A few years back, the nation’s most notorious junk food junkie had a change of heart. Cookie Monster, who subsisted solely on the chocolate chip cookies, went from singing, “C is for cookie,” to “eat poultry and greens along with your chocolate chips.”
Cookie’s new ditty was just a small part of a larger undertaking by Sesame Street Workshop to improve the health of their young viewers and families. And thus far, their efforts have been successful at increasing awareness, a main goal of media-based public health campaigns.
The program began its focus on health in 2004, said Cynthia Barron, senior project director of outreach for Sesame Street Workshop. Barron said they noticed a lot of intervention in the area of childhood obesity around this time. Most of the efforts, however, were aimed at school-aged children – removing soda machines from schools or increasing physical education courses.
“We know habits are formed early on and it’s critical for parents to have education as well,” she said.
Sesame Street creates its programs for children between the ages of two and five years old. They gear their programs toward prevention and take on topics like good nutrition, increasing physical activity and improving oral health.
“We identify an unmet need for our target audience,” Barron said. “It is education for young children and we have great furry Muppets, but we want to make sure our messaging is on target.”
Two of their key messages are “eat your colors,” and how to differentiate between “sometime” and “anytime” food – ergo Cookie Monster’s integration of broccoli and other nutritious foods into his diet.
Sesame Street created a Healthy Habits for Life campaign and worked with first lady Michelle Obama to create messages surrounding healthy eating and exercise. Barron said they have tried to create a 360-degree approach using programming, games, apps, outreach and resources for homes, schools and daycare providers.
Population health media campaigns have to take a broad-spectrum approach to mitigate the negative health messages kids receive from their environment and other media, said Georges Benjamin, executive director of the American Public Health Association.
“People need to understand that eating in a more healthy way isn’t necessarily an innate response, nor is exercise,” he said. “These things are all crafted on the environment in which we live. Media campaigns are an issue awareness tool and educational tool that gets supplemented by other interventions.”
Benjamin points to seat belts and anti-smoking campaigns as examples of how media has helped change public health behaviors.
“It is difficult for a person to get in a car and not have their kids encourage them to buckle up … that was not the case when I was growing up,” he said.
Brian Flay, a professor in the college of Public Health and Human Sciences at Oregon State University, said media campaigns can change health behaviors, but “it’s not easy to do.”
“Most media messages are focused on giving people information, and information is only one of the hundreds of things that influence behavior,” Flay said. “A message has to reach its target audience; has to be exciting to keep their attention long enough; and then the audience has to process it in some way like talking about it with others, like their parents.”
Douglas Evans, vice president for public health and environment at RTI International, reported in a 2008 article on results of some of the major public health campaigns in recent years.
From 1999 to 2002, smoking amongst youth in the United States dropped from 25 to 18 percent. Evans reported that the widespread “truth” non-smoking campaign was said to account for about 22 percent of that decline. A state program in California focused on getting families to drink “1% Or Less” helped reduce sales of whole milk from 66 percent to 24 percent. Overall, Evans reported that social media efforts can positively change the health habits of anywhere from 5 percent to 10 percent of the viewing audience.
Though there is not a lot of data to the effect, public health education campaigns may reduce healthcare costs.
The Virginia Cooperative Extension has a nutrition program that trains about 8,000 low-income families annually in areas like improving diets, stretching food dollars and safe food handling. The program tested its efficacy in 2009 and found that, for every $1 invested in the program, $10.64 could be found in reduced healthcare costs. Further analysis found benefit ratios from more than $2 to up to $17 for each dollar invested.
What Evans calls “edutainment” like Sesame Street is successful because it reaches a wide audience; combines branding with education; and it is able to address multiple risk factors like health and social issues.
Sesame Street’s Barron said one example of TV program’s success is its Healthy Habits multi-media outreach kits for childcare providers of at-risk families. They studied the results of the program and found that 98 percent of providers said their children improved or greatly improved food choices while in the program. Also, 45 percent of participants’ parents said their children talked more about healthy topics like sometime and anytime foods.