It's What You Do! Reflections on the VERB™ Campaign

Introduction 

The VERB™ campaign began because the U.S. Congress was concerned about childhood obesity and children's poor lifestyle habits (e.g., being physically inactive), and they believed that it was important to reach children with health messages early in life using commercial marketing strategies.1

When we first heard that Congressional funding would be coming to CDC for a campaign to reach children with health messages through the media, we recognized that CDC stood on the threshold of a unique opportunity. It was unprecedented for Congress to fund a public health campaign that targeted children aged 9–13 years (tweens) directly and to provide $125 million for the first year alone. With this opportunity also came the challenge of bringing together the best practices of the commercial marketing, social marketing, evaluation, and public health fields. So, it was with excitement that we embarked on the path of bringing these worlds together to improve children's health.

The papers in this supplement2, 3, 4, 5, 6, 7, 8, 9, 10, 11 to the American Journal of Preventive Medicine give readers a glimpse into the issues, ideas, and experiences we gained in bringing commercial and social marketing techniques to a public health issue. Along the journey, we learned how to brand a health behavior, reach tweens in an ever-changing media environment, and leverage the campaign's nonmonetary assets to engage communities in the campaign.

Other articles in this supplement describe the campaign components, present the methodology for the evaluation, and use evaluation data to address several research questions. In this introduction, we reflect on our experiences directing CDC's Youth Media Campaign (VERB™ It's what you do!) and offer anecdotal evidence using the strategies and tactics to illustrate our insights. In addition, we point to the other articles in this supplement to describe how we rose to the challenge to create the VERB™ It's what you do! campaign and inspired tweens to increase their levels of physical activity. As of this writing, two descriptive papers12, 13 and two outcome papers14, 15 about the VERB campaign have been published elsewhere. The papers in this supplement build upon those papers.

Funding for VERB 

In fiscal year (FY) 2001, Congress appropriated $125 million and directed CDC to coordinate an effort to plan, implement, and evaluate a campaign designed to clearly communicate messages that will help kids develop habits that foster good health over a lifetime… [using] the same communication tactics that are employed by the best kids' marketers.1

To fulfill Congress's mandate, CDC created VERB, a campaign based on social marketing principles that involved paid media advertising, promotions, and national and community partnerships to encourage physical activity among tweens.1, 12, 13 Congressional appropriations in subsequent years were $68.4 million in FY 2002,16 $51.3 million in FY 2003,17 $36 million in FY 2004,18 and $59 million in FY 2005.19 This funding allowed us to purchase media time and create in-school and community promotions to reach the audience and to compete on an even playing field with commercial marketers who were also advertising to tweens.

Marketing to Tweens 

The VERB campaign was a complex, multi-component one, staffed by a team spread across the U.S. and operated in the fast-paced world of advertising and marketing. The team included CDC staff; advertising and public relations agencies (including four agencies that each specialized in reaching a specific ethnic audience); and an independent contractor to evaluate the campaign's effectiveness (Table 1). The campaign's extended team included numerous media organization partners (e.g., Nickelodeon, ABC Disney); it was launched nationally in mid-June 2002 and ended on September 30, 2006.

Table 1. Agencies that VERB contracted with for advertising, marketing, public relations, and evaluation services

	Agency	Location	Agency type	Target audience
	General-market creative agencies
	Frankel, an Arc Worldwide company	Chicago IL	Marketing	General public
	Saatchi & Saatchi New Yorka	New York NY	Advertising	General public
	Publicis Dialogb	Chicago IL	Public relations	General public
	Manning, Selvage & Leec	Washington DC and New York NY	Public relations	General public
	Leo Burnettd	Chicago IL	Advertising	General public
	Ethnic audiences creative agencies
	APartnership	New York NY	Marketing	Asian Americans
	PFI Marketing	New York NY	Marketing	African Americans
	G&G Advertising	Albuquerque NM and Billings MT	Marketing	American Indians
	Garcia 360°	San Antonio TX	Marketing	Hispanics/Latinos
	Evaluation agency
	Westat	Rockville MD	Research and evaluation	Not applicable

a Campaign Years 1–3 b Campaign Years 1–2 c Campaign Years 3–4 d Campaign Year 4

The decision to brand physical activity was a direct result of the Congressional mandate, which said that we should use the same communication tactics that are employed by the best kids' marketers.1 We live in an enormously crowded media environment where advertising messages abound. In 2001, Kunkel20 estimated that on average each child views more than 40,000 television commercials each year, double the number children saw in the 1970s. Advertising of foods and beverages alone cost more than $11 billion in 2004, with $5 billion spent on television advertising.21 Indeed, the nation's youth are savvy consumers in a quickly evolving world filled with a myriad of media options, and they are more technologically advanced than any previous generation.22

