The purpose of the conference was to bring television public service directors from around the country together with representatives of the National Heart, Lung, and Blood Institute, the American Heart Association, and Porter Novelli, to discuss issues related to television public service advertising. Of particular interest was the subject of health PSAs and specifically those on cardiovascular disease and high blood cholesterol. The meeting was funded as a public service by Merck, Sharp & Dohme.

Overview of The Conference and of NHLBI

Mike White, Director of the National Heart, Lung, and Blood Institute (NHLBI), opened the conference with an introduction to NHLBI and to the institute's education programs. NHLBI's Office of Prevention, Education and Control (OPEC) oversees the development and implementation of several health education campaigns, including the National High Blood Pressure Education Program and the National Cholesterol Education Program (NHBPEP and NCEP).

Overview of the National Cholesterol Education Program

Dr. James Cleeman, Coordinator of the NCEP, reported that the goal of the NCEP is to reduce the prevalence of high blood cholesterol in the U.S., and thereby reduce the number of deaths from cardiovascular disease. For every 1 percent reduction in a person's cholesterol level, there is a 2 percent reduction is risk of death from cardiovascular disease.

Research indicates the public is aware of the relationship between high cholesterol and diet, but that people are not knowledgeable about which foods to avoid and therefore don't know how to change their diets to lower cholesterol levels. Research also shows that the public is ahead of physicians in understanding the importance of cholesterol. Therefore, it is important to educate the physician as well as public communities about high blood cholesterol. In addition to the public education campaign, the NCEP also has worksite, professional and patient education programs.

The Role of Research

Dr. Rob Gould, Senior Vice President and Director of Research at Porter Novelli, presented insights from qualitative research on high blood cholesterol. They indicate that while people are becoming more aware of the problem of high blood cholesterol, there are many barriers to their becoming motivated to finding out their cholesterol number. These barriers include: perceived invulnerability, especially among younger people ("a heart attack would never happen to me"); fatalism ("there's nothing I can really do about it anyway"); feeling overburdened ("there are already so many things I'm supposed to do, not do, eat, not eat.")

NHLBI and AHA Campaigns

Terry Bellicha, chief of NHLBI's communications and public information branch, and Brigid McHugh, director of public relations for AHA, gave overviews of their public education campaigns. Ms. Bellicha cited research that indicates that next to the physician, the public considers mass media as the most important source of health education.

One difference between NHLBI's and AHA's programs is that AMA has gravitated toward a combined heart disease risk factor approach in its PSAs, while NHLBI presently produces separate messages for high blood pressure and cholesterol. According to Ms. Bellicha, the National High Blood Pressure Education Program (NHBPEP) is a mature campaign, which has passed the awareness-generating stage and is aimed at a more targeted audience, specifically aware hypertensives. The National Cholesterol Education Program (NCEP), on the other hand, is still in this early awareness-building stage and is aimed at a more universal audience.

AHA's spots emphasize the seriousness of cardiovascular disease, and reflect their research findings that adults tend to respond to a message about their families. Specifically, men say that heart disease is a concern to them because of the responsibility the feel for their families, and women echo this in their feelings about their spouses and children.

Summary of Discussion

Production - Distribution and the Airing of PSAs

Combined vs. Separate Distribution

The subject of combined versus separate distributions for NHLBI's high blood pressure and cholesterol PSAs was raised --does a combined distribution work for or against the two campaigns? The response from public service directors (PSDs) was mixed. While some said that it is station (or personal) policy to accept only one PSA per reel or organization at a time, others said they would view the high blood pressure and cholesterol spots independently, and base their decision to air on the quality and merit of the spot. It was expressed that there often isn't time to view all the spots that come in, and that if there are two campaigns on one tape, one may simply be overlooked.

It was unanimous that if high blood pressure and cholesterol spots are distributed separately and at different times, it will reduce the chances of one campaign being aired at the expense of the other.

Local Affiliation and Personal Delivery

Both NHLBI and AHA work with and nurture affiliates at the state and local levels, to get them involved with the local tagging and distribution of cardiovascular disease-related PSAs. Just how much of a factor are local tagging and delivery in airing PSAs? Generally, PSDs were strongly in favor of local tagging and affiliation with a local health organization, but they don't place great importance on personal delivery. It was expressed, in fact, that there isn't time to meet with everyone who drops by the station with a PSA.

