Anita H. Courtney

Promoting Physical Activity Among Youth Through Community‐Based Prevention Marketing

BACKGROUND Community-based prevention marketing (CBPM) is a program planning framework that blends community-organizing principles with a social marketing mind-set to design, implement, and evaluate public health interventions. A community coalition used CBPM to create a physical activity promotion program for tweens (youth 9-13 years of age) called VERB Summer Scorecard. Based on the national VERB media campaign, the program offered opportunities for tweens to try new types of physical activity during the summer months. METHODS The VERB Summer Scorecard was implemented and monitored between 2004 and 2007 using the 9-step CBPM framework. Program performance was assessed through in-depth interviews and a school-based survey of youth. RESULTS The CBPM process and principles used by school and community personnel to promote physical activity among tweens are presented. Observed declines may become less steep if school officials adopt a marketing mind-set to encourage youth physical activity: deemphasizing health benefits but promoting activity as something fun that fosters spending time with friends while trying and mastering new skills. CONCLUSIONS Community-based programs can augment and provide continuity to school-based prevention programs to increase physical activity among tweens.

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.

Increasing Physical Activity in Children 8 to 12 Years Old: Experiences with Verb™ Summer Scorecard:

Interventions which facilitate physical activity of youth are vital for promoting community health and reducing obesity. This study assessed the results of a community-driven program, VERB™ Summer Scorecard, as knowledge of exposure to and awareness of community-based interventions for physical activity among youth could inform design and implementation of such interventions. A total of 2,215 youth ages 8 to 12 years responded to a survey about physical activity. Ordinal logistic regression suggested that youth who participated in this program were 1.73 times (95%CI = 1.41, 2.11) more likely to report high physical activity than nonparticipating youth 9 mo. after the interventions first full-scale application. The program appeared to appeal more to girls than boys. Such results are encouraging for use in communities.

Breast Cancer Screening: A Social Marketing Study

Breast cancer is one of the leading types of preventable cancer among women in the United States. Despite improvements in mammography and early detection techniques for breast cancer, special population groups within the United States continue to experience high incidence and mortality rates. This paper focuses on Kentuckys underserved populations. The research objectives were to: 1) identify the factors that motivate women at risk to be screened for breast cancer; and, 2) identify the factors that deter women at risk from being screened for breast cancer. A combination of quantitative (survey n=407) and qualitative (focus groups=19; in-depth interviews=58) research methods were used to examine factors that influence mammography use. Factors that motivate women to have mammograms include: physician referral; the belief that early detection will improve breast cancer outcomes; and, the belief that a mammogram is an effective test. Factors deterring women from having mammograms include: lack of physician referral; cost; and, the belief that mammography is dangerous. Research findings point to the need for a comprehensive, integrated approach to increasing utilization rates. This approach includes recommendations for increasing physician referrals, modifying service delivery, training staff, and development of client education materials and a public information campaign. These recommendations have been incorporated into a social marketing plan to increase utilization of mammography services in the state of Kentucky.

VERB™ Summer Scorecard: Increasing Tween Girls' Vigorous Physical Activity

OBJECTIVE We assessed changes in the frequency of self-reported physical activity (PA) among tween girls exposed and not exposed to the VERB™ Summer Scorecard (VSS) intervention in Lexington, Kentucky, during 2004, 2006, and 2007. METHODS Girls who reported 0-1 day per week of PA were classified as having little or no PA. Girls who reported 2-3 days of PA were classified as low PA performers; 4-5 days of PA were labeled as moderate performers; and 6-7 days of PA were identified as high performers. Logit regression analysis of survey data from girls identified trends in PA frequency across time. RESULTS In 2004, participant girls were more likely than girls unfamiliar with VSS (reference group girls) to report high frequency of PA (OR = 1.44, CI = 1.18, 1.70). In 2006, participants were statistically less likely than reference group girls to report low frequency of PA (OR = 1.75, CI = 1.33, 2.21). In 2007, VSS participants were consistently more likely to report moderate frequency (OR = 1.56, CI = 1.35, 1.77) and high frequency of PA (OR = 1.44, CI = 1.24, 1.64) than reference group girls. CONCLUSION An innovative, community-driven intervention demonstrated promise for increasing PA among tween girls. VSS may have transportability to other communities to help reverse the secular trend of declining PA for this population segment.

Grab ‘N’ Go Breakfast at School: Observations from a Pilot Program

Daily breakfast consumption has been associated with maintenance of healthful weight in youth and improved cognitive performance in the classroom. In one study, less than 50% of middle school youth reported eating breakfast daily. The United States Department of Agriculture (USDA) suggests ‘‘Grab ‘N’ Go’’ as a strategy for increasing school breakfast program participation. Grab ‘N’ Go is a school-based meal delivery concept that enables children and youth to select healthful food options quickly, easily, and economically. In 2004, a Grab ‘N’ Go breakfast program founded on USDA suggestions was developed by a Kentucky-based public health coalition, with input from coalition members, a youth board, school nutrition management and staff, and the school principal, as well as data obtained from 11 focus groups with parents and 9to 13-year-olds.

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.

Nutrition and fitness education in the workplace

The goal of our project is to encourage our 320 co-workers to improve their nutrition and fitness behaviors so they can enhance their own health and become more effective health educators. Because our co-workers make thousands of health-related contacts a month, they are an important and influential group to reach. Health-care professionals who practice good nutrition and fitness habits are likely to be more credible and dynamic when conveying this information to clients. The majority of health department employees know the principles of nutrition