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Public Service Announcements and Exposure to Health and Risk Messages

Summary and Keywords

Public service announcements (PSAs) emerged after World War II in the United States as a promising strategy for increasing awareness of important social issues and changing beliefs, attitudes, and behavior. Research at that time showed that PSA campaigns had limited success in changing attitudes and behavior. Even so, both in the U.S. and internationally, sponsoring agencies and organizations continued to produce PSAs, hoping they would create significant behavior change.

In the 1980s, a more informed view of what PSAs can achieve began to emerge as practitioners of social marketing demonstrated that media campaigns can produce behavior change when they are designed and executed according to the principles and best practices followed by the advertising industry. Beginning in the 1990s, PSA-based campaigns to promote public action through programs and policy change became more common. Research has shown that such campaigns can play a key role in shaping the public agenda, changing perceptions of social norms, reinforcing school- and community-based programs, and building support for and then publicizing changes in public policy, all of which can foster individual behavior change.

PSAs and other media executions are best designed using a planning scheme that is grounded in advertising best practices and behavior change theory and that uses those media executions as part of a broader intervention effort. These various elements can be brought together by using a media planning guide that outlines how the campaign will work in sync with other intervention activities and what its key messages will be.

In the United States, federal regulations that outlined broadcasters’ public service obligations were loosened in the 1980s, making it increasingly difficult to get donated time for PSAs and other public service messages. More broadly, the increased focus of broadcasters, cable networks, and print publications on generating revenue has magnified this problem. Faced with strong competition, campaign planners need a strategy for convincing media gatekeepers to give priority to their messaging.

The rise of social media (e.g., Facebook, Instagram, Twitter) has opened up a new means of putting PSAs before the public. For example, once a message is posted on a video-sharing website such as YouTube, it can be linked to the sponsoring organization’s website, where additional intervention-related material can be found, as well as to websites hosted by other groups. Promotional efforts through national, state, and community organizations can draw an initial audience, with the hope that they will share the link with their social media and email contacts and that eventually the message will “go viral.”

PSAs remain a viable media alternative for public communication campaigns, despite the fact that major media outlets do not often provide donated time or space for such advertising. In some cases, a PSA-driven campaign will be supported by a large budget, but while such campaigns have a better chance of success, the resources required are seldom available. The emergence of social media has created a new way to build an audience. Successful examples of social media campaigns are emerging, but why some campaigns take off and others do not requires additional study.

Keywords: behavior change theory, diffusion of innovations theory, intervention planning, media planning guide, public communication campaigns, public service announcements, social marketing, social media, stages of change model

Public service announcements (PSAs)—television, radio, and print advertising messages that promote social causes and are usually disseminated without charge—have been a staple of mass communication campaigns in the United States since after World War II. Radio and other mass media had been used to sell war bonds (Cartwright, 1949). Then, following the war, the success of consumer-oriented marketing, plus the spread of television in American homes, stimulated the development of ambitious PSA-based communication campaigns to promote a range of social causes (Paisley & Atkin, 2012).

Research during the postwar period showed that PSA campaigns, no matter how clever or dramatic the messaging might be, had limited success in changing attitudes and behavior (Griffiths & Knutson, 1960). It appeared that PSAs could reinforce existing attitudes and beliefs (Alcalay, 1983), but that little else could be accomplished since audiences more often pay attention to and remember information that supports their existing opinions, and they employ psychological defenses to fend off unwelcome messages (Bauer, 1964). Even so, both in the United States and internationally, sponsoring agencies and organizations continued to produce PSAs, hoping they would create significant behavior change.

By the 1980s, a more informed view of what PSA campaigns can achieve began to emerge. Practitioners of social marketing—the application of commercial advertising methods to promote social causes—demonstrated that media campaigns, including those based on PSA messaging, can play a meaningful role in changing attitudes and behavior when they are designed and executed according to principles and best practices followed by the advertising industry (DeJong & Winsten, 1990; Siegel & Lotenberg, 2007).

Beginning in the 1990s, PSA-based campaigns to promote public action through programs and policy change became more common (Abroms & Maibach, 2008). The intellectual drive for these campaigns came from the unique perspective offered by the field of public health, which historically has focused on identifying and controlling environmental factors in disease prevention. Research shows that these campaigns can play a key role in shaping the public agenda (Dearing & Rogers, 1996), changing perceptions of social norms (DeJong & Smith, 2012), reinforcing school- and community-based programs (Flay, 1986), and building support for and publicizing changes in public policy (Wallack & Dorfman, 1996), all of which can foster individual behavior change.

