Drugs + HIV: Learn the Link Campaign:
How IQ Solutions and the National Institute on Drug Abuse (NIDA)
Adapted a Television PSA for Hispanic Teens

Everly Macario, ScD, MS, EdM, Senior Social Marketing Strategist, IQ Solutions, Inc. , 11300 Rockville Pike, Suite 901, Rockville, MD 20852; 773-752-7732; Everly_Macario_ScD97@post.harvard.edu

Jennifer A. Isenberg, MS, Project Manager, IQ Solutions, Inc. , 11300 Rockville Pike, Suite 901, Rockville, MD 20852; 240-221-4307; jisenberg@iqsolutions.com

Ileana Quintas, Senior Strategist and Chief Executive Officer, IQ Solutions, Inc. , 11300 Rockville Pike, Suite 901, Rockville, MD 20852; 301-984-4416; iquintas@iqsolutions.com

(pdf version)

Abstract

The National Institute on Drug Abuse (NIDA) launched the Drugs + HIV: Learn the Link Campaign to raise young people's awareness of the intersection of non-injection drug abuse, risky sexual behaviors, and HIV transmission. This case study examines the approach used to culturally adapt, or "transcreate," NIDA's Text Message television PSA-designed for all youth, with an emphasis on reaching African Americans and females age 13 to 18-so that it would be appropriate for a different audience: Hispanic teens. To reinforce knowledge and motivate Hispanic youth to "use their brains, keep their bodies healthy, and stay drug free" (the Campaign's tagline), we tailored the way consequences of drug abuse are portrayed in the adapted PSA. This process included making audience-specific decisions on several PSA elements, including who should serve as the main character's confidant (family member instead of friend); the main character's reaction to her HIV diagnosis (appropriate level of emotion); characteristics of the actors (Hispanic in appearance and a mix of ethnicities represented at a party); technology type represented (cell phone text messaging); terminology and music used (universal teen slang and Reggaetón); extent of mixing English with Spanish (some Spanish in primarily English content); and storyline (niece sets up an in-person meeting via text message to tell her aunt she is HIV-positive, with the underlying message that family will help). The "transcreation" process made for a culturally relevant final product and allowed for cost savings in the concepting and scripting phases.

BACKGROUND

The connection between drug use and unprotected sex is an especially perilous one. In addition to the direct threat of HIV transmission through shared intravenous needles, non-injection drug and alcohol use also increase the chance of contracting HIV by adversely affecting the parts of the brain used to make decisions. By compromising the ability to weigh risks, drug use can cause an increase in unsafe sex behavior that can lead to HIV infection. In 2005, the National Institute on Drug Abuse (NIDA) launched the Drugs + HIV: Learn the Link Campaign to raise young people's awareness of this link between non-injection drug use, risky sexual behaviors, and HIV transmission.

NIDA launched Phase I of Drugs + HIV: Learn the Link in conjunction with World AIDS Day 2005 (December 1). The campaign included a television public service announcement (PSA) called Text Message. The campaign's initial target audience included young people age 13 to 18, with an emphasis on reaching African Americans and females in this age group, as African Americans are hit the hardest from HIV and females are increasingly being affected by HIV.^1,2 The campaign incorporated a multicultural, age-appropriate theme of text messaging (sending brief text messages by cell phone), a popular trend among the teenage target audience.

During Phase II of the campaign, NIDA extended its campaign reach to Hispanic teens, members of the fastest growing ethnic group in the United States (see Figure 1)3 who are also disproportionately affected by HIV.⁴

Purpose of this Case Study

In this case study, we outline and examine the approach we chose to guide the cultural adaptation of NIDA's Text Message PSA so that it would be appropriate for Hispanic teens age 13 to 18, a process known as "transcreation. " The Drugs + HIV: Learn the Link Campaign cycle entailed a full continuum of program management aspects-from an initial strategic plan to implementation and evaluation. This case study, however, focuses exclusively on how consumer and opinion leader research informed the development of the "transcreated" PSA. The resulting PSA (called After the Party) represents one component within NIDA's larger Drugs + HIV: Learn the Link umbrella campaign. Descriptions of partnering activities, grassroots outreach, collateral materials, promotion efforts, dissemination strategies, and budget items are available elsewhere.^*

METHODS

IQ Solutions, Inc. ^α employed a 10-step process to create a television PSA appropriate for Hispanic youth living in the United States. See Table 1 for a summary of the steps used to culturally adapt NIDA's Text Message PSA. These steps are fleshed out in the section below.

