developing health communication campaigns to address drug
TRANSCRIPT
Developing Health Communication Campaigns to Address Drug
Overdose Prevention
Brittany Curtis, MBAHealth Communication SpecialistDivision of Overdose Prevention
Centers for Disease Control and Prevention
Loretta Jackson Brown, PhD, RN, CNNLead Health Communication Specialist
Division of Overdose PreventionCenters for Disease Control and Prevention
Welcome!
Loretta Jackson Brown, PhD, RN, CNNLead, Education, Campaigns, and Implementation Team
Division of Overdose PreventionCenters for Disease Control and Prevention
Brittany Curtis, MBAHealth Communication SpecialistDivision of Overdose Prevention
Centers for Disease Control and Prevention
Disclaimer
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the
Centers for Disease Control and Prevention or the Department of Health and Human Services.
Faculty Disclosures• Loretta Jackson Brown, PhD, RN, CNN, has no financial relationships to
disclose relating to the subject matter of this presentation.
• Brittany Curtis, MBA, has no financial relationships to disclose relating to the subject matter of this presentation.
• The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational use(s) of drugs, products, and/or devices (any use not approved by the US Food and Drug Administration).
• Applicable CME staff have no relationships to disclose relating to the subject matter of this activity.
• This activity has been independently reviewed for balance.
Today’s Learning Objectives
Translate research findings to messaging
and materials for a drug overdose
prevention communications effort.
Identify strategies and/or tactics that
would be effective in reaching key
audiences about drug overdose prevention,
specifically drugs such as cocaine, meth, and
other stimulants.
Describe the importance of evaluation in
determining the effectiveness of their
communications efforts.
Today’s Agenda
• Drug Overdose Campaign Background
• Translating Research to Audience Focused Content
• Strategies for Dissemination
• Measuring Campaign Performance
Understanding the Drug Overdose Prevention Landscape
Age-adjusted Rates of Drug Overdose Deaths by State, 2019
Centers for Disease Control and Prevention. 2019 Drug Overdose Death Rates.
CDC's State Unintentional Drug Overdose Reporting System (SUDORS) 24 states and the District of Columbia reporting, January-June 2019. Overdose Deaths and the Involvement of Illicit Drugs.
Nonfatal Drug Overdose ED Visit Rates for Ages 25-34
Centers for Disease Control and Prevention. 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes.
Methadone
Cocaine
Methamphetamine
Other Opioids
Heroin
Opioid
0 50 100 150 200
Emergency Department Visit Rate (per 100,000 population)
Most Commonly Used Substances Among 18- to 34-Year-Olds
• Among 18- to 25-year-olds:– Cannabis – Prescription stimulants– Prescription benzodiazepines
• Among 26- to 34-year-olds:– Methamphetamines– Cocaine– Opioids– Heroin
Centers for Disease Control and Prevention. 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes.
Substance Involved in Drug Overdose Deaths Vary by Age
Centers for Disease Control and Prevention. 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes.
• Among 25- to 34-year-olds:– Heroin– Synthetic opioids other than methadone
• Among 35- to 44-year-olds:– Psychostimulants with abuse potential – Methadone
• Among 45- to 54-year-olds:– Prescription opioids– Natural and semi-synthetic opioids– Cocaine
Majority with Substance Use Disorders Do Not Receive Treatment
Substance Abuse and Mental Health Service Administration. National Survey for Drug Use and Health, 2019: Assistant Secretary for Health Presentation.
People with Substance Use Disorder (Ages 12+)
Treatment No Treatment
89.7%
10.3%
Post-Pandemic Considerations• Over 93,000 drug overdose deaths occurred in the United States in
2020, the highest number of overdose deaths ever recorded• Synthetic opioids (primarily illicitly manufactured fentanyl) appear to be
the primary driver of the increases in overdose deaths• Overdose deaths involving cocaine also increased by over 20% from
the previous year– Based upon earlier research, these deaths are likely linked to co-
use or contamination of cocaine with illicitly manufactured fentanyl or heroin
Kariisa et al. MMWR 2019 https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
Campaign Priority Topic Areas
Research and Strategic Planning Uncovered 4 Key Areas for Focus
Polysubstance Use
• Intentional
Synthetic Opioids
• Fentanyl in drug supply
Harm Reduction
• Naloxone
Reducing Stigma
• Treatment (Medication-assisted treatment, Medications for opioid use disorder)
• Recovery
Audience Selection
Creating Drug Overdose Campaigns for 18- to 34-year-olds
• Age range that is most likely to misuse prescription drugs and use illicit substances
• Experience high rates of overdose deaths, from multiple substances
Centers for Disease Control and Prevention. 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes.
