1200 word literature review for 15 Articles + Questions

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ommunication and Marketing As Climate hange–Intervention Assets Public Health Perspective

dward W. Maibach, PhD, Connie Roser-Renouf, PhD, Anthony Leiserowitz, PhD

bstract: The understanding that global climate change represents a profound threat to the health and well-being of human and nonhuman species worldwide is growing. This article examines the potential of communication and marketing interventions to influence population behavior in ways consistent with climate change prevention and adaptation objectives. Specifically, using a framework based on an ecologic model of public health, the paper examines: (1) the potential of communication and marketing interventions to influence population behaviors of concern, including support for appropriate public policies; (2) potential target audiences for such programs; and (3) the attributes of effective climate change messages. Communication and marketing interventions appear to have considerable potential to promote important population behavior change objectives, but there is an urgent need for additional translational research to effectively harvest this potential to combat climate change. (Am J Prev Med 2008;35(5):488–500) © 2008 American Journal of Preventive Medicine

t b a t l t w o f

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ntroduction

Either we will achieve an awareness of our place in the living and life-giving organism of our planet, or we will face the threat that our evolutionary journey may be set back thousands or even mil- lions of years. That is why we must see this issue as a challenge to behave responsibly and not as a harbinger of the end of the world.

– Vaclav Havel former president of the Czech Republic1

he potential health effects of climate change have been reviewed extensively.2–7 Earth system changes, including rising temperatures, increas-

ng climate variability, increased rainfall in some areas nd drought in others, and more frequent severe eather events, have considerable potential to affect uman health. Severe weather events may result in

njuries and fatalities, and heatwaves can cause direct ffects such as dehydration, heat asthenia, heat exhaus- ion, and heat stroke; excess deaths during heatwaves esult primarily from underlying cardiovascular and espiratory diseases. Ecosystem changes can increase

rom the Center for Climate Change Communication, George ason University (Maibach, Roser-Renouf), Fairfax, Virginia; and the

chool of Forestry and Environmental Studies, Yale University (Leise- owitz), New Haven, Connecticut

Address correspondence and reprint requests to: Edward W. aibach, PhD, Center for Climate Change Communication, George

c ason University, 4400 University Drive, MS 6A8, Fairfax VA 22030.

-mail: emaibach@gmu.edu.

88 Am J Prev Med 2008;35(5) © 2008 American Journal of Preventive Medicine • Publish

he range, seasonality, and infectivity of some vector- orne diseases. Heavy rainfalls and related factors are ssociated with waterborne disease outbreaks, and hese may increase the risk of foodborne illness. Higher evels of carbon dioxide and heat may promote produc- ion of allergens (e.g., pollen) by such plants as rag- eed, and warmer weather may promote the formation f ground-level ozone. Humidity combined with heat acilitates fungal growth and transmission.

Potential indirect effects—for which data are less vailable and uncertainties are greater—include men- al health consequences, population dislocation, and ivil conflict. In addition, changes in the patterns of ests, parasites, and pathogens affecting wildlife, live- tock, agriculture, forests, and coastal marine organ- sms can alter ecosystem composition and functions, nd changes in these life-support systems carry impli- ations for human health.8 The burden of these onditions is expected to increase as climate change dvances. Successfully addressing climate change as a public

ealth threat will require both mitigation and adapta- ion strategies, or, in more common public health erms, primary and secondary prevention strategies. rimary prevention requires aggressive efforts to re- uce atmospheric levels of greenhouse gases, both by educing emissions and by sequestering gases already in he atmosphere (e.g., through reforestation). Second- ry prevention requires efforts to adapt to a changing

limate in ways that protect population health and

0749-3797/08/$–see front matter ed by Elsevier Inc. doi:10.1016/j.amepre.2008.08.016

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ell-being. Examples of adaptation include reinforcing evees in coastal areas, implementing heatwave pre- aredness plans in urban areas, and reforestation. There is an urgent need to influence people’s behav-

or—on a large scale or population basis—to help revent and reduce the burden of climate change on uman and other populations. Social and behavioral cience intervention methods offer important tools to his end. Here, two broad sets of tools—communication nd social marketing—are examined as assets for ounting a public health response to climate change. ommunication is defined as the production and ex- hange of information to inform, influence, or moti- ate individual, institutional, and public audiences, and ocial marketing as the development and distribution of roducts or services to influence behavior on a large cale for the purpose of societal benefit rather than ommercial profit.

First, a summary is presented of what is known about he drivers of population behavior, along with a frame- ork that organizes these influences. Current knowl- dge is then reviewed about (1) the potential of com- unication and social marketing to influence population

ehavior, (2) general public audiences for climate change nterventions, and (3) effective message strategies to nfluence these audiences. It is important to note that he majority of the research cited here was conducted ith people in the U.S., and that recommendations are ade primarily for the current American context. any of the general points, however, likely have rele-

ance to other developed nations and even to develop- ng nations.

nfluencing Population Behavior: Understanding he Challenge

he public health community, like many others, was low to recognize the threat of climate change. The hemes of World Health Day 2008 (Protecting Health gainst Climate Change) and National Public Health eek 2008 (Climate Change: Our Health in the Bal-

nce) make clear that the threat is now recognized. The eed for the public health community to mobilize its ssets against that threat is now obvious.

Fortunately, the public health community has much o offer. Perhaps most notably, this community has oth breadth and depth of experience in understand-

ng and responding to population behavior-change hallenges (see Text Box for an example).

Historically, when people fail to behave in ways that re in their own or society’s best interest—as judged by ublic health professionals, environmental scientists, nd other similar experts—the tendency has been to ssume that the cause must be either a lack of relevant nowledge on their part (i.e., an information deficit)

nd/or misguided attitudes. The prescription that has t

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ended to follow this diagnosis is: to change people’s ehavior, we must provide them with the knowledge hey lack and/or persuade them to change their ttitudes.15

In the public health community over the past several ecades, this “information deficit” view of population ehavior—although appealing in its simplicity and ap- arent face validity—has been largely supplanted by cologic views of population behavior. The “people and laces” framework (Figure 1) is one example of an cologic model.16,17 The framework describes popula-

Text Box

Chronic disease prevention provides an example of the type of challenges that climate change poses. Over the past several decades, the public health community has focused on understanding and preventing chronic dis- eases through population-based intervention strate- gies.9,10 Many of the underlying behavioral and eco- nomic factors that make chronic diseases so challenging to control in the modern era appear to have direct relevance to climate change control. For example:

● People have a strong innate tendency to value imme- diate benefits more than future benefits.11 Although many of the costs—including monetary (e.g., retrofit- ting buildings with energy-efficient devices), time and effort (e.g., using active or mass transit options rather than driving in one’s car), and social (e.g., challenging people’s preferences about whether dinner should include meat or not)—associated with prevention and adaptation are necessarily borne in the present, many of the associated benefits don’t accrue for months (e.g., reduced utility bills, reduced BMI), years, or even decades into the future (e.g., reduced global warming, heart disease averted).

● People have a tendency to consume resources in proportion to how available and affordable the resources are.12 In societies where resources are readily available and affordable (such as the U.S.), this tendency can lead to excess consumption, that is, consumption levels that exceed the individu- al’s—or society’s—best long-term interests. Well- documented examples of such excess consumption include calories and electronic media content.13

Production, distribution, and consumption of such resources are typically dependent on fossil fuels at present.

