TY - JOUR
AU1 - Andrade, E L
AU2 - Evans, W D
AU3 - Barrett, N D
AU4 - Cleary, S D
AU5 - Edberg, M C
AU6 - Alvayero, R D
AU7 - Kierstead, E C
AU8 - Beltran, A
AB - Abstract Immigrant Latino youth represent a high-risk subgroup that should be targeted with health promotion efforts. However, there are considerable barriers to engagement in health-related programming. Little is known about the engagement possibilities of social marketing campaigns and digital strategies for traditionally ‘hard-to-reach’ immigrants, underscoring the importance of testing these techniques with immigrant Latino adolescents. We developed and piloted a place-based social marketing campaign in coordination with the branded, Positive Youth Development-based (PYD) Adelante intervention targeting risk factors for co-occurring youth substance abuse, sexual risk and violence. Building on prior research, we conducted a four-phase formative research process, and planned the Adelante social marketing campaign based on findings from one group interview and ongoing consultation with Adelante staff (n=8) and four focus groups with youth (n=35). Participants identified four overarching campaign themes, and suggested portrayal of resilient, proud youth who achieved goals despite adversity. Youth guided selection of campaign features and engagement strategies, including message/visual content, stylistic elements, and a mixed language approach. We developed a 12-month campaign to be delivered via print ads, multi-platform social media promotion, contests, youth-generated videos, blog posts, and text messaging. We describe the process and outcome of campaign development and make recommendations for future campaigns. Introduction Latinos are the largest ethnic minority in the United States, and Latino adolescents represent an important and growing population. In 2014, Latinos constituted 17.3% of the total US population and 22.8% of the population ages 10–19 [1, 2]. It is estimated that by 2060, Latinos will represent 28.6% of the overall US population and 34% of adolescents ages 10–19 [1]. Latino adolescents are an increasingly significant population with respect to the nation’s economy, social structure and health status. However, they continue to experience widespread health disparities [3–7], especially related to mental health, substance use, obesity, sexually transmitted infections, unintended pregnancy and asthma [8–14]. Immigrant Latinos who have migrated in recent years (as opposed to having generations of establishment in the United States) represent a particularly high-risk subgroup that should be targeted with health promotion efforts. Yet, Latino immigrants face numerous barriers to engagement in traditional health-related programming, including linguistic, social and cultural isolation; time constraints; financial or transportation barriers; unsafe neighborhoods; discrimination and fear [15–22]. Unique to families from this subgroup, managing migration and resettlement stressors, including securing employment, child school enrollment and ensuring access to food and housing, can overshadow other pressing health and social needs [16, 23], resulting in further disengagement from health promotion efforts. Adding to these challenges, shifting migration patterns in recent years have resulted in a drastic increase in unaccompanied and/or recently-arrived immigrant Latino adolescents in the Unites States, who tend to have complex needs, and may settle in communities that are ill-equipped to adequately meet their health, educational or developmental needs. Engagement is a first step in meeting these needs, and strategies that have shown promise include participatory program planning, integration of comprehensive services and multi-sectoral partnerships [24–31]. However, considerable challenges remain for overcoming barriers to Latino immigrant adolescent engagement, and the use of social marketing campaigns and digital media have not been widely tested with this population. In the present study, we developed and piloted a place-based social marketing campaign in coordination with a branded program for Latino immigrant youth, called Adelante. Social marketing, branding and digital media for adolescent engagement The concept of ‘engagement’ is paramount for health-promoting behavior change, and engagement can increase program effects; nevertheless, this area is largely understudied [32–36]. For this research effort, we operationalized engagement as the degree of interest, interaction and participation in a program, and engagement is more likely to occur when: there is connectivity and multiple points of contact between participant and program; participation is easy yet rewarding and participants are interested in and identify with campaign messages (i.e. having increased ‘brand equity’) [32, 37]. Social media can offer many of these attributes to increase engagement. For youth in particular, these attributes intersect with fundamentals of adolescent development by providing opportunities for identity exploration [38] through personalized content creation, ubiquitous social connection and engagement with elements of social-cultural modeling from the digital community [39]. Social marketing campaigns have demonstrated effectiveness in improving engagement and numerous adolescent health-related behaviors [40–42]. Furthermore, the rapid expansion in access to digital technologies has afforded unprecedented opportunities to engage young people in health promotion interventions, and branded campaigns have harnessed the power of digital media, gaining traction with young audiences [12, 40, 43–52]. Nevertheless, campaigns specifically targeting Latino adolescents are few and far between. Little is known about the engagement possibilities of social marketing campaigns and digital strategies for traditionally ‘hard-to-reach’ immigrants [36, 53, 54], underscoring the importance of testing these techniques with immigrant Latino adolescents. Background Adelante intervention As part of a long-standing community-academic partnership to address health disparities among Latinos living in Langley Park, MD, USA, we developed and implemented the 4-year, multi-level Adelante intervention to target risk factors for co-occurring substance abuse, sexual risk and interpersonal violence among Latino immigrant youth ages 12–24 [55]. An integral part of the Adelante intervention was to test innovative engagement strategies using branding and digital media [56–58]. Adelante implementers had considerable success engaging a core group of youth participants; however, participant barriers and limited programmatic capacity created ongoing challenges to broader community youth engagement. Specifically, participants often faced barriers to attending activities without chaperoned transportation due to neighborhood safety concerns, and parents were