A Call to Action: Supporting Black Maternal and Infant Health Using the Collective Impact Model.

This commentary advocates for a comprehensive approach to addressing the Black maternal and infant health crisis, utilizing the collective impact model with health equity at its center. Black women in the United States face alarmingly high rates of maternal morbidity and mortality compared to white women. Black women are twice as likely to have premature and low birthweight babies than white women, exposing both the expectant woman and child to various health risks. This crisis stems from systemic racism, implicit bias in healthcare, and a lack of targeted health communications for pregnant Black women. The urgency of this situation requires a bold and unified response through collaboration and coordination among healthcare providers, local and grassroots community-based organizations (CBOs), and digital health communicators. A comprehensive Black maternal and infant health campaign embedded within the collective impact model and led by a dedicated backbone organization would facilitate the coordination and involvement of diverse stakeholders. Central to these efforts should be the acknowledgment that systemic racism perpetuates health inequities. Consequently, any initiatives to improve health outcomes should prioritize health equity by valuing and incorporating Black women's perspectives. This involves crafting a responsive strategy and placing Black women at the forefront of content creation, program strategy, and evaluation. Through a collaborative effort involving healthcare partners, CBOs, and health communicators, we can have an impact far more significant than any single initiative. Immediate action is needed to dismantle systemic barriers and ensure every Black woman and infant receives the care and support they deserve. Black maternal health disparities in the United States have been widely acknowledged and studied. It is well-established that Black women face significantly higher rates of maternal morbidity and mortality compared to their white counterparts, indicative of a severe healthcare crisis. This opinion piece contributes to the discourse by proposing a comprehensive solution grounded in the collective impact model, which emphasizes collaboration and coordination across various stakeholders. This approach represents a shift from past siloed efforts, aiming to tackle the urgent issue of Black maternal and infant health with a multidisciplinary approach centered on health equity.

The Association Between Receiving the Flu and COVID-19 Vaccines and Related Factors, Data from the StopFlu Campaign in Eight States and the District of Columbia, 2022.

Given the evolving nature of the COVID-19 pandemic and the importance of vaccines, it is imperative to understand the relationships between receiving the COVID-19 vaccine and other vaccines, such as the flu vaccine. Data were obtained from a survey as part of an evaluation of the StopFlu Kaiser Permanente media campaign, promoting the flu and COVID-19 vaccines in communities of color across eight states and the District of Columbia. The outcome considered was receiving the COVID-19 vaccine. The exposure considered was receiving the flu vaccine. Covariates included demographic factors, and sources of trusted health information. Overall, 4,185 participants had complete data and were included the analysis. Logistic regression was used to assess the relationship between receiving the flu vaccine and COVID-19 vaccine. Among participants, 77.8% reported receiving the COVID-19 vaccine and 55.4% received the flu vaccine. After adjusting for demographics and sources of trusted health information, participants reporting receiving the flu vaccine had 5.18 times the odds of also receiving the COVID-19 vaccine [Adjusted Odds Ratio (AOR): 5.18 95% Confidence Interval (CI): 4.24-6.32]. Trusting advice from a doctor and healthcare organization also had increased odds of receiving the COVID-19 vaccine. (AOR: 1.84 95%CI: 1.45-2.33, AOR: 2.08 95%CI: 1.64-2.63). This study demonstrates that promotion of one vaccine may influence uptake of other vaccines, which is important given the highly politicized nature of the COVID-19 vaccine. Further research could provide more insight into how promotion of a vaccine could impact behavior with regards to another.

A Multifaceted Campaign to Combat COVID-19 Misinformation in the Hispanic Community.

