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The opioid overdose epidemic continues to devastate lives across the United States and has worsened during the COVID-19 pandemic. In this paper, we review 166 online-accessible opioid-related campaigns to understand the current state of the science and practice of campaigns to address the opioid crisis. The findings suggest that health promotion practitioners can have a greater impact on reducing overdose deaths if they move beyond awareness-raising messaging about opioid misuse and place a greater emphasis on driving demand for evidence-based treatments such as medications for opioid use disorder and on reducing stigma related to treatment and recovery.

Highlights • We describe communication campaigns in an intervention to reduce opioid deaths. • The community-engaged model includes three phases. • Five campaigns will focus on naloxone, MOUD, and stigma reduction. • Community surveys and fidelity measures gauge process and impact. • Our model could help communities address other public health issues., Background The HEALing Communities Study (HCS) is testing whether the Communities that Heal (CTH) intervention can decrease opioid overdose deaths through the implementation of evidence-based practices (EBPs) in highly impacted communities. One of the CTH intervention components is a series of communications campaigns to promote the implementation of EBPs, increase demand for naloxone and medications for opioid use disorder (MOUD), and decrease stigma toward people with opioid use disorder and the use of EBPs, especially MOUD. This paper describes the approach to developing and executing these campaigns. Methods The HCS communication campaigns are developed and implemented through a collaboration between communication experts, research site staff, and community coalitions using a three-stage process. The Prepare phase identifies priority groups to receive campaign messages, develops content for those messages, and identifies a “call to action” that asks people to engage in a specific behavior. In the Plan phase, campaign resources are produced, and community coalitions develop plans to distribute campaign materials. During the Implement stage, these distribution plans guide delivery of content to priority groups. Fidelity measures assess how community coalitions follow their distribution plan as well as barriers and facilitators to implementation. An evaluation of the communication campaigns is planned. Conclusions If successful, the Prepare-Plan-Implement process, and the campaign materials, could be adapted and used by other communities to address the opioid crisis. The campaign evaluation will extend the evidence base for how communication campaigns can be developed and implemented through a community-engaged process to effectively address public health crises.

Highlights • HEALing Communities Study is a parallel-group cluster randomized controlled trial. • Communities That HEAL intervention’s goal is to reduce opioid overdose deaths. • Structured consensus decision-making strategy guided study measure development. • More than 80 study measure specifications and a common data model were developed. • The study will provide methodology and longitudinal community data for research., Background Opioid overdose deaths remain high in the U.S. Despite having effective interventions to prevent overdose deaths, there are numerous barriers that impede their adoption. The primary aim of the HEALing Communities Study (HCS) is to determine the impact of an intervention consisting of community-engaged, data-driven selection, and implementation of an integrated set of evidence-based practices (EBPs) on reducing opioid overdose deaths. Methods The HCS is a four year multi-site, parallel-group, cluster randomized wait-list controlled trial. Communities (n = 67) in Kentucky, Massachusetts, New York and Ohio are randomized to active intervention (Wave 1), which starts the intervention in Year 1 or the wait-list control (Wave 2), which starts the intervention in Year 3. The HCS will test a conceptually driven framework to assist communities in selecting and adopting EBPs with three components: 1) A community engagement strategy with local coalitions to guide and implement the intervention; 2) A compendium of EBPs coupled with technical assistance; and 3) A series of communication campaigns to increase awareness and demand for EBPs and reduce stigma. An implementation science framework guides the intervention and allows for examination of the multilevel contexts that promote or impede adoption and expansion of EBPs. The primary outcome, number of opioid overdose deaths, will be compared between Wave 1 and Wave 2 communities during Year 2 of the intervention for Wave 1. Numerous secondary outcomes will be examined. Discussion The HCS is the largest community-based implementation study in the field of addiction with an ambitious goal of significantly reducing fatal opioid overdoses.

