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Beyond Wheeling Walks: Enhanced planning, environment, and policy components Bill Reger-Nash, Ed. D, WVU Beyond Wheeling Walks: Enhanced planning, environment, and policy components Bill Reger-Nash, Ed. D, WVU Prevention Research Center Linda Cooper, MSW, LCSW Kenneth J Simon, Ed. D Adrian Bauman, MD, Ph. D Kevin M. Leyden, Ph. D Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

PRESENTATION OUTLINE Ø Ø Ø Ø Background Community capacity building Formative research and message PRESENTATION OUTLINE Ø Ø Ø Ø Background Community capacity building Formative research and message development Pilot testing of the targeted ads Program implementation and evaluation Results Policy and environment change Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Leading Contributors to Premature Death Physical Inactivity/Diet Tobacco Alcohol Microbial Agents Toxic Agents Motor Leading Contributors to Premature Death Physical Inactivity/Diet Tobacco Alcohol Microbial Agents Toxic Agents Motor Vehicles Firearms 350, 000 435, 000 85, 000 75, 000 55, 000 43, 354 28, 663 Mokdad JAMA, 2005 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

West Virginia has one of the very highest rates of total CVD deaths in West Virginia has one of the very highest rates of total CVD deaths in U. S. (per 100, 000) US 386. 6 WV 436. 8 MN 322. 0 HI 306. 6 BRFSS, 2000 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

PROJECT PHASES Wheeling Walks Phase I --1999 -2001 PARTICIPATORY PLANNING Phase II --2000 -2001 PROJECT PHASES Wheeling Walks Phase I --1999 -2001 PARTICIPATORY PLANNING Phase II --2000 -2001 - MESSAGE DEVELOPMENT - PREPARATION for CAMPAIGN Phase III --2001 -2002 CAMPAIGN and EVALUATION Phase IV --2002 > On-going POLICY & ENVIRONMENT Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

PHASE I – Community Involvement • Establish initial community Steering Committee /Advisory Board • PHASE I – Community Involvement • Establish initial community Steering Committee /Advisory Board • Pursue grant sources • 12 -week Participatory Planning program • Develop protocols • Select media producers • Identify staff and consultants Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Wheeling Walks Targeted Message and Audience • a targeted public health physical activity message: Wheeling Walks Targeted Message and Audience • a targeted public health physical activity message: 30 minutes or more of moderate-intensity walking almost every day. • to a targeted audience: Insufficiently active adults, ages 50 -65, in a West Virginia community Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Target Population 78% of 55 -64 year olds were insufficiently active BRFSS 2001 Bill Target Population 78% of 55 -64 year olds were insufficiently active BRFSS 2001 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Funding Sources Wheeling Walks • Benedum Foundation • Robert Wood Johnson Foundation • West Funding Sources Wheeling Walks • Benedum Foundation • Robert Wood Johnson Foundation • West Virginia Bureau for Public Health • Ohio Valley Medical Center • Wheeling Hospital • Wes. Banco Bank Corp Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

METHODOLOGY - a basis in theory: • Social Ecological Approach • Participatory Planning • METHODOLOGY - a basis in theory: • Social Ecological Approach • Participatory Planning • Mc. Guire Communication Model • Elaboration Likelihood • Theory of Planned Behavior • Transtheoretical Model • Social Marketing • A BRIEF REVIEW: Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Campaigns using mass media structured, co-ordinated, & multi-faceted Multi-strategy campaign legislative & regulatory paid Campaigns using mass media structured, co-ordinated, & multi-faceted Multi-strategy campaign legislative & regulatory paid Media unpaid community interventions & community development health professional education Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

PHASE II –Message Development (Formative Research) -- An Elicitation Survey to identify salient psychosocial PHASE II –Message Development (Formative Research) -- An Elicitation Survey to identify salient psychosocial factors about moderate-intensity walking. (30 people) -- A Quantitative Survey to identify which psychosocial factors differentiate regular walkers and insufficiently active. (300 people) -- A Qualitative Pretesting of ad storyboards to guide final ad production. (80 people) Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

TIME ENERGY Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006 TIME ENERGY Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

TV ad : Woman Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, TV ad : Woman Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Print ad: man Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006 Print ad: man Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