frequently unavailable due to employment obligations. During program implementation, Langley Park was a destination for a substantial influx of youth migrants (some unaccompanied) with numerous complex needs, and Adelante quickly reached outreach, programming and service delivery capacity. In order to connect youth to a broader Adelante social network and increase engagement in Adelante’s prevention messages, we implemented a place-based social marketing campaign. Connecting through social media offered a unique opportunity to engage youth in the Adelante community and brand, reaching those who otherwise might not have been able to participate. Moreover, an important purpose of engagement with youth was to link participation in Adelante activities with the values and aspirations represented in the brand. This manuscript presents the formative research process for the Adelante social marketing campaign. Expanding upon prior research, which included participatory Adelante brand development [57] and use of new media and entertainment education applications [58], we conducted formative research for 8 months using an active audience engagement methodology [59] to develop the framework, messages, channels and features of a 1-year campaign. The active audience engagement methodology (as described by Hecht and Miller-Day, and also referred to as ‘applied.2’) [59] is an approach for communication research that uses theory, tests theory and/or develops theory in community contexts, whereby communities are actively engaged to address significant social concerns. This approach places emphasis on working collaboratively with communities to achieve socially significant outcomes while enhancing linkages among research, practice and public policy [59]. This approach was selected due to its consistency with our overall academic-community partnership mission, which sought to conduct community-based participatory research and implement interventions to address health disparities. Thus, using this approach, the formative research had four aims: (i) operationalize theoretical constructs for the campaign; (ii) develop and test campaign messages, framing and visual aspects; (iii) identify campaign strategies and (iv) finalize campaign materials and the implementation plan. Formative research was conducted in four phases, one for each aim (Table I). This study contributes to larger research efforts that evaluate campaign effects as well as evaluate the overall Adelante intervention for improving target risk behaviors (presented elsewhere). Table I. Adelante campaign formative research phases Phase  Purpose  Activities  Phase 1 (Aim 1)  Identify campaign goals and framework  IRB review and approval  Identify PYD constructs, campaign attitudinal, behavioral targets  Conduct group interview with Adelante staff (n = 8)  Develop preliminary campaign messages  Phase 2 (Aim 2)  Test preliminary message concepts  Conduct 2 focus groups with youth (n = 19)  Elicit audience attitudes, norms, values, media preferences  Develop campaign themes (4)  Phase 3 (Aim 3)  Revised ad and message concept testing;  Conduct 2 focus groups with youth (n = 16)  Develop branded ads (27) and messages (54)  Ascertain language, dissemination channels  Phase 4 (Aim 4)  Finalize ad content, style, imagery, language  Establish vendor contracts for ad placement, poster printing, text messaging, social media messaging  Finalize implementation plan and timeline  Create additional campaign components (text messages, blog posts, videos)  Phase  Purpose  Activities  Phase 1 (Aim 1)  Identify campaign goals and framework  IRB review and approval  Identify PYD constructs, campaign attitudinal, behavioral targets  Conduct group interview with Adelante staff (n = 8)  Develop preliminary campaign messages  Phase 2 (Aim 2)  Test preliminary message concepts  Conduct 2 focus groups with youth (n = 19)  Elicit audience attitudes, norms, values, media preferences  Develop campaign themes (4)  Phase 3 (Aim 3)  Revised ad and message concept testing;  Conduct 2 focus groups with youth (n = 16)  Develop branded ads (27) and messages (54)  Ascertain language, dissemination channels  Phase 4 (Aim 4)  Finalize ad content, style, imagery, language  Establish vendor contracts for ad placement, poster printing, text messaging, social media messaging  Finalize implementation plan and timeline  Create additional campaign components (text messages, blog posts, videos)  Table I. Adelante campaign formative research phases Phase  Purpose  Activities  Phase 1 (Aim 1)  Identify campaign goals and framework  IRB review and approval  Identify PYD constructs, campaign attitudinal, behavioral targets  Conduct group interview with Adelante staff (n = 8)  Develop preliminary campaign messages  Phase 2 (Aim 2)  Test preliminary message concepts  Conduct 2 focus groups with youth (n = 19)  Elicit audience attitudes, norms, values, media preferences  Develop campaign themes (4)  Phase 3 (Aim 3)  Revised ad and message concept testing;  Conduct 2 focus groups with youth (n = 16)  Develop branded ads (27) and messages (54)  Ascertain language, dissemination channels  Phase 4 (Aim 4)  Finalize ad content, style, imagery, language  Establish vendor contracts for ad placement, poster printing, text messaging, social media messaging  Finalize implementation plan and timeline  Create additional campaign components (text messages, blog posts, videos)  Phase  Purpose  Activities  Phase 1 (Aim 1)  Identify campaign goals and framework  IRB review and approval  Identify PYD constructs, campaign attitudinal, behavioral targets  Conduct group interview with Adelante staff (n = 8)  Develop preliminary campaign messages  Phase 2 (Aim 2)  Test preliminary message concepts  Conduct 2 focus groups with youth (n = 19)  Elicit audience attitudes, norms, values, media preferences  Develop campaign themes (4)  Phase 3 (Aim 3)  Revised ad and message concept testing;  Conduct 2 focus groups with youth (n = 16)  Develop branded ads (27) and messages (54)  Ascertain language, dissemination channels  Phase 4 (Aim 4)  Finalize ad content, style, imagery, language  Establish vendor contracts for ad placement, poster printing, text messaging, social media messaging  Finalize implementation plan and timeline  Create additional campaign components (text messages, blog posts, videos)  Methods Theoretical underpinnings and previous research The Adelante intervention and campaign formative research were grounded in an adapted Positive Youth Development (PYD) framework, using a multi-level, asset-based approach for risk prevention [55, 60, 61]. The Adelante intervention focused on four of six PYD constructs (known as ‘Cs’) most relevant to immigrant Latino youth, representing key components of adolescent ‘thriving:’ Competence, Confidence, Connection and Contribution, as well as other factors, including