Challenging Dogma

Sunday, May 6, 2012

The VERB Campaign: A Failed Attempt in the Effort to End Childhood Obesity in the United States – Sarah Collier

With the obesity pandemic becoming more and more insurmountable and the ludicrous number of failed anti-obesity campaigns, the demand for a powerful, effective, cost-efficient health intervention has reached an all time high. In order for a health campaign to effectively create behavior change, certain variables must be considered to effectively convey the intervention. Past interventions have proved to be expensive, inconsistent and ineffective. More recently, public health officials have begun applying marketing and advertising theories to draw on the principles behind psychological theories resulting more effective penetration of the health message with target audience. One such campaign that utilized this revolutionary marketing strategy was the VERB campaign that was created by the U.S. Department of Health and Human Services’ Center for Disease Control and Prevention (CDC). In an effort to decrease American childhood obesity and promote good, life-long health behaviors, Congress appropriated $339 million to this campaign to combat the growing trend of physical inactivity (1). VERB was meant to target all young American adolescents between the ages of 9 and 13 by engaging them in sponsored events and encouraging them to get outside and play more often. The campaign’s success was marked by high enrollment rate and brand recognition by its target audience, but, despite its tremendous potential for anti-obesity behavior change, the initial achievement tapered off after the third year and several major issues arose due to the incorrect assumptions that had been made about this population (1). The biggest mistakes that were made by the VERB team, which was comprised of the CDC and a number of marketing agencies, was to make the assumption that all children have access to a safe place to play outside of school, the campaign’s mixed messages regarding parental involvement as well as the assumption that parents have the time and resources to not only motivate their children but to be active themselves, and the stereotyping of the target audience based on race and ethnicity. Despite the millions of dollars spent and countless hours of strategizing, the presence of these fundamental flaws has brought me to believe that this campaign’s self-proclaimed great success would have been sort lived had it continued beyond the allotted 5 years.
VERB was a 5 year national campaign that was launched in June of 2002 and was designed to encourage young adolescents, or tweens (age 9 to 13 years old) to be more physically active everyday (2). It utilized a complex combination of social marketing to deliver a positive message about physical activity via experimental marketing, mass media, community and school promotions, the internet and partnerships with both national organizations and local communities that drew on the theory of planned behavior and social cognitive theory (1). The biggest targets for VERB promotions were schools, community centers, and recreational centers which were invited to participate in 1- to 3-week classroom-based activities. For example, VERB Yellowball promotion supplied teachers, youth leaders, etc. with a kit that contained VERB brand basketballs, activity ideas, promotional posters, a reproducible letter informing parents about the campaign, prizes, and applications for twenty $1,000 grants as an incentive for schools and communities (2). VERB team members organized play areas and street games at festivals and camps as well channeled traffic to the campaign’s interactive website that enabled children to choose virtual classmates, blog about their experiences, record their physical activity for prizes and get virtual tutoring on sport skills like soccer and tennis (1).  
The VERB team, consisting of advertising firms, public relations agencies, public health workers, communities and media partners (e.g. Disney and Nickelodeon), was guided by the theory of planned behavior and the social cognitive theory as the core principles on which this intervention was built (3). The theory of planned behavior, originally proposed by Icek Ajzen in the late 1980s, states that attitude about a behavior, subjective norms and self efficacy work together to create a person’s intentions and behaviors (4). The social cognitive theory states that we acquire certain behavioral patterns through a combination of observed behaviors, environmental factors and personal factors including self efficacy and emotional coping processes (5). One of the elements that distinguished this campaign’s approach from other national health behavior campaigns was that these psychological theories were combined with modern marketing and advertising tactics in order to produce an effective marking strategy that would not only penetrate the target audience but also result significant behavioral change (1). Experimental marketing in the form of sponsored events and promotional samples were used by VERB to tie the product, physical activity, to a fun experience that was relevant to tweens in order to create an intriguing buzz among the target audience (3). Type of marketing approach has been proven to have a greater effect on adolescents than television advertisements or the internet (3). Another unique attribute of this campaign was the decision to brand VERBTM­­ which is characterized by the promotion of a product that defines a unique identity for its consumers, is a recognizable symbol of the product’s core values, and creates a connection between the product and its target audience. The VERB brand used bright, inspiring images and positive, kid-friendly language in its promotions to convey the message that physical activity as a fun and cool way for tweens to spend time (6).
