News Release

Evidence shows that, overall, mass media campaigns have beneficial effects on health

Peer-Reviewed Publication

The Lancet_DELETED

Many areas of health have been targeted by mass media campaigns, and a Review published Online First (www.thelancet.com) an in this week's Lancet shows that overall, these campaigns have had a beneficial effect—although not in every scenario. The Review is written by Dr Melanie Wakefield, Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia, and colleagues. A linked Lancet Editorial says the clear messages for governments are that they should restrict young people's exposure to unhealthy behaviours in media channels, while using those same channels to promote healthy behaviours.

The authors say: "The great promise of mass media campaigns lies in their ability to disseminate well defined behaviourally focused messages to large audiences repeatedly, over time, in an incidental manner, and at a low cost per head.

As we discuss in this Review, however, that promise has been inconsistently realised: campaign messages can fall short and even backfire."

Both direct and indirect effects of mass media campaigns are explored in the paper. For example, a person watching an antismoking campaign on television could be directly affected, but they could also indirectly affect others by telling them about the campaign.

The authors found the following in relation to various spheres in health:

Smoking: Comprehensive reviews of controlled field experiments and population studies show that mass media campaigns were associated with a decline in young people starting smoking and with an increase in the number of adults stopping. Smoking prevention in young people seems to have been more likely when mass media efforts were combined with programmes in schools, the community, or both. Many population studies have documented reductions in adult smoking prevalence when mass media campaigns have been combined with other tobacco control strategies, such as increases in tobacco taxation or smoke-free policies. However, antismoking campaigns by tobacco companies themselves (first in the 1990s) have increased the risk of current or future smoking among youth. One theory for this is these types of campaigns present tobacco as forbidden fruit, making tobacco seem more attractive and promoting use.

Alcohol: Antialcohol campaigns (apart from drink-driving) have not been successful, and the authors say this could be due to widespread alcohol marketing and the view of drinking as a social norm. Safe drinking campaigns sponsored by alcohol companies have also been unsuccessful, because the messages are viewed as ambiguous by the target audience.

Illicit drugs: Inconsistent findings. Most peer-reviewed evidence is from the USA, which had mixed results, with some campaigns reducing marijuana use but one national campaign actually increasing it.

Nutrition/activity/heart disease: In the USA in the 1970s and 80s, these programmes improved behaviours, eg, changing diet and increasing physical activity. While there was only a small decrease in the overall risk of cardiovascular disease, similar in size to those not exposed to the campaign, researchers successfully argued that these campaigns worked in tandem with national campaigns such as the US National Cholesterol education program to contribute to risk reduction across the board. Diet related campaigns to boost low-fat milk and fruit and vegetable consumption have generally improved healthy food selection; and efforts to increase physical activity through media campaigns have been successful, with the authors pointing out the over 50s and children as positive examples. But the authors note that once campaigns are over, effects are difficult to sustain.

HIV: Media campaigns have yielded beneficial results for example in Europe, people engaging in casual sex increased their condom use, although they did not reduce their number of sexual partners.

Birth control: Young African women increased condom use from 5% to 18% to protect against pregnancy, in the presence of HIV condom-promoting media campaigns.

Cancer screening and prevention: Combining media campaigns with reminder letters for women to encourage them to go for pap smears to screen for cervical cancer, and to go for mammograms to detect breast cancer, has been successful provided the screening services are present and easily accessible. Without the services present, mass media campaigns to screen for cervical cancer have had little or no effect. The Australian state of Victoria's 15-year-old sunsmart campaign, to protect against skin cancer, has shown substantial improvements in its populations' sun protection attitudes and rates of sunburn.

Child survival: Mixed results. In Bangladesh, immunisations increased after a mass media campaign. In countries (mainly high-income) where sudden infant death syndrome is monitored (eg. Australia, UK, US, Norway, Sweden), media campaigns recommending children sleep on their backs have seen, in some areas, a reduction of 50% in deaths of this type.

Road safety: Media campaigns to boost seat-belt use have been a great success and have seen increased use and reduced highway deaths and injuries.

The authors say that campaigns that involve one off or episodic behaviour (eg, screening, vaccination, not using aspirin to treat children) are more successful than ongoing behaviour (food choices, physical activity). They acknowledge the counteracting effects of powerful advertising campaigns (eg for alcohol and unhealthy food) and social norms. The increasingly fractured nature of the media also makes it more difficult to hit large populations with such campaigns. They conclude: "isolation of the independent effects of mass media campaigns is difficult. Substantial evidence has, however, been garnered from study designs that, in isolation, are less than classically excellent, but in aggregate yield a substantial body of support for the conclusion that mass media campaigns can change population health behaviours.

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

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Dr Melanie Wakefield, Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia. T) +61 409 569 210 (mobile) E) melanie.wakefield@cancervic.org.au

Lancet Press Office T) +44 (0) 20 7424 4949 E) tony.kirby@lancet.com

For full Review and Editorial see: http://press.thelancet.com/media.pdf

NOTE: THE ABOVE LINK IS FOR JOURNALISTS ONLY; IF YOU WISH TO PROVIDE A LINK TO THE FREE ABSTRACT OF THIS PAPER FOR YOUR READERS, PLEASE USE THE FOLLOWING, WHICH WILL GO LIVE AT THE TIME THE EMBARGO LIFTS: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60809-4/abstract


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