Sixth AnnualSocial Marketing Conference

of the California Nutrition Network

Susan B. Foerster, ChiefCancer Prevention and Nutrition Section

California Department of Health Services

August 5-6, 2003

California Nutrition Network

•“Grow” fruit and vegetable intake to 5 to 9 servings, increasing detectibly by 2003.

•Increase daily physical activity to 30 minutes in adults and 60 minutes in children and teens.

•Increase participation in federal nutrition assistance programs, especially Food Stamps.

• Our audience is Caucasian, Latino and African American families, current or potential participants in the Food Stamp Program.

• The potential population includes 1.5 million households and 3.6 million children at 185% of the Federal Poverty Level.

Social Marketing, as Defined, Works!

California Nutrition Network Definition of Social Marketing

“…The use of commercial marketing approaches to achieve a social goal…

includes the traditional mix of advertising, public relations, promotion, and personal sales, and addsconsumer empowerment, community development,

partnership, media advocacy, and policy-systems-and-environmental change…”

A Multi-Level Campaign Is Needed!

National(5 A Day, Food Stamp Outreach, Team Nutrition,

Changing the Scene, Verb Campaign, etc.)

State(5 a Day, Nutrition Network, CPL, state agencies and organizations)

Regions(Media Markets)

Counties, Cities, School Districts(Local Governments)

Communities

Theory of the Problem

• Inadequate knowledge/belief by consumers

• Not enough promotion/selling of healthy behaviors

• Inadequate access, high environmental barriers

• Inadequate policies in state, local and private sectors

• Inadequate attention by intermediaries• Inadequate resources, understanding of

solutions• Inadequate leadership, infrastructure

for change

Social Marketing Elements Aligned withProgram Evaluation Measures and Additional Activities

Social Structure, Public Policy

Interpersonal, Lifestyle Influences,Primary Prevention

Individual

Institutional and Organizational

Community

personal sales (via materials distribution)consumer empowerment

advertising*, public relations*, partnerships, empowerment (community), community development

*Categorization in the specific sphere depends on how the construct was operationalized

Promotions*Institutional Change

SEM Constructs CPNSActivities/ Measures

Increase fruit & vegetable intakeIncrease physical activityIncrease participation in food assistance programs

K-A-B about diet and activity

reach of retail, schools, faith channels

reach of electronic and print media coverage, progress in community

development or work groups

development of policy platform and educational efforts completed

Policy and systems changes

So, How Is California Doing?

We’re a Work in Progress!

Local Incentive Awards and Special Projects Awards and Growth, by Channel

0

10

20

30

40

50

60

1 2 3 4 5 6 7

Nu

mb

er o

f Pro

gra

ms

Low Resource SchoolDistricts/Schools

Local HealthDepartments

PublicColleges/Universities

County Office ofEducation

Indian TribalOrganizations

Cooperative ExtensionAgencies

Cities

Park & Recreation Departments

First 5 Commissions

$3 $5 $8.5 $16.6 $46 $53.6 $66 Program Year and Funding Level in Millions

Media Impressions and Contacts via State and Local

Social Marketing Activities

2.2 / adult

Data are from SAAR reports and USDA progress reports

0

200,000,000

400,000,000

600,000,000

800,000,000

1,000,000,000

1,200,000,000

3 4 5 6

Program Year

Con

sum

er Im

pres

sion

s

Direct

PR Events

Advertising

54 / adult

4.7 / LI person

5.5/ LI person

Current Levels of Food Insecurity1 and Food Stamp Participation2 in California

8.3%

20.0%

53.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

FoodInsecurity

withHunger

FoodInsecurity

woHunger

FoodStamp

Usage - %Eligible

1 2001 California Health Interview Survey; Percentage of total CHIS population with household income <200% FPL2 Schrim AL, Castner LA; Mathematic Policy Research, 2002

10%

20%

30%

40%

84 86 88 90 92 94 96 98 00

Latino

Black

State

White

Low Income

Change in Consumer Outcomes Physical Inactivity

by Race/Ethnicity

1 Inactive includes those reporting no leisure time activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise in the past 30 days.2 Low income includes those reporting a household income of less than $20,000.Source: California Dept. of Health Services, Cancer Surveillance Section, SRG.

Healthy People 2010 Goal

Percent of Adults

2001

Change in Consumer Outcomes Fruit and Vegetable Trends

by Race/Ethnicity

0

1

2

3

4

5

6

19

89

19

91

19

93

19

95

19

97

19

99

20

01

Years

Se

rvin

gs

of

Fru

its

an

d

Ve

ge

tab

les

White

Latino

Asian/PacificIslander

AfricanAmerican

Change in Consumer Outcomes Fruit and Vegetable Trends

by Income

0

1

2

3

4

5

6

1989

1991

1993

1995

1997

1999

2001

Years

Se

rvin

gs

of

Fru

its

an

d

Ve

ge

tab

les

$50,000+

$35,000-$49,999

$25,000-$34,999

$15,000-$24,999

<$15,000

Change in Consumer OutcomesFruit and Vegetable Trends

by Education Level

0

1

2

3

4

5

6

19

89

19

91

19

93

19

95

19

97

19

99

20

01

Years

Ser

vin

gs

of

Fru

its

and

V

eget

able

sCollegeGrad

SomeCollege

High SchoolGrad

<HighSchool

30%

40%

50%

60%

70%

92 93 94 95 96 97 98 99 00 01 02

Latino

Black

State

White

Asian/Other

Change in Health Outcomes

Rates of Overweight1

1992-2002 by Race/Ethnicity

1 Overweight = BMI of 25 or higher. Based on reported height and weight.Age-adjusted to the 1990 California population.Source: California Dept. of Health Services, Cancer Surveillance Section, SRG.

Healthy People 2010 Goal

Percent of Adults

25%

35%

45%

55%

65%

75%

85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01

<HS

HS Grad

>HS

Change in Health Outcomes Rates of Overweight1

1992-2001, by Education Level

1 Overweight = BMI of 25 or higher. Based on reported height and weight.Age-adjusted to the 1990 California population. Data not available for 2000.Source: California Dept. of Health Services, Cancer Surveillance Section, SRG.

Healthy People 2010 Goal

Percent of Adults