The mixture of unique methods and characteristics designed by the CDC and the collaborating marketing agencies gave the VERB campaign incredible potential for success in the battle against childhood obesity.  However, due to a number of incorrect fundamental assumptions and the desire to keep the brand exclusively directed towards tweens but able to be generalized and applied all races and regions within the demographic, the VERB campaign dug its own grave. Despite the overwhelming number resources, VERB’s brand image crisis, shown through irrelevant images and presence of mixed messages, in addition to its failure to address long standing, logistical barriers to living an active life-style weakened the campaign’s message and inevitably resulted in an insignificant behavioral outcome among high risk demographics.
Accessibility or Lack Thereof
            VERB promotes tweens to incorporate more physical activity into their everyday lives by encouraging both in-school and free-time play; yet, it fails to address many of the common barriers attributed to decreased physical activity ultimately abandoning a vulnerable demographic within target audience, urban, minority children.
Community involvement was one of the core elements used by VERB to ensure the general success of the intervention. The campaign team collaborated with communities all over the United States to arrange events at local festivals, camps and sporting events (3). Therefore, images of community parks and recreational centers are common themes in the campaign’s advertisements. Unfortunately, not all communities are the same. Manicured soccer fields, community pools and modern recreational facilities are difficult, if not impossible, to find in urban and low SES communities. Even the culture and the sense of community are vastly different in a suburban environment than they are in a city. In some suburban areas, like those depicted in VERB’s advertisements, there seems to be a greater sense of pride and personal accountability for maintaining a safe, happy, and prosperous community. These characteristics are comparatively rarer in urban neighborhoods where residents tend to have a more individualist view of their living environment rather than collectivistic. Both sides of the original VERB team, the public health officials from the CDC and the contracted marketing agencies, were well aware of the environmental and health disparities that are present amongst the assorted regions in the United States (3). Formative research and focus group sessions merely reiterated many of the previously understood barriers to physical activity.
One of the biggest flaws made by this campaign was the assumption that all children within the target audience have equal access to a safe place to play with appropriate supervision or the means to afford enrollment in an existing community program when school is no longer in session. Due to a variety of reasons including lack of funding, personnel, availability of space and the liability associated with childcare, many communities, especially those of low socioeconomic standing (SES), are unable to offer afterschool and summer programs. This is especially true for minority children of low SES living in urban environments. Research indicates that low-SES and high-minority groups have reduced access to facilities which directly contribute ethnic disparities in physical activity and overweight patterns (7). During a focus group designed to collect information about the target audience, urban African American tweens reported that lack of transportation, unsafe neighborhoods, and limited availability of programs as major barriers to living an active life-style (1). By neglecting to find a solution to this major issue, the VERB campaign essentially ignored the bracket of urban-American minority children of low SES, that are ironically at the highest risk for becoming overweight/obese and developing early onset of chronic diseases like diabetes and cardiovascular disease (7).
The whole design of branding VERB was to help tweens more easily identify with the campaign. Promotions and mini-interventions such as VERB Yellowball helped to achieve the desired principles behind the theory of planned behavior and the social cognitive theory. For example, the establishment within the target audience of a positive attitude towards leading an active-lifestyle, the brand’s status as a fun, cool program that all their peers are involved in, and the sense of increased self-confidence to try new activities combined to result in a significant increase in physical activity (1). However, VERB’s blatant exclusion of the inner-city demographic became apparent in the inability of urban tweens to identify with the suburban images that are depicted by the brand. The result of this decision was the estrangement of urban, minority tweens from this national health campaign.
Mixed Messages for Parents
Although the campaigns primary audience was tweens (ages 9 to 13), VERB developed messages for parents, the secondary targeted audience, to encourage them to support their child’s participation in physical activity; however, advertising specifically directed towards parents was intentionally kept to minimum resulting in the confusion of a parents role in the intervention (8). The growing trend of inactivity is not only a concern for children but a major issue in the adult population. Nevertheless, the VERB campaign banked a large portion of its advertising towards this secondary audience on the willingness and readiness of American parents from all backgrounds, SESs and regions to support and join in on the effort of increasing their child’s physical activity.
