Like any marketing campaign, social marketing demands good market research as a foundation, Mitchell said at the recent Demand Treatment Leadership Institute, held in late September in Denver, Colo. "You have to find out what people care about," using techniques like surveys or focus groups, he said. "Think about how the audience views a problem, and play to that. It's not about us and what we want -- it's about the audience."

While commercial marketing is intended to get people to buy products or use services, social marketing aims to encourage behavioral change, Mitchell said. "We're trying to get people to reject tobacco or drugs, use seat belts, use condoms, talk about sex, etc..," he said.

In any marketing campaign, Mitchell added, there must be an exchange between the marketer and the consumer. In social marketing, the trade-off for behavioral change is a perceived benefit to the audience: the desired behavior must be seen as fun, easy, or popular, said Mitchell. For a physician conducting a brief intervention for addiction, for instance, the payoff could be earning the respect of his peers for a job well done, he said.

'Truth' and Consequences

Unfortunately, some of the best marketing people in the world work for the tobacco industry, which has been very successful in making its products seem fun and popular -- even when seeming to say the opposite. That was the challenge facing Mitchell and his colleagues when they began designing the Truth campaign with funding from Florida's share of the national tobacco settlement.

"We looked at past prevention programs and saw that most of them didn't work," he said. "Research showed that kids knew about the health dangers of smoking, but use was rising, anyway. The tobacco companies were not hiding the dangers -- they were selling it."

Cigarette companies had successfully associated their brands with individuality, independence, and "coolness," and researchers also found that kids smoked for the nicotine high and to relieve stress. When weighed against all these perceived benefits, the positives of not smoking -- better health and "making some adults happy" -- too often came up short, said Mitchell.

"We looked at this and said it's amazing that more kids don't smoke," he said. "So we had to overcome the benefits of smoking and add more benefits for not smoking."

Taking a page from the tobacco industry's book, the Truth campaign created an anti-smoking "brand" aimed at redefining tobacco and the companies that sell it to kids. Edgy commercials featured bungy jumpers and portrayed tobacco executives as killers; one memorable spot showed young people being escorted out of the headquarters of Philip Morris in New York after trying to confront tobacco-company executives with statistics about smoking deaths.

Recognizing that most youth culture springs from the city streets -- even for kids who live in rural areas -- the Truth campaign ads also had a distinctly urban feel. In the past, Mitchell said, most anti-smoking campaigns attracted mostly "nerds"; the Truth campaign aimed to cast a wider net by making the fight against Big Tobacco seem hip, rebellious, and youth-oriented. "We repositioned the tobacco industry as old white guys who want you to smoke," said Mitchell. "We gave kids a way to make fun of adults."

The results of the campaign were impressive: After the ads were released, Florida saw its first decline in youth smoking in 19 years, with smoking among middle-school students falling 19 percent, and smoking by high-school students down 8 percent.

Slogans are Secondary

In the case of Demand Treatment!, the goal is to increase the number of people receiving addiction treatment services. But that begs some important social-marketing questions, said Mitchell, such as defining the size of the current market share (e.g. what percentage of the population is currently getting treatment), who the target audience is, and what the goals of the marketing campaign will be.

Mitchell said one of the best approaches he heard about during the Demand Treatment meeting was a proposal to have doctors screen hospital patients for warning signs of addiction, then allow them to refer patients to social workers who could provide brief interventions. "We shouldn't [only] be asking doctors to change their behavior in the short amount of time they have with patients," said Mitchell, "but rather people who are less stressed for time."

Mitchell said such a system would make screening easy for doctors to do and -- based on positive outcome data -- encourage them to make more referrals.

While the TV ads, brochures, and catch-phrases associated with social-marketing campaigns tend to get most of the public attention, it's the underlying philosophy that really matters, said Mitchell. "In all marketing, the slogans are secondary," he said. "What's important is communicating something that can change a behavior."   

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