Any new public health program that tries to reach tweens must compete within this crowded media marketplace. VERB was no exception. Therefore, we hired professionals with commercial marketing experience in advertising, public relations, branding, and marketing to youth for CDC's internal campaign staff. They became VERB's creative team within CDC. We also contracted with agencies with proven track records in marketing to youth, contracting separately for marketing to the tween population as a whole (i.e., the general market) and for marketing to each of four minority ethnic audiences (i.e., African Americans, Asian Americans, American Indians, and Hispanics). We believed that targeting messages specifically for each of these audiences was important for ensuring that all of the nation's youth would be reached by the campaign. Huhman et al.4 describe the marketing tactics of each ethnic agency.

The CDC's creative team propelled us rapidly forward in developing the brand, initial marketing strategies, and advertising products. The team members understood the operations of advertising and marketing agencies and were familiar with the high costs associated with a paid media campaign. However, they and the contracting agencies had to learn public health, government rules for doing business, and the best way to work with CDC and the USDHHS. In contrast, CDC's public health staff had to learn commercial advertising and marketing to youth.

By the end of the campaign, the strategies employed and products developed garnered over 50 industry awards. Recognition from peers in the advertising and marketing industry provide an indirect measure of the degree to which this campaign was able to employ innovative commercial marketing strategies and compete within the tween media market.

Marketing Physical Activity to Kids 

We used the commercial marketing techniques commonly used by U.S. manufacturers and businesses. Marketing management is the art and science of choosing target markets and building profitable relationships with them.23 We followed standard industry practices: segmenting the market, selecting a target audience, defining and positioning the product, selecting a marketing mix, and managing the efforts. Through this process, we developed a relationship between tweens and our product. We believed that what we were selling—physical activity as a fun and cool way to spend time—was something tweens would buy.

A key decision was to brand our product (physical activity). Branding is a common approach of commercial marketers to reach their target audience, but one that is seldom used by public health agencies. To brand physical activity as “fun” and “cool,” we first had to create a name and logo that would convey the desired image of the product to the target audience and that would also generate a positive attitude toward physical activity among tweens. Asbury et al.,2 in this issue, provide an overview of the branding methods and the way in which we applied them; they also describe the research findings that led to the development of the brand itself and the concepts underlying the development of the brand strategy. Through a research-informed process with tweens, parents, and influencers, we chose the name VERB™ and the tagline It's what you do! 2, 6 The brand connotes children having fun while being physically active.

A vital component of any branding strategy is to ensure that all messages about the brand reflect the brand's core attributes.2, 24 The core attributes of the VERB brand of physical activity were that it was fun, provided opportunities for exploration and discovery, and gave children many ways to socialize with friends.2 Everyone involved with the campaign, including private and public partners, had to incorporate these attributes into whatever VERB activities they implemented. This brought consistency to all campaign messages and activities while allowing each creative agency, media organization partner, and national or community partner to create original materials that used the VERB logo and the brand's core attributes. For communities in particular, this allowed them to leverage VERB's popular appeal to tweens, apply it to local programs, and achieve a more successful result than they could have achieved without VERB.5 The expectation that these attributes would be incorporated into all VERB-related programs was communicated to everyone involved in the campaign so that messages delivered to tweens were “on brand.”

The initial campaign strategy was not without the need for corrections. In the beginning, VERB delivered broad social messages to tweens, messages that encouraged tweens to be physically active and to be socially involved (e.g., take dance lessons with other kids, join the orchestra or debate club). However, experts at a meeting convened by CDC about 6 months after the campaign was launched observed that combining physical activity and pro-social messages was confusing; we were, in fact, sending a mixed message to tweens to be both physically active and sedentary. We were advised to focus on only one outcome objective. From that point on, the campaign's message was focused squarely and solely on getting tweens to be physically active.