Parents and caretakers play an influential role in the development of many life-long health behaviors including health maintenance, eating habits, and activity level (8). As children age into adulthood they begin to garner a greater ability and thirst to make their own decisions. Parents serve as role models and provide guidance in the development of a child’s attitudes, perceptions and actions (8). Relative to the theory of planned behavior and the social cognitive theory, they contribute to subjective norms and social influences that lead to the development of their child’s behavior patterns (4, 5, 8). Parents provide emotional and psychological support as well as logistical support for children’s life-styles in the form of time and money (8). Children need transportation to soccer games, friends’ houses, piano lessons and a variety of other destinations. In regards to the VERB campaign, the data indicated that parent’s positive attitudes, beliefs and behaviors regarding physical activity resulted significant behavioral outcomes; however, this result was entirely dependent on the parent’s awareness of the campaign (8). Despite to the dozens of promotions directed towards tweens, mere print ads in 21 national women’s magazines and two public service announcements that were aired on limited bases were the main vehicles for conveying the invention’s messages to parents (8). In an attempt to protect the “coolness” of the campaign, the VERB team forfeited the use to the VERB brand identity in these advertisements and overlooked the importance of timely outreach to adults to gain their early buy-in (6). Approximately a quarter of the surveyed parents of Asian background responded that they did not detect a message from VERB to them and their family (9). As a result, the importance of the parent’s role in the intervention was lost.
There seems to be an obvious discrepancy in the role parents were meant to play in the VERB campaign. In order for the intervention to be successful, parents are expected to support their children and even engage them in some type of physical activity. The integral portion behind this behavior is the presence of positive beliefs and attitudes regarding physical activity which was found to have been significantly influenced by an increased exposure to VERB promotions and brand (8). Since adult exposure to VERB was limited, a huge pressure was placed on parents to take the initiative to support and increase their child’s activity level on their own. However, physical inactivity is a growing trend among all age groups in the United States. Therefore, it is highly likely that the parents of an inactive child are also inactive themselves and are likely to have a less positive attitude toward physical activity in general. I believe this assumption was one the biggest mistakes made by this campaign.
The VERB campaign provides number of ideas for increasing physical activity that are written in kid-friendly language and utilize bright, inspiring images; however, they rely too heavily on the assumptions and stereotypes surrounding specific ethnicities. One example of a promotion that was used by this campaign and directed at children of all ages, ethnicities and regions was the “Step into the Sun” television commercial that depicted children playing outside with a glowing orb that is reminiscent of the sun. The ad featured inspiring metaphors, a trendy soundtrack and a message that simply read: “Play outside” (10).  Throughout the campaign, the VERB team marketed its messages directly to tweens in kid-language through popular kid media channels like Nickelodean, Sports Illustrated for Kids, and Teen People (6). In addition to the general marketing strategy, unique promotions were specifically designed for ethnic subgroups of interest; however, these racially influence ads depicted obvious activity-specific stereotypes and created a disconnect between minorities and VERB. Despite these radical marketing tactics, VERB failed to draw on other characteristics may have increased its overall effectiveness within minority populations.
In addition to the campaign’s general marketing strategy that targeted the American tween population as a whole, the team believed that a secondary marketing strategy aiming culturally-specific messages at the four subgroups (African American, Hispanic, Asian and Native America) would ensure that all of the nation’s youth would be reached by the campaign (6). The race-specific promotions were intended to boost the self efficacy of children in these ethnic or racial subgroups in order to increase the frequency and duration of physical activity. According to the theory of planned behavior, self efficacy, or one’s belief in his or her ability to succeed, is a major predictor of human behavior. With this theory in mind the VERB team contracted four organizations (i.e. Garcia 360˚, PFI Marketing, etc.) that specialized in marketing towards African Americans, Hispanic people, Asians and Native Americans (6). Each agency created a mini-campaign that included race/cultural-specific messages, tailored visual imagery and a defined language that would be used when targeting that race or ethnicity (9). Although it was plausibly unintentional, in the process of designing these race-specific campaigns, VERB’s marketing strategy breached a level of stereotyping that significantly diminished the campaign’s relevancy and overall effectiveness. The most striking evidence of the failure caused by this marketing tactic is the low enrollment rate and disappointing behavioral outcomes despite the high rate of brand familiarity within the target audience and penetration of these unique cultural promotions (6, 9).
