Communication Campaigns: Social Marketing Practices and Dissemination of Breast Cancer Risk Information to the Lay Public Communication Campaigns: Social Marketing Practices and Dissemination of Breast Cancer Risk Information to the Lay Public Chuck Atkin, Ph.D. Kami Silk, Ph.D. Department of Communication Michigan State University

Overview ► Identify fundamental campaign components ► Discuss social marketing practices ► Present options for risk representations ► Provide a dissemination plan for risk messages

Communication Campaign Strategies Basic model of communication: S OURCE M ESSAGE C HANNEL R ECEIVER

Overview of components ► SOURCE: SPONSOR & MESSENGER ► MESSAGE: PERSUASIVE APPEALS &. INFORMATION CONTENT ► CHANNEL: MEDIA & INTERPERSONAL ► AUDIENCE: Social Marketing concepts

Health Message Sources SPONSOR Creates and disseminates messages Creates and disseminates messagesMESSENGER Models who are featured in messages Models who are featured in messages

SPONSORING ORGANIZATION ► Government agencies ► Associations and foundations ► Medical and educational institutions ► Corporations High vs. low visibility High vs. low visibility High vs. low credibility High vs. low credibility

Credibility of BC Sources (0-10 scale) ► 10 American Cancer Society ► 9 Federal agencies ► 9 Medical centers ► 9 Komen Foundation ► 8 Universities ► 3 Pharmaceutical firms

Messenger = Personalization ► Credibility: Expertise, Trust ► Relevance: Identification ► Attractiveness: Attention-getting

Health Messengers ► Expert specialist doctor… researcher ► Specially experienced person G victim… survivor… successful role model victim… survivor… successful role model ► Public official gov leader… agency director gov leader… agency director

Source Messenger ► Celebrity G athlete… entertainer ► Average person G typical girl… mom ► Professional performer ► Unique character G

Channels: Comprehensive Array ► Television: News, PSA spots, Talk G ► Radio: PSAs, News coverage, Call-in ► Newspaper: News, Editorial comment ► Magazine: Feature stories, News

Channels ► Internet Web pages G ► Billboards/Posters G ► Pamphlets/Booklets G ► Direct mail/ materials

BC stories seen per year ► 9 TV public service spots ► 8 Magazine stories ► 8 TV newscast stories ► 7 Newspaper news/feature items ► 4 TV content in talk shows/dramas ► 20% have searched internet for BC

Channels: Interpersonal ► Informal family… friends ► Internet chat room ► Professional doctor… teacher TWO-STEP FLOW TWO-STEP FLOW

Direct vs. Indirect Impact Message  Target audience Message  Influentials  Target audience Message  Policymakers  Target audience

Campaign message environment MEDIA STORIES ABOUT… ► Breast Cancer ► Environmental risks ► Nutrition ► Exercise

NEWS COVERAGE in National Media Environmental risk factors: ► 12% Use of Hormones/Estrogen/Progesterone/HRT ► 6% Use of other pharmaceuticals ► 3% Obesity ► 2% Exposure to chemical contaminants ► 2% Eating certain unhealthy foods ► 1% Exposure to pesticides ► 1% Lack of exercise ► 1% Exposure to second-hand smoke Note: Heredity = 16% Note: Heredity = 16%

KEY NEWS CATEGORIES 38% TREATMENT (surgical, chemo, radiation) 35% 35% PREVENTION (mostly aspirin… 10% obesity, exercise, food) 30% PREVALENCE of BC (number, odds, trends) 23% DETECTION SCREENING (self, mammo) 2% PARENT ACTIONS to PROTECT DAUGHTERS

Environmental Factors Limited ► Lifestyle practices & environmental contaminants infrequent; HRT dominates coverage at expense of other risk factors ► Likely to limit perceptions of susceptibility to the neglected risks (although emphasis on prevalence should contribute to vulnerability) ► Almost no information to educate parents about how to protect daughter or how to take collective action

Persuasive Appeals ► Physical health incentives -- general disease vs. breast cancer -- general disease vs. breast cancer ► Psychological (e.g., security) ► Social (e.g., normative)

Persuasive appeals Positive promise vs. Negative threat Expectancy vs. Value Negative: Susceptibility vs. Severity Negative: Susceptibility vs. Severity Positive: Promise vs. Payoff Positive: Promise vs. Payoff Self Efficacy vs. Response Efficacy

Implications of Treatment Emphasis ► Based on positive treatment news, 90% of women perceive that survival rate is high or rising… do they infer less severity? ► Does belief of lower fatality risk lead women to have a lower level of concern and consequently less focus on prevention behavior? ► Are mothers be less likely to take action to protect their young daughters?