Purpose The aim of this paper is to enhance the effectiveness of pharmacovigilance programs that provide information about medical products to benefit consumers, aid health care professional’s decision-making and improve community health. This research sought to determine whether distinct segments of consumers can be identified for prescription drug safety social marketing and communication activities and if these segments would respond differently to information about prescription drug products. Design/methodology/approach Theories of risk information-seeking behavior were used to develop questions for respondents in an online survey panel. Latent class analyses identified clusters that were similar in their ability to accurately interpret risks and benefits, preferred sources of health information, medication use and other related factors. Multinomial logistic regression models identified demographic and psychographic differences across the segments. Logistic and linear regression models were then used to compare each segment’s responses to a specific drug safety information product. Findings The 1,244 respondents were clustered into four segments: not engaged (12 per cent), low-involvement users (29 per cent), careful users (50 per cent) and social information seekers (9 per cent). These segments were distinguished by perceived seeking control, self-appraisal of skill, information insufficiency, self-efficacy, information competency and health literacy. Sources of health information and health-seeking behaviors were also different across the four segments. Significant differences were found among the segments in their comprehension and perceived utility of the content and their intentions to take relevant actions. Practical implications From an array of potential behavioral influences, adults can be segmented by risk information-seeking constructs and related behaviors. These segments respond differently to drug safety information. Use of the personas developed in this work can help pharmacovigilance programs around the world develop more relevant and tailored social marketing products, services and content. Originality/value A social marketing approach using empirically tested theoretical constructs can be useful for drug safety or pharmacovigilance programs. The results were used to create personas that quickly convey relevant information to drug safety program managers and staff.

Contemporary societies around the world face a number of what have been termed ‘wicked problems’ (Churchman, 1967; Rittel & Webber, 1973). These issues include but are not restricted to health ineq...

In Indonesia, where stroke is the leading cause of death, we designed and tested a brief intervention to increase physician-patient conversations about stroke prevention in community health centers. The pilot study used a quasi-experimental design involving repeated cross-sectional data collection over 15 weeks to compare pre- and during-intervention differences within four centers. We conducted exit interviews with 675 patients immediately following their medical appointments to assess whether physicians discussed stroke risks and provided recommendations to modify their risk behaviors. From pre-intervention to during intervention, patients reported more frequent physician recommendations to modify their stroke risk behaviors. We also conducted interviews with eight providers (physicians and nurses) after the intervention to get their feedback on its implementation. This study demonstrated that a brief intervention to motivate physician-patient conversations about stroke prevention may improve these conversations in community health centers. While interventions to reduce risk hold considerable promise for reducing stroke burden, barriers to physician-patient conversations identified through this study need to be addressed.

Many ideas about best practices for risk communication share common ground with social marketing theory and practice: for example, segmentation, formative research, and a focus on behavioral outcomes. Social marketing first developed as a methodology to increase the public health impact of programs and to increase the acceptability and practice of behaviors that improve personal and social well-being. The core concepts of this approach are to be people-centered and to aim for large-scale behavior change. An international consensus definition of social marketing describes it as an integration of theory, evidence, best practices, and insights from people to be served. This integrated approach is used to design programs that are tailored to priority groups’ needs, problems, and aspirations and are responsive to a competitive environment. Key outcomes for social marketing efforts are whether they are effective, efficient, equitable, and sustainable. The 4P social marketing mix of Products, Prices, Places, and Promotion offers both strategic and practical value for risk-communication theory and practice. The addition of products, for example, to communication efforts in risk reduction has been shown to result in significantly greater increases in protective behaviors. The Cover CUNY case demonstrates how full attention to, and consideration of, all elements of the marketing mix can be used to design a comprehensive risk-communication campaign focused on encouraging college student enrollment for health insurance. The second case, from the drug safety communication arena, shows how a systems-level, marketplace approach is used to develop strategies that focus on key areas where marketplace failures undermine optimal information-dissemination efforts and how they might be addressed.

Community-based prevention marketing (CBPM) is a community-driven framework for program planning, which applies social marketing concepts and techniques to the development of health behavior interventions. Whereas community members who comprise an action committee or coalition set the goals and make programmatic decisions, social marketing provides the planning framework to guide program design, implementation, and evaluation. CBPM has guided successful initiatives to promote physical activity in both youth and adults, to increase safety eyewear use in agricultural settings, and to delay alcohol and tobacco initiation among youth. However, the emergence of evidence-based policy has fostered renewed interest in “upstream” approaches to health behavior change that, in the United States, have included community partnerships as an important tool for policy development. Unfortunately, these community partnerships have had variable success because of the lack of a systematic framework for identifying, selecting, tailoring, and promoting evidence-based policies. We describe the adaptation and application of CBPM to improve community capacity for identifying and promoting evidence-based policies. The resulting framework, CBPM for Policy Development, is comprised of the following eight steps: (1) build a strong foundation for success; (2) review evidence-based policy options; (3) select a policy to promote; (4) identify priority audiences among beneficiaries, stakeholders, and policy makers; (5) conduct formative research with priority audiences; (6) develop a marketing plan for promoting the policy; (7) develop a plan for monitoring implementation and evaluating impact; and (8) advocate for policy change. We provide a description of each step and an examination of the experiences and lessons learned in applying it to youth obesity prevention.

