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Chapter 1
defInIng socIal MarketIng
I believe the genius of modern marketing is not the 4Ps, or audience research, or even exchange, but rather the management paradigm that studies, selects, bal- ances, and manipulates the 4Ps to achieve behavior change. We keep shortening “the marketing mix” to the 4Ps. And I would argue that it is the “mix” that matters most. This is exactly what all the message campaigns miss—they never ask about the other 3Ps and that is why so many of them fail. —Dr. Bill Smith Executive Vice President Academy for Educational Development
S ocial marketing, as a discipline, has made enormous strides since its distinction in the early
1970s, and has had a profound positive impact on social issues in the areas of public health, injury prevention, the environment, community involvement, and more recently, financial well-being. Fundamental principles at the core of this practice have been used to help reduce tobacco use, decrease infant mortality, stop the spread of HIV/AIDS, prevent malaria, help eradicate guinea worm disease, make wearing a bike helmet a social norm, decrease littering, stop bullying, increase recycling, encourage the homeless to participate in job training pro- grams, and persuade pet owners to license their pets and “scoop their poop.” Social marketing as a term, however, is still a mystery to most, misunderstood by many, and increasingly confused with others such as behavioral economics (a framework we consider in this book) and social media (one of many potential promotional tactics to choose from). A few even worry about using the term with their administrators, col- leagues, and elected officials, fearing they will associate it with socialism, manipulation, and sales. This chapter is intended to create clear distinctions and to answer common questions. How does social marketing differ from commercial marketing, nonprofit mar- keting, cause marketing, and public education? Everyone argues it is more than commu- nications, but what’s the “more”? Do people who do social marketing actually call themselves social marketers? Where do they work? We support the voices of many who advocate an expanded role for social marketing and social marketers, challenging professionals to take this technology “upstream” to influence other factors that effect positive social change, including laws, enforcement, public policy, built environments, school curricula, community organizations, business
Chapter 1 Defining Social Marketing 3 practices, and the media. We also encourage distinguishing and considering “midstream” audiences, those influential others closer to our target audiences (e.g., family, friends, neighbors, healthcare providers). We begin this and all chapters with an inspiring case story, this one from Africa. We conclude with one of several Marketing Dialogues that feature discourses among practitio- ners on the social marketing listserv seeking to shape, evolve, and transform this discipline. MARKETING HIGHLIGHT
Sustainable Malaria Prevention
NetMark’s Success Story in Africa
Background
In Africa alone, almost 3,000 people die from malaria every day.^1 That number bears repeating: Almost 3,000 people die from malaria every day in Africa, more than 1 million each year. Additional statis- tics^2 are just as astonishing:
- • Malaria is the number one cause of death for pregnant mothers and chil- dren under five years of age
- • One out of 20 children in Africa dies of malaria before the age of five
- • The primary cause of absenteeism in African schools is malaria
- • Families spend approximately 20% of their income on malaria treatments
- • Public health institutions spend up to 40% of their budgets on outpatient treatment for malaria And perhaps the greatest tragedy is that many of these illnesses, deaths, and related expenditures are preventable. The World Health Organization (WHO) recommends insecticide-treated nets (ITNs) as the best way for families to protect themselves from malaria, proven to reduce the risk of infec- tion by up to 45% and the risk of death by 30%. In 1999, the United States Agency for International Development (USAID) funded an effort called NetMark to increase demand for and appropriate use, availability, and affordability of ITNs, through the commer- cial sector if possible. At the time, ITNs were not even available for sale in most African countries. ITNs were provided by govern- ments and donors. By 2009, more than 60 million nets had been sold by NetMark’s partners in its seven countries of operation.^3 This case highlight describes the pro- gram’s rigorous application of social mar- keting principles, including the use of all 4Ps in the traditional marketing mix. Case information was provided by Dr. Willard Shaw at the Academy for Educational Development (AED) in Washington, D.C., the agency implementing the project.
