Personal Protective Actions You Can Take in a Flu Pandemic

Young woman under the covers in bed blowing her nose.

Every fall and winter the United States experiences epidemics of seasonal influenza (flu). Sometimes a flu pandemic occurs due to a new flu virus that spreads and causes illnesses around the world. We cannot predict when a flu pandemic will occur, but over the past 100 years, we have documented four flu pandemics resulting in close to 1 million deaths in the United States alone. 1Get a flu vaccine! The most important way to prevent the flu in everyone 6 months and older is to get a yearly flu vaccine.

When a flu pandemic happens, it can take up to 6 months before a vaccine against a new flu virus is available. Antiviral drugs can help manage the symptoms of the flu, shorten the time you are sick by 1 or 2 days, and prevent serious flu complications, like pneumonia. But, there may be a limited supply of these medications during a pandemic so nonpharmaceutical interventions (or NPIs) may be the only prevention tools available during the early stages of a pandemic.

There are things you can do, apart from getting vaccinated and taking medications, to help slow the spread of a flu pandemic. NPIs, also known as “community mitigation measures,” are important because they will be the first line of defense in the absence of a pandemic vaccine. NPIs may be more effective when used early and in a layered approach (i.e., using more than one measure at a time). During the 1918 pandemic, cities that put NPIs in place quickly reported fewer deaths.2,3 NPIs may be used in different settings, including homes, schools, workplaces, and places where people gather (e.g., parks, theaters, and sports arenas).

Personal protective measures to prevent flu at all times

Photo of someone washing their hands in a sink.CDC recommends using some NPIs to prevent seasonal flu and other respiratory infections. To help prevent the flu, you should always:

  • Stay home when sick and away from others as much as possible,
  • Stay away from people who are sick as much as possible,
  • Cover your coughs and sneezes with a tissue,
  • Wash your hands often with soap and water,
  • Avoid touching your eyes, nose, or mouth, and
  • Regularly clean surfaces and objects that you use a lot.

Personal protective measures to prevent flu during a pandemic

Many of these NPIs would still be recommended during a pandemic, but some would be reserved for use during a flu pandemic. Depending on the severity of a pandemic, CDC might recommend:

  • Stay home if exposed to a sick household member,
  • Use a face mask when sick and out in crowded community settings, and
  • Implement community measures to reduce exposure to pandemic flu (coordinating school closures, limiting face-to-face contact in workplaces, and postponing or canceling mass gatherings).

CDC is preparing for a flu pandemic

There is always a threat that a flu pandemic will arise, so CDC is taking steps to prepare. In 2017, CDC issued updated community mitigation guidelines to help state and local public health departments and their community partners make plans before the next pandemic happens. Visit www.cdc.gov/npi to access the updated guidelines; plain-language planning guides for the general public and community settings; and additional NPI communication, education, and training materials. You can find more information about seasonal and pandemic flu at www.cdc.gov/flu and at www.cdc.gov/flu/pandemic.

Footnotes:

1 Past Pandemics: https://www.cdc.gov/flu/pandemic-resources/basics/past-pandemics.html

2 Hatchett RJ, Mecher CE, Lipsitch M. Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proc Natl Acad Sci U S A. 2007; 104:7582-7.

3 Markel H, Lipman HB, Navarro JA, et al. Nonpharmaceutical interventions implemented by US cities during the 1918–1919 influenza pandemic. JAMA. 2007; 298:644-54.

Kentucky Takes a Novel Approach to Fight the Opioid Crisis

A pile of prescription medicine bottles.

The opioid overdose epidemic is a public health emergency. The state of Kentucky has the third highest rate of drug overdose in the country. The FindHelpNowKY.org website bridges a gap between Kentucky residents and timely access to substance use treatment facilities and services. It provides near real-time available openings at local area substance use disorder (SUD) facilities.

Tailoring treatment optionsUsing an innovative approach. Kentucky teens will take the lead in advertising FindHelpNowKY.org. Using federal funding, the team is running a challenge for high school students to produce campaign advertisements to promote the website and raise awareness about the risks of drug use. The top student-produced print, broadcast, billboard, and radio ads will be incorporated into the "Don't Let Them Die--Find Help Now KY" campaign.

You can use over 30 different search criteria on the website to find the right SUD treatment facility for your needs. These criteria include accepted insurance, gender identity, facility type (inpatient and outpatient treatment facilities etc.), and co-occurring treatment for mental health disorders. Over 500 SUD treatment facilities appear on the website who update their opening availability daily to facilitate rapid matching of individual treatment need with available treatment. The easy to use design of the FindHelpNowKY.org landing page helps high-priority populations, like adolescents and pregnant women, find treatment options and availability.

Providing FindHelpNowKY.org to Those in Need

FindHelpNowKY.org is running a promotional campaign during the summer of 2018 to:

  1. Raise awareness of the site as a valuable resource to quickly locate SUD treatment facilities with available openings. TV spots, radio ads, billboards, and digital media ads will run to reach primary audiences.
  2. Drive website traffic and use by:
    1. family and friends of individuals with SUDs, and individuals with SUDs (primary audiences); and
    2. health care providers including primary care providers and first responders (secondary audiences). The website is being promoted at physician association meetings, and physician pocket cards with SUD resources, including FindHelpNowKY.org will be distributed
  3. Inform the public about SUD educational information available on FindHelpNowKYorg.