Healthy People sets the decennial public health agenda for the United States (US). Healthy People 2020 includes objectives for social marketing education and training in schools of public health and for applying it in state health departments. In the present study, two online surveys were conducted to estimate the application of, as well as education and training opportunities available in, social marketing in the US. First, state health department professionals were surveyed online regarding application of eight social marketing benchmarks in their disease prevention and health promotion programs. Eight of 29 participating state health departments used social marketing. Second, an online survey was administered to associate deans of US schools of public health concerning education and professional development opportunities available for students and public health professionals, respectively. Forty percent (20/50) of associate deans participated. In the past academic year, four schools reported offering a social marketing course and six additional schools reported offering a combined health communication/social marketing course. Professional development opportunities in social marketing were even more limited. The present findings may serve as baseline measures for the national objectives to increase the use of social marketing in US disease prevention and health promotion. The paper concludes with discussion of the challenges for schools of public health and other enterprises in meeting the social marketing education and training needs of the public health workforce.

Creative use of new mobile and wearable health information and sensing technologies (mHealth) has the potential to reduce the cost of health care and improve well-being in numerous ways. These applications are being developed in a variety of domains, but rigorous research is needed to examine the potential, as well as the challenges, of utilizing mobile technologies to improve health outcomes. Currently, evidence is sparse for the efficacy of mHealth. Although these technologies may be appealing and seemingly innocuous, research is needed to assess when, where, and for whom mHealth devices, apps, and systems are efficacious. In order to outline an approach to evidence generation in the field of mHealth that would ensure research is conducted on a rigorous empirical and theoretic foundation, on August 16, 2011, researchers gathered for the mHealth Evidence Workshop at NIH. The current paper presents the results of the workshop. Although the discussions at the meeting were cross-cutting, the areas covered can be categorized broadly into three areas: (1) evaluating assessments; (2) evaluating interventions; and (3) reshaping evidence generation using mHealth. This paper brings these concepts together to describe current evaluation standards, discuss future possibilities, and set a grand goal for the emerging field of mHealth research.

This article documents the emergence of social media, and specifically social network sites (SNS) and their impact on health information–seeking and health-related behaviors. We review surveys of user behavior on SNS to document how health information is being transformed into a social health experience rather than an individual or clinical endeavor. We then turn to the research evidence for how SNS may influence health behaviors. Although there is a substantial literature that provides support for the role of social variables in the genesis and management of health and disease, there is little scientific grounding for how to leverage these variables to improve health in either online or offline milieus. We conclude with recommendations for practice to optimize the use of social media and its contribution to improved health outcomes, and pose a series of questions that may guide the development of a research agenda in this area. The technological innovations of blogs, podcasts, interactive media, and SNS have enabled many people to create, post, and share their own messages and content by using a variety of digital social communication tools and platforms. People and organizations can now quickly create and deliver content through more interactive Web sites and online communities where, for example, people with medical conditions can seek, give, and receive advice from other patients and healthcare providers.1,2 New communication technologies and the emergence of what has been dubbed Web 2.0 are providing the opportunity for health professionals and patients alike to engage with 1 another, their peers, friends, and families in ways unimaginable just a few years ago. The speed and scale of adoption of social media is changing the way we think about and communicate with people formerly known as audiences and the way doctors and patients interact,2,3 bringing about a …