Social Marketing ► Adapting commercial marketing strategies to plan, develop, implement, & evaluate pro-social programs/campaigns. ► Emphasis is on selling an idea rather than a product ► Uses a traditional marketing mix that incorporates the “Four Ps”

Social Marketing and Breast Cancer ► Product  Prevention; engage in healthy behaviors as a protective function ► Price  Uncertainty and fear; time and resources to engage in healthy behaviors ► Place  Interpersonal channels, media vehicles, ► Promotion  Integrate media campaigns, school-based programs, physician and family interactions, media advocacy efforts

Social Marketing and Breast Cancer ► Publics  Adolescent girls, mothers, policymakers, health educators ► Partnership  Schools, community-based organizations ► Policy  Need an environment that supports prevention; e.g., school lunch and physical education programs ► Purse Strings  Where will $$$ come from for prevention and promotion?

Risk Communication

The National Research Council (1989) defined risk communication as: ► “...an integrative process of exchange of information and opinions among individuals, groups, and institutions; often involves multiple messages about the nature of the risk or expressing concerns, opinions, or reactions to risk messages or to the legal and institutional arrangements for risk management.”

Risk Communication Experts ► Similar to technical estimates of annual fatalities ► Logarithmic in character ► Concerned with probability ► Unrelated to many dimensions of risk The Public ► Risk Perceptions strongly affected by several ideas  Threat to future generations  How Catastrophic  Controllability  If Voluntary or Not  Obtained Benefits ► More qualitative in nature

Risk Communication Risk Communication “Risk perceptions” include [Weinstein]:  Beliefs about the nature of the potential consequences  Beliefs about the probability of these consequences  Beliefs about personal risk and the factors that modify one’s risks

Risk Communication ► Different properties associated with risk impact lay public perceptions. ► Increased Perceived Risk  Infrequent  Catastrophic  Involuntary ► Decreased Perceived Risk  Frequent  Familiar  Voluntary

Seven Cardinal Rules of Risk Communication (Covello & Allen, 1988) ► Accept and involve the public as a partner. ► Plan carefully and evaluate your efforts. ► Listen to the public's specific concerns. ► Be honest, frank, and open. ► Work with other credible sources. ► Meet the needs of the media. ► Communicate clearly and with compassion.

How do we communicate risks?

RISK FACTORS Breast Cancer

Objective of Risk Message ► Screening detection ► Prevention behaviors ► Individual vs. Collective action ► Protecting Self vs. Other

Conveying BC Risk Factors PRESENT RISK FACTOR IN ISOLATION: -- SIMPLY IDENTIFY FACTOR -- SIMPLY IDENTIFY FACTOR -- SPECIFY DEGREE (Verbal) -- SPECIFY DEGREE (Verbal) -- SPECIFY DEGREE (Numerical) -- SPECIFY DEGREE (Numerical) -- SPECIFY and EXPLAIN (Rationale) -- SPECIFY and EXPLAIN (Rationale)

Multiple Risk Factors Multiple Risk Factors PRESENT RISK CLAIMS IN CONTEXT: -- RANK ORDERING -- RANK ORDERING -- NUMBER OF OTHER RISK FACTORS -- NUMBER OF OTHER RISK FACTORS -- COMPARISON WITH FAMILIAR RISK -- COMPARISON WITH FAMILIAR RISK

Options for Representing Risk ► Risk time frame: 5 Years vs. Lifetime ► Odds (1 in 9) vs. Percent (11%) ► Authority statement vs. evidence ► Self vs. loved one

Other strategy considerations ► Provide intuitive explanation / rationale to convince audience of risk claim? ► How to overcome time lag between behavior and disease? ► What if actual risk is less than expected risk?

NCI Risk Assessment Tool ► Current age ► Age first menstrual period ► Age first full pregnancy ► First-degree BC relatives ► Benign biopsies ► LCIS ► Race / ethnicity CALCULATES 5-YEAR AND LIFETIME ODDS ( % ) CALCULATES 5-YEAR AND LIFETIME ODDS ( % )

NCI Comprehensive List 1. Age 2. Personal history of BC 3. Family history 4. LCIS 5. Gene changes (BRCA1 BRCA2) 6. Age of menarche 7. Age of first child birth 8. HRT (E+P)

NCI List (continued) 9. White race 9. White race 10. Radiation therapy 11. Breast density 12. Took DES 13. Overweight ( post-menopause) 14. Lack of physical activity 15. Drinking alcohol

Note at end of NCI list: “Other possible risk factors are under study…” ► “e ffect of diet” ► “physical activity” ► “whether certain substances in the environment can increase the risk of breast cancer”

NCI caveats re risk factors ► Most women who have known risk factors do not get breast cancer REASSURANCE? COMPLACENCY? REASSURANCE? COMPLACENCY? ► Most women with breast cancer do not have a family history of the disease… they have no clear risk factors except for growing older UNCERTAINTY? VIGILANCE? FEAR? FATALISM? UNCERTAINTY? VIGILANCE? FEAR? FATALISM?

BC Risk Factors (0-10 scale) BC Risk Factors (0-10 scale) ► 9 Smoking cigarettes ► 9 Genetics / Family history ► 7 HRT ► 7 Secondhand smoke ► 6 High-fat foods in childhood ► 6 Obesity in childhood ► 4 Chemicals / Pesticides