Benefit-Cost Analysis of the HHS COVID-19 Campaign: April 2021-March 2022.

INTRODUCTION: This study estimated the benefits and costs of the U.S. Department of Health and Human Services' We Can Do This COVID-19 public education campaign (the Campaign) and associated vaccination-related impacts. METHODS: Weekly media market and national Campaign expenditures were used to estimate weekly first-dose vaccinations that would not have occurred absent the Campaign, weekly Campaign-attributed complete vaccinations, and corresponding COVID-19 cases, hospitalizations, and deaths averted. Benefits were valued using estimated morbidity and mortality reductions and associated values of a statistical life and a statistical case. Costs were estimated using Campaign paid media expenditures and corresponding vaccination costs. The net Campaign and vaccination benefit and return on investment were calculated. Analyses were conducted from 2022 to 2024. RESULTS: Between April 2021 and March 2022, an estimated 55.9 million doses of COVID-19 vaccines would not have been administered absent the Campaign. Campaign-attributed vaccinations resulted in 2,576,133 fewer mild COVID-19 cases, 243,979 fewer nonfatal COVID-19 hospitalizations, and 51,675 lives saved from COVID-19. The total Campaign benefit was $740.2 billion, and Campaign and vaccination costs totaled $8.3 billion, with net benefits of approximately $732.0 billion. For every $1 spent, the Campaign and corresponding vaccination costs resulted in benefits of approximately $89.54. CONCLUSIONS: The We Can Do This COVID-19 public education campaign saved more than 50,000 lives and prevented hundreds of thousands of hospitalizations and millions of COVID-19 cases, representing hundreds of billions of dollars in benefits in less than one year. Findings suggest that public education campaigns are a cost-effective approach to reducing COVID-19 morbidity and mortality.

Differences in social media use by COVID-19 vaccination status.

The near-ubiquitous use of social media in the United States (U.S.) highlights the utility of social media for encouraging vaccination. Vaccination campaigns have used social media to reach audiences, yet research linking the use of specific social media platforms and vaccination uptake is nascent. This descriptive study assesses differences in social media use by COVID-19 vaccination status among adults overall and those who reported baseline vaccine hesitancy. We used data from a nationally representative longitudinal survey of U.S. adults administered between January 2021-August 2022 (n = 2,908). Results indicated a positive association between frequent Instagram and/or Twitter use and vaccination status (p <.05). Among baseline vaccine hesitant adults, results indicated a positive association between frequent TikTok, Instagram, and/or Twitter use and vaccination status (p <.05). Findings have implications for research that examines the content of social media platforms and their environment on vaccine attitudes and uptake.

Trends in primary, booster, and updated COVID-19 vaccine readiness in the United States, January 2021-April 2023: Implications for 2023-2024 updated COVID-19 vaccines.

OBJECTIVE: COVID-19 vaccines have mitigated the severity of COVID-19 and its sequelae. The emergence of new SARS-CoV-2 variants and waning immunity conferred by COVID-19 vaccination have necessitated booster and updated COVID-19 vaccines. This study examined trends in vaccine readiness-a composite measure of intention and uptake-for the primary, booster, and 2022-2023 updated (bivalent) COVID-19 vaccines among U.S. adults. METHODS: Data from the nationally-representative U.S. Department of Health and Human Services' COVID-19 Monthly Outcome Survey from January 2021 to April 2023 were analyzed (N = 140,180). We conducted pairwise comparisons (weighted t-tests) to assess for significant between-month differences in the proportion of participants in each vaccine-readiness category (vaccine ready, wait and see, and no vaccine intention) for the following outcomes: (1) primary; (2) booster; and (3) updated COVID-19 vaccine readiness. RESULTS: From January 2021 to April 2023, significant increases in the primary vaccine ready group were accompanied by decreases in the wait and see and no vaccine intention groups (p < 0.001). From January to September 2022, the no booster intention group notably increased (p < 0.001), whereas the booster ready group decreased (p < 0.001), and the wait and see group remained stable (p = 0.116). From October 2022 to April 2023, the no updated vaccine intention group increased (p < 0.001), the wait and see group decreased (p < 0.01), and the updated vaccine ready group remained unchanged (p = 0.357). CONCLUSIONS: Findings show decreased vaccine readiness for the booster and 2022-2023 updated (bivalent) COVID-19 vaccines relative to the primary COVID-19 vaccines. Implications for the 2023-2024 updated COVID-19 vaccines are discussed.