Segmenting the Audience and Targeting Tweens 

The campaign messages were delivered to tweens directly, not through their parents or teachers. Tweens (children aged 9 to 13) are at a pivotal age: They are actively exploring the world around them, increasingly making their own decisions, emerging from childhood, and becoming independent of their parents.22 Targeting this age group allowed us to address a population at a critical time in their lives, when the foundation for lifelong behaviors is being established. The advertisements and messages were designed for, and tested with, this population.2, 4, 6 Berkowitz et al.6 describe the audience research process. Having the campaign team talk with tweens through formative research was critical. Not asking tweens' opinions or not listening to tweens could have resulted in pricey mistakes. Advertising production costs, especially for television, are expensive and neither funds nor time were available to start over. Therefore, we took the messages directly to tweens using kid language and through kid media channels, channels that kids valued (e.g., Nickelodeon, Cartoon Network, ABC Disney, Sports Illustrated for Kids, Teen People). VERB was a true for-kids-by-kids brand and campaign. Tweens talked. We listened and acted on what they said.

The parents of tweens and adults who influence them (e.g., teachers, youth leaders) were VERB's secondary audience.11, 12, 13 Instead of asking adults to be messengers for VERB, we asked parents and influencers to encourage, support, recognize, and reward tweens for being physically active. However, a tradeoff to creating a kid-owned campaign delivered through kid–popular channels was lower recognition and understanding of VERB among adults because they were less exposed and less directly involved with the brand. Price et al.11 detail the efforts to reach parents. Their article also discusses parental awareness of VERB and parents' attitudes and beliefs about physical activity.

Another contributing factor to lower recognition was the position we took initially in being highly protective of VERB as a for-kids-by-kids campaign. The result was a delay in building support for VERB among partner organizations and professional colleagues. In retrospect, a public relations strategy to inform and establish an understanding of VERB as a kids' marketing campaign and how they could support the campaign's goals might have been helpful. We did this internally within CDC; however, in our attempt to protect the “coolness” of VERB for tweens, we overlooked the importance of timely outreach to adults to gain their early buy-in. Doing so may have allowed us to more easily build grassroots and community support for the campaign, and do it sooner.

Positioning the Product: We Sold the Pleasure, Not the Pain 

To sell a product (physical activity or anything else), it is important to understand everything about the product. Figure 1 illustrates the many dimensions of physical activity to tweens. To tweens, physical activity is not just about being physically active—it is also about making social connections, increasing self-esteem, acquiring expertise, being inspired, having fun, being creative, and being in control. The promises of these attributes were all important motivators for us to use when selling physical activity to tweens.

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Figure 1. The many dimensions of physical activity for tweens. Source: Frankel, an Arc Worldwide Company.

In contrast to many health messages delivered to children, including those about physical activity, VERB messages were positive and can-do, not negative and don't do.2 With positive messages, the campaign could empower children to make their own choices and increase the likelihood that VERB would inspire tweens to engage in physical activity. After all, at their age, tweens are looking to assert control over their own behavior and lives.22

The Right Media Mix: We Controlled Where and How Frequently Advertisements Were Placed 

It helps to have money. For 5 years, the VERB campaign had dedicated Congressional funding to formative research and brand creation to purchase television, radio, print, Internet, and out-of-home (theater, billboard) advertising. In contrast to PSA campaigns, which rely on donated media time, VERB controlled where, when, and how frequently the VERB advertisements appeared and we did not need to compete with other PSAs for limited free advertising time. The resources also allowed us to create new advertising materials across a variety of channels on a regular basis, allowing us to capture attention with novel messages and avoid wear out or boredom with the advertisements. This control guaranteed that VERB's physical activity messages would reach tweens with sufficient frequency to be remembered and to motivate them to follow through on VERB's call to action—to get out and go play.