Target Audiences and
Desired Behaviors
Although primary audiences ( downstream ) were the most-at-risk populations—pregnant
Chapter 1 Defining Social Marketing 5 all its countries. It constantly encouraged public health authorities to promote mar- ket segmentation by focusing publicly funded free and highly subsidized ITNs on high-risk and poor populations while allowing the commercial sector to market to the people who could afford to buy an ITN. It also lobbied national regulatory agencies to streamline the process of reg- istration for quality ITN brands. After convincing multinational net and insecti- cide manufacturers to invest in developing retail ITN markets, NetMark helped them identify country distributors ( place ) will- ing to invest in promoting retail sales. NetMark worked with both groups on annual brand marketing plans using a joint risk/joint investment process, with NetMark investing in market research, generic promotion of ITNs, and coordina- tion with the public sector and donors, and the commercial firms doing what they do best—manufacturing, distributing, and promoting their own brands. NetMark provided some “matching funds” to dis- tributors for activities aimed at expanding the reach of their retail networks (e.g., sales teams, marketing materials), reim- bursing distributors for 50% of specific investments. Manufacturers also provided distributors with brand promotion support and technical assistance. The confidential brand marketing plans identified special audiences to target, with some distribu- tors targeting special groups (nongovern- mental organizations, churches, boarding schools, etc.) in addition to the general public. There was ongoing tension between NetMark’s public health focus on reaching as many at-risk people as possible and the commercial sector’s more conservative approach of managing risk and ensuring return on investment. NetMark’s promotional efforts sought to build demand for ITNs by informing the public about the dangers of malaria and the benefits of sleeping under treated nets. Two multinational advertising and product promo- tion agencies helped develop an advertising and communication campaign with region- and country-specific components. The initial tag line “Mosquitoes KILL. KILLMosquitoes” (see Figure 1.2) was based on research show- ing that consumers valued the killing power of any insect control product. Each brand con- ducted a marketing campaign of its own, which was coordinated with the generic cam- paign. The generic campaign included mass media (print, television, and radio) as well as special promotions such as wall murals, point- of-purchase materials, street theatrics, and road shows (see Figure 1.3). Figure 1.2 Initial campaign tagline.^6
6 P A R T I U N D E R S T A N D I N G S O C I A L M A R K E T I N G
Outcomes
A quick summary of accomplishments included the following:
- • Creating Supply: In 1999, there were only 2 ITN brands commercially available in Africa; by 2008, there were 22, with 50 commercial partners providing increased access, higher net quality, lower prices, more brands in the marketplace, and creation of jobs for manufacturing, promoting, dis- tributing, and selling ITNs.
- • Creating Demand: In 2009, awareness of ITNs among women ages 15 to 49 was more than 90% and ownership was as high as 64% in Ghana and 91% in Ethiopia. NetMark partners sold more than 60 million nets by 2009. - • Ensuring Equity: NetMark’s com- mercial discount voucher program enabled 2.2 million families with children under five to buy an ITN in a local shop at discounts from 40% to 100% and served as an excellent tool to attract new retailers. In addition, NetMark helped governments and donors distribute 2.3 million ITNs. - • Ensuring Sustainability: NetMark partnered with 42 African and 9 multinational commercial partners who invested over $90 million in creating national ITN markets and made organizational changes to support growing retail markets. This will help ensure a sustainable supply of ITNs when donors are no longer willing or able to supply free nets. Figure 1.3 Painted wall murals promoting benefits.^7