This overview of public service advertising first examines what television, radio, and print PSAs can potentially accomplish, taking into account the inherent limitations of these mediums and the strategic advantages of using PSAs, not in isolation, but as part of a broader intervention. The next section outlines a strategic planning process for developing effective PSA messages, which culminates in a media planning guide that specifies the key messages and outlines how the PSA campaign will work in sync with other intervention activities. This planning process is illustrated by a U.S. government-sponsored PSA campaign designed to address the problem of underage alcohol use. The final section considers the challenges related to disseminating PSAs and describes how the availability of social media has opened up new ways to put PSAs and other media messages before their intended audience.

Developing Effective PSA Messages

PSA campaigns that fail to change behavior have important shortcomings in common. First, PSA campaigns typically ignore the mass media’s potential to support an agenda that focuses on changing institutions, communities, and societal factors, including public policy (Wallack & DeJong, 1995). This failing often arises from not fully understanding the multilevel factors that affect people’s behavior (Maibach, Abroms, & Marosits, 2007). Likewise, PSA messages are typically used in stand-alone campaigns rather than in support of other programs and initiatives that are underway.

Second, PSA messages are almost always designed to increase awareness, increase knowledge, and change attitudes in the often misplaced hope that these messages will lead people to make different behavioral choices. Such campaigns can be important, but they seldom work for the majority of people whose behavior is resistant to change (Abroms & Maibach, 2008). Overlooked is the need to teach new behavioral skills, demonstrate (and not just promise) the benefits of alternative behaviors, and build up people’s confidence in their ability to apply those skills successfully (Eldredge et al., 2016).

Avoiding these shortcomings requires using a strategic planning process whose starting point is not to conjure up a breakthrough message that might inspire the intended audience to act, but rather to develop a set of strategic objectives for a comprehensive intervention plan, after which the best way of using PSAs or other communication options to support that effort can be decided upon. Choosing the level at which an intervention will operate is the single most significant decision that planners will make. In many cases, an environmental approach that focuses on changing institutional, community, or societal factors will be a more effectual way of proceeding since even small environmental-level changes can result in large numbers of people changing their behavior. In other cases, however, an intervention that focuses on addressing individual or interpersonal factors will be the best course. Whatever intervention level is chosen, there is a role that public service advertising can play in advancing that work.

The campaign planning team can guide its work by completing a media planning guide, as shown in Table 1, which will outline how the PSA campaign will work in sync with other intervention activities and what its key messages will be. Below, each element of the planning guide is explained and then illustrated by the “Talk. They hear you.” campaign, a PSA-based public health campaign that was sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, to address underage alcohol use. The completed media planning guide for the campaign appears in Table 2.

Problem Analysis

The first strategic planning step is to conduct a thorough problem analysis. The scope and direction of this analysis should be guided by the social ecological framework, which considers the individual and interpersonal factors that influence behavior, as well as environmental factors that operate at the institutional, community, or societal levels (Golden, McLeroy, Green, Earp, & Lieberman, 2015).

The “Talk. They hear you.” campaign was motivated by the disturbing finding that one-third of US adolescents have had a least one drink by age 15 (SAMHSA, 2016a). In fact, experimentation with alcohol often begins as early as age 9 (Duncan, Duncan, & Strycker, 2006). Importantly, several studies have documented that early onset of alcohol use is associated with a wide range of negative alcohol-related consequences, including alcohol dependence, heavy episodic drinking, interpersonal violence, motor vehicle crashes, suicide, unintentional injury, other drug use and dependence, having unplanned and unprotected sex, and academic and employment problems (Hingson & White, 2014).

Target Group

At this point, the planning team should specify which segment of the population experiencing the health problem will be the focus of the intervention, as defined by geographic, demographic, psychological, and problem-relevant characteristics. Based on its problem analysis, the SAMHSA planning team specified the campaign’s target group as children ages 9–15 years.

The next step is to state the performance objectives for the designated target group. An effective performance objective uses precise wording to define a specific behavior that can be observed and measured. Since all 50 states have an age-21 minimum legal drinking age, the performance objectives for SAMHSA’s campaign stated that the target group will abstain from drinking alcohol until they reach age 21, even if they have already experimented with alcohol. Importantly, any delay in drinking onset lowers the risk of subsequent alcohol-related problems (Hingson & White, 2014).

Up next is developing a list of individual- and environmental-level change objectives that an intervention might focus on to achieve the performance objectives. Individual-level change objectives focus on individual determinants of behavior, as articulated by the Health Belief Model, the Theory of Planned Behavior, and Social Cognitive Theory (National Cancer Institute, 2005). Such objectives should also define an action, again so that their attainment can be observed and measured.

