Abstract
Purpose:
To assess if exposure to the Choose Water public health media campaign increased parents’ intentions to promote healthier beverage consumption in their household.
Design:
A cross-sectional evaluation administered post-campaign.
Setting:
A 2017 internet panel survey in Los Angeles County, California.
Participants:
The survey included 499 parents of young children.
Intervention:
The Choose Water media campaign included digital media and out-of-home advertisements (eg, transit shelters, interiors of buses) in both English and Spanish.
Measures:
Dichotomous outcome variables were parental intentions to give child(ren) (1) more water and (2) less sugar-sweetened beverage consumption in their households. The independent variable was campaign exposure, categorized as no exposure, exposed but did not discuss visual, and exposed and discussed visual with someone.
Analysis:
Descriptive, bivariate, and multivariable logistic regressions.
Results:
Among those who were exposed and discussed a campaign visual, the adjusted odds of intending to promote water consumption were 2.82 times greater than for those who reported no exposure (95% confidence interval [CI]: 1.46-5.46). Similar odds to promote less sugar-sweetened beverage consumption were observed for those who were exposed and discussed a campaign visual (adjusted odds ratio: 3.27, 95% CI: 1.76-6.08). Those with the lowest educational attainment discussed the visual(s) less (10.5%).
Conclusion:
Word of mouth may enhance health messaging by allowing time for intended audiences to process campaign content within their interpersonal network.
Purpose
Excess consumption of sugar-sweetened beverages (SSBs) is a major contributor to obesity. 1 For children, successful weight management can be achieved when SSBs are replaced with noncaloric beverages 2 such as water. Unfortunately, SSB consumption remains high for children in low-income households. In Los Angeles County (LAC), 16% of lower income children consumed at least 1 regular soda per day as compared to 2% of children from higher income households. 3 Several states and local jurisdictions have implemented public health media campaigns as a strategy to discourage at-risk populations from consuming excess SSBs. 4,5
The present study evaluates the impact of a media campaign on parental intentions to promote more water and less SSB consumption among LAC low-income households with young children. We describe how varying levels of campaign exposure, particularly whether seeing a visual and discussing its content with someone, affected parental intentions. The study addresses 3 gaps in the literature. First, few studies have examined campaigns that target parents’ beverage decision-making for their children. 5,6 Second, investigators typically have not examined whether participants discussed campaign content with someone in their interpersonal network, despite findings that media exposure coupled with conversations about the content may help increase healthy behaviors. 7 Lastly, media evaluations have not routinely examined campaign receptivity by socioeconomic status (SES); media exposure and health behaviors can vary by SES. 8
Methods
Design and Sample
The LAC Department of Public Health (DPH) initiated the Choose Water campaign between 2015 and 2017; campaign visuals are depicted in Figure 1. To assess the campaign’s reach and potential impact, a 20-minute Internet panel (post-campaign) survey, available in English and Spanish, was administered to LAC parents in March 2017. The survey sample was derived from an online research panel in which potential participants were contacted via e-mail and then recruited into the study only if they met eligibility-based screening criteria. Eligible survey participants were between 18 and 74 years of age, lived in households with incomes less than $100 000, and provided care for at least one child between 1 and 7 years of age. Of the 1252 contacted, 501 were eligible and completed the entire survey (40%). The final analytic sample (n = 499) excluded 2 respondents who were missing information on education.
Choose Water campaign images.
Measures
The study had 2 dichotomous dependent variables which captured household intention to change water and SSB consumption. All participants were shown the Choose Water campaign visuals and then asked to indicate their agreement with each of the following statements: (1) “This ad makes me want to take action and give my child(ren) more water to drink”; and (2) “This ad makes me want to give fewer sugar-sweetened beverages to my child(ren).” In analyses, responses were coded as 0 if participants reported “disagree somewhat/disagree strongly/neither agree nor disagree/agree somewhat” and 1 if participants reported “agree strongly.”
The independent variable was self-reported exposure to the Choose Water campaign. Participants were shown the campaign images and then asked the following main question: “Before taking this survey had you seen this advertisement or any other images associated with the campaign?” Participants who answered “yes” were asked a follow-up question: “Did you speak [discuss] with anyone about these ads or did someone bring them up to you in conversation?” In the analyses, a 3-category exposure variable was created based on responses to the main and follow-up question. Responses were coded as 0 (ie, “not exposed”) if respondents reported “no” to the main question, 1 (ie, “exposed but did not discuss the visual[s]”) if respondents reported “yes” to the main question and “no” to the follow-up question, and 2 (ie, “exposed and discussed the visual[s]”) if respondents reported “yes” to both the main and follow-up questions.
Covariates included gender, age, race/ethnicity, educational attainment, total annual family income before taxes, number of children under age 18 years in the household, and knowledge regarding SSB consumption.
Intervention
The Choose Water campaign ran for 10 weeks in 2015 and an additional 6 weeks in 2017 distributed across LA County. Two English and 2 Spanish speaking focus groups (comprised of 8 participants each) informed the selection of campaign visuals in which participants preferred drinking water shown in environmentally friendly containers (eg, glasses, refillable bottles). The campaign included out-of-home advertisement messaging placed on approximately 700 spaces including transit shelters and interiors of buses. Digital media, social media, and radio were also utilized. There were an estimated 272 million campaign impressions.