expectations about the future, service access, perceived discrimination and positive identity. These variables, working together in a community context, are hypothesized mediating factors leading to reductions in substance abuse and related risk behaviors. We also used social marketing principles for campaign development to augment the program’s impact on Latino adolescent attitudes, norms and prevention behaviors [42, 62]. We conceived the Adelante campaign as an intervention ‘megaphone’ that would broadly disseminate branded prevention messages. For the Adelante campaign, the 4 Ps of social marketing [42, 62] were operationalized as follows: (i) Products—choosing alternatives to substance use; practicing safe sex through the use of condoms and birth control and choosing non-violent resolutions to conflicts; (ii) Price—perceived costs associated with choosing alternatives to risk behaviors or overcoming obstacles to PYD; (iii) Place—physical locations and communication channels that provided access to Adelante and (iv) Promotion—Latino youths’ preferred messages, style elements and visual imagery. These conceptualized 4P’s guided the campaign’s planning, messages and implementation. Study population The formative research study population consisted of Latino immigrant youth ages 12–19 recruited from Adelante (n = 35) and program staff (n = 8). Langley Park is situated in close proximity to Washington, DC, USA and is a low-income community that is predominantly foreign-born (67.6%) and Latino (80%) [63], with most residents originating from Central American countries, including El Salvador (46.53%), Guatemala (32.86%), and Honduras (10.41%) (S. D. Cleary, unpublished results). A recent study by Cleary and colleagues (2014) estimated that among adolescent Latinos ages 12–17, 66% were recently arrived immigrants, having lived in the United States for one year or less. Data collection and measures In Phase 1, our team identified PYD constructs to target and established campaign objectives (Aim 1), after which we formulated interview and focus group protocol and preliminary campaign concepts. We conducted a semi-structured group interview with Adelante staff to inquire about key risk factors to target and in-person program prevention messages to reinforce through the campaign. We sought to explore salient audience concerns, common risk scenarios and cultural considerations. Phase 2 included campaign concept development. We conducted two focus groups with Adelante participants (n = 19), one in Spanish and one in English (Aim 2). We developed a bilingual, semi-structured focus group protocol, and groups were moderated by a trained, bilingual facilitator. We sought to elicit information regarding Adelante brand-related attitudes, norms and values, perceived barriers to prevention and campaign material preferences. We also inquired about media consumption patterns. A primary focus group question was: ‘What does Adelante mean to you and how would you depict that meaning in an ad, photo, or message?’ We created eight preliminary campaign messages with photos and 4 preliminary campaign taglines for participant reaction. Examples included: ‘Adelante is making good choices; Adelante is setting goals and achieving them’; and ‘Adelante is resilience no matter what’. A tagline example was: ‘Langley Park youth are taking the first step towards a life they want. You can too’. Finally, we proposed PYD construct-related scenarios and asked participants to describe what they would say or do in that particular situation. Based on Phase 2 findings, we developed overarching campaign themes and preliminary branded ad concepts that included imagery from a photography session with ten Adelante youth and actors from the Adelante webnovela, Victor and Erika. In Phase 3, we conducted two focus groups with Adelante youth (n = 16), one in English and one in Spanish, to obtain feedback on ads and messages, and to confirm campaign strategies (i.e. materials language and optimal dissemination channels) (Aim 3). Ads and messages were reviewed by theme, and youth indicated ad preferences and voted for two favorite ads per theme. We examined feedback by dominant language of respondents to determine whether audience segmentation should be considered. We also scanned the community for advertising locations. In Phase 4, we finalized campaign ads, messages, and the implementation plan, and launched the campaign (Aim 4). We finalized ads based on audience language and media preferences, and selected three ads per theme to place in bus shelters, with the remainder placed on social media platforms or printed as posters for display throughout the community. We also developed additional campaign components to be disseminated via social media, text messages and the Adelante website. Data analysis Each phase informed subsequent phases and analyses followed the same iterative format. For Phase 1, data consisted of detailed notes taken at research team meetings and the Adelante staff group interview. These notes were summarized and findings guided preliminary campaign ad and message concepts. For Phases 2 and 3, data included focus group audio recordings and detailed notes taken by two bilingual research team members. Focus group notes were compiled and cross-checked for consistency between note-takers and accuracy and completeness with the audio recordings. The notes were systematically hand-coded by two research team members to identify salient themes, which were then reviewed by the research team and focus group facilitator. Specific recommendations for campaign development were summarized by theme, and participant votes were tallied to identify preferred ads and messages. Interpretation of focus group findings was guided by campaign aims and Adelante operationalized PYD constructs. Finally, findings were interpreted in the context of the intervention community and previous research, and at each stage, campaign materials, research protocol and formative research findings were reviewed with Adelante staff and participants to gain their input for campaign development, thus validating research findings and campaign decision-making. All research protocol were approved by the GWU Institutional Review Board (IRB). Results The following presents findings from campaign formative research. Campaign evaluation results are presented elsewhere. Campaign goals and guiding framework (Aim 1) In Phase 1, we established overarching campaign goals: (i) increase engagement, Adelante brand recognition and brand equity among youth ages 12–19 living in Langley Park, MD, USA, (ii) contribute to youth PYD assets improvement (hypothesized mediating variables for intervention outcomes) and (iii) contribute to improved attitudes and decreased substance use, violence and sexual risk behaviors (intervention outcomes). Drawing from Adelante intervention