8 P A R T I U N D E R S T A N D I N G S O C I A L M A R K E T I N G (Continued) Social Marketing is a set of evidence- and experience-based concepts and principles that provide a systematic approach to understanding behaviour and modifying it for social good. It is not a science but rather a form of ‘technik’; a fusion of science, practical know-how, and reflective practice focusing on continuously improving the performance of programmes aimed at producing net social good. —Jeff French, 2011 Social Marketing critically examines commercial marketing so as to learn from its successes and curb its excesses. —Gerard Hastings, 2011 Social Marketing is the application of marketing principles to shape markets that are more effective, efficient, sustainable, and just in advancing people’s well-being and social welfare. —Craig Lefebvre, 2011 Social Marketing is a process that involves (a) carefully selecting which behaviors and segments to target, (b) identifying the barriers and benefits to these behaviors, (c) developing and pilot testing strategies to address these barriers and benefits, and, finally, (d) broad scale implementation of successful programs. —Doug McKenzie-Mohr, 2011 Social Marketing is a way to reduce the barriers and increase the facilitators to behaviors that improve the quality of life for individuals and society. It uses concepts and planning processes from commercial marketing to make behaviors “fun, easy, and popular.” It goes beyond communication, public service announcements, and education to give you a 360-degree view of potential causes and solutions for health and human service problems. —Mike Newton-Ward, 2011 Social Marketing is the activity and processes for understanding, creating, communicating, and delivering a unique and innovative offering to overcome a societal problem. —Sharyn Rundle-Thiele, 2011 Social Marketing is the use of marketing principles and techniques to promote the adoption of behaviors that improve the health or well-being of the target audience or of society as a whole. —Nedra Weinreich, 2011
Chapter 1 Defining Social Marketing 9
We Focus on Behaviors
Similar to commercial sector marketers whose objective is to sell goods and services, social marketers’ objective is to successfully influence desired behaviors. We typically want to influence target audiences to do one of four things: (a) accept a new behavior (e.g., composting food waste); (b) reject a potentially undesirable behavior (e.g., starting smoking), which is why we refer more often to behavior influence than behavior change; (c) modify a current behavior (e.g., increase physical activity from three to five days of the week or decrease the number of fat grams consumed); or (d) abandon an old undesir- able behavior (e.g., talking on a cell phone while driving). It may be the encouragement of a one-time behavior (e.g., installing a low-flow showerhead) or the establishment of a habit and the prompting of a repeated behavior (e.g., taking a five-minute shower). More recently, Alan Andreasen suggested a fifth arena, in which we want to influence people to continue a desired behavior (e.g., giving blood on an annual basis), and a sixth, in which we want people to switch a behavior (e.g., take the stairs instead of the elevator).^8 Although benchmarks may be established for increasing knowledge and skills through education and efforts may need to be made to alter existing beliefs, attitudes, or feelings, the bottom line for the social marketer is whether the target audience adopts the behavior. For example, a specific behavior that substance abuse coalitions want to influence is women’s consumption of alcohol during pregnancy. They recognize the need to inform women that alcohol may cause birth defects and convince them that this could happen to their baby. In the end, however, their measure of success is whether the expectant mother abstains from drinking. Perhaps the most challenging aspect of social marketing (also its greatest contribution) is that it relies heavily on “rewarding good behaviors” rather than “punishing bad ones” through legal, economic, or coercive forms of influence. And in many cases, social market- ers cannot promise a direct benefit or immediate payback in return for adopting the proposed behavior. Consider, for example, the task of influencing gardeners to pull their dandelions instead of using harmful chemicals. It’s tough to show the healthier fish their actions helped to support. And it’s tough to convince youth who want to look good to use sunscreen so they will (maybe) avoid skin cancer later in life. As you will read in subsequent chapters, this is why a systematic, rigorous, and strategic planning process is required—one that is inspired by the wants, needs, and preferences of target audiences and focuses on real, deliverable, and near-term benefits. It should be noted, however, that many believe this heavy reliance on individual voluntary behavior change is outdated and have moved on to applying social marketing technologies to influence other change factors in the environment (e.g., laws, policies, media). These are elaborated upon later in this chapter.