Phase I: Created an English-language PSA, Text Message, and released it on World AIDS Day 2005 (December 1)⁵

In advance of World AIDS Day 2005 (December 1), IQ Solutions and NIDA developed a PSA for television that capitalizes on teens' growing use of cell phones and text messaging as a means to communicate. The PSA opens with a young African American girl strolling down a city sidewalk, stopping to respond to a message on her cell phone. The exchange, which is visible to the audience on the screen, follows: ^Β

As the two friends exchange text messages, the visual is now a sequence of party scenes-a flashback montage suggestive of drug-taking that leads to sexual involvement. The sequence carries the message that drugs impair judgment and can result in risky sexual behavior and subsequent HIV infection.

Phase II: Initiated and carried out a multi-stage "transcreation" process for culturally adapting the Text Message PSA

Step 1. Conducted an environmental scan

IQ Solutions conducted an environmental scan to capture statistics related to HIV/AIDS and drug abuse within Hispanic populations; appropriate media channels for reaching them; and methods for developing audience-specific materials. The scan findings are presented below.

HIV, Drugs, and Risky Behaviors: A Concern for Hispanic Teens

Hispanic youth represent a large and fast-growing segment of the United States population. Over the next 10 years, the number of Hispanic teens is expected to grow by 25 percent, from 3.3 million to 4.1 million.⁶

Hispanic teens (age 13 to 19) are disproportionately affected by HIV/AIDS. Although this group represents only 16 percent of teenagers in the United States, it accounted for 21 percent of new AIDS cases reported among teens in 2003^.4 AIDS prevalence among Hispanics is clustered in a few states, with 87 percent of new cases and 89 percent of Hispanics living with AIDS concentrated in just 10 states.⁴

Drug use and unprotected sex are the two main routes of exposure to AIDS for Hispanic people. Men and adolescent boys have been nearly as likely to be infected by unprotected sex with men as by intravenous drug use, while women and adolescent girls were more likely to be infected as a consequence of their own intravenous drug use or that of a male sex partner. As of 2004, 43 percent of the 136,560 HIV cases reported for Hispanic males had resulted from unprotected sex with other men, while an almost equal proportion, 39 percent, resulted from intravenous drug use alone or in combination with unprotected sex with men. For the 32,801 Hispanic females infected with HIV in the same period, 56 percent was due to intravenous drug use (37 percent directly, 19 percent to a male sex partner who used intravenous drugs), while 27 percent resulted from unprotected sex with a man.⁷

According to surveys conducted in 2002 and 2003, Hispanic youth age 12 to 17 were as likely as their non-Hispanic peers to report abusing prescription drugs, and admitting to using inhalants and cocaine with slightly greater frequency. Those born in the United States, who represent 77.8 percent of all Hispanic youth, were much more likely than their immigrant peers to report abusing alcohol and illegal drugs in the prior month, and they were somewhat more likely than non-Hispanic Americans to report using illegal drugs.^8‡

Geography and Nationality: Location Matters

The United States Hispanic population is highly concentrated in a few states. As of the 2000 Census, 80% lived in the following states: New Mexico, California, Texas, Arizona, Colorado, Florida, New York, New Jersey, and Illinois.³ See Figure 2 for a visual image of the distribution of Hispanics in the United States.

Although AIDS cases among Hispanics have been reported throughout the country, the impact of the epidemic on this population is not uniformly distributed. The Northeast has the greatest proportion of Hispanics estimated to be living with AIDS (38%) and new AIDS cases among Hispanics (36%)⁴ See Figure 3 for a ranking of states based on the number of Hispanics living with AIDS.

In the United States, Hispanics representing varying countries of origin tend to cluster in different geographic regions. Many Spanish speakers who live in the East are of Puerto Rican, Cuban, or Dominican (i.e., Caribbean) origin, while on the West Coast, the heritage is mostly Mexican. People of South American origin are more randomly scattered throughout the country. See Figure 4 for a breakdown of Hispanic sub-populations by region of the country.⁹

Hispanics watch more television on average than do other Americans (3.6 hours per day vs. 3.2 hours per day).¹⁰ In a 1997 study, 70 percent of Hispanics surveyed had heard about HIV/AIDS in the last month from a television news program, 44 percent from a television entertainment show, 42 percent from talk/call-in radio shows, and 34 percent from other radio programming.¹¹

Broad exposure to media channels does not indicate a generic mainstreaming of taste or media preference, however-cultural context matters. One factor is the sometimes dramatic variation in media consumption by ethnic subgroups. Central American Hispanics, for example, are the most likely subgroup to watch television, while Cuban Americans are the most likely to read weekly magazines.¹²