Another important way VERB stood out was in how messages were delivered to audiences. Heitzler et al.3 discuss how we used experiential marketing tactics to create opportunities for tweens to experience having fun being physically active and to be excited by it. We also took advantage of the technologic and digital advancements that are transforming the way messages are delivered. Youth are comfortable using multiple communication media simultaneously and, increasingly, use personal media devices to communicate with each other. With that knowledge in mind, we designed an interactive website for tweens and created content for it that was refreshed regularly. However, designing a website that resonated positively with tweens took some time. Web-usage data during the first 6 months suggested that some parts of the website were not grabbing tweens' attention. Thus, we redesigned it to include more activities and game-oriented material, and prior to its launch, evaluated the usability of the site and tweens reaction to the redesign.

Over time, we learned how to integrate and leverage the advertising, marketing, and website activities to effectively reach tweens. For example, for “Yellowball,” the VERB campaign's final national activity promotion, we distributed 500,000 large yellow balls printed with the VERB logo to tweens throughout the country; encouraged them to play with the balls; go to VERB's tween website to blog about how they played; and then pass the balls on to friends or family members to encourage other children to play. At the VERB website, the tweens could also create a video of kids playing with the VERB-branded yellow balls and e-mail it to their friends. This provided a virtual experience, especially for tweens who had not directly received a VERB yellow ball.

In addition, with the permission of parents, VERB sent text messages to tweens' cell phones or computers reminding them to play. For example, during a 3-month promotion in summer 2005, 19,486 tweens signed up to have a text message sent to their cell phone reminding them about fun activities to get out and play. This created opportunities for tweens to discover VERB right in their own world.

We Invested in Evaluation 

The importance of evaluating programs is well accepted; however, for a variety of reasons, it is frequently not done or not done well. Most often, the reasons are a limited program budget, diversity in the interventions, or difficulties measuring the outcomes or in making causal claims. Following CDC's evaluation guidelines,25 we developed a logic model that drew on behavioral science theory, physical activity literature, and public health practice to show the outcome goals and various pathways to achieve them.12 It was the foundation for strategic planning and message development. The logic model guided CDC's funding decisions to ensure that reaching tweens was not compromised when we faced reduced Congressional appropriations. The evaluation activities included formative, process, and outcome measures. Berkowitz et al.6 discuss the evaluation process in detail.

From the outset, our commitment to invest in evaluation put us in a unique position to describe the campaign's effectiveness. We were able to collect baseline data as a point of reference for outcome evaluation, an advantage many campaigns do not have.14 Potter et al.7 describe the importance of these data and how we used propensity score analysis to examine the campaign's effectiveness. Huhman et al.8 discuss the campaign's short-term effect on tweens' awareness of VERB and how we used the data on awareness to refine campaign activities. As Congressional funding for the campaign decreased, we continued to give funding priority to protecting the integrity of the longitudinal evaluation design.14 As of this writing, two outcome papers have been published14, 15 and a summative outcome evaluation paper is in preparation.

Because of CDC's strong commitment to evaluate the campaign rigorously, the evaluation findings add to a growing body of evidence that a well-planned and executed paid media campaign can be an effective public health intervention.10, 14, 15 Berkowitz et al.10 demonstrated that increasing the amount of marketing can increase levels of awareness and levels of physical activity. In addition, analytical methods for evaluating national media campaigns were advanced.7, 26 Bauman et al.9 were also able to add to our understanding of how media campaigns affect behavior by testing McGuire's hierarchy-of-effects model27 and examining the mechanisms through which media effects occurred.9

We Worked Upstream; We Worked Downstream 

Andreasen argued that for social marketing efforts to be effective, they must focus not only downstream on bringing about individual behavior change, but also upstream on the structures and processes that bring about societal change.28, 29 Focusing upstream allows the campaigner to address environmental barriers that impede individual behavior change. From the outset, VERB looked at both individual and structural changes. The advertisements targeted individual behaviors. Yet, we believed that for behavior change to be sustainable, we needed to have communities remove environmental and structural barriers that inhibit physical activity.5 Therefore, we created a CDC partnership team charged with working upstream to foster relationships with communities and organizations that serve youth. Bretthauer-Mueller et al.5 detail how we provided resources and technical assistance to national and community partners to create or improve supportive environments for physical activity and thus provide opportunities for children to be physically active.5

Going Upstream and Downstream Created Waves 

Oil and water don't mix. At times, this adage described how the commercial marketing and public health worlds related to one another during the VERB campaign. Views between the two worlds diverged (Table 2), in particular their views with regard to return on investment (ROI) and on the role of community involvement in a national campaign. It took time and persistence for the VERB staff to learn how to bring the two worlds together for a win–win outcome.

