National Public Health Dashboards: Protocol for a Scoping Review.

BACKGROUND: The COVID-19 pandemic highlighted the importance of robust public health data systems and the potential utility of data dashboards for ensuring access to critical public health data for diverse groups of stakeholders and decision makers. As dashboards are becoming ubiquitous, it is imperative to consider how they may be best integrated with public health data systems and the decision-making routines of diverse audiences. However, additional progress on the continued development, improvement, and sustainability of these tools requires the integration and synthesis of a largely fragmented scholarship regarding the purpose, design principles and features, successful implementation, and decision-making supports provided by effective public health data dashboards across diverse users and applications. OBJECTIVE: This scoping review aims to provide a descriptive and thematic overview of national public health data dashboards including their purpose, intended audiences, health topics, design elements, impact, and underlying mechanisms of use and usefulness of these tools in decision-making processes. It seeks to identify gaps in the current literature on the topic and provide the first-of-its-kind systematic treatment of actionability as a critical design element of public health data dashboards. METHODS: The scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The review considers English-language, peer-reviewed journal papers, conference proceedings, book chapters, and reports that describe the design, implementation, and evaluation of a public health dashboard published between 2000 and 2023. The search strategy covers scholarly databases (CINAHL, PubMed, Medline, and Web of Science) and gray literature sources and uses snowballing techniques. An iterative process of testing for and improving intercoder reliability was implemented to ensure that coders are properly trained to screen documents according to the inclusion criteria prior to beginning the full review of relevant papers. RESULTS: The search process initially identified 2544 documents, including papers located via databases, gray literature searching, and snowballing. Following the removal of duplicate documents (n=1416), nonrelevant items (n=839), and items classified as literature reviews and background information (n=73), 216 documents met the inclusion criteria: US case studies (n=90) and non-US case studies (n=126). Data extraction will focus on key variables, including public health data characteristics; dashboard design elements and functionalities; intended users, usability, logistics, and operation; and indicators of usefulness and impact reported. CONCLUSIONS: The scoping review will analyze the goals, design, use, usefulness, and impact of public health data dashboards. The review will also inform the continued development and improvement of these tools by analyzing and synthesizing current practices and lessons emerging from the literature on the topic and proposing a theory-grounded and evidence-informed framework for designing, implementing, and evaluating public health data dashboards. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52843.

Testing Multiple Methods to Effectively Promote Use of a Knowledge Portal to Health Policy Makers: Quasi-Experimental Evaluation.

BACKGROUND: Health policy makers and advocates increasingly utilize online resources for policy-relevant knowledge. Knowledge brokering is one potential mechanism to encourage the use of research evidence in policy making, but the mechanisms of knowledge brokerage in online spaces are understudied. This work looks at knowledge brokerage through the launch of Project ASPEN, an online knowledge portal developed in response to a New Jersey legislative act that established a pilot program for adolescent depression screening for young adults in grades 7-12. OBJECTIVE: This study compares the ability to drive policy brief downloads by policy makers and advocates from the Project ASPEN knowledge portal using a variety of online methods to promote the knowledge portal. METHODS: The knowledge portal was launched on February 1, 2022, and a Google Ad campaign was run between February 27, 2022, and March 26, 2022. Subsequently, a targeted social media campaign, an email campaign, and tailored research presentations were used to promote the website. Promotional activities ended on May 31, 2022. Website analytics were used to track a variety of actions including new users coming to the website, page views, and policy brief downloads. Statistical analysis was used to assess the efficacy of different approaches. RESULTS: The campaign generated 2837 unique user visits to the knowledge portal and 4713 page views. In addition, the campaign generated 6.5 policy web page views/day and 0.7 policy brief downloads/day compared with 1.8 views/day and 0.5 downloads/day in the month following the campaign. The rate of policy brief page view conversions was significantly higher for Google Ads compared with other channels such as email (16.0 vs 5.4; P<.001) and tailored research presentations (16.0 vs 0.8; P<.001). The download conversion rate for Google Ads was significantly higher compared with social media (1.2 vs 0.1; P<.001) and knowledge brokering activities (1.2 vs 0.2; P<.001). By contrast, the download conversion rate for the email campaign was significantly higher than that for social media (1.0 vs 0.1; P<.001) and tailored research presentations (1.0 vs 0.2; P<.001). While Google Ads for this campaign cost an average of US $2.09 per click, the cost per conversion was US $11 per conversion to drive targeted policy web page views and US $147 per conversion to drive policy brief downloads. While other approaches drove less traffic, those approaches were more targeted and cost-effective. CONCLUSIONS: Four tactics were tested to drive user engagement with policy briefs on the Project ASPEN knowledge portal. Google Ads was shown to be effective in driving a high volume of policy web page views but was ineffective in terms of relative costs. More targeted approaches such as email campaigns and tailored research presentations given to policy makers and advocates to promote the use of research evidence on the knowledge portal website are likely to be more effective when balancing goals and cost-effectiveness.