Another factor is a striking determination to maintain ties to distinctive cultural practices and institutions, even as the younger generation develops a parallel fluency in the "mainstream" Anglo culture. Hispanics in the United States tend to maintain their culture by adhering to traditional language (Spanish) and placing emphasis on family, food preferences, religious customs, and festivities. This attachment to Hispanic distinctiveness suggests that bilingual ability will become a marker of "cool" and will trend upward, rather than fade away due to assimilation.¹³ So, despite the many sources of diversity in Hispanic culture, there is also profound commonality that ultimately derives from shared Catholicism, Spanish language, and Latin American roots.¹⁴

Public health messages targeted toward Hispanic people can be created in one of three ways: 1. creation from scratch (i.e., not modeled on existing materials); 2. through "transcreation" (e.g., adaptation from another version); or 3. by direct, word-for-word translation (i.e., attention to literal, not conceptual, translation). Each of these methods has advantages and disadvantages related to time commitment (e.g., number of layers of study during formative research), resources (e.g., budget, labor, expertise), and specificity (e.g., cultural and linguistic accuracy and relevance to the intended audience).

While "creation from scratch" yields the most specificity, and therefore a product that most likely will resonate effectively with the target audience, it almost always requires a greater commitment of time and resources. In contrast, while direct translation is less costly, it risks yielding a product that is not as relevant to the intended population. "Transcreation"-a term used to describe a process that involves translating existing English-language materials into Spanish and then adapting them for Hispanic audiences so they sound natural to native speakers and are culturally appropriate and linguistically accurate-represents a middle ground that provides a practical alternative given the reality of limited resources.¹⁵ Figure 5^† illustrates the trade-offs among the three methods for developing materials for Hispanic audiences.

Step 2. Obtained feedback from an internal Hispanic work group

Hispanic staff at IQ Solutions and Hispanic marketing professionals in the field provided feedback on the original Text Message PSA. They commented on possible approaches for adapting visuals, language, music, color, sequence, duration, characters, and additional scenes. This input helped project staff determine how Text Message could be culturally adapted.

Step 3. Convened a Hispanic community work group

IQ Solutions convened a work group comprised of a cross-functional team of community-level individuals with expertise and insight on Hispanic teens. The role of this group was to assure relevancy of the adapted Text Message PSA to Hispanic teens.

Members included Hispanic teens, representatives from local Washington, DC-area Hispanic community service organizations, national Hispanic organizations, and NIDA staff. Members provided opinions on the effectiveness of various messages and their appropriateness for different Hispanic subgroups (e.g., Cubans, Mexicans, Puerto Ricans, Dominicans, and South and Central Americans).

Step 4. Developed three PSA concepts for testing with members of the target audience

Based on the research and development process involved in creating Text Message, as well as the environmental scan findings and advice from the internal and community Hispanic work groups, we created three culturally relevant PSA concepts for testing with Hispanic teens (flashbacks of a party scene are shown in each):

1. Dear Diary. Through inner dialogue, a teenage girl shares her personal experience dealing with an HIV diagnosis with the viewing audience.
2. Cell Phone. A teenage girl calls her cousin on her cell phone to share her recent HIV diagnosis.
3. Text Message. Two teens communicate through text messages about another girl's recent HIV diagnosis.

Step 5. Performed consumer research: Tested three PSA concepts during 12 focus groups in three cities

To test the three audience-informed concepts, IQ Solutions conducted 12 one-hour focus groups with 100 Hispanic teens age 13 to 18-four groups each in Los Angeles, Miami, and New York City. We selected these cities for our consumer research because they are located in states with a disproportionate number of Hispanics living with AIDS (see "Geography and Nationality: Location Matters" section earlier in this document). Focus groups in each city included teens with a mix of family backgrounds, reflecting the population of each city. In Miami, for example, most participants were from Cuba and South America.

In each city, IQ Solutions recruited 18 Hispanic teenage boys and 18 Hispanic teenage girls. We divided the focus groups by gender and into two age groups (13 to 15 years and 16 to 18 years). Parents gave their consent to have their children participate.

Focus groups viewed the three PSA concepts in different sequences, to ensure each PSA's fair representation, and offered feedback on PSAs separately as well as on elements that were common to all concepts. The same two bilingual moderators conducted all focus groups; the male moderated the boys' focus groups (while the female took notes) and the female moderated the girls' focus groups (while the male took notes). Two project team members also took notes and provided bilingual and client-related support at each group.

