether the behavior in a cessation campaign was addictive, and whether the campaign promoted the commencement of a new behavior, versus cessation of an old behavior, or prevention of a new undesirable behavior. Given the small campaign effect sizes, campaign planners should set modest goals for future campaigns. The results can also be useful to evaluators as a benchmark for campaign effects and to help estimate necessary sample size.