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Volume 1:
No. 4, October 2004
STEP-BY-STEP: MAKING YOUR
COMMUNITIES HEALTHIER
Skin and Colon Cancer Media Campaigns in Utah
Camille Broadwater, MPH, Janet
Heins, MPH, Catherine Hoelscher, MPH,
Adam Mangone, Cami Rozanas
Suggested citation for this article: Broadwater C, Heins J, Hoelscher C, Mangone A, Rozanas
C. Skin and colon cancer media campaigns in Utah. Prev Chronic Dis
[serial online] 2004 Oct [date cited]. Available from:
URL: http://www.cdc.gov/pcd/issues/2004/
oct/04_0023.htm.
Abstract
The mission of the Utah Cancer Action Network is to reduce cancer incidence
and mortality in Utah. Established in 2003, the network selected skin and colon cancers
as the first priorities in its comprehensive plan. In its first year of
operation, the network planned and implemented a cancer awareness campaign that was organized
along two tracks: 1) marketing research, consisting of two telephone surveys,
and 2) two advertising/awareness campaigns, one for colon cancer and one for
skin cancer. The first telephone survey was conducted in January 2003 to obtain
a baseline measurement of the Utah population’s knowledge, attitudes, and behaviors.
The advertising campaigns were launched in April 2003, and the second
telephone survey was conducted in May.
In January 2003, 18% of survey respondents reported seeing or hearing skin
cancer prevention or sun protection announcements; in May, this percentage
increased to 76%. In January, 36% indicated they had seen, read, or heard
colorectal cancer early detection announcements; in May, this percentage
increased to 79%.
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Introduction
The Utah Cancer Action Network (UCAN) was established in 2003 with a mission
to reduce cancer incidence and mortality in Utah through collaborative efforts
that provide services and programs directed toward comprehensive cancer
prevention and control. Its open membership includes 72 participating partners
ranging from universities to hospitals to the Utah State House of
Representatives. Staff from the Utah Department of Health
Cancer Control Program provide administrative support to UCAN:
two full-time employees and one half-time support employee plan,
implement, and monitor program activities.
UCAN is funded by grants from the Centers for Disease Control
and Prevention. In fiscal year 2003, UCAN received approximately
$1 million: $322,000 for its Comprehensive Cancer core activities,
$330,000 for the colon cancer campaign, $330,000 for the skin cancer campaign,
and $29,000 for a prostate cancer program.
One of UCAN’s primary responsibilities is to recommend
priorities for cancer prevention and early detection efforts in
Utah. UCAN selected skin and colon cancers as the first priorities
in its comprehensive plan. UCAN’s goals are consistent with
the goals of Healthy People 2010 (1). One goal is to
reduce the incidence of skin cancer in Utah by decreasing the
proportion of adults and young people who acquire sunburn to less
than 30% by 2005. Another goal is to promote and increase colon
cancer screening rates to 50% among people aged 50 or older who
have 1) had a fecal occult blood test in the past two years and
2) ever had a sigmoidoscopy.
To that end, in its first year of operation, the network planned and implemented a cancer awareness campaign
that was organized along two tracks: 1)
marketing research, consisting of two telephone surveys, and 2)
two advertising/awareness campaigns (one for colon cancer and one
for skin cancer). The goal of the awareness campaign was
two-fold: first, to create a brand and messaging strategy to
establish the newly formed UCAN as a community cancer prevention leader; and,
second, to increase public awareness about the importance of
early detection and prevention of colon cancer and skin
cancer.
Skin cancer incidence in Utah
In Utah, people are at increased risk of developing skin cancer because of a predominance of sunny days,
a high altitude, and residents with fair skin. Utah has approximately 241 sunny days annually,
and the U.S. has an estimated 213 sunny days each year. Utah ranks third among
all U.S. states in average elevation (6100 ft). Approximately 89% of the state’s population is white, compared
with the national average of 75%, for the year 2000 (2). These factors may contribute to higher incidence of skin cancer that consistently exceeds the national average.
According to Surveillance, Epidemiology, and End Results (1996–2000), the age-adjusted incidence rate for melanoma in Utah was 19.93 per 100,000, and the national average was 17.52 per 100,000 (3).
Looking forward, it is projected that 420 Utahns will be diagnosed with malignant melanoma in 2004 (4).
Additionally, the 2000 Utah Behavioral Risk Factor Surveillance System indicated that nearly 48% of adults reported obtaining sunburn in the previous 12 months (5).