The "Link" Message. Overall, participants in the three focus group cities and across age and gender groups were positive about and clearly understood the message put forth in all of the PSA renditions. While the younger groups could cognitively make the link between alcohol, drugs, risky behavior, and HIV, they did not necessarily identify with the party scene presented.

Emotion Conveyed. Though the "link" message was clear in all concepts, most youth felt the PSAs did not convey adequate emotion. Participants in all focus groups commented that the use of cell phones and text messaging (used in the Cell Phone and Text Message concepts) depersonalized the issue. They remarked that the actors' reactions were too bland, feeling that none of the PSA renditions evoked enough of a feeling of the devastation they thought was warranted for an HIV-positive diagnosis.

Use of Technology. While the use of technology-a cell phone-helped get participants' attention, they did not find it realistic to have such a difficult conversation either over the phone or through text messaging. They suggested using the cell phone to set up a meeting with a confidant to discuss a problem of such magnitude. They also thought the cell phone and its features (style and ringing tone) should be more technologically up-to-date.

Personal Story Concept. The majority of participants liked the idea of having one person "telling" the audience her story in an inner-dialogue mode (used in the "Dear Diary" concept); it brought them closer to the scenario because the person in the spot was talking "directly" to them. They said they did not like the idea of two teens "talking about" the Hispanic girl who "got HIV" (used in the "Text Message" concept). Participants thought showing the girl taking responsibility for her actions would be more powerful than taking a gossipy angle.

Importance of Family Members. Responses varied with respect to the best person with whom to confide about having HIV. For some, a cousin might be close enough to share such news. For others, the idea of telling someone in the family was terrifying for fear of being shunned. As the honor of the family plays a large role in Hispanic culture, a major fear reported was how to tell one's parents. However, given the close ties to families, many thought they would inevitably tell their parents first.

Mixing Languages. Participants said they would prefer to be reached using a mix of Spanish and English, as this is how they speak in their every day lives. However, they added that the words used must be carefully chosen and sound natural. For example, participants reported they would not use "¡Ay Dios mío! (Oh my God!)" and "tipo (guy)" in their conversations.

The Actors. Participants, on the whole, accepted the "look and feel" of the actors from the original Text Message spot, although the girl on the cell phone was not always perceived to be Hispanic, and the teens in the party scene were perceived to be older-a nagging issue for the younger participants.

Recommendations. Based on the findings, IQ Solutions melded the Dear Diary and Cell Phone concepts, added parents as a motivator, used a mix of English and Spanish, and highlighted the emotional quality of the issue to produce two approaches for one revised concept.

Step 6. Developed storyboards for two approaches to adapting a popular PSA concept and conducted local interview testing to validate the cultural relevancy of the proposed changes

Honing in on the findings accumulated during the previous five steps, IQ Solutions interviewed a diverse group>^χ of nine bilingual teens at a Washington, DC health center to validate the cultural relevancy of potential revisions to the chosen concept, as well as to obtain feedback on Spanish translations. We asked these nine youth to react to nuances in two different approaches for the conveying the same concept.^Φ

Most of the nine teens preferred to start the PSA with the phrase "What was I thinking?" instead of "How will I tell my family?" They felt this showed reflection and remorse over the main character's past actions and enticed the audience to want to know what happens next. They all preferred to see the girl on the screen instead of a blank screen with only words, as they thought this visual evoked a gripping personal story.

Almost all of the nine youth thought the use of text message type overlaid on visuals provided an extra way for viewers to understand or catch all the words spoken in the PSA. They provided feedback on the accuracy and impact of certain phrases translated for the Spanish parts of the spot.

Step 7. Re-worked scripts, created new animatics, and re-tested concept via an online survey

Upon presentation of the culturally adapted concept and storyboards to the client (NIDA), staff requested that the PSA maintain a focus on the use of technology. They raised concern about ending the spot with the phrase, "How will I tell my family?" Some staff worried that while the phrase might be effective as a deterrent to engaging in risky behavior for teens who might already be HIV-positive, the fear of disappointing family might keep viewers from seeking help. Given the desire to end on a message of determination and hope-leaving viewers understanding that the main character can turn to her family for help-we chose to end the PSA with "I need my family" ("necesito mi familia").

Also, because family was determined to be a motivating factor for Hispanic teens, and because the fear of disappointing one's parents was noted as overwhelming by this audience, NIDA requested a "middle of the road" solution to the challenge of properly selecting the person in whom the PSA's main character confides: an aunt.

