Project no.:
Project acronym:
Project title:
518368
MAX
Successful Travel Awareness Campaigns and Mobility Management Strategies
Integrated Project
6.2 Sustainable Development
1.6.2 Sustainable Surface Transport Objective
3.1.1.1.3 Advancing Knowledge on innovative measures in urban transport
Title of Report:
MAX-WPA TF5: Case study on VERB
physical activity campaign from the USA
Status: Final
Period covered:
Start date of project:
1 Oct. 2006
Date of preparation:
Duration:
3 Sept 2008
36 months
Version:
Prepared by:
Sonja Kahlmeier, WHO Regional
Office for Europe and Nick Cavill,
Cavill Associates, United Kingdom
Checked by:
Verified by:
Status:
Dissemination level:
Final
Public
Project co-funded by the European Commission within the Sixth Framework Programme (2002-2008)
Table of Contents
1
Overview of the case study, objectives and research questions ................................................................. 5
2
VERB: It’s what you do ................................................................................................................................. 7
3
4
2.1
Background Context ................................................................................................................................ 7
2.2
The VERB Campaign .............................................................................................................................. 7
Method ......................................................................................................................................................... 10
3.1
Literature review ................................................................................................................................... 10
3.2
Sources of quantitative data .................................................................................................................. 11
3.3
Campaign & education Materials ......................................................................................................... 11
3.4
Interviews .............................................................................................................................................. 11
Results and Discussion ................................................................................................................................ 12
4.1
What are the elements of the VERB campaign and how do they relate to each other? ......................... 12
4.1.1
Building a marketing team within the public sector ...................................................................... 12
4.1.2
Developing the brand .................................................................................................................... 12
4.1.3
Controlling the media .................................................................................................................... 13
4.1.4
Devising the Message.................................................................................................................... 14
4.1.5
Marketing approach and the message receiver .............................................................................. 15
4.1.6
A combination of ‘Upstream’ and ‘Downstream’ interventions ................................................... 15
4.1.7
Partnerships with Community Organisations ................................................................................ 16
4.1.8
A commitment to quality evaluation ............................................................................................. 16
4.1.9
Relationships between the elements of the campaign ................................................................... 17
4.2
Do the elements of the conceptual framework match up with elements found in the VERB? Campaign
17
4.3
Does the VERB campaign offer any additional elements which can be added to the conceptual
framework? ....................................................................................................................................................... 18
4.4
Are there particular success factors or barriers to success evident in the VERB campaign? .............. 18
4.4.1
Success factors .............................................................................................................................. 18
4.4.2
Barriers .......................................................................................................................................... 19
4.5
Does the VERB campaign demonstrate a balance of emotional and rational approaches within its
message? ........................................................................................................................................................... 20
4.6
5
Has VERB changed behaviour? ............................................................................................................ 21
Conclusions .................................................................................................................................................. 23
5.1
Recommendations for campaign design ................................................................................................ 23
5.2
Recommendations for task force 5 ........................................................................................................ 23
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1
Overview of the case study, objectives and research questions
This case study aims to investigate the VERB campaign conducted between 2002 and 2006 in the USA. The
campaign was designed to increase physical activity among children aged 9–13 years (called ‘tweens’ in the
US). The campaign’s strategy was to surround tweens (the primary target audience) with messages from
multiple points of influence, including television, print, radio, internet, community outreach, events, schools,
local and national partnerships, and public relations. The campaign also directed marketing efforts to parents as a
secondary audience for the campaign.
VERB provided an excellent example of a youth campaign with learning that could be applied to travel
awareness for a number of reasons:

It focused on physical activity through increased cycling and walking, which has direct relevance to
travel behaviour (as VERB included messages on cycling and walking as transport)

the behaviour (physical activity) has many similarities to travel awareness in terms of the challenge
facing campaigners

the age group (12-15) is relevant to travel awareness as it is the age at which attitudes towards travel are
formed, as young people start to think about learning to driving