The Communication Infrastructure as a Social Determinant of Health: Implications for Health Policymaking and Practice.

Policy Points Persistent communication inequalities limit racial/ethnic minority access to life-saving health information and make them more vulnerable to the effects of misinformation.  Establishing data collection systems that detect and track acute gaps in the supply and/or access of racial/ethnic minority groups to credible health information is long overdue. Public investments and support for minority-serving media and community outlets are needed to close persistent gaps in access to credible health information.

Advertising Susceptibility and Youth Preference for and Consumption of Sugar-Sweetened Beverages: Findings from a National Survey.

OBJECTIVE: This study investigated variables that may mediate the relationship between advertising susceptibility and adolescent preference for and consumption of sugar-sweetened beverages (SSBs), with the goal of informing inoculation-based mitigation approaches grounded in media literacy and messaging resistance. DESIGN: The study utilized data from a nationally representative sample of US adolescents (ages 12-17 years, n = 1,657) from the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating survey. MAIN OUTCOME MEASURE: Variables of interest were SSB preference and consumption, advertising susceptibility, perceived self-efficacy to make good nutritional choices, perceived SSB consumption by peers, and attitude toward SSBs. Exposure to obesogenic environments was examined as a moderator. ANALYSIS: Direct and mediated associations between advertising susceptibility and SSB preference were estimated through a series of regression and mediation analyses. RESULTS: Advertising susceptibility was a strong predictor of SSB preference (unstandardized B = .29, SE = .026, P < .001), which, in turn, was a strong predictor of consumption (unstandardized B = .10, SE = .01, P < .001), controlling for potential mediators. The only statistically significant mediator of this association was perceived peer consumption (unstandardized B = .38, SE = .08, P < .001), which was stronger for adolescents with higher exposure to obesogenic environments. CONCLUSIONS AND IMPLICATIONS: This study offers developers of inoculation-based strategies additional insight into levers that could be targeted for building adolescent resistance to advertising effects.

A Multiyear Assessment of Public Response to a Statewide Drug Take-Back and Disposal Campaign, 2010 to 2012.

This study is the first to analyze public response to a drug take-back program, the American Medicine Chest Challenge, in a single state over a period of 3 years (2010-2012). The study utilized a three-wave repeated cross-sectional design and an annual phone survey conducted with a representative sample of adults ( N = 906 in 2010, N = 907 in 2011, and N = 906 in 2012), which assessed exposure to the campaign, drug disposal behaviors, possible mediators of campaign effects (risk appraisal, personal agency, normative influence, and interpersonal talk), and potential confounders. Logistic regression and causal mediation analysis were employed to estimate confounder-adjusted direct and mediated effects of the campaign. Results showed that the campaign reached a sizable portion (50% to 60%) of state adults and that campaign exposure was associated with increased likelihood of having conversations with others about this topic. About 55% of all adults in the state reported taking at least one of the actions recommended by the campaign, and campaign exposure was associated with increased likelihood of disposing of prescription drugs at a drug collection day event (adjusted odds ratio = 4) and of talking to a child about the risks associated with prescription drug abuse (adjusted odds ratio = 2). The causal mediation analysis demonstrated that the campaign influenced audiences by reinforcing their efficacy to safely dispose of prescription drugs, but also potentially by stimulating conversations among community members about this topic. Drug take-back campaigns can be an effective mechanism to decrease the availability of prescription drugs in communities.