To integrate a more emotional ending and a modern cell phone (through which a text message conversation with an aunt could take place), a small re-shoot for additional, relevant footage was required. Prior to the re-shoot, IQ Solutions validated possible methods for incorporating modern technology, the aunt as confidant, and a more emotional script with 18 teens via an online survey. We asked the teens whether they liked the PSA concept in general and specifically the intermixing of Spanish and English. We also asked them whether there was anything unrealistic or confusing in the ad.

Online teens thought the ad was clear and realistic, and liked its bilingual aspect. They did not like the ad's suggestion that friends might not be looking out for you. A few thought that a teen girl would first contact a friend rather than a family member.

Step 8. Conducted targeted re-shoot to obtain additional relevant footage

In casting the re-shoot, the project team took care to re-hire the same Hispanic female main character used in Text Message and hired an "aunt" who looked similar enough to the main character to be believably related and young enough to realistically serve the role of confidant to a teen.

The goal of the re-shoot was to round out the story by obtaining footage of the main character text messaging her aunt, emotionally recounting her story, and understanding she could seek family support.

Step 9. Re-edited and re-recorded PSA

Because we changed the script and shot new footage, the project team (including a Hispanic NIDA staff member) next moved into re-editing, re-recording the voiceovers, and color correcting the footage for the culturally adapted spot. During this process, we paid attention to selecting footage and recording new voiceovers that highlighted the seriousness of the main character's situation, but left the viewer understanding that she could and would turn to her family for help.

Step 10. Produced final PSA adaptation

DISCUSSION AND LESSONS LEARNED

Hispanic youth who participated in our transcreation process-from the young age of 13 to the later teen years up to 19-clearly understood how drugs are linked to HIV. For this message to be relevant, however, it must strike a personal chord. At each step of the transcreation process, IQ Solutions and NIDA were faced with decision points and questions (listed below) that could have taken us in a multitude of directions. We knew that each decision would determine whether the PSA struck a personal chord among Hispanic teens-or not.

We had to decide whether to feature a teen girl or boy and his/her age range. Given that females are accounting for increasing numbers of AIDS cases,^16π we decided to feature a young woman and keep one of the same female actors^ψ used in Text Message. Because older teens are more likely to engage in sexual activity than younger teens,^{17 ε} and younger teens emulate older teens, we deliberately wanted the female actor to look like an older teen.

Younger girls and boys in the focus groups could not relate to a party scene as well as older girls and boys. However, younger teens appeared more sympathetic than their older counterparts to what transpires in the PSA. As younger teens are often influenced by the actions of older ones, we intended for the PSA to inspire younger teens to avoid predicaments that older ones are more likely to confront already. In fact, some younger teens reported they thought they could be faced with similar situations to those of the main character when they got older.

Focus group participants agreed that the main actress should have appeared more emotional and upset based on the weight of the HIV news. However, the project team decided against having the actress too dramatic or somber, as we suspected this might turn off audience members to our message-particularly persons living with HIV. Instead, we wanted to retain a hopeful, not fearful, message so that all viewers felt like there was help if they reached out for it.

Because target audience members insisted they would not communicate their HIV status with a confidant via cell phone, text messaging was used as a quick and practical way to set up a personal meeting to tell a confidant privately, in-person. Given text messaging's increasing popularity,¹⁸ we kept the "feel" of it as a mode of communication by typing text on the screen (rather than on the cell phone where it would be harder for television viewers to decipher).

Revealing that a person has contracted HIV, in and of itself, did not stir focus group participants' emotions. Focus group boys and girls shared that the most critical consequence of an HIV diagnosis, second only to sickness, is facing parents. Hispanic youth with whom IQ Solutions talked are keenly aware of the potential for losing face, and suffering grave disappointment, when letting parents down.

There was no consensus from the boys and girls we asked with respect to whom they would first tell about an HIV-positive test result. Many Hispanic youth said they might first tell a friend about contracting HIV, as they might not have a sufficiently close relationship to a relative outside a parent. Some were concerned that a relative beyond the nuclear family, such as a cousin, might reveal the news to the extended family. Teens told us they dreaded the idea of their parents' rejecting-or even disowning-them as a consequence of divulging this type of information. Some youth with strong relationships to cousins and aunts/uncles, however, said they would first share this kind of information with those family members before telling it to friends.

We then decided to pick a "middle of the road" solution to the challenge of properly selecting the PSA main character's confidant. Rather than a friend, for whom this kind of first-hand news would be too burdensome, or a parent, for whom this kind of news would be overwhelming, we selected an aunt. We believed an aunt could be emotionally close but distant enough to serve as a source of clear-headed support and mentorship before an HIV-positive teen girl is ready to approach her parents.