When planning how to encourage children ages 9 to 15 years to abstain from alcohol until age 21, the SAMHSA planning team highlighted several individual-change objectives, which are listed below after a brief description of each category. Many of these objectives are expressed as statements that the target audience should endorse. It is important to note that these objectives might be achieved directly with an intervention operating at either the individual or interpersonal level, but they would also be helpful in giving shape to an environmental intervention operating at the institutional, community, or societal level.

Table 1. Media planning guide.

Problem Analysis

What is the health problem and who experiences it? What causes or contributes to the problem?

Target Group

Which segment of the population experiencing the health problem will be the focus of the intervention?

What are the performance objectives for the target group? Which individual-level and environmental-level change objectives might the intervention focus on in order to achieve the performance objectives?

Intervention Level

What is the best way to realize the performance objective? At which level of the social ecological model will the intervention operate?

Target Audience

What is the intended audience for the intervention—the target group itself, family members, peers, institutional leaders, community leaders, policy makers? Explain the rationale.

What are the performance objectives for the target audience?

Obstacles

What might stand in the way of the target audience realizing the performance objectives?

Which individual-level and environmental-level change objectives might the intervention focus on in order to achieve the performance objectives?

Intervention Plan

What is the nature and scope of the primary intervention directed to the target audience?

How can the mass media be used to advance that strategy? What can the target audience do immediately after seeing or hearing the communications message?

Key Promise

What is the most important benefit that the target audience will obtain if they act on the communications message?

Support Statements

What else does the target audience need to know, think, or believe in order for the message to motivate their taking action? Think in terms of both rational and emotional content.

Net Impression

What should the target audience say or think after seeing or hearing the communications message?

Tone

What feeling should the message have—emotional, authoritative, light? Should the message’s tone change over the course of the message? If so, then how?

Media

What channels of communication will be used—television PSA, radio PSA, print advertisements, billboards, posters, website, social media? What level of media cooperation is needed?

Collaborators

What sponsors or collaborators are needed?

Continuing Activities

What other intervention elements can be built off of the media campaign?

Knowledge

In general, important points of knowledge include the seriousness of the problem, personal risk factors, the existence of behavioral alternatives and their features, and other key factual information such as warning signs, locations of services, or sources of additional information. SAMHSA campaign objectives: (1) Describe the negative physical, mental, academic, and social consequences associated with youth drinking. (2) Agree: “Drinking alcohol before age 21 can interfere with brain development.” (3) Cite the laws pertaining to underage drinking. (4) List the common reasons that youth have for choosing not to drink.

Attitudes and Beliefs

What people choose to do is strongly influenced by the positive or negative reactions and feelings they have about the behavioral alternatives available to them, which in turn are grounded in a set of supportive beliefs. SAMHSA campaign objectives: (1) Agree: “There are plenty of ways to have fun that don’t involve drinking.” (2) Agree: “My grades or extracurricular activities might suffer if I were to start drinking.” (3) Agree: “I will support other students who choose not to drink.”

Perceived Outcomes

People engage in behaviors that have more benefits than costs. Potential benefits are stronger inducements when they are greatly valued, immediate, and have a high probability of being realized. People are responsive to the threat of negative consequences, though in general the expectation of rewards for “good” behavior will be a stronger motivator than the expectation of punishment for “bad” behavior (Bandura, 1986). SAMHSA campaign objectives: (1) Agree: “My decision not to drink will help me accomplish my personal goals.” (2) Agree: “I will feel better physically and have more energy if I do not drink.”

Social Norms

People are greatly influenced by the expectations of other persons or groups with whom they identify. These perceived expectations, in turn, are informed by observations of what other people say or do in particular circumstances. SAMHSA campaign objectives: (1) Agree: “Only a small percentage of people my age choose to drink.” (2) Agree: “Students at my school will respect my decision not to drink.” (3) Agree: “I would be letting my parents down if I were to start drinking.” (4) Agree: “The media misrepresents alcohol as being central to having fun or being successful.”

Personal Norms

People are more likely to engage in new behaviors that are consistent with their personal values and self-image and to reject behaviors that are in conflict with their personal standards. SAMHSA campaign objectives: (1) Agree: “I don’t want the image of being a drinker.” (2) Agree: “Drinking is not consistent with who I am as a person.” (3) Agree: “I will have greater respect for myself if I continue not to drink.”

Behavioral Skills

People must have the skills necessary to perform a behavioral alternative under particular circumstances. SAMHSA campaign objectives: (1) Demonstrate how to use nonconfrontational responses to turn down an invitation to go drinking or attend a drinking-related event. (2) Describe what to do when out with friends who start drinking.

