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Influencing the Parents of Children Aged 9–13 Years

Findings from the VERB Campaign

      Background

      The CDC's VERB campaign was designed to increase physical activity among children aged 9–13 years (tweens). As part of the strategy to surround tweens with support to be physically active, VERB developed messages for parents, the secondary target audience, to encourage them to support their tween's physical activity.

      Design

      Multiple regression analyses were conducted to determine whether parent awareness of VERB was a significant predictor of seven factors that related to parental attitudes, beliefs, and supportive behaviors for tweens' physical activity using the Youth Media Campaign Longitudinal Survey (YMCLS).

      Setting/participants

      Parents (N = 1946) of U.S. children aged 9–13 years.

      Intervention

      Advertising directed at tweens through paid television, radio, print, Internet, and schools was the primary VERB intervention; tween advertising could have been also seen by parents. Messages directed at parents encouraging their support of tweens' physical activity were delivered in English through mainly print and radio. In-language messages for Latino and Asian audiences were delivered through print, radio, television, and at events.

      Main outcome measures

      Parents' awareness of VERB; parents' attitudes, beliefs, and support for their tweens' physical activities.

      Results

      Awareness increased each year of the campaign; more than 50% of parents were aware of VERB by the third year of the campaign. Parents reported that their main source of awareness was television, the main channel used to reach tweens. Awareness of VERB was predictive of positive attitudes about physical activity for all children, belief in the importance of physical activity for their own child, and the number of days parents were physically active with their child.

      Conclusions

      Parents' awareness of VERB was associated with positive attitudes, beliefs, and behavior. Parents' awareness probably resulted from a combination of messages directed to parents and tweens. To maximize audience reach, social marketers who are developing health messages should consider the potential value of parents and their children seeing or hearing the same messages, separately or together.

      Introduction

      Using a social marketing framework, the CDC developed the VERB campaign to promote the physical activity of children aged 9–13 years (tweens). 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.
      Social marketing campaigns aimed at children often target parents as a secondary audience because parents are key influencers of their children's attitudes and behaviors in several areas, including underage drinking,
      • Ary D.V.
      • Tildesley E.
      • Hops H.
      • Andrews J.
      The influence of parent, sibling, and peer modeling and attitudes on adolescent use of alcohol.
      tobacco use,
      • Griffin K.W.
      • Botvin G.J.
      • Doyle M.M.
      • Diaz T.
      • Epstein J.A.
      A six-year follow-up study of determinants of heavy cigarette smoking among high-school seniors.
      • Chassin L.
      • Presson C.C.
      • Todd M.
      • Rose J.S.
      • Sherman S.J.
      Maternal socialization of adolescent smoking: the intergenerational transmission of parenting and smoking.
      and eating preferences.
      • Birch L.L.
      • Fisher J.O.
      Development of eating behaviors among children and adolescents.
      • Stratton P.
      • Bromely K.
      Families' accounts of the causal processes in food choice.
      Several large-scale social marketing campaigns with children as the primary audience targeted parents as the secondary audience (e.g., the National Anti-Drug Youth Media Campaign,
      Office of National Drug Control Policy
      The national youth anti-drug media campaign communication strategy statement.
      • Stephenson M.T.
      • Quick B.L.
      Parent ads in the National Youth Anti-Drug Media Campaign.
      the U.S. Department of Agriculture's Team Nutrition program,
      United States Department of Agriculture (USDA)
      Food and Nutrition Service Team Nutrition.
      CDC's Bone Health campaign
      CDC
      Powerful bones, powerful girls.
      ).
      In this paper, the focus is on the VERB campaign's marketing efforts directed to parents. The conceptual background for the VERB campaign and the rationale for directing messages to parents are described; also presented are a summary of campaign efforts to reach parents, a report of the findings of the effects on parents, and a discussion about the implications for the VERB campaign and similar future campaigns.

