Alyssa B. Mayer

Community-Based Prevention Marketing for Policy Development A New Planning Framework for Coalitions

Community-based prevention marketing (CBPM) is a community-driven framework for program planning, which applies social marketing concepts and techniques to the development of health behavior interventions. Whereas community members who comprise an action committee or coalition set the goals and make programmatic decisions, social marketing provides the planning framework to guide program design, implementation, and evaluation. CBPM has guided successful initiatives to promote physical activity in both youth and adults, to increase safety eyewear use in agricultural settings, and to delay alcohol and tobacco initiation among youth. However, the emergence of evidence-based policy has fostered renewed interest in “upstream” approaches to health behavior change that, in the United States, have included community partnerships as an important tool for policy development. Unfortunately, these community partnerships have had variable success because of the lack of a systematic framework for identifying, selecting, tailoring, and promoting evidence-based policies. We describe the adaptation and application of CBPM to improve community capacity for identifying and promoting evidence-based policies. The resulting framework, CBPM for Policy Development, is comprised of the following eight steps: (1) build a strong foundation for success; (2) review evidence-based policy options; (3) select a policy to promote; (4) identify priority audiences among beneficiaries, stakeholders, and policy makers; (5) conduct formative research with priority audiences; (6) develop a marketing plan for promoting the policy; (7) develop a plan for monitoring implementation and evaluating impact; and (8) advocate for policy change. We provide a description of each step and an examination of the experiences and lessons learned in applying it to youth obesity prevention.

Applying Systems Science to Evaluate a Community-Based Social Marketing Innovation A Case Study

In the United States, community coalitions are an important part of the public health milieu, and thus, subject to many of the same external pressures as other organizations—including changes in required strategic orientation. Many funding agencies have shifted their funding agenda from program development to policy change. Thus, the Florida Prevention Research Center created the Community-Based Prevention Marketing (CBPM) for Policy Development framework to teach community coalitions how to apply social marketing to policy change. The research reported here was designed to explicate the framework’s theory of change. We describe and demonstrate a hybrid evaluation approach: utilization-focused developmental evaluation. The research question was “What are the linkages and connections among CBPM inputs, activities, immediate outcomes, intermediate outcomes, and ultimate impacts?” We implemented a case study design, with the case being a normative community coalition. The study adhered to a well-developed series of steps for system dynamics modeling. Community coalition leaders may expect CBPM to provide immediate gains in coalition performance. Results from causal diagramming show how gains in performance are delayed and follow an initial decline in performance. We discuss the practical implications for CBPM’s developers—for example, importance of managing coalition expectations—and other social marketers—for example, expansion of the evaluation toolkit.

Evaluative Indices Assigned to Contraceptive Methods by University Undergraduates.

Abstract Background: Preordinate attitudes and beliefs about contraception may influence acceptance or rejection of a particular method. Purpose: We examined the attitudes about contraception methods held by undergraduate students (N=792) at two large southeastern universities in the United States. Methods: Twelve methods were rated on 40 semantic differential scales. Means of the scale sum scores for men and women were compared using t-tests. Results: Among women the most favorably rated methods were: abstinence, oral contraceptive, male condom, Nuva ring, contraceptive patch, emergency contraception, male sterilization, female sterilization, diaphragm and female condom, each yielding a mean above the scale midpoint. The most negatively rated methods were withdrawal and douche. For men, the ratings in descending order were: oral contraceptive, male condom, abstinence, contraceptive patch, emergency contraception, female sterilization, Nuva ring, female condom, diaphragm, withdrawal, male sterilization and douche. There were four statistically significant (P < 0.05) gender differences, with abstinence, male condom, male sterilization and Nuva ring all rated more favorably by women. Discussion: These evaluative indices suggest that contraceptive methods elicit varied responses among potential users that theoretically could manifest themselves in acceptance or rejection of a particular method. Improved understanding of the traits by which potential users judge contraception may be beneficial in fostering communication between potential users and practitioners who provide relevant advice. Translation to Health Education Practice: Health educators and other practitioners engaged in contraception counseling must consider that persons may already hold strong feelings about some methods before they enter the clinical setting.

Social Marketing and Policy Making: Tools for Community-Based Policy Advocacy

The Florida Prevention Research Center (FPRC) at the University of South Florida has been funded by the U.S. Centers for Disease Control and Prevention (CDC) since 1998. In that time, its staff of researchers and practitioners have codeveloped with its community partners a wealth of tools for using social marketing to address local problems. Similar to the field of social marketing, the FPRC is evolving from exclusively developing ‘‘downstream’’ innovations to working farther ‘‘upstream,’’ which means we are frequently developing and testing new types of tools for those purposes. In this ‘‘Tools from the Field’’ paper, we share some tools and lessons learned for carrying out social marketing with community coalitions as well as preview forthcoming tools emanating from our latest CDC-funded research.

Health Disparities and Converging Epidemics in Jail Populations: Protocol for a Mixed-Methods Study

Background Incarcerated populations have increased in the last 20 years and >12 million individuals cycle in and out of jails each year. Previous research has predominately focused on the prison population. However, a substantial gap exists in understanding the health, well-being, and health care utilization patterns in jail populations. Objective This pilot study has 5 main objectives: (1) define recidivists of the jail system, individuals characterized by high incarceration rates; (2) describe and compare the demographic and clinical characteristics of incarcerated individuals; (3) identify jail-associated health disparities; (4) estimate associations between incarceration and health; and (5) describe model patterns in health care and jail utilization. Methods The project has two processes—a secondary data analysis and primary data collection—which includes a cross-sectional health survey and biological sample collection to investigate infectious disease characteristics of the jail population. This protocol contains pilot elements in four areas: (1) instrument validity and reliability; (2) individual item assessment; (3) proof of concept of content and database accessibility; and (4) pilot test of the “honest broker” system. Secondary data analysis includes the analysis of 6 distinct databases, each covered by a formal memorandum of agreement between Northern Arizona University and the designated institution: (1) the Superior Court of Arizona Public Case Finder database; (2) North Country Health Care; (3) Health Choice Integrated Care; (4) Criminal Justice Information Services; (5) Correctional Electronic Medical Records; and (6) iLEADS. We will perform data integration processes using an automated honest broker design. We will administer a cross-sectional health survey, which includes questions about health status, health history, health care utilization, substance use practices, physical activity, adverse childhood events, and behavioral health, among 200 Coconino County Detention Facility inmates. Concurrent with the survey administration, we will collect Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus (samples from the nose) and dental microbiome (Streptococcus sobrinus and Streptococcus mutans samples from the mouth) from consenting participants. Results To date, we have permission to link data across acquired databases. We have initiated data transfer, protection, and initial assessment of the 6 secondary databases. Of 199 inmates consented and enrolled, we have permission from 97.0% (193/199) to access and link electronic medical and incarceration records to their survey responses, and 95.0% (189/199) of interviewed inmates have given nasal and buccal swabs for analysis of S. aureus and the dental microbiome. Conclusions This study is designed to increase the understanding of health needs and health care utilization patterns among jail populations, with a special emphasis on frequently incarcerated individuals. Our findings will help identify intervention points throughout the criminal justice and health care systems to improve health and reduce health disparities among jail inmates. International Registered Report Identifier (IRRID) RR1-10.2196/10337