California's SNAP-Ed Be Better Social Marketing Campaign: Mothers' Fruit and Vegetable Consumption and Facilitation of Children's Healthy Behaviors

Objective: Evaluation of California Department of Public Health's (CDPH) three-year social marketing campaign (Be Better) to encourage healthy eating and water consumption among SNAP-Ed California mothers. Andreasen's social marketing framework was used to outline the development and evaluation of the campaign. Design: Quantitative, pre-post cross-sectional study with three cohorts nested within survey years. Generalized Estimating Equation (GEE) modeling was used to obtain population estimates of campaign reach and changes in mothers' fruit and vegetable (FV) consumption and facilitative actions towards their children's health behaviors. Setting: CalFresh Healthy Living (California's SNAP-Ed) Participants: Three separate cohorts of SNAP mothers were surveyed (pre, post) between 2016 and 2018 inclusive. A total 2,229 mothers (ages 18 to 59), self-identified as White, Latina, African American, or Asian/Pacific Islander participated. Results: Approximately 82 percent of surveyed mothers were aware of the campaign as assessed by measures of recall and recognition. Ad awareness was positively associated with mothers' FV consumption (R2=0.45), with the proportion of FVs on plates, and with behaviors that facilitate children's FV consumption and limit unhealthy snacks and sugary drinks (βs ranged from 0.1 to 0.7). Conclusions: The campaign successfully reached 82 percent of surveyed mothers. Positive associations between California's Be Better campaign and targeted health behaviors were observed, although the associations varied by year and media channel (i.e., television, radio, billboards, digital). Most associations between ad awareness and outcomes were noted in years two and three of the campaign, suggesting that more than one year of campaign exposure was necessary for associations to emerge. © The Authors 2023.