Despite the use to multicultural actors and models, VERB’s stereotypical promotions produced the opposite result of what was intended. In fact, the after the first year, a positive association between awareness of the campaign and physical activity was detected for white children but not for African American or Hispanic children (9). The unfortunate irony is that these subgroups are more likely to be less physically active than whites and have a much higher risk for becoming overweight and obese (8).  Although the correlation was only significant in the white tween group, this finding has been generalized for the entire American tween population in literature published about VERB as an indication the campaign’s success. However, with a closer look at the data, it is evident that although the goal for the targets audiences’ awareness was being met, African American, Asian, Hispanic and Native American children were not responding to the advertising as well as white tweens (9). A large portion of any brands effectiveness is the audiences’ ability to identify with the product. When designing the mini-campaigns, the team incorporated recognizable cultural elements and culture-specific activities such as dancing and music with activities like basketball and running. A focus group with G&G Advertising revealed that tweens liked the music and visual elements of VERB advertisements to reflect their cutlure, but would be resistant to advertisements that stereotyped them (9).  The culturally stereotypical images used in these promotions lessened the target audience’s ability to identify with the VERB brand and detracted from the promotion’s empowering images and slogans causing the campaign’s message to be lost.
Discussing the Solutions
Organizing community with Incentives
            One obvious mistake made by VERB was neglecting to understand the nature of all the different types of communities within the United States. It was foolish of the VERB team members to assume that all communites have the resources to provide a safe, supervised area of play for children. This is especially issue for low SES urban areas that lack both the space and money for overwhelming demand to offer an affordable program to the community. Thus, VERB could have spent more of its multimillion dollar budget on incentives and support for communities to organize programs that fit in with the campaign’s messages and brand identity, similar to a franchise.
In the process of establishing a community programs and events such as a festivals, summer camps or afterschool programs, VERB would provide monetary assistance (approximately 60%  or more of the overall cost of the program for very low SES communities) as well as activity ideas and marketing in the community. The percentage of monetary assistance would depend upon number of factors including the SES of the community and would be reviewed by a central authority within the campaign that would delegate the programs payout. The monetary support would allow the program to offer a decreased tuition and greatly alleviate the burden that low SES communities experienced with the VERB campaign. This method would be highly effective amongst racial and ethnic minorities. Formative research discovered that community events in high-density Hispanic neighborhoods via grassroots events, participation in festivals, and mobile marketing tours gave VERB the ability to reach its target audiences with direct one-on-one interaction. These events created opportunities to feature the sampling of different activities to help further teach the ease and importance of physical activity (9). With this approach communities would be attracted to the incentives provided by VERB and would make safe, supervised, positive atmospheres more available to children of all racial and regional backgrounds. In addition, the overall budget of the campaign, $339 million dollars, would be more evenly distributed throughout the country allowing for a more equal opportunity for children to take advantage of VERB.
Family involvement
Why not emphasize family involvement with VERB? Walt Disney Company many other family brands also target children as their primary audience yet are mindful of the fact that parents control both the living environment and resources. Therefore, these organizations are able to create a wholesome, family-friendly image while still maintaining a fun, cool image that is appealing and relevant to tweens. This would be accomplished by duel advertising that would incorporate tween- and family- friendly messages that would still utilize celebrity endorsements and depict families with tweens in the promotions doing cool, fun activities to maintain the desire image of the VERB brand. Duel advertising would also streamline the campaign marketing budget by eliminating the need for the design of separate, unique campaign strategies and gain the early support of adult influencers that was missing from the original scheme.