Association between vaccination beliefs and COVID-19 vaccine uptake in a longitudinal panel survey of adults in the United States, 2021-2022.

COVID-19 vaccine hesitancy has been a major limiting factor to the widespread uptake of COVID-19 vaccination in the United States. A range of interventions, including mass media campaigns, have been implemented to encourage COVID-19 vaccine confidence and uptake. Such interventions are often guided by theories of behavior change, which posit that behavioral factors, including beliefs, influence behaviors such as vaccination. Although previous studies have examined relationships between vaccination beliefs and COVID-19 vaccination behavior, they come with limitations, such as the use of cross-sectional study designs and, for longitudinal studies, few survey waves. To account for these limitations, we examined associations between vaccination beliefs and COVID-19 vaccine uptake using data from six waves of a nationally representative, longitudinal survey of U.S. adults (N = 3,524) administered over a nearly 2-year period (January 2021-November 2022). Survey-weighted lagged logistic regression models were used to examine the association between lagged reports of vaccination belief change and COVID-19 vaccine uptake, using five belief scales: (1) importance of COVID-19 vaccines, (2) perceived benefits of COVID-19 vaccination, (3) COVID-19 vaccine concerns and risks, (4) normative beliefs about COVID-19 vaccination, and (5) perceptions of general vaccine safety and effectiveness. Analyses controlled for confounding factors and accounted for within-respondent dependence due to repeated measures. In individual models, all vaccination belief scales were significantly associated with increased COVID-19 vaccine uptake. In a combined model, all belief scales except the benefits of COVID-19 vaccination were significant predictors of vaccine uptake. Overall, belief scales indicating the importance of COVID-19 vaccines and normative beliefs about COVID-19 vaccination were the strongest predictors of COVID-19 vaccine uptake. Findings demonstrate that changes in vaccination beliefs influence subsequent COVID-19 vaccine uptake, with implications for the development of future interventions to increase COVID-19 vaccination.

Association Between the "We Can Do This" Campaign and COVID-19 Booster Uptake, U.S., 2021-2022.

Introduction: Monovalent COVID-19 boosters lower the risk of COVID-19 disease, infection, hospitalization, and death. This study examined associations between exposure to a booster public education campaign (the booster campaign) and the increases in booster uptake and reduced length of time until booster uptake among U.S. adults. Methods: Data included a national survey panel of U.S. adults and booster campaign paid media (i.e., digital impressions and TV gross rating points) from September 2021 to May 2022. Multilevel logistic regression models examined the association between exposure to the booster campaign and the likelihood of booster uptake. A Cox proportional hazard model evaluated the association between the booster campaign and booster uptake timing. Interaction terms between the booster campaign media variables and first-dose COVID-19 vaccine date examined differential effects of the booster campaign based on when individuals received their first dose. Results: Interactions between first-dose vaccination date and the booster campaign were statistically significant for cumulative digital impressions (ß=4.75e-08; 95% CIs=5.93e-09, 8.90e-08) and TV gross rating points (ß = 4.62e-05; 95% CIs=5.09e-06, 8.73e-05), suggesting that booster uptake was strongest among those who received their first-dose COVID-19 vaccine later. Booster campaign cumulative digital impressions and TV gross rating points were associated with accelerated booster uptake among those with later first-dose vaccination dates (digital: ß=9.98e-08; 95% CIs=2.70e-08, 1.73e-07; TV: ß=0.0001; 95% CIs=2.80e-05, 0.0002), relative to those with earlier first-dose vaccination dates. Conclusions: The booster campaign may have increased monovalent booster uptake and reduced how long individuals waited until getting their booster. Public education campaigns show promise in stemming the tide of pandemic fatigue and increasing booster confidence.

Racial and ethnic differences in COVID-19 vaccine readiness among adults in the United States, January 2021-April 2023.