PYD constructs described earlier, we selected constructs deemed most conducive to achieving campaign goals, including Confidence, Social-Cultural Connection, Connection to Peers, Connection to School and Contribution [55]. We decided against including PYD constructs centered on building skills in a particular area (i.e. Competence), which was beyond the campaign’s scope. Finally, during interviews, Adelante staff provided guidance on campaign message framing, tone and ensuring message authenticity: Using fear or guilt will backfire. Instead, use a motivating, inspiring, and positive approach in your messages. Don’t make the language too formal or use too much ‘street’ language. It will look like you are trying too hard. It won’t be authentic. Avoid coming off as authoritative or condescending adults. That will push youth away. We decided to integrate the campaign with the ongoing Adelante intervention. For example, in addition to amplifying intervention messages in the campaign, in-person activities should involve youth participants in campaign message development, campaign ad and video content creation, and the campaign should highlight youth achievements that are consistent with Adelante brand ideals. Campaign themes (Aim 2) For ad development, we completed a photography session with Adelante youth participants (Fig. 1). Ad photographs represented program participant diversity in terms of age and gender. Fig. 1. View largeDownload slide Photography session. Fig. 1. View largeDownload slide Photography session. Findings from focus groups in Phase 2 guided preliminary development of campaign themes, ads and messages for testing in Phase 3. Youth provided their interpretation of the Adelante brand for representation in campaign materials. When asked what Adelante means to them, youth offered words and phrases, such as: moving forward, leadership, fun, culture, path to a brighter future, learning, support, shared memories and friendship. The concept of ‘resilience’ was an overarching thematic finding. One participant expressed a sentiment shared by respondents: Overcoming. Adelante helps us to get through different obstacles in our families, school … you learn more and you can improve yourself … how you speak, the things you can do. To promote youth resilience, campaign materials portrayed challenges that Langley Park youth commonly face and ways to overcome them and prevent risk. Additionally, consistent with Phase 1 findings, youth preferred positive messages and imagery and discouraged ‘negative’ content. Participants suggested loss-framed photos (i.e. a youth participating in violence) be accompanied by imagery of positive alternatives (i.e. youth amicably resolving differences) (Fig. 2). Fig. 2. View largeDownload slide Campaign ad example. Fig. 2. View largeDownload slide Campaign ad example. Participants also recommended youth engagement strategies, including posing questions and addressing the audience directly, portraying situations that entice youth to visit the Facebook page and promoting opportunities or contests. As a result of youth feedback, we identified four overarching campaign themes. The first theme, Adelante Is, helps the audience to understand that Adelante can mean different things to different people, but is unified by the concept of ‘moving forward,’ and that the Adelante program is a reliable, supportive resource to help youth move forward. Adelante is family, a better future, a place to go with a lot of resources. Adelante helps you pass classes, look for scholarships, speak to counselors at school. Adelante will always be there, no matter the circumstances. The second theme, Adelante is About Choices, builds on the ‘turning the corner’ concept, and promotes audience reflection on choices leading to self-improvement or increased risk. Respondents suggested portraying risk scenarios, such as fighting, unprotected sex, or substance use, where youth are faced with choices, and when paired with messages, show the right choice. You have to keep going no matter what and resist anything that comes your way. You can change your life for the better one choice at a time. The third theme, Adelante is Living Your Dream, taps into youths’ desire for a future with opportunities, and provides personalized interpretations of what it means to ‘move forward’ in life, while positioning Adelante as helping youth to pursue their dreams. Adelante helps you to set short-term and long-term goals of things you want to achieve, and somebody always reminds me of my goals to keep me moving forward. We all want to finish school, but there are people who also have to work to help their families. Those people who do everything have to persevere.’ The fourth theme, Belong to Something Bigger than Yourself, taps into a construct common in Latino culture—collectivism—and illustrates what it means to be part of the Adelante community, the Langley Park community and the larger Latino cultural community. This theme is responsive to sentiments of loneliness and isolation expressed by participants as relevant to the immigrant youth experience. You feel good being here and sharing something positive instead of negative. You make a lot of new friends. When you don’t know anyone and you don’t speak the language, you feel isolated, but when you are with people like you, you feel more trust. This idea speaks to me. Overall, campaign themes encourage youth audience members to thrive by making positive choices, avoiding risk behaviors, being part of a positive peer group and contributing to their community. Campaign strategy (Aim 3) In Phase 3, we tested 27 preliminary ads conveying 54 different messages that were guided by four campaign themes, the PYD framework and the Adelante brand. Focus group results aided in decision-making regarding audience segmentation, language, stylistic elements and dissemination channels. Campaign audience Despite our anticipation of two possible audience segments, there was considerable consensus between focus groups that a single audience format was best. Thus, a single set of ads and messages were identified for both English-speaking, more acculturated youth and Spanish-dominant, less acculturated youth. Since Langley Park is very diverse in terms of language, country of origin, and years living in the United States, we decided to use a ‘mixed language strategy’. Youth participants preferred this approach and encouraged a slight tendency towards Spanish to ensure broadest comprehension (i.e. most English-dominant youth also read and understood Spanish): Everybody understands Spanish, but not everyone speaks English well. If you want to reach everyone, Spanish is the safest bet. Consistent with this suggestion, for mixed language ads, more complex text was in Spanish, and simpler text in English. We also decided to complete an additional photography session to