PHASE III –Campaign and Evaluation Wheeling Walks • 8 -WEEK Mass media-based CAMPAIGN • PHASE III –Campaign and Evaluation Wheeling Walks • 8 -WEEK Mass media-based CAMPAIGN • MONTH 5 Public relations BOOSTER CANCELLED due to Sept 11, 2001 • MONTH 11 BOOSTER Campaign • EVALUATION at: - Baseline - Immediate Post - 6 Months Post - 12 months Post Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Mc. Guire Cascade of the sequential stages of message delivery essential to behavior change Mc. Guire Cascade of the sequential stages of message delivery essential to behavior change RECEPTION Exposure to and awareness of message PROCESSING Receive, comprehend, and think about message RESPONSE Current beliefs altered, new ones remembered, and behavior changed Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Reception Processing Response Behavior beliefs argument quality PLACEMENT elaboration normative intention BEHAVIOR likelihood beliefs Reception Processing Response Behavior beliefs argument quality PLACEMENT elaboration normative intention BEHAVIOR likelihood beliefs to act FREQUENCY cues control beliefs Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

PHASE III –Campaign and Wheeling Walks Evaluation 1. A telephone survey questionnaire of 1, PHASE III –Campaign and Wheeling Walks Evaluation 1. A telephone survey questionnaire of 1, 472 residents --Baseline --Immediately post-intervention -- 6 months post-intervention --12 months post-intervention 2. Earned media 3. Environmental and Policy Change Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Wheeling Walks PAID ADVERTISING - 8 weeks Gross # Rating Points -- Two 30 Wheeling Walks PAID ADVERTISING - 8 weeks Gross # Rating Points -- Two 30 -second television ads 683 5, 100 -- Two 60 -second radio ads 1, 988 3, 450 -- Two 1/8 page newspaper ads 28 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

PUBLIC RELATIONS Wheeling Walks to generate Earned Media included: WEEK 1 --campaign KICK-OFF press PUBLIC RELATIONS Wheeling Walks to generate Earned Media included: WEEK 1 --campaign KICK-OFF press conference WEEK 3 --press conference with physicians WEEK 4 --a mid-campaign progress report press event WEEK 6 --1 st Mayor’s Fitness Cup –noon-time walk WEEK 7 --Intergenerational Walk WEEK 8 --campaign finale press conference Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

RESULTS –EARNED MEDIA Wheeling Walks 76 -- TV news stories 48 -- Radio news RESULTS –EARNED MEDIA Wheeling Walks 76 -- TV news stories 48 -- Radio news stories 49 -- Newspaper articles (23 --Front Page) 107 -- TV / Radio interviews / promotions 2 -- USA Today article w/ pix Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Wheeling Walks Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006 Wheeling Walks Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Wheeling Walks RESULTS—TELEPHONE QUESTIONNAIRES SELF-REPORT --Baseline to Immediate-post Percent Increase 14% difference 32% 18% Wheeling Walks RESULTS—TELEPHONE QUESTIONNAIRES SELF-REPORT --Baseline to Immediate-post Percent Increase 14% difference 32% 18% Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Wheeling Walks RESULTS—POSITIVE STAGE CHANGES From Baseline precontemplation, and preparation 12% difference 62%* 50% Wheeling Walks RESULTS—POSITIVE STAGE CHANGES From Baseline precontemplation, and preparation 12% difference 62%* 50% CDC —April 13, 2006 Bill Reger-Nash, Ed. D. WVU Community Medicine * p<. 001)

Attitude. 33 . 13. 31 Treatment. 11 Intention . 15 Walking Status . 42 Attitude. 33 . 13. 31 Treatment. 11 Intention . 15 Walking Status . 42 Control All paths with coefficients are significant at. 01 or better Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Best “Predicted” Model, Chi-square[3] = 39. 73; p <. 00001 Treatment Intention . 18 Best “Predicted” Model, Chi-square[3] = 39. 73; p <. 00001 Treatment Intention . 18 . 15 Walking Status . 57 Control Beliefs All paths with coefficients are significant at. 01 or better Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

4 -week Media BOOSTER Wheeling Walks --11 th month --334 TV ads (30 -second) 4 -week Media BOOSTER Wheeling Walks --11 th month --334 TV ads (30 -second) --95 Radio ads (60 -second) --6 1/8 -page Newspaper ads --Public Relations events -Kick-Off Press Conference -Celebrity visitor (Adrian Bauman) -2 nd Annual Mayor’s Fitness Cup -Closing celebration --Weekly columns by PI (BRN) Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