Support of others is a key factor for mothers who choose to breastfeed their infants, including those who balance work outside the home and breastfeeding. However, little research has been done to understand how maternal support during the postpartum period impacts mothers' ability to later balance work and breastfeeding, in particular full-time work and exclusive breastfeeding. The results of this qualitative study indicate that the timing of support plays a key role in mothers' ability to successfully overcome barriers during the early postpartum period, thus building maternal self-efficacy in addressing problems encountered when they return to work.To understand the experience of low-income women who successfully balance full-time work and exclusive breastfeeding for the recommended 6 months, interviews were conducted with women who met study criteria for income level, work status, and exclusive breastfeeding. Breastfeeding peer counselors were also interviewed as key informants. Interviews were recorded, transcribed, and coded for themes. The results of both sets of interviews were triangulated with a focused literature review to assure the soundness of the qualitative analysis.Timing of support included acute support, such as help establishing a successful latch needed during the first 2 weeks after delivery, to deal with breastfeeding problems that mothers perceived as being mentally and emotionally overwhelming and longer-term support needed to overcome problems perceived as being less intense.The research invites further exploration into the relationship between breastfeeding support provided by mothers' support system, including healthcare professionals, during the postpartum period and rates of breastfeeding duration and exclusivity.

PurposeThe purpose of this paper is to explore the field of social marketing. The field needs to evaluate what works, and more importantly for it to prosper and remain relevant, it must discover and incorporate concepts and techniques from other disciplines that are aligned around core ideas of people‐centered and socially oriented.Design/methodology/approachThe paper reviews new insights and understandings from modern social marketing practice, social innovation, design thinking and service design, social media, transformative consumer research, marketing theory and advertising practice and develops a model for transforming social marketing thought, research and practice.FindingsA three dimensional model is presented that includes: scope – co‐creation, conversations, communities and markets; design – honoring people, radiating value, engaging service and enhancing experiences; value space – dignity, hope, love and trust.Originality/valueThe presentation weaves together a set of ideas from different disciplines that together strengthen the social marketing approach and provide a broader set of outcomes and perspectives that can be incorporated into work in this field.

A perennial problem in social marketing and public policy is the plight of at-risk consumers. The authors define at-risk consumers as marketplace participants who, because of historical or personal circumstances or disabilities, may be harmed by marketers’ practices or may be unable or unwilling to take full advantage of marketplace opportunities. This definition refers to either objective reality or perceptions. Early research focused on consumers who were at risk because they were poor, ethnic or racial minorities, immigrants, women, or elderly. Today's researchers also study consumers who are at risk because they are from religious minorities, disabled, illiterate, homeless, indigent, lesbian, gay, bisexual, or transgender. The authors identify four tensions affecting research on and policy and marketing applications for at-risk populations: the value of focusing on (1) vulnerabilities versus strengths, (2) radical versus marginal change, (3) targeting versus nontargeting, and (4) encouraging knowledgeable versus naive consumers. They conclude with a discussion of the significance of including at-risk consumers as full marketplace participants and identify future research directions.

PurposeSocial marketing has evolved differently in the developing and developed worlds, at times leading to different emphases on what social marketing thought and practice entail. This paper aims to document what those differences have been and provide an integrative framework to guide social marketers in working with significant social and health issues.Design/methodology/approachAn integration of views about social marketing is proposed that is focused on the core roles of audience benefits; analysis of behavioral determinants, context and consequences; the use of positioning, brand and personality in marketing strategy development; and use of the four elements of the marketing mix to tailor offerings, realign prices, increase access and opportunities; and communicate these in an evolving media environment.FindingsIdeas about branding and positioning, core strategic social marketing concerns, have been better understood and practiced in developing country settings. Social marketing in developing countries has focused much more on products and services, with a concomitant interest in pricing and distribution systems. In developed countries, social marketing has too often taken the 1P route of using persuasive communications for behavior change. The integrative framework calls for an expansion of social marketing to product and service development and delivery, using incentives and other behavioral economic concepts as part of the price element, and extending place as both an access and opportunity idea for behaviors, products and services.Practical implicationsThe framework pulls together social marketing ideas and practices from the diversity of settings in which they have been developed and allows practitioners and academics to use a common set of concepts to think about and design social marketing programs. The model also gives social marketers more latitude in how to use price and place in the design of programs. Finally, it also provides a platform for how we approach social change and public health in the years ahead through market‐based reform.Originality/valueFive challenges to social marketing are identified – achieving equity, influence of social networks on behaviors, critical marketing, sustainability, scalability and the need for comprehensive programs – that may serve to focus and coalesce social marketing research and practice around the world.