capture more recently migrated, less acculturated youth in campaign imagery. This overall bilingual/bicultural strategy mirrors the Adelante intervention, which engages both subgroups in bilingual programming. Stylistic elements for campaign ads Focus group participants provided feedback on the preliminary ads regarding youth featured, tone, topics addressed, backgrounds and color scheme, and portrayal of the Langley Park community. Youth preferred ads showing youth they would likely know or resembled people from their neighborhood. I wouldn’t change the people, keep them—others might recognize their friends. I remember this soccer game, and everyone knows that they won. Similarly, youth connected with ads including recognizable locations and typical community scenes. I know that business that sells alcohol. That’s a bad place to hang around. Respondents preferred action-oriented ads in a natural, outdoor setting instead of portraits and photos that used a voyeur perspective (i.e. capturing a private conversation between two people) as opposed to youth looking directly at the camera. They aren’t looking at the camera, so it looks natural. It makes me wonder what they are talking about. She is not doing much, but the other photos show people doing things. Youth were notably drawn to visual ad elements, and then the message as a secondary point of interest. For this reason, we placed importance on choice of photos, color, font and backgrounds. Participants responded positively to vibrant colors and scenes that were easy to decipher, such as youth in caps and gowns graduating from high school or two people studying in a library. I can tell that they want a future because they have their cap and gowns. I can tell they are moving forward and making the first step, which is to graduate. I like the words, the meaning, the message. It motivates you and gives you something to look forward to, like the [turning the] corner graphic. Respondents also liked ads showing youth in groups, and ads that were not too ‘cluttered’ with text. Being part of something is attractive, like the photo and message. I like that they’re all laughing. It makes people think the neighborhood is fun and has fun things to do. Sometimes you get bored and you want to participate in something fun. This makes me want to go to the website. I don’t have to think about it or read a lot. Youth were firm in their commitment to portraying positive aspects of Langley Park and promoting ethnic pride. You should put the best things about Langley Park. I’m Latino and I’m proud. We like that. We should be proud of who we are, our heritage, where we come from. It makes me feel proud, sometimes people feel embarrassed…it motivates me about being Latino because Latinos are ‘lo máximo,’ makes me feel good … someone going through a bad phase would see this and feel better. Youth were averse to style elements or fonts resembling graffiti, which they associated with gang activity. I don’t like the design in background. It makes me think of gangs. Regarding message content, participants were interested in topics relevant to their daily lives, including educational attainment, friendships, sports and recreation, romantic relationships, bullying and violence, substance use and peer pressure. It’s an important message. It’s something youth should know about, you should talk to your partner. It gets my attention…To me this is Adelante because they teach this message. I think it would speak to kids being bullied or who want to cause problems. Some youth were drawn to content related to civic engagement, community participation or broader social issues, such as immigration reform. I like that there is somebody to help on one side – this is a good thing. It means you should let other people help you. Media consumption and dissemination channels Participants also characterized online access and media consumption. Most youth accessed internet via smart phones, with fewer using a home computers/tablets, Xbox or smart TVs. Participants described limitations in cellular data plans or Wi-Fi access, limiting internet access. Most youth reported Wi-Fi use at home and free ‘hot spots’; fewer youth used cellular data plans. Participants were open to receiving text messages from the Adelante campaign, as long as they were interesting, relayed positive messages, not too frequent (multiple texts per day), and promoted opportunities, such as jobs and scholarships. Youth identified the popularity of other texting apps, like Kik, Groupme or imessage as a barrier to this format. Most youth regularly used social media, especially Facebook, Youtube, Snapchat, Instagram and Twitter. Consequently, we decided to target platforms that youth and the Adelante intervention were already using that could also be tracked for evaluation purposes. Youth participants also provided information on common youth ‘community hangouts’ in order to identify public spaces or traffic thoroughfares for print ad placement. Potential locations included: bus stops, a local mall, a community center, local basketball courts, area parks, the local high school, at apartment buildings and local businesses. Engagement strategies In the focus groups, we also reviewed ideas with youth participants to increase engagement of community youth. We decided to emphasize social media as an engagement portal for youth, as opposed to the Adelante website since youth participants indicated that they were less likely to access a website directly. Respondents were receptive to the idea of contests via social media, where youth could win prizes. Building on youths’ interest in seeing their peers in campaign materials, we worked with Adelante staff to identify youth who were role models, leaders, and represented Adelante brand ideals to appear in campaign materials. As part of the Adelante Ambassadors activity [64], youth created video-based dramatizations and shared their stories through blog posts and in video format. Adelante campaign overview (Aim 4) Building on our prior research and findings from formative Phases 1–3, we launched the Adelante social marketing campaign in August of 2015, and campaign components included: print ads in bus shelters and posters throughout the community; social media promotion with prevention messaging, videos and contests; text messaging with prevention messages and resource information and blog posts. Campaign materials promoted attitudes, norms or behaviors that increased PYD assets and decreased risk behavior related to substance use, sexual risk or interpersonal violence. All messages were guided by PYD constructs, developed around campaign themes (Aim 2) and disseminated via preferred channels for youth (Aim 3) (Table II). Table II. Overview of campaign components and dissemination targets Component  Theme  Platform/location  Quantity  Frequency/duration  Bus shelter