Measuring progress

Kentucky assessed the need for the FindHelpNowKy.org website based on a physician focus group, Office of Drug Control Policy (ODCP) input, and community mental health centers’ feedback. These stakeholders helped identify the need for this website and the need for more timely access to SUD treatment. Metrics to measure success will include website analytics, surveys of SUD treatment providers, and average search time

FindHelpNowKY.org has had over 100,000 page views and over 26,000 unique searches from February 1, 2018- August 7, 2018.. Approximately 40% of website visits originated from social media, google searches, and referrals from other websites. Most users spent an average of 7.5 minutes on the website, suggesting that they were reading and engaged with the content. Visitors also ran 2-3 searches during their visits, indicating that they conducted unique searches based on differing search criteria.

Common searches also included seeking long-term residential or outpatient treatment facilities that accept Medicaid or Medicare. The FindHelpNow domain is being obtained by Kentucky so that interested states can use the FindHelpNow website platform with their respective state facility data in it.

Learn more

  • If you or a loved one requires assistance or information on SUD treatment and prevention topics contact the statewide hotline number 1-833-8KY-HELP
  • Kentucky Drug Overdose Prevention Program (http://www.mc.uky.edu/kiprc/programs/kdopp.html)
  • Don’t Let Them Die, The Governor of Kentucky’s communication campaign that seeks to raise awareness of the dangers of opioid use

We want to hear from you!

Leave a comment below about what your state is doing to combat the opioid overdose epidemic. This was developed by the Kentucky Drug Overdose Prevention Program at the Kentucky Injury Prevention and Research Center, at the University of Kentucky’s College of Public Health as bona fide agent for the Kentucky Department for Public Health. The project was a collaboration between the office of Kentucky Governor Matt Bevin, Kentucky Cabinet for Health and Family Services, and Justice and Public Safety Cabinet.

Funding for the website came from the CDC National Center for Injury Prevention and Control. FindHelpNowKY.org was supported by Cooperative Agreement Number, 5 NU17CE002732-03, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Preventing Prescription Opioid Overdoses in New York State

A pile of prescription medicine bottles.

Like many states, New York is suffering from the consequences of the opioid overdose epidemic. There has been a dramatic increase in the number of overdoses due to both prescription and illicit drug use in recent years. Overdoses are killing people of all races and ages. The New York State Department of Health (NYSDOH) is coordinating statewide prevention interventions to save lives and prevent opioid overdoses.

Adapting the RxAwareness Campaign for New York State

Tamera's Rx Awarness story
The Rx Awareness campaign videos tell the real stories of people whose lives have been negatively impacted by prescription opioid use and abuse.

The NYSDOH’s Prescription Drug Overdose Prevention Program is using the CDC RxAwareness Campaign. The campaign ran from February 2018 to June 2018. This is an evidence-driven prescription opioid overdose prevention campaign that tells the real stories of people whose lives have been torn apart by opioid use and abuse.  The campaign aims to:

  • Increase everyone’s awareness that opioids can be addictive and dangerous
  • Increase the number of individuals that choose options other than opioids for safe and effective pain management
  • Decrease the number of individuals who use opioids for non-medical or recreational reasons

NYSDOH is using six 30-second testimonial video ads and five 30-second radio ads featuring people and families affected by prescription opioid abuse and overdose. This campaign includes Facebook ads, popular website display banners, streaming audio, and Google Search ads. Web banner ads and online search ads designed and audience tested by CDC were also used.

Real-time Monitoring Makes a Difference

The beauty of digital marketing is that it allows for real-time monitoring and optimization. The NYSDOH monitored two key metrics from the campaign every week:

  1. Click-through rates (CTR): the ratio of people who clicked on an ad compared to the total number of people who viewed the ad.
  2. Cost-per-click (CPC): the price that is paid for each click on the ad.

Continuously assessing the performance of individual ads allowed NYSDOH to swap out lower performing ads for higher performing ads. For example, mobile placements were showing strong performance, so more of the budget was allocated towards these placements and the budget for lower performing ads was reduced. High performance ads have greater reach, which leads to greater impact and increases the likelihood that the campaign will achieve its goals.

Evaluation Findings Help NY Maximize their Ad Budget

NYSDOH learned several things through real-time monitoring and evaluation:

  • Overall, women are spending nearly twice as long as men on the DOH campaign website, www.health.ny.gov/rxawareness
  • Adults 35 to 54 years old have a stronger click-through rate than the adults who are 35 to 54 years old and parents of teenagers
  • Banners on one weather site currently have the highest click-through rates and have resulted in the longest average time spent on the landing page
  • The click-through rates of online search ads increased consistently from May – June 2018
  • Public commenting on ads help NYSDOH understand how the campaign is being accepted

The NYSDOH continues to evaluate activity in this campaign. NYSDOH will utilize these findings in future campaigns.

Learn more:

This communication campaign was supported by the Cooperative Agreement Number, 5 NU17CE002742-03, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

We want to hear from you!

Leave a comment below and share how you are monitoring and evaluating your digital campaigns.