The American Medicine Chest Challenge: Evaluation of a Drug Take-Back and Disposal Campaign.

OBJECTIVE: Prescription drug take-back programs provide a safe and convenient way to dispose of expired, unwanted, or unused medications that people store in homes, thus limiting the potential misuse of prescription drugs. This study evaluated public response to a social marketing campaign promoting a community-based drug take-back program, the American Medicine Chest Challenge. METHOD: A telephone survey was conducted with a representative sample of adults in New Jersey (N = 906) 2 weeks following the conclusion of the statewide collection day event in November 2010. The survey assessed public exposure to the campaign and the extent to which it is associated with public perceptions and behaviors the campaign was designed to influence. RESULTS: The campaign, which relied heavily on community channels for the dissemination of messages, was able to reach directly more than 60% of its target audience. When potential confounders were controlled for, campaign exposure was a strong predictor of a respondent having one or more conversations with others about medicine disposal (odds ratio [OR] = 2.4, 95% CI [1.5, 3.6]); actually disposing of expired, unwanted, or unused medicine in a collection site (OR = 2.14, 95% CI [1.15, 3.9]); and talking to kids about the dangers of prescription drug abuse (OR = 1.65, 95% CI [1.1, 2.45])-all of which were exclusively promoted through the campaign. CONCLUSIONS: This case illustrates the potential efficacy of community-based prevention marketing efforts to stimulate community discourse regarding the dangers of prescription drug misuse and to decrease the availability of expired, unwanted, or unused medicine in the community.

Adolescent egocentrism and indoor tanning: is the relationship direct or mediated?

This paper explored how imaginary audience and personal fable ideations contribute to adolescent indoor tanning intentions directly and indirectly through the way they shape pro-tanning attitude and association with peers who use tanning beds. Five hundred and ninety-five male (n = 207) and female (n = 387) adolescents, ranging in age from 11 to 19 (M = 16.87; SD = 1.34) years completed a cross-sectional survey. Measures included imaginary audience, personal fable (three dimensions: invulnerability, uniqueness, and omnipotence), pro-tanning attitude, association with peers who use tanning beds, and tanning bed use intentions. Bootstrapping analyses documented that imaginary audience ideations are indirectly associated with indoor tanning intentions through the mediation of pro-tanning attitude and association with peers who use tanning beds. Of the personal fable ideations, only invulnerability ideation is indirectly associated with indoor tanning intentions through the mediation of association with peers who use tanning beds. Design and evaluation of interventions and campaigns to reduce indoor tanning must be targeted to adolescents varying in imaginary audience ideations differently.

A Theory-Grounded Measure of Adolescents' Response to a Media Literacy Intervention.

Media literacy interventions offer promising avenues for the prevention of risky health behaviors among children and adolescents, but current literature remains largely equivocal about their efficacy. The primary objective of this study was to develop and test theoretically-grounded measures of audiences' degree of engagement with the content of media literacy programs based on the recognition that engagement (and not participation per se) can better explain and predict individual variations in the effects of these programs. We tested the validity and reliability of a measure of engagement with two different samples of 10th grade high school students who participated in a pilot and actual test of a brief media literacy curriculum. Four message evaluation factors (involvement, perceived novelty, critical thinking, personal reflection) emerged and demonstrate acceptable reliability.

The impact of information about the female condom on female condom use among males and females from a US urban community.

This study investigates the impact of exposure to information about a relatively new prevention method, the female condom (FC), on actual FC use in a community of adults at risk of HIV/STI. A community-wide survey from a mid-size US city is used to estimate unbiased effects of information about the FC on FC use among sexually active men and women. To control for potential confounders we use propensity score matching (PSM) which matches the group exposed to FC information to participants who were not exposed, achieving a statistical quasi-randomization in terms of ten measured confounders. Comparisons of exposed to unexposed participants matched on their propensity scores conclude that information about the FC increases initiation of FC use, such that eleven percent more of the men and women who receive FC information reported ever using the FC. We demonstrate the use of PSM and illustrate some of its strengths and limitations.

Sensation seeking and alcohol use by college students: examining multiple pathways of effects.