ads  Adelante Is  See Fig. 3  3 bus shelters  3 month  Choices  3 bus shelters  3 month  Dreams  3 bus shelters  3 month  Belong  3 bus shelters  3 month  Poster ads  Adelante Is  See Fig. 3  30 posters  3 month  Choices  30 posters  3 month  Dreams  30 posters  3 month  Belong  30 posters  3 month  Social media promotion  Adelante Is  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Choices  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Dreams  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Belong  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Videos  Choices  Facebook, Youtube, Website https://www.youtube.com/watch?v=todbTLPy8JU  Post on Adelante Youtube channel and website  Length: 1: 55 min  Available for 7 months  https://www.youtube.com/watch?v=v4cZ3Ilk17E  Share 4 times on Facebook  Length: 1: 12 min  Available for 6 months  Dreams  Facebook, Youtube, Website https://www.youtube.com/watch?v=Lx9zwMycY44  Post on Adelante Youtube channel and website  Length: 1: 42  Available for 4 months  Share 4 times on Facebook  https://youtu.be/1dJ3iUfrjR4  Length: 2: 24  Available for3 months  Contests  Adelante Is  Facebook, Twitter, Website  1  1–3 weeks in duration;  Choices  Facebook, Twitter, Website  1  Dreams  Facebook, Twitter, Website  1  Every 3 months  Belong  Facebook, Twitter, Website  1  Text Messaging  Adelante Is  Text message  50  Daily for 3 months  Choices  Text message  50  Daily for 3 months  Dreams  Text message  50  Daily for 3 months  Belong  Text message  50  Daily for 3 months  Blogs  Adelante Is  Website, Facebook, Twitter  2  Available for 9 months  Choices  Website, Facebook, Twitter  2  Available for 7 months  Dreams  Website, Facebook, Twitter  2  Available for 5 months  Belong  Website, Facebook, Twitter  2  Available for 2 months  Component  Theme  Platform/location  Quantity  Frequency/duration  Bus shelter ads  Adelante Is  See Fig. 3  3 bus shelters  3 month  Choices  3 bus shelters  3 month  Dreams  3 bus shelters  3 month  Belong  3 bus shelters  3 month  Poster ads  Adelante Is  See Fig. 3  30 posters  3 month  Choices  30 posters  3 month  Dreams  30 posters  3 month  Belong  30 posters  3 month  Social media promotion  Adelante Is  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Choices  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Dreams  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Belong  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Videos  Choices  Facebook, Youtube, Website https://www.youtube.com/watch?v=todbTLPy8JU  Post on Adelante Youtube channel and website  Length: 1: 55 min  Available for 7 months  https://www.youtube.com/watch?v=v4cZ3Ilk17E  Share 4 times on Facebook  Length: 1: 12 min  Available for 6 months  Dreams  Facebook, Youtube, Website https://www.youtube.com/watch?v=Lx9zwMycY44  Post on Adelante Youtube channel and website  Length: 1: 42  Available for 4 months  Share 4 times on Facebook  https://youtu.be/1dJ3iUfrjR4  Length: 2: 24  Available for3 months  Contests  Adelante Is  Facebook, Twitter, Website  1  1–3 weeks in duration;  Choices  Facebook, Twitter, Website  1  Dreams  Facebook, Twitter, Website  1  Every 3 months  Belong  Facebook, Twitter, Website  1  Text Messaging  Adelante Is  Text message  50  Daily for 3 months  Choices  Text message  50  Daily for 3 months  Dreams  Text message  50  Daily for 3 months  Belong  Text message  50  Daily for 3 months  Blogs  Adelante Is  Website, Facebook, Twitter  2  Available for 9 months  Choices  Website, Facebook, Twitter  2  Available for 7 months  Dreams  Website, Facebook, Twitter  2  Available for 5 months  Belong  Website, Facebook, Twitter  2  Available for 2 months  Table II. Overview of campaign components and dissemination targets Component  Theme  Platform/location  Quantity  Frequency/duration  Bus shelter ads  Adelante Is  See Fig. 3  3 bus shelters  3 month  Choices  3 bus shelters  3 month  Dreams  3 bus shelters  3 month  Belong  3 bus shelters  3 month  Poster ads  Adelante Is  See Fig. 3  30 posters  3 month  Choices  30 posters  3 month  Dreams  30 posters  3 month  Belong  30 posters  3 month  Social media promotion  Adelante Is  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Choices  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Dreams  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Belong  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Videos  Choices  Facebook, Youtube, Website https://www.youtube.com/watch?v=todbTLPy8JU  Post on Adelante Youtube channel and website  Length: 1: 55 min  Available for 7 months  https://www.youtube.com/watch?v=v4cZ3Ilk17E  Share 4 times on Facebook  Length: 1: 12 min  Available for 6 months  Dreams  Facebook, Youtube, Website https://www.youtube.com/watch?v=Lx9zwMycY44  Post on Adelante Youtube channel and website  Length: 1: 42  Available for 4 months  Share 4 times on Facebook  https://youtu.be/1dJ3iUfrjR4  Length: 2: 24  Available for3 months  Contests  Adelante Is  Facebook, Twitter, Website  1  1–3 weeks in duration;  Choices  Facebook, Twitter, Website  1  Dreams  Facebook, Twitter, Website  1  Every 3 months  Belong  Facebook, Twitter, Website  1  Text Messaging  Adelante Is  Text message  50  Daily for 3 months  Choices  Text message  50  Daily for 3 months  Dreams  Text message  50  Daily for 3 months  Belong  Text message  50  Daily for 3 months  Blogs  Adelante Is  Website, Facebook, Twitter  2  Available for 9 months  Choices  Website, Facebook, Twitter  2  Available for 7 months  Dreams  Website, Facebook, Twitter  2  Available for 5 months  Belong  Website, Facebook, Twitter  2  Available for 2 months  Component  Theme  Platform/location  Quantity  Frequency/duration  Bus shelter ads  Adelante Is  See Fig. 3  3 bus shelters  3 month  Choices  3 bus shelters  3 month  Dreams  3 bus shelters  3 month  Belong  3 bus shelters  3 month  Poster ads  Adelante Is  See Fig. 3  30 posters  3 month  Choices  30 posters  3 month  Dreams  30 posters  3 month  Belong  30 posters  3 month  Social media promotion  Adelante Is  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Choices  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Dreams  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Belong  Facebook, Twitter, Instagram  50; 100; 30  Weekly  Videos  Choices  Facebook, Youtube, Website https://www.youtube.com/watch?v=todbTLPy8JU  Post on Adelante Youtube channel and website  Length: 1: 55 min  Available for 7 months  https://www.youtube.com/watch?v=v4cZ3Ilk17E  Share 4 times on Facebook  Length: 1: 12 min  Available for 6 months  Dreams  Facebook, Youtube, Website https://www.youtube.com/watch?v=Lx9zwMycY44  Post on Adelante Youtube channel and website  Length: 1: 42  Available for 4 months  Share 4 times on Facebook  https://youtu.be/1dJ3iUfrjR4  Length: 2: 24  Available for3 months  Contests  Adelante Is  Facebook, Twitter, Website  