Combining Social Norms and Social Marketing to Address Underage Drinking: Development and Process Evaluation of a Whole-of-Community Intervention

Toward Sustainable Diets-Interventions and Perceptions Among Adolescents: A Scoping Review

Adolescence is an important life stage during which shifts toward more healthy and sustainable diets can be promoted. Adolescents have increasing influence over their food choices, informed by their developing personal knowledge and values, affecting long-term dietary behaviors into adulthood. The recent literature regarding adolescents' (1) perceptions of environmentally sustainable diets and (2) interventions to support adolescents to eat sustainably was reviewed in this study. We reviewed published literature that focused on adolescent participants and their perceptions of, or interventions to support, sustainable dietary habits. Five electronic databases were searched to include studies published since 2012 that met the inclusion criteria, including reporting of participants aged between 11 and 18 years, reporting on adolescents' perceptions of sustainable diets or interventions implemented to improve the sustainability of adolescents' diets, and framed in the context of sustainability. Data were extracted, including study and participant characteristics, methodology, and results in relation to each of the 2 research focus areas. Twenty-eight articles were included in the review. Findings suggest that adolescents' understanding of what constitutes sustainable eating is poor. Adolescents who had previously received education regarding sustainable diets valued nature and health, or were from a rural or indigenous community, were more likely to value environmentally sustainable-food choices. Interventions which target adolescents' understanding of and aspiration to make sustainable-food choices appears to improve their attitudes toward sustainable food, whereas interventions to increase the availability of sustainable foods improved the environmental sustainability of adolescents' dietary intake. Multicomponent, tailored, and community-based interventions were most effective; however, the long-term effect of these interventions remains unclear. More research is needed in low- and middle-income countries, with consideration of adolescents' level of autonomy in food choice in local food environments and the long-term effectiveness of interventions. Systematic Review Registration: Open Science Framework identifier osf.io/h3jz6.

Process Evaluation in Health Communication Media Campaigns: A Systematic Review

Objective. The objective is to examine the scope of health communication media campaign process evaluation methods, findings, and dissemination practices. Data Source. A systematic review of peer-reviewed literature was conducted using database searches. Study Inclusion and Exclusion Criteria. Published studies on process and implementation evaluation of health campaigns with a media component were included. Exclusion criteria included not health, non-empirical, no media campaign, or a focus on other evaluation types. Data Extraction. Articles were assessed for general campaign information, theory use, and details about process evaluation plan and procedures. Data Synthesis. A coding scheme based on 9 process evaluation best practice elements (e.g., fidelity and context) was applied. Process evaluation methods, measures, and reporting themes were synthesized. Results. Among 691 unique records, 46 articles were included. Process evaluation was the main focus for 71.7% of articles, yet only 39.1% reported how process evaluation informed campaign implementation strategy. Articles reported 4.39 elements on average (SD = 1.99; range 1-9), with reach (87.0%) and recruitment (73.9%) described most frequently, yet reporting was inconsistent. Further, the level of detail in reporting methods, theory, and analysis varied. Conclusions. Process evaluation provides insight about mechanisms and intervening variables that could meaningfully impact interpretations of outcome evaluations; however, process evaluations are less often included in literature. Recommendations for evidence-based process evaluation components to guide evaluation are discussed.

A community intervention to reduce alcohol consumption and drunkenness among adolescents in Sweden: a quasi-experiment

Background

Several studies have examined the effect of community interventions on youth alcohol consumption, and the results have often been mixed. The aim of this study is to evaluate the effectiveness of a community intervention known as the Öckerö Method on adolescent alcohol consumption and perceived parental attitudes towards adolescent drinking.

Method

The study is based on a quasi-experimental design, using matched controls. Self-report studies were conducted among adolescents in grades 7–9 of compulsory education in four control and four intervention communities in the south of Sweden in 2016–2018. Baseline measures were collected in autumn 2016 before the intervention was implemented in the intervention communities. Outcomes were the adolescents’ alcohol consumption, past-year drunkenness, past-month drunkenness and perceived parental attitudes towards alcohol.