Racial and ethnic minority groups have been disproportionately affected by COVID-19 and have experienced systemic, attitudinal, and access-related barriers to COVID-19 vaccination. We examined differences in COVID-19 vaccine readiness-a composite measure of vaccination intention and behavior-between non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian American/Pacific Islander, and American Indian/Alaska Native U.S. adults. Using data from a cross-sectional survey administered to nationally representative samples of âˆ¼ 5,000 U.S. adults each month from January 2021 to April 2023 (n = 135,989), we conducted weighted ttests comparing the monthly percentage of participants from racial/ethnic groups who were "Vaccine Ready." Initial racial/ethnic disparities in vaccine readiness were attenuated within a 7-month period, after which adults from most minority racial/ethnic groups became equally or more vaccine ready compared to non-Hispanic White adults (p < 0.05). Findings suggest that barriers to vaccine readiness that were more prevalent in non-White racial/ethnic groups may have largely been addressed.

Message Fatigue and COVID-19 Vaccine Booster Uptake in the United States.

Dissemination of public health information plays an essential role in communicable disease control and prevention. However, widespread and repeated messaging could become counterproductive if it leads to avoidance and disengagement due to message fatigue. Americans have been inundated with accurate and inaccurate COVID-19 information from myriad sources since the start of the pandemic. Using the health belief model (HBM) as a guiding framework, this study examines COVID-19-related message fatigue among adults in the United States who have gotten at least one dose of a COVID-19 vaccine and the association between message fatigue and COVID-19 booster uptake and intentions. A special survey module of The COVID States Project was fielded between August and September 2022 (n = 16,546). Results showed moderately high levels of message fatigue among vaccinated individuals. Message fatigue was negatively associated with the likelihood of having gotten a COVID-19 booster and intentions to do so among those who had not yet received a booster, above and beyond variance explained by the HBM constructs. These findings underscore the importance of monitoring and mitigating COVID-19-related message fatigue in encouraging the public to stay up to date with COVID-19 vaccination.

Association Between the United States Department of Health and Human Services' COVID-19 Public Education Campaign and Initial Adult COVID-19 Vaccination Uptake by Race and Ethnicity in the United States, 2020-2022.

Non-Hispanic Black (Black) and Hispanic/Latino (Latino) populations face an increased risk of COVID-19 infection, hospitalization, and death from COVID-19 relative to non-Hispanic White (White) populations. When COVID-19 vaccines became available in December 2020, Black and Latino adults were less likely than White adults to get vaccinated due to factors such as racial discrimination and structural barriers to uptake. In April 2021, the U.S. HHS COVID-19 public education campaign (the Campaign) was launched to promote vaccination through general and audience-tailored messaging. As of March 2022, Black and Latino adults had reached parity with White adults in COVID-19 vaccine uptake. This study evaluated the relationship between Campaign exposure and subsequent vaccine uptake among Black, Latino, and White adults in the United States and assessed whether participant race/ethnicity moderated the relationship between Campaign exposure and vaccine uptake. Campaign media delivery data was merged with survey data collected from a sample of U.S. adults (n = 2,923) over four waves from January 2021 to March 2022. Logistic regression analysis showed that cumulative Campaign digital impressions had a positive, statistically significant association with COVID-19 vaccine uptake, and that participant race/ethnicity moderated this association. Compared with White adults, the magnitude of the relationship between cumulative impressions and vaccination was greater among Black and Latino adults. Results from a simulation model suggested that the Campaign may have been responsible for closing 5.0% of the gap in COVID-19 vaccination by race/ethnicity from April to mid-September 2021. We discuss implications for future public education campaigns that aim to reduce health disparities.

Evaluation of the "We Can Do This" Campaign Paid Media and COVID-19 Vaccination Uptake, United States, December 2020-January 2022.

Public education campaigns are promising methods for promoting vaccine uptake. In April 2021, the U.S. Department of Health and Human Services launched the We Can Do This COVID-19 public education campaign. This study is one of the first evaluations of this COVID-19 public education campaign. We tested associations between channel-specific campaign exposure (i.e. digital, TV, radio, print, and out-of-home advertising) and COVID-19 first-dose vaccinations among a nationally representative online sample of 3,278 adults. The study introduces novel ways to simultaneously evaluate short- and long-term cumulative media dose, filling an important gap in campaign evaluation literature. We observed a positive, statistically significant relationship between the short-term change in digital media dose and the likelihood of first-dose vaccination, and a positive, statistically significant relationship between long-term cumulative TV dose and the likelihood of first-dose vaccination. Results suggest that both digital and TV ads contributed to vaccination, such that digital media was associated with more immediate behavioral changes, whereas TV gradually shifted behaviors over time. As findings varied by media channel, this study suggests that public education campaigns should consider delivering campaign messages across multiple media channels to enhance campaign reach across audiences.