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns. In the coming months we will look at other examples.

The Right Accessories for Your #SunSafeSelfie

HEADER PHOTO_SunSafeSelfie_Public Health Matters

CDC is encouraging everyone to show off their favorite ways to stay sun-safe. Snap a photo of yourself, your friends, and your family using sun protection while outdoors and share on social media. Be sure to tag the photo with #SunSafeSelfie and check out other photos with the hashtag. Most importantly, practice what you post year-round by planning ahead, so you are always prepared to protect your skin when spending time outdoors!

Check out these sun-safety “props” you can toss in a beach bag, backpack, or your car to stay protected wherever you go (and feature in your next #SunSafeSelfie):

  • Sunscreen to slather on. Use a sunscreen with SPF 15 or higher on any skin that will be exposed to the sun. And remember: it’s not a magic umbrella! You should reapply every 2 hours no matter what, and also after swimming, sweating, or toweling off.
  • A large-size lid.
  • Sleeves for safety, pants for protection. Long-sleeved shirts and clothing that reaches the ankles are great ways to block those rays. There’s plenty of breezy clothing that has built-in sun protection, too.
  • Squint-stoppers. Bright sunlight can damage your eyes as well as your skin. Pick a pair of shades with lenses that block 100% of the sun’s rays and go safe in style.
  • Portable protection. Staying in the shade is also a great way to block the rays. Umbrellas, shade tents, and awnings make a big difference when you bring them along to parks, concerts, and festivals. Be sure to take advantage of permanent shade structures, too. Have your picnic under that overhang or your pick-up game of hoops in a covered pavilion.

You’ll want to use these all together for the best protection. Even if your face is shaded in your selfie—that’s the point! Use your pic to encourage friends and family to keep their skin sun-safe and healthy.

The 1918 Flu Pandemic: Why It Matters 100 Years Later

Group photo of Red Cross nurses in Boston wearing personal protective equipment.

100 years ago, an influenza (flu) pandemic swept the globe, infecting an estimated one-third of the world’s population and killing at least 50 million people. The pandemic’s death tollAmerican soldiers returning home on the Agamemnon, Hoboken, New Jersey was greater than the total number of military and civilian deaths from World War I, which was happening simultaneously.  At the time, scientists had not yet discovered flu viruses, but we know today that the 1918 pandemic was caused by an influenza A (H1N1) virus. The pandemic is commonly believed to have occurred in three waves. Unusual flu-like activity was first identified in U.S. military personnel during the spring of 1918. Flu spread rapidly in military barracks where men shared close quarters. The second wave occurred during the fall of 1918 and was the most severe. A third wave of illness occurred during the winter and spring of 1919.

Here are 5 things you should know about the 1918 pandemic and why it matters 100 years later.

1. The 1918 Flu Virus Spread Quickly

500 million people were estimated to have been infected by the 1918 H1N1 flu virus. At least 50 million people were killed around the world including an estimated 675,000 Americans. In fact, the 1918 pandemic actually caused the average life expectancy in the United States to drop by about 12 years for both men and women.Flu patients in Iowa

In 1918, many people got very sick, very quickly. In March of that year, outbreaks of flu-like illness were first detected in the United States. More than 100 soldiers at Camp Funston in Fort Riley Kansas became ill with flu. Within a week, the number of flu cases quintupled. There were reports of some people dying within 24 hours or less. 1918 flu illness often progressed to organ failure and pneumonia, with pneumonia the cause of death for most of those who died.  Young adults were hit hard. The average age of those who died during the pandemic was 28 years old.

2. No Prevention and No Treatment for the 1918 Pandemic Virus

In 1918, as scientists had not yet discovered flu viruses, there were no laboratory tests to detect, or characterize these viruses. There were no vaccines to help prevent flu infection, noPolicemen patrol the streets in masks in Seattle to ensure public safety. antiviral drugs to treat flu illness, and no antibiotics to treat secondary bacterial infections that can be associated with flu infections. Available tools to control the spread of flu were largely limited to non-pharmaceutical interventions (NPI’s) such as isolation, quarantine, good personal hygiene, use of disinfectants, and limits on public gatherings, which were used in many cities. The science behind these was very young, and applied inconsistently. City residents were advised to avoid crowds, and instructed to pay particular attention to personal hygiene. In some cities, dance halls were closed. Some streetcar conductors were ordered to keep the windows of their cars open in all but rainy weather. Some municipalities moved court cases outside. Many physicians and nurses were instructed to wear gauze masks when with flu patients.

3. Illness Overburdened the Health Care System

An estimated 195,000 Americans died during October alone. In the fall of 1918, the United States experienced a severe shortage of professional nurses during the flu pandemic because large numbers of them were deployed to military camps in the United States and abroad.A black-and-white advertisement for the Chicago School of Nursing. This shortage was made worse by the failure to use trained African American nurses. The Chicago chapter of the American Red Cross issued an urgent call for volunteers to help nurse the ill. Philadelphia was hit hard by the pandemic with more than 500 corpses awaiting burial, some for more than a week. Many parts of the U.S. had been drained of physicians and nurses due to calls for military service, so there was a shortage of medical personnel to meet the civilian demand for health care during the 1918 flu pandemic. In Massachusetts, for example, Governor McCall asked every able-bodied person across the state with medical training to offer their aid in fighting the outbreak.