At the height of the COVID-19 pandemic, the Public Good Projects, Hispanic Communications Network and World Voices Media joined forces to launch a nationwide, multifaceted campaign which aimed to increase vaccine confidence and decrease misinformation on social media within Hispanic communities. We created a Spanish vaccine misinformation tracking system to detect and assess misinformation circulating in online Spanish conversations. We used our media monitoring findings to work with Hispanic social media (SM) influencers, volunteers, and celebrities to spread pro-vaccine messaging online. We created misinformation-responsive SM assets, newsletters, talking points and trainings for Hispanic-serving community-based organizations (CBOs) to help them respond to misinformation and increase vaccine uptake. We used our misinformation findings to inform the creation of mass media communications such as radio PSAs and op-eds. In Year 1, our new Spanish monitoring system captured and organized 35 M Spanish and 212.7 M English posts about COVID-19 misinformation. We recruited 496 paid influencers, 2 Hispanic celebrities and 1,034 digital volunteers. We sent 70 newsletters to an average of 1539 CBO subscribers, containing 206 talking points and 344 resources (SM assets, toolkits, videos) in English and Spanish to support their outreach. Our radio PSAs reached 26.9 M people and the op-eds reached 2.9 M people. This project shows the proliferation of misinformation circulating in online Spanish conversations. It also shows we were effective at reaching our target audience with fact-based COVID-19 misinformation prebunk and debunk messaging.

Opioid Use Disorder Stigma and Support for Harm Reduction in Rural Counties.

Background: The opioid crisis is a public health emergency in the United States, particularly in rural Pennsylvania. Stigma in rural communities is a treatment barrier and impacts harm reduction programming availability.Objectives: The current study utilized an observational, cross-sectional design to examine latent subgroups of stigma and differences in support for harm reduction strategies (i.e., safe injection facilities, syringe services programs, fentanyl test strips, Naloxone distribution). Participants included rural Pennsylvanians (n = 252), taken from a statewide survey of opioid use disorder (OUD) stigma. Participants reported OUD public stigma (i.e., attitudes/perceptions about OUD, willingness to engage with individuals with OUD) and support for harm reduction strategies.Results: Latent class analysis identified 4 stigma classes: 1) high stigma (HS), 2) high judgment/low stigmatizing behavior (HJ/LB), 3) high stigmatizing behavior/low stigmatizing attitude (HB/LA), and 4) low stigma (LS). ANCOVAs identified subgroup differences in harm reduction support. The HS group indicated less support for safe injection sites, syringe services programs, and fentanyl test strips, compared to the HB/LA and LS groups. The HS group indicated less support for Naloxone distribution compared to the HJ/LB, HB/LA, and LS groups. Lastly, the HJ/LB group indicated less support for each program compared to the LS group.Conclusions/Importance: Findings highlight that OUD stigma profiles differ across rural Pennsylvania and are associated with varying support for harm reduction strategies. Individuals with less stigma report more support for harm reduction strategies. Interventions to implement harm reduction strategies should consider varying levels of stigma and use a targeted approach to inform implementation and messaging strategies.

Digital Volunteers as Trusted Public Health Communicators.

BACKGROUND: Social media influencers are increasingly being positioned by health campaigns as trusted messengers who can share public health information with their communities. There is also an opportunity for campaigns to work with unpaid, digital volunteers (DVs) who want to use their platforms for good, despite not being compensated. DVs are a cost-effective way of supplementing an influencer-driven messaging campaign. EVALUATION APPROACH: Our influencer and DV network, El Beacon, aims to spread pro-COVID-19 vaccination messages on social media to the Hispanic community. Since 2021, 3,001 DVs have been recruited. Process metrics related to DVs are tracked using a variety of software including Facebook ads manager, Sprout Social, and Hubspot. Metrics received include the number of volunteer sign-ups, cost per lead generated, ad performance, organic and paid impressions and engagement of ads and El Beacon social content, newsletter open rates, newsletter clickthrough rates, and newsletter engagement. IMPLICATIONS FOR PRACTICE: Understanding best practices for recruiting and retaining DVs for a public health campaign can help other practitioners optimize their experience working with DVs. Some of these best practices include: identify a specific DV target audience that will be most receptive to your message and best reached by your recruitment efforts, be responsive to what resonates with your DVs, be flexible in how you define "network engagement," and use paid influencers to help build momentum.

Growing and Glowing: A Digital Media Campaign to Increase Access to Pregnancy-Related Health Information for Black Women During the COVID-19 Pandemic.