Given the strong sense of obligation to and respect for family in the Hispanic culture, NIDA chose to end the PSA with "I need my family" ("necesito mi familia"). The project team believed this would elicit a visceral reaction among our intended audience members. Moreover, we thought "family" would be broader than "parents." Explicitly avoiding the word "parents" would take attention away from the agonizing notion of having to face one's mother and father about an HIV-positive diagnosis.

Participants in our focus groups generally felt that two of the main actors in the original Text Message PSA did not "look Hispanic." While they mentioned the main actress' skin tone was not an issue, they claimed her hairstyle and make-up made her look African American or English-speaking Caribbean. They agreed, however, that the party scene portraying youth of many ethnicities paralleled their own social lives, as well as allayed their concerns about a PSA produced with an uninformed bias toward one particular ethnic group. Because existing footage from the Text Message PSA included a party scene depicting a mix of ethnicities, we used the same scene in the transcreated PSA.

IQ Solutions initially considered creating a Spanish-only PSA for Spanish-language media. As Spanish-language, bilingual, and English television stations in Hispanic markets report, Hispanic teens today more readily identify with an intermixing of English and Spanish ("Spanglish") in an ad aired on English-language, mainstream television stations than with an ad aired on a Spanish-language-only station. This is consistent with our environmental scan findings (see Step 1). It is more normative for Hispanic youth to mix English and Spanish than not, particularly when hanging out with friends. Incorporating a mix of English and Spanish also reaches parents and other key influencers in the household. ^∑ Companies such as Toyota have seized on this characteristic in their most recent advertisements.19 ∞ We realized, however, that if this hybrid way of speaking sounded contrived or "too stereotypical" in our PSA, we would lose our audience.

In the transcreated PSA, we carefully interspersed some Spanish throughout a primarily English narrative. For example, the phrase, "¿Qué estaba pensando?" (What was I thinking?), was the most popular in our testing and therefore ended up in the final PSA rendition. We included some text message language in Spanish to emphasize key points. In the final transcreated ad, English text message type over visuals is always accompanied by a Spanish voice-over and vice versa, so teens with varying abilities in either language can understand each line.

The project team selected slang terms that would be understood by teens from different countries of origin. While the word "high" for some focus group participants was associated only with the effects of marijuana, we decided to use this term anyway because it was the least confusing among the alternatives.

"Hooking up" was not necessarily interpreted as only having sexual intercourse; it also connoted kissing, petting, or dating. Target audience members said this term is often associated with a one-time encounter rather than with a relationship with a steady boy- or girlfriend. The project team agreed that the smaller message that someone can contract HIV even by "hooking up" with someone just once would drive the larger PSA's message home even harder.

IQ Solutions' formative research told us that music for a PSA on the topics of drugs and HIV should not be overly upbeat. We knew the music we selected, additionally, could not distract from the PSA's message.

Because of the cross-over interests of non-Hispanic and Hispanic teenagers (including those musically related),²⁰ we blended Latin-influenced Reggaetón with general market Hip Hop music in the transcreated PSA's party dancing scene.

There was consensus by the target audience that the PSA's message was driven home when the music suddenly comes to a screeching halt. They said that this obvious change in tone forces viewers to focus on the key message of the PSA, and hooks one in emotionally.

IQ Solutions' focus group research showed, in unanimity, that the camera had to unambiguously indicate that alcohol and drugs were both brought to the party, and to show that pills were given to the main actress. The purpose of focusing on pills was to enhance the PSA's realism and believability. Many focus group participants perceived the pills in the PSA to be Ecstasy, a drug they considered would cause a young person to "lose control."

To provide authenticity, IQ Solutions learned from the transcreation process that we had to refer to actors' characters by their "real" proper names. The use of names (e.g., "Carlos" and "Ana") in the party scene gives partygoers a face and breeds familiarity. The intention was to help PSA viewers imagine themselves in the party scene.

Feedback also indicated that focusing on a single actor to deliver the message, as opposed to shifting the conversation between two people, would enhance clarity. Focus group participants supported the concept of an inner dialogue, as this introspective perspective would be what would happen in reality.

Critical decision points

Some youth surveyed during the transcreation process did not like the idea of portraying friends getting other friends in trouble. Several focus group participants shared their belief that they did not think their friends would steer them in the wrong direction, such as by offering potentially harmful drugs. While this may be true, we also heard that the party scene, including drug sharing, is typical in the teen years when peer pressure reigns.