As the numbers of sick rose, the Red Cross put out desperate calls for trained nurses as well as untrained volunteers to help at emergency centers. In October of 1918, Congress approved a $1 million budget for the U. S. Public Health Service to recruit 1,000 medical doctors and more than 700 registered nurses.

At one point in Chicago, physicians were reporting a staggering number of new cases, reaching as high as 1,200 people each day. This in turn intensified the shortage of doctors and nurses.  Additionally, hospitals in some areas were so overloaded with flu patients that schools, private homes and other buildings had to be converted into makeshift hospitals, some of which were staffed by medical students.

4. Major Advancements in Flu Prevention and Treatment since 1918

The science of influenza has come a long way in 100 years!A man dress in personal protective equipment in a laboratory. Developments since the 1918 pandemic include vaccines to help prevent flu, antiviral drugs to treat flu illness, antibiotics to treat secondary bacterial infections such as pneumonia, and a global influenza surveillance system with 114 World Health Organization member states that constantly monitors flu activity. There also is a much better understanding of non-pharmaceutical interventions–such as social distancing, respiratory and cough etiquette and hand hygiene–and how these measures help slow the spread of flu.

There is still much work to do to improve U.S. and global readiness for the next flu pandemic. More effective vaccines and antiviral drugs are needed in addition to better surveillance of influenza viruses in birds and pigs. CDC also is working to minimize the impact of future flu pandemics by supporting research that can enhance the use of community mitigation measures (i.e., temporarily closing schools, modifying, postponing, or canceling large public events, and creating physical distance between people in settings where they commonly come in contact with one another). These non-pharmaceutical interventions continue to be an integral component of efforts to control the spread of flu, and in the absence of flu vaccine, would be the first line of defense in a pandemic.

5. Risk of a Flu Pandemic is Ever-Present, but CDC is on the Frontlines Preparing to Protect Americans

Four pandemics have occurred in the past century: 1918, 1957, 1968, and 2009. The 1918 pandemic was the worst of them. But the threat of a future flu pandemic remains. A pandemic flu virus could emerge anywhere and spread globally.A crowd of people with the Washington Monument in the distance.

CDC works tirelessly to protect Americans and the global community from the threat of a future flu pandemic. CDC works with domestic and global public health and animal health partners to monitor human and animal influenza viruses. This helps CDC know what viruses are spreading, where they are spreading, and what kind of illnesses they are causing. CDC also develops and distributes tests and materials to support influenza testing at state, local, territorial, and international laboratories so they can detect and characterize influenza viruses.  In addition, CDC assists global and domestic experts in selecting candidate viruses to include in each year’s seasonal flu vaccine and guides prioritization of pandemic vaccine development. CDC routinely develops vaccine viruses used by manufacturers to make flu vaccines. CDC also supports state and local governments in preparing for the next flu pandemic, including planning and leading pandemic exercises across all levels of government. An effective response will diminish the potential for a repeat of the widespread devastation of the 1918 pandemic.

Visit CDC’s 1918 commemoration website for more information on the 1918 pandemic and CDC’s pandemic flu preparedness work.

4 Tips to Stay Healthy Around Your Pet

Father Reading Book With Son And Daughter And Pet Dog At Home

Pets, whether covered in fur, feathers, or scales, are an important part of our lives—most American households own at least one pet. Many people see their pet as a member of the family that brings joy and amusement to their life. But did you know that having a pet can even help improve your health? Having a pet can decrease your blood pressure, cholesterol, triglyceride levels, and feelings of loneliness. Pets can also encourage you to be active and get outside, and provide opportunities to socialize.

The risk of getting a disease from a pet is low for most people, but some groups are more likely to get sick from the germs spread by pets, and their illness may be more severe. Young children, older adults, people with weakened immune systems, and pregnant women are especially vulnerable to certain zoonotic infections.While there are many benefits to pet ownership, animals can sometimes carry germs that make us sick. Zoonotic diseases can spread between people and animals—even our pets. In the past decade, we’ve seen outbreaks of illness in people linked to pets such as puppies, rats, hamsters, guinea pigs, turtles, lizards, geckos, hedgehogs, and even water frogs.

You might not realize that the everyday activities involved in caring for your pet can result in the spread of germs from pets to people. Handling pet food and toys, cleaning cages, and yes, even kissing your pet, can pass germs from the pet to you. Pets can spread germs even if they look clean and healthy.

All of this may sound scary, but knowing about zoonotic diseases and the simple things you can do to reduce the risk will help you enjoy your pets and stay healthy. Adopt these four simple habits to help you, your family, and your pets stay healthy and happy.

