Media Ecosystems and Multiple Stakeholders: A Smokefree Living Media Advocacy Campaign

Background:  Exposure to secondhand smoke (SHS) is a major public health problem. Individuals living in multi-unit housing (MUH) are especially vulnerable. Nationally, more than one in three nonsmokers living in rental housing are exposed to SHS. Limited protections exist for market-rate MUH residents compared to those in public housing. High-need communities, particularly Latino, African-American, and Asian-American/Pacific Islander, are disproportionately exposed. Lack of information and confusion about rental laws impedes both tenants and landlords from taking action.

Program background:  Smokefree Apartments Los Angeles is a CDC REACH funded education and outreach initiative to increase access to smokefree apartments in high-need L.A. communities through voluntary policy adoption. The UCLA Center for Health Policy Research, working with community based organizations, is educating landlords and tenants to expand smokefree housing practices. A key component is smokefree messaging dissemination. We employed a multi-pronged media advocacy campaign approach seeking to reframe the housing narrative. Specifically we sought to: 1) place focus on negative health impacts from SHS and the disproportionately affected high-need communities; 2) neutralize opposition stakeholders through education and shared objectives, primarily housing advocates viewing this as aiding evictions and gentrification; 3) appeal to decision makers who could affect policy change.

Evaluation Methods and Results:  We utilized landlord survey data and resident focus group testing to develop appropriate messaging for high-need communities, stakeholders, and the owner/landlord community. Our resulting campaign (“It’s Time for All L.A. to Breathe Easy”) highlighting health complications and economic impact from SHS generated significant media attention, performing beyond program benchmarks. More than two dozen media outlets (some with national reach) covered our launch. Our media coverage reached an audience of nearly 14 million people, with an earned media value of approximately $2.5 million. Our on-the-ground outreach and education campaign successfully convinced one of the area’s largest housing advocates to ally with our cause instead of oppose it. Our efforts attracted the attention of the City of Los Angeles Housing Department which is collaborating with us on developing guidelines for apartments and other rent controlled properties.

Conclusions:  Some public health issues, such as smokefree housing, are challenged by compelling and competing public interests. Scarcity of housing has formidably delayed achieving smokefree housing policies in many cities. A variety of factors influence stakeholders' positions: lack of knowledge of health and economic effects of SHS, confusing or contradictory policy, and misperceptions about the issue. This is further complicated when the public health issue requires clear policy directive, degrees of adoption, and individual behavior change. To successfully counterbalance these challenges and reframe the public health policy narrative, multi-stakeholder media advocacy campaigns require multiple messaging techniques built around an integrated strategy.

Implications for research and/or practice:  We need to examine media advocacy campaigns for public health issues in more of an ecosystem context, particularly those issues lacking a clear policy directive. Multiple factors often influence overall strategy as well the type, format, and delivery of messaging where there are multiple stakeholders with varying levels of vested interest, access to information, issue knowledge and modes of media consumption.