RESULTS—TELEPHONE QUESTIONNAIRES Wheeling Walks Immediate 12 -mos Post Knew about campaign------Saw TV ads-------------Heard Radio RESULTS—TELEPHONE QUESTIONNAIRES Wheeling Walks Immediate 12 -mos Post Knew about campaign------Saw TV ads-------------Heard Radio ads----------Saw or heard news stories-----Heard about campaign: at worksite------------via faith-based programs----via speakers----------- 90% 89% 77% 93% 33% 36% 81% 83% 5% 4% 4% 5% Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Wheeling Walks Group A= Baseline daily walking minutes <=10 minutes Bill Reger-Nash, Ed. D. Wheeling Walks Group A= Baseline daily walking minutes <=10 minutes Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

PHASE IV – POLICY and ENVIRONMENT Process Outcomes: • Mayor designated Walkable Wheeling Task PHASE IV – POLICY and ENVIRONMENT Process Outcomes: • Mayor designated Walkable Wheeling Task Force, Monthly meetings since 2001, Trails Master Plan now approved by City Council 03/06 • Develop walking opportunities in the community o Upgrade and connect trails (DOT added trails , city exercised eminent domain in December 2005) o Adding rest rooms and telephones o Improve overall safety & aesthetics o Plan for an urban state park • Engaged city, county, and state agencies: streets, highways, recreation department, schools, parks, planning CDC —April 13, 2006 Bill Reger-Nash, Ed. D. WVU Community Medicine

Assessment of SOCIAL CAPITAL Walkable Wheeling Task Force members Nov 99 Feb 01 Feb Assessment of SOCIAL CAPITAL Walkable Wheeling Task Force members Nov 99 Feb 01 Feb 02 (n=32) Mean [sd] Commitment 4. 10 [0. 75] Enjoyment 4. 47 [0. 73] Confidence 4. 16 [0. 79] Shared Purpose 4. 25 [0. 72] Contribution Valued 4. 20 [0. 85] Trust 4. 28 [0. 58] (n=33) (n=29) Mean [sd] 4. 27 [0. 78] 4. 38 [0. 75] 4. 36 [0. 90] 4. 44 [0. 62] 4. 52 [0. 57] 4. 45 [0. 79] 4. 66 [0. 48] 4. 66 [0. 55] 4. 69 [0. 54] 4 55 [0. 78] 4. 72 [0. 45] * # * * * Data were analyzed as pairwise independent comparisons of means; significance was set at p<0. 01 due to multiple testing. *p<0. 01 comparing 1999 to 2002 # p<0. 01 “Commitment” comparing 2001 to 2002 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Differences / modifications to WV WALKS Bill Reger-Nash, Ed. D. WVU Community Medicine CDC Differences / modifications to WV WALKS Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Weekly column Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006 Weekly column Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

PAID ADVERTISING - 8 weeks Wheeling Walks WV WALKS --Two 30 -second television ads PAID ADVERTISING - 8 weeks Wheeling Walks WV WALKS --Two 30 -second television ads 683 356 Gross Rating Points 5, 100 3, 016 --Two 60 -second radio ads Gross Rating Points 1, 988 1, 763 3, 450 1, 876 --Two 1/8 -page newspaper ads 28 39 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

WV WALKS RESULTS—TELEPHONE QUESTIONNAIRES Baseline to Immediate-post Percent Increase 12% difference 27% 15% Bill WV WALKS RESULTS—TELEPHONE QUESTIONNAIRES Baseline to Immediate-post Percent Increase 12% difference 27% 15% Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