      Conceptual Background for Parents As Influencers

      Campaign planners drew on communication and behavior theories to develop the VERB campaign.
      • Huhman M.
      • Heitzler C.
      • Wong F.
      The VERB campaign logic model: a tool for planning and evaluation.
      Two behavior theories that were used to guide the campaign were the theory of planned behavior
      • Ajzen I.
      The theory of planned behavior.
      (TPB) and social cognitive theory
      • Bandura A.
      Social foundations of thought and action: a social cognitive theory.
      (SCT). TPB proposes that behavior can be predicted by a person's intentions to perform the behavior and their perceptions of control over the behavior. The determinants of intention include attitudes toward the behavior, subjective norms (significant others' beliefs regarding the behavior), and perceived behavioral control. Principles of SCT that were applied to VERB were that a person's behavior is affected by their beliefs about the outcomes of a behavior and the values placed on the outcome, others' observations and reinforcement of the behavior (social influences) and self-efficacy (confidence to perform the behavior). Campaign planners directed messages at parents because they are an important component of subjective norms (TPB) and social influences (SCT) for their children's behavior. Parents constitute one of the strongest socializing agents for their children
      • Bugental D.B.
      • Goodnow J.J.
      Socialization processes.
      and although friends begin to take on more importance during pre-teen years, adolescents continue to rely on their parents for guidance and support in many areas, including health behaviors.
      Aeffect
      Life's First Great Crossroad.
      • Resnick M.
      • Bearman P.
      • Blum R.
      • et al.
      Protecting adolescents from harm: findings from the National Longitudinal Study on Adolescent Health.
      The parent component of the VERB campaign was also guided by the literature on children's physical activity, which indicates that parents can positively support their children's physical activity through multiple mechanisms. Parents can provide logistical support, such as transportation to sporting events or recreational facilities
      • Hoefer W.R.
      • McKenzie T.L.
      • Sallis J.F.
      • Marshall S.J.
      • Conway T.L.
      Parental provision of transportation for adolescent physical activity.
      and paying fees for team sports.
      • Sallis J.F.
      • Prochaska J.J.
      • Taylor W.C.
      • Hill J.O.
      • Geraci J.C.
      Correlates of physical activity in a national sample of girls and boys in grades 4 through 12.
      Several parental social support factors have been linked to increased levels of physical activity among children and adolescents, including parental encouragement for the child to be fit,
      • McGuire M.T.
      • Hannan P.J.
      • Neumark-Sztainer D.
      • Falkner Cossrow N.H.
      • Story M.
      Parental correlates of physical activity in a racially/ethnically diverse adolescent sample.
      adolescents' perception of their parents' encouragement for physical activity,
      • Saunders R.P.
      • Pate R.R.
      • Felton G.
      • et al.
      Development of questionnaires to measure psychosocial influences on children's physical activity.
      parents' beliefs in the importance of children's physical activity,
      • Trost S.G.
      • Sallis J.F.
      • Pate R.R.
      • Freedson P.S.
      • Taylor W.C.
      • Dowda M.
      Evaluating a model of parental influence on youth physical activity.
      parents observing their child be active,
      • Trost S.G.
      • Sallis J.F.
      • Pate R.R.
      • Freedson P.S.
      • Taylor W.C.
      • Dowda M.
      Evaluating a model of parental influence on youth physical activity.
      and being physically active with the child.
      • Heitzler C.D.
      • Martin S.L.
      • Duke J.
      • Huhman M.
      Correlates of physical activity in a national sample of children aged 9–13 years.
      In addition, general family characteristics such as family cohesion, parental engagement, and parent–child communications have been found to be significant predictors of adolescent physical activity levels.
      • Ornelas I.J.
      • Perreira K.M.
      • Ayala G.X.
      Parental influences on adolescent physical activity: a longitudinal study.
      Parents can also encourage their children's physical activity through socialization and direct modeling.
      • Kenyon G.S.
      • McPherson B.D.
      Becoming involved in physical activity and sport: a process of socialization.
      • Sallis J.
      • Prochaska J.
      • Taylor W.
      A review of correlates of physical activity of children and adolescents.
      • Baranowski T.
      • Anderson C.
      • Carmack C.
      Mediating variable framework in physical activity interventions How are we doing? How might we do better?.
      However, the research on parent modeling of physical activity has been mixed, with some studies showing strong support
      • Baranowski T.
      • Anderson C.
      • Carmack C.
      Mediating variable framework in physical activity interventions How are we doing? How might we do better?.
      • Sallis J.F.
      • Alcaraz J.E.
      • McKenzie T.L.
      • Hovell M.F.
      • Kolody B.
      • Nader P.R.
      Parental behavior in relation to physical activity and fitness in 9-year-old children.
      while others finding little relationship.
      • DiLorenzo T.M.
      • Stuckey-Ropp J.S.
      • Van Der Wal J.S.
      • Gotham H.J.
      Determinants of exercise among children II. A longitudinal analysis.
      • Anderssen N.
      • Woldb B.
      • Torsheim T.
      Are parental health habits transmitted to their children? An eight year longitudinal study of physical activity in adolescents and their parents.
      Demographic factors such as higher educational and income levels of parents
      • Yang X.
      • Telama R.
      • Laakso L.
      Parents' physical activity, socioeconomic status and education as predictors of physical activity and sport among children and youth—a 12-year follow-up study.
      • Kristjansdottir G.
      • Vilhjalmsson R.
      Sociodemographic differences in patterns of sedentary and physically active behavior in older children and adolescents.
      • McVeigh J.A.
      • Norris S.A.
      • de Wet T.
      The relationship between socio-economic status and physical activity patterns in South African children.
      have also been associated with increased physical activity levels among children. Similarly, race and ethnicity have been found to be a significant predictor for children's physical activity, with whites more likely to be physically active than African Americans and Hispanics.
      • Trost S.G.
      • Pate R.R.
      • Dowda M.
      • Ward D.S.
      • Felton G.
      • Saunders R.
      Psychosocial correlates of physical activity in white and African-American girls.
      • Gordon-Larsen P.
      • McMurray R.G.
      • Popkin B.M.
      Adolescent physical activity and inactivity vary by ethnicity: The National Longitudinal Study of Adolescent Health.
      It has been suggested, though, that racial and ethnic differences in physical activity may largely be the result of socioeconomic factors.
      • Brustad R.J.
      Attraction to physical activity in urban schools children: parental socialization and gender influences.
      Based on the theoretical foundations for the campaign, the scientific literature on children's physical activity, and formative research conducted with tweens for the campaign, which reinforced the key role of parents in guiding the tweens' choices of activities,
      Aeffect Inc
      Excerpts from research to support development of the Youth Media Campaign: revealing target audience receptiveness to potential message concepts.
      campaign planners developed messages for parents that would inform, educate, and model supportive and praising behavior. The overall goal for messages directed at parents was to increase their awareness of the importance of tweens' physical activity and encourage positive attitudes and supportive behaviors (both verbal and nonverbal) for facilitating tweens' physical activity. The advertising aimed at parents informed them about methods to influence their tweens and stressed the value of being active with them. Below, the marketing strategy used to disseminate parent-directed messages is described.