Table 2. Comparison between the characteristics of public health and marketing

	Characteristic	Public health	Marketing
	Main goal	To persuade people to adopt healthy lifestyle behaviors	To sell products and services and earn profits
	Function	To conduct scientific research, translate research into practice, design and implement evidence-based interventions, and base messages on scientific evidence	To devise psychosocial, ethnographic, and market-based messages and strategies to encourage people to buy products and services; to be creative and devise new strategies and tactics to reach audiences
	Approvals	Follow government and agency policies and rules, and comply with agency clearance procedures (can be lengthy)	Follow copyright, trademark, and, contest and sweepstakes rules, campaign brand guidelines, and media organization partner policies and guidelines. Attention to timely approval process
	Pertinent laws	Comply with child protection laws	Comply with child protection laws
	Style for messages	Fact-based information clearly stated	Create fun, cool, edgy brand with emotional connection to targeted consumers and cutting edge strategies and tactics.
	Pace	Generally slow: government agencies are complex, can involve multiple layers of vetting, and priority is on being inclusive	Generally faster: efficiency is important; time is money and delays increase costs
	Focus	On long-term lifestyle behavioral outcomes	On short- or medium-term outcomes
	Evaluation	Carefully designed and scientifically rigorous evaluation	Quick assessment of the short- and medium-term return-on-investment

Return on Investment 

The VERB campaign was government-funded, but the commercial advertising world in which VERB existed is for-profit and driven by a desire for short-term ROI. Producing a good ROI meant, first, creating break-through or attention-grabbing advertising concepts and cutting-edge marketing strategies and products and then delivering them to as many tweens as possible using as little time, resources, and effort as possible.23, 24, 30, 31 The marketing and advertising agencies approached CDC and the VERB campaign in the same way they approach a commercial client. Their goal was to increase physical activity by the most tweens they could reach in the most cost-effective manner. Commercial advertisers and marketers do not expect, nor do they try, to reach every single consumer and have everyone as a customer. Often the income derived from reaching the last segments of a group of potential consumers is outweighed by the costs of reaching them. Therefore, the return on the additional investment would be relatively low, causing the marketer not to pursue those difficult-to-reach consumers. Yet, for a public health agency, the most-difficult-to reach segment may be the segment at greatest risk for disease and is the segment that public health desires the most to reach. Although public health and commercial marketers both seek a good ROI, the ROI for public health is often measured much further into the future than the ROI for commercial marketers. Public health wants long-term behavior changes (or profits); commercial marketers want or need only more-immediate profits. It takes time to achieve the public health goals of health behavior change or improved health outcomes, but the potential long-term payoff of investing in helping people in communities throughout the U.S. to prevent disease and live healthy lifestyles (including being physically active) could be substantial.

Partnering with Community Organizations 

The campaign struggled particularly with defining the role of community partners in a national marketing campaign during the first year. As a public health agency, we wanted to engage communities as campaign partners. Public health actively builds the capacity and engages communities in addressing their own needs. Moreover, individual communities want ownership and a voice in what happens in their own backyard, which often isn't practical or efficient in the private sector. The creative agencies and media organization partners were unfamiliar with working with individual communities as partners. Inviting community input on business decisions or customizing campaign activities and schedules for individual communities, although expected initially by the community partners, was difficult to accommodate. Additionally, for in-market activity promotions that were owned by VERB's media organization partners, community partners did not understand that the media partners controlled the decisions affecting their own programs, not the creative agencies or CDC.