Perceived Behavioral Control

People will attempt an alternative behavior only if they have strong self-efficacy beliefs—that is, they are confident they can perform the behavior at specific times and places, and that they can call upon effective strategies to overcome possible barriers and constraints (Bandura, 1986). SAMHSA campaign objectives: (1) Agree: “My friends and I can find things to do that don’t involve drinking.” (2) Agree: “No matter what people might say to me, I can successfully turn down a drink of alcohol.” (3) “I can call my parents to come and get me if I find myself in an uncomfortable situation.”

Cues to Action

Internal or external cues can serve as reminders to engage in a new behavior. SAMHSA campaign objectives: (1) Create a calendar reminder to plan ahead for things to do that don’t involve drinking. (2) Set up a smartphone text reminder to check in with parents.

Environmental-level change objectives that might contribute to achieving the target group’s performance objectives are linked to interpersonal, institutional, community, and societal factors, as outlined in the social ecological framework. For example, factors operating at the interpersonal level include family and peer influences: their expectations for other people’s behavior, the behavior they model and reinforce, and the social support they provide, especially when someone they care about is attempting to change their behavior (Berkman & Glass, 2000). Change objectives at the institutional, community, and societal levels often focus on implementing and enforcing new policies, expanding services, or implementing new programs. Each objective should specify the change agent—that is, the family members, peers, institutional leaders, community leaders, policy makers, or other individuals who can effect change at the specified level.

Intervention Level

From this set of individual-level and environmental-level objectives, planners must decide what the intervention’s primary focus should be. An environmental-level change objective should be pursued if it is an essential change to make in order for large numbers of people to modify their behavior, and if accomplishing that objective requires a detailed intervention plan and a sustained effort. In some cases, of course, environmental-level change objectives can be achieved by members of the target group themselves and do not require a third-party intervention plan. The remaining issue is whether that change objective in fact is achievable, given available resources, other priorities, and the political climate, as well as the potential change agent’s capacity and opportunity to act. In other cases, an intervention operating at the individual or interpersonal level will actually be the best course of action for changing the target group’s health behavior, but that decision is best made only after the possibilities offered by environmental-level interventions have been given careful consideration. Ultimately, a decision on the intervention’s primary focus requires a judgment call, albeit one that is informed by a review of the literature, program experience, and expert opinion.

Table 2. Media Planning Guide for “Talk. They hear you.”

Problem Analysis

High rates of underage drinking among American youth:

The most commonly used drug by youth is alcohol.

Youth begin to experiment with alcohol as early as age nine.

Alcohol use and heavy episodic (“binge”) drinking increases as youth enter adolescence.

Target Group

Children ages 9–15 years from diverse sociodemographic backgrounds

Performance Objective(s):

Children who do not drink will continue to abstain from drinking alcohol until they reach age 21.

Children who have experimented with alcohol or started drinking will discontinue drinking until they reach age 21.

Intervention Level

Interpersonal level, with a focus on parents, guardians, and other adult caretakers

Target Audience

Parents, guardians, and other adult caretakers of children ages 9–15 years from diverse sociodemographic backgrounds (“parents”)

Rationale: Parental involvement, monitoring, and communication is a protective factor against underage alcohol use.

Performance Objective(s):

Parents will initiate and sustain an ongoing dialogue with their children, beginning at age 9 and continuing until they reach the legal drinking age.

Obstacles

Lack of knowledge and awareness of the problem

Not knowing how other parents tackle the issue, or how or when to begin a conversation

What to say or how to respond to the child’s statements and questions

Unable to identify natural times to have the conversation

Lack of self-efficacy for initiating and continuing a useful dialogue

Intervention Plan

SAMHSA website (http://underagedrinking.samhsa.gov) to guide parents on how to talk to their preadolescent and adolescent children about alcohol, consistent with their family rules and expectations

Parents will go to the SAMHSA website to access information on underage drinking and guidance on effective parenting strategies

Key Promise

“By initiating a direct conversation with my child about alcohol, I can take a positive, proactive step that will influence my child’s decision about drinking.”

Support Statements

Rational: “As a parent, I play a direct role in influencing my child’s alcohol behavior. Through the SAMHSA website, I can identify ways, times, and places that are appropriate for initiating this conversation with my child.”

Emotional: “I am shocked at how young underage drinking starts among children. I don’t want my child to be one of them.”

Net Impression

“My child could be exposed to alcohol even when very young. This conversation seems a bit daunting, but I can visit the SAMSHA website and get tips on how and when to bring up this topic, so like other parents I can have an effective conversation with my child about alcohol.”

