Public Service Announcements Not Getting Message Across

Breast cancer specialists were alarmed last year when research from the National Cancer Institute revealed mammography use had dropped so sharply that doctors feared a rise in invasive cancers.

Clearly, some women were not getting the message that mammograms save lives. They had not been reached by all the walkathons and pink awareness bows affixed on everything from T-shirts to cans of soup. The answer? Perhaps more messages.

"We're talking about doing some public service announcements," said Dr. Clare Bradley, executive vice president of IPRO, a health quality organization in Lake Success and chair of a "strike force" on mammography for the American Cancer Society.

Awareness about breast cancer screening may not be the only public health and safety campaign in need of reinvigoration. Earlier this month, a new medical study cited rising rates of melanoma among young women, even in the face of strong efforts discouraging too much sun exposure. And despite millions spent to remind people to avoid drinking and driving, or abusing prescription drugs, those problems persist, generation to generation. Experts cite complacency, vanity and ignorance as the reasons behind the failure of some health messages.

Sending a message

Mass media public service announcements remain the high-end staple of any large-scale effort to persuade people to adopt healthy habits or avoid dangerous ones.

With 60 years of data on mass-media PSA campaigns now in -- those aided by television's power -- experts say spots with strong take-home themes and powerful images are those most likely to succeed. Over time, as with feature films, the PSAs have grown bolder, with their imagery to the point where one featured the stomach-turning, plaque-packed goo from the carotid artery of a smoker. It wasn't long ago that the approach was far more sentimental, as with an ad featuring a 9-year-old girl and her smoker-mother tethered to a respirator.

Said Sarah Perl, assistant commissioner in New York City's Tobacco Control Bureau: "These ads prompt people to remember that they want to quit."

The modern public health "campaign," experts are quick to say, is more than ads on TV. Health information is shared doctor-to-patient and also is transmitted through dozens of journals -- many now online -- which in turn are written up in newspapers and magazines and aired in broadcast reports. "People generally welcome health information; they really want to know about prevention," said Dr. Dorothy Lane, a professor of preventive medicine at Stony Brook University Medical Center.

Meanwhile, some groups, strapped for advertising money, cannot get their messages on television or radio. Jerry Roucoulet, an addiction counselor at the Long Island Council on Alcoholism and Drug Dependence, said he conveys his point in person at schools, taking his message to children as young as second grade. Roucoulet said he savors the rare opportunities when national drug and alcohol organizations sponsor PSA campaigns.

"From time to time there are some very good ads that come out from federal agencies," Roucoulet said. "But there are not enough of them."

PSA goal

Perhaps the granddaddy of the public health and safety campaign is that featuring the now-iconic Smokey Bear, which has advised people about forest fire prevention since 1944. Like dozens of other ads, Smokey Bear was produced by the Ad Council, a nonprofit organization in Manhattan and Washington of advertising professionals that oversees $2 billion of ads produced annually without charge by a variety of agencies. Newspapers and magazines that publish print versions of the ads do so at no cost.

The council's campaign against drunken driving started in 1983, with one widely known version including a screen dissolve that transformed four beer-drinking teenagers in a car into four skeletons. Paula Veale, an executive vice president with the council, said accidents caused by drunken drivers dropped from 68 percent in 1982 nationwide to 45 percent in 2006. She said response to the ads was strong but also credits the efforts of Mothers Against Drunk Driving and other advocacy organizations.

Perhaps some of the grisliest ads in television history have been sponsored by the New York City Department of Health, which mounted its graphic war against cigarettes two years ago. In one spot, former smoker Ronoldo Martinez is described as a 39-year-old -- he looks closer to 60 -- who can no longer swim, play baseball or easily shower. He has a hole in his throat, the result of cancer. He speaks to his audience in an artificial voice made possible with an electronic-assist device he presses against his throat.

Perl said the ads have had a tremendous impact because they are "hard-hitting."

"There was a fourfold jump in the number of calls to 311," the city services line, where callers are referred to smoking-cessation programs.

Other campaigns, relying less on shock value, also have resonated. The American Cancer Society has produced a recent series of PSAs focusing on colonoscopy. The ads have so galvanized the public that colon-cancer screening rates have risen sharply, experts say.

Campaign stalls

But some campaigns seem to sputter. An alarming number of young people continue to start smoking cigarettes to appear cool, say researchers, despite extensive evidence linking smoking to lung cancer. Women interviewed on Long Island recently cited personal-appearance issues as they defended their hours under sunlamps at strip-mall tanning salons. Then there's breast cancer awareness.

IPRO's Bradley said the American Cancer Society was so concerned about a drop-off in breast cancer screening that started around 2000 that it convened a "strike force" on the issue.

The former commissioner of the Suffolk County Department of Health Services attributes decreasing usage to a variety of reasons, including a declining number of mammography facilities and fewer physicians involved in reading the X-rays.

She's also acutely aware of the role that PSAs can play. Bradley said if resources allocated to raising colonoscopy awareness were shared with efforts promoting mammography, more women could be screened.

Tuning out

But some health advocates say the breast cancer screening message simply became stale. Maryann Napoli, a health advocate with the Center for Medical Consumers in Manhattan, said it is also possible mammography rates have declined because some women, like herself, are no longer open to the message that yearly mammograms are important.

Napoli, who in her 60s is in a key screening demographic, added that an increasing amount of health information loses its impact because it turns out to be wrong -- or is made obsolete by new findings.

"For years, women were told to get their first mammogram at age 35," she said of the so-called baseline mammogram. "But scientists later found that routine mammography in younger women did not lower overall rates of invasive breast cancer. So they quietly removed that message and never told the public why."

Copyright (c) 2008, Newsday, Melville, N.Y.