BACKGROUND: Low birthweight is a health issue disproportionately experienced by Black women. In Hillsborough County, Florida, Black women experience higher rates of low birthweight compared to the rest of Florida. This study examines the feasibility of a second attempt to use a digital low birthweight campaign to increase knowledge about low birthweight and pregnancy among Black women in Hillsborough. METHODS: Content for the Growing and Glowing campaign was delivered on social media through a web series with local prenatal care providers and educational images. Two cross-sectional surveys examined changes in pregnancy-related knowledge, attitudes, and behaviors among Black women in Hillsborough. Digital metrics showed campaign reach and engagement. RESULTS: Growing and Glowing attained 1,234 followers, 805,437 impressions, and a reach of 19,875. Web series videos were viewed almost 27,000 times, with 89% average viewer retention. The website attracted 2,634 unique page views. Evaluation surveys showed significant improvements in positive pregnancy-related intentions. Women aware of the campaign showed significantly higher awareness of the importance of prenatal care, and higher awareness of local resources. CONCLUSION: Results from the second study of this campaign approach suggest that using a highly targeted digital intervention can be a well-received and potentially effective way to deliver pregnancy-related health information to Black women, even during a global pandemic. This approach has numerous benefits in reaching women who may fall outside traditional health marketing approaches.

A multi-site intervention using influencers to communicate about syringe service programmes.

Introduction: In the USA, syringe services programmes (SSPs) provide a range of harm reduction services and have numerous benefits for communities. However, stigma, misconceptions about SSPs and changing policies/legislation remain a challenge to effective implementation. This study reviews the implementation of two digital interventions, Appalachian Influence and Shared Influence, which used social media influencers and digital volunteers to communicate positive information about harm reduction and SSPs. Methods: The intervention was designed to deliver accurate and supportive messaging in locally relevant and meaningful ways. Messaging was informed by interviews with subject matter experts and community organisations, and was integrated into prompts used by local influencers (paid individuals with more than 1,000 followers) and digital volunteers (unpaid individuals with no following requirement, who joined the project independently). Results: In the first 6 months of implementation, Appalachian Influence and Shared Influence engaged a total of 9,014 individuals, 236 of whom were paid influencers and 8,778 of whom were digital volunteers. Paid influencer posts achieved a total of 868,943 impressions, 42,432 engagements and 1,567 comments. Comments on paid influencer posts were overwhelmingly positive, with 87.4% positive and 0.8% negative. Interviews showed the importance of understanding local realities, leading with compassion and emphasising the 'human' aspects of dependency and addiction in messaging. Conclusion: This study shows the potential to implement an influencer-led social media intervention to reach people with authentic and compassionate messaging about harm reduction and SSPs. Future research should examine intervention effectiveness and how this approach can be applied to other stigmatised topics.

Mental Health Stigma Reduction in the Midwestern United States: Evidence from a Digital Campaign Using a Collective Impact Model.

Addressing mental stigma is a key component of improving mental health outcomes. A digital media campaign was implemented to reduce mental health stigma in the Omaha Metropolitan area. The campaign used evidence-based approaches within a collective impact framework. Two surveys were conducted at baseline and at 10-month follow-up to evaluate the campaign within the Omaha and Council Bluffs intervention region, and a control region in Iowa. Analysis revealed significant improvements in desires for social distance and perceptions toward treatment efficacy within the intervention group. Improvements were seen across measures of personal and community attitudes towards mental health conditions, confidence in supporting others, and likelihood of disclosing a mental health condition. The trends were generally not replicated within the control group. Respondents who were aware of the campaign showed fewer stigmatizing views, including lower desires for social distance, improved attitudes toward treatment, and significant improvements in providing support and caring for their own mental health. The results suggest that the implemented evidenced-based approach could potentially create positive shifts in stigma reduction. This evaluation further supports the potential for scaling and adapting digital media campaigns for stigma reduction in different geographic locations.

The Opioid Epidemic and the State of Stigma: A Pennsylvania Statewide Survey.