Including Secondary Audiences in Drug Overdose Prevention Campaigns
• Secondary audiences play an important role as people who can support young adults who use drugs:– Friends– Family– Caregivers– Healthcare Providers– First Responders– Physicians
• Each campaign will contain additional outreach materials to help these audiences support young adults who use drugs and reduce stigma
Centers for Disease Control and Prevention. 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes.
Analyzing Key Findings from Concept Testing
Key Informant Interviews (KIIs) to Test Creative Concepts
• Spoke with several Certified Peer Recovery Specialists• One-hour calls• Shared three creative concepts, each with design and messages
across each of the four campaigns• Asked about their personal and professional experiences, as some
were the intended audience, prior to their recovery
Creative Concepts Tested During KIIsFentanyl
StigmaPolysubstance Use
Harm Reduction (Naloxone)
Interviews Led to Additional Concept Testing• Refine the intended audience
– Break the 18- to 34-year-old age group into two age groups, 18-24 and 25-34
• Ensure appealing design– Multiple comments on size of font and colors for readability; and
imagery that foster a non-judgmental sentiment
• Use inclusive, non-stigmatizing language– Continue to ensure messaging was refined to each topic and
reduced stigma– Address other drivers of substance use such as mental health,
culture, and need for connection
Refined Creative Concepts for In-depth Interviews• Adjusted creative concepts, based on KII feedback
• Conducted in-depth interviews (IDIs) with two refined audience segments, 18-24 and 25-34, from October to November 2020
• Goal of the IDIs was to gather insights within each age range to:– Refine and tailor messages for important drug overdose prevention
topics– Identify the most appropriate creative concept(s)– Understand communication styles, channels, and preferences– Identify which topics were most relevant to which audience segment
Creative Executions Tested in IDIs
Polysubstance Use Harm Reduction (Naloxone)
Fentanyl Stigma(Recovery/MAT/MOUD)
IDIs Uncovered Need for Revisions to Concept, Messaging, and Creative Execution
• Fentanyl– Focus on unintentional fentanyl exposure– Expand beyond fentanyl being laced in pills to include broader drug
supply (eg, fentanyl’s presence in cocaine, MDMA, etc.)
• Polysubstance Use– Taking more than one drug at the same time is the norm– Focus on intentional polysubstance use (knowingly mixing drugs)– Include information about consequences of mixing different kinds of drugs
(eg, stimulants and depressants, two depressants, etc.)
IDIs Uncovered Needs for Revisions to Concept, Messaging, and Creative Execution (cont’d)
• Risk Reduction – Focus on naloxone and its benefits/uses– Educate about what naloxone is (people knew of Narcan, not naloxone)– Normalize carrying and using naloxone– Connect the importance of naloxone with the presence of fentanyl in drug supply
• Stigma– Include messaging about multiple pathways to recovery (not one right way;
doesn’t look the same for everyone)– Normalize recovery, that it’s something many people go through, and that it can
take time, or even multiple attempts (reiterating that it’s not a linear process)– Tailor messages about specific treatment options, such as MOUD, to secondary
audiences (caregivers, health care providers, etc.)
Red Flag Testing Materials and Messages
Red Flag Testing for Static/Animated/Radio AdsConducted as 4 Separate Studies
• For each campaign, we spoke with young adults ages 18 to 34 who use drugs using 60-minute interviews
• Shared a static ad, an animated ad, a radio ad, and key messages in each interview (all from the same campaign)
• Participants shared reactions to each ad and the message to provide insight around:– First impressions of the ads (including any concerns)– Clarity of the messaging– Relevancy to the intended audience– Areas for improvement to help the ad resonate better with the
intended audience
Video Ads Red Flag Tested Separately
• Because of the time needed for production, video ads were tested separately from the other campaign materials as 2 studies:– Study 1: fentanyl and naloxone videos
• Will be completed by October 2021– Study 2: stigma and polysubstance use videos
• Will be completed in November 2021
• In each study, we will share the 60-second and 30-second video spots from the corresponding campaigns with nine members of the intended audience for this effort (young adults ages 18 to 34 who use drugs)
Key Findings From Red Flag Testing• Participants shared critical feedback on ads across the graphical elements,
messaging, tone, and call to action, identifying key final revisions:– In one fentanyl campaign ad, a pill image was flagged as being triggering
for people who use drugs. This image was removed from the final ads.– In one polysubstance use campaign ad, participants felt the imagery and
the messaging were disconnected and unclear. This ad was removed from the final assets.
– In the stigma campaign radio ad, one of the quotes about recovery did not feel believable to the audience. We revised the quote to be more relatable and authentic.
– In the naloxone campaign ads, participants did not like seeing only part of the naloxone nasal spray dispenser on the side of the ads, especially since many were unfamiliar with naloxone. The ads were adjusted to show the full naloxone dispenser to increase awareness of what naloxone looks like.