It is the largest campaign of its kind in the world

It was extremely well evaluated and results published in the peer-reviewed literature (see section 3.1)
and the evaluation team members were willing to share their learning
The overall case study objectives are the following (cf. other case study in other WPA-TF’s):
 To refine the conceptual framework developed for WPA, more concretely with respect to combining
awareness raising with education.
 To assess in detail the strategy of combining awareness raising activities and educational activities;
 To examine success factors which may be applicable to travel awareness campaigns;
 To understand in detail the role of emotional and rational arguments within this particular campaign.
The following research questions will be analysed using the information generated by the case study (cf other
case studies):
 What are the different educational and awareness raising elements in the VERB campaign and how do
they relate to each other?
 Do the elements of the conceptual framework match up with elements found in this campaign case?
 Does the VERB campaign offer any additional elements which can be added to the conceptual
framework?
 Why was the campaign designed in this way?
 Are there particular success factors or barriers to success evident in the campaign?
 Does the campaign demonstrate a balance of emotional and rational approaches within its message?
 Did the VERB campaign change behaviour?
Following the conclusions from WPA-TF1, the following issues will also be investigated in this case study.
(a) Firstly, it is important to address the issues raised in the major conclusions 1-3 highlighted in the overall
conclusions.
page 5 / 23
a.
Importance of the planning stage to understand audience needs and attitudes and to fine-tune
segmentation.
b.
To recognise the ongoing dialogue between the campaign designer/manager at all stages of the
campaign process.
c.
The need to strengthen the evaluation of campaign results so as to ensure that funding partners
and other stakeholders are assured with regard to the effectiveness of a campaign.
(b) It is well documented that stakeholder support is a key to success but there is also a need to investigate
the importance of social networks at the community level.
(c) The literature points to the way in which emotional messages should be used to engage interest. Our
initial review of case studies points to the use of rational messages with little emotion involved yet
individualised travel marketing seems to deliver results. Is there an optimum mix of emotion and
rationality? Is there a sequencing which is important?
(d) The use of champions rather than celebrities is an area where little work has been undertaken and the
message giver work will develop this.
(e) Some theories relating to marketing and campaigns have been discussed in this review. Taskforces 2-5
should attempt to analyse whether the campaigns they are studying to explore the influence of these
theories in their design
(f) The revised conceptual framework will contain more detail about evaluation processes at different stages
of campaigns. TF 2-5 should attempt to identify examples of evaluation in campaigns to aid their
research.
page 6 / 23
2
VERB: It’s what you do
2.1
Background Context
NOTE. The VERB campaign has been well documented, so the vast majority of the descriptive detail on
the campaign is taken directly from the papers listed in section 3.1. The authors of these papers are
thanked for providing such rich detail. In addition, this information has been supplemented with
personal opinions, and notes from interviews with campaign staff (see section 3).
In 2001, US Congress gave $125 million to the Centre for Disease Control (CDC) to launch a campaign that
would help children develop habits to foster good health over a lifetime and to use methods that are employed by
marketing and communications agencies in their promotion of commercial products to children and young
people.
The VERB campaign was one response to the call of many US public health advocates who saw the promotion
of youth physical activity as an increasingly pressing national priority in the USA. Despite the physical and
mental health benefits associated with childrens regular participation in physical activity, many youths do not
meet national guidelines for engagement in physical activity. Concern for the consequences of a sedentary
lifestyle is heightened by the rise in childhood obesity and the diagnosis of children with type 2 diabetes and
cardiovascular disease risk factors.
The importance attached to this issue is illustrated by the level of funding awarded to CDC for the campaign: the
largest ever for a single initiative. The style of promotion was also different from previous attempts to increase
young peoples physical activity. The main innovation was that the campaign targeted tween “customers” directly
through sophisticated methods of commercial marketing, branding a behaviour (instead of a product) around
which messages would be delivered through substantial paid media and associated unpaid media and partnership
activity.
VERB went on to become the largest publically funded physical activity youth campaign conducted in the world.
It is particularly important for consideration for MAX as it was very comprehensively evaluated.
2.2
The VERB Campaign
The VERB campaign combined national paid advertising with school and community promotions and internet
activities to encourage the 21 million 9- to 13-year-olds in the USA to be physically active every day.
The campaign was launched in 2002 by the Centers for Disease Control and Prevention. VERB used commercial
methods of youth marketing to advertise being physically active as cool, fun, and a chance to have a good time
with friends.
The campaign was built around the brand “VERB,” the part of speech that expresses action. The tag line was
“It’s what you do.” Tweens were invited to answer the question “what’s your Verb?” and to think about how
physical activity and movement could be integrated into their lives.
Formative research reports for the VERB campaign are available from
http://www.cdc.gov/youthcampaign/research/reports.htm.
Marketing activities were conducted from June 2002 to September 2006. Television advertising, placed mainly
on cable networks popular with children, was the primary delivery vehicle for the campaign.
page 7 / 23
Community-focused and promotions in schools supplemented the advertising in Year 1 and expanded in Year
2; activity promotion kits were delivered to numerous community-based organisations and schools across the
US. Partnerships with national and local groups also increased in Year 2. The aim was to expand opportunities
for children to be active. An “activity finder” was added to VERB’s child website that directed children to
locate an activity of interest in their ZIP code area.
In Year 1, the national media buy was estimated to deliver 188 gross rating points (GRPs) per week, 119 of them
through television. GRPs are an estimated percentage of the target audience exposed to advertising. GRPs are
calculated by multiplying the estimated reach of a medium (e.g., percentage of children likely to see an ad on
cartoon shows on Saturday morning) by the number of opportunities to see the ad. After 1 year of the VERB
campaign, positive behavioural effects were found in subgroups of children in the target audience (e.g., children
aged 9 to 10 and girls). On the basis of the year-1 findings, the media buy for year 2 was adjusted to better reach
older children and boys. In year 2, lower funding reduced the television delivery to an estimate of 106 GRPs per
week. Years 3 and 4 saw a continuation of the media strategy with a lower proportion going into media spend
and more into supporting activities.
VERB used a broad mix of campaign tactics to reach tweens and their parents. The campaign was designed to
surround tweens at home, in school, and in the community to give VERB visible presence in their everyday
lives.