We Use a Systematic Planning Process That Applies
Traditional Marketing Principles and Techniques
The American Marketing Association defines marketing as “the activity, set of institu- tions, and processes for creating, communicating, delivering, and exchanging offerings
11 Phase Scoping Selecting Understanding Designing Managing Step
Purpose^ and focus
Situation^ analysis
Target^ audience
Behavior^ objectives and^ goals
Barriers, benefits,^ and competition
Positioning
Marketing^ mix: The^ intervention^ tools
- Evaluation plan
Budget
Plan to^ implement Technique examples Literature reviews, epi and scientific data SWOT analysis, peer interviews Andreasen’s nine criteria (see Chapter 6) McKenzie- Mohr’s three criteria (see Chapter 7) Knowledge, attitudes, and practice studies Perceptual maps The 4Ps Logic model Objective and task method Include a pilot prior to rollout Feedback loops Findings at this step may suggest adjustments to the target audience and/or behavior objectives and goals A pretest of draft strategies may suggest changes in the 4Ps design A pilot may suggest changes, especially in the marketing mix Table 1. Social Marketing Planning Process: Phases, Steps, Techniques, and Feedback Loops
12 P A R T I U N D E R S T A N D I N G S O C I A L M A R K E T I N G organizations who have the opposite view of what is good. Abortion is an example of an issue where both sides argue that they are on the “good” side, and both use social marketing techniques to influence public behavior. Who, then, gets to define “good”? Some propose the United Nations’ Universal Declaration of Human Rights (http://www.un.org/en/ documents/udhr/) as a baseline with respect to the common good, while other perspectives and discussions are elaborated upon in the Marketing Dialogue at the end of Chapter 2. WHERE DID THE CONCEPT ORIGINATE? When we think of social marketing as “influencing public behavior,” it is clear that this is not a new phenomenon. Consider efforts to free slaves, abolish child labor, influence women’s right to vote, and recruit women into the workforce (see Figure 1.4). Launching the discipline formally more than 40 years ago, the term social marketing was first introduced by Philip Kotler and Gerald Zaltman, in a pioneering article in the Journal of Marketing , to describe “the use of marketing principles and techniques to advance a social cause, idea or behavior.”^12 In intervening decades, growing interest in and use of social marketing concepts, tools, and practices has spread from public health and safety to use by environmentalists, community advocates, and poverty workers, as is evident in the partial list of seminal events, texts, and journal articles in Box 1.2. (See Appendix B for additional resources.) Box 1. Social Marketing: Seminal Events and Publications 1970s 1971: A pioneering article by Philip Kotler and Gerald Zaltman, “Social Marketing: An Approach to Planned Social Change” in the Journal of Marketing , coins the term social marketing. More distinguished researchers and practitioners join the voice for the potential of social marketing, including Alan Andreasen (Georgetown University), James Mintz Figure 1.4 “Rosie the Riveter,” created by the War Ad Council to help recruit women^11
14 P A R T I U N D E R S T A N D I N G S O C I A L M A R K E T I N G HOW DOES SOCIAL MARKETING DIFFER FROM COMMERCIAL MARKETING? There are a few important differences between social marketing and commercial marketing. In the commercial sector, the primary aim is selling goods and services that will pro- duce a financial gain for the corporation. In social marketing, the primary aim is influ- encing behaviors that will contribute to societal gain. Given their focus on financial gain, commercial marketers often favor choosing primary target audience segments that will provide the greatest volume of profitable sales. In social marketing, segments are selected based on a different set of criteria, including prevalence of the social problem, ability to reach the audience, readiness for change, and others that will be explored in depth in Chapter 6 of this text. In both cases, however, marketers seek to gain the greatest returns on their investment of resources. (Continued) 2005: The National Social Marketing Centre, headed by Jeff French and Clive Blair- Stevens, is formed in London, England. 2005: The 10th annual conference for Innovations in Social Marketing is held. 2005: The 16th annual Social Marketing in Public Health conference is held. 2006: A text by Alan Andreasen, Social Marketing in the 21st Century , describes an expanded role for social marketing. 2007: Gerard Hastings’s book Social Marketing: Why Should the Devil Have All the Best Tunes? is published. 2008: The first World Social Marketing Conference is held in Brighton, England. 2010s 2010: The 20th annual Social Marketing in Public Health conference is held. 2010–2011: More books are published, including the second edition of Hands-On Social Marketing by Nedra Weinreich; Social Marketing for Public Health: Global Trends and Success Stories by Hong Cheng, Philip Kotler, and Nancy Lee; Social Marketing to Protect the Environment: What Works by Doug McKenzie-Mohr, Nancy Lee, Wesley Schultz, and Philip Kotler; Social Marketing and Public Health: Theory and Practice by Jeff French; and the third edition of Fostering Sustainable Behavior by Doug McKenzie-Mohr. The Journal of Social Marketing is launched in Australia. 2011: The second World Social Marketing Conference is held in Dublin, Ireland, and the International Social Marketing Association is launched.