This study tests the proposition that peer influence mediates the effect of sensation seeking, a personality trait, on alcohol use among college students. Cross-sectional data to test this proposition were collected from a representative sample of college students at a large public northeastern university (N = 427). Results of hierarchical regression analyses showed that, as hypothesized, sensation seeking influenced personal alcohol use both directly and indirectly, through its impact on students' frequency of association with alcohol-using peers and the size of their drinking norm misperception. The findings suggest that interventions that seek to limit the frequency in which high sensation seekers associate with peers whose alcohol use is extreme or, alternatively, seek to facilitate social interactions of high sensation seekers with normative peers, may supplement efforts to influence sensation seekers' alcohol and other drug use through tailored mass media advertisements.

Social distance, perceived drinking by peers, and alcohol use by college students.

Many colleges in the United States are employing social norms marketing campaigns with the goal of reducing college students' alcohol use by correcting misperceptions about their peers' alcohol use. Although the typical message used in these campaigns describes the quantity and frequency of alcohol use by the average student on campus, many students may find such a vague comparison to others to be socially irrelevant. This study compares the relative weight of perceptions about alcohol use by distant versus proximate peers in the prediction of college students' personal drinking behavior. The results of analyzing data collected from a sample of college students at a large public northeastern university (N=276) show that, as hypothesized, perceived alcohol use by proximate peers (best friends and friends) was a stronger predictor of students' personal alcohol use than perceived alcohol use by more distant peers (such as students in general), controlling for other strong predictors of alcohol use by college students (age, gender, race, off-campus residency, and sensation-seeking tendencies). The implications of these findings for the design of more effective social norms messages are discussed.

Sensation seeking and adolescent drug use: the mediating role of association with deviant peers and pro-drug discussions.

In this study, I examined direct and indirect influences of sensation seeking, a personality trait, on adolescent drug use. I hypothesized that some or even most of the contribution of sensation seeking to drug use by adolescents is mediated through association with deviant peers and communication with peers that is favorable toward drug use. I examined the role of additional risk or protective factors in facilitating or impeding association with deviant peers, pro-drug communication, and marijuana use as well. The results of analyzing nationally representative cross-sectional data from the evaluation of the National Youth Anti-Drug Media Campaign support the study's hypotheses and suggest that different factors may protect high sensation-seeking adolescents from using drugs or engaging in activities (e.g., association with deviant peers) that may increase their risk for drug use. I discuss the theoretical, methodological, and practical implications of these findings to the design of health communication interventions.

Using Theory to Design Evaluations of Communication Campaigns: The Case of the National Youth Anti-Drug Media Campaign.

We present a general theory about how campaigns can have effects and suggest that the evaluation of communication campaigns must be driven by a theory of effects. The National Youth Anti-Drug Media Campaign illustrates both the theory of campaign effects and implications that theory has for the evaluation design. Often models of effect assume that individual exposure affects cognitions that continue to affect behavior over a short term. Contrarily, effects may operate through social or institutional paths as well as through individual learning, require substantial levels of exposure achieved through multiple channels over time, take time to accumulate detectable change, and affect some members of the audience but not others. Responsive evaluations will choose appropriate units of analysis and comparison groups, data collection schedules sensitive to lagged effects, samples able to detect subgroup effects, and analytic strategies consistent with the theory of effects that guides the campaign.

Effect of news coverage on the prevalence of drunk-driving behavior: evidence from a longitudinal study.

OBJECTIVE: To examine the proposition that antidrunk driving messages in the news media contributed indirectly to the decline in drunk driving over the past two decades through their impact on related policy making processes. METHOD: Time series regression techniques are applied to longitudinal data to examine the causal association between drivers' involvement in drunk-driving behavior, the volume of news coverage devoted to the drunk driving issue, and related policy making. RESULTS: Results show a significant contribution of news coverage to drunk-driving-related policy actions, which in turn are associated with a reduction in drunk driving among young and high-risk drivers. There was no evidence of a direct causal association between news coverage and change in drunk-driving behavior. CONCLUSIONS: News coverage of alcohol-related risky behaviors seems to provide a cost-effective way of reducing the prevalence of these practices by attracting institutional attention and prompting related environmental changes. Future interventions may benefit from actively seeking to influence news coverage of risky behaviors.