Formative research showed that promotions that included family as an important core value would be highly effective especially amongst the specificly targeted ethnic subgroups (Asian, Native American and Hispanic) (9). Garcia 360°, an advertising agency that specializes in marketing to the Hispanic community, heard from tweens that family responsibilities (e.g., babysitting siblings after school while parents worked) were barriers to their participating in structured programs, especially for girls (9). In fact, APartnership’s and Garcia 360°’s original recommendation was to gain parental acceptance and invite children’s involvement in the campaign as a family rather than just an individual (9). These campaigns would maintain the fun, cool brand image while educating parents and tweens about the benefits of physical activity by linking associating physical activity to children’s school performance, overall health and status of popularity. Thus, parents’ role in intervention would be clearly delineated  through the positive images depicted in VERB promotions that would persuade them to encourage their child’s physical activity while still maintaining the VERB brand identity that physical activity is a fun and cool thing for tweens to do.
Incorporating non-stereotypical promotions and a variety of activities
Was this tactic for sending culturally specific messages in the first place?
VERB poured millions of dollars into racially specific formative research that was used to design four mini-campaigns targeting African American, Hispanic, Asian and Native American children with the use of identifiable cultural images, phrases and the use of traditional language. However, in the later years of the campaign there was a strategic shift to market of ethnic-specific messages to parents only, instead of tweens and parents separately. This was due to the fact that funds were running low and the data already indicated that VERB’s general-audience materials were reaching minority tweens (9). Prior to this shift, Garcia 360˚ had spent the majority of its budget on promotions that delivered VERB’s messages to the Hispanic community in Spanish. Though many minority children are bilingual, VERB’s marketing strategy towards the subgroups disregarded that fact that being of a specific race or ethnicity doesn’t necessarily determine language preference. In fact, during the follow up surveys, only 18% of the Hispanic tweens and 40% of Hispanic parents that were surveyed preferred to communicate in Spanish (9). Thus a large portion of the campaigns budget could have been saved for the incentives that were previously proposed. It is important for the campaign to provide materials, instructions and promotions in various languages, but a balance of cultural characteristics is necessary to avoid obvious stereotypes.
There I propose that VERB reassess its marketing strategies to help eliminate cultural and racial stereotypes. This would be done by depicting children in their promotions engaging in a variety of activities. In addition, formative research showed that African-American tweens reported a preference for safe, noncompetitive activities (9). This information varifies another discrepancy in that most of VERB’s promotions utilize competitive sports to inspire physicals activity resulting in the lack of interest by this subgroup that was evident in the demographic being least affected by VERB. Therefore, it is important for the campaign to provide some fun promotions that feature non-competitive activity like going for a hike, kayaking, rock-climbing, dancing and lifting weights as well.
            This the adaptations, VERB will able more cost-effective and better able to influence American tween of all regional and cultural backgrounds to increase their physical activity in the hope of decreasing some of the long-term help implication that this generation is expected to experience (e.g. early onset of diabetes, obesity, etc.).
  1. Huhman ME. The Influence of the VERB Campaign on Children’s Physical Activity in 2002 to 2006. The American Journal of Medicine 2010; 100: 638-645.
  2. The VERB Campaign Website. Centers for Disease Control.
  3. Heitzler C. Bringing “Play” to Life:The Use of Experiential Marketing in the VERB Campaign American Journal of Preventive Medicine 2008; 34: S188-S193.
  4. 4.      Ajzen I. The Theory of Planned Behavior. Orgainzational Behavior and Human Descision Processes 1991; 50: 179-211.
  5. 5.      Social cognative theory: Explanation of behavioral patterns. University of Twente Website.
  6. 6.      Wong F. It’s What You Do!: Reflections on the VERB Campaign. American Journal of Medicine 2008; 34: 175 – 182.
  7. 7.      Gordon-Larsen P, Nelson MC, Page P, Popkin BM. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics. 2006 Feb;117(2):417-24.
  8. 8.      Price SM, Huhman M, Potter LD. Influencing the parents of children aged 9–13 years: findings from the VERB campaign. Am J Prev Med. 2008;34(6S):S267–S274
  9. 9.      Huhman ME. The VERB™ Campaign’s Strategy for Reaching African-American, Hispanic, Asian, and American Indian Children and Parents. The American Journal of Preventative Medicine 2008; 34: S194-S209.
  10. 10. VERB: Step into the Sun Advertisement. Youtube Website 2012.

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