Recalled Exposure to COVID-19 Public Education Campaign Advertisements Predicts COVID-19 Vaccine Confidence.

This study examined the relationship between recalled exposure to the We Can Do This COVID-19 Public Education Campaign (the Campaign) and COVID-19 vaccine confidence (the likelihood of vaccination or vaccine uptake) in the general population, including vaccine-hesitant adults (the "Movable Middle"). Analyses used three waves of a triannual, nationally representative panel survey of adults in the U.S. fielded from January to November 2021 (n = 3,446). Proportional odds regression results demonstrated a positive, statistically significant relationship between past 4-month Campaign recall and vaccine confidence, controlling for lagged reports of Campaign recall and vaccine confidence; concurrent and lagged fictional campaign recall; survey wave; and sociodemographics. Results indicated that as one moves from no Campaign recall to infrequent recall, there is a 29% increase in the odds of being in a higher vaccine confidence category. Findings offer evidence of the impact of a COVID-19 public education campaign on increasing vaccine confidence.

The Initial Relationship Between the United States Department of Health and Human Services' Digital COVID-19 Public Education Campaign and Vaccine Uptake: Campaign Effectiveness Evaluation.

BACKGROUND: Over 1 million people in the United States have died of COVID-19. In response to this public health crisis, the US Department of Health and Human Services launched the We Can Do This public education campaign in April 2021 to increase vaccine confidence. The campaign uses a mix of digital, television, print, radio, and out-of-home channels to reach target audiences. However, the impact of this campaign on vaccine uptake has not yet been assessed. OBJECTIVE: We aimed to address this gap by assessing the association between the We Can Do This COVID-19 public education campaign's digital impressions and the likelihood of first-dose COVID-19 vaccination among US adults. METHODS: A nationally representative sample of 3642 adults recruited from a US probability panel was surveyed over 3 waves (wave 1: January to February 2021; wave 2: May to June 2021; and wave 3: September to November 2021) regarding COVID-19 vaccination, vaccine confidence, and sociodemographics. Survey data were merged with weekly paid digital campaign impressions delivered to each respondent's media market (designated market area [DMA]) during that period. The unit of analysis was the survey respondent-broadcast week, with respondents nested by DMA. Data were analyzed using a multilevel logit model with varying intercepts by DMA and time-fixed effects. RESULTS: The We Can Do This digital campaign was successful in encouraging first-dose COVID-19 vaccination. The findings were robust to multiple modeling specifications, with the independent effect of the change in the campaign's digital dose remaining practically unchanged across all models. Increases in DMA-level paid digital campaign impressions in a given week from -30,000 to 30,000 increased the likelihood of first-dose COVID-19 vaccination by 125%. CONCLUSIONS: Results from this study provide initial evidence of the We Can Do This campaign's digital impact on vaccine uptake. The size and length of the Department of Health and Human Services We Can Do This public education campaign make it uniquely situated to examine the impact of a digital campaign on COVID-19 vaccination, which may help inform future vaccine communication efforts and broader public education efforts. These findings suggest that campaign digital dose is positively associated with COVID-19 vaccination uptake among US adults; future research assessing campaign impact on reduced COVID-19-attributed morbidity and mortality and other benefits is recommended. This study indicates that digital channels have played an important role in the COVID-19 pandemic response. Digital outreach may be integral in addressing future pandemics and could even play a role in addressing nonpandemic public health crises.

Reach, Receptivity, And Beliefs Associated With the Fresh Empire Campaign to Prevent and Reduce Cigarette Use Among Youth in the United States.

PURPOSE: To determine the association between exposure to FDA's Fresh Empire tobacco public education campaign and tobacco-related beliefs. DESIGN: Repeated cross-sectional data collection design with embedded longitudinal cohort over six data collection waves. SETTING: 30 US evaluation markets. SAMPLE: Hip Hop peer crowd-identified US youth aged 12-18 (N = 5,378). MEASURES: Self-reported brand and video ad awareness (saw any ad at least sometimes) and perceived effectiveness (1-5 scale) to describe campaign awareness and receptivity. Exogenous exposure was measured using population-adjusted broadcast and digital video impressions. Tobacco-related beliefs included beliefs about smoking risks, attitudes towards tobacco-free people and lifestyles, and normative beliefs about smoking. ANALYSIS: Descriptive analyses of awareness, receptivity, and agreement with tobacco-related beliefs. Logistic regression models to determine the relationship between broadcast and digital video impressions and beliefs. INTERVENTION: Fresh Empire campaign. RESULTS: The campaign generated a high level of reach (71% brand and 66% video ad awareness at final wave) and messages were well-received (across waves 3.5-4.1 mean perceived effectiveness scores). Higher broadcast television exposure was associated with increased agreement with five beliefs related to addiction/control, being a bad influence on family/friends, and cosmetic effects of smoking (breath and attractiveness) (ORs = 1.16-1.27, (Ps < .05)). CONCLUSION: Fresh Empire successfully reached and resonated with Hip Hop-identified youth. The campaign was associated with a limited number of targeted beliefs.