Tone

A mood of unease, followed by a sense of growing confidence and concluding with a warm, positive feeling of connection

Media

Communication channels:

SAMHSA website

Television, radio, and print PSAs distributed for pro bono use by media outlets

Facebook, YouTube, Twitter (#TalkTheyHearYou)

Press and media coverage

Collaborators

National and community-level organizations, local coalitions, and SAMSHA grantees

Continuing Activities

Personalized action plan: Online component that helps parents develop a tailored action plan to help parents have the conversation

Partner toolkit: Downloadable toolkit for any interested organization so they too can implement the campaign on a local level

Target Audience

The planning team’s next step is to specify a well-defined target audience for the communication message, which in some cases should be segmented into subgroups with similar geographic, demographic, psychological, and problem-relevant characteristics. In some cases, the target audience will be the target group itself, but often it will be family members, peers, or change agents able to act on an institutional, community, or societal level. The target audience for the SAMHSA campaign was parents, guardians, or other adult caretakers (“parents”) of children ages 9–15 years.

Although many parents think they have little influence over their children’s decisions about drinking, a substantial number of studies have underscored the importance of parental involvement, monitoring, and communication even during a child’s late adolescence or early adulthood, and even in environments where other risk factors are present (Wood, Read, Mitchell, & Brand, 2004). Youth are less at risk when their parents take an active role in their life: declaring a clear expectation of no substance use, establishing firm family rules, monitoring their whereabouts and activities, getting to know their friends, trying to understand their problems, and helping them come up with constructive solutions (Donaldson, Handren, & Crano, 2016; Hausheer, Doumas, Esp, & Cuffee, 2016).

Obstacles

The planning team needs to consider what might stand in the way of the target audience doing what is being asked of them. Depending on the nature and extent of those obstacles, it can be useful to detail a full list of individual-level and environmental-level change objectives that the intervention should focus on to change the target audience’s behavior, just as was done for the target group.

There are many reasons why parents do not talk to their children about not drinking. Most parents underestimate the problem, not realizing how early youth drinking begins, how heavily young people often drink, or how dangerous it can be, even if they do not drive after drinking. Some parents think that the wiser choice is to teach youth how to drink responsibly at home, yet the evidence is clear that teens whose parents attempt to do this actually drink more frequently and at heavier levels outside the home (Kaynak, Winters, Cacciola, Kirby, & Arria, 2014). Many parents also accept the idea that, despite the minimum legal drinking age, underage alcohol use is a normal rite of passage—and is, in fact, something they did when they were young, often with little consequence. Importantly, they may look to other parents, but their informal observations find little evidence that others are talking frequently to their children about drinking. Even if they know it is important to talk with their children, they often lack confidence in knowing what to say, when to say it, and how to respond to what their children say or ask.

Intervention Plan

The planning team can now outline the nature and scope of the primary intervention directed to the target audience, which in turn should lead to changes in the target group’s behavior. The plan should also specify how the PSAs or other mass media will be used to advance that strategy, specifically by engaging the target audience to take action right after seeing or hearing the communications message.

Because young people value and listen to what their parents have to say, SAMHSA’s intervention plan called for creating a website that provides guidance to parents, guardians, and other adult caretakers on how to talk to their preadolescent and adolescent children about the importance of participating in healthy and fun activities that do not involve alcohol, consistent with their family’s rules and the parent’s expectations. The goal is not a one-time conversation, but an ongoing dialogue. From here, SAMHSA went on to plan a public service campaign that would motivate the target audience to visit the website to learn more about how to approach these conversations with their children.

Key Promise

PSA messages should emphasize one essential benefit to motivate the target audience to change their behavior, which advertisers refer to as the “key promise.” In many cases, the benefit may not be directly related to the issue of concern, but may instead build on the audiences’ existing motives, needs, values, or self-image. For example, with “Truth,” Florida’s antitobacco PSA campaign, planners had the insight that adolescents who valued their own autonomy would reject smoking if that action were positioned as a refusal to acquiesce to tobacco company manipulation (Sly, Hopkins, Trapido, & Ray, 2001). There are several theories of human motivation that campaign planners can use to stimulate their thinking about possible motivators (McGuire, 2012). For the SAMHSA campaign, as shown in Table 2, the key promise presented to parents was straightforward: initiating a direct conversation with their child would positively influence their child’s decision not to drink.

Support Statements

The PSA messages can be bolstered by presenting information that addresses the most important obstacles that appear to be preventing the target audience from engaging in the desired behavior. Having two types of support statements is useful, one being a rational statement of fact, observation, or belief, and the other being a more emotional statement that conveys the personal significance of accomplishing the performance objective. For the SAMHSA campaign, the rational message reinforced the idea that parents can and do influence their child’s decisions about drinking, while also describing the content posted on the campaign website. The emotional message underscored the shocking fact that underage drinking can start at a very young age.