Older boys in the focus groups, more often than younger boys, felt they would not succumb to risky behaviors, as they claimed to have the ability to control themselves even when impaired by the effects of alcohol and drugs. Perhaps this sentiment was felt because the test PSA concepts featured a female instead of a male who contracts HIV. A handful of boys admitted to feeling the girl in the PSA "deserved what she got."

One of the most critical decisions we had to make was how dramatic to ask the main female actor to behave as she reflects about the night of the party. The final transcreated PSA does not show her "freaking out" because we did not want to offend those persons living with HIV/AIDS who might view the PSA. We wanted to underscore the message that there is help if needed upon such a diagnosis. This was a tricky balance to strike-we needed the actor to convey enough emotion to instill the gravity of such a situation yet not have her be overly dramatic for risk of disconnecting the audience or unintentionally marginalizing those viewers living with HIV/AIDS.

CONCLUSIONS

Utilizing a comprehensive transcreation model is a viable and effective option for creating a PSA and can have advantages over both direct translation and creation from scratch. Our transcreation process made for a culturally relevant final product and allowed for cost savings in the concepting and scripting phases.

In addition to being appropriate for the targeted Hispanic teen audience, the transcreated PSA strengthened the overall branding of the campaign by extending the campaign message. The original Text Message PSA portrayed two young women telling the story of a third young woman's HIV diagnosis; the transcreated After the Party PSA delved more deeply into the inner thoughts and angst of this third young woman. The theme and "look and feel" of both PSAs are obviously similar and therefore will be recognizable to viewers as falling within the same unifying campaign.

The rigorous transcreation method of adaptation was critical for assuring the target audience would not be not offended or confused, but rather connected to the message and motivated to action. The project team involved members of the target audience (Hispanic teens) from the start to ensure the relevance of messages directed to them. While we used some existing conceptual and scripting ideas, talent, and footage to save costs, we also engaged in a targeted re-shoot to get the visuals just right for the adapted story.

Hispanic youth on the whole seem to clearly understand the consequences of illicit drug, as well as alcohol, abuse, including the possible risk of contracting HIV. To reinforce this knowledge base and elevate teens' motivation to "use their brains, keep their bodies healthy, and stay drug free" (the Campaign's tagline), it was critical to culturally tailor the way the consequences of drug abuse are portrayed in the adapted PSA according to what genuinely resonates with Hispanic youth. This included making decisions on factors such as the person selected as confidant and her reaction; characteristics of the actors; technology, terminology, and music selected; extent of mixing English with Spanish; and storyline.

IQ Solutions looks forward to evaluating the impact of the transcreated PSA as the campaign unfolds.

ACKNOWLEDGEMENTS

IQ Solutions, Inc. would like to thank the National Institute on Drug Abuse (NIDA), Mary's Center for Maternal and Child Care, Identity, Inc., the Duke Ellington School of the Arts, and all of the teens and experts who made the transcreated PSA possible.

^* Contact Jennifer Isenberg, an author of this case study, for more information on these activities.

^αIQ Solutions, Inc. is the health communications contractor to the National Institute on Drug Abuse (NIDA).

^βSee the appendix to this case study for the storyboard used to create the final Text Message PSA. To view the Text Message PSA, visit http://www.hiv.drugabuse.gov/.

^‡17.1 percent native-born/14.1 percent immigrant Hispanic youths reported alcohol use in the previous month; 10.3/8.5 binge alcohol use; and 12.3/5.7 illicit drug use.

^†Figure 5 was created by Everly Macario and Jennifer Isenberg, authors of this case study, in 2006.

^χYouth represented a mix of gender, age, countries of family origin, birth country, and length of time in the United States.

^ΦSee the appendix to this case study for the storyboards used during this phase of the testing (Step 6).

^λTo view the transcreated 30-second PSA (After the Party) visit: http://www.hiv.drugabuse.gov/.

^πFrom 2001 through 2005, the estimated number of AIDS cases in the United States increased 17% among females and 16% among males.

^ψ This actress was not only familiar with our project, focus group participants also reported she "looked" Hispanic.

^ε The median age at first intercourse is 16.9 years for boys and 17^.4 years for girls.

^∑During the June 2006 focus group recruitment and screening process, we asked 120 teens about their viewing habits:

• The majority of Hispanic youth (51 percent) watched only English-language TV.
• About 45 percent of youth watched both English- and Spanish-language TV.
• Only 4 percent watched Spanish-language TV exclusively.
• Teens said they are most likely to watch Spanish-language programs with their parents.