Final Evaluation Findings for This Free Life, a 3-Year, Multi-Market Tobacco Public Education Campaign for Gender and Sexual Minority Young Adults in the United States.

INTRODUCTION: This Free Life was the first multi-market, primarily digital campaign designed to change tobacco-related beliefs among lesbian, gay, bisexual, and transgender (LGBT) young adults. Our evaluation sought to determine whether campaign exposure resulted in changes in tobacco-related beliefs. We summarize awareness and receptivity at the conclusion of the campaign and assess the effect of campaign exposure on tobacco-related beliefs in campaign treatment markets compared with control markets. AIMS AND METHODS: Twenty-four US designated market areas were selected to receive the campaign or serve as control markets. A baseline survey was conducted in 2016, with six follow-up surveys conducted approximately 6 months apart over the course of the 3-year campaign. 12 324 LGBT young adult survey participants were recruited via intercept interviews and social media. Campaign effects on outcomes were estimated using difference-in-difference panel regression models, with p-values corrected for multiple comparisons. RESULTS: Brand and ad awareness peaked in treatment markets approximately 2.5 years into the 3-year campaign and were significantly higher in treatment than control markets. Brand equity and ad receptivity were generally high and similar across LGBT subgroups. There were small but significant campaign effects on five tobacco-related beliefs, with difference-in-difference estimates ranging from 1.9 to 5.6 percentage points. CONCLUSIONS: This Free Life, the first multi-market tobacco public education campaign for LGBT young adults, reached and resonated with a large and diverse population, and had a small effect on beliefs involving social aspects of smoking. These findings should inform future communication efforts aimed at reducing tobacco use among LGBT young adults. IMPLICATIONS: Modest overall campaign effects suggest that further research on effective campaign messaging and delivery to LGBT young adults is needed. Campaign messaging style, delivery channels, and targeted outcomes likely contributed to these findings. Health communication efforts for LGBT young adults should consider the limitations of digital media in achieving sufficient exposure. Ad style and content optimized for a digital environment is an area that will benefit from further development.

Family Child Care Providers' Nutrition Practices and Policies: Happy Healthy Homes.

OBJECTIVE: Determine the impact of family child care home providers' nutrition knowledge, confidence, and perceived barriers on program nutrition best practices and written nutrition policies. METHODS: Cross-sectional analysis of self-reported surveys of 49 female providers in Oklahoma City analyzed with Spearman correlation, multivariate linear and logistic regression (α < 0.05). RESULTS: Confidence and barriers were significantly correlated (rs(47) = -0.4, P = 0.004). Independent variables explained 36% of practices (r2 = 0.357). Nutrition knowledge (standard ß = 0.442, P = 0.001) and confidence (standard ß = 0.358, P = 0.008) were significantly associated with practices; barriers were not. No significant association between independent variables and written policies resulted. CONCLUSIONS AND IMPLICATIONS: Provider nutrition knowledge and confidence appear to be suitable targets to improve nutrition practices. Further research can evaluate possible influences on the presence and quality of family child care home written nutrition policies and specific nutrition policy topics associated with healthier nutrition practices.

Cell-free DNA ultra-low-pass whole genome sequencing to distinguish malignant peripheral nerve sheath tumor (MPNST) from its benign precursor lesion: A cross-sectional study.