Net Impression

The net impression is a summary statement that captures what the target audience will say or be thinking after exposure to the public services message. This statement incorporates the key promise and the support statements, but can include other vital information as well. The net impression statement for the SAMHSA campaign was as follows: “My child could be exposed to alcohol even while very young. This conversation seems a bit daunting, but I can visit the SAMSHA website and get tips on how and when to bring up this topic, so like other parents I can have an effective conversation with my child about alcohol.”

Tone

The planning team should also specify what feeling the PSA messages should have. What can be especially effective is a shift in tone as the PSA moves from depicting the problem to offering an actionable and effective solution. This was the case for the SAMHSA campaign, as shown in Table 2.

SAMHSA’s campaign messaging, informed by behavior change theory, went beyond presenting information about the scope of the underage drinking problem to communicate the benefits of establishing an ongoing dialogue, demonstrate how to initiate a conversation, and reassure parents that this is something they could do successfully, even if they struggled at first to say and do the right thing. These PSAs could never cover the full range of topics that would be of help to parents, even with a more substantial budget. Instead, the PSAs seek to illustrate the type of information that parents could find and learn from on the website.

A 60-second television PSA illustrates how the media planning guide informed the advertisement’s creative approach (SAMHSA, 2013). A father—a white man, perhaps in his late 30s—is working in his garage when his son Brian, a young teenager, appears to be headed out with his skateboard. Throughout the conversation, the hesitancy in the father’s speech, coupled with his facial expressions, communicates that he is uncertain about initiating a talk with his son, but still determined to see it through. Viewers hear their interjected thoughts as the conversation unfolds, which is shown in italics.

Father: Oh . . . hey, bud. Where, uh . . . where you headed?

Brian (holding a skateboard): Uh, just gonna hang out.

Father: It’s a school night. With Gary and Todd. . .

Brian: Yeah.

Father: Not sure about those two. I’ve been meaning to ask you—this is tougher than I thought—is there any drinking going on in this crowd?

Brian (showing mild resentment): No.

Father: I hope not, because alcohol can lead you to say things and do things that you really wish you hadn’t. Isn’t this what you’re supposed to say?

Brian: I know.

Father: So if any of your buddies ever pressure you to take a drink, just tell them you promised your Dad you wouldn’t. I’d do anything to keep you safe.

Brian: Okay, I will.

Father: I hope this is working.

Brian: I promise. I love you, too, Dad.

Announcer: They really do hear you, so start the conversation even before they’re teenagers. For tips on what to say, visit underagedrinking.samhsa.gov.

As the announcer speaks, the father calls out his son’s name and then hands him his forgotten skateboarding helmet, further illustrating how he guides his son to stay safe. The PSA closes with a graphic with the “Talk. They hear you.” campaign slogan and the URL for the SAMHSA website. There is a similarly constructed PSA that features a mother and her daughter who wants to go to a sleepover at a friend’s house (SAMHSA, 2014).

Collaborators

PSA campaigns rely on a variety of collaborators to help develop and disseminate the campaign. These include communication venues that might donate advertising time or space for the PSAs, plus local, state, or national organizations that may be involved in implementing the primary intervention or can devote resources to ensuring the target audience’s exposure to the message. SAMHSA reached out to several governmental and nongovernmental organizations that share the agency’s mission to prevent underage drinking.

Continuing Activities

As noted previously, a PSA campaign should not be a stand-alone effort, but should instead be integrated with other intervention activities. Accordingly, the SAMHSA campaign’s YouTube channel provides parents with several materials. The first is an animated video that introduces an interactive smartphone app that uses scenario-based instruction to teach parents how to bring up the topic of alcohol and to ask their child questions, plus tips they can refer to if they get stuck while rehearsing (SAMHSA, 2015). Also posted are the 60-second television PSAs, plus 30- and 15-second versions, and 60- and 30-second versions of a Spanish-language television PSA. There is an additional English-language PSA that informs parents that some children start to experiment with alcohol as early as age 9, and that it is never too early to talk about the dangers of underage drinking, after which they are referred to the website for tips on how to initiate the conversation. Website viewers can also watch a video of the 45-minute 2013 press conference where the SAMHSA campaign was officially launched or an 8-minute highlight video of the event. There are also interviews with SAMHSA officials who were serving when the campaign was launched.