● People have a tendency to conserve physical effort expenditures.14 This innate human tendency has been greatly enabled in the developed world by the proliferation of labor-saving devices (e.g., cars, home appliances, power tools). Like other re- sources, the production, distribution, and use of these devices currently depends on fossil fuels.

ion health—and environmental outcomes—as being

Am J Prev Med 2008;35(5) 489

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etermined primarily by population behavior, which, in urn, is determined by people-related and place-related actors. The people-related factors that influence pop- lation behavior are organized into three levels of nalysis: individual-level factors (such as beliefs and kills), social network-level factors (such as behavioral odeling and social reinforcement), and group-, com- unity- or population-level factors (such as social

orms and collective efficacy). The place-related fac- ors—as identified by Farley and Cohen18—are de- cribed in broad terms as the availability and cost of roducts and services, the attributes of physical struc- ures, social structures (i.e., laws and policies), and the ultural and media messages in our communities. hese place-related factors manifest at two levels of nalysis: the local level and the distal level. Local-level actors describe people’s immediate environment— heir homes, schools, workplaces, and neighborhood hops—and influence population behavior only in a iven locale. Distal-level factors originate further field—in state, national, and multinational capitals, nd in the headquarters of multinational corpora- ions—and exert influence on population behavior ver wider geographic areas. The framework also ac- nowledges that place-related factors—for example, armful environmental exposures—can exert direct

nfluence on population health and environmental

igure 1. A “people and places” framework

utcomes, but the framework intentionally emphasizes n

90 American Journal of Preventive Medicine, Volume 35, Num

he role of human agency in causing or preventing hose environmental exposures.

The potential of communication and social marketing s means to influence population health and environ- ental outcomes becomes clear in the context of this

ramework. Specifically, most of the people- and place- ased drivers of population behavior potentially can be

nfluenced through communication and/or social arketing.

he Potential of Communication and Marketing to nfluence the Drivers of Climate Change–Related ehavior

emarkably little progress has been made in under- tanding how best to influence climate change–related ehaviors on a population basis, especially given the

ikelihood of severe negative consequences that may rise—including health, environmental, and economic mpacts.19 The research literature on individual climate hange–mitigation behaviors has focused primarily on our broad categories: household energy use, recycling, urface transportation behavior, and purchase of green” products.20 The research literature on individ- al-level adaptation has focused primarily on issues elated to increasing household preparedness against

atural disasters, such as hurricanes.21

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nfluencing Individual-Level Drivers of opulation Behavior

he intervention studies conducted to date have primarily ttempted to influence population behavior by targeting ndividual-level factors. The large majority of 38 recently eviewed household energy conservation interventions, or example, used communication to influence individu- l-level drivers of population behavior.22 In this and other eviews, several modes of communication have shown romising ability to reduce energy use23:

The provision of tailored or customized recommen- dations— based on home energy audits— has been shown in some (but not all) studies to reduce energy use in the range of 4% to 21%.24 –27

The provision of feedback (i.e., specific information about the amount of energy being used)— especially when the feedback is frequent or continuous— has been shown to reduce energy use in the range of 5% to 13%.28 –32

Encouraging people to set an energy- reduction goal—especially if they are given feedback about their progress toward the goal— has been shown to appreciably reduce household energy consumption.33,34

Using mass media to model behaviors of interest has long been known to be an effective population behavior-change strategy35; regrettably, only a single study that has tested this approach to influence climate change–relevant behavior was found. In that study, TV was used to model ways to reduce house- hold electricity use. The programming led to a 10% reduction in household electricity use, although the reduction was not apparent a year later.36

Eco-labeling programs have been shown to influ- ence population behavior—at least some people’s behavior under certain conditions.37 People who hold pro-environmental attitudes are most likely to be influenced. Moreover, to be effective, people must understand the label, must believe that the “green-designated” product offers meaningful envi- ronmental benefits, and must trust the organization that has given the designation (with government designations being more trusted than industry des- ignations).23 The effectiveness of eco-labeling pro- grams tends to increase over time as consumers develop trust in the labeling system.

A number of communication campaigns promoting household disaster preparedness have been evaluated. Their behavioral impact has ranged from no behavior change at all to a relatively great deal of public and household change.21 The more successful campaigns typically used what are now commonly accepted as

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good campaign design practices: simple clear messages b

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(e.g., specifying who is at risk, how severe and how certain the risk is, and what can be done to reduce the risk or diminish losses), repeated often (e.g., through a variety of interpersonal and media channels, electron- ically and in print), by a variety of trusted sources (e.g., scientists, community leaders, journalists).

Marketing interventions—in which improvements are ade to products or services, their prices and availability,

nd how they are promoted (to enhance their perceived alue to potential customers)— have also shown promise s tools for population behavior management with a ariety of climate change–relevant behaviors:

Financial incentives to install energy-efficient appli- ances can substantially increase homeowners’ pur- chase of such appliances, especially if the offers are aggressively promoted (i.e., communicated).38

Green energy programs—in which utility companies offer their residential customers energy from renew- able sources at a premium price— have a growing

presence in the marketplace. Programs with more aggressive marketing features—l o w minimum purchase requirements, short contract lengths, and aggressive promo- tion— have higher customer participa- tion and total energy purchases.39

● Travel demand management programs— which use a variety of marketing methods— have been shown to substantially i n - crease use of public transportation (20%–33%) and active transport modes (including walking [16%] and cycling [6%–91%]), and to reduce the number of car trips taken (10%) and distance traveled by car (17%).40

nfluencing Social Network–Level Drivers f Population Behavior

elatively few studies have attempted to influence opulation behavior through social network–level in- erventions. One important exception is a series of tudies in which block leaders were recruited in neigh- orhoods to model household recycling behavior and xhort and assist neighbors to recycle. The approach esulted in significant neighborhood-wide increases in ecycling.41–43 Opinion-leader interventions of this type eserve considerable additional research attention be- ause of their potential to influence a wide range of limate change–mitigation and adaptation behaviors.44

nfluencing Community-Level Drivers f Population Behavior

ommunication interventions that influence people’s ormative beliefs—that is, people’s beliefs about the

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ehavior of others—have been shown to promote a

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ange of relevant behaviors including recycling,45 re- uced household electrical use,46 and reduced hotel owel use (which has direct water-use implications).47

ecent advances in understanding how to use these nexpensive methods to manage population behavior ave readied them for widespread application.48 And, iven the rapidly growing literature suggesting that ommunity-level variables can be far more powerful han individual-level variables in shaping population ehavior,49 there is a pressing need for intervention esearch on other community-level drivers of popula- ion behavior.

nfluencing Place-Based Drivers of Population ehavior

espite the importance of the attributes of place, little ntervention research has been conducted to test strat- gies for influencing these attributes. Some illustrative eal-world examples, however, include:

The limited availability and higher up-front costs of compact fluorescent lighting (CFL) have, until re- cently, depressed demand for the product.50 Prior to 2007, retail shelf space and marketing promotion for CFLs was severely limited, and prices were exorbi- tantly high by comparison.51 Each of these factors has improved recently, in part due to retailing giant WalMart’s successful initiative to sell one million CFLs in 2007.52

Sidewalks and certain other physical attributes make some communities more walkable than others. Res- idents in walkable neighborhoods get more physical activity and do more of their errands on foot, than do residents in less walkable neighborhoods.53 A small but growing number of campaigns are advo- cating neighborhood/city reconfigurations to make them more supportive of active living.54

Low gasoline taxation in the U.S. fosters higher consumption. It is estimated that increasing the gasoline tax to $2/gallon would reduce short-term consumption by �15% and long-term consumption by �60%. Similarly, federal subsidies on a range of products—including oil production and large sport utility vehicles—lower their price to encourage con- sumption, thereby creating taxpayer-supported greenhouse gas pollution. A range of individuals and organizations are advocating for substantial in- creases in the federal gas tax, or more generally for a carbon tax or a cap-and-trade system to limit carbon emissions, but their efforts thus far have failed to gain political traction due to lack of broad public support.55

Advertisements and other types of media can rein- force, or even help create, consumerist values and behaviors. A recent study in China, for example, demonstrated that exposure to consumption-related

and Western-originated media content is contribut- t

92 American Journal of Preventive Medicine, Volume 35, Num

ing to the growth of consumerist values.56 Con- versely, a media campaign in England by the Alli- ance Against Urban 4x4s is attempting to reverse the rising trend of SUV sales by creating and sustaining a public debate in the media about the use of SUVs in the urban environment, highlighting their effect on society and the environment, and countering images depicted in industry advertising (www.stopurban4x4s. org.uk).