Colon cancer incidence in Utah
It was estimated that 700 new cases of colon cancer would be
diagnosed and 300 Utahns would die from colon cancer Utah in 2003 (6). Colon
cancer is most common in men and women aged 50 and older (6,7). The risk
increases with age: 93% of cases
were diagnosed in people aged 50 years and older (6,7). Colon cancer
is the number two cancer killer in both the United States and
Utah, and it is more than 90% preventable if properly screened
(7).
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The Cancer Awareness Media Campaigns
Utah Department of Health Cancer Advertising Awareness
Survey
To assess public knowledge, attitudes, and health behaviors
regarding skin and colon cancers both prior to and after the
launch of the UCAN advertising campaigns, UCAN contracted with a local (Salt
Lake City) marketing research firm to conduct the 2003 Utah Department of Health
Cancer Advertising Awareness Survey. The research firm was selected because of
its experience in opinion polls, marketing, customer information, and social
and public policy research. Two telephone surveys were
administered by the research firm: one in January 2003 and
another in May 2003. The sample for both surveys was an equal
probability telephone sample of all Utah households. The January
survey was designed to obtain a baseline measurement of
the Utah population’s knowledge, attitudes, and behaviors.
The January survey was developed by the Cancer Program staff in conjunction
with the marketing research firm. Prior to administering the survey, a draft
survey instrument was prepared and tested among 23 randomly selected Utah
residents in a focus group setting. The focus group participants were asked to
complete the survey as if they were respondents, and they were also asked to
provide feedback on questions, especially if they were unclear about the intent
of a question, if there were terms they did not understand, or if the survey
format was not clear. Feedback from these pretest interviews helped to formulate
the final questionnaire.
January survey data collection began on January 20, 2003, and
concluded by January 31. All sampling during the course of
the survey research relied on random-digit-dial protocols. When a
household was contacted, an adult within the household was
identified and asked to participate in the survey, which required an average of
10 minutes for participants to complete. The overall
survey response rate for the January 2003 administration was 81%,
and 816 individuals completed the survey.
The January survey was divided into two target audiences, one
for skin cancer, which targeted an audience of adults aged 18–49 with children, and another for colon cancer,
which targeted an audience of adults aged 50 and older; 407 individuals completed the skin cancer surveys
and 409 individuals completed the colon cancer surveys.
UCAN advertising campaigns
In February 2003, UCAN contracted with a local advertising firm to develop
two advertising campaigns. Incorporating feedback from the January survey, UCAN developed several test
messages for both colon and skin cancer. For skin cancer, UCAN focused on the
issues of personal risk assessment and protective clothing. For
colon cancer, UCAN focused on the perception that colon cancer
primarily affects males and that screening is necessary only when
symptoms are present. To help test the messages within each
target audience, UCAN conducted focus group research, twice for
skin cancer and twice for colon cancer. Each focus group consisted
of eight or nine participants. Focus group results determined the
creative strategy that shaped the key messages.
Skin cancer campaign
The primary messages developed by the advertising firm for UCAN’s skin cancer campaign are “Don't take the sun
lightly” and “Cover up or use sunscreen on yourself and
your children every day.” The campaign’s take-home message is that parents would protect their children if they realized the
dangers of sun exposure. The campaign was launched on April 1,
2003, and the accompanying integrated campaign materials included radio and
television ads, print ads, banners, billboards, and collateral
materials such as posters, rack cards, water bottles, lip balm,
and sunscreen packets.
To maximize the campaign’s budget and exposure, UCAN solicited donated
space and airtime from selected media outlets. For every dollar
spent, two dollars were donated in airtime or promotional value.
These donations included Internet exposure, radio remotes,
tie-ins with entertainment and sporting events, and weather forecast
sponsorships. In addition, for each hour of paid
staff time, the
advertising firm donated one hour of staff time. We also forged contacts
with businesses and community organizations — including
parent-teacher associations, WIC (Special Supplemental Nutrition
Program for Women, Infants, and Children), Utah State Parks,
pharmacies, physicians, local health departments, utility
companies, fast food chains, and retail outlets — to disseminate
materials and circulate the message within the community.
Colon cancer campaign
The colon cancer campaign was launched on April 1, 2003.
The key messages developed by the advertising agency were:
- “The fact is, there are no early warning signs of colon
cancer.”
- “If you’re 50 or older, call your doctor to find
out which colon cancer screening option is right for
you.”
- “A simple test saves lives.”
Those messages were implemented as part of an integrated and comprehensive
marketing strategy. Television, radio, print, public relations, and grassroots
efforts targeted an audience aged 45 and older. Local media talent, which appealed to
our target demographic group, were recruited as spokespeople and
were used to help break down the social stigma surrounding colon
cancer. Physicians made public appearances and provided
interviews to validate both UCAN and its message. Additionally, Utah’s
local ABC Television affiliate broadcast a live colonoscopy to
eradicate myths about the procedure and show that it is simple
and painless.