  1. Choose the right pet
    Not all pets are right for all people. In addition to thinking about the pet’s needs, consider who will be around the pet at home. Are there young kids in the house, or maybe a relative over 65? Certain pets, including reptiles, amphibians, and rodents, are not recommended for children 5 years of age and younger, adults 65 years of age and older, and people with weakened immune systems because they’re more likely to get sick. Rodents and cats can carry diseases that cause birth defects, so think about waiting to adopt one of these pets if you or someone in your home is pregnant. Talk to your veterinarian about choosing the right pet.
  2. Keep your pet healthy
    Keeping your pet healthy helps to keep you healthy. Make sure pets get a good diet, fresh water, shelter, and exercise. Regular veterinary care is also important for your pet. Many pets need routine vaccinations, de-worming, and flea and tick control to protect them, and their owners, from certain diseases. Every pet—whether it’s a dog, cat, hamster, ferret, or iguana—should receive life-long veterinary care. If you think your pet might be sick, talk to your veterinarian. Also, remember to include your pets in your emergency preparedness plans so you can keep them safe and healthy in an emergency.
  3. Practice good hygiene
    Washing your hands is one of the best ways to stay healthy around pets and can also protect you against other diseases. Always wash your hands after playing with, feeding, or cleaning up after your pet. Pets can contaminate surfaces in your home with germs—you don’t have to touch your pets to get sick from the germs they might be carrying. Keep your pets away from people food and areas where food and drink are prepared, served, consumed, or stored. Always clean up dog feces (poop) from your yard and public areas to prevent the spread of parasites and other germs to people. If you’re pregnant and have a cat, avoid changing the litter box.
  4. Supervise kids around pets
    Always supervise young children around pets, even trusted family pets. Children, especially those 5 years of age and younger, can be at higher risk for pet-related illnesses because they often touch surfaces that may be contaminated, put objects in their mouths, and are less likely to wash their hands. Children are often the victims of bites and scratches and are more likely to get seriously ill from certain diseases spread from pets. Don’t let kids kiss pets or put their hands or objects in their mouths after playing with pets. Help them to wash their hands after they interact with any animal.

We all love our pets, but it’s important to know the risks that come with any animal contact, especially for people who are more vulnerable to certain diseases. Practicing healthy pet habits can help you enjoy your pets while staying healthy.

You can learn more about pets on CDC’s Healthy Pets Healthy People website, and be sure to check out this feature for more tips on staying healthy around pets.

 

Raising Awareness to Prevent Prescription Opioid Overdoses

A jumble of orange prescription pill bottles with white labels and lids.

In 2016, 115 Americans died every day from an opioid overdose – that is more than 42,000 drug overdose deaths that involved an opioid including prescription opioids, heroin, and/or illicitly manufactured fentanyl. Prescription opioids (like hydrocodone, oxycodone, and morphine) are prescribed by doctors to treat moderate to severe pain, but have serious risks and side effects.Using prescription opioids can have a number of side effects, even when taken as directed: • Tolerance—meaning you might need to take more of the medication for the same pain relief • Physical dependence—meaning you have symptoms of withdrawal when the medication is stopped • Increased sensitivity to pain • Constipation • Nausea, vomiting, and dry mouth • Sleepiness and dizziness • Confusion • Depression • Low levels of testosterone that can result in lower sex drive, energy, and strength • Itching and sweating

Anyone who takes prescription opioids can become addicted to them. Families across the county are dealing with the health, emotional, and economic effects of the opioid epidemic. The opioid overdose epidemic is a public health emergency and Americans of all races and ages are being killed by opioid overdoses.

Rx Awareness campaign tackles prescription opioids

Rx Awareness is CDC’s latest effort in the fight against the opioid overdose epidemic. Rx Awareness aims to:

  1. Increase Americans’ awareness and knowledge about the risks of prescription opioids, and
  2. Prevent inappropriate use of prescription opioids.

Rx Awareness uses the tagline, “It only takes a little to lose a lot” to educate the public about dangers of prescription opioids, including misuse, abuse, and overdose. The campaign features real-life accounts from people recovering from opioid use disorder and from people who have lost loved ones to prescription opioid overdose.

Public awareness campaigns, like Rx Awareness, are important in the fight against opioids. The more equipped people are with information and resources about the risks of opioids, the more we can support those affected by this epidemic. The cornerstone of Rx Awareness is a series of testimonial videos, and the campaign also includes radio advertisements, digital advertisements, billboards, posters, newspaper advertisements, and a website.

States are on the frontlines of the opioid overdose epidemic

CDC created the Rx Awareness campaign for states, coalitions, and communities to implement across the country. When the campaign was launched in 2017 it included an implementation guide to support CDC-funded states to use the campaign materials. State and local health departments and community organizations can take part in the Rx Awareness campaign and use the tested campaign materials and resources to launch local campaigns, support local prevention activities, and raise awareness about the risks of prescription opioids.

States are critical in preventing opioid overdoses. Through the Overdose Prevention in States (OPIS) effort, CDC is working with 45 states and Washington D.C. to provide scientific expertise, enhanced surveillance activities, and support resources to prevent risks of opioid use disorder, overdose, and death. The resources and information from this effort help combat prescription and illicit opioid abuse and overdose and is the heart of the CDC’s work on this epidemic.

Everyone can help stop opioid overdoses

The best ways to prevent opioid overdose are to: (1) improve opioid prescribing practices, (2) reduce exposure to opioids, (3) prevent misuse, and (4) treat opioid use disorder. Anyone can take action to help end the opioid overdose epidemic. You have a role in preventing opioid-related overdoses.

