A social media counter-marketing campaign to improve diet in young adults

Stanford University, Stanford CA

Investigators

Abstract

Unhealthy diet quality contributes to 1 in every 5 deaths in the US. Unhealthy diet quality is especially worrying among young adults (ages 18-29), who have worse diet quality than every other adult age group. Social media messaging campaigns can be an effective, low-cost way to improve diet quality, but need to be optimized to the needs of young adults. We propose that a counter-marketing campaign can improve diet quality among young adults—while eliciting less weight stigma and disordered eating—relative to a traditional health education campaign. Counter-marketing campaigns expose how some food companies use deceptive or harmful marketing practices to sell unhealthy foods. By exposing these practices, counter-marketing campaigns appeal to young adults’ values of autonomy and respect. Exposing these practices also emphasizes industry responsibility for diet and weight, which could minimize weight stigma and disordered eating. Counter-marketing has a long history of success in reducing smoking but is under-used and under-studied for improving diet. We propose 3 Aims to optimize and evaluate a social media counter-marketing campaign for young adults. In Aim 1, we will optimize a counter-marketing campaign to encourage young adults to eat healthier foods. We will (a) conduct qualitative interviews with young adults to identify their core values and attitudes, (b) develop counter-marketing campaign themes targeted to these values and attitudes, and (c) identify the 3 most promising themes using a ratings experiment with a nationally representative sample of young adults. Working with a marketing agency, we will develop a counter-marketing campaign using these themes to test in Aim 2. In Aim 2, we will test if a counter-marketing campaign improves diet quality more than a health education campaign or a control campaign. In a 3-arm RCT, we will randomly assign young adults to a counter-marketing campaign, a health education campaign, or an attention control campaign about safe driving. Using our social media RCT protocol, we will deliver the 3-month campaigns to young adults via Instagram. We will use social media analytics to tailor the frequency, timing, and type of campaign posts to maximize engagement. We will assess diet quality (Healthy Eating Index) at 0 months (pre-intervention), 3 months (initial campaign effects, immediately post-intervention) and 9 months (sustained campaign effects, 6 months post-intervention) using repeated 24-hour dietary recalls. In Aim 3, we will test if a counter-marketing campaign elicits less internalized weight stigma and disordered eating attitudes and behaviors than a health education campaign. We will (a) survey all young adults in the RCT at 0, 3 and 9 months and (b) conduct qualitative interviews at 9 months with a purposive sample of RCT participants. The proposed research makes a significant contribution by guiding development of a fundamentally new approach for improving diet quality while minimizing harmful unintended consequences.