When communication and marketing interventions re used to influence place-based drivers of population ehavior, they often target different audiences and use ifferent methods than campaigns seeking to influence eople-based factors. Segments of the general public— r, stated differently, segments of the voting or purchas-

ng public—can be targets of these initiatives when allying grassroots support for the proposed place- ased modifications is helpful. The ultimate target udiences, however, are the people whose decisions ontrol the attributes of place (e.g., elected officials). lected, appointed, and career officials at all levels of overnment (local, state, national, as well as multina- ional government organizations [e.g., the European nion]) are one such category of target audience. overnment officials, through acts of commission and mission, have the capacity to influence the physical nd social structures of communities directly, and have he capacity to influence the availability and cost of roducts and services indirectly through regulation nd, to a lesser extent, the prevalence of media mes- ages. Decision makers in a wide range of businesses nd nongovernmental organizations (NGOs) are a econd such category of target audience. Through their perating decisions, these people directly influence the vailability and cost of products and services, the phys- cal structures, and the media messages in communi- ies. They also play a number of important roles in nfluencing community social structures indirectly through their support or opposition). All of these hould be considered important target audiences for limate change communication and social marketing nitiatives.

he Potential of Multi-Level Interventions

s has been illustrated above, initiatives that seek to nfluence population behavior with single-level inter- entions—that is, attempting to create change in one, ut only one, of the five levels of influence on popula- ion behavior—can have a measurable impact on pop- lation behavior. In most cases documented thus far, owever, the impact has been modest. That single-level interventions typically have only a odest population impact makes perfect sense in the

ontext of ecologic models of behavior. The causes of opulation behavior are multifactorial, thus interven-

ions targeting only one of those factors are likely to

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ave only modest success. The literature suggests that ulti-level interventions hold greater promise.57

An important interplay also exists between people nd the attributes of place. Using a traditional public ealth example, programs to prevent micronutrient alnutrition have been shown to be most successful hen two conditions are ensured: (1) fortified staple

oods are made widely available in the community (i.e., nfluencing place) and (2) promotional efforts are mplemented to heighten consumer demand for those ortified foods (i.e., influencing people).58 Similarly, he effectiveness of incentive programs to promote the urchase of energy-efficient household appliances has aried by a factor of 10, depending on how aggressively hey were promoted to members of target house- olds.59 In short, active communication plays an impor-

ant role in stimulating the uptake of useful new roducts and services. There exist only a few examples of multi-level climate

hange interventions. A compelling one was a social arketing initiative implemented in Hood River OR

hat resulted in a 15% decrease in community-wide lectrical consumption as a result of a multi-level inter- ention targeting households.60,61 Built on the basis of xtensive marketing research, the program influenced ttributes of place by offering financial incentives and n-home assistance to help residents install various nergy-conserving devices, and it influenced people— oth individuals and social networks—through aggres- ive use of media and word-of-mouth initiatives. In sum, his program modified the Hood River community in a ariety of ways that made it easier and more normal for esidents to adopt energy-saving measures.

In an excellent review of communication as a policy nstrument through which to alter environmentally ignificant behaviors, Stern62 concludes that communi- ation can influence certain important drivers of be- avior (i.e., personal capabilities, habits and routines, alues, attitudes, beliefs and personal norms, and the ocial context in which behaviors are or are not per- ormed), but has no capacity to influence the poten- ially more important institutional, economic, and tech- ologic drivers of behaviors (including laws and egulations, financial costs and rewards, available tech- ology, and convenience). Stern concludes that larger nd more sustainable changes in population behavior re likely to require use of the full range of policy nstruments, including communication, voluntary col- aborative actions by industry, command and control, conomic instruments, and service and infrastructure. e suggest that, when focused appropriately, commu-

ication and marketing can be used to effect change mong the institutional, economic, and technologic rivers of behavior. Specifically, although communica- ion and marketing are typically thought of as means to

nfluence populations, they also provide means to t

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nfluence the people who control the attributes of place hat drive population behavior.

Governments can—and in many instances have— ponsored communication and social marketing cam- aigns targeting climate change–related behaviors. overnment campaigns typically target people-based rivers of population behavior, but they can also be sed to target place-based factors that are controlled by he private and NGO sector. California’s success at olding its per-capita energy consumption constant ver the past several decades provides an excellent xample. When government policies contribute to the prob-

em, NGO- and citizen-sponsored campaigns can be sed to advocate changes in government policy. The ublic health literature uses various concepts and terms o describe the use of communication and marketing to nfluence the attributes of place in this manner. These nclude policy advocacy, media advocacy, and dissemi- ation of evidence-based practices. Organizations in

he private sector have a different set of concepts and erms to describe these activities including business-to- usiness marketing and lobbying.

udiences for Climate Change Communication nd Marketing Campaigns

ecent polls indicate that about half of U.S. residents elieve that climate change is already having dangerous ffects on people or will within the next decade63—an ncrease of 20 percentage points since 2004—and 19% elieve it is a very serious threat to them and to their amilies. Anecdotally, the frightening projections of rising eas, flooding, mass extinctions, and displaced popula- ions arouse concern and motivate action in some, but eave others with feelings of indifference, despair, disbe- ief, powerlessness, or cynicism. This highlights a funda-

ental truth: There is no such thing as “the general ublic.” To reach and influence audiences effectively, ampaigns must be targeted on the basis of audiences’ nterests, values, and current behavioral patterns.64,65

Audience segmentation has traditionally been based n demographic traits, but demographics alone are

neffective predictors of global warming attitudes and ractices.66 Segmentation using a variety of psychoso- ial variables, a method with a long history in the public ealth arena, is likely to offer a more promising ap- roach.15,67 For example, recent research has identi- ed several distinct interpretive communities of risk i.e., audience segments) based on differences in global arming risk perceptions, policy preferences, values, eliefs, and media use.68,69

nterpretive Communities of Risk

eiserowitz and Slovic conducted a nationally represen-

ative survey of adults in the U.S. (n�810) in 2005 and

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dentified five distinct interpretive communities based n people’s perceptions of ten varied hazards (terror-

sm, the Iraq War, global warming, nuclear power, esticides, genetically modified food, gun control, mar-

juana, legal abortion, and homosexuality) (AL, unpub- ished observations, 2008). Each segment exhibited a onsistent pattern of perceptions across the various isks, driven in part by the group’s underlying values. ach segment also exhibited unique sociodemo- raphic, political, and religious characteristics, which ere used to label them. Focusing specifically on the issue of global warming,

hree audience segments, representing 63% of people n the U.S., were found to have high perceptions of risk ssociated with climate change:

The Liberal Left (14% of the total sample). These people tended to be high SES, nonreligious, white, Democratic women with egalitarian values and a liberal political orientation. They also were much more likely to perceive a high degree of risk associ- ated with environmental and technologic threats, and a low degree of risk associated with moral threats (homosexuality, abortion, and marijuana use). Alarmists (12% of the total sample). This interpre- tive community tended to be religious, low SES, minority women who were politically disaffected. They perceived a higher than average degree of risk associated with all of the risks assessed (environmen- tal, technologic, national security, and moral). Mainstream Americans (37% of the total sample). This segment tended to have a high school educa- tion, be politically independent, and hold moderate political views. They tended to perceive all hazards as relatively moderate risks, with the exception of global warming, the Iraq War, and terrorism, which they rated as high to very high risks.