1  1–3 weeks in duration;  Choices  Facebook, Twitter, Website  1  Dreams  Facebook, Twitter, Website  1  Every 3 months  Belong  Facebook, Twitter, Website  1  Text Messaging  Adelante Is  Text message  50  Daily for 3 months  Choices  Text message  50  Daily for 3 months  Dreams  Text message  50  Daily for 3 months  Belong  Text message  50  Daily for 3 months  Blogs  Adelante Is  Website, Facebook, Twitter  2  Available for 9 months  Choices  Website, Facebook, Twitter  2  Available for 7 months  Dreams  Website, Facebook, Twitter  2  Available for 5 months  Belong  Website, Facebook, Twitter  2  Available for 2 months  Campaign ads We developed a total of 35 final ads that communicated 105 different messages. We decided to use three types of ads for the campaign: print ads placed at bus shelters, posters placed throughout the community and ads promoted on Adelante social media platforms (Fig. 3). All ads were branded with the Adelante color scheme and graphics, portrayed Adelante youth, and provided information on how to connect via social media, the Adelante website, or an opt-in to a text messaging service in English or Spanish. Fig. 3. View largeDownload slide Map of campaign ad placement locations. Fig. 3. View largeDownload slide Map of campaign ad placement locations. We planned to place a total of 12 ads, with 3 ads per campaign theme, at high-traffic bus shelters in central community locations for 3 months per theme (Fig. 4). Ads to be placed at bus stop shelters were selected based on criteria related to: prevention message content (i.e. to address all Adelante risk behavior prevention targets); portrayal of the target audience demographics (i.e. both genders, first and second generation immigrants); inclusion of key messages promoted by Adelante (i.e. the importance of an education, pride in ethnic identity); and preferences of youth who participated in the formative research process. Fig. 4. View largeDownload slide Bus shelter ad example. Fig. 4. View largeDownload slide Bus shelter ad example. We also planned to place 120 posters in local businesses, community centers and school locations for each campaign theme’s 3-month time period (Fig. 5). Locations were selected based on suggestions from youth participants in Phases 2 and 3 of formative research and from Adelante program staff. Fig. 5. View largeDownload slide Poster ad example. Fig. 5. View largeDownload slide Poster ad example. All campaign ads were intended for promotion on Adelante social media platforms, including ads that would be placed at bus shelters or displayed as posters (Fig. 6). Social media promotion posts would deliver weekly posts across platforms, which include prevention messaging accompanied by a campaign ad, entertaining GIF or link to a news story or other content of interest. Fig. 6. View largeDownload slide Social media post example. Fig. 6. View largeDownload slide Social media post example. Videos A total of four videos were developed for two of the four themes and were disseminated on social media and via the Adelante YouTube channel. We planned videos to include dramatizations of scenarios created and enacted by Adelante youth participants (Fig. 7) as well as personal success stories of youth (Fig. 8). Videos were created by Adelante Ambassadors, were available on the Adelante YouTube channel and were promoted on social media platforms four times per video with accompanying prevention messages. Fig. 7. View largeDownload slide Youth dramatization video example. Fig. 7. View largeDownload slide Youth dramatization video example. Fig. 8. View largeDownload slide Youth achievement video example. Fig. 8. View largeDownload slide Youth achievement video example. Contests In order to boost online engagement, monthly contests were planned, and prizes would be awarded for engaging individuals in their network (i.e. having the most likes, shares and comments to their posts) as well as effort (i.e. creating user-generated posts that were creative, well-written or attempt to highlight social issues). We created contest hashtags in collaboration with Adelante Ambassadors to track participation and determine contest winners (Fig. 9). Fig. 9. View largeDownload slide Social media contest entry post. Fig. 9. View largeDownload slide Social media contest entry post. Text messaging We created a total of 200 text messages in English and Spanish (50 messages per campaign theme) containing prevention messages, motivational quotes and information for youth resources i.e. local health and social services, scholarship programs, events) to disseminated via an opt-in text messaging drip campaign. Messages were automated using a texting service (EZ Texting) for weekly delivery, and consisted of four introductory messages that would be followed by a series of messages corresponding to campaign themes and prevention topics. Opt-in information was included on campaign posts, social media promotion materials and posters. Blog posts on Adelante website We planned to create a total of eight blog posts that would be housed on the Adelante program website and promoted through social media platforms. Blog posts addressed health issues related to prevention focus topics of the Adelante program (preventing substance use, sexual risk and interpersonal violence) and shared personal stories of Adelante participants. Discussion Branding strategies, as well as the use of digital technologies, have demonstrated success in social marketing campaigns aimed at preventing youth risk behaviors [40–52], and they show considerable promise for reaching Latino immigrant youth for risk prevention as well as for the reduction of barriers to engagement in health promotion programming. There have been relatively few social marketing campaigns targeting Latino audiences, and there is a paucity of branded campaigns for Latino immigrant adolescents, despite the rapid growth and public health relevance of this population. Employing campaign branding strategies has been shown to increase engagement and reduce risk behaviors [32, 37]. Our formative research supported branding as a useful strategy for campaign development and for reaching immigrant Latino youth with prevention messaging. Youth participants easily recognized and understood the Adelante brand and its applications to their own circumstances. Youth also provided interpretations of what the brand meant to them and guided campaign development by sharing how they envisioned manifestations of the Adelante brand in campaign content, imagery, message framing and tone. Youth participants also indicated that social media was widely used by peers in their community regardless of how recently they had migrated to the United States. Youth were very interested in using social media to connect with supportive adults and their virtual peer networks and in consuming videos and other