Among public health communication and marketing professionals, there is a growing sense of excitement about new media. New media-defined as those media that are based on the use of digital technologies, such as the Internet, computer games, mobile phones, and digital television- are seen as potentially valuable tools for implementing public health communication campaigns. By increasing interaction and engagement, new media may aid traditional public health campaigns in raising awareness, spreading influence, and ultimately, changing behavior.

The use of many forms of new media has become widespread among the U.S. population. According to recent surveys by the Pew Internet and American Life Project, three out of four American adults use the Internet,¹ and of those, 48% visit videosharing sites such as YouTube,² 39% read blogs,¹ and 16% use social networking sites such as Facebook or MySpace.1 Furthermore, 75% of U.S. adults have cell phones, and of those, 62% use their cell phones for accessing the Internet and/or participating in other digital activities such as texting, taking pictures or recording a video.³ These use statistics provide a strong argument for the integration of such media into traditional communication campaigns.

Yet, despite the widespread use of new media by the public, there are few instances where new media have been used in the context of public health campaigns and even fewer which have been documented in the published literature. This volume of Cases in Public Health Communication & Marketing is devoted to addressing this gap. In this volume, we have solicited case studies which represent instances of new media being used in the development, dissemination and/or evaluation of public health media campaigns.^4-8 By bringing together a collection of such cases into one volume, it is our hope that these cases can serve as models which inspire the design of future public health campaigns. Furthermore, by bringing together such cases, we hope to elucidate both what we already know and what we need to know about using new media effectively in public health media campaigns.

The campaigns described in this volume ranged in budget, scope and media platforms used (See Table 1, next page, for an overview of campaign media). The Verb Campaign was a national, governmentsponsored campaign with a multimillion dollar budget,⁴ while the campaign waged by Sustainable Table was sponsored by a small non-profit with much more limited resources and budget.⁷ Yet, despite differences in size and scope across all campaigns, there were many commonalities. All campaigns made use of new media in combination with traditional forms of media. Most campaigns had new media efforts which consisted of a website, a profile on various social networking sites, videos posted to video sharing sites, and a blog or vlog (video blog). Additionally, a couple of campaigns - the Verb Campaign and It's Your (Sex) Life - made use of text messaging and interactive games. These two campaigns also embraced the functionalities of user-generated content (UGC), and allowed the target audience to be the creators of parts of their new media campaign content.

Most encouraging was that all campaigns were, in fact, found to be successful - at least with some of their efforts - in using new media to expand the dissemination of their campaign messages. Whether measured with page views to websites, downloads of campaign videos, or numbers of text messages sent, all campaigns were able to generate significant exposure to their campaign materials with new media. This was found to be true even for the campaigns with tightly restricted budgets for ad distribution such as RE3.org which by posting its ads on YouTube was able to generate over 30,000 additional views of its campaign ads.⁶ In addition to dissemination, new media proved to be valuable in increasing the longevity of campaigns. For example, Verb was able to significantly prolong the life of its campaign after the campaign budget ended, as the ads posted on YouTube and its website continued to receive many downloads and views after the campaign officially ended.⁴

The ability of new media to increase dissemination or extend campaign length speaks to the fact that many of the tools for creating and serving new media are available free on the Internet or for a nominal price (See Table 2 for a description of new media resources). While some of these may take only seconds to make use of (e.g. posting an existing ad on YouTube), other applications may consume many human resource hours for their creation and maintenance (e.g. creating and maintaining a blog). That said, in general, once traditional campaign materials are developed, the additional resources required for new media appears to be comparatively minimal, and those efforts may have longlasting effects.

A second lesson from these cases is that not all new media platforms are equally successful. One of the components with mixed reviews was the blogs. While most of the campaigns created a campaign blog, blogs varied significantly in their ability to attract traffic and generate interaction. The vlogs (video blogs) created by MTV viewers for the It's Your (Sex) Life campaign generated over 60,000 views in one week when they were featured on the homepage of MySpace.⁸ However, both the RE3.org and the Sustainable Table blogs were not highly trafficked and received few comments per blog posting, with more postings occurring for action-oriented items.^6,7 Data on blog use need to be carefully considered in designing public health interventions, and significant attention may need to be paid to the promotion of blogs.⁷ For example, Sustainable Table was able to increase blog traffic from 2,800 to 10,000 users per month by introducing guest bloggers and increasing their online and offline blog promotion efforts.⁷

Finally, and perhaps most importantly, these cases illustrate that there is a need for evaluations which inform campaign planners not only about how many times a given component of a campaign was viewed (e.g. total page views), but by whom it was viewed and to what effect. Attention needs to be paid to whether those consuming new media are in fact members of the intended target audience and, more importantly, to whether new media efforts are reaching a large proportion of the target audience. Furthermore, outcome evaluations which measure changes in beliefs, attitudes and behaviors are necessary to understand whether new media efforts are in fact contributing to the intended campaign effects. This kind of measurement goes beyond tracking the reach of the campaign, which continues to be the most common monitoring and evaluation parameter for new media-based interventions.