Partnership development for national social marketing campaigns is a much copied, but poorly researched, area of practice. As part of the development of Phase II of the Centers for Disease Control's National Bone Health Campaign, several needs-assessment and market analysis activities were conducted to develop partnership strategies that were responsive to the needs of both potential campaign priority audiences and those of possible partner organizations. We discuss how the findings present strategic options for partnership recruitment and some of the key marketing issues that need to be considered in crafting an effective partnership model at the local, state and national level.

Social media brings a new dimension to health care for patients, providers, and their support networks. Increasing evidence demonstrates that patients who are more actively involved in their healthcare experience have better health outcomes and incur lower costs. In the field of cardiology, social media are proposed as innovative tools for the education and update of clinicians, physicians, nurses, and medical students. This article reviews the use of social media by healthcare providers and patients and proposes a model of "networked care" that integrates the use of digital social networks and platforms by both patients and providers and offers recommendations for providers to optimize their use and understanding of social media for quality improvement.

As part of the national 5 A Day for Better Health program, a communication strategy based on a social marketing model was developed to guide the program's media campaign. Using this approach, the campaign focused on consumer wants and needs to help increase the prospects of influencing consumer behavior.The work discussed herein describes how consumer research was used to select and profile a target audience for the national 5 A Day media campaign. It shows how formative consumer research data from multiple sources were integrated to make practical strategic campaign decisions based on the target consumer's perspective.

Creative use of new mobile and wearable health information and sensing technologies (mHealth) has the potential to reduce the cost of health care and improve well-being in numerous ways. These applications are being developed in a variety of domains, but rigorous research is needed to examine the potential, as well as the challenges, of utilizing mobile technologies to improve health outcomes. Currently, evidence is sparse for the efficacy of mHealth. Although these technologies may be appealing and seemingly innocuous, research is needed to assess when, where, and for whom mHealth devices, apps, and systems are efficacious. In order to outline an approach to evidence generation in the field of mHealth that would ensure research is conducted on a rigorous empirical and theoretic foundation, on August 16, 2011, researchers gathered for the mHealth Evidence Workshop at NIH. The current paper presents the results of the workshop. Although the discussions at the meeting were cross-cutting, the areas covered can be categorized broadly into three areas: (1) evaluating assessments; (2) evaluating interventions; and (3) reshaping evidence generation using mHealth. This paper brings these concepts together to describe current evaluation standards, discuss future possibilities, and set a grand goal for the emerging field of mHealth research.

The National Cholesterol Education Program (NCEP) has identified a need to convey practical approaches for the management of high blood cholesterol (BC) to physicians. Our study was a joint effort between the Pawtucket Heart Health Program and the Brown University Department of Family Medicine to improve family medicine residents’ attitudes, knowledge, selfefficacy, and practices regarding cholesterol screening and management. Thirty-six resident physicians received a BC screening and management training program. This program included training in BC screening using the fingerstick method and a desktop analyzer, diet assessment and counseling, and a management protocol for evaluation and treatment of high BC based on NCEP guidelines. The training program also includedevaluation of residents’ BC screening activity, incentives, chart audits, and biweekly articles in the departmental newsletter. We administered a survey to residents before and one year after the training program began to assess self-reported knowledge, attitudes, self-efficacy, and practices for BC management. Survey results indicated that the residents significantly improved their reported knowledge and attitudes about BC management. In addition, they significantly increased their reported self-efficacy and practices in dietary counseling and patient education. Residents also indicated that the training program was worthwhile, necessary, and practical and that many would use the materials and protocols in their future practices.

Understanding the process of behavior change interventions is critical to achieving campaign effectiveness and successful program replication. The present article presents a community education monitoring system (CEMS) using data from the Stanford Five-City Project (FCP), the Minnesota Heart Health Program (MHHP) and the Pawtucket Heart Health Program (PHHP). CEMS records the number and type of intervention activities, outcome objectives, targets of change (individual, organizational or environmental), channel(s) of dissemination and proportion of programs funded by the community. These data illustrate (1) the application of theory for each project, (2) data-based program administration, (3) feedback for revising programs and (4) type of reach or 'dose' information obtained from intervention monitoring. Process evaluations such as CEMS provide critical links between field realities and evaluation outcomes. This type of evaluation develops standards for measuring program reach and allows comparisons with other programs. CEMS also illustrates how programs enact theory. Validation studies are critical to the continued successful use of CEMS. The first step, however, is to develop a uniform way of describing complex multichannel behavior change programs. CEMS in a refined form should prove invaluable to health promotion program planners whether in research or service settings.