Background: The opioid epidemic is a public health crisis. Among initiatives surrounding treatment and prevention, opioid use disorder (OUD) stigma has emerged as a subject for intervention. Objectives: This study examines overall results and demographic differences of three subscales of a public stigma survey instrument: general attitudes, social distance, and treatment availability and effectiveness. Methods: A statewide sample of Pennsylvanian adults (N = 1033) completed an online survey about the opioid epidemic. Weighted percentage level of agreement was reported for each item. To determine significant differences in responding across demographic groups (gender, race, and urban/rural status), multiple one-way ANOVAs were analyzed. Significant differences in the level of agreement and disagreement (p < .05) were reported. Results: The majority of respondents agreed that the opioid epidemic is a problem and that anyone can become addicted to opioids; however, many Pennsylvanians still disagree that OUD is a medical disorder and continue to endorse social distance beliefs of people with OUD. Most participants agreed that there are effective treatments available, and that recovery was possible; however, a large portion of participants were unsure whether specific treatments are effective. Subscale mean differences were significant for gender and age. Conclusions/Importance: Findings highlight that stigmatized attitudes, behaviors, and beliefs about individuals who use opioids are still prevalent and that uncertainty remains about the effectiveness of OUD treatment. OUD interventions should use targeted messaging in order to impact the ongoing opioid crisis.

Social media influencers can be used to deliver positive information about the flu vaccine: findings from a multi-year study.

Large-scale digital flu vaccine campaigns have experienced difficulty increasing vaccination coverage among African Americans and Hispanics, and are routinely inundated by negative responses from vaccine opponents. A digital campaign employing user-generated content from social media 'micro' influencers who are predominantly followed by African Americans and Hispanics was implemented during the 2018-19 and 2019-20 flu seasons to disseminate positive information about the flu vaccine. At the time, this constituted the largest influencer-driven health campaign focused on these communities in the United States. Comments on posts were qualitatively coded to determine content perceptions among those exposed to posts. Digital metrics were also analyzed. During Year 1, posts reached 9 million+ social media users and generated 64 612 likes or shares, and 1512 responses. In Year 2, posts reached 8 million+ users and generated 155 600 likes or shares, and 3122 responses. Around 94% of public responses to posts were positive, suggesting this is a promising strategy to communicate health information and could shift social norms, particularly for heavily debated topics such as vaccination. This strategy represents a more community-led and participatory approach than most large-scale vaccination campaigns have attempted, with immediate applicability to communications about the COVID-19 vaccine.

Building Strong Futures: The Feasibility of Using a Targeted Digital Media Campaign to Improve Knowledge About Pregnancy and Low Birthweight Among Black Women.

OBJECTIVE: Low birthweight is one of the main causes of poor health outcomes among newborns, with Black women having a disproportionately high prevalence. A digital intervention targeted Black women in Orange County, Florida with information on positive pregnancy-related knowledge and attitudes related to low birthweight. This paper reports on campaign methods for the first 2.5 years of implementation. METHODS: Campaign content was tailored toward Black women, around a reproductive empowerment lens. Content focused on emphasizing healthy pregnancy-related behaviors and creating positive representations of Black women throughout the various stages of pregnancy through both static images and a web series. Digital metrics gauged campaign engagement. Three cross-sectional online surveys conducted in the intervention county examined Black women's pregnancy-related knowledge, attitudes, and behaviors. RESULTS: After two years of campaign implementation, social media accounts showed 1784 followers. While Facebook showed more average monthly impressions, Instagram showed more average monthly engagements. Survey results showed some increases in knowledge about prenatal care, weight gain, exercise, and the health impacts of low birthweight. CONCLUSIONS FOR PRACTICE: This study highlights the potential for a culturally-appropriate digital intervention to promote positive pregnancy outcomes among at-risk women. Digital interventions offer a potential way to achieve positive pregnancy-related behavior changes on a larger scale. This may be particularly important given that the COVID-19 pandemic may be changing the ways that pregnant women access information. Studies should examine the impact and feasibility of using culturally-appropriate digital interventions that directly address Black women and their specific experiences during pregnancy.