BACKGROUND: The leading cause of mortality for patients with the neurofibromatosis type 1 (NF1) cancer predisposition syndrome is the development of malignant peripheral nerve sheath tumor (MPNST), an aggressive soft tissue sarcoma. In the setting of NF1, this cancer type frequently arises from within its common and benign precursor, plexiform neurofibroma (PN). Transformation from PN to MPNST is challenging to diagnose due to difficulties in distinguishing cross-sectional imaging results and intralesional heterogeneity resulting in biopsy sampling errors. METHODS AND FINDINGS: This multi-institutional study from the National Cancer Institute and Washington University in St. Louis used fragment size analysis and ultra-low-pass whole genome sequencing (ULP-WGS) of plasma cell-free DNA (cfDNA) to distinguish between MPNST and PN in patients with NF1. Following in silico enrichment for short cfDNA fragments and copy number analysis to estimate the fraction of plasma cfDNA originating from tumor (tumor fraction), we developed a noninvasive classifier that differentiates MPNST from PN with 86% pretreatment accuracy (91% specificity, 75% sensitivity) and 89% accuracy on serial analysis (91% specificity, 83% sensitivity). Healthy controls without NF1 (participants = 16, plasma samples = 16), PN (participants = 23, plasma samples = 23), and MPNST (participants = 14, plasma samples = 46) cohorts showed significant differences in tumor fraction in plasma (P = 0.001) as well as cfDNA fragment length (P < 0.001) with MPNST samples harboring shorter fragments and being enriched for tumor-derived cfDNA relative to PN and healthy controls. No other covariates were significant on multivariate logistic regression. Mutational analysis demonstrated focal NF1 copy number loss in PN and MPNST patient plasma but not in healthy controls. Greater genomic instability including alterations associated with malignant transformation (focal copy number gains in chromosome arms 1q, 7p, 8q, 9q, and 17q; focal copy number losses in SUZ12, SMARCA2, CDKN2A/B, and chromosome arms 6p and 9p) was more prominently observed in MPNST plasma. Furthermore, the sum of longest tumor diameters (SLD) visualized by cross-sectional imaging correlated significantly with paired tumor fractions in plasma from MPNST patients (r = 0.39, P = 0.024). On serial analysis, tumor fraction levels in plasma dynamically correlated with treatment response to therapy and minimal residual disease (MRD) detection before relapse. Study limitations include a modest MPNST sample size despite accrual from 2 major referral centers for this rare malignancy, and lack of uniform treatment and imaging protocols representing a real-world cohort. CONCLUSIONS: Tumor fraction levels derived from cfDNA fragment size and copy number alteration analysis of plasma cfDNA using ULP-WGS significantly correlated with MPNST tumor burden, accurately distinguished MPNST from its benign PN precursor, and dynamically correlated with treatment response. In the future, our findings could form the basis for improved early cancer detection and monitoring in high-risk cancer-predisposed populations.

Oklahoma Family Child Care Home Provider Perceptions of the Child and Adult Care Food Program and Menu Contents.

AIMS: In 2017, the Child and Adult Care Food Program (CACFP), which reimburses qualifying food expenses for Family Child Care Home (FCCH) providers, was substantially enhanced. This study's purpose was to explore the perceptions of Oklahoma FCCH providers of these enhancements and to determine current meal practices as an opportunity to foster collaborations between educators, service providers, and health and nutrition professionals. METHODS: This mixed-methods study included a cross-sectional survey (n=30) and semi-structured interviews (n=30) and menu analysis (n=25) of FCCH providers participating in the CACFP. RESULTS: There were 30 survey and interview respondents. Five main themes emerged from the qualitative interviews with providers: 1) they are satisfied, but... ; 2) base meals on what is creditable; 3) choose foods that children will eat; 4) serve what they perceive as healthy; and 5) have limited food preparation time. Quantitative menu analysis indicates most menus met minimum requirements of the CACFP. However, only 4% served a vegetable/fruit for snack; 27% served family-style meals; and 20% limited pre-fried foods. The providers expressed frustrations with CACFP implementation, and they demonstrated limited knowledge of child nutrition. CONCLUSIONS: Providers want to do what is best for children while saving money and time. Collaborative practice between allied health, nutrition, and CACFP service providers and child educators would likely assist FCCH providers in meeting nutrition best practices.

The effect of the food environment on fresh produce served in family child care homes.