content relevant to their life experiences. Regardless of youth connectivity with new media, we also included traditional media in the campaign approach so as to not exclude youth still experiencing barriers to digital engagement, including limited internet connectivity due to costs or other constraints and individual media preferences that excluded social media. An added tool for youth engagement was the portrayal of peers familiar to them in campaign materials, including classmates, program participants or members of a well-known and successful local youth soccer team. The inclusion of community residents in ads was more appealing than the use of stock photos; youth questioned the authenticity of the individuals in the stock photos and could easily distinguish that they were not actually from their community. One potential pitfall of using local youth in ads is that these youth are not separated from their own risk behaviors, which are easily observable to the target audience. Campaign planners should recruit youth who represent brand ideals, to the greatest extent possible, in their own life, and youth should be made aware that their own conduct will reflect on the program and campaign. Place-based campaigns should assess and seek to overcome barriers to engagement for immigrant Latino youth. In order to boost initial engagement, we used clear calls to action in campaign messages and ads, including encouragement to join the Adelante social media network, visit the webpage, contact program implementers, or to make positive decisions in accordance with Adelante brand ideals. In addition, implementers of youth-centered programming are also important sources of information for campaign development and outreach strategies. Implementers should be involved in the formative process and provide feedback on campaign materials regarding relevance to community context, pressing risk factors experienced by youth and potential barriers to reaching the target audience. For this study, we designed the campaign to address specific identified barriers to engagement, which would enable youth participants to interact with the Adelante community and digital network, experience social modeling of Adelante brand ideals, gain information about available resources and services and engage with health promotion and risk prevention messaging. This is particularly important in community contexts where migrant populations have exceeded the community’s capacity to conduct outreach and effectively connect them with prevention services, thus propagating health disparities. Additional barriers to engagement for communities with substantial populations of recently arrived Latino immigrants include service ineligibility, linguistic, social and cultural isolation and participant fear of accessing programs and resources due to legal status. Engagement of immigrant Latino youth via digital networks is a novel way to reach this community with important health and prevention information, as well as to connect them to crucial sources of social support, thus minimizing some barriers. Adelante brand ideals and applications had meaning for target audience representatives because the brand and brand execution elements were developed in collaboration with target audience members. Consequently, campaign ads that built on the Adelante brand resonated with our audience (results presented elsewhere). We recommend that future campaigns and prevention programs utilize branding strategies and participatory approaches to brand development. Many immigrant communities are diverse in terms of language spoken, length of time in the United States, media preferences, educational levels and media preferences. We recommend that future programs seeking to engage immigrant Latino youth consider using varying campaign strategies and structures with regards to language, content and channels. Campaign planners should consider a mixed language strategy instead of bifurcating youth audiences by dominant language. Campaigns should also build on youth preferences for social media platforms, post format (i.e. using visual imagery, multimedia formats), and manner in which their peer group or community are portrayed. Also, regardless of widespread use of social media, we recommend that future campaigns for immigrant Latino youth also consider a similar multi-channel approach that includes traditional media. Furthermore, using a participatory approach, particularly as it relates to brand development and youth-generated campaign content [57, 58], will be especially useful in future campaigns seeking to reach similar audiences. Using an active audience engagement methodology [59], we were able to: create an appealing brand; develop campaign ads and messages tailored to the local context; portray community residents in ads, videos, blog posts and social media promotion; represent youth and the community in a way that was acceptable to the target audience; operationalize PYD theoretical constructs using locally-relevant scenarios, concepts and imagery and identify appropriate engagement tools, such as contests, video dramatizations and program youth achievement stories. Future campaigns should consider this combination of elements as a model for reaching immigrant Latino youth audiences. Limitations and future directions There are important limitations to consider when interpreting the result of this study. First, the sample of youth participants consisted of predominantly Central American immigrants, and results may not be generalizable to other immigrant youth populations or youth originating from other Latin American countries. Future research seeking to employ similar methods should exercise due diligence when formulating social marketing campaigns for audience engagement, prevention message dissemination and health behavior change. Second, this study did not include an examination of campaign effectiveness or elaborate on the features of the social media posts that were particularly engaging for this population. The next steps of our research will include evaluation of campaign outcomes, an examination of the most engaging social media content and features for this youth audience, and an evaluation of the overall Adelante program and campaign to reduce risk behavior and promote PYD. Funding National Institute of Minority Health and Health Disparities [Grant number 1P20MD006898-01]. 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TI - Development of the place-based Adelante social marketing campaign for prevention of substance use, sexual risk and violence among Latino immigrant youth
JF - Health Education Research
DO - 10.1093/her/cyx076
DA - 2018-04-01
UR - https://www.deepdyve.com/lp/oxford-university-press/development-of-the-place-based-adelante-social-marketing-campaign-for-0rgs4leqXm
SP - 125
EP - 144
VL - 33
IS - 2
DP - DeepDyve
ER -