[Content Themes and Influential Voices Within Vaccine Opposition on Twitter, 2019]. / Temas de contenido y voces influyentes dentro de la oposición a las vacunas en Twitter, 2019.

OBJECTIVES: To report on vaccine opposition and misinformation promoted on Twitter, highlighting Twitter accounts that drive conversation. METHODS: We used supervised machine learning to code all Twitter posts. We first identified codes and themes manually by using a grounded theoretical approach and then applied them to the full data set algorithmically. We identified the top 50 authors month-over-month to determine influential sources of information related to vaccine opposition. RESULTS: The data collection period was June 1 to December 1, 2019, resulting in 356 594 mentions of vaccine opposition. A total of 129 Twitter authors met the qualification of a top author in at least 1 month. Top authors were responsible for 59.5% of vaccine-opposition messages. We identified 10 conversation themes. Themes were similarly distributed across top authors and all other authors mentioning vaccine opposition. Top authors appeared to be highly coordinated in their promotion of misinformation within themes. CONCLUSIONS: Public health has struggled to respond to vaccine misinformation. Results indicate that sources of vaccine misinformation are not as heterogeneous or distributed as it may first appear given the volume of messages. There are identifiable upstream sources of misinformation, which may aid in countermessaging and public health surveillance.

Content Themes and Influential Voices Within Vaccine Opposition on Twitter, 2019.

Objectives. To report on vaccine opposition and misinformation promoted on Twitter, highlighting Twitter accounts that drive conversation.Methods. We used supervised machine learning to code all Twitter posts. We first identified codes and themes manually by using a grounded theoretical approach and then applied them to the full data set algorithmically. We identified the top 50 authors month-over-month to determine influential sources of information related to vaccine opposition.Results. The data collection period was June 1 to December 1, 2019, resulting in 356 594 mentions of vaccine opposition. A total of 129 Twitter authors met the qualification of a top author in at least 1 month. Top authors were responsible for 59.5% of vaccine-opposition messages. We identified 10 conversation themes. Themes were similarly distributed across top authors and all other authors mentioning vaccine opposition. Top authors appeared to be highly coordinated in their promotion of misinformation within themes.Conclusions. Public health has struggled to respond to vaccine misinformation. Results indicate that sources of vaccine misinformation are not as heterogeneous or distributed as it may first appear given the volume of messages. There are identifiable upstream sources of misinformation, which may aid in countermessaging and public health surveillance.

Evaluation of a campaign to reduce consumption of sugar-sweetened beverages in New Jersey.

Obesity is a leading cause of premature death in the U.S., in part due to consumption of sugar sweetened beverages (SSBs). In New Jersey, African Americans, Hispanics, and those of low income have the highest rates of SSB consumption. This study evaluates the impact of NJ Sugarfreed, a campaign designed to reduce sugar-sweetened beverage (SSB) consumption across New Jersey. From 12/1/17-9/30/18, we used a collective impact model to create targeted statewide campaigns that reduce SSB consumption among New Jersey residents, with an emphasis on African American and Hispanic low-income mothers/caregivers who are often gatekeepers to children's SSB consumption. Passaic County, New Jersey received a higher dose intervention. Messages were disseminated through social media, partner organizations, and community partnerships. Campaign impact was examined through evaluation surveys and analysis of beverage sales. Baseline and follow-up surveys (n = 800 baseline; n = 782 follow-up) showed positive trends toward decreased soda consumption and increased knowledge about SSBs. Passaic respondents showed a 5% decrease in those who consume 1+ soda per day, compared to a 1% decrease among New Jersey respondents. Analysis of overall SSB beverage sales showed the most pronounced decreases in Passaic (7% decrease) compared to New Jersey (6%). By drawing upon best practices in message development and the use of various platforms for dissemination, combined with community-based participation, we have provided more evidence to support the use of a collective impact model as a way of reducing unhealthy behaviors that impact health disparities.

Alcohol use in fishing communities and men's willingness to participate in an alcohol, violence and HIV risk reduction intervention: qualitative findings from Rakai, Uganda.