Paid media advertising. The primary vehicle for reaching into the home was paid advertising in general market
and ethnic media channels. VERB commercials aired on age appropriate television and radio channels such as
Cartoon Network, Nickelodeon, The WB, ABC Saturday Morning Disney (including Radio Disney),
Telemundo, and BET. Print advertising was placed in youth publications such as Sports Illustrated for Kids,
TIME for Kids, Teen People, and Seventeen.
Examples of parent publications include Family Circle, Parent Magazine, Ebony, and Indian Country Today.
Spanish and Asian language advertising and advertorials appear in publications such as Korea Times, World
Journal, and Los Padres. Examples of VERB advertising are at
http://www.cdc.gov/youthcampaign/advertising/index.htm
Added-value opportunities. In addition to paid media placements, the campaign negotiated added-value
opportunities from media partners. For example, media partners have produced VERB public service
advertisements using popular TV stars, that were aired in prime time. Examples include VERB sponsorship of
Nickelodeon’s Wild and Crazy Kids Show, Sports Illustrated for Kids’ Road Show, and Teen People’s Break for
the Beach. These added-value PSAs and sponsorships were thought to have increased the “cool factor” and
marketing reach of the VERB campaign among tweens.
Activity promotions. Several times a year, VERB featured promotions that invited community- based
organisations and schools throughout the United States to participate. For example, in 2003, VERB proclaimed
the day of the summer solstice (the longest day of the year) as the “Longest Day of Play” and created a
promotion with Radio Disney to motivate tweens to be active all day long. During fall 2003, when the clocks
were turned back one hour from daylight saving to standard time, VERB featured its “Extra Hour for Extra
Action” (EHEA) promotion, which included a kit of innovative and fun VERB materials for teachers and youthserving organisations to use in activating tweens. Participating EHEA schools and organisations were eligible to
apply for a small grant to support physical activity at the end of the three-week promotion.
Schools. Schools were used as a natural venue for reaching tweens; giving youth a prime opportunity to discover
their interests and develop skills. For example, working with youth publications like Weekly Reader and TIME
for Kids, VERB distributes custom-developed materials to middle schools throughout the country. Primedia’s
ChannelOne allows VERB advertising to reach tweens through schools. In-school vehicles include book covers,
day planners, and customised lesson plans that incorporate physical activity into the classroom and encourage
tweens to try many different VERBs. In total, 3,000 schools per year were reached across the US through
working with agents who sent activity promotions to each school, linked to lesson plans. This worked especially
well among minority audiences; the evaluation showed that they were reached more effectively through this
route than white kids.
Community-based events and grassroots marketing. VERB participated in existing community events, including
cultural festivals such as the Harvest Moon Festival (Los Angeles, Calif), Calle Ocho (Miami, Fla), and the
page 8 / 23
Gathering of Nations Pow Wow (Albuquerque, NM). At these grassroots community events, VERB hosted an
“activity zone,” a dedicated space for tweens to try out different activities such as kicking a soccer ball, dancing,
performing martial arts, or other activities. Another community-based tactic is the use of “street teams,” teams of
five to eight college-aged men and women hired to engage tweens in being physically active at events and tween
hangouts, including malls, parks, and community centres. Street teams create buzz about VERB and build
affinity for the brand as tweens tell their friends and siblings about their fun experiences and show off their
VERB gifts. The street teams distribute VERB-branded gifts to tweens, such as foot bags, T-shirts, temporary
tattoos, and Frisbee disks.
Contests and sweepstakes. To increase the value of the product and reward tweens for being active, many media
partners sponsored VERB contests and sweepstakes. For example, Channel One sponsored a pedometer-based
middle-school competition, Make Every Move Count. The schools that accumulated the most steps won an
"Action Pack" of physical activity equipment and materials to support their physical activity programs. In
addition, YM (Your Magazine) featured the VERB Move It to Groove It contest, where tween contestants
competed to win a video dance party for their entire school.
Public relations. VERB communicated almost continuously with the news media, stakeholders, and partner
organisations to offer information on the importance of youth physical activity to parents and other influencers
and to spotlight current campaign activities, such as events and promotions. The campaign maintains good
relationships with key members of the tween/teen and parent news media to keep them current on the campaign
and to serve as resources for information about youth physical activity, childhood weight problems, and related
topics. News media materials are tailored to meet specific needs, media tours are conducted in key markets, and
special news media coverage is arranged when appropriate.
Community partnerships. In the first year of VERB, the campaign developed local partnerships in the nine cities
that received extra marketing activities to bring the VERB brand to life and to establish a foundation of support
in those locations. In the later years, the goal of VERB became the recruitment of organisations across the
country to become site partners (organisations that can provide opportunities for tweens to be physically active)
or outreach partners (organisations that can reach parents or influence the environment to support tweens'
participation in physical activity).
There was also some effort made to work with community champions on the campaign. Some local communities
picked up on VERB in a promotion called summer scorecard and worked with local champions to promote it.
For example one local football coach at university was used in a locally-produced public service announcement
instead of celebrities. This was very popular with the target audience locally as he was well known in the
community
Corporate partnerships. VERB secured partnerships with corporations to extend the reach and appeal of the
campaign to tweens. For example, VERB successfully negotiated partnerships with professional sports leagues
for its ProVERB initiative; those who have made commitments include the National Football League, National
Hockey League, Major League Soccer, and Women’s Tennis Association. These sports leagues provided
content for the VERBnow.com web site for tweens, donated athlete-signed merchandise for prizes, and provided
opportunities for VERB sponsorship of their grassroots sports clinics.
Web sites. In partnership with AOL, VERB has created http://www.VERBnow.com , a web site designed
exclusively for tweens that includes the VERB Recorder, where tweens can report their participation in physical
activity and become eligible to win prizes for being active. A parent site, http://www.VERBparents.com,
includes in-language pages (Spanish, Chinese, Korean, and Vietnamese) in partnership with ethnic media
partners. In addition, http://www.cdc.gov/VERB was created for partners and stakeholders to access information
about the VERB campaign and to view advertising.
page 9 / 23
3
Method
A triangulation/multi-method approach to data collection was used to address the research questions. Relevant
literature on the campaign was scrutinised, with the basis of enquiry being the research questions, and
quantitative data was examined, derived from the documents (listed below).
The VERB campaign has been extremely well documented in the academic literature, so this case study draws