Chapter 1 Defining Social Marketing 15 Although both social and commercial marketers recognize the need to identify and position their offering relative to the competition, their competitors are very different in nature. Because, as stated earlier, the commercial marketer most often focuses on selling goods and services, the competition is often identified as other organizations offering similar goods and services. In social marketing, the competition is most often the current or preferred behavior of our target audience and the perceived benefits associated with that behavior, including the status quo. This also includes any organizations selling or promoting competing behaviors (e.g., the tobacco industry). For a variety of reasons, we believe social marketing is more difficult than com- mercial marketing. Consider the financial resources the competition has to make smoking look cool, yard cleanup using a gas blower easy, and weed-free lawns the norm. And consider the challenges faced when trying to influence people to do any of the following:
- • Give up an addictive behavior (e.g., stop smoking)
- • Change a comfortable lifestyle (e.g., reduce thermostat settings)
- • Resist peer pressure (e.g., be sexually abstinent)
- • Go out of their way (e.g., take unused paint to a hazardous waste site)
- • Be uncomfortable (e.g., give blood)
- • Establish new habits (e.g., exercise five days a week)
- • Spend more money (e.g., buy recycled paper)
- • Be embarrassed (e.g., let lawns go brown in the summer)
- • Hear bad news (e.g., get an HIV test)
- • Risk relationships (e.g., take the keys from a drunk driver)
- • Give up leisure time (e.g., volunteer)
- • Reduce pleasure (e.g., take shorter showers)
- • Give up looking good (e.g., wear sunscreen)
- • Spend more time (e.g., flatten cardboard boxes before putting them in recycling bins)
- • Learn a new skill (e.g., create and follow a budget)
- • Remember something (e.g., take reusable bags to the grocery store)
- • Risk retaliation (e.g., drive the speed limit) Despite these differences, we also see many similarities between the social and com- mercial marketing models:
- • A customer orientation is critical. The marketer knows that the offer (product, price, place) will need to appeal to the target audience, solving a problem they have or satisfying a want or need.
- • Exchange theory is fundamental. The target audience must perceive benefits that equal or exceed the perceived costs they associate with performing the behavior.^13 As Dr. Bill Smith often purports, we should think of the social marketing paradigm as “Let’s make a deal!”^14
Chapter 1 Defining Social Marketing 17 WHO DOES SOCIAL MARKETING? In most cases, social marketing principles and techniques are used by those on the front lines responsible for improving public health, preventing injuries, protecting the environment, engendering community involvement, and, more recently, enhancing financial well-being. It is rare that these individuals have a social marketing title. More often, they are program managers or those working in community relations or communication positions. Efforts usually involve multiple change agents who, as Robert Hornik points out, may or may not be acting in a consciously coordinated way.^15 Most often, organizations sponsoring these efforts are public sector agencies : international agencies such as WHO; national agencies such as the Centers for Disease Control and Prevention, departments of health, departments of social and human services, the Environmental Protection Agency, the National Highway Traffic Safety Administration, and departments of wildlife and fisheries; and local jurisdictions, including public utilities, fire departments, schools, parks, and community health clinics. Nonprofit organizations and foundations also get involved, most often supporting behaviors aligned with their agency’s mission. For example, the American Heart Association urges women to monitor their blood pressure, the Kaiser Family Foundation uses their Know HIV/AIDS campaign to promote testing, and the Nature Conservancy encourages actions that protect wildlife habitats. Professionals working in a for-profit organization in positions responsible for corporate philanthropy, corporate social responsibility, marketing, or community rela- tions might support social marketing efforts, often in partnership with nonprofit orga- nizations and public agencies that benefit their communities and customers. Although the primary beneficiary is society, they may find that their efforts contribute to organizational goals as well, such as a desired brand image or even increased sales. Safeco Insurance, for example, provides households with tips on how to protect rural homes from wildfire; Crest supports the development of videos, audiotapes, and interactive lesson plans to promote good oral health behaviors; and thousands of customers at Home Depot’s stores have attended weekend workshops focusing on water conserva- tion basics, including drought-resistant gardening (see Figure 1.5). Finally, there are marketing profession- als who provide services to organizations Figure 1.5 Home Depot’s Arizona stores offered weekend workshops on water conservation basics, including drought-resistant gardening. More than 3, consumers attended.