Results

Estimating Difference-in-Difference models using Linear Probability Models, we found no empirical evidence that the intervention has any effect on adolescents’ drinking habits, or on their perceptions of their parents’ attitudes towards adolescent drinking.

Conclusion

This is the first evaluation of this method, and we found no evidence that the intervention had any effect on the level of either young people’s alcohol consumption or their past-year or past-month drunkenness, nor on their parents’ perceived attitudes toward adolescent drinking. A further improvement would be to employ a follow-up period that is longer than the three-year period employed in this study.

Trial registration

ISRCTN registry: Study ID: 51635778, 31th March 2021 (Retrospectively registered).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10755-3.

Exposure to peers' pro-diversity attitudes increases inclusion and reduces the achievement gap

There is a dearth of empirically validated pro-diversity methods that effectively create a more inclusive social climate. We developed two scalable interventions that target people's perceptions of social norms by communicating to them that their peers hold pro-diversity attitudes and engage in inclusive behaviours. We tested the interventions in six randomized controlled trials at a large public university in the United States (total n = 2,490). Non-marginalized students exposed to our interventions reported more positive attitudes toward outgroups and greater appreciation of diversity, whereas marginalized students had an increased sense of belonging, reported being treated more inclusively by their peers and earned better grades. While many current pro-diversity initiatives focus on raising awareness about the fact that implicit bias and subtle discrimination are widespread, our findings spotlight the importance of drawing people's attention to their peers' pro-diversity values and attitudes to create positive and lasting effects on the social climate.

Using Social Marketing to Reduce Salt Intake in Iran

Objectives: WHO has recommended that the average salt intake must be <5 grams per day. However, people consume salt much more in many countries. In this study, we design and implement an intervention based on social marketing model to reduce salt consumption in Yasuj, Iran. Materials and Methods: This study employed a quasi-experimental pretest-posttest with control group design which consisted of a formative research (qualitative-quantitative) and an interventional phase. To collect the qualitative data, six focus group discussions by participating of 66 people were established. The qualitative data were analyzed manually using directed content analysis. In quantitative study, 166 people aged 25-50 years completed a KAP questionnaire, and their average salt intake was determined through measuring sodium in their urine sample. By analyzing the data, marketing mix components were determined for designing an intervention. An educational package (including posters for installing in the kitchen, pamphlets, phone counseling, four educational classes, and brief interventions done by physicians and other health personnel) focused on reducing salt intake and using alternatives was developed. For one month, program was implemented for intervention group. Two months later, KAP survey and measuring the urine sodium were repeated for intervention and control groups. The data was compared for two groups, before and after the intervention by using independent t-test, paired t-tests and repeated measures ANOVA. Results: The qualitative findings showed that most participants agreed that the salt intake was high in Iran. Most of them recommended home-based and family-driven strategies to reduce salt intake, offered using healthier alternatives for salt, and recognized physicians and health care providers in healthcare facilities as the most important to encourage people to reduce salt intake. After the intervention, the mean and standard deviation of KAP were improved significantly in intervention group. The mean salt intake decreased significantly by 3.01 ± 2.38 in the intervention group and repeated measures ANOVA showed significant change over time (P < 0.001) and a significant difference between two groups (P = 0.04)_. Also, the interaction between time and group was significant (P = 0.001). Conclusion: The mean salt intake among the study population was approximately three times more than the level recommended by the WHO. The social marketing-based intervention succeeded in reducing the salt intake of the study subjects by ~3 grams on average.

The relationship between parental attitudes and children's alcohol use: a systematic review and meta-analysis

AIMS

The main aim of this study was to assess the relationship between parental attitudes towards children's alcohol use and their child's alcohol use. Secondary aims included assessing the relationship between attitudes reported by parents and those perceived by children, and between perceived parental attitudes and children's alcohol use.