heavily on the articles listed in 3.1 below, including extensive quotations.
In addition to reviewing the literature, a semi-structured telephone interview with the programme director was
carried out to address specific components of the campaign in more detail.
The findings were summarised from each source and triangulated between sources to identify common themes
and divergences.
3.1
Literature review
The VERB campaign has been extensively reported in the academic literature.
This case study has drawn on this literature and quotes extensively from many of the following papers:
Asbury, L.D., Wong, F.L., Price, S.M., and Nolin, M.J. (2008). “The VERB™ campaign: applying a
branding strategy in public health.” Am J Prev Med; 34(6S):S183–S187.
Bauman, A., Bowles, H.R., Huhman, M., et al. (2008). “Testing a hierarchy-of-effects model: pathways
from awareness to outcomes in the VERB™ campaign 2002-2003.” Am J Prev Med;34(6S):S249 –S256.
Berkowitz, J.M., Huhman, M., and Nolin, M.J. (2008). “Did augmenting the VERB™ campaign advertising
in select communities have an effect on awareness, attitudes, and physical activity?” Am J Prev Med ,
34(6S):S257–S266.
Berkowitz, J.M., Huhman, M., Heitzler, C.D., Potter, L.D., Nolin, M.J., and Banspach, S.W. (2008)
“Overview of formative, process, and outcome evaluation methods used in the VERB™ campaign.” Am J
Prev Med;34(6S):S222– S229.
Bretthauer-Mueller, R., Berkowitz, J.M., Thomas, M., et al. (2008). “Catalyzing community action within a
national campaign: VERB™ community and national partnerships.” Am J Prev Med;34(6S):S210 –S221.
Heitzler, C.D., Asbury, L.D., and Kusner, S.L. (2008) “Bringing “play” to life: the use of experiential
marketing in the VERB™ campaign.” Am J Prev Med, 34(6S):S188 –S193.
Huhman, M. E., Potter, L. D., Duke, J. C., Judkins, D. R., Heitzler, C. D., and Wong, F. L. (2007).
„Evaluation of a national physical activity intervention for children: VERB campaign, 2002-2004.”
American Journal of Preventive Medicine, 32(1), 38-43.
Huhman, M., Bauman, A., and Bowles, H.R. (2008)“Initial outcomes of the VERB™ campaign: tweens’
awareness and understanding of campaign messages.” Am J Prev Med;34(6S):S241–S248.
Huhman, M., Berkowitz, J.M., Wong, F.L., et al. (2008). “The VERB™ campaign’s strategy for reaching
African-American, Hispanic, Asian, and American Indian children and parents.” Am J Prev
Med;34(6S):S194 –S209.
Huhman, M., Potter, L. D., Wong, F. L., Banspach, S. W., Duke, J. C., and Heitzler, C. D. (2005). „Effects
of a mass media campaign to increase physical activity among children: year-1 results of the VERB
campaign.” Pediatrics, 116(2), e277-284.
page 10 / 23
Potter, L.D., Judkins, D.R., Piesse, A., Nolin, M.J., and Huhman, M. (2008). “Methodology of the outcome
evaluation of the VERB™ campaign.” Am J Prev Med;34(6S):S230 –S240.
Price, S.M., Huhman, M., and Potter, L.D. (2008). “Influencing the parents of children aged 9–13 years:
findings from the VERB™ campaign.” Am J Prev Med, ;34(6S):S267–S274.
Wong, F. L, Greenwell, M., Gates, S., and Berkowitz, J.M. “It’s what you do! Reflections on the VERB™
campaign.” Am J Prev Med 2008;34(6S):S175–S182.
Wong, F., Huhman, M., Heitzler, C., et al. (2004). “VERB™—a social marketing campaign to increase
physical activity among youth.” Prev Chronic Dis;1:A10
3.2
Sources of quantitative data
Data on the campaign come primarily from the following papers:
Bauman, A., Bowles, H. R., Huhman, M., et al. (2008). “Testing a hierarchy-of-effects model: pathways
from awareness to outcomes in the VERB™ campaign 2002-2003.” Am J Prev Med, 34(6S):S249 –S256.
Berkowitz, J. M., Huhman, M., and Nolin, M.J. (2008). “Did augmenting the VERB™ campaign
advertising in select communities have an effect on awareness, attitudes, and physical activity?” Am J Prev
Med, 34(6S):S257–S266.
Huhman, M. E., Potter, L. D., Duke, J. C., Judkins, D. R., Heitzler, C. D., and Wong, F. L. (2007).
„Evaluation of a national physical activity intervention for children: VERB campaign, 2002-2004.”
American Journal of Preventive Medicine, 32(1), 38-43.
Huhman, M., Bauman, A., and Bowles, H. R. (2008). “Initial outcomes of the VERB™ campaign: tweens’
awareness and understanding of campaign messages.” Am J Prev Med, 34(6S):S241–S248.
Huhman, M., Potter, L. D., Wong, F. L., Banspach, S. W., Duke, J. C., and Heitzler, C. D. (2005). „Effects
of a mass media campaign to increase physical activity among children: year-1 results of the VERB
campaign.” Pediatrics, 116(2), e277-284.
Welk, G. J, Wickel, E., Peterson, M., Heitzler, C. D., Fulton, J., and Potter, L. D. (2007). “Reliability and
Validity of Questions on the Youth Media Campaign Longitudinal Survey.” Medicine & Science in Sports
& Exercise, 39(4):612-621,.
3.3
Campaign & education Materials
Extensive details of campaign materials are given in section 2.2.
Campaign materials can also be viewed at the following sites:
http://www.cdc.gov/youthcampaign/advertising/index.htm
http://www.VERBnow.com
Selected materials are also pasted into this case study.
3.4
Interviews
An interview was conducted with Dr Marian Huhman, Director at the Centre for Disease Control, Atlanta, USA.
page 11 / 23
4
Results and Discussion
4.1
What are the elements of the VERB campaign and how do they relate to each
other?
The key elements of the VERB campaign were distilled in the following article, and this section summarises
selected findings from that paper including many verbatim quotations.
Wong, F.L., Greenwell, M., Gates, S., Berkowitz, J.M. (2008) “It’s what you do! Reflections on the
VERB™ campaign.” Am J Prev Med, 34(6S):S175–S182.
4.1.1
Building a marketing team within the public sector
The VERB campaign was a complex, multi-component one, staffed by a team spread across the U.S. and
operated in the fast-paced world of advertising and marketing. Any new public health programme needs to
compete within this crowded media marketplace. Therefore, the VERB team hired professionals with
commercial marketing experience in advertising, public relations, branding, and marketing to youth for CDC’s
internal campaign staff. The CDC’s creative team developed the brand, initial marketing strategies, and
advertising products. The team members understood the operations of advertising and marketing agencies and
were familiar with the high costs associated with a paid media campaign. However, it is interesting that they and
the contracting agencies had to learn public health, government rules for doing business, and the best way to
work with public bodies such as the CDC. In contrast, CDC’s public health staff had to learn commercial
advertising and techniques for effective marketing to youth.
By the end of the campaign, the VERB team had collected over 50 industry awards. Recognition from peers in
the advertising and marketing industry provide an indirect measure of the degree to which this campaign was
able to employ innovative commercial marketing strategies and compete within the tween media market.
4.1.2
Developing the brand
The VERB team used the commercial marketing techniques commonly used by U.S. manufacturers and
businesses. The VERB team followed standard industry practices: segmenting the market, selecting a target
audience, defining and positioning the product, selecting a marketing mix, and managing the efforts. Through
this process, the VERB team developed a relationship between tweens and the product. A key decision was to
brand the product (physical activity). Branding is a common approach of commercial marketers to reach their
target audience, but one that is seldom used by public health agencies. To brand physical activity as “fun” and
“cool,” the VERB team first had to create a name and logo that would convey the desired image of the product to
the target audience and that would also generate a positive attitude toward physical activity among tweens.
Through a research-informed process with tweens, parents, and influencers, the VERB team chose the name
VERB™ and the tagline It’s what you do! The brand connects children having fun while being physically