18 P A R T I U N D E R S T A N D I N G S O C I A L M A R K E T I N G Box 1. A Declaration of Social Marketing’s Unique Principles and Distinctions Nancy R. Lee, Michael L. Rothschild, Bill Smith March 2011 Principles Shared With Other Disciplines Many of social marketing’s key characteristics have been widely adopted by other fields, and in turn social marketing has integrated practices developed elsewhere. Among the important characteristics it shares with others are:
- • AUDIENCE ORIENTATION: Social marketers view their audience as decision-makers with choices, rather than students to be educated, or incorrigibles to be regulated. Social Marketing begins with a bottom-up versus a top-down perspective, and therefore rejects the paternalist notion that “experts know what is best and will tell people how to behave for their own good” in favor of an audience-centered approach which seeks to understand what people want and provides them support in acquiring it.
- • SEGMENTATION: In order to enhance efficiency and effectiveness, subsets of populations are selected, evaluated, and then prioritized as targets based on useful aggregation variables. The segments selected are those most likely to adopt the intended behavior or most important to the organization’s goals, and to provide value in yielding societal benefit. Even among difficult to reach populations, strategies are developed that appeal to those within the chosen population that are the “most ready for action.”
- • BEHAVIOR FOCUS: Behavior is defined as an individual’s observable action or lack of action. Social marketing is interested in behavior that results in societal benefit. Many marketing strategies also have intermediate responses, but Social Marketing success is ultimately measured on whether the desired behavior was adopted. It is not sufficient to merely change awareness, knowledge, attitudes, or behavioral intentions.
- • EVALUATION: Efforts are evaluated, focusing on ongoing measurement of outcomes (levels of target audience behavior change), and the intended impact this has had on societal benefits. Social Marketing is a continuous process in which evaluation and monitoring provide data on the audience’s preferences and the environmental changes necessary to maintain and expand the impact of programs.
- • CONSIDERATION OF UPSTREAM & MIDSTREAM TARGET AUDIENCES: Efforts to influence individuals downstream are often enhanced by also targeting those who are upstream (policy makers, corporations), and/or those who are midstream (e.g. friends, family and influential others). Unique Principles While social marketing integrates many characteristics common to other forms of behavior change, four core principles remain truly unique to social marketing.
- • VALUE EXCHANGE: Social Marketing is unique with respect to other behavior change tools in that the offer that is made is based on an understanding of the target audience’s perceived self-interest that will be rewarded for performing the desired behavior. The concept of value exchange states that consumers will choose a behavior in exchange for receiving benefits they consider valuable and/or reducing barriers that they consider to be important. An exchange may result when the marketer has created a program that is perceived by each side to provide value.
- • RECOGNITION OF COMPETITION: In a free-choice society there are always alternative options available. Competition can be described in terms of choice offerings available in the environment that lead to alternative behaviors. Social Marketing strategies lead to a unique exchange offering that is perceived by the audience to have greater value than that of any other available option.
- • THE 4Ps OF MARKETING: Product, Place, Price and Promotion represent the fundamental building blocks of Social Marketing interventions. These tools are used to reduce the barriers that make it difficult for people to behave as desired, and to increase the benefits that induce people to be more likely to behave. The tools are used in concert to develop a favorably perceived relationship that is more appealing than all alternate choices. Social marketers assess and then balance the need for, and use of, these four elements to influence optimal change.
- • SUSTAINABILITY: Sustainability results from continuous program monitoring and subsequent adjustment to changes occurring in the audience and environmental condition. This is necessary to achieve long run behavior.