      Marketing Strategy for Parents

      In contrast to the tween general-market strategy, the general-market strategy for parent-directed messages did not include paid advertising on national broadcast or cable television networks.
      The general-market parent advertising was largely in print, with messages placed in 21 national women's magazines, such as Good Housekeeping, Woman's Day, Working Mother, and Family Circle. Two television PSAs directed at parents were also produced and aired on a limited basis in the first 2 years of the campaign. Media efforts directed at ethnic parent markets included in-language television advertising for Hispanic or Latino (Spanish) and Asian-American (Korean, Mandarin, Cantonese, Vietnamese) parents. Radio advertising and print advertisements were developed for African American and American Indian parents. Messages directed at parents did not use the VERB brand after the second year of the campaign, because campaign planners became concerned that the VERB brand identity, for tweens by tweens might be compromised if tweens thought the brand was also for adults.

      Methods

      The VERB outcome evaluation was designed primarily to assess the campaign's effect on tweens' attitudes and behaviors related to physical activity. The main data-collection instrument for the evaluation, the Youth Media Campaign Longitudinal Surveys (YMCLS)
      • Potter L.D.
      • Judkins D.R.
      • Piesse A.
      • Nolin M.J.
      • Huhman M.
      Methodology of the outcome evaluation of the VERB campaign.
      was intended to measure the effects of the VERB campaign intervention in its totality, rather than the effect of individual campaign elements (e.g., messages directed to parents). Parents were interviewed during YMCLS to obtain consent to talk to their tweens, collect household demographics, and capture a limited number of parent variables that were viewed as possible covariates and mediators in the tween intervention study. Post-hoc analysis revealed that data from the parents held useful insights about VERB's influence with parents, although the data were insufficient to conduct a comprehensive outcome evaluation. The goal of the current study is to explore the effects of the VERB campaign on parents, based on the YMCLS data. Parents' general awareness of the campaign and its association with parent attitudes, beliefs, and behaviors is examined as related to tweens' physical activity.

      Design and Sample

      The sample for this study came from the baseline (2002) and follow-up (2003, 2004, 2005) YMCLS. The 2002 baseline survey was conducted prior to any VERB advertising with children aged 9–13 years and one parent of each child. Survey participants were selected through random digit dialing, and the telephone interviews were administered with computer-assisted technology. Interviews were conducted in English and Spanish; 8% of the parent interviews were conducted in Spanish. For the baseline survey, individuals in 60.5% of sampled households completed the screening interview. Among eligible adult respondents, 3084 (87.0%) completed the parent interview. About 15% attrition occurred among parent respondents at each year of follow-up, resulting in a sample for this study of 1946 parents who completed the baseline and all 3 years of follow-up surveys. There was evidence of response bias among households remaining in the YMCLS sample in 2005. Respondents in 2005 were significantly more likely to be white and have higher incomes and educational levels compared to the original baseline sample in 2002 (Table 1).
      Table 12002 and 2005 YMCLS respondent demographics
      2002 respondent demographics2005 respondent demographics
      Total%Total%
      Overall31141001946100
      Tweens' race/ethnicity
      Significant differences between 2002 and 2005 respondents, p<0.01
       White204965.8143873.9
       Black38312.31859.5
       Hispanic49015.722011.3
       Other1926.21035.3
      Household income ($)
      Significant differences between 2002 and 2005 respondents, p<0.01
       ≤25,00063720.528814.8
       25,000–50,00082426.548324.8
       50,000–75,00073423.648024.7
       >75,00091929.569535.7
      Parents' education
      Significant differences between 2002 and 2005 respondents, p<0.01
       High school graduate or less112436.153627.5
       Some college102532.964933.4
       College graduate or more9653176139.1
      low asterisk Significant differences between 2002 and 2005 respondents, p<0.01
      The analysis used unweighted YMCLS data. The YMCLS was designed to create national population estimates of children aged 9–13 years, not their parents. Demographic information collected on parents was not detailed enough to permit population estimates to be made. For example, data were not collected on noncustodial parents or on custodial parents living outside the residence in which the child was interviewed. This made weighting to a national parent population inappropriate. The IRB at the CDC and Westat approved this study.

      Measures

      Parental awareness of VERB and source of awareness

      In the follow-up surveys (2003–2005), parents were asked, Have you seen, read, or heard about any messages or advertising for getting kids active? Parents that responded affirmatively were asked, What is the name of the message or advertising? Those who spontaneously responded VERB, without prompting, were categorized as having unaided awareness. Parents who could not recall the campaign name were prompted with the following question, There are many ads on television, radio, and in newspapers and magazines with slogans you may or may not remember. Have you heard, read, or seen any ads with the slogan:____; they were read a list of four possible answers, which included VERB: It's What You Do! The interviewer was instructed to rotate the list of possible responses. Parents who responded yes based on the VERB prompting were categorized as having aided awareness. Parents who could not recall the campaign even after being prompted about VERB were categorized as having no awareness. Unaided awareness and aided awareness were combined for this study to create the overall VERB-awareness variable. Beginning in 2005, parents who reported VERB awareness (either aided or unaided) were asked about all the places (sources) they had seen, read, or heard about VERB.