Conversely, two other interpretive communities had elatively low perceptions of risk associated with climate hange:

Optimists (21% of the total sample). Optimists tended to be high SES, white, nonreligious, conser- vative, Republican urban men. They perceived all of the hazards, including global warming, as relatively low risks to U.S. society. They also tended to hold strong anti-egalitarian and pro-individualist values. The Religious Right (16% of the total sample). The Religious Right tended to be white, highly religious, conservative, Republican rural men. They perceived moral issues such as legal abortion, homosexuality, and marijuana as very great risks to U.S. society, but saw nuclear power, global warming, and the Iraq War as relatively low risks. They held strong hierar- chical values, and like Optimists, also held strong

anti-egalitarian and pro-individualist values. n

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This study supports the view that there are diverse udiences within the U.S. population, each predis- osed to interpret global warming, along with other azards, in different ways, drawing on different life ircumstances, experience, social networks, and value rientations. This understanding of the underlying orldview of the various audience segments could be sed to tailor messages that resonate with the values nd predispositions of each group.

Although the example provided here focuses on egmenting the general public for purposes related to romoting climate change prevention, the rationale for egmenting audiences and tailoring messages is equally ompelling when targeting more specialized audiences, specially those who influence the attributes of place e.g., elected and appointed government officials, small usiness owners, corporate officials). Moreover, seg- entation will also be an asset when pursuing climate

hange–adaptation objectives.

ffective Climate Change Messages ear Appeals

he climate change literature contains frequent warn- ngs to avoid fearful messages,70–72 yet the more gen- ral persuasive communication literature indicates that ear appeals are effective in motivating behavior hange, especially if they are accompanied by efficacy- nhancing information.73–75 Witte and Allen’s meta- nalysis75 of 93 fear appeal experiments, for example, emonstrated that there is a positive, albeit small, verage correlation (0.16) between fear and behavioral utcomes, and that the effects of fear are significantly ugmented with stronger fear messages and when fear essages are accompanied by efficacy-enhancing essages. This contradiction—between the warnings to avoid

ear in climate change communication and experimen- al evidence indicating its effectiveness—may be driven, n whole or part, by an artifact of the research methods.

ost research on fear appeals has been conducted in ab settings with students as subjects, whereas in natural ettings, the probability that people will choose not to ttend to fearful messages can be quite high.76 Witte nd Allen’s meta-analysis, however, found that defen- ive reactions are also prevalent in lab studies, with tronger fear appeals engendering stronger defen- ive responses, particularly when combined with a eak efficacy message. Given the potential impor-

ance of fear in climate change communication, dditional research—ideally a combination of labo- atory and field research—is urgently needed to esolve the contradiction.

Pending further research, we recommend that when otentially fearful content is presented, it be accompa-

ied by strong efficacy-enhancing messages. Relevant

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fficacy-enhancing information can include identifying ecommended actions through which to reduce the hreat, persuasive affirmations that collectively the au- ience is capable of implementing these actions (i.e., nhancing perceptions of collective efficacy), and sup- orting the individual audience members’ sense of ersonal efficacy in taking action. Further, we recommend a more nuanced approach

o presenting fear-based or threatening information. ore accurate perceptions of the threat of global arming might be raised with tailored descriptions of

he potential impacts. Much of the description of global arming to date has focused on the threat to people, laces, and species psychologically, spatially, and tem- orally distant from most residents of the U.S. For xample, descriptions of the potential impacts of cli- ate change on polar bears have become increasingly

ommon. It is likely, however, that not all audiences espond equally to the potential threat to these charis- atic animals. Other segments may be more motivated

y descriptions of the potential human health, national ecurity, economic, or theological implications of cli- ate change, particularly given the importance (as

escribed below) of personal risk as a motivator.77

elf-Protection Versus Altruism

isk communication research typically finds that peo- le must feel personally threatened for messages to

nfluence behavior.78 However, the political science iterature on sociotropic motivations suggests that it is ot perceptions of personal threat but rather percep-

ions of societal threat that influence people’s sup- ort for public policies.79 Our current research is uggesting that both forms of perceived risk—personal nd societal—may be relevant in shaping climate- elevant behaviors (CR, unpublished observations, 2008). espondents to a nationally representative survey were sked to assess the seriousness of global warming as a hreat to (1) themselves, (2) future generations, and (3) ll life on earth. They were also asked which of 14 ro-environmental behaviors they perform. Correlating hese two sets of measures, behavior was found to be more ighly correlated to the perceived threat of global warm-

ng to future generations (r�0.25) than to the perceived hreat to self (r�0.21) or to all life on earth (r�0.22; �11,269, p�0.001, two-tailed). These correlations sug- est that people choose environmental behaviors for ultiple reasons, with concern for human progeny as the

trongest of the three.

ognitive Outcomes

lthough polling data indicate that the vast majority of .S. residents believe climate change is happening, any do not understand the science underlying the

henomenon (e.g., there is a persistent erroneous

elief that the hole in the ozone is letting in too much a

ovember 2008

eat),77 the human causes of climate change, or the cientific consensus on this point.63 Clearly, there is a reat deal that could be taught: the science, the poten- ial consequences, the contribution of people’s actions o the problem, the changes people can make both to

itigate and adapt, and the skills needed to make these hanges. A few of these issues are addressed below. It hould be noted, however, that in the absence of tructural changes that make the promoted behaviors onsiderably easier, knowledge changes are likely to be neffective, except among those who are already trongly motivated.

mproving people’s understanding of the science. The rgument can be made that so long as people know that limate change is dangerous, and they understand that educing fossil fuel use is the most viable means for reventing further climate change, a full understand-

ng of the physical causes and mechanisms of climate hange is unnecessary. The limited research on this osition, however, is unclear. Bord and colleagues80

ssessed the importance of actual knowledge about lobal warming in explaining people’s intentions to do omething about it; they found that the most powerful redictor of stated intentions to take voluntary actions as knowing what causes climate change and what does ot. In a recent study, Leiserowitz,81 however, found no ignificant relationship between accurate knowledge of limate change causes and solutions on the one hand nd risk perceptions, policy preferences, or reported ehaviors on the other. He found that, in the U.S., limate literacy—knowledge of the causes of and solu- ions to global warming—was extremely poor. For xample, he found that most people incorrectly be- ieved that nuclear power plants, toxic waste, and erosol spray cans cause global warming. Ultimately, he ound that overall climate literacy was so poor that it ouldn’t explain any of the variance among U.S. resi- ents in terms of risk perceptions, policy preferences, r behaviors. This does not mean, however, that more substantial

nd accurate knowledge is not vitally important. It imply suggests that many people in the U.S. are urrently relying on a variety of factors other than cientific knowledge of the causes and solutions to form heir climate change attitudes, preferences, and behav- ors. It also suggests that given the limited attention and

ental storing capacity available to most people for roblems like global warming, there is a critical need or research that identifies exactly what factual knowl- dge is the most important and useful—either to help eople understand the potential risks or to guide their references and behaviors.82

Likewise, many researchers have identified the need or an effective metaphor to explain climate change. ommunicators have been searching for bridging met-

phors, and first-rung theories—simple analogies such

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s “the heart is a pump” to convey the essential pro- esses and significance of climate change.72,83 An anal- gy is the “ozone hole”—commonly thought of as a hole in the ceiling”—which is often presented as a uccessful example of a first-rung theory; it was highly ffective in conveying the problem and motivating upport for policies to address it—so successful, in fact, hat it’s been difficult to separate it from climate hange in the public mind.