BACKGROUND: Higher produce consumption in childhood decreases risks of short- and long-term malnutrition, obesity, and disease. Children in early care programs, including family child care homes (FCCHs), receive 50-67% of daily nutrition while in care. Procuring nutritious foods requires grocer access, which is absent in food deserts (FDs). AIM: To determine if FCCH food environment (FE) impacted distance to grocers and amount of fresh produce served. METHODS: Using a cross-sectional design, Modified Retail Food Environment Index scores determined census tract FD status. FCCH and grocer addresses were geocoded and distance to the nearest grocers was calculated. Fresh produce was observed during two lunches. RESULTS: FE did not influence distance to grocers or fresh produce served. Non-desert FCCHs tended to serve fresh produce more frequently. The amount of fresh produce served was overall low. CONCLUSION: Further studies are warranted to inform policies aimed to reduce provider barriers regarding service of fresh produce.

LGBT young adults' awareness of and receptivity to the This Free Life tobacco public education campaign.

PURPOSE: This study measures awareness of and receptivity to the Food and Drug Administration's This Free Life campaign seeking to change tobacco-related attitudes and beliefs among lesbian, gay, bisexual and/or transgender (LGBT) young adults. METHODS: Participants were young adults who self-identify as LGBT. The evaluation uses a treatment-control design. This study includes data from four survey rounds with participants from each round invited to participate in subsequent rounds and new participants invited to account for attrition. Bivariate analyses assess treatment-control differences in campaign awareness by round. We used multivariable logistic regression models with a time×treatment interaction and covariates to assess whether increases in awareness were greater in treatment than control from follow-ups 1 to 4. Descriptive statistics describe perceived effectiveness and models explore covariates of perceived effectiveness. RESULTS: At each round, an increasing number of participants in treatment were brand aware (25%-67%) and reported high (16%-34%) and medium (16%-25%) video awareness compared with control (all p<0.001). Regressions revealed interactions in brand and video awareness, wherein the effect of treatment on awareness increased more over time, with significant treatment-control differences in change from follow-up 1 to 4 (all p<0.05). Reactions to all but one ad were positive (one neutral) with mean perceived effectiveness scores from 3.21 to 3.92 ('neither disagree nor agree' to 'agree' on 5-point scale). Perceived effectiveness differed by LGBT identity (all p<0.05). CONCLUSIONS: At follow-up 4, This Free Life reached most of the campaign audience in treatment markets and has achieved higher awareness in treatment than control markets, at individual survey rounds and over time.

Influencer prevalence and role on cigar brand Instagram pages.

PURPOSE: Influencers market products for tobacco companies on social media. This is the first study to systematically examine leading cigar brands' use of influencers on their brand Instagram pages. METHODS: We identified 24 leading cigar brands, using July 2017-June 2018 US retail data. We identified cigar brands that had official appearing Instagram pages, with at least one influencer in the past 20 posts. We coded characteristics of the past three posts from each of five brand pages that contained influencers, such as setting and what the influencer was doing. Finally, we described influencer characteristics. RESULTS: Approximately one-third of the 24 brands had official Instagram accounts with at least one influencer in the past 20 posts. We identified 28 influencers, typically people of colour from the hip-hop music industry, some with millions of followers. Influencers included Bella Thorne (@bellathorne), Shaquille O'Neal (@shaq) and T.I. (@troubleman31). Brands' posts that contained influencers showed the influencer using/holding a product, wearing branded merchandise or appearing in photos with a brand watermark. Three brands' pages posted sponsored event photos (ie, concerts and events using branded backgrounds). DISCUSSION: Cigar brands commonly use influencers to market their products on brand Instagram pages. Results are consistent with previous findings that cigar companies' marketing may target younger African Americans and highlight the potential utility of education campaigns that similarly engage influencers.

To Speak to Me, Address Us: Insights From LGBT Young Adults to Inform Public Education Campaigns.

Draft advertising concepts were tested in a series of focus groups among 140 lesbian, gay, bisexual, and transgender (LGBT) young adults aged 18 to 24 in seven U.S. cities in 2015. In this secondary analysis of focus group transcripts, young adult responses to tested concepts belie deeper lessons that have broader application for public education campaigns among LGBT young adult audiences. Respondents valued seeing both individuals who were like them and also unlike them, preferring a diverse portrayal of the fuller spectrum of LGBT communities, a finding which has implications for campaign segmentation of LGBT audiences. More broadly tailored communications for LGBT audiences can be appropriate as long as portrayals are diverse. These young adults expressed the desire to see nuanced, humanizing content that avoids playing into existing stereotypes. These findings also show how qualitative research can benefit segmentation and how research and communications can address the needs of subgroups within diverse segments.