RESULTS –EARNED MEDIA Wheeling Walks WV WALKS 76 77 -- TV news stories 48 RESULTS –EARNED MEDIA Wheeling Walks WV WALKS 76 77 -- TV news stories 48 27 -- Radio news stories 49 40 -- Newspaper articles (23 --Front Page) 107 1, 241 -- TV / Radio interviews / promotions 2 -- USA Today article w/ pix Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Cost comparison of Wheeling Walks, WV WALKS, and Project Active Annual cost Per month Cost comparison of Wheeling Walks, WV WALKS, and Project Active Annual cost Per month per Intervention changed person Project Active Lifestyle change Structured exercise $205. 80 $591. 72 $17. 50 $49. 31 Wheeling Walks Wheeling only TV media market WV WALKS $38. 47 $3. 20 $19. 00 $1. 58 $18. 27 $1. 52 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Basis of calculations Wheeling Walks a. Total campaign cost $120, 000 b. Total media Basis of calculations Wheeling Walks a. Total campaign cost $120, 000 b. Total media area population 418, 000 c. Total ages 50 -65 (18. 6%) / 40 -65 (27%) 77, 748 d. Target Population (insufficiently active) (58% / 60% )* 45, 094 e. Exposed to campaign message (target population) (92% / 82%)* 41, 486 f. Cost per individual exposed to message (a/e) $ 2. 89 Cost per month (f/12) $ . 24 g. Individuals self-report changed (14% / 12% of d. )* h. Cost per changed person (a/g) i. Cost per month ( h/12) 6, 313 $ 19. 00 $ 1. 58 *Percent derived from intervention surveys. Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

POLICY and ENVIRONMENT Process Outcomes in Morgantown: • Work in concert with City and POLICY and ENVIRONMENT Process Outcomes in Morgantown: • Work in concert with City and University via WV WALKS Community Advisory Board • Diverting large industrial truck traffic from downtown • Develop walking opportunities in the community - Upgrade and connect trails - Adding new and paving sidewalks ($150 k per year) - Developing community walking league • Coordinated study (Zande Engineering) to make WVU-HSC campus more walkable • Physicians writing “prescriptions for walking” CDC —April 13, 2006 Bill Reger-Nash, Ed. D. WVU Community Medicine

Assessment of Policymakers • Mail survey to assess whether WV Walks intervention focused on Assessment of Policymakers • Mail survey to assess whether WV Walks intervention focused on changing the attitudes and behavior of the public can also affect policymakers • Survey mailed to all municipal elected officials, appointed heads of departments, and all individuals appointed to serve on government boards/commissions (133 in Morgantown and 120 in Huntington ) • Response rates Morgantown PRE POST n=76 57. 1% n=58 43. 4% Huntington n-38 31. 7% n=34 29. 3% Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Walking Issues • Morgantown – Baseline: Ranked 4 th – Post Campaign: Ranked 1 Walking Issues • Morgantown – Baseline: Ranked 4 th – Post Campaign: Ranked 1 st – P < 0. 05 (t-test for differences in proportion means) • Huntington – Not mentioned Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Community Problem Issues Morgantown – Lack of Pedestrian Walkways, Crosswalks and Sidewalks – Poorly Community Problem Issues Morgantown – Lack of Pedestrian Walkways, Crosswalks and Sidewalks – Poorly Planned Development and Sprawl – Traffic Congestion Huntington – Underage Drinking – Drug and Alcohol Abuse – Crime Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Environment and policy changes have great potential to influence human behavior. They can impact Environment and policy changes have great potential to influence human behavior. They can impact and sustain change in entire populations for a small financial investment. BUT HOW DO WE DO THIS? O’Donnell MP. Am J Health Promot. 1989; 2(2): 5. Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

WORLD HEALTH ORGANIZATION 1 st International Conference on Health Promotion November 21, 1986 Ottawa, WORLD HEALTH ORGANIZATION 1 st International Conference on Health Promotion November 21, 1986 Ottawa, CANADA OTTAWA CHARTER FOR HEALTH PROMOTION “Health promotion is the process of enabling people to increase control over, and to improve, their health…People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health. ” Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Lessons Learned • • • Health / other sectors participating together in PA campaigns Lessons Learned • • • Health / other sectors participating together in PA campaigns Organized efforts, sequenced, adequately resourced Over arching theme consistency, brand Targeted Message Exposure, Exposure Policy makers are community members Timetable of media, other components Sub-themes or audience segments Well evaluated at all levels Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

PROJECT MODEL Policy and Environmental / INFRASTRUCTURE changes WHEELING WALKS /WV WALKS Task Force PROJECT MODEL Policy and Environmental / INFRASTRUCTURE changes WHEELING WALKS /WV WALKS Task Force Mass media-based CAMPAIGN 12 -week CHPP Initial STEERING COMMITTEE Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

Exercise Prevention of CHD Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, Exercise Prevention of CHD Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006

 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006 Bill Reger-Nash, Ed. D. WVU Community Medicine CDC —April 13, 2006