Analysis
A descriptive analysis shows the study sample by the varying levels of campaign exposure (Supplemental 1). Bivariate and multivariable logistic regression analyses tested the association between campaign exposure and the 2 outcome variables. Study materials were approved by the DPH Institutional Review Board.
Results
Approximately 23.2% of the sample had a high school degree or less and 61.8% self-reported as Hispanic/Latino (Supplement 1). Of the total sample, approximately 17% (86/499) of survey respondents were exposed to at least one visual but did not discuss the visual with someone, while 26% (131/499) were exposed to at least one visual and had discussed the visual with someone. Exposure varied by education. While 23.2% of the total sample had a high school degree or less, only 10.5% of those “exposed and discussed the visual(s)” were from this lowest level of education.
Compared to “not exposed” participants, those who were exposed and discussed the visual(s) with someone had higher adjusted odds of intending to give their child(ren) more water to drink (adjusted odds ratio [AOR]: 2.82, 95% confidence interval [CI]: 1.46-5.46) and to give their child(ren) fewer SSBs to drink (AOR: 3.27, 95% CI: 1.76-6.08) (Table 1).
Study Outcomes After Exposure to the Choose Water Campaign, Results From the 2017 Choose Water Internet Panel Survey in Los Angeles County (n = 499).a
Abbreviations: CI, confidence interval; OR, odds ratio.
a Multivariable logistic regression analysis controlling for gender, age, race/ethnicity, education, income, number of children living in household, and knowledge regarding sugar-sweetened beverage consumption. Bold values indicate P < .05.
Discussion
Summary
The present study evaluated a large countywide, public health media campaign designed to reduce SSB consumption among low-income households with young children. Survey participants who were exposed to and discussed Choose Water visual(s) reported greater intentions to positively change the behaviors of interest. Exposure alone (without discussing the visual) was not associated with the study outcomes. Although those who both saw the campaign and discussed the visual(s) may represent a more receptive and motivated group, campaign exposure may have also increased the frequency and depth of personal conversations about health, which in turn, enhanced the participants’ motivation to change intentions through peer support. This assertion is based on empirical evidence that interpersonal communications may help explain the association between media campaign exposure and health behaviors. 8
Descriptive study findings suggested that those with lower educational attainment experienced more barriers to discussing the campaign with someone. This finding aligns with prior studies that access to and receipt of social support for behavior change are generally less available for lower income populations in the United States. 9
Limitations
Participants may not have accurately remembered seeing the visual(s). The use of aided recall was employed to mitigate this possibility. The measurement of intention, while a decent proxy, is not an indication of actual behavior change.
Significance
Public health media campaigns targeted at low-income parents may be effective if they focus on ensuring equitable opportunities to engage in meaningful dialogue about health. Creating engaging campaigns that promote interpersonal communication may be important for understanding and changing health behaviors. By encouraging these conversations, key messaging from relatively short-term campaigns could be amplified over a longer period of time, serving as a much-needed catalyst to changing social norms around SSB consumption.
So What?
What is already known about this topic?
Research shows that public health media campaigns can encourage behavior change, but little is known about the role of conversations initiated by campaign content.
What does this article add?
This study evaluates a media campaign and shows that those who were exposed and discussed the campaign visual(s) with someone had higher odds of intending to give their child(ren) more water and fewer SSBs to drink compared to those not exposed to the campaign. Those with lower educational attainment experienced more barriers to discussing the campaign with someone.
What are the implications for health promotion practice or research?
Public health media campaigns targeted at parents can focus on ensuring equitable opportunities for all populations to engage in meaningful dialogue about health.
Supplemental Material
Supplemental Material, sj-pdf-1-ahp-10.1177_0890117120908785 - Does Exposure to the Choose Water Campaign Increase Parental Intentions to Promote More Water and Less Sugar-Sweetened Beverage Consumption?
Supplemental Material, sj-pdf-1-ahp-10.1177_0890117120908785 for Does Exposure to the Choose Water Campaign Increase Parental Intentions to Promote More Water and Less Sugar-Sweetened Beverage Consumption? by Julia I. Caldwell, Brenda Robles, Rachel Tyree, Renee White Fraser, Kelly A. Dumke and Tony Kuo in American Journal of Health Promotion
Footnotes
Authors’ Note
R.T., R.W.F., K.A.D., and T.K. conceptualized and assisted with the original design of the survey. R.W.F. and Fraser Communications supervised the data collection. J.C. and B.R. conceptualized the analysis plan for the survey data. All authors contributed to the interpretation of the results and writing of the manuscript. They have reviewed and approved this version for publication. This project has been reviewed and received approval from the Los Angeles County Department of Public Health Institutional Review Board.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The project was in part supported by a grant from the First 5 LA Commission, Agreement # 08379.1. Interpretation of the data are those of the authors and do not necessarily represent the views of the Los Angeles County Department of Public Health, First 5 LA, or any organization mentioned in the text.
Supplemental Material
Supplemental material for this article is available online.
References
Supplementary Material
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