You can take steps to reduce your risk for prescription opioid misuse and help prevent opioid overdose deaths in your community:

  • Learn more about prescription opioids so you can help those at risk for opioid use disorder and overdose in your community.
  • Practice responsible use if you are prescribed opioids for pain and work with your doctor to ensure you are getting the safest, most effective pain management possible.
  • Help those struggling with addiction find the right care and treatment. Anyone who takes prescription opioids can become addicted and help is available if you or someone you know is battling opioid use disorder.
  • Spread the word and increase awareness in your community about the risk and dangers of prescription opioids. By sharing campaign materials you can broaden the reach of the message that, “It only takes a little to lose a lot.”
  • Know the signs and symptoms of an opioid overdose to help prevent opioid overdose death. If you suspect someone is overdosing, it is important that you don’t leave the person alone and that you call 911.

Learn more

We want to hear from you!

Comment below if you have you noticed the Rx Awareness campaign in your community.

Evaluating Communication Campaigns

Black man holding belly of his pregnant wife making heart. Pregnant woman and loving husband hugging tummy at home. Heart of hands by multiethnic couple on pregnant belly.

Health communication and marketing campaigns that promote positive behavior change are a cornerstone of public health and behavioral science. Designing and implementing quality campaigns on a tight budget and in an urgent timeframe is a challenge that most health communication professionals share. Research and evaluation are critical for a successful campaign. CDC is using leading research and evaluation methods to develop quality campaigns, while keeping costs low and sticking to tight timelines.

A great example is CDC’s design and implementation of The Domestic Readiness Initiative on Zika Virus Disease, also Domestic Zika Campaign: By the Numbers. Since its launch in early summer 2016, the campaign has generated over 350 million impressions and nearly 555,000 clicks across search, social, and display in the United States. In Puerto Rico, the campaign got over 10 million impressions, and 26,000 clicks on a range of media buys that covered the entire island.known as the Domestic Zika Campaign. This bilingual digital campaign sought to increase Zika awareness among the general population and expectant parents in the United States and its territories. Campaign messages were also developed to change knowledge and attitudes regarding Zika transmission, beliefs about the risks of Zika, and the perceived ability (self-efficacy) to protect oneself against Zika.

CDC identified several methods to get tailored messaging to our target audiences. Based on the work for this campaign, there are 10 methods that can help you reduce costs and improve the efficacy of your communication or health marketing campaign.

Formative Research

  1. Use “mixed” methods or alternative approaches. When feasible, mixed assessment techniques can enhance and complement different types of data collection. Your budget may not allow you to conduct in-depth formative research, but you can use one primary research or evaluation method and then supplement with other methods that are less costly. For example, conducting qualitative focus groups might not account for all of your audience segments, but you could perform a literature search to complement your qualitative data. Additionally, when circumstances dictate, sometimes substituting one evaluation activity for another may be just as effective (or close to it). During the Domestic Zika Campaign we used “triad” interviews, which only involved three participants, when we did not have the time or the budget to conduct a full suite of focus groups, and this was supplemented with previous survey data on closely related topics.
  2. Invest in market data. Public, non-proprietary market data, such as data from the US Census, PEW, and Gallup, allow you to get to know your audience at no cost. Outside marketing firms may also be willing to share “older” proprietary data that may be from a year or two ago at little or no cost. During the Domestic Zika Campaign, secondary data donated from Annenberg surveys(?) were key to our analysis of each of our target demographics’ media habits and informed the mass media and digital media strategies and plans. The cost is your time in building relationships with like-minded partners and analyzing the data for a specific purpose.
  3. Identify alternative data. When traditional surveying of knowledge, attitudes, and behaviors is not feasible, sometimes you can use alternative data (usually less expensive). During the Domestic Zika Campaign, we did not have sufficient time to get approval for our survey from the Office of Management and Budget (OMB) and field a traditional campaign evaluation survey. Instead, to meet our tight timeline, we acquired data about our audiences’ insecticide purchasing behavior in the stores where our advertisements had been placed, and compared them to similar product purchasing data from stores that did not display our advertisements. Building partnerships with organizations who have data, even from related issues, that can offer insights to you is a great long-term investment in both implementing and evaluating programs—especially when we have a shared commitment to protecting people from diseases.

Monitoring & EvaluationDigital Media in an Emergency. During a public health emergency or disease outbreak, even a small number of strategically placed, paid digital media spots can deliver messages to those who need them most. This type of message can often be placed within 24 – 48 hours. During the Zika response, CDC developed and executed behavioral intent studies using data collected by Google Health and Nielsen to study the effect of media exposure on audiences’ intent to take action to protect themselves from Zika. • We monitored exposure to digital campaign banners on the Google Display Network and compared those exposures to an increase in internet search for specific Zika-related terms. • We employed channel-targeted messaging, which helped to amplify CDC’s weekly Zika theme content on Facebook to reach audiences beyond the people who were already following the CDC page. This cost-efficient strategy extended the reach of posts to tens of thousands more people within the specific geographic areas.