The SAMHSA website has a page devoted to the campaign with links to a multitude of resources for both parents and other organizations (SAMHSA, 2016b): (1) the smartphone app; (2) advertising materials, including television, radio, and print PSAs; “live read” radio scripts, including one set for Native American audiences; web banners and buttons; the campaign’s QR Code; and posters, including a set that can be customized; (3) the campaign’s Twitter feed at #TalkTheyHearYou, where parents can share the steps they have taken to prevent underage drinking; (4) a set of ten one-page guides on special topics (e.g., “Answering Your Child’s Tough Questions About Alcohol,” “Family Agreement Form: Avoiding Alcohol,” “Why Your Child Might Start Drinking”); and (5) an interactive “Action Plan” activity to help parents map out what they want to say and how to approach both the initial and later conversations. There are also links for a “Partner Toolkit” for national, state, and local agencies that includes PSAs, media identity templates, customizable parent resources, and materials for schools.

Reaching the Target Audience

Most public service campaigns that use television, radio, and print advertising fail to reach their audience. Broadcast stations and cable networks typically use PSAs as “filler” when they have unsold commercial time, which means airtimes during off-hours or during programs with small audiences, which may or may not represent the intended target group. Likewise, newspapers and other print publications keep on hand several PSAs of various sizes that they can slot in when needed. This has been a long-standing problem when working with broadcast stations, but it was worsened in the U.S. during the 1980s by the loosening of regulations that outlined broadcasters’ public service obligations.

Because campaign organizers want to ensure audience exposure to their campaign, the competition for getting donated time and space is fierce. A public service campaign’s success in doing so depends in part on the issue involved and its perceived importance to the media “gatekeepers,” who establish public service priorities for each media outlet. Gatekeepers will also respond more favorably to PSAs that are creative and have a connection with a local program or organization (Hammond, Freimuth, & Morrison, 1987). Advertisements that promote a blatant political agenda or focus on a highly controversial topic are less likely to be used, though radio stations, having more narrowly defined audiences, are sometimes willing to air provocative messages. Campaign planning teams have responded to the intensified competition by trying to build relationships with media gatekeepers through press kits, fact sheets, and personal contact. The Advertising Council, a major producer of public service campaigns, tries to link up with community groups that can pitch a campaign to local stations’ public service directors.

Some recent campaigns have responded to the restricted availability of donated public service time by purchasing air time, using it exclusively or in combination with donated time. Business managers at many television and radio stations are willing to sell air time for public service campaigns at greatly reduced rates or to offer a mix of paid and donated time slots. It is much easier for managers to justify donating air time when an organization can pay for at least some commercials at regular rates.

Purchasing air time is controversial within the public service community (Murry, Stam, & Lastovicka, 1996). While some advocates focus on the need to get their messages on the air in the best time slots, others express concern that paying for media time will cause the broadcasters to demand payment for other public service advertising. This concern may be overblown. In general, station managers recognize that public service organizations have variable resources, and the fact that some might be able to pay for small amounts of airtime does not necessarily lessen the managers’ commitment to offer donated time to others.

Clearly, however, the restricted financial resources of most public service agencies limit the extent to which airtime can be purchased, especially with television. Even the U.S. Department of Health and Human Services, which sponsors numerous public service campaigns, generally does not have funding for buying television air time. For most public service agencies, however, radio, billboards, and transit cards represent more realistic venues for paid advertising. There have been notable exceptions. For example, in California, where increased tobacco excise taxes made it possible for the state’s tobacco control program to run paid advertising during premium broadcast hours and in high-circulation magazines and newspapers, the media campaign contributed to significant declines in overall cigarette consumption (Lightwood & Glantz, 2013). Florida’s highly successful “Truth” campaign used the state’s settlement with tobacco companies to fund a multimillion dollar media campaign that could buy air time during programs with heavy teen viewership (Sly et al., 2001). At a national level, the anti-drug campaign organized by the White House’s Office of National Drug Control Policy (ONDCP) had a federal government budget appropriation to pay for its antidrug advertising (Kelder, Maibach, Worden, Biglan, & Levitt, 2000).

The rise of social media—including Facebook, Instagram, Twitter, and others—has opened up a new means of putting PSAs and other types of messaging before the public. For example, once a message is posted on a video-sharing website such as YouTube, it can be linked to the sponsoring organization’s website, where additional intervention-related material can be found, as well as to websites hosted by other groups (Suggs, 2006). Promotional efforts through national, state, and community organizations can draw an initial audience, with the hope that they will share the link with their social media and email contacts, and that eventually the message will “go viral.”

Thus, PSAs remain a viable media alternative for public communication campaigns, despite the fact that major media outlets do not often provide donated time or space for such advertising. In some cases, a PSA-driven campaign will be supported by a large budget, but while such campaigns have a better chance of success, the resources required are seldom available. The emergence of social media has created a new way to build an audience. Successful examples of social media campaigns are emerging, but why some campaigns take off and others do not requires additional study.