active.
page 12 / 23
A vital component of any branding strategy is
to ensure that all messages about the brand
reflect the brand’s core attributes. The core
attributes of the VERB brand of physical
activity were that it was fun, provided
opportunities for exploration and discovery,
and gave children many ways to socialise
with friends. Everyone involved with the
campaign, including private and public
partners, had to incorporate these attributes
into whatever VERB activities they
implemented. This brought consistency to all
campaign messages and activities while
allowing each creative agency, media
organisation partner, and national or
community partner to create original
materials that used the VERB logo and the
brand’s core attributes. For communities in
particular, this allowed them to leverage
VERB’s popular appeal to tweens, apply it to
local programs, and achieve a more
successful result than they could have
achieved without VERB.
The expectation that these attributes would be
incorporated into all VERB-related programs
was communicated to everyone involved in
the campaign so that messages delivered to
tweens were “on brand.” The initial
campaign strategy did need some corrections
in the early phases. In the beginning, VERB
delivered broad social messages to tweens,
messages that encouraged tweens to be
physically active and to be socially involved
(e.g., take dance lessons with other kids, join
the orchestra or debate club). However,
experts at a meeting convened by CDC about 6 months after the campaign was launched observed that
combining physical activity and pro-social messages was confusing, and the VERB team were advised to focus
on only one outcome objective. From that point on, the campaign’s message was focused squarely and solely on
getting tweens to be physically active.
4.1.3
Controlling the media
Many government campaigns in the USA rely on Public Service Announcements (PSAs) to communicate
messages. These have the advantage that they are free to air, but the disadvantage that the communicator has
little or no control over where or when the PSA will be shown. In contrast, the VERB campaign had sufficient
budget for formative research and brand creation and the purchase of television, radio, print, internet, and out-ofhome (theatre, billboard) advertising. In contrast to PSA campaigns, which rely on donated media time, VERB
controlled where, when, and how frequently the VERB advertisements appeared and the campaign therefore did
not need to compete with other PSAs for limited free advertising time. This allowed the VERB team to create
new advertising materials across a variety of channels on a regular basis, enabling them to capture attention with
page 13 / 23
novel messages and avoid wear out or boredom with the advertisements. This control guaranteed that VERB’s
physical activity messages would reach tweens with sufficient frequency to be remembered and to motivate them
to follow through on VERB’s call to action—to get out and go play.
Another important way VERB stood out was in how messages were delivered to audiences. Experiential
marketing tactics were used to create opportunities for tweens to experience having fun being physically active.
The VERB team also took advantage of the technologic and digital advancements that are transforming the way
messages are delivered. An interactive website was designed for tweens including content that was refreshed
regularly. Initial feedback showed that some parts of the website were not grabbing tweens’ attention, so it was
redesigned to include more activities and game-oriented material.
Over time, the VERB team learned how to integrate and leverage the advertising, marketing, and website
activities to effectively reach tweens. For example, in the “Yellowball” campaign, 500,000 large yellow balls
printed with the VERB logo were distributed to tweens throughout the country. Tweens were encouraged to play
with the balls; go to VERB’s tween website to blog about how they played; and then pass the balls on to friends
or family members to encourage other children to play. At the VERB website, the tweens could also create a
video of kids playing with the VERB-branded yellow balls and email it to their friends. This provided a virtual
experience, especially for tweens who had not directly received a VERB yellow ball.
In addition, with the permission of parents, VERB sent text messages to tweens’ cell phones or computers
reminding them to play. For example, during a 3-month promotion in summer 2005, 19,486 tweens signed up to
have a text message sent to their cell phone reminding them about fun activities to get out and play.
4.1.4
Devising the Message
The campaign message was focused on physical activity and play. But the VERB team made sure that they ‘Sold
the Pleasure, Not the Pain’. This meant focusing on aspects such as ‘fun’ ; ‘being cool’; ‘exploring’; ‘discovery’
rather than sweat, energy effort or health. An example is given below:
Formative research showed that to tweens, physical
activity is not just about being physically active—it is
also about making social connections, increasing selfesteem, acquiring expertise, being inspired, having
fun, being creative, and being in control. The
promises of these attributes were all important
motivators for VERB to use when selling physical
activity to tweens. In contrast to many health
messages delivered to children, including those about
physical activity, VERB messages were positive and
can-do, not negative and don’t do. With positive
messages, the campaign could empower children to
make their own choices and increase the likelihood
that VERB would inspire tweens to engage in
physical activity.
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4.1.5
Marketing approach and the message receiver
a.marketing physical activity to ‘tweens’
The campaign messages were delivered to tweens directly, not through their parents or teachers. It was thought
that tweens (children aged 9 to 13) are at a pivotal age: they are actively exploring the world around them,
increasingly making their own decisions, emerging from childhood, and becoming independent of their parents.
Targeting this age group allowed the campaign to address a population at a critical time in their lives, when the
foundation for lifelong behaviours is being established. The advertisements and messages were designed for, and
tested with, this population, to avoid creating messages that did not resonate with the target audience.
The VERB team took the messages directly to tweens using kid language and through kid media channels,
channels that kids valued (e.g., Nickelodeon, Cartoon Network, ABC Disney, Sports Illustrated for Kids, Teen
People). VERB aimed to be ‘for-kids-by-kids’ brand and campaign.
b. marketing to parents
The parents of tweens and adults who influence them (e.g., teachers, youth leaders) were VERB’s secondary
audience. Instead of asking adults to be messengers for VERB, the VERB team asked parents and influencers to
encourage, support, recognise, and reward tweens for being physically active. This aimed to have a ‘multiplier
effect’ by communicating messages from the parents to the target audience of tweens. VERB spent approx 15%
of media spend to appeal directly to parents. This used a separate brand: ’60 Play’ instead of ‘VERB’.
However, a tradeoff to creating a kid-owned campaign delivered through kid–popular channels was lower
recognition and understanding of VERB among adults because they were less exposed and less directly involved
with the brand. Another contributing factor to lower recognition was the position the VERB team took initially
in being highly protective of VERB as a ‘for-kids-by-kids’ campaign. The result was a delay in building support
for VERB among partner organisations and professional colleagues. In retrospect, the VERB team have reported
that a public relations strategy to inform and establish an understanding of VERB as a kids’ marketing campaign