One campaign in this volume, which went beyond tracking reach was the Parents Speak Up National Campaign sponsored by the U.S. Dept of Health and Human Services.⁵ This campaign used an existing, commercially-available Internet panel to conduct an outcome evaluation. The Internet panel was surveyed on multiple occasions to evaluate whether ads from the campaign changed beliefs and behaviors related to parent-child communication about sex. Campaign planners can evaluate campaigns, as in this case, by buying access to an existing Internet panel or, in cases where they have direct access to the target audience and can create their own sample, by using Internet-based survey tools like Survey Monkey to conduct surveys. Using either methodology, future studies should seek to document the impact of online activities on behavior in order to assess the cost-effectiveness and efficacy of new media efforts. Granting agencies should encourage smaller organizations to conduct these kinds of evaluation studies by providing dedicated funds for the measurement of behavioral results.

We hope that readers of these cases will see the early signs of success and be inspired by them and motivated to develop the next generation of new media public health interventions. As researchers and practitioners, we should continue to monitor data on new media use, establish standard protocols and guidelines for its use, and generate measurable and replicable outcomes of its use. With the explosion of UGC, we should also continue to explore campaigns where the target audience is an integral part of the health communication and marketing process. Through these steps, we will be able to help public health professionals and organizations take full advantage of the opportunities presented through new media.

Acknowledgments

The authors would like to thank Nalini Padmanabhan for assistance in the development of Tables 1 and 2.

References

1. Pew Internet and American Life Project Tracking Surveys ( March 2000-February-March 2007 ) http:// www.pewinternet.org/trends/Internet_Activities_6.11.07.htm, Pew Internet and American Life Project. Accessed 11th June, 2007.
2. Raine, L. (2008) Pew Internet Project Data Memo: Video Sharing Websites. January 9, 2008. Pew Internet and American Life Project. www.pewinternet.org/pdfs/Pew_Videosharing_memo_ Jan08.pdf Accessed June 10, 2008
3. Horrigan, J. Mobile Access to Data and Information. March 5, 2008. Pew Internet and American Life Project. http://www.pewinternet.org/PPF/r/244/report_display.asp. Accessed June 10, 2008
4. Huhman, M. New Media and the VERB™ Campaign: Tools to Motivate Tweens to be Physically Active. Cases in Public Health Communication & Marketing. Volume 2, July 2008. Available from: http://www.casesjournal.org/volume2
5. Evans, WD; Davis, KC; Zhang, Y. Health Communication and Marketing Research with New Media: Case Study of the Parents Speak Up National Campaign Evaluation. Cases in Public Health Communication & Marketing. Volume 2, July 2008. Available from: http://www.casesjournal.org/volume2
6. Hamilton, L; Dennings, K; Abroms, LC. Promoting Recycling in North Carolina with New Media: the RE3.org Campaign. Cases in Public Health Communication & Marketing. Volume 2, July 2008. Available from: http://www.casesjournal.org/volume2
7. Williams, A; Zraik, D; Schiavo, R; Hatz, D. Raising Awareness of Sustainable Food Issues and Building Community via the Integrated Use of New Media and Other Communication Approaches. Cases in Public Health Communication & Marketing. Volume 2, July 2008. Available from: http://www.casesjournal.org/volume2
8. Hoff, T; Mishel, M; Rowe, I. Using New Media to Make HIV Personal: A Partnership of MTV and the Kaiser Family Foundation. Cases in Public Health Communication & Marketing. Volume 2, July 2008. Available from: http://www.casesjournal.org/volume2

Author Information

Lorien C. Abroms, ScD is an assistant professor at The George Washington University School of Public Health and Health Services. She is the supervising editor for Volume 2 of Cases in Public Health Communication & Marketing. Renata Schiavo, PhD, MA is a Senior Health Communications Consultant and the Founder and Principal of Strategic Communications Resources. She is also an Adjunct Assistant Professor of Public Health at New York University, Steinhardt School, Department of Nutrition, Food Studies and Public Health. R. Craig Lefebvre, PhD is an Adjunct Professor at The George Washington University School of Public Health and Health Services. He is an architect and designer of public health and social change programs and produces the blog "On Social Marketing and Social Change" [socialmarketing.blogs.com].