      Parents' attitudes, beliefs, and behavioral support for their tweens' physical activities

      The attitude and belief questions were asked of all parents during the baseline and the follow-up surveys. Responses to individual questions were summed to create four subscales of attitudes and beliefs about physical activities for tweens (Table 2). Behavioral support for their tweens' physical activity was measured through three questions that were asked of all parents during the baseline and follow-up surveys (Table 2).
      Table 2Measures of parents' attitudes, beliefs, and support for tweens' physical activity
      Global measuresScaleSurvey items combined for global measuresCronbach's alpha
      Attitude and belief measures
      Attitudes about PA for all children1 = strongly disagreeKids who do regular PA have more self-confidence0.82
      5 = strongly agreeKids who do regular PA are healthy
      Kids who do regular PA will be healthier adults
      Beliefs about parents' ability to influence own tweens' PA level1 = not very confidentConfidence in ability to influence child's organized PA0.77
      5 = extremely confidentConfidence in ability to influence child's free-time PA
      Beliefs about importance of their tweens' PA1 = not very importantImportance of child's participation in organized PA0.52
      5 = extremely importantImportance of child's participation in free-time PA
      Perceived barriers to their children engaging in PA1 = strongly disagreeTransportation problems0.69
      5 = strongly agreeFew opportunities for children's PA nearby
      PA too expensive
      Not enough time to keep children involved in PA
      Not comfortable with outside play near home
      Behavioral support measures
      Parent attends sporting events1 = neverFrequency of parent or another adult in household attending events related to child's sports, clubs, or other activities during the past school yearNA
      5 = always
      Parent transports child to PA1 = neverFrequency of parent or another adult in their household taking child to and from activitiesNA
      5 = always
      Parent physically active with child0–7 daysNumber of days a parent or another adult in household and the child are physically active together in the past 7 daysNA
      NA, not applicable

      Statistical Methods

      Paired t-tests were used to examine differences in VERB awareness measures by campaign year. Independent t-tests were used to examine the differences in parents' attitude, belief, and behavioral support measures by overall VERB awareness in 2005. Multiple regression analysis was conducted to explore the influence of VERB awareness on seven parental attitude, belief, and behavioral support measures for their tweens' physical activity in 2005. Each of these seven measures was the outcome variable in separate regression analyses. Predictors in the regression models were the respective baseline (2002) attitude, belief, and behavioral support measures, demographics (child's age, parent's education, household income, race/ethnicity), and parent awareness. In addition, because parents' attitudes and beliefs influence their supportive behaviors,
      • Trost S.G.
      • Sallis J.F.
      • Pate R.R.
      • Freedson P.S.
      • Taylor W.C.
      • Dowda M.
      Evaluating a model of parental influence on youth physical activity.
      the 2005 parents' attitude and belief measures regarding tweens' physical activity were included as potential predictors in the regression models for behavioral support. Predictors were entered into each regression model simultaneously. All analysis was conducted using SPSS 13.0.

      Results

      Parent Awareness of VERB

      Awareness of VERB (unaided, aided, overall) increased significantly during each successive year of the campaign (Table 3). In 2005, among parents reporting awareness of VERB, television was the most frequently reported medium for learning about VERB (88%) and more than half (51%) reported television as the only source for awareness. Print (28%) and radio (15%) were second and third most frequently reported sources for learning about VERB.
      Table 3Parent awareness of VERB, by campaign year (%)
      200320042005
      VERB awareness
      Overall3449
      p<0.001.
      55
      p<0.001.
      Aided3040
      p<0.001.
      45
      p<0.001.
      Unaided49
      p<0.001.
      10
      p<0.05;
      low asterisk p<0.05;
      low asterisklow asterisk p<0.001.

      Parent Attitudes, Beliefs, and Support by VERB Awareness

      In 2005, parents aware of VERB were significantly more likely to (1) have positive attitudes about physical activity for all children, (2) believe in the importance of physical activity for their own child, (3) be confident of their ability to influence their child's physical activity, and (4) have been physically active with their child during the 7 days before the survey than were parents who were unaware of VERB (Table 4).
      Table 4Parents' attitudes, beliefs, and support for children's physical activity by 2005 VERB awareness
      Total (N=1946)Parents aware of VERB (n=1077)Parents unaware of VERB (n=869)p value
      Attitudes and beliefs in 2005 (mean)
       Attitudes about PA for all children7.96 ± 1.328.07 ± 1.277.83 ± 1.38<0.001
       Beliefs about importance of PA for their children4.07 ± 1.264.08 ± 1.273.92 ± 1.34<0.008
       Beliefs about ability to influence their children's PA3.59 ± 1.463.43 ± 1.493.3 ± 1.54<0.05
       Perceived barriers to their children's PA4.63 ± 2.844.54 ± 2.834.74 ± 2.85<0.15
      Support behaviors in 2005 (mean)
       Attended children's PA event4.14 ± 1.224.15 ± 1.224.13 ± 1.22<0.77
       Transported children to PA4.24 ± 1.084.26 ± 1.064.21 ± 1.12<0.34
       In past 7 days, parent and child active together1.63 ± 1.671.75 ± 1.691.48 ± 1.62<0.001