The metaphor of the greenhouse effect has been riticized because many people aren’t familiar with how reenhouses work, and greenhouses are generally per- eived as good things. Likewise the warming metaphor mbedded in the term global warming may sound like a ositive change to some individuals.84 In response, ovelock85 has suggested the name global heating. One esearch paper that has been influential in the environ- ental community argues that describing climate

hange as “a blanket of carbon dioxide around the orld that is trapping heat” is easily understood and

mproves people’s understanding.72 Unfortunately, owever, although the blanket metaphor may be useful

or explaining how these gases trap heat, it carries no onnotative sense of the threats posed by this process. n fact, warm blankets are likely to evoke positive mages and feelings among an American audience.

etaphors engage people’s embodied experiential nowledge, schemas, and mental models (e.g., a hole in ceiling is a bad thing and needs to be fixed) and can

trongly determine subsequent inferential processing, eading people to particular conclusions about the ignificance or proper response to an issue. Climate hange still lacks a single, powerful, and encapsulating etaphor.

he “controversy.” Public uncertainty about the reality nd causes of climate change is fed by an emphasis on ontroversy in news stories. The belief that there is a lot f disagreement among scientists over the reality of limate change is held by 40% of the public, and only 7% understand that humans are the cause.63 Al- hough dated, research by Wilson86 found that most ournalists didn’t understand climate change, exagger- ted the debate, and underplayed the scientific consen- us, and Wilkins87 identified the tendency for global arming stories to emphasize a technologic fix frame ather than individual contributions and policy solu- ions. The impact of these frames is largest with audi- nce members who hold ideologies that are not pro- nvironmental88; specifically, the people least inclined o accept climate change as a serious risk find confir-

ation of their beliefs in the balanced reporting styles, hich present both sides of the controversy when none ctually exists.

In combating the misconception that the scientific ommunity disagrees about climate change and its

uman causes, one body of research suggests that c

96 American Journal of Preventive Medicine, Volume 35, Num

ommunicators should not repeat the assertions of the oubters. “Myth-busters” research has found that when false statement is repeated in order to refute it, the

epetition merely serves to reinforce the false belief.89

ver time the refutation is forgotten, but the false elief has been reinforced simply because the audience ember has heard it repeated again. New assertions

hat make no reference to the false claims are more ffective for refuting myths.90 For example, rather than ounter the statement “Climate change is part of a atural weather cycle” in a manner that repeats the ssertion, it is preferable to state: “The scientific evi- ence is clear; human activity is contributing to climate hange.”

otential consequences. Studies show that the public as difficulty understanding the projections and prob- bilities scientists use to estimate the potential impact f climate change. Moreover, debate around the pro-

ected consequences can result in public apathy and tall policy change.91 Communication, then, should mphasize what we know, rather than what we don’t now. Moser and Dilling advise communicators to “lead ith the strongest argument—that is, with the greatest

cientific certainty and confidence.”71

Krosnick and colleagues92 conducted research to dentify specific cognitions or beliefs that predict peo- le’s perception of climate change as a serious national

ssue that warrants federal public policy response. In ssence, they demonstrated five key beliefs that predis- ose people to support an aggressive public policy esponse: (1) climate change is real, (2) I am certain it s real, (3) is it human caused, (4) it is harmful to eople, and (5) the problem can be solved. These eliefs, therefore, can be considered important objec- ives for climate change–communication campaigns.

kills. Although “smart meters” are rapidly gaining arket share in some nations, home energy use in the .S. is still essentially invisible. People receive monthly ome energy bills, which is analogous to receiving a ingle non-itemized bill at the end of the month for all ood purchases.93 This lack of timely and specific eedback discourages involvement and skill develop-

ent in energy-reduction strategies.

ormative Research

he list of options to reduce energy consumption is xtensive, and presenting consumers with a long list of ecommended actions may create an overwhelming nd confusing disincentive to action. Efforts to encour- ge behavior change should be preceded by an analysis f which behaviors will have the greatest impact in educing carbon emissions.94 After the most relevant ehaviors have been identified, a careful study of udience knowledge is needed to ensure that the

ampaign is providing new information, not repeating

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hat the audience already knows or overlooking infor- ational gaps that render audience members incapa-

le of complying with message recommendations.82

owever, identifying the lack of knowledge is not nough. Research must also identify the other barriers hat prevent people from changing their behavior, ncluding time and financial resources, social norms, ack of skills, and structural opportunities to change.

ith all this in mind, campaigners may then select and arget behaviors that (1) will have the maximum impact n carbon emissions, (2) are not overly constrained by tructural barriers, and (3) are new to the audience.

alues and Framing

udiences are most receptive to content that is consis- ent with their existing attitudes and beliefs; selective ttention and avoidance make it less likely that incon- istent information will be received.95,96 Some segments f the U.S. population may reject or ignore information bout climate change if they feel it conflicts with their alues (e.g., libertarian values) or core beliefs (e.g., eligious beliefs that assert we should exercise domin- on over nature).69

Choosing message frames for climate change that are onsistent with the values of target groups is one mportant way to make the recommended behaviors or olicies easier to accept. Conservation messages, for xample, can use an economic frame (This is an excellent ay to save money); an energy independence frame (This

s a means for our country to free itself from dependence on oreign oil); a legacy frame (This is a way to protect our hildren’s future); a stewardship frame (This is how I honor y moral obligation to protect the abiding wonders and mystery

f life); a religious frame (This is a way to serve God by rotecting His creation); or a nationalist frame (Innovative echnology will keep our nation’s economy strong). Each of hese frames is likely to resonate more effectively with he values of different segments of people in the U.S.

essaging Suggestions

iven these considerations, some educated guesses can e made about the most effective communication strat- gies for the five audience segments introduced above. hese suggestions, however, are only educated guesses, nd should be tested empirically.