Alcohol use, intimate partner violence (IPV) and HIV infection are associated, but few programmes and interventions have addressed their synergistic relationship or been evaluated for effectiveness and acceptability. This is a critical gap in populations with high rates of alcohol use, HIV and IPV, such as Uganda's fishing communities. This study examined drinking norms, barriers and facilitators to engagement in a risk reduction programme, and ideas for tailoring. Results showed that alcohol use is common in fishing villages. While men and women drink, gendered notions of femininity deem alcohol largely unacceptable for women. Plastic sachets of liquor were the most common alcoholic drink. Participants did not understand the definition of 'hazardous drinking', but recognised connections between drinking, violence and sexual risk-taking. The idea of an alcohol, IPV and HIV risk reduction intervention was supported, but barriers need to be addressed, including how best to help those uninterested in reducing their drinking, addressing normalisation of drinking and how best to inform those who truly need intervention. Intervention to people living with HIV around the time of diagnosis and treatment may be warranted. Study findings highlight the potential to integrate alcohol and IPV reduction programmes into an HIV service provision.

A Multistate Asian-Language Tobacco Quitline: Addressing a Disparity in Access to Care.

OBJECTIVES: We conducted a dissemination and implementation study to translate an intervention protocol for Asian-language smokers from an efficacy trial into an effective and sustainable multistate service. METHODS: Three state tobacco programs (in California, Colorado, and Hawaii) promoted a multistate cessation quitline to 3 Asian-language-speaking communities: Chinese, Korean, and Vietnamese. The California quitline provided counseling centrally to facilitate implementation. Three more states joined the program during the study period (January 2010-July 2012). We assessed the provision of counseling, quitting outcomes, and dissemination of the program. RESULTS: A total of 2004 smokers called for the service, with 88.3% opting for counseling. Among those opting for counseling, the 6-month abstinence rate (18.8%) was similar to results of the earlier efficacy trial (16.4%). CONCLUSIONS: The intervention protocol, based on an efficacy trial, was successfully translated into a multistate service and further disseminated. This project paved the way for the establishment of a national quitline for Asian-language speakers, which serves as an important strategy to address disparities in access to care.

Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation.

INTRODUCTION: E-cigarettes are largely unregulated and internet sales are substantial. This study examines how the online market for e-cigarettes has changed over time: in product design and in marketing messages appearing on websites. METHODS: Comprehensive internet searches of English-language websites from May-August 2012 and December 2013-January 2014 identified brands, models, flavours, nicotine strengths, ingredients and product claims. Brands were divided into older and newer groups (by the two searches) for comparison. RESULTS: By January 2014 there were 466 brands (each with its own website) and 7764 unique flavours. In the 17 months between the searches, there was a net increase of 10.5 brands and 242 new flavours per month. Older brands were more likely than newer brands to offer cigalikes (86.9% vs. 52.1%, p<0.01), and newer brands more likely to offer the more versatile eGos and mods (75.3% vs. 57.8%, p<0.01). Older brands were significantly more likely to claim that they were healthier and cheaper than cigarettes, were good substitutes where smoking was banned and were effective smoking cessation aids. Newer brands offered more flavours per brand (49 vs. 32, p<0.01) and were less likely to compare themselves with conventional cigarettes. CONCLUSIONS: The number of e-cigarette brands is large and has been increasing. Older brands tend to highlight their advantages over conventional cigarettes while newer brands emphasise consumer choice in multiple flavours and product versatility. These results can serve as a benchmark for future research on the impact of upcoming regulations on product design and advertising messages of e-cigarettes.

Lessons Learned From Monitoring Spanish-Language Vaccine Misinformation During the COVID-19 Pandemic.