Historiography

Few public service campaigns have been rigorously evaluated (Snyder & LaCroix, 2012). Campaigns involving academic researchers tend to be low-budget, short-term, and localized efforts, while full-scale national and regional campaigns are rarely evaluated, partly due to the expense, but also due to the difficulty of setting up a research design that permits meaningful inferences about a campaign’s impact. The common failure to evaluate these large-scale campaigns has impeded progress in learning what types of campaign strategies work best (Hornik, 2002).

The optimal research design for evaluating a public service campaign would be a true experimental design, with large numbers of individual communities randomly assigned to either a treatment group that is exposed to the campaign or a control group that is not. With large samples, random assignment would ensure that extraneous variables that might influence the outcome measures are distributed equally across the two groups. This means that any outcome differences between the groups could be more confidently attributed to the campaign itself, rather than to preexisting differences between the communities. Because of the financial costs such a study would involve, and because of the impracticality of running community-level campaigns in several places at once, a true experiment of this type has not been done.

By necessity, then, researchers who study the impact of public service advertising have resorted to a variety of nonexperimental research designs, each of which has important limitations. The first type are small-scale, quasiexperimental studies that assess the impact of local or regional campaigns by comparing “treatment” (campaign) and “control” (no campaign) communities. Fiscal limitations often restrict the communities to one or two per experimental condition. The design is called “quasi-experimental” because the communities are not randomly assigned to experimental conditions or they are too small in number for random assignment to be a critical feature of the design.

Exposure studies compare the knowledge, attitudes, and behaviors of people who have been exposed to the campaign versus those who have not (Surkan, DeJong, Herr-Zaya, Rodriguez-Howard, & Fay, 2003). The principal shortcoming of this research strategy is that exposure to the media campaign is not determined through random assignment, which means that any differences between low- and high-exposure groups are open to a variety of alternative interpretations. For example, study respondents who recall the message may already be engaging in the promoted behavior or otherwise be primed to pay attention to and remember the message. Another significant drawback is that respondents often cannot report accurately whether they have been exposed to a campaign, especially when the campaign’s message can be conflated with those of similar efforts.

Time-series studies involve the examination of data for an extended period of time, both before and after the introduction of the media campaign. There are important limitations to this method. First, time-series modeling requires that reliable and valid data are available over an extended period of time. In many cases, the only data available for time-series analyses will be broad indicators, such as statistics on alcohol-related traffic fatalities, rather than specific indicators of project objectives, such as the use of designated drivers.

A second limitation is the extreme difficulty of disentangling a mass communication campaign’s contribution from that of other programs or even from broader historical trends or events. For the purposes of program evaluation, the time-series technique requires that there be a major, signal event whose occurrence can be precisely defined in time, such as the beginning of a new antismoking campaign in a government-controlled media environment (Palmgreen, Donohew, Lorch, Hoyle, & Stephenson, 2002) or the introduction of a new concept such as the designated driver (Winsten, 1993). In the field of public service work, however, the occurrence of such events is rare.

This means, of course, that there is no truly definitive research to show that public service campaigns can have a significant and meaningful impact on health-related knowledge, attitudes, and behavior, nor is it likely that there ever will be. Thus, skeptics who doubt whether such campaigns can ever be effective can easily find support for their position by pointing to weaknesses in the research methods that have been used. Despite the limitations of the available research, there is sufficient evidence to support the continued development of public service campaigns that are designed using a planning scheme grounded in advertising best practices and behavior change theory and are part of a broader intervention effort.

Further Reading

Backer, T. E., Rogers, E., & Sopory, P. (1992). Designing health communication campaigns: What works? Newbury Park, CA: SAGE.Find this resource:

    Glanz, K., Rimer, B. K., & Su, S. M. (2002). Making health communication programs work. Washington, DC: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. Retrieved from http://www.cancer.gov/pinkbook.Find this resource:

      Hornik, R. C. (Ed.). (2002). Public health communication: Evidence for behavior change. Mahway, NJ: Erlbaum.Find this resource:

        Maibach, E. W., & Parrott, R. L. (1995). Designing health messages: Approaches from communication theory and public health practice. Thousand Oaks, CA: SAGE.Find this resource:

          Rice, R. E., & Atkin, C. K. (Eds.). (2015). Public communication campaigns (4th ed.). Thousand Oaks, CA: SAGE.Find this resource:

            Siegel, M., & Lotenberg, L. D. (2007). Marketing public health: Strategies to promote social change (2d ed.). Sudbury, MA: Jones and Bartlett.Find this resource:

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