Final Ads and Messages
Polysubstance Use
PosterDigital static ads/banners
Fentanyl
Static Ad A
Static Ad B
Poster
Harm Reduction Strategies (Naloxone)Digital static ads
Social static stories
Reducing Stigma (Recovery, MAT, MOUD)
Poster A Poster B Digital Ads
cdc.gov/stopoverdose
• Launched in August 2021
• Features links to all campaigns about preventing drug overdose
• Includes other federal resources related to each campaign
• Spanish-language website and resources will be available in the near future
Strategies for Dissemination
Gleaning Dissemination Insights from Formative Research
• Dissemination-specific questions were built into the moderator’s guides for KIIs and concept-testing IDIs
– In what formats do you like to receive information? – Where do you go to get information (online, friends/peers, etc.)?– What sources of information do you use and trust? – Where would you expect to see a product/ad like this?
Findings Informed Dissemination Strategy• Ensure materials reach people who use drugs “where they are.”
Key informants emphasized the importance of displaying messaging in places where people use drugs, such as clubs/raves/concerts, public restrooms, gas stations, motels/hotels
• Expand intended audience to include parents, caregivers, and other important members of the community (eg, healthcare providers, first responders). Key informants reported that the designs for naloxone and recovery would be relevant to people outside the intended audience
• Ensure any digital campaign products link to more information and resources, offer a range of relatable content, and possibly include real-life examples of recovery
Psychographic Audience Profiles Provided Key Insights into Intended Audience Habits
• Psychographic audience profiles contain psychological aspects that influence consumer behavior such as lifestyle, social status, opinions, beliefs, and activities
I care about emerging
technology.
Spending time with family is important to
me.
I take time for self-care at least once
per week.
Final Dissemination Strategy is Multi-pronged• Using formative research and audience profiles, CDC developed a
multi-pronged dissemination strategy to meet the intended audience of 18- to 34-year-old young adults and engage secondary audiences
• Dissemination tactics include:– Paid media campaign (with a heavy focus on digital channels)– Donated media – Earned media outreach– Partner and stakeholder outreach
• All campaigns were launched as part of a paid media campaign in late August; the paid media campaign will run through mid-November 2021
Paid Media is State-focused and Heavily Digital• Evaluated prevalence and burden data around drug
overdose prevention topics addressed through these campaigns to guide market selection
• Selected tactics that align with intended audience media consumption habits (heavily digital in nature)– Streaming radio ads (eg, Pandora, Spotify)– Paid social media (Instagram, Facebook)– Google Discovery ads– Place-based ads (delivery bag inserts,
pharmacy bags)
• Tactics differed slightly for English and Spanish ads based on audience consumption habits
Donated Media is Placed Nationally• TV and radio public service announcements (PSAs) and out-of-home
ads placed as donated media
• Leveraged donated PSAs nationally to supplement the market-specific placement of paid media campaign, providing free national coverage and exposure across each topic/campaign
Bulletin ad for naloxone
Earned Media Supports National and Local Reach • Developing pre-recorded podcasts (one for each campaign) to post on
cdc.gov/stopoverdose and distribute to hosting platforms (in English and Spanish)
• Writing and pitching a matte article about all 4 campaigns for placement in national and local print publications (in English and Spanish)– Including multicultural publications in outreach list
• Developing a press release to engage national outlets, letting them know about the campaigns and their goals
Strategic Stakeholder Outreach Amplifies Campaign• Partner and stakeholder outreach will amplify the campaign reach by
helping distribute materials and resources to additional audiences that may not be engaged through paid media or earned media tactics
• List of organizations includes those that serve:– Primary and secondary audiences (including large retailers,
restaurant organizations, first responders, HCPs, and pharmacists)– Spanish-speakers from the primary audiences– Multicultural organizations that reach both primary and secondary
audiences
• CDC tailored implementation kits for these organizations that focus on the campaigns most relevant to the audience
Measuring Campaign Performance
A Variety of Metrics Demonstrate Performance• CDC is tracking and monitoring metrics across dissemination tactics to
gauge campaign reach and understand how well certain assets perform (for each campaign and the effort overall)
• Metrics, or key performance indicators, come from a variety of sources, depending on the dissemination strategy and tactics:– Website metrics– Paid media campaign– Donated media asset placement – Earned media activities– Outreach efforts related to partner and stakeholder engagement
Additional Analysis Conducted through Social Media Commentary Listening
• CDC will also monitor comments on all paid social media campaign posts to provide insights around conversations related to current campaign efforts
• Posts will be monitored regularly to flag conversations of interest (positive or negative)
• A final report on social media commentary will provide highlights and key takeaways, overall sentiment breakdown, sentiment breakdown by campaign topic, and comment volume over time