  1. Take advantage of social media analytics. Social media platforms like Facebook, Twitter, Instagram, and Google AdWords allow you to target specific geographic areas and have built-in analytics tools that the user has access to at no additional cost. The Domestic Zika Campaign used data analytics to look at the performance of specific advertisements and the corresponding click-through rate to Zika-related campaign websites. Using social media platforms as a primary channel for the campaign allowed for more precise audience targeting, rapid message modifications, and real-time metrics. Using the data, we developed tailored advertisements that engaged key audiences and encouraged them to take preventive actions. For example, one of our treatments, the “carousel advertisement format” on Facebook, had the highest engagement with our target audience and provided a platform to communicate in-depth information about actions people could take to prevent Zika infection. Most organizations have access to someone who specializes in web analytics who can offer their insight.
  2. Conduct A/B testing. A/B testing is a way to compare two versions of something to figure out which performs better. A/B testing is used to assess different options of campaign messages or creative concepts in real time and measures which one people actually use more among different channels, such as Facebook and Twitter. The Domestic Zika Campaign tested messages and materials on a number of social and digital platforms to determine which channels our audience preferred. For example, we conducted an A/B test of an existing “Cover Your Body and Use Repellent” advertisement against two new advertisements that presented the “Cover” and “Repellent” content as two separate messages. We conducted a qualitative analysis of user comments on the advertisements and found that users had a negative reaction to the “Cover” action step given the high temperatures in areas with risk of Zika.
  3. Refresh your materials. Build in regular measurements to track and observe public response and evaluate public complacency towards your campaign to avoid a decrease in behavioral change outcomes. This can occur for two reasons: 1. Message fatigue, when the attention of your target audience is reduced because they have had repeated exposures to the campaign messages; or 2. Risk fatigue, when your audience no longer receives or responds to messages about the health threat.  You can refresh and adjust your campaign messages without creating new messages from scratch. During the second phase of the Domestic Zika Campaign we revised materials that were targeted towards men by adding images of males with their pregnant partners because we were informed by both women and men that they had become complacent about behaviors men could perform to protect both themselves and their partners from Zika virus infection and transmission.

General Rules of Thumb

  1. Do not reinvent the wheel. Know what is available in your organization.  Do you have existing contracts in place to purchase things quickly.  If you have to get permissions to do research, do you have processes in place to navigate them efficiently? As a federal agency, anytime we want to ask more than 9 people a question, we have to get approval from the Office of Management and Budget, which typically takes many months. Knowing this, CDC set up a process called the Health Message Testing System, which is generic request set up in advance with OMB that programs can use to quickly get permission to test a specific message with a specific audience. These approvals can be obtained in days instead of months.
  2. Track current events. Scan and track prominent news and social media. Be aware of current events and issues that arise over the course of your campaign. The news media will cover what is timely, and you can take advantage of this coverage to enhance your campaign efforts. During the initial phase of the Domestic Zika Campaign, the proposed use of the chemical pesticide Naled in Puerto Rico created a controversy for public health and government officials on the island. Tracking the controversy allowed us to address this issue by adding a media relations effort to the campaign and provided more opportunities to disseminate the most effective prevention messages.
  3. Partner with influential bloggers. Influential bloggers can help enhance and further disseminate your campaign messages, increasing the reach to and saturation of your target audience. One of the main goals of the Domestic Zika Campaign was to amplify CDC’s Zika prevention messages. We worked with a well-known television news celebrity who was pregnant and chose not to attend the summer Olympics in Rio de Janeiro, Brazil. We pitched the story to mom and parenting bloggers and packaged it with CDC-branded messaging and the opportunity for an interview with a CDC subject matter expert. The cost of working with a blogger can vary, and you need to vet them carefully, but there can be great benefits by partnering with someone who is a natural fit for your cause and/or message content AND who is already reaching your target audience.
  4. Welcome donated media. Opportunities may arise for you to take advantage of “value-added” or donated media, which can help extend your communication efforts and increase the number of measurement points to evaluate. If you purchase a large number of services, the outside vendor might be willing to add additional advertising or other activities so the campaign will not incur any additional costs. For instance, we acquired donated time for the public service announcements developed by the Domestic Zika Campaign to run in movie theaters in Puerto Rico.

Do you have any other suggestions to improve the quality and timeliness of health marketing and communication campaigns on a budget? Please leave a comment below.

Fred Fridinger is a Senior Health Communications Specialist in the Office of the Associate Director for Communication (OADC). During his 22- year career at CDC, he has worked on various campaigns and communication efforts, including those addressing moderate physical activity and healthy eating, genetics, chronic fatigue syndrome, and Zika prevention. In his current position, he oversees the market research function for OADC, which involves the Porter Novelli Styles and Nielsen Scarborough syndicated data bases.

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.

7 Ways to ‘Be Gutsy’ this March!

Let’s face it: your colon isn’t exactly a dinner party topic. It takes a lot of guts to bring up colorectal cancer—to your parents, your spouse, your doctor, your friends. Don’t be afraid to pipe up about the second-leading cancer killer of both men and women, because it’s proven that simple steps save lives.