      Attitude and Belief Regression Models

      A series of multiple regression analyses were conducted to examine the effects of parents' awareness of VERB on the four parent attitudes and belief measures. The primary goal of these analyses was to determine whether awareness was a significant predictor of attitudes and beliefs regarding tweens' physical activity while controlling for baseline attitudes and beliefs. Findings indicated that baseline attitudes and beliefs explained the most variance across all four attitude and belief outcomes. However, VERB awareness was a significant predictor of two 2005 attitude and belief outcomes: (1) parents' attitudes about physical activity for all children and (2) parents' beliefs about the importance of physical activity for their children (Table 5).
      Table 5Summary of regression analysis for parents' 2005 attitudes and beliefs about children's physical activity
      Parents' attitudes about PA for all childrenParents' beliefs in their ability to influence their child's PAParents' beliefs about importance of their child's PAParents' perceived barriers to PA for children
      p value0.0010.0010.0010.001
      Adjusted R-square0.160.220.240.43
      Predictors Beta (SE)
       Baseline attitudes and beliefs0.38 (0.02)
      p<0.001.
      0.41 (0.02)
      p<0.001.
      0.46 (0.02)
      p<0.001.
      0.53 (0.02)
      p<0.001.
       Household income0.00 (0.03)−0.02 (0.02)0.00 (0.02)−0.15 (0.02)
      p<0.001.
       Age of child in 2005−0.04 (0.02)−0.16 (0.02)
      p<0.001.
      −0.12 (0.02)
      p<0.001.
      −0.02 (0.02)
       Parents' education0.06 (0.02)
      p<0.05;
      −0.01 (02)0.04 (0.02)−0.05 (0.02)
      p<0.01;
      Child race/ethnicity
       Black0.01 (0.02)0.10 (0.02)
      p<0.001.
      0.03 (0.02)0.02 (0.02)
       Hispanic−0.04 (0.02)0.05 (0.02)
      p<0.05;
      0.04 (0.02)0.09 (0.02)
      p<0.001.
       Other−0.01 (0.02)0.04 (0.02)0.03 (0.02)0.04 (0.02)
      p<0.05;
      Parents' awareness of VERB0.07 (0.02)
      p<0.01;
      0.03 (0.02)0.05 (0.02)
      p<0.05;
      −0.02 (0.02)
      low asterisk p<0.05;
      low asterisklow asterisk p<0.01;
      low asterisklow asterisklow asterisk p<0.001.

      Supportive Behavior Regression Models

      A series of multiple regression analyses were conducted to examine the effects of parents' awareness of VERB on the three 2005 parent supportive behavior measures. Parents' awareness was a significant predictor of only one supportive behavior measure (number of days during the previous week a parent and child were physically active together). Similar to the attitude and belief regression findings, baseline measures of parental supportive behavior explained the most variance across all three regression models (Table 6).
      Table 6Summary of regression analysis for parents' 2005 support of children's physical activity
      Parent attends child's sport eventParent transports child to PAParent and child active together
      p value0.0010.0010.001
      Adjusted R-square0.250.190.16
      Predictors Beta (SE)
       Baseline measures of support for days parent and child active0.26 (0.02)
      p<0.001.
      0.28 (0.02)
      p<0.001.
      0.26 (0.02)
      p<0.001.
       Parents' attitudes about PA for all children0.02 (0.02)0.06 (0.02)
      p<0.05;
      0.03 (0.02)
       Parents' belief in their ability to influence their children's PA0.17 (0.02)
      p<0.001.
      0.12 (0.02)
      p<0.001.
      0.15 (0.02)
      p<0.001.
       Parents' belief about importance of their children's PA0.03 (0.02)0.02 (0.02)0.06 (0.03)
      p<0.05;
       Parents' beliefs about barriers to PA for their children−0.11 (0.02)
      p<0.001.
      −0.08 (0.02)
      p<0.01;
      −0.03 (0.02)
       Household income0.08 (0.03)
      p<0.01;
      0.10 (0.03)
      p<0.001.
      −0.04 (0.02)
       Age of child in 2005−0.06 (0.02)
      p<0.01;
      −0.09 (0.02)
      p<0.001.
      −0.09 (0.02)
      p<0.001.
       Parents' education0.08 (0.02)
      p<0.01;
      0.04 (0.02)−0.07 (0.02)
      p<0.01;
      Child's race/ethnicity
       Black−0.05 (0.02)
      p<0.05;
      −0.04 (0.02)−0.04 (0.02)
       Hispanic−0.11 (0.02)
      p<0.001.
      −0.05 (0.02)
      p<0.05;
      −0.005 (0.02)
       Other−0.04 (0.02)
      p<0.05;
      0.02 (0.02)−0.01 (0.02)
      Parents' awareness of VERB−0.01 (0.02)0.002 (0.02)0.05 (0.02)
      p<0.05;
      low asterisk p<0.05;
      low asterisklow asterisk p<0.01;
      low asterisklow asterisklow asterisk p<0.001.

      Awareness Effect Size

      The standardized beta coefficients in the regression models represent the relative effect size for each predictor. The effect size for parental awareness of VERB ranged from 0.02 to 0.07. In the regression models, where awareness was a significant predictor, effect sizes were modest for awareness and ranged from 0.05 to 0.07 (Table 5, Table 6), yet these are typical of effect sizes found in other media campaign evaluation.
      • Synder L.B.
      • Hamilton M.A.
      • Mitchell E.W.
      • Kiwanuka-Tondo J.
      • Fleming-Milici F.
      • Proctor D.
      A meta-analysis of the effect of mediated health communication campaigns on behavior change in the United States.