The Liberal Left, with relatively high SES and high levels of education, has a greater propensity to seek and process information deeply, and can likely be reached through a variety of print channels. Because this group already perceives climate change as a high risk, the information of greatest value to them may be the relative efficacy of various actions they can take (and how to take those actions) and policies they can support, to reduce their personal and their

community’s carbon emissions.97 n

ovember 2008

Alarmists also already perceive climate change as a high risk, but some may lack basic knowledge, skills, financial resources, or structural opportunities to change their climate-related behaviors. Efficacy- enhancing messages, as well as messages that high- light the monetary benefits of some behavioral changes, are likely to be of value. As their primary source of information, television is probably the most effective medium. Mainstream Americans are also highly concerned about climate change. Like the Liberal Left and Alarmists, however, they probably lack a clear under- standing of the changes in behavior they might make, and the possible costs and benefits to them- selves, their communities, and the world at large associated with those behaviors. Given the size, po- sition, and importance of this segment, we encour- age immediate in-depth investigation of this group’s climate change perceptions and behaviors with ap- propriate research methods. Optimists, with strongly individualist worldviews and low perceptions of climate change as a threat, are unlikely to be receptive to most environmentalist messages about climate change. Messages emphasiz- ing energy independence and the economic benefits of conservation are more likely to resonate with them. They may best be reached through newspa- pers and the Internet—their primary sources of information. The Religious Right, who also generally do not perceive climate change as a significant threat, may be most receptive to messages framed in moral terms, including the stewardship ethic found in Genesis and the moral duty of Christians to help the poor and needy (i.e., those millions likely to be most affected by climate change). Television and talk radio may be the most effective channels for reach- ing members of this audience.

onclusion

recent meta-analysis of the health campaign liter- ture found that, on average, persuasive media cam- aigns evoke personal behavior change among 9% of

heir target audience.98 Somewhat larger effect sizes ere found among campaigns that (1) promoted behav-

ors enforceable by law (e.g., seatbelt use); (2) achieved a igher than average exposure to the campaign (i.e., reater message reach and frequency) among members f the target audience; and (3) presented new informa- ion (versus information that had already been commu- icated previously in other ways). Regrettably, to the est of our knowledge, no similar analysis has been onducted to assess the impact of campaigns seeking to enerate public support for policy solutions. For a variety of reasons—including the conservative

ature of meta-analysis, the modest levels of funding

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ypically devoted to health communication campaigns, nd the fact that all campaigns reviewed sought to nfluence only individual-level drivers of population ehavior—we see this 9% level as establishing the lower ounds for behavior change that can be accomplished ith public health communication campaigns. More ggressive communication and marketing campaigns or multiple overlapping campaigns) that target both eople- and place-based drivers of population behavior,

ncluding public policy, when sustained over longer eriods of time, have the potential to multiply the inimum effect size into a broad-based shift in societal

eliefs, norms, and practices. The National High Blood ressure Education Program—which is credited for aving helped lower U.S. stroke mortality rates by 60%—is one example of such a campaign (www.nhlbi. ih.gov/about/nhbpep/),99 and the Campaign for obacco-Free Kids is a second illustrative example

ocused exclusively on influencing public policies to upport the public’s health (www.tobaccofreekids.org).

At the individual level efforts should be made to craft ommunication and marketing campaigns targeting arious strategically important audiences. Among the ve audiences identified by Leiserowitz and Slovic, for xample, Mainstream Americans appear to be a partic- larly important target audience given their proportion

n the overall population and their apparent interest in hanging their climate-related behaviors. Communica- ion campaigns targeting such audiences should be ocused tightly on providing information that will help udience members pursue both personal and societal i.e., policy) action. Marketing campaigns targeting uch audiences should improve the availability of prod- cts and services that make it easier for audience embers to reduce their use of fossil fuels and act in

ther ways that reduce greenhouse gas emissions. Ad- itional audience segmentation research is urgently eeded to validate and refine, or replace, the segments escribed here, and to improve understanding of the

nformation and other factors that will move members f each segment to action at a personal, family, and ocietal level. This will entail conducting formative esearch to identify cognitive and skills deficits, social nd environmental barriers that can be modified, and ffective framing strategies. At the social-network level there is an urgent need to

dentify and activate popular opinion leaders within all trata of society, including the government and com- ercial sectors. Personal influence, especially that of

ommunity opinion leaders, is a powerful source of ocial change that will be needed to engage U.S. esidents in responding rapidly to the issue of climate hange.

At the community level, there are fewer models of uccess on which to base climate change interventions, et the emerging literature in public health indicates

he importance of community-level attributes in driving

98 American Journal of Preventive Medicine, Volume 35, Num

opulation behavior. Social norms campaigns, which ave been shown to be an effective way to influence opulation rates of a range of conservation behaviors, hould be made a high priority both for their potential ffectiveness and low cost. Campaigns that specifically ddress people’s collective efficacy—the belief that this s a problem we can solve—may help overcome the endency to continue to overuse common resources e.g., as happens in the “tragedy of the commons”).

At the place level—local and distal—aggressive strat- gies need to be implemented to improve the availabil- ty and price of products and services that help people educe their carbon emissions, remove structural bar- iers to behavior change, and implement policies that ncourage energy conservation. Among other things, his will require building public support (or demand) or local, state, federal, and multinational policies that ramatically reduce greenhouse gas emissions and help eople adapt to unavoidable climate changes. All of these actions will require investment of public

nd philanthropic resources. A portion of those re- ources should be directed to conducting translational esearch that will help to ensure that communication nd marketing programs created with public, philan- hropic and private sector resources are, in fact, effec- ive at motivating and supporting the necessary changes n population behavior. If the experience of the Na- ional High Blood Pressure Education Program is a alid indicator, public and philanthropic investments in uch research will, in turn, stimulate large investments n program development by organizations in the pri- ate sector.

o financial disclosures were reported by the authors of this aper.

eferences 1. Havel V. Our moral footprint. The New York Times 2007 Sep 27. 2. Haines A, Patz JA. Health effects of climate change. JAMA 2004;291:

99–103. 3. Patz JA, Campbell-Lendrum D, Holloway T, Foley JA. Impact of regional

climate change on human health. Nature 2005;438:310–17. 4. Patz JA, Olson SH. Climate change and health: global to local influences on

disease risk. Ann Trop Med Parasitol 2006;100:535–49. 5. McMichael AJ, Woodruff RE, Hales S. Climate change and human health:

present and future risks. Lancet 2006;367:859–69. 6. Haines A, Kovats RS, Campbell-Lendrum D, Corvalan C. Climate change

and human health: impacts, vulnerability and public health. Public Health 2006;120:585–96.

7. Intergovernmental Panel on Climate Change. Climate change 2007: im- pacts, adaptation and vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. Parry ML, Canziani OF, Palutikof JP, van der Linden PJ, Hanson CE, eds. Cambridge UK: Cambridge University Press, 2007. www.ipcc.ch/ ipccreports/ar4-wg2.htm.

8. Epstein PR. Climate change and human health. N Engl J Med 2005; 353:1433–6.

9. Brownson RC, Remington PL, Davis JR. Chronic disease epidemiology and control. Washington DC: American Public Health Association, 1998.

0. Yach D, Hawkes C, Gould CL, Hofman KJ. The global burden of chronic

diseases: overcoming impediments to prevention and control. JAMA 2004; 291:2616–22.

ber 5 www.ajpm-online.net

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1

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2

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4

4

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4

4

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5

5

5

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1. Simpson CA, Vuchinich RE. Temporal changes in the value of objects of choice: discounting, behavior patterns, and health behavior. In: Bickel W, Vuchinich R, eds. Reframing health behavior change with behavioral economics. Mahwah NJ: Lawrence Erlbaum Associates, 2000:193–215.

2. Bickel WK, Marsch LA. The tyranny of small decisions: origins, outcomes, and proposed solutions. In: Bickel W, Vuchinich R, eds. Reframing health behavior change with behavioral economics. Mahwah NJ: Lawrence Erl- baum Associates 2000;341–91.

3. Maibach E. The influence of the media environment on physical activity: looking for the big picture. Am J Health Promot 2007;21:S353–62.

4. Epstein LH, Saelens BE. Behavioral economics of obesity: food intake and energy expenditure. In: Bickel W, Vuchinich R, eds. Reframing health behavior change with behavioral economics. Mahwah NJ: Lawrence Erl- baum Associates 2000;293–312.

