Motor Vehicle Injury – Alcohol-Impaired Driving: Mass Media Campaigns

The Task Force finding is based on evidence from a systematic review of 8 studies (search period through June 2000). The review was conducted on behalf of the Task Force by scientists from CDC’s Division of Unintentional Injury Prevention with input from a team of specialists in systematic review methods and experts in research, practice and policy related to motor vehicle injury prevention.

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Eight studies qualified for the systematic review.

• Total alcohol-related crashes: median decrease of 13% (interquartile interval: 6% to 14% decrease; 7 studies)
• Injury-producing alcohol-related crashes: median decrease of 10% (interquartile range: 6% to 14% decrease; 6 studies)
• Proportion of drivers who had consumed alcohol: net decreases of 30% and 158% (2 studies)
• Evaluated mass media campaigns had several components in common:
  • A theoretical framework in communications research
  • Pretested messages
  • High levels of audience exposure to the message, mostly through paid advertising
• Results did not differ according to the message appeals used.

• Cost–benefit analyses were conducted for two of the campaigns evaluated in this review. One campaign was conducted in Australia, and the other was implemented in two cities in Kansas.
  • In all three sites evaluated, the estimated societal benefits substantially exceeded the costs of developing and airing the campaign messages.
  • Monetary values are presented in 1997 U.S. dollars.
• One analysis reported on the first 23 months of a campaign in Victoria, Australia.
  • The cost was $403,174 per month for advertisement development, supporting media, media placement, and concept research.
  • Estimated savings from medical costs, productivity losses, pain and suffering, and property damage were $8,324,532 per month, with $3,214,096 of these savings coming from averted medical costs.
• Analyses of six-month campaigns in Wichita (using paid media) and Kansas City, Kansas (using public service announcements) reported total costs of $454,060 and $322,660, respectively. These costs included planning and evaluation research, message production, and media scheduling.
  • Total savings from averted costs of insurance administration, premature funeral, legal and court, medical payments, property damage, rehabilitation, and employers’ losses were estimated at $3,431,305 for the Wichita campaign and $3,676,399 in Kansas City.

Results should be applicable to carefully planned and pretested mass media campaigns, with ads that reach the intended audience often enough, implemented in an environment with other ongoing prevention activities (e.g., grassroots activities, enhanced law enforcement efforts), and targeted to any audience of driving age.

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

Results from the Community Guide review indicate that under some conditions, well-executed mass media campaigns can contribute to a reduction in alcohol-impaired driving (AID) and alcohol-related crashes. They also suggest that such campaigns are cost saving.

The characteristics of the campaigns evaluated in this review may serve as a preliminary guide to evaluating the potential for success of a proposed mass media campaign, but several research questions will need to be addressed to maximize the effectiveness and efficiency of future programs. A list of such questions is provided in the list below. Foremost among these is the question of the relative effectiveness of specific campaign themes and messages. It is unlikely that all potential messages are equally effective for changing drinking and driving behavior, and some may prove not to be effective at all or even to be counterproductive. Another important question relates to the potential impact of the changing media market, with increasing market segmentation, emerging technology to allow consumers to avoid exposure to broadcast messages, and opportunities for individually tailored message delivery via the Internet. The impact of these changes should be evaluated and future campaigns adapted to the changing media environment.

The campaigns reviewed tended to take place in areas with relatively high levels of law enforcement and other activities to prevent AID. These activities may have helped provide a context in which the audience was predisposed to react positively to the campaign messages. It is not clear whether these campaigns might have had similar effects in a setting where strong AID-prevention activities were not in place.

Evaluating Message Content Effects

• What is the relative effectiveness and cost-effectiveness of various campaign themes (e.g., law enforcement, legal penalties, social stigma, guilt, injury to self and others) for reducing AID and alcohol-related crashes? For influencing public support for stronger prevention activities?

Evaluating Message Delivery Effects

• What is the dose–response curve for varying levels of advertising exposure (e.g., none, light, moderate, and heavy)? Does the shape of this curve vary according to message content and the outcome evaluated?
• What is the relative effectiveness and cost-effectiveness of different media types (TV, radio, etc.)? Paid advertising and public service announcements?
• What is the optimal exposure schedule for AID mass media campaigns (e.g., intermittent waves of messages vs. a steady flow)?
• How should mass media campaigns be adapted to the changing media environment (e.g., market segmentation, Internet, message filtering devices)?

Evaluating Message/Recipient Interactions

• To what extent are certain population groups more or less likely to be influenced by mass media campaigns?
• Are some themes more likely than others to influence “hard-to-reach” target groups (e.g., enforcement themes for "hard-core" drinking drivers)?

Improving Research Design

• What measurement issues need to be addressed to improve assessment of media and message exposure? What research designs can best address problems in measuring exposure?

• Evaluated mass media campaigns had several components in common:
  • A theoretical framework in communications research
  • Pretested messages
  • High levels of audience exposure to the message, mostly through paid advertising
• Campaigns were implemented in settings that had other prevention efforts in place, such as high-visibility enforcement of impaired driving laws.
• Campaign messages ranged from those focused on law enforcement activities and the legal consequences of drinking and driving to the social and health consequences of alcohol-impaired driving. Results did not differ according to the message appeals used.
• Included studies assessed intervention effectiveness on fatal crashes, fatal and nonfatal injury crashes combined, crashes that damage property, and drivers’ BACs.