      Discussion

      The goal of this study was to explore parent awareness of the VERB campaign and its association with attitudes, beliefs, and supportive behaviors related to tweens' physical activity using parent interview data collected from YMCLS. These findings suggest that the campaign did reach parents, with more than half of all parents reporting awareness of VERB by the third year of the campaign (2005). Overall, VERB awareness was associated with parents' improved attitudes, beliefs, and support for their tweens' physical activity. In addition, after controlling for baseline responses to attitude, belief, and support measures, parental awareness of VERB remained a significant predictor of parents' attitudes about physical activity for all children, beliefs in the importance of physical activity for their children, and the number of days parents were physically active with their children.
      Interestingly, these results also indicated that the majority of parents reported learning about VERB from television (88%), and over half reported exposure only via television. This finding was puzzling because the potential for general-market parents to have seen parent-directed television ads was limited to two PSAs in first 2 years of the campaign. Hispanic and Asian in-language parent ads were on television; however, when these groups were excluded from the analysis, VERB awareness through television remained at 88%. The campaign ads that were specifically directed at parents (e.g., providing tips on how to support tweens' physical activity) were primarily in women's magazines. Furthermore, while the VERB brand was used in the advertisements targeted to parents in the first 2 years of the campaign, by the third year, the advertisements targeted to parents no longer used the VERB logo, but the survey continued to ask parents about awareness of the VERB brand.
      The pattern of findings for parent awareness suggests that parents probably became aware of VERB from seeing advertising messages directed to tweens. VERB advertisements directed at tweens were extensively broadcast on national children's television networks such as Nickelodeon and Disney throughout all years of the campaign. Research on television viewing suggests that parents and children frequently co-view television (i.e., they watch programs together). Co-viewing is estimated to be as high as 70% during prime time, and some studies suggest that television viewing may be one of the most frequently shared activities among family members.
      • St. Peters M.
      • Fitch M.
      • Huston A.C.
      • Wright J.C.
      Television and families: what do young children watch with their parents?.
      • Sang F.
      • Schmitz B.
      • Tasche K.
      Developmental trends in television coviewing of parent-child dyads.
      • Dorr A.
      • Kovaric P.
      • Doubleday C.
      Parent-child coviewing of television.
      • Carpenter C.J.
      • Huston A.C.
      • Spera L.
      Children's use of time in their everyday activities during middle childhood.
      • Nielsen A.C.
      The television audience.
      • Timmer S.G.
      • Eccles J.
      • O'Brien K.
      How children use time.
      Co-viewing is widely studied; it is one way parents can mitigate the influence of television on their children and results in many positive outcomes.
      • Rossiter J.R.
      • Robertson T.S.
      Children's television viewing: an examination of parent-child consensus.
      For example, co-viewing allows parents an opportunity to discuss advertising and program messages with their children and increases communication and understanding between parent and child.
      • Ward S.
      • Wackman D.
      Family and media influences on adolescent consumer learning.
      • Sheikh A.A.
      • Moleski L.M.
      Conflict in the family over commercials.
      • Nathanson A.I.
      Identifying and explaining the relationship between parental mediation and children's aggression.
      • Austin E.W.
      • Pinkleton B.E.
      • Fujioka Y.
      The role of interpretation processes and parental discussion in the media's effects on adolescents' use of alcohol.
      The current study has several limitations. The data were all self-reported and subject to social desirability bias. The YMCLS was designed to be nationally representative of children aged 9–13 years, not of their parents. Moreover, the attrition rate among respondents over the course of the longitudinal survey reflects certain response biases. Households in the 2005 YMCLS sample were more likely to be white, have higher educational and income levels compared to households in the baseline sample. Thus these findings cannot be generalized to all U.S. parents. In addition, the longitudinal nature of the survey (e.g., annual phone calls asking about VERB) may have contributed to the parents' awareness of VERB (panel conditioning). Furthermore, this analysis cannot rule out the possibility that the observed relationships are causally reversed from what the campaign intended. That is, parents with positive attitudes about physical activity were predisposed to recall the VERB campaign. However, by including baseline measures of attitudes, beliefs, and behaviors in the regression models, we controlled for these potential confounders.
      The YMCLS was designed primarily to measure VERB-related outcomes with regard to tween attitudes, beliefs, and behaviors. Parental data were collected mainly to permit better covariate control on the tweens' outcomes. Therefore for several reasons (e.g., cost, survey length), a limited number of parental measures were included in YMCLS. In particular, although we hypothesize that parents viewing of advertising targeted to tweens was the primary source of VERB awareness, parents were not specifically asked about their television co-viewing behavior. Our ability to examine the effects of all advertising directed to parents is limited because some did not use the VERB brand and our study had only one global VERB awareness measure for parents. Consequently, we cannot rule out alternative explanations to co-viewing, such as parent awareness resulting from parent-directed messages from the first 2 years of the campaign when the VERB brand logo was used in parent messaging. However, we believe this is unlikely because television (88%) was the most frequently reported medium for learning about VERB and parent-directed messages were primarily in women's magazines, a source of awareness reported by only 28% of parents. Alternatively, these findings may reflect exposure to television PSAs directed to parents in the first 2 years of the campaign. This also seems unlikely, given that there were only two television PSAs for general-market parents, while tween-directed advertising was extensively aired on national children's television networks during this same time frame. Thus even during the first 2 years of the campaign, when parent ads included the VERB brand logo and television PSAs for parents were aired, parent awareness data likely reflect encounters with a small volume of promotions targeted at parents or a larger volume of advertisements intended for tweens.
      Parents are important influencers of their children's attitudes and behaviors in a range of areas, including physical activity.
      • Ary D.V.
      • Tildesley E.
      • Hops H.
      • Andrews J.
      The influence of parent, sibling, and peer modeling and attitudes on adolescent use of alcohol.
      • Griffin K.W.
      • Botvin G.J.
      • Doyle M.M.
      • Diaz T.
      • Epstein J.A.
      A six-year follow-up study of determinants of heavy cigarette smoking among high-school seniors.
      • Chassin L.
      • Presson C.C.
      • Todd M.
      • Rose J.S.
      • Sherman S.J.
      Maternal socialization of adolescent smoking: the intergenerational transmission of parenting and smoking.
      • Birch L.L.
      • Fisher J.O.
      Development of eating behaviors among children and adolescents.
      • Stratton P.
      • Bromely K.
      Families' accounts of the causal processes in food choice.
      • Trost S.G.
      • Sallis J.F.
      • Pate R.R.
      • Freedson P.S.
      • Taylor W.C.
      • Dowda M.
      Evaluating a model of parental influence on youth physical activity.
      • Synder L.B.
      • Hamilton M.A.
      • Mitchell E.W.
      • Kiwanuka-Tondo J.
      • Fleming-Milici F.
      • Proctor D.
      A meta-analysis of the effect of mediated health communication campaigns on behavior change in the United States.
      For that reason the VERB campaign made efforts to reach parents as part of the campaign's overall strategy to surround tweens with encouraging messages about physical activity. The VERB campaign strategy to reach parents was largely educational rather than one of persuasion. Our findings suggest that the campaign was successful in reaching many parents, probably through a combination of marketing materials directed to them and parental viewing of television advertisements intended for tweens. Co-viewing may provide a unique opportunity for influencing parents and has potential implications for other social marketing campaigns that include parents as a secondary target audience. Planners of such campaigns may need to consider the consequences of parents and children viewing a message together but having different interpretations. Campaign planners may need to craft messages in such a way to ensure that multiple interpretations of an advertisement (e.g., parents view it as healthy, while tweens view it as “cool” and “fun”) are at least consistent with overall campaign goals. In the case of VERB, while co-viewing was not explicitly intended, campaign planners conducted formative research with parents to ensure that VERB advertisements directed at tweens were also acceptable to parents. Campaign planners may also consider creating messages that depict interactions between parents and tweens (e.g., being physically active together by biking) in advertisements that are most likely to be co-viewed. Further research needs to be conducted on the value of co-viewing in health communication campaigns.
      The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the CDC.
      No financial disclosures were reported by the authors of this paper.