20 P A R T I U N D E R S T A N D I N G S O C I A L M A R K E T I N G engaged in social marketing campaigns , firms such as advertising agencies, public rela- tions firms, marketing research firms, and marketing consulting firms—some that spe- cialize in social marketing. WHAT SOCIAL ISSUES CAN BENEFIT FROM SOCIAL MARKETING? Table 1.2 presents 50 major social issues that could benefit from the application of social marketing principles and techniques. This is only a partial list but representative of the aforementioned five major arenas social marketing efforts usually focus on: health promotion, injury prevention, environmental protection, community involvement, and financial well-being. For each of the social issues listed, the status could improve if and when we are successful in increasing the adoption of desired related behaviors. Health-Related Behaviors to Impact Tobacco Use One in five (20.6%) adults 18 and older smokes cigarettes.a Heavy/Binge Drinking More than a fourth (26%) of 18- to 24-year-olds binge drink (have five or more drinks on one occasion).b Fetal Alcohol Syndrome 3.3% of pregnant women binge drink and 8.3% drink frequently.c Obesity Almost half (49.4%) of adults do not exercise at recommended levels.d Teen Pregnancy 37% of sexually active 9th through 12th graders did not use a condom during their last sexual intercourse.e HIV/AIDS About a fourth (24% to 27%) of Americans living with HIV are unaware of their infection.f Fruit and Vegetable Intake More than three out of four adults (76.5%) do not consume the recommended five or more servings a day.g High Cholesterol 23% of adults have never had their cholesterol checked.h Breastfeeding 57% of mothers do not meet recommendations to breastfeed infants until they reach at least six months.i Breast Cancer 25% of women 40 and older have not had a mammogram within the past two years.j Prostate Cancer 48% of men 40 and older have not had a PSA test within the past two years.k Colon Cancer In 2010, 35% of adults 50 and older had never had a sigmoidoscopy or colonoscopy.l Birth Defects 60% of women of childbearing age are not taking a multivitamin containing folic acid.m Table 1.2 50 Major Issues Social Marketing Can Impact
Chapter 1 Defining Social Marketing 21 Immunizations 10% of 29- to 35-month-old children are not receiving all recommended vaccinations.n Skin Cancer Only 9% of youths wear sunscreen most of the time.o Oral Health 30% of adults have not visited a dentist or dental clinic in the past year.p Diabetes One third of 20.8 million Americans with diabetes are not aware that they have the disease.q Blood Pressure 30% of the estimated 60 million Americans with high blood pressure don’t know they have it.r Eating Disorders 57% of college students cite cultural pressures to be thin as a cause of eating disorders.s Injury Prevention–Related Behaviors to Impact Drinking and Driving 16% of high school students report having ridden one or more times in the past year in a car driven by someone who had been drinking.t Seatbelts Observation surveys nationwide indicate that at least 16% of people do not wear a seatbelt.u Head Injuries More than a third (35%) of children riding bicycles wear helmets improperly.v Proper Safety Restraints for Children in Cars 83% of children ages four to eight ride improperly restrained in adult safety belts.w Suicide 8.4% of 9th through 12th graders attempted suicide one or more times during the past 12 months.x Domestic Violence Around the world, at least one woman in every three has been beaten, coerced into sex, or otherwise abused in her lifetime. Most often the abuser is a member of her own family.y Gun Storage An estimated 3.3 million children in the United States live in households with firearms that are always or sometimes kept loaded and unlocked.z School Violence 5% of students in high schools reported carrying a gun onto school property during a given month.aa Fires Roughly half of home fire deaths result from fires in the small percentage (4%) of homes with no smoke alarms.bb Falls More than one third of adults 65 and older fall each year. In 2003, more than 13, people 65+ died from injuries related to falls.cc Household Poisons More than 4 million accidental poisonings are reported each year; 65% of those involve children, and the most common poisoning agents among small children are vitamins, aspirins, cleaning products, and beauty supplies.dd Environmental Behaviors to Impact Waste Reduction Only 50% of all paper, 45% of all aluminum beer and soft drink cans, and 34% of all plastic soft drink bottles are recycled.ee (Continued)