Localization and community involvement are so important to local stations that nationally-produced PSAs (even those that are locally tagged) often lose out to non-profit community organizations like the Boy Scouts and senior citizens groups.

Packaging -- Presenting the PSAs

Public service directors suggested that information about the incidence of the disease in their own communities could be persuasive. For example, while they are aware of the incidence and importance of high blood pressure, they don't have the same knowledge of high blood cholesterol. Photoboards are necessary, especially if the PSD doesn't have time to view the spot. It should be indicated whether a shorter version(s) is included on the tape.

A "media alert" or advisory is a useful and appreciated tool for informing a PSD that new spots are coming.

Free information and/or materials are offered through the PSA to viewers who call or write the sponsoring organization, PSDs would appreciate seeing just what is being offered. If an organization offers a free booklet in its PSA, for example, send one along with the spot.

Beyond Packaging -- Providing a Complete Proposal

Public Service Directors are very busy. They do more than just watch and air public service announcements. They get involved with community affairs, programming, special events, the news -- and more.

Because public service directors are typically involved with other projects, it is helpful to them if a PSA comes with ideas for tying in with other things, such as a special program, community events, news stories, and station promotions.

An ideal public service proposal would have many interrelated elements, would be easy to implement, would make the station look good in the community, and would require little effort on the part of the public service director.

The public service department at a TV station is non-revenue generating -- so any package that offers ways and means to make example e, a proposal that includes both paid and public service advertising would be reviewed.

The Impact of Deregulation

In general, deregulation has had little or no impact on local stations' public service advertising policies (the networks were never governed by FCC regulations regarding PSAs). But while many have not changed their commitment to public service issues, some have reduced the number of different PSAs they air and increased their commitment to specific campaigns.

One source of competition (and this ties in with the post-deregulation environment) for public service airtime at many stations is station promotion. Stations are having to compete more actively for viewers within their own markets, and these ratings wars can cut into non-assigned airtime.

Sometimes, a station general manager or other executive will commit a percentage of airtime to a particular campaign, and the public service director doesn't have a choice in the matter. An example of this is the Partnership for a Drug-Free America campaign, which enlisted guaranteed airtime from stations around the country.

Spot Length Preference

In general, 30-, 20- and 10-second spots are still the most preferable, although 15-second PSAs are becoming more common. Not all advertisers purchase two back-to-back 15-second time slots, so more 15-second availabilities are being given to the PSDs to fill.

Other Comments and Suggestions

Strong commercial endorsements (like a "Brunswick" sign in a bowling alley) will most likely keep a PSA from being approved for airing.

Spokespersons from television are risky -- they may be from a competing network, and/or their shows may be canceled, and/or they may "fall from grace," all of which will work against the PSA.

A mix of races within a PSA is a good bet -- it appeals to broad racial, geographic and socioeconomic audiences.

Even music styles can affect the acceptance of a message -- by the audience and by the public service director.

In reaction to "Megacampaigns," such as the one sponsored by the Partnership for a Drug-Free America, the PSDs said they might not air a spot because they know the competition is also running it. However, as noted above, they may be required to air such a spot because the station manager has made a commitment to sponsor the campaign.

Typically, the lead time before a spot will get aired (if approved) after it is delivered to the station is four weeks.

The average shelf life of a PSA is three months. But, if a spot is well-liked, the public service director may choose to air it for a longer period of time.

If a station does a "fair-type" promotion (health fair,etc.), other stations in that market typically won't focus on that topic during the promotional time. But they may concentrate on it at a later date.

Thank-you notes for donated airtime are appreciated.

Summary

Cholesterol is a relatively new health topic. It's unrealistic to expect that airplay of cholesterol spots would match that of high blood pressure spots yet. Though the experts at NHLBI and AHA understand the importance of cholesterol in heart disease, that sense of importance and basic understanding is not yet fully shared by public service directors, the general media and the public. As awareness builds, so will airplay of cholesterol PSAs.

Public service directors are busy. There are dozens of things competing for their attention every day. Gaining an understanding of those competing forces will help organizations and agencies fine-tune the production and distribution of materials, packaging, and public service announcements to optimize airplay and to create broader, more inclusive programs.

The conference gave all participants the chance to ask straight questions -- and get straight answers -- to many of the issues involved in public service advertising. The lessons learned will be valuable in developing and implementing short- and long-term communications strategies for cholesterol and other health-related messages.