natural diffusion of information about the health consequences of tobacco use and the deliberate efforts by advocacy agencies to affect public opinion (Warner and Martin, 2003). Similarly, it will likely be easier to implement policies to prevent childhood obesity if the general public is informed about the issues and strongly supportive of the need to address them.

Lessons Learned from Other Media Campaigns on Public Health Issues

A number of media campaigns covering a range of public health issues have been targeted to adults or the general public. For example, media efforts were successfully used to encourage parents to put their infants to sleep on their backs to avoid Sudden Infant Death Syndrome (Moon et al., 2004) and to discourage the use of aspirin for children’s fevers to avoid Reye’s syndrome (Soumerai et al., 1992). The outcomes of the “Back to Sleep” and the Reye’s syndrome campaigns were encouraging, but their objective may be simpler than the sorts of actions recommended for energy-balance campaigns. A major national effort to encourage parents to monitor their children so as to reduce their risk of drug use has not yet shown evidence of behavior change, although it is still ongoing (Hornik et al., 2003).

A broader range of campaigns addressing parents’ own behaviors related to energy balance has shown mixed results. Evaluations of a series of mass-media-based interventions undertaken in the 1990s to promote adult physical activity provide a mixed picture of success, with most reporting fairly good levels of recall of messages and changes in knowledge about the benefits of exercise. Only sometimes, however, did results show evidence of actual increases in self-reported physical activity, even over the short term (Owen et al., 1995; Vuori et al., 1998; Wimbush et al., 1998; Bauman et al., 2001, 2003; Hillsdon et al., 2001; Miles et al., 2001; Reger et al., 2002; Renger et al., 2002).

In addition to these predominantly mass-media-focused efforts, there were other multicomponent campaigns for which mass media was but one (albeit important) channel that addressed not only physical activity but other outcomes as well (see Chapter 6). Initial success from the Stanford Three Community Study and the North Karelia Project demonstrated the promise of this approach, and were followed by three large National Heart, Lung, and Blood Institute-funded community trials in the 1980s—the Stanford Five-City Project, the Minnesota Heart Health Program, and the Pawtucket Heart Health Program (Farquhar et al., 1990; Luepker et al., 1994; Carleton et al., 1995). The multiyear Minnesota Heart Health Program reported greater adult physical activity in its experimental communities than in its control communities (Luepker et al., 1994); and the Stanford Five-City Project reported similar patterns (Young et al., 1996), as well as



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