^∞During the 2006 Super Bowl, Toyota launched a "hybrid" commercial featuring English and Spanish to showcase the 2007 Camry Hybrid, which runs on gas and electrical power. The spot features a Hispanic father and his son driving in a Camry Hybrid. Though the father speaks English, a Spanish accent is detectable. The son, however, speaks perfect English with no trace of an accent. The father explains how the new hybrid can switch back and forth between gas and electric power. His son immediately relates his family's experience to the vehicle and says, "Like you, with English and Spanish!" The father tells his son why he speaks two languages and why he bought a hybrid: "I'm always thinking of your future." The ad concept leverages the hybrid nature of blending languages and culture while preserving a unique identity. To view the ad, visit http://video.google.com/videoplay?docid=-4484245883891789484.

REFERENCES

1. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2004. Vol. 16. Atlanta: US Department of Health and Human Services, CDC; 2005:1-46.

2. Anderson RN, Smith BL. Deaths: leading causes for 2002. National Vital Statistics Reports 2005;53(17):67-70.

3. Pew Hispanic Center, Hispanics: A People in Motion (Trends 2005). http://pewhispanic.org/files/reports/40.pdf.

4. The Henry J. Kaiser Family Foundation, HIV/AIDS Policy Fact Sheet—Latinos and HIV/AIDS, Fact Sheet #6007-03, February 2006. http://www.kff.org/hivaids/upload/6007-03.pdf.

5. Information on NIDA's Text Message PSA: "NIDA Involves Students in Development of HIV Public Service Announcement." http//www.nih.gov/nihrecord/12_16_2005/story04.htm. Accessed December 18, 2006.

6. Elena del Valle, ed., Hispanic Marketing and Public Relations: Understanding and Targeting America's Largest Minority 2005 (companion Web site http://www.HispanicMPR.com), 133.

7. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, vol. 16, Cases of HIV Infection and AIDS in the United States, 2004, tables 19a, 21a. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2004report/default.htm.

8. NSDUH Report: Substance Abuse Among Hispanic Youths, August 19, 2005. http://oas.samhsa.gov/2k5/HispanicYouth/HispanicYouth.htm.

9. Hispanic/Latino Market Profile. Magazine Publishers of America. U.S. Census Bureau 2000. www.magazine.org/content/Files/MPAHispMktPro.pdf.

10. Media Giants Are Glued to Latino TV. BusinessWeek Online. September 24, 2001. http://www.businessweek.com/magazine/content/01_39/b3750042.htm. Accessed 12/21/06.

11. Kaiser Foundation, "Two New Studies on Latinos and AIDS in America," May 1, 1998. http://www.kff.org/hivaids/1392-latinospr.cfm.

12. Public Service Hispanic Outreach, on White Paper Online. http://www.radioaccessreports.com/hispanicwhitepaper.html.

13. Meneses Research http://www.mensesresearch.com/hispanic_markets.htm.

14. Latino Health in the U.S.: A Growing Challenge. Edited by Carlos W. Molina and Marilyn Aguirre-Molina. American Public Health Association. Washington, DC. 1994.

15. Felicia M. Solomon, Alicia C. Eberl-Lefko, Margo Michaels, Everly Macario, Gina Tesauro, Julia H. Rowland, "Development of a Linguistically and Culturally Appropriate Booklet for Latino Cancer Survivors: Lessons Learned," Health Promotion Practice 6.4 (October 2005):405-413.

16. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2005. Vol. 17. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2006: page 6. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/.

17. The Henry J. Kaiser Family Foundation, U.S. Teen Sexual Activity Fact Sheet, Fact Sheet #3040-02, January 2005.

18. Carolyn Y. Johnson, "Do u txt ur kdz?" The Boston Globe. December 17, 2006.

19. Information on Toyota's Camry Hybrid ad: http://www.tundrasolutions.com/forums/toyota-scion-and-lexus-news/56068-toyota-launches-all-new-camry-hybrid/. Accessed on 12/18/06.

20. Natalie Boden, BodenPR. Adding "Gasolina" to your Marketing Strategy: Four Tips to Reaching U.S. Hispanic Youth. http://www.hispanicmpr.com/resources/articles/adding-gasolina-to-your-marketing-strategy-four-tips-to-reaching-us-hispanic-youth/. Accessed on 1/10/07.

STORYBOARD FOR ORIGINAL TEXT MESSAGE PSA (2005)

STEP 6. STORYBOARDS TESTED (2006)- TWO DIFFERENT APPROACHES FOR THE SAME CONCEPT FOR THE TRANSCREATED PSA