METHODS

Meta-analysis of studies reporting on the associations between parental attitudes towards children's alcohol use and children's self-reported alcohol use. Published, peer-reviewed cross-sectional and longitudinal studies were identified from the following databases up to April 2018: Medline, PsycINFO, EMBASE, Scopus and Web of Science. Quality assessment was performed by using guidelines developed by Hayden, Cote & Bombardier. Pooled effect sizes were calculated by using random-effects meta-analyses, if there were at least two studies that could be included per analysis. Of 7471 articles screened, 29 were included comprising data from 16 477 children and 15 229 parents.

RESULTS

Less restrictive parental attitudes towards children's alcohol use were related to higher rates of alcohol use initiation [odds ratio (OR) = 1.45, 95% confidence interval (CI) = 1.17-1.80], alcohol use frequency (OR = 1.52, 95% CI = 1.24-1.86) and drunkenness (OR = 1.58, 95% CI = 1.35-1.85) among children. Less perceived restrictive parental attitudes were related to higher alcohol use frequency (OR = 1.76, 95% CI = 1.29-2.40). Perceived parental attitudes were not clearly related to alcohol use initiation. Parent-reported attitudes and perceived parental attitudes were weakly positively correlated (r = 0.27, P = ≤ 0.001). The strength of the relationship between parental attitudes and children's alcohol use frequency attenuated with children's age. Study design, sample size, study location and levels of alcohol use frequency did not have a detectable effect on the relationship.

CONCLUSIONS

Less restrictive parental attitudes towards children's alcohol use are associated with increases in children's alcohol use onset, alcohol use frequency and drunkenness. Children's perception of less restrictive parental attitudes is associated with children's alcohol use.

The Use of Social Digital Networks by NGDO from a Social Marketing Perspective

The social marketing paradigm has been changing due to the use of digital social networks. This causes Non-Governmental Development Organizations’ efforts to focus on achieving a greater reaction from the public in these communication channels. We propose that the way forward is to analyze aspects of messages that give rise to a greater response from the audience. In this regard, we have analyzed 3608 Facebook and Twitter publications with the combination of content analysis and correlation analysis. We have considered three aspects: purpose, theme, and quality of the message. We have also listed a breakdown of quality and purpose parameters in order to become more fully acquainted with these aspects. The objectives of this research are firstly to carry out the communication profiles of the NGDOs studied from the points of view of the organizations and the public. Secondly, to analyze the reaction from the public (interactions) measured by the sum of likes plus the number of shares for each post, on Facebook and Twitter, according the parameters considered. The results showed that the most published messages from the organizations do not usually coincide with those that have the most impact on the public. Another proven aspect is that Twitter posts about behavior have more effectiveness than informative messages. Likewise, quality aspects, such as hashtags, mentions, or links, are not succeeding in generating public reaction.

When are they old enough to drink? Outcomes of an Australian social marketing intervention targeting alcohol initiation

INTRODUCTION AND AIMS

This paper reports on the evaluation of an Australian whole-of-community social marketing intervention targeting social norms, which aimed to reduce inflated perceptions of the prevalence of underage drinking and increase the age at which alcohol initiation is considered acceptable.

DESIGN AND METHODS

A community-wide intervention was delivered in a single community over a period of 2 years, targeting adolescents, parents and community members. Pre-and post-intervention computer-assisted telephone interview surveys were conducted in the intervention and a matched comparison (control) community. A total of 417 respondents completed both surveys (215 in the intervention community and 202 in the control community).

RESULTS

The intervention community saw an increase of 6 months in the average age at which it is perceived to be acceptable for young people to have a sip/taste of alcohol and 5 months in the average age at which it is perceived to be acceptable to have weak/watered down alcohol. Furthermore, there was a reduction in the perception of the prevalence of alcohol consumption by young people to a level consistent with actual underage drinking rates. In comparison, the control community saw no change in any of these variables.

DISCUSSION AND CONCLUSIONS

This study provides preliminary evidence that a whole-of-community social marketing intervention can change perceptions of the prevalence, and acceptability, of underage drinking. Given the central role of social norms in decisions regarding alcohol consumption, these changes have the potential to reduce parental supply and thus underage drinking.