5. Rogers E, Storey D. Communication campaigns. In: Berger C, Chaffee S, eds. Handbook of communication science. Newbury Park CA: Sage, 1986;817–46.

6. Maibach E, Abroms L, Marosits M. Communication and marketing as tools to cultivate the public’s health: a proposed “people and places” framework. BMC Public Health 2007;7:88.

7. Abroms L, Maibach E. The effectiveness of mass communication to change public behavior. Ann Rev Public Health 2008;29:219–34.

8. Farley T, Cohen D. Prescription for a healthy nation: a new approach to improving lives by fixing our everyday world. Boston: Beacon Press, 2005.

9. Lutzenhiser L. Marketing household energy conservation: the message and the reality. In: Deitz T, Stern P, eds. New tools for environmental protection: education, information, and voluntary measures. Washington DC: National Academy Press, 2002:49–65.

0. Deitz T, Stern P, eds. New tools for environmental protection: education, information, and voluntary measures. Washington DC: National Academy Press, 2002.

1. Mileti DS, Peek LA. Understanding individual and social characteristics in the promotion of household disaster preparedness. In: Deitz T, Stern P, eds. New tools for environmental protection: education, information, and voluntary measures. Washington DC: National Academy Press, 2002; 125–39.

2. Abrahamse W, Steg L, Vlek C, Rothengatter T. A review of intervention studies aimed at household energy conservation. J Environmental Psych 2005;25:273–91.

3. Th�gersen J. Promoting “green” consumer behavior with eco-labels. In: Deitz T, Stern P, eds. New tools for environmental protection: education, information, and voluntary measures. Washington DC: National Academy Press, 2002:83–104.

4. Winett RA, Love SQ, Kidd C. The effectiveness of an energy specialist and extension agents in promoting summer energy conservation by home visits. J Environmental Systems 1982;12:61–70.

5. Hirst E, Grady S. Evaluation of a Wisconsin utility home energy audit program. J Environ Systems 1982;12:303–20.

6. McMakin AH, Malone EL, Lundgren RE. Motivating residents to conserve energy without financial incentives. Environ Behav 2002;34:848–63.

7. McClelland L, Cook SW. Promoting energy conservation in master- metered apartments through group financial incentives. J Appl Soc Psychol 1980;10:20–31.

8. Hutton RB, Mauser GA, Filatrault P, Ahtola OT. Effects of cost-related feedback on consumer knowledge and consumption behavior: a field experimental approach. J Consumer Research 1986;13:327–36.

9. Van Houwelingen JH, Van Raaij FW. The effect of goal-setting and daily electronic feedback on in-home energy use. J Consumer Research 1989;16:98–105.

0. Winnet RA, Neale MS, Grier HC. Effects of self-monitoring and feedback on residential electricity consumption. J Appl Behav Anal 1979;12:173–84.

1. Seligman C, Darley JM. Feedback as a means of decreasing residential energy consumption. J Appl Psychol 1977;62:363–8.

2. Hayes SC, Cone JD. Reduction of residential consumption of electricity through simple monthly feedback. J Appl Behav Anal 1981;14:81–8.

3. Becker LJ. Joint effect of feedback and goal-setting on performance: a field study of residential energy conservation. J Appl Psychol 1978;63:428–33.

4. McCalley LT, Midden CJH. Energy conservation through product- integrated feedback: the roles of goal-setting and social orientation. J Econ Psychol 2002;23:589–603.

5. Bandura A. Social foundations of thought and action: a social cognitive approach. Englewood Cliffs NJ: Prentice Hall, 1986.

6. Winett RA, Leckliter IN, Chinn DE, Stahl B, Love SQ. Effects of television

modeling on residential energy conservation. J Appl Behav Anal 1985;18:33–44.

ovember 2008

7. Banerjee A, Solomon BD. Eco-labeling for energy efficiency and sustain- ability: a meta-evaluation of U.S. programs. Energy Policy 2003;31:109–23.

8. Stern P. Information, incentives and proenvironmental consumer behav- ior. J Consumer Policy 1999;22:461–78.

9. Wiser R, Olson S, Bird L, Swezey B. Utility green pricing programs: a statistical analysis of program effectiveness. Berkeley CA: Lawrence Berke- ley National Laboratory, 2004. eetd.lbl.gov/EA/EMP/.

0. Taylor MAP, Ampt ES. Traveling smarter down under: policies for volun- teer travel behavior change in Australia. Transportation Policy 2003;10:165–77.

1. Burn S. Social psychology and the stimulation of recycling behaviors: the block leader approach. J Appl Soc Psychol 1991;21:611–29.

2. Hopper J, Nielsen J. Recycling as an altruistic behavior: normative and behavioral strategies to expand participation in a community recycling program. Environ Behav 1991;23:195–220.

3. Shrum LJ, Lowrey TM, McCarty JA. Recycling as a marketing problem: a framework for strategy development. Psych Marketing 1994;11:393–416.

4. Dearing JW, Maibach EW, Buller DB. A convergent diffusion and social marketing approach for disseminating proven approaches to physical activity promotion. Am J Prev Med 2006;31:S11–23.

5. Schultz PW. Changing behavior with normative feedback interventions: a field experiment on curbside recycling. Basic Appl Soc Psychol 1999; 21:25–36.

6. Schultz PW, Nolan JM, Cialdini RB, Goldstein NJ, Griskevicius V. The constructive, destructive and reconstructive power of social norms. Psych Science 2007;18:429–34.

7. Goldstein NJ, Griskevicius V, Cialdini RB. Invoking social norms: a social psychology perspective on improving hotels’ linen-reuse programs. Cornell Hotel Restaurant Admin Q 2007;48:145–50.

8. Cialdini RB. Descriptive social norms as underappreciated sources of social control. Psychometrika 2007;72:263–8.

9. Kawachi I, Berkman L. Social cohesion, social capital and health. In: Berkman L, Kawachi I, eds. Social epidemiology. New York: Oxford University, 2000:74–190.

0. Tiedemann K. Price, product life and market share for CFLs. Paper presented at Advanced Technology in the Environmental Field, Feburary 7, 2006, Lanzarote, Canary Islands, Spain.

1. Sandahl LJ, Gilbride TL, Ledbetter MR, et al. Compact fluorescent lighting in America: lessons learned on the way to market. Richland WA: Pacific Northwest National Laboratory, 2006.

2. Barbara M. Wal-Mart puts some muscle behind power-sipping bulbs. New York Times 2007 Jan 2. www.nytimes.com/2007/01/02/business/02bulb. html.

3. Saelens BE, Sallis JF, Black JB, Chen D. Neighborhood-based differences in physical activity: an environment scale evaluation. Am J Public Health 2003;93:1552–8.

4. Yancey A, Fielding J, Flores G, Sallis J, McCarthy W, Breslow L. Creating a robust public health infrastructure for physical activity promotion. Am J Prev Med 2007;32:68–78.

5. Frank R. A way to cut fuel consumption that everyone likes, except the politicians. New York Times 2006 Feb 16. www.nytimes.com/2006/02/16/ business/16scene.html.

6. Paek HJ, Pan Z. Spreading global consumerism: effects of mass media and advertising on consumerist values in China. Mass communication. Society 2004;7:491–515.

7. Valente TW, Schuster DV. The public health perspective on communicat- ing environmental issues. In: Deitz T, Stern P, eds. New tools for environ- mental protection: education, information, and voluntary measures. Wash- ington DC: National Academy Press, 2002;105–24.