      Supplementary data

      References

        • Ary D.V.
        • Tildesley E.
        • Hops H.
        • Andrews J.
        The influence of parent, sibling, and peer modeling and attitudes on adolescent use of alcohol.
        Int J Addict. 1993; 28: 853-880
        • Griffin K.W.
        • Botvin G.J.
        • Doyle M.M.
        • Diaz T.
        • Epstein J.A.
        A six-year follow-up study of determinants of heavy cigarette smoking among high-school seniors.
        J Behav Med. 1999; 22: 271-284
        • Chassin L.
        • Presson C.C.
        • Todd M.
        • Rose J.S.
        • Sherman S.J.
        Maternal socialization of adolescent smoking: the intergenerational transmission of parenting and smoking.
        Dev Psychol. 1998; 34: 1189-1201
        • Birch L.L.
        • Fisher J.O.
        Development of eating behaviors among children and adolescents.
        Pediatrics. 1998; 101: 539-549
        • Stratton P.
        • Bromely K.
        Families' accounts of the causal processes in food choice.
        Appetite. 1999; 33: 89-108
        • Office of National Drug Control Policy
        The national youth anti-drug media campaign communication strategy statement.
        Executive Office of the President, Washington DC1997
        • Stephenson M.T.
        • Quick B.L.
        Parent ads in the National Youth Anti-Drug Media Campaign.
        J Health Commun. 2005; 10: 701-710
        • United States Department of Agriculture (USDA)
        Food and Nutrition Service.
        (Alexandria VA)
        • CDC
        Powerful bones, powerful girls.
        (Atlanta GA: CDC)
        • Huhman M.
        • Heitzler C.
        • Wong F.
        The VERB campaign logic model: a tool for planning and evaluation.
        Prev Chronic Dis. 2004; ([serial online]) (Jul [date cited])
        • Ajzen I.
        The theory of planned behavior.
        Organ Behav Hum Decis Process. 1991; 50: 179-211
        • Bandura A.
        Social foundations of thought and action: a social cognitive theory.
        Prentice Hall, Englewood Cliffs, NJ1986
        • Bugental D.B.
        • Goodnow J.J.
        Socialization processes.
        in: Damon I.W. Handbook of child psychology. Wiley, New York1998
        • Aeffect
        Life's First Great Crossroad.
        • Resnick M.
        • Bearman P.
        • Blum R.
        • et al.
        Protecting adolescents from harm: findings from the National Longitudinal Study on Adolescent Health.
        JAMA. 1997; 278: 823-832
        • Hoefer W.R.
        • McKenzie T.L.
        • Sallis J.F.
        • Marshall S.J.
        • Conway T.L.
        Parental provision of transportation for adolescent physical activity.
        Am J Prev Med. 2001; 21: 48-51
        • Sallis J.F.
        • Prochaska J.J.
        • Taylor W.C.
        • Hill J.O.
        • Geraci J.C.
        Correlates of physical activity in a national sample of girls and boys in grades 4 through 12.
        Health Psychol. 1999; 18: 410-415
        • McGuire M.T.
        • Hannan P.J.
        • Neumark-Sztainer D.
        • Falkner Cossrow N.H.
        • Story M.
        Parental correlates of physical activity in a racially/ethnically diverse adolescent sample.
        J Adolesc Health. 2002; 30: 253-261
        • Saunders R.P.
        • Pate R.R.
        • Felton G.
        • et al.
        Development of questionnaires to measure psychosocial influences on children's physical activity.
        Prev Med. 1997; 26: 241-247
        • Trost S.G.
        • Sallis J.F.
        • Pate R.R.
        • Freedson P.S.
        • Taylor W.C.
        • Dowda M.
        Evaluating a model of parental influence on youth physical activity.
        Am J Prev Med. 2003; 25: 277-282
        • Heitzler C.D.
        • Martin S.L.
        • Duke J.
        • Huhman M.
        Correlates of physical activity in a national sample of children aged 9–13 years.
        Prev Med. 2006; 42: 254-260
        • Ornelas I.J.
        • Perreira K.M.
        • Ayala G.X.
        Parental influences on adolescent physical activity: a longitudinal study.
        Int J Behav Nutr Phys Act. 2007; 4: 3
        • Kenyon G.S.
        • McPherson B.D.
        Becoming involved in physical activity and sport: a process of socialization.
        in: Rarick G. Physical activity: human growth and development. Academic Press, New York1973
        • Sallis J.
        • Prochaska J.
        • Taylor W.
        A review of correlates of physical activity of children and adolescents.
        Med Sci Sports Exerc. 2001; 32: 963-975
        • Baranowski T.
        • Anderson C.
        • Carmack C.
        Mediating variable framework in physical activity interventions.