and how they could support the campaign’s goals might have been helpful. The VERB team did this internally
within CDC; however, in an attempt to protect the “coolness” of VERB for tweens, the VERB team may have
overlooked the importance of timely outreach to adults to gain their early buy-in. Doing so may have allowed the
campaign to more easily build early grassroots and community support for the campaign.
4.1.6
A combination of ‘Upstream’ and ‘Downstream’ interventions
A common metaphor in public health is that of ‘upstream’ and ‘downstream’ interventions. This refers to a
metaphorical situation in which many people are drowning after falling into a river. The ‘downstream’ solution
is to improve the speed at which the victims are pulled from the river and taken to hospital; the upstream solution
is to put a fence around the river and prevent the situation happening in the first place. In social marketing it is
argued that for campaigns to be effective, they must focus not only downstream on bringing about individual
behaviour change, but also upstream on the structures and processes that bring about societal change. Focusing
upstream allows the campaigner to address environmental barriers that impede individual behaviour change.
From the outset, VERB looked at both individual and structural changes. The advertisements targeted individual
behaviours. Yet, the VERB team believed that for behaviour change to be sustainable, the environmental and
structural barriers that inhibit physical activity need to be removed. Therefore, the VERB team created a CDC
partnership team charged with working upstream to foster relationships with communities and organisations that
serve youth. Resources and technical assistance were provided to national and community partners to create or
improve supportive environments for physical activity and thus provide opportunities for children to be
physically active. An example is the campaigns work with the National Recreation Parks Association: cobranded activity kits were produced with them specifically for their target groups.
page 15 / 23
This focus on both upstream and downstream interventions appeared to have led to some tension within the
VERB campaign. The VERB campaign was government-funded, but the commercial advertising world in which
VERB existed was for-profit and driven by a desire for short-term return on investment (ROI). Commercial
advertisers and marketers do not expect, nor do they try, to reach every single consumer and have everyone as a
customer. Often the income derived from reaching the last segments of a group of potential consumers is
outweighed by the costs of reaching them. Therefore, the return on the additional investment would be relatively
low, causing the marketer not to pursue those difficult-to-reach consumers. Yet, for a public health agency, the
most-difficult-to reach segment may be the segment at greatest risk for disease and is the segment that public
health desires the most to reach. Although public health and commercial marketers both seek a good ROI, the
ROI for public health is often measured much further into the future than the ROI for commercial marketers.
4.1.7
Partnerships with Co mmunity Organisations
It is reported that the campaign struggled particularly with defining the role of community partners in a national
marketing campaign during the first year. As a public health agency, the VERB team wanted to engage
communities as campaign partners. However, the creative agencies and media organisation partners were
unfamiliar with working with individual communities as partners. Inviting community input on business
decisions or customising campaign activities and schedules for individual communities, although expected
initially by the community partners, was difficult to accommodate. Additionally, for in-market activity
promotions that were owned by VERB’s media organization partners, community partners did not understand
that the media partners controlled the decisions affecting their own programs, not the creative agencies or CDC.
These community partners were also unfamiliar with branding and the need to protect the brand, especially a
new, not-yet-established brand.
The initial strategy to engage communities was to ask them to “supply” or bring children to VERB-sponsored
events. An early in-market campaign strategy was for the VERB campaign to associate itself with kid-popular
brands; thus, the VERB team sponsored Nickelodeon’s Wild & Crazy Kids TV show and mobile tour. The
VERB team brought the mobile tour to targeted communities and relied on community partners to identify and
transport tweens to VERB sponsored events scheduled on specific days and times. The VERB team learned
through this experience that transporting hundreds of tweens to scheduled VERB events was difficult, costly, and
resource-intensive for community partners. It involved having community partners pay for buses and bus drivers,
arrange for chaperones and lunch, and obtain parent permission for the participating tweens. The experience led
the creative team and creative agencies to change strategies and provide national VERB activity promotions,
mobile tours, and ‘guerrilla tours’ instead of in-market events. The change in strategy brought VERB to tweens
instead of tweens to VERB.
4.1.8
A commit ment to quality evaluation
The importance of evaluating programs is well accepted; however, for a variety of reasons, it is frequently not
done or not done well. Most often, the reasons are a limited programme budget, diversity in the interventions, or
difficulties measuring the outcomes or in making causal claims. Following CDC’s evaluation guidelines, the
VERB team developed a logic model that drew on behavioural science theory, physical activity literature, and
public health practice to show the outcome goals and various pathways to achieve them. It was the foundation
for strategic planning and message development.
The logic model guided CDC’s funding decisions to ensure that reaching tweens was not compromised when the
VERB team faced reduced Congressional appropriations. The evaluation activities included formative, process,
and outcome measures. This approach put the campaign in a unique position to describe the campaign’s
effectiveness. The VERB team were able to collect baseline data as a point of reference for outcome evaluation,
an advantage many campaigns do not have. As funding for the campaign decreased, the VERB team continued
to give funding priority to protecting the integrity of the longitudinal evaluation design. Because of CDC’s
page 16 / 23
strong commitment to evaluate the campaign rigorously, the evaluation findings add to a growing body of
evidence that a well-planned and executed paid media campaign can be an effective public health intervention.
4.1.9
Relationships between the elements of the ca mpaign
VERB was very well integrated with a strong relationship between the different elements. One agency (Centre
for Disease Control) had overall responsibility for the campaign design, delivery and evaluation, so ensured high
levels of coordination between the different elements. As noted above the only significant tensions occurred
between the public health and marketing professionals. This related to issues such as speed of delivery; return on
investment; and commitment to standards of evaluation.
One area where strong relationships were probably difficult [NB to be investigated in the interview] was
between the mass media communication elements and the ‘upstream’ efforts to change the environment for
physical activity. As CDC is a national agency, it is likely to have limited real influence on local-level issues
such as planning decisions, or building codes. It would seem likely that this element of the campaign was more
focused on issuing guidance, resources and technical assistance to local community partners.
4.2
Do the elements of the conceptual framework match up with elements found in
the VERB? Ca mpaign
The VERB campaign has the following elements in common with the framework:

A clear marketing plan based around consumer research and feedback

A single message ‘sender’ with a strong brand and coordination function
page 17 / 23

Physical interventions (such as road shows or events) targeted closely to market segments

The use of inspirational messages (“It’s what you do!”) coupled with rational underpinnings (“there has
been a dramatic increase in childhood obesity”)

The use of social marketing to stakeholders (e.g. public health professionals)

Direct marketing to the target audience

Paying attention to feedback from the campaign target audience
4.3
Does the VERB ca mpaign offer any additional elements which can be added to
the conceptual fra mework?
The following elements from VERB might be considered for the conceptual framework.

Monitoring and evaluation. The conceptual framework would benefit from clearer ‘feedback loops’ so
that learning from the campaign can be acted upon. This was a clear priority in VERB.

Use of a logic model for behaviour change. The VERB campaign set out very clearly what they
expected to happen as a result of the campaign. This set out all the likely steps, such as: exposure to the
messages; acceptance of the messages; awareness of the messages and brand; understanding; reducing
barriers to activity; trialling new behaviour; adopting new behaviour; etc. Such a model is based on
behaviour change theory and can then guide the campaign, and structure the evaluation.

Use of ‘upstream’ physical environmental change elements. The framework focuses on physical
interventions, but these are generally seen to be campaign-focused interventions such as events,
promotional days etc. VERB ran such physical interventions but also employed a team to focus on
‘upstream’ environmental change to support physical activity.

Parents as target audience. Parents are different to stakeholders; they are influencers and gatekeepers
of youth behaviour. VERB targeted both stakeholders (e.g. school teachers) and parents.
4.4
Are there particular success factors or barriers to success evident in the VERB
campaign?
As stated in the previous sections, there are a number of factors that contributed to the success of VERB
4.4.1
Success factors
A. A high level of (initial) funding
Many health promotion campaigns suffer from insufficient investment. VERB was well-funded initially, to the
tune of $125 million. This allowed a very comprehensive approach to be taken.
B. A very focused scientific and considered approach
The CDC VERB team appeared to have taken a very focused scientific and evidence-based approach to the
development, planning and implementation of the campaign. This included:

The use of formative research to inform the campaign development
page 18 / 23

Use of behaviour change theory to guide the campaign

The use of logic models

An understanding of the use (and constraints) of social marketing

A commitment to evaluation
C. Combination of public health and marketing expertise
CDC employed top-drawer marketing experts to complement their public health skills and experiences. This
approach appeared to have paid dividends as the resulting team was multi-disciplinary and could learn from each
other. This resulted in some tensions (see above and below) but it appears that these were ‘creative tensions’
rather than real barriers.
One of the main positive outcomes from this partnership was the clear focus on developing a strong brand for the
campaign. It seems unlikely that CDC would have given this much emphasis to brand development had they not
worked so closely with marketing professionals.
D. A commitment to high-quality evaluation
As stated above the CDC team put a great deal of emphasis on evaluation. This included formative evaluation;
baseline measures; regular surveys; and control areas (where there was no boost to advertising spend). The latter
element is extremely rare in campaign evaluation. The evaluation design was so strong that results were
published in peer-reviewed literature and one paper was even able to contribute to the literature on marketing
theories (Bauman et al, 2008).
E. Coordination of physical and marketing interventions
VERB combined marketing messages encouraging the target audience to change behaviour with two types of
physical interventions:

Events so that tweens could try out new activities and be part of the campaign

‘Upstream’ interventions to attempt to change the environment to support physical activity
4.4.2
Barriers
A. lack of ongoing finance
VERB funds were cut short after the initial phase. This appears to have been due to a political decision, and not
really to do with lack of effectiveness of the campaign. This severely limited the ability of the campaign to
continue with sustained behaviour change.
page 19 / 23
B. A massive population to reach
The campaign was aimed at 21 million 9- to 13-year-olds in the USA. This is an enormous target audience to
reach, only possible with sustained high level investment in an ongoing campaign.
C. lack of real influence on the environment
As noted above, the VERB team attempted to influence decision that affected the environment for physical
activity (such as the building of bike lanes or better parks). However, they have limited influence for a number
of reasons:

The slow pace of change in interventions to change environments

The lack of real authority over local decision making

The devolved administration in the US, with much power vested in the State governments
4.5
Does the VERB ca mpaign demonstrate a balance of emotional and rational
approaches within its message?
Verb tended to deliver messages to tweens that were primarily based on ‘emotional’ approaches; while message
to parents and other influencers tended to be more rationally-based.
In speaking to tweens, VERB messages tended to diverge from the “just-the-facts” delivery that is central to
many public health campaigns. Rather than say,
“Engage in moderate-to-vigorous physical activity for
at least 60 minutes each day,” the campaign asked
tweens to discover new activities they like to do.
To inspire tweens to do their own VERBs (physical
activities), the campaign did not simply tell tweens
that physical activity is for all tweens, it showed them
with appealing visuals. CDC made sure that casting
for television and print ads included children of varied
racial and ethnic backgrounds, body weights, and
ability levels — including children with disabilities —
to convey a sense of “kids like me do this” and “I can
do that.” VERB featured positive “can do” messages,
not negative adult-delivered or adult-enforced “must
do” or “don’t do” messages.
page 20 / 23
The approach to parents was subtly different: parents and others who influence tweens were asked to
support, recognise, and praise children for being active; to encourage them to try new activities; and to be
physically active as a family or group. VERB gave tips on how to communicate to tweens and engage them in
being active in creative, positive, and fun ways. At the same time, facts on the health risks of inactivity and
excessive screen time on the benefits of being physically active were the messages for adults. The messages
were further tailored for different audiences, especially ethnic audiences, to address the specific parenting
priorities learned through audience research.
4.6
Has VERB changed behaviour?
VERB uses a sophisticated research design to evaluate the impact of the campaign. The first year of the
campaign consisted of national advertising, plus extra marketing activities in nine CDC-selected communities.
The CDC based its selection of the nine communities on a variety of factors, including the size of the media
market, racial and ethnic diversity, geographic diversity across the United States, existing infrastructure, and
population size. Six of the nine communities received even more local advertising so that the CDC could
evaluate whether the added media made a measurable difference in behavioural outcomes. These six evaluated
communities were called “high-dose” communities.
Cohorts of children and parents were interviewed annually via a telephone survey (Youth Media Campaign
Longitudinal Survey). The first cohort (baseline) was surveyed in 2002 prior to VERB advertising and was
repeated annually through 2006. A second cohort was surveyed in 2004–2006. A third, cross-sectional sample
was surveyed in 2006. Each cohort consisted of a nationally representative sample of children to enable
generalisability to the nation as a whole. Propensity scoring was used to control for confounding influences. The
outcomes were analysed for dose-response effects (i.e., whether higher levels of awareness led to stronger
effects) and overall awareness effects (i.e. the difference between children unaware of VERB and all children in
the United States). Secular trends in children’s physical activity during the life of the campaign were also
examined. This article also discusses weighting and imputation, alternative analyses used to assess the adequacy
of the propensity methods, and the challenges involved in media campaign evaluations.
page 21 / 23
Most of the outcome data are yet to be reported (as the papers are in press with academic journals). However the
main outcome paper (Huhman et al, 2007) from the first phase of the campaign reported the following outcomes
from the VERB campaign:
“After 2 years, a dose–response effect was detected in the study population. The more children who reported
seeing VERB messages, the more physical activity they reported and the more positive their attitudes were about
the benefits of being physically active. Children aware of VERB reported engaging in significantly more
physical activity than children unaware of VERB. These results were considerably stronger than the effects after
Year 1, which were only for physical activity among subpopulations.”
Ongoing evaluation (to be published) shows that the VERB campaign has continued to positively influence
children’s attitudes about physical activity and their physical activity behaviours and expanded the effects to
more children. With adequate and sustained investment, health marketing shows promise to affect the attitudes
and behaviour of children.
page 22 / 23
5
Conclusions
5.1
Reco mmendations for campaign design
VERB was a well-designed, evidence-based campaign that was effective in changing behaviour. There are a
number of aspects of the campaign that should be replicated in other campaigns – whether on health promotion
or travel awareness:

Ensure campaigns are funded at a level consistent with the size of the target population, the complexity
of the issue, and the timescale thought necessary to see behaviour change. VERB might have been able
to demonstrate even greater success had it been funded for long enough.

Base campaigns on the best evidence of effectiveness and the most appropriate theory of behaviour
change.

Use marketing techniques from the commercial sector and adapt them appropriately for ‘selling’
behaviour change.

Conduct high-quality evaluation that is focused on establishing whether the campaign met its
objectives.

Combine upstream and downstream interventions that work simultaneously: for example encouraging
people to walk and cycle while also working to increase the number and quality of places for walking
and cycling.

Include ‘experiential’ marketing – giving people the chance to try the new behaviour. An example
might be free bus passes or cycle training.
5.2
Reco mmendations for task force 5
Task Force 5 emphasises education and travel awareness activity. It is interesting to note that the VERB
campaign did not really use educational approaches in its campaign. Although the campaign disseminated a great
deal of information to tweens (and their parents) much of this was motivational or encouraging in nature. There
was much less emphasis on ‘teaching’ tweens about physical activity and health. This is probably because the
campaign found in formative research that actually tweens knew enough facts about physical activity, they just
didn’t put them into practice. Can the same be said for travel behaviour? There are probably instances when
there is a need for education (where is the bus stop? How much does it cost? Etc) but mainly travel awareness
campaigns share more similarities with health promotion campaigns than differences. It may be that travel
awareness campaigns should begin to move away from thinking of themselves as educators, and consider them
as marketers of social change.
VERB appeared to demonstrate the potential of a lifetime approach to physical activity promotion. Although
evaluation data are still in press, it does appear that VERB showed that a well conducted campaign can lead to
longer-term change in attitudes.
The campaign also demonstrated the value of the ‘multiplier effect’: both from children to parents and from
teachers (and other community members) to children. Issues of branding have to be treated carefully – to ensure
that the campaign aimed at one target audience does not suffer from being directed at another.
In conclusion, the VERB campaign has demonstrated the value of a well-planned, theory-driven and well funded
campaign in changing a complex behaviour. Many of the learning points from this campaign can be applied
directly to travel awareness campaigning.
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