The prevalence of Type 2 diabetes (DM2) is rapidly rising, especially among minority and low-income youth. There is an unmet need to engage youth in identifying solutions to reverse this trajectory. Social marketing campaigns and entertainment education are effective forms of health communication for engaging populations in health-promoting behaviors. Critical to curbing the epidemic is moving the diabetes conversation away from individual behavior alone and toward a socio-ecologic perspective using a public health literacy framework. We developed an academic-community partnership to develop, implement, and evaluate a DM2 prevention campaign targeting minority and low-income youth. The Bigger Picture uses hard-hitting, youth-generated “spoken-word” messages around key environmental and social drivers of the DM2 epidemic. Campaign goals included promoting health capacity and civic engagement. This paper focuses on the development and implementation of the campaign, including (a) rationale and theoretical underpinnings; (b) steps in campaign creation; (c) testing the campaign messaging; and (d) campaign dissemination and evaluation planning. A youth-created health communication campaign using a public health literacy framework with targeted, relevant, and compelling messaging appears to be a promising vehicle for reaching at-risk youth to increase knowledge of and attitudes about preventing DM2, change social norms, and motivate participation in health promotion initiatives.

Purpose. To examine the reach, efficacy, and adoption of The Bigger Picture, a type 2 diabetes (T2DM) social marketing campaign that uses spoken-word public service announcements (PSAs) to teach youth about socioenvironmental conditions influencing T2DM risk. Design. A nonexperimental pilot dissemination evaluation through high school assemblies and a Webbased platform were used. Setting. The study took place in San Francisco Bay Area high schools during 2013. Subjects. In the study, 885 students were sampled from 13 high schools. Intervention. A 1-hour assembly provided data, poet performances, video PSAs, and Web-based platform information. A Web-based platform featured the campaign Web site and social media. Measures. Student surveys preassembly and postassembly (knowledge, attitudes), assembly observations, school demographics, counts of Web-based utilization, and adoption were measured. Analysis. Descriptive statistics, McNemar's v 2 test, and mixed modeling accounting for clustering were used to analyze data. Results. The campaign included 23 youth poet-created PSAs. It reached .2400 students (93% selfidentified non-white) through school assemblies and has garnered .1,000,000 views of Web-based video PSAs. School participants demonstrated increased short-term knowledge of T2DM as preventable, with risk driven by socioenvironmental factors (34% preassembly identified environmental causes as influencing T2DM risk compared to 83% postassembly), and perceived greater personal salience of T2DM risk reduction (p , .001 for all). The campaign has been adopted by regional public health departments. Conclusion. The Bigger Picture campaign showed its potential for reaching and engaging diverse youth. Campaign messaging is being adopted by stakeholders.

As Type 2 diabetes spikes among minority and low-income youth, there is an urgent need to tackle the drivers of this preventable disease. The Bigger Picture (TBP) is a counter-marketing campaign using youth-created, spoken-word public service announcements (PSAs) to reframe the epidemic as a socio-environmental phenomenon requiring communal action, civic engagement and norm change. Methods: We examined whether and how TBP PSAs advance health literacy among low-income, minority youth. We showed nine PSAs, asking individuals open-ended questions via questionnaire, then facilitating a focus group to reflect upon the PSAs. Results: Questionnaire responses revealed a balance between individual vs. public health literacy. Some focused on individual responsibility and behaviors, while others described socio-environmental forces underlying risk. The focus group generated a preponderance of public health literacy responses, emphasizing future action. Striking sociopolitical themes emerged, reflecting tensions minority and low-income youth experience, such as entrapment vs. liberation. Conclusion: Our findings speak to the structural barriers and complexities underlying diabetes risk, and the ability of spoken word medium to make these challenges visible and motivate action. Practice Implications: Delivering TBP content to promote interactive reflection has potential to change behavioral norms and build capacity to confront the social, economic and structural factors that influence behaviors.