A major success for the colon campaign was the ability of UCAN to negotiate
partnerships that resulted in a three-to-one match for every media dollar spent. Radio
and television stations across the state freely promoted UCAN’s colon cancer message through local programming,
event sponsorship, and news stories. The two largest newspapers
in the state printed at no cost a twelve-page UCAN tabloid
insert that contained articles written by doctors and health
experts from around the state.
Finally, the colon cancer campaign was supported by a
grassroots effort that penetrated the community through
parent-teacher associations, businesses, physicians, local health
departments, and event sponsorships that included the Huntsman
Senior World Games in St. George, Utah.
May follow-up survey
In May, four to six weeks after both campaigns had been launched, another
pair of surveys was administered to assess public knowledge, attitudes, and
health behaviors regarding skin and colon cancers; 426 adults aged 18 to 49 completed the
post-campaign skin cancer surveys and 403 adults aged 50 and older
completed post-campaign colon cancer surveys. The May follow-up
survey began on May 23, 2003, and concluded on June 9. The
response rate for the May 2003 administration was 68%.
Key research findings
Key research findings are summarized in
Table 1 and
Table 2.
In January 2003, 18% of survey respondents reported seeing or
hearing skin cancer prevention or sun protection announcements.
The May follow-up survey showed that in less than four weeks on
air, recall of UCAN skin cancer ads reached 76%. Among those
recalling ads, 78% could “play back” the main message or other
specific ad content.
In January 2003, only 36% of survey respondents had heard or
seen advertising about colon cancer. This percentage more
than doubled to 79% in May. Of the 79% that had heard or seen an
ad, 85% could recall of one of UCAN’s main messages.
In addition to increasing awareness of UCAN’s message through advertising, we also generated favorable publicity. The skin cancer public-relations effort generated more than 33 newspaper articles
statewide, 14 television interviews and appearances, and more
than a dozen radio interviews with physicians, cancer survivors,
and health care professionals.
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Conclusions
Awareness campaigns for skin cancer prevention and early colon cancer detection clarify important issues for the
public and help move them toward appropriate health behaviors. The
initial print, radio, and television campaign continues to expand
and reach additional Utahns. Although this is the initial data
reported for the Utah statewide media campaign, time and funds
have been allocated to do annual follow-up surveys.
Utah received funds to continue the two media campaigns into a
second year. For the second year, the funding level for colon
cancer remained the same, but only one-sixth of the original funds
was available for skin cancer. A grant application for funds for
a third year has been submitted and is pending approval. The
telephone post-campaign survey data for year two are being collected. Also, campaign pieces have been
offered for use in other communities throughout the United
States.
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Author Information
Corresponding author: Janet Heins, MPH,
Health Program Coordinator, Utah Department of Health, P.O. Box
142107, Salt Lake City, UT 84114-2107. Telephone: 801-538-6235.
E-mail: jheins@utah.gov.
Author affiliations: Camille Broadwater,
MPH, College of Nursing, University of Utah, Salt
Lake City, Utah; Catherine Hoelscher, MPH, Breast
and Cervical Cancer Program, Utah Department of Health, Salt Lake
City, Utah; Adam Mangone, Love Communications, Salt Lake City,
Utah; Cami Rozanas, Crowell Advertising, Marketing and PR Agency,
Salt Lake City, Utah.
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References
- U.S. Department of Health and Human Services.
Healthy
people 2010:
understanding and improving health. Washington (DC): U.S. Government
Printing Office; 2000 Nov.
- U.S. Census Bureau.
State and county quick facts [Internet]. Washington (DC): The
Bureau; 2001.
- National Cancer Institute.
Surveillance, Epidemiology, and End Results
(SEER) program stats database 1975-2001 [Internet]. Bethesda (MD): The Institute;
2002.
- American Cancer Society, Inc. Cancer facts & figures 2004. Atlanta
(GA): The Society; 2004.
- U.S. Department of Health and Human Services.
2000 Utah Behavioral Risk Factor Surveillance
System. Atlanta (GA): Centers for Disease Control and Prevention; 2001.
- American Cancer Society, Inc. Cancer facts & figures 2003. Atlanta
(GA): The Society; 2003.
- U.S. Department of Health and Human Services.
Facts on colorectal screening
[Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2002.
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Table 2.
Key Findings From Public Awareness Surveys on Skin
Cancer, Adults Aged 18–49, Utah, 2003
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