title: Health Communication and Social Marketing Campaigns for Sexually Transmitted Disease Prevention and Control: What Is the Evidence of their Effectiveness?
abstract: BACKGROUND
  Despite the ubiquity of sex in the media, a culture of silence surrounds sexual health in the United States, serving as a barrier to sexually transmitted disease (STD) prevention, testing, and treatment. Campaigns can increase STD-related knowledge, communication, and protective behaviors. This review assesses the effectiveness of STD prevention and testing campaigns in the United States to inform the field on their use as a strategy for affecting behavior change.
  
  
  METHODS
  A comprehensive literature search was conducted to identify original research articles, published between 2000 and 2014, which report on US media campaigns promoting community- or population-level STD testing or prevention behaviors and are evaluated for impact on one or more behavioral outcomes. Titles and abstracts were independently reviewed by 2 researchers.
  
  
  RESULTS
  The review yielded 26 articles representing 16 unique STD testing and/or prevention campaigns. Most campaigns were developed using formative research and social marketing or behavioral theory. Most campaigns (68.75%) used posttest-only or pretest-posttest designs without comparison groups for evaluation; only 5 campaigns used control groups, and these proved challenging (i.e., achieving necessary exposure and avoiding contamination). Nearly all campaigns found differences between exposed and unexposed individuals on one or more key behavioral outcomes. Several campaigns found dose-response relationships. Among evaluations with uncontaminated control groups whose campaigns achieved sufficient exposure, sustained campaign effects were observed among targeted populations.
  
  
  CONCLUSIONS
  Current findings suggest that campaigns can impact targeted STD-related behaviors and add to the evidence that greater exposure is associated with greater behavior change.
authors.affiliation: From the *Division of STD Prevention, Centers for Disease Control & Prevention (CDC), Atlanta, GA; and †School of Journalism and Mass Communication, University of North Carolina at Chapel Hill, NC.
authors.forename: Allison L
authors.initials: AL
authors.lastname: Friedman
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Kachur
authors.forename: Seth M
authors.initials: SM
authors.lastname: Noar
authors.forename: Mary
authors.initials: M
authors.lastname: McFarlane
mesh_terms: D055317:Evidence-Based Practice; D058015:Health Communication / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D012736:Sex Education / Q000458:organization & administration*; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control*; D040241:Social Marketing; D057545:Social Stigma; D014481:United States / Q000453:epidemiology