        Am J Prev Med. 1998; 15: 266-297
        • Sallis J.F.
        • Alcaraz J.E.
        • McKenzie T.L.
        • Hovell M.F.
        • Kolody B.
        • Nader P.R.
        Parental behavior in relation to physical activity and fitness in 9-year-old children.
        Am J Dis Children. 1992; 146: 1383-1388
        • DiLorenzo T.M.
        • Stuckey-Ropp J.S.
        • Van Der Wal J.S.
        • Gotham H.J.
        Determinants of exercise among children.
        Prev Med. 1998; 27: 470-477
        • Anderssen N.
        • Woldb B.
        • Torsheim T.
        Are parental health habits transmitted to their children?.
        J Adolesc. 2006; 29: 513-524
        • Yang X.
        • Telama R.
        • Laakso L.
        Parents' physical activity, socioeconomic status and education as predictors of physical activity and sport among children and youth—a 12-year follow-up study.
        Int Rev Soc Sport. 1996; 31: 273-288
        • Kristjansdottir G.
        • Vilhjalmsson R.
        Sociodemographic differences in patterns of sedentary and physically active behavior in older children and adolescents.
        Acta Paediatr. 2001; 90: 429-435
        • McVeigh J.A.
        • Norris S.A.
        • de Wet T.
        The relationship between socio-economic status and physical activity patterns in South African children.
        Acta Paediatr. 2004; 93: 982-988
        • Trost S.G.
        • Pate R.R.
        • Dowda M.
        • Ward D.S.
        • Felton G.
        • Saunders R.
        Psychosocial correlates of physical activity in white and African-American girls.
        J Adolesc Health. 2002; 31: 226-233
        • Gordon-Larsen P.
        • McMurray R.G.
        • Popkin B.M.
        Adolescent physical activity and inactivity vary by ethnicity: The National Longitudinal Study of Adolescent Health.
        J Pediatr. 1999; 135: 301-306
        • Brustad R.J.
        Attraction to physical activity in urban schools children: parental socialization and gender influences.
        Res Q Exerc Sport. 1996; 67: 316-323
        • Aeffect Inc
        Excerpts from research to support development of the Youth Media Campaign: revealing target audience receptiveness to potential message concepts.
        Soc Mar Q. 2005; 11: 47-56
        • Potter L.D.
        • Judkins D.R.
        • Piesse A.
        • Nolin M.J.
        • Huhman M.
        Methodology of the outcome evaluation of the VERB campaign.
        Am J Prev Med. 2008; 34: S230-S240
        • Synder L.B.
        • Hamilton M.A.
        • Mitchell E.W.
        • Kiwanuka-Tondo J.
        • Fleming-Milici F.
        • Proctor D.
        A meta-analysis of the effect of mediated health communication campaigns on behavior change in the United States.
        J Health Commun. 2004; 9: 71-96
        • St. Peters M.
        • Fitch M.
        • Huston A.C.
        • Wright J.C.
        Television and families: what do young children watch with their parents?.
        Child Dev. 1991; 62: 1409-1423
        • Sang F.
        • Schmitz B.
        • Tasche K.
        Developmental trends in television coviewing of parent-child dyads.
        J Youth Adolesc. 1993; 22: 531-542
        • Dorr A.
        • Kovaric P.
        • Doubleday C.
        Parent-child coviewing of television.
        Journal of Broadcasting and Electronic Media. 1989; 33: 35-51
        • Carpenter C.J.
        • Huston A.C.
        • Spera L.
        Children's use of time in their everyday activities during middle childhood.
        in: Bloch M. Pellegrini A. The ecological context of children's play. Ablex, Norwood NJ1989
        • Nielsen A.C.
        The television audience.
        AC Nielsen, Chicago IL1975
        • Timmer S.G.
        • Eccles J.
        • O'Brien K.
        How children use time.
        in: Juster F.T. Stafford F.P. Time goods and well-being. The Institute for Social Research, Ann Arbor MI1985
        • Rossiter J.R.
        • Robertson T.S.
        Children's television viewing: an examination of parent-child consensus.
        Sociometry. 1975; 38: 308-326
        • Ward S.
        • Wackman D.
        Family and media influences on adolescent consumer learning.
        Am Behav Sci. 1971; 14: 415-427
        • Sheikh A.A.
        • Moleski L.M.
        Conflict in the family over commercials.
        J Commun. 1977; 27: 152-157
        • Nathanson A.I.
        Identifying and explaining the relationship between parental mediation and children's aggression.
        Communic Res. 1999; 26: 124-143
        • Austin E.W.
        • Pinkleton B.E.
        • Fujioka Y.
        The role of interpretation processes and parental discussion in the media's effects on adolescents' use of alcohol.
        Pediatrics. 2000; 105: 343-349