8. Darnton-Hill I, Nalubola R. Fortification strategies to meet micro-nutrient needs: successes and failures. Proceedings of the Nutrition Society 2002;61:231–41.

9. Stern PC, Aronson JM, Darley DH, et al. The effectiveness of incentives for residential energy conservation. Eval Rev 1986;10:147–76.

0. Gardner G, Stern P. Environmental problems and human behavior. New York: Allyn and Bacon, 1996.

1. Keating K, Flynn CB. Researching the human factor in Hood River: buildings don’t use energy, people do. Proceedings of the American Council for an Energy Efficient Economy Washingon DC: ACEEE Press, 1984.

2. Stern P. Changing behavior in households and communities: what have we learned. In: Deitz T, Stern P, eds. New tools for environmental protection: education, information, and voluntary measures. Washington DC: National

Academy Press, 2002;201–12.

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8

8

8

8 8

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8

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9

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9

9

9

9

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5

3. Leiserowitz A. American opinions on global warming: a Yale University/ Gallup/Clear Vision Institute poll. 2007. environment.yale.edu/documents/ downloads/a-g/AmericansGlobalWarmingReport.pdf.

4. Maibach E, Rosthschild M, Novelli W. Social marketing. In: Glanz K, Rimer B, Lewis FM, eds. Health behavior and health education: theory, research, and practice, 3rd edition. Indianapolis IN: Jossey-Bass, 2002;437–61.

5. Slater M. Choosing audience segmentation strategies and methods for health communication. In: Maibach E, Parrott R, eds. Designing health messages: approaches from communication theory and public health practice. Thousand Oaks CA: Sage, 1995:186–98.

6. Pew Research Center. Little consensus on global warming: partisanship drives opinion. 2006 Jul 12. people-press.org/reports/display.php3?ReportID�280.

7. Maibach E, Weber D, Massett H, Hancock G, Price S. Understanding consumers’ health information preferences: development and validation of a brief screening instrument. J Health Commun 2006;11:717–36.

8. Leiserowitz A. American risk perceptions: is climate change dangerous? Risk Anal 2005;25:1433–42.

9. EcoAmerica and SRI Consulting, Business Intelligence. The American Environmental Values Survey: American views on the environment in an era of polarization and conflicting priorities. 2006. ecoamerica.typepad. com/blog/2006/12/american_enviro.html.

0. Moser SC. More bad news: the risk of neglecting emotional responses to climate change information. In: Moser SC, Dilling L, eds. Creating a climate for change: communicating climate change and facilitating social change. New York: Cambridge University Press, 2007:64–80.

1. Moser S, Dilling L. Making climate hot: communicating the urgency and challenge of global climate change. Environ 2004;46:33–46.

2. Frameworks Institute. Talking global warming. 2001. www.ucusa.org/assets/ documents/ssi/UCSpretotorev.pdf.

3. Boster FJ, Mongeau P. Fear-arousing persuasive messages. In: Bostrom R, Westley B, eds. Communication yearbook, 8. Newbury Park CA, 1984:330–71.

4. Sutton SR. Fear-arousing communications: a critical examination of theory and research. In: Eiser JR, ed. Social psychology and behavioral medicine. New York: John Wiley & Sons, 1982;303–37.

5. Witte K, Allen M. A meta-analysis of fear appeals: implications for effective public health campaigns. Health Educ Behav 2000;27:591–615.

6. Hastings G, Stead M, Webb J. Fear appeals in social marketing: strategic and ethical reasons for concern. Psychol Market 2004;21:961–86.

7. Leiserowitz A. Communicating the risks of global warming: American risk perceptions, affective images and interpretive communities. In: Moser S, Dilling L, eds. Creating a climate for change: communicating climate change and facilitating social change. New York: Cambridge University Press, 2007:44–63.

8. Weber E. Experience-based and description-based perceptions of long- term risk: why global warming does not scare us (yet). Clim Change 2006;77:103–20.

9. Sears DO, Funk CL. The role of self-interest in social and political attitudes. Adv Exp Soc Psychol 1991;24:1–91.

0. Bord RJ, O’Connor RE, Fisher A. In what sense does the public need to understand global climate change? Public Understanding Sci 2000;9:199–212.

00 American Journal of Preventive Medicine, Volume 35, Num

1. Leiserowitz A. Global warming in the American mind: the roles of affect, imagery, and worldviews in risk perception, policy preferences and behav- ior. Dissertation. Eugene OR: University of Oregon, 2003.

2. Fischhoff B. Nonpersuasive communication about matters of greatest urgency: climate change. Env Science Tech Online 2007;41:7204–8.

3. Ungar S. Public scares: changing the issue culture. In: Moser SC, Dilling L, eds. Creating a climate for change: communicating climate change and facilitating social change. New York: Cambridge University Press, 2007: 81–8.

4. Auburn A, Grady J. The missing conceptual link: talkback testing of simplifying models for global warming. 2001.

5. Lovelock J, Lovelock JE. The revenge of Gaia. New York: Basic Books, 2006. 6. Wilson KM. Drought, debate, and uncertainty: measuring reporters’ knowl-

edge and ignorance about climate change. Public Understanding Sci 2000;9:1–13.

7. Wilkins L. Between facts and values: print media coverage of the green- house effect, 1987–1990. Public Understanding Sci 1993;2:72–84.

8. Corbett JB, Durfee JL. Testing public (un)certainty of science: media representations of global warming. Sci Commun 2004;26:129–51.

9. Schwarz N, Sanna L, Skurnik I, Yoon C. Metacognitive experiences and the intricacies of setting people straight: implications for debiasing and public information campaigns. Advances Exp Soc Psychol 2007;39:127–61.

0. Mayo M, Schul Y, Burnstein E. “I am not guilty” vs “I am innocent”: successful negation may depend on the schema used for its encoding. J Exp Soc Psychol 2004;40:443–9.

1. Dilling L, Moser SC. Introduction. In: Moser SC, Dilling L, eds. Creating a climate for change: communicating climate change and facilitating social change. New York: Cambridge University Press, 2007:1–27.

2. Krosnick JA, Holbrook AL, Lowe L, Visser PS. The origins and conse- quences of democratic citizens’ policy agendas: a study of popular concerns about global warming. Clim Change 2006;77:7–43.

3. Kempton W, Montgomery L. Folk quantification of energy. Energy Int J 1982;7:817–28.

4. Stern PC. Toward a coherent theory of environmentally significant behav- ior. J Soc Iss 2000;56:407–24.

5. Wicks R. Message framing and constructing meaning: an emerging para- digm in mass communication research. In: Kalbfleisch P, ed. Communica- tion Yearbook, 29. Mahwah NJ: Lawrence Erlbaum, 2005;331–61.

6. Lazarsfeld P, Berelson B, Gaudet H. The people’s choice. New York: Columbia University Press, 1948.

7. Costanzo M, Archer D, Aronson E, Pettigrew T. Energy conservation: the difficult path from information to action. Am Psychol 1986;41:521–8.

8. Snyder L, Hamilton M. A meta-analysis of U.S. health campaign effects on behavior: emphasize enforcement, exposure, and new information, and beware the secular trend. In: Hornik R, ed. Public health communication: evidence for behavior change. Mahweh NJ: Lawrence Erlbaum Associates, 2002:357–83.

9. Roccella EJ. The contribution of public education toward the reduction of CVD mortality: experience from the National High Blood Pressure Educa-

tion Program. In: Hornik R, ed. Public health communication: evidence for behavior change. Mahwah NJ: Erlbaum, 2002;73–84.

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