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Health Communication and Social Marketing: Health Communication Campaigns That Include Mass Media and Health-Related Product Distribution

Health communication campaigns apply integrated strategies to deliver messages designed, directly or indirectly, to influence health behaviors of target audiences. Messages are communicated through various channels that can be categorized as:

  • Mass media (e.g., television, radio, billboards)
  • Small media (e.g., brochures, posters)
  • Social media (e.g., Facebook©, Twitter©, web logs)
  • Interpersonal communication (e.g., one-on-one or group education)

Drawing on concepts from social marketing, a health communication campaign can be combined with other activities such as distribution of products to further influence health behaviors. The current review was devised to evaluate the effectiveness of the combination of health communication campaigns that meet specific criteria with the distribution of health-related products that also meet specific criteria.

Intervention Definition

This review evaluates the effectiveness of interventions that combine two components to increase the appropriate, repeated use of evidence-based, health-related products:

  1. A health communication campaign that uses messages to increase awareness of, demand for, and appropriate use of the product. The messages must be delivered through multiple channels, one of which must be mass media, to provide multiple opportunities for exposure; and
  2. Distribution of a health-related product, free of charge or at a reduced price (e.g., discount coupons), to reduce cost, access, and convenience-related barriers among targeted users.

Health-related products eligible for this review:

  • Have been shown through an evidence-based process (such as a peer-reviewed systematic review or multiple rigorous studies) to improve health-related outcomes (e.g., increased physical activity; smoking cessation; reductions in disease, injury, or death)
  • Are tangible
  • Are not a service (e.g., mammogram)
  • Are not exclusively available though prescription or administration by a health professional (e.g., vaccination or prescribed medication)
  • Require repeated use for desired health promotion and/or disease and injury prevention effects (e.g., using condoms, wearing helmets) rather than a one-time behavior (e.g., installing smoke alarms)
  • Cannot be a specific food product (e.g., oatmeal) marketed as being “healthful”

Summary of Task Force Findings and Recommendations

Based on strong evidence of effectiveness for producing intended behavior changes, the Community Preventive Services Task Force recommends health communication campaigns that use multiple channels, one of which must be mass media, combined with the distribution of free or reduced-price health-related products (defined above).

The specific behaviors promoted in the included studies were the use of products that:

  • Facilitate adoption and/or maintenance of health-promoting behaviors (i.e., increased physical activity through pedometer distribution combined with walking campaigns).
  • Facilitate and/or help to sustain cessation of harmful behaviors (i.e., smoking cessation through free or reduced cost over-the-counter nicotine replacement therapy [OTC NRT]).
  • Protect against behavior-related disease or injury (i.e., condoms, child safety seats, recreational safety helmets, sun-protection products).

Because results were positive across all of the six behaviors evaluated, these findings are likely to apply to a broader range of health-related products that meet the review’s product eligibility criteria in the intervention definition. The effectiveness of interventions promoting the use of health-related products other than those distributed in the reviewed studies should be assessed to ensure applicability.

The systematic review focused only on interventions that included a mass media component; therefore, this recommendation is specific to such interventions. The results may or may not apply to campaigns that do not include a mass media component, which were outside of the scope of the review.

Read the full Task Force Finding and Rationale Statementfor details including implementation issues, possible added benefits, potential harms, and evidence gaps.

Results of the Systematic Review

Twenty-two studies with 25 study arms qualified for the review.

  • Results from analyses show that effects were favorable for the following outcomes:
    • Health promoting behaviors: absolute median change of 8.4 percentage points (Interquartile Interval [IQI]: 2.7 to 14.5 percentage points;20 study arms)
      • Use of child safety seats: absolute median change of 8.6 percentage points (IQI: -9.2 to 9.6 percentage points; 3 study arms)
      • Use of condoms: absolute median change of 4.0 percentage points (IQI: -4.0 to 10.8 percentage points; 4 study arms)
      • Use of helmets: absolute median change of 8.4 percentage points (IQI: 2.1 to 18.5 percentage points; 10 study arms)
      • Smoking cessation: absolute median change of 10.0 percentage points (IQI: 3.1 to 16.9 percentage points; 3 study arms)
    • The remaining 5 study arms also evaluated interventions with generally favorable results, but reported results that could not be expressed as percentage point changes in health behaviors: condom use, 2 study arms; physical activity (pedometer use), 2 study arms; and sun protection product use, 1 study.
  • Results suggest that health communication campaigns that include mass media, and product distribution interventions are applicable to:
    • A wide variety of broad or narrowly-defined populations provided they are appropriately segmented and targeted.
    • Products evaluated in this review and products that were not included but meet the criteria. Interventions were shown to be effective for:
      • Both free and discounted products
      • Single use (e.g., condoms) and reusable (e.g., recreational safety helmets)

These reviews were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to marketing, health communications, health literacy and social marketing.

Economic Evidence

An overall conclusion about the economic merits of the intervention cannot be reached because available economic information and analyses were incomplete.

The economic review is based on evidence from 15 studies (search period January 1980–December 2009). Included studies provided limited economic information on health communication campaigns to increase use of child booster and car seats (1 study), pedometers (1 study), condoms (4 studies), recreational helmets (5 studies), and nicotine replacement therapy (4 studies). There were no studies of interventions that promoted use of sun protection products.

There were several limitations to the quality of the cost and benefit estimates.

  • Intervention costs
    • Most of the studies included either the cost of media or the cost of the product distributed, and not both.
    • Volunteer labor and in-kind contributions were not valued.
    • Target populations were not specified making per capita calculations impossible.
  • Economic benefits
    • Monetized benefits from healthcare averted and productivity gains, and quality-adjusted life year (QALY) saved were rarely estimated or modeled.
    • Most studies reported proximal benefits such as quits among smokers or reductions in unprotected sex.
  • Cost-benefit and cost-effectiveness
    • Overall assessments could not be made because of incomplete assessments of costs and benefits.

Supporting Materials


Robinson MN, Tansil KA, Elder RW, Soler RE, Labre MP, Mercer SL, Eroglu D, Baur C, Lyon-Daniel K, Fridinger F, Sokler LA, Green LW, Miller T, Dearing JW, Evans WD, Snyder LB, Viswanath KK, Beistle DM, Chervin DD, Bernhardt JM, Rimer BK, and the Community Preventive Services Task Force. Mass media health communication campaigns combined with health-related product distribution: a Community Guide systematic review Adobe PDF File [PDF - 6.11 MB]. Am J Prev Med 2014;47(3):360-71.

Jacob V, Chattopadhyay SK, Elder RW, Robinson MN, Tansil KA, Soler RE, Labre MP, Mercer SL, and the Community Preventive Services Task Force. Economics of mass media health campaigns with health-related product distribution: a Community Guide systematic review Adobe PDF File [PDF - 1.63 MB]. Am J Prev Med 2014;47(3): 348-59.

Community Preventive Services Task Force. Combination of mass media health campaigns and health-related product distribution is recommended to improve healthy behaviors Adobe PDF File [PDF - 1.36 MB]. Am J Prev Med 2014;47(3):372-4.

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The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Use of trade names is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Health communication and social marketing: health communication campaigns that include mass media and health-related product distribution. Last updated: MM/DD/YYYY.

Review completed: December 2010