available to pay for the outreach channels and prime time exposure for target groups needed on a continuing basis. In contrast, ordinary massmedia programs and news do reach large audiences with their messages. They can achieve high and continuing exposure to healthy messages.

Such heavy exposure may be effective for a variety of reasons: sheer repetition so that messages (1) may be more likely to be heard and paid attention to, particularly if the repetition occurs across a variety of channels; (2) may communicate social expectations for behavior, and (3) may produce a greater likelihood of community discussion of the message possibly producing personal reinforcement for behavior change.

Thus if the media cover an issue extensively, it may be possible to achieve changes in behavior not practicable with controlled educational interventions. However the problem for programs that take this route is the difficulty of convincing media to cover an issue in a way consistent with sponsors’ goals. The solutions that people have used include buying or obtaining donated advertising time; engaging in media advocacy—a deliberate attempt to create controversy or to leverage a news event to stimulate media coverage of an issue (Wallack and Dorfman, 1996); undertaking public relations efforts to encourage media coverage; and working with producers and writers of entertainment programs or talk shows to encourage incorporation of messages in those programs. Different programs have used each of these strategies, with varying success (Wallack and Dorfman, 1996; Hornik et al., 2003; Wray et al., 2004).

In March 2004, DHHS announced an obesity-focused campaign called “Small Steps” that is comprised of a series of public service announcements recommending that Americans take small and achievable steps toward increasing physical activity and reducing calorie consumption to improve their health and reverse the obesity epidemic (DHHS, 2004). The initiative and advertisements provide suggestions such as choosing fruit for dessert and doing sit-ups in front of the television—easily accomplished actions that DHHS anticipates will appeal to Americans searching for achievable weight-management goals. The campaign, which is part of a larger DHHS effort, the Steps to a Healthier U.S. Initiative, is addressed both to adults and children and is implemented through awards to large urban communities, rural communities, and tribal consortiums. Because this program was launched as this report was being written, results on effectiveness are not yet available.

Over the past 10 years, government and private groups have undertaken major media campaign efforts to influence a variety of other youth behaviors, including tobacco use and drug use. Current evidence suggests that the anti-tobacco campaigns have been successful, while the anti-drug campaigns have had less success. Tobacco use among youth has been declining since 1997, and there is evidence linking some of that decline to



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