COVID-19 vaccine misinformation is a global threat, and digital and social media support its spread. Addressing Spanish-language vaccine misinformation is critical. In 2021, we began a project to increase vaccine confidence and uptake in the United States by assessing and opposing Spanish-language COVID-19 vaccine misinformation circulating in the United States. Analysts identified trending Spanish-language vaccine misinformation each week, and trained journalists provided communications guidance for addressing the misinformation, which we delivered to community organizations via a weekly newsletter. We identified thematic and geographic trends and highlighted lessons learned to inform future efforts to monitor Spanish-language vaccine misinformation. We collected publicly available Spanish- and English-language COVID-19 vaccine misinformation across various media sources (eg, Twitter, Facebook, news, blogs). Analysts identified top trending vaccine misinformation in the Spanish query and compared it with vaccine misinformation in the English query. Analysts examined misinformation to identify its geographic source and dominant conversation themes. From September 2021 through March 2022, analysts flagged 109 pieces of trending Spanish-language COVID-19 vaccine misinformation. Through this work, we found that Spanish-language vaccine misinformation is easily identifiable. Linguistic networks are not distinct, and vaccine misinformation often circulates across English and Spanish queries. Several websites have outsized influence in promoting Spanish-language vaccine misinformation, suggesting that it may be important to focus on a handful of hyperinfluential accounts and websites. Efforts to address Spanish-language vaccine misinformation must incorporate collaboration with local communities and emphasize community building and empowerment. Ultimately, addressing Spanish-language vaccine misinformation is not an issue of data access and knowledge of how to monitor it; it is an issue of prioritization.

Examining engagement and responses to a digital binge drinking campaign for young males in Florida.

Objective: This study evaluates Drunken Rewind, an animated digital media campaign designed to reduce binge drinking. Participants: The campaign was targeted to white males aged 18-34, who are at the highest risk of binge drinking. Methods: The intervention consisted of an animated series that merged health communications approaches with marketing strategies to disseminate health messages. Digital metrics and comments were analyzed to assess receptivity toward the intervention. Results: The series amassed over 900,000 views and 1,762 followers across four social media platforms. Viewer retention rate was between 67%-73% over three seasons; 68.3% of comments on the videos were positive. Conclusions: This study adds evidence that a digital intervention aimed at reducing binge drinking can be feasibly implemented and positively received by a population that is difficult to reach with health messaging. This approach may be useful when applied to other health issues young adults perceive to have lower risk.

Persuasive COVID-19 vaccination campaigns on Facebook and nationwide vaccination coverage in Ukraine, India, and Pakistan.

Social media platforms have a wide and influential reach, and as such provide an opportunity to increase vaccine uptake. To date, there is no large-scale, robust evidence on the offline effects of online messaging campaigns. We aimed to test whether pre-tested, persuasive messaging campaigns from UNICEF, disseminated on Facebook, influenced COVID-19 vaccine uptake in Ukraine, India, and Pakistan. In Ukraine, we deployed a stepped-wedge randomized controlled trial (RCT). Half of the 24 oblasts (provinces) received five weeks of the intervention, the other half ten weeks of the intervention. In India, an RCT with an augmented synthetic control was conducted in five states (Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Rajasthan), whereby 40 out of 174 districts were randomized to receive six weeks of intervention. In Pakistan we deployed a pre-post design, whereby 25 city districts received six weeks of the intervention. Weekly COVID-19 vaccination data was sourced through government databases. Using Poisson regression models, the association between the intervention and vaccine uptake was estimated. In Ukraine we conducted a survey among Facebook users at three time points during the RCT, to ascertain vaccination intentions and trust in vaccines. The campaigns reached more than 110 million Facebook users and garnered 2.9 million clicks. In Ukraine, we found that the intervention did not affect oblast-level vaccination coverage (Relative Risk (RR): 0.93, 95% Confidence Interval (CI) 0.86-1.01). Similarly, in India and Pakistan we found no effect of our intervention (India: RR 0.85, 95% CI 0.70-1.04; Pakistan: RR 0.64, 95% CI 0.01-29.9). The survey among Facebook users in Ukraine showed that trust in vaccines and information sources was an important predictor of vaccination status and intention to get vaccinated. Our campaigns on Facebook had a wide reach, which did not translate in shifting behaviours. Timing and external events may have limited the effectiveness of our interventions.