Here’s how you can Be Gutsy for colorectal cancer prevention:

  1. Digest some information. CDC’s Screen for Life: National Colorectal Cancer Action Campaign gives you the lowdown on what colorectal cancer is and who can get it. (Hint: it’s anybody, but there are ways to lower your risk.) You can hear celebrities like Meryl Streep share how colorectal cancer has affected their lives, share graphics and facts, and even test your knowledge with a quiz.
  2. Get yourself a little screen time. Be famous for smart choices—there are lots of different screening tests for colorectal cancer. Most colorectal cancer cases happen in people 50 and older, so if you’re between 50 and 75 years old, experts say you should be screened. Remember, the best test is the one that gets done!
  3. Go history hunting. Some people are at higher-than-average risk for colorectal cancer. If you or a family member has had it before, you could be at risk. You’re also more likely to get it if you have an inflammatory bowel disease like Crohn’s or certain genetic illnesses. Talk to your doctor about whether you should be screened.
  4. Trust your gut. The point of recommended colorectal screening is finding growths called polyps that can turn into cancer if left alone. But if you’re having symptoms like stomach pains or weight loss for no reason, or if you see blood when you use the bathroom, talk to your doctor. Other problems than cancer can cause these symptoms, too.
  5. Scale it back. Here’s one a lot of Americans still don’t know: being overweight or obese is associated with at least 13 different types of cancer, including colorectal cancer. Healthy eating and physical activity help keep weight down and lower risk.
  6. If you drink, think. Drinking too much alcohol can cause your health to take a hit. That includes a higher risk of colorectal and other cancers, as well as other problems that might come up now or later in life.
  7. Quit for quality of life. Cigarette smoking can cause colorectal cancer and other cancers outside the lungs. If you smoke, you can cut your cancer risk by quitting now. You’ll do friends and family a favor, too, by keeping them away from damaging secondhand smoke.

You have the tools and know-how to lower your risk of colorectal cancer. Be Gutsy and spread the word!

Responding to Emergencies One Behavior at a Time

A group of Ebola response volunteers in Nigeria.

To improve the health and safety of people in the United States and around the world, we have to influence and change behaviors. It can be difficult to try new things, or stop old things as behaviors range from simple to complex, but one way to consider behavior change is to think of any change as a passive or active choice.

Public health practitioners must think about interventions in terms of the behaviors they are asking people to adopt, stop or continue. What would encourage someone to change what they are currently doing? Before you can influence someone’s behavior or change their choices about a behavior (risky or protective) you need to know how their judgments and decisions are made about that behavior in the first place.

Behaviors are rooted in traditions

During the Ebola response behavior change was critical to prevent people from getting sick and ultimately stop a disease threat. In the wake of the outbreak, communities in West Africa were encouraged to give up or change their traditional burial practices. Some of these longstanding rituals, like washing the body, proved dangerous because the virus can live on the skin of a victim after death. Communicators developed public health messaging to help change social norms and customs for burials. It was important to understand behavioral science and anthropology in order to communicate about safe burial practices in a way that would make people choose to change a behavior that was ingrained in their culture.

Behaviors are rooted in social 7 Things to Consider When Communicating About Health. Trust: Will people trust the information? Who is the best source to put the information out? Information: What information is necessary, and how will people find it? How much is enough, or too much? Motivation: How relevant is the information to the people we’re trying to reach? Environment: What are the conditions that surround and affect the audience? Capacity: What is people’s ability to act on the information? Are there barriers? Perception: What will the audience think about the information? What will inspire them to act on it? Response: How will people respond? What can we do to stay engaged with them and give them support as they take action?norms

The 2016 Zika virus outbreak is the first time in more than 50 years that a virus has been linked to serious birth defects. Due to the impact of Zika virus infection during pregnancy, social norms and perceptions around provider visits had to be addressed to alleviate concerns about the cost of screening. Clinicians were educated about the risks associated with Zika virus, how to prevent infections, and reporting suspected cases to their state, local, or territorial health departments and women were offered free clinical services, education, and access to Zika prevention kits.

Behaviors are rooted in beliefs

The fight to eradicate polio teaches us the importance of beliefs in behavior change during a response to a public health threat. Creating an effective polio vaccine was only the first step in the effort to eradicate polio. Of course an effective vaccine was necessary to prevent polio virus infections, but getting communities to accept the vaccine was equally important. Public health practitioners created messages that build on cognitive, developmental, and social psychology to persuade parents to bring their children into clinics to get vaccinated.

Behaviors inform preparedness and response

Responding to emergencies effectively requires combined expertise in many fields, including behavioral science. Epidemiology, for example, allows us to understand how many people have a disease and characterize the disease, while behavioral science identifies the role of human behavior and psychosocial factors. Behavioral science expertise can identify methods to communicate and design campaigns to change behavior that are culturally and socially acceptable.

It is important that we maintain humility when we try to understand why people do or think what they do. We often assume that we understand human behavior, but we must remain open-minded when working with people from all different backgrounds and cultures. Who’s to say that what our culture considers right and true necessarily translates to the same belief systems elsewhere? Thus public health ethics is also an important consideration when suggesting behavioral change interventions. When we are in situations that are particularly dangerous or stressful, our assumptions about other people’s behavior can lead to recommendations or actions that seem counterintuitive or wrong to them. Careful application of behavioral science is critical to any mission that seeks to improve public health and safety, here and around the world.

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.