For those who still question the value of new media in public health campaigns, the election of Barack Obama as the 44th president of the United States can be instructive. Obama's campaign strategy...

The Pawtucket Heart Health Program (PHHP), in its attempt to treat obesity in the community, has delivered many traditional group and self-help weight loss programs. However, in order to reach a sufficient number of people to produce a public health impact in Pawtucket, PHHP devised a monthly city-wide "weigh-in." This program, designed to be delivered by volunteers, allowed individuals to set a weight loss goal and pledge a monetary incentive toward this goal. Self-help materials and the opportunity to join weight loss groups were provided. In the pilot study, 129 (61%) of 213 enrollees completed the 10-week program with a mean weight loss of 8.2 lb (p less than .001). A large decrease in total serum cholesterol was also observed. Nonpersonnel costs, including the total costs of the cholesterol measurement, were $1.30 per pound lost. Moreover, success is also evident by continued availability of the program and the increasing number of new participants "referred" to the weigh-in by members.

Health promoters wishing to successfully replicate community-based heart health interventions from major research and demonstration programs, face numerous obstacles in the adoption process. Unfortunately, there is little specific literature to guide them through the process. A case study is presented to demonstrate that by closely examining differences between the resources and user settings in terms of geography, socio-demography, policy, organizational structure and perceived goals, health promoters can identify and avoid failure points. We examine the transfer and adaption of a cholesterol intervention from Pawtucket Heart Health Program in urban USA to a rural setting in Australia and we recommend a series of five logical steps when considering such adoptions. Process data from the adapted intervention, North Coast Cholesterol Check campaign, indicates that it is as successful as its counterpart in the USA. The new intervention has itself become a model program in Australia. This success can be largely attributed to the considerable planning effort which made it possible to modify the organizational structure to accept an innovative strategy and also to tailor the resource program for an ideal fit to the new user setting.

Adherence to referral recommendations given to participants at blood cholesterol screening programs is a critical aspect of these efforts to help detect and control high blood cholesterol in the US adult population. In this study, 386 participants who had received two consecutive blood cholesterol measurements above 240 mg/dl (6.21 mmol/l) were interviewed by telephone 3 months after their second measurement (May 1987 - May 1988). Approximately 40% of respondents had seen a physician by the time of the interview; another 30% reported having scheduled an appointment. There was no significant difference in adherence behavior between participants who received a letter reiterating the referral and those who did not. However, participants who received the letter reported greater physician attention to the evaluation and treatment of their high blood cholesterol, primarily because these participants stated that they visited their physician for their high blood cholesterol. Significantly higher rates of further blood tests, cholesterol education material distribution, cholesterol-lowering medication prescription and patient-physician discussions about cholesterol were the result. These findings suggest that consumers can be effective in stimulating and reinforcing physician practice behaviors related to cholesterol control. However, strategies must be crafted so that consumers are aware of, and appreciate, the necessity of seeking physician care when they become aware of a high blood cholesterol level.

Action by individuals to acquire information about their health has been an element incorporated throughout theory, research, and programs related to health promotion. This report describes an attempt to determine if an information-seeking dimension could be empirically identified in a general community-resident sample, and if so, to examine some of its characteristics. A total of 281 adults aged 18-75 were contacted by telephone using random digit dialing and were interviewed about a variety of personal health practices. Factor analysis identified a five-item cluster representing a tendency to seek out information about health. Women were more likely than men to report seeking information. In addition, more frequent information-seeking was associated with favorable responses to several other health-related practices. Formal health service use was the only type of health practice not associated with information-seeking, perhaps because regularity of contact is influenced strongly by health professionals (e.g., reminder cards and having staff call to schedule annual exams). Overall, results of the investigation support the importance of information-seeking as a component of a personal health practice repertoire. Additional attention might be directed toward elaborating its role as a "process" variable in health education programs and social marketing efforts, particularly in areas such as response to recruitment messages, dropout vs. maintenance, and differential gains on outcome measures of program effectiveness.