These community partners were also unfamiliar with branding and the need to protect the brand, especially a new, not-yet-established brand. One key element of a branding approach is ensuring that all communications to the target audience are “on brand,” remaining true to the brand personality and contributing positively to its equity.23, 24, 30, 31 The CDC creative team and the creative agencies ferociously protected the VERB brand as they would any valued commercial brand, especially in its infancy. Creativity, efficiency, and quality were achieved by having direct control over the planning, production, and execution of advertising and in-market programs and activities. Tactics and activities that might diminish positive perceptions of the brand by tweens were avoided. Moreover, although communities wanted to create their own marketing and other materials for tweens, our need to protect the brand won out in the initial years of the campaign. This was a source of tension for all involved.

In retrospect, VERB was experiencing the same cart-before-the-horse reality that many new programs encounter, adding to the challenge of bridging the gap between brand protection and community partnerships. Community partnerships were started simultaneously with planning and creating the campaign—before the brand creation was complete and initial campaign strategies and products developed. In essence, we had community partners but little to share with them because the VERB brand and campaign itself was still being defined.

Finding Ways to Engage Communities 

The initial strategy to engage communities was to ask them to “supply” or bring children to VERB-sponsored events. An early in-market campaign strategy was for the VERB campaign to associate itself with kid-popular brands; thus, we sponsored Nickelodeon's Wild & Crazy Kids TV show and mobile tour. We brought the mobile tour to targeted communities and relied on community partners to identify and transport tweens to VERB-sponsored events scheduled on specific days and times.5, 10 We learned through this experience that transporting hundreds of tweens to scheduled VERB events was difficult, costly, and resource-intensive for community partners. It involved having community partners pay for buses and bus drivers, arrange for chaperones and lunch, and obtain parent permission for the participating tweens. The experience led the creative team and creative agencies to change strategies and provide national VERB activity promotions, mobile tours, and guerilla tours3 instead of in-market events. The change in strategy brought VERB to tweens instead of tweens to VERB.

Over time, the campaign developed nonmonetary assets that could be shared with communities, although receiving dollars would always have been welcomed by communities. One of the brand's best assets was that it was highly recognized nationally and popular among tweens.2, 8 In addition, since the VERB brand had become well established among tweens, and key community partners had time to learn about the campaign and the importance of brand protection, the creative team and creative agencies were more willing to accept the use of the VERB logo on locally-developed products. Community partners capitalized on this brand asset and leveraged it to support local initiatives. Indeed, community leaders were enthusiastic about bringing VERB into their local community—and being a part of this larger campaign themselves. The national advertising and marketing activities inspired tweens to be physically active. Local communities provided the places for kids to play. Because the campaign generated awareness and interest in physical activity among tweens, communities utilized their limited resources to ensure that opportunities for tweens to be active in their own neighborhoods were plentiful. See Bretthauer-Mueller et al.5 in this supplement for examples of these activities.

By using these nonmonetary assets, communities could bring the campaign home and create ownership of supporting local tweens to be physically active. Communities, in turn, could create an atmosphere and environment conducive to sustained tween physical activity that a national media campaign could not do alone.

Conclusion 

This article reflects on the challenges associated with directing the VERB campaign. These insights are the culmination of 5 years of lessons learned from first-hand experiences, trial-and-error, mistakes made and corrected, partner and stakeholder feedback, and campaign evaluation findings. The VERB team's commitment to rise to every campaign opportunity and overcome every challenge was fueled by a passion for making children healthier.

Congressional funding meant that we had the luxury of a paid media campaign and a robust intervention, which allowed us to buy media time and space during the times when tweens were most likely to see the VERB advertisements. Most public health campaigns without such funding rely on donated media time and space, which means airtime during the hours when the intended audience is unlikely to be watching or listening.

The need for a bridge between the public health's and private agencies' view of the world was paramount. The need to involve communities while protecting the brand challenged our thinking and was often a source of conflict. Yet, finding a solution was a necessary step for a public health agency using commercial marketing practices to reach tweens and deliver messages in a by-kids-for-kids campaign.

The VERB campaign was a champion for a movement to get tweens to be active, play, and have fun. In the long term, a nation of active tweens could help lower the prevalence of childhood and adult obesity. Communities can ride the momentum of the VERB movement and offer tweens inspiring and creative opportunities to be physically active every day right in their own neighborhoods.