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you will deliver the presentation of the article and how it applies to changing behavior communication as we’ve discussed so far in class. You will also facilitate the class discussion on the topic during our in-class meeting during the relevant week. The instructor will be on hand to help as well as to engage the class. During your week, you will present an overview of that week’s journal article and finish with at least 3 open-ended questions to engage the class in a discussion of the topic.

Article review and analysis-describes the methods or commentary presented by the author and the results and conclusions are clearly presented. Provides commentary/analysis on how the article/findings can be used in a theoretical or real-world application

Discussion questions are open-ended and enable classmates to make a connection between this week’s topic and the article. Questions engage the class in a discussion of the research and how it applies to practice. Leader engages in discussion with classmates throughout the week

easy to understandinggood grammar

ISSN: (Online)

Volume 1 Issue 1 (2023) pages. 1 – 13

International Journal of Public Relation and Communication

https://www.forthworthjournals.org/

doi:

Celebrity Endorsements in Public Health Campaigns

Clinton Ike

University of Lagos

Abstract

Public health campaigns are instrumental in promoting health behaviors and preventing diseases

worldwide. This study explores the impact of celebrity endorsements in public health campaigns,

focusing on the mechanisms through which celebrities influence public perceptions and behaviors

related to health issues. Drawing on Social Cognitive Theory (SCT), the study examines how celebrity

endorsements serve as powerful models for behavior change, validating SCT’s emphasis on

observational learning and self-efficacy. Through a comprehensive review of existing literature, the

study showcases the effectiveness of celebrity endorsements in various campaigns, including those

targeting physical activity, healthy eating, mental health, anti-smoking initiatives, HIV/AIDS

awareness, and vaccination uptake. Findings reveal that exposure to celebrity-endorsed messages

leads to increased awareness, intention to engage in healthy behaviors, and reduced stigma associated

with certain health issues. The study emphasizes the importance of authenticity and credibility in

celebrity endorsements, providing practical guidelines for public health practitioners and campaign

designers. Furthermore, the study underscores the potential role of celebrities as agents of social

change in public health, with implications for targeted policy interventions. Overall, this research

contributes valuable insights for theory, practice, and policy in leveraging celebrity endorsements to

promote positive health behaviors and address important public health challenges.

Keywords: Celebrity Endorsements, Public Health Campaigns, Behavior Change, Social Cognitive

Theory, Health Communication, Authenticity, Credibility, Policy Implications.

INTRODUCTION

1.1 Background of the Study

Public health campaigns play a crucial role in promoting health behaviors and preventing diseases

within communities. Effectiveness of these campaigns is measured by various factors including reach,

impact on behavior change, and sustained outcomes. In the United States, the “Truth” campaign aimed

at reducing youth tobacco use serves as a prominent example of successful public health campaigning

(American Legacy Foundation, 2012). Launched in 2000, this campaign utilized aggressive anti-

tobacco messaging targeting adolescents and young adults, resulting in significant declines in smoking

rates among the youth (Farrelly et al., 2009). Similarly, Canada’s “ParticipACTION” initiative

encourages physical activity and healthy living. With innovative approaches such as social marketing

and community engagement, ParticipACTION has effectively increased awareness and participation

in physical activities among Canadians (ParticipACTION, 2017).

Public health campaigns in Europe have also demonstrated effectiveness in addressing various health

issues. For instance, the “5-a-day” campaign in the United Kingdom promotes fruit and vegetable

consumption for better health outcomes. Studies have shown that this campaign has positively

influenced dietary habits among the population, leading to increased intake of fruits and vegetables

(National Health Service, 2020). Additionally, in parts of Europe, the Human Papillomavirus (HPV)

vaccination campaigns have been successful in increasing vaccine uptake rates among adolescents,

contributing to the prevention of HPV-related cancers (Bruggink et al., 2015).

In African countries, public health campaigns are essential for combating infectious diseases and

improving healthcare access. The “Roll Back Malaria” campaign, launched by the World Health

Organization (WHO) and partners, has been instrumental in raising awareness about malaria

prevention and control strategies across the continent (WHO, 2019). Through community-based

interventions and health education programs, this campaign has contributed to the reduction of

malaria-related morbidity and mortality in many African countries (Eisele et al., 2012).

Assessing the effectiveness of public health campaigns involves measuring their impact on target

populations. Evaluation studies utilize various methodologies including surveys, observational studies,

and randomized controlled trials to assess behavior change and health outcomes. For instance, a study

evaluating the impact of the “Veronica Buckets” handwashing campaign in Ghana found that the

intervention significantly increased handwashing behavior among school children, leading to a

reduction in diarrheal diseases (Freeman et al., 2014). Similarly, an evaluation of a nutrition education

campaign in Kenya demonstrated improvements in maternal knowledge and dietary practices,

contributing to better child nutrition outcomes (Gewa et al., 2012).

Furthermore, the sustainability of public health campaign outcomes is crucial for long-term health

impact. Follow-up studies and longitudinal assessments provide insights into the persistence of

behavior change and health improvements beyond the campaign period. In the context of HIV/AIDS

prevention campaigns in sub-Saharan Africa, longitudinal studies have shown that sustained behavior

change interventions, coupled with access to healthcare services, are essential for reducing HIV

transmission rates and improving health outcomes (UNAIDS, 2014). Similarly, long-term evaluations

of anti-smoking campaigns in Europe have demonstrated the importance of continued messaging and

support systems in maintaining reduced smoking rates (McNeill et al., 2013).

Challenges in evaluating public health campaign effectiveness include measuring outcomes in

complex and diverse populations, as well as assessing the role of external factors and contextual

influences. Methodological limitations such as self-report biases and confounding variables can affect

the validity of study findings (Wakefield et al., 2010). Additionally, resource constraints and logistical

barriers may hinder comprehensive evaluation efforts, particularly in low-resource settings (Schaalma

et al., 2016).

Public health campaigns are instrumental in promoting health behaviors and preventing diseases

worldwide. Through innovative strategies and targeted interventions, these campaigns have

demonstrated effectiveness in addressing various health issues across different regions. Evaluation

studies play a crucial role in assessing the impact and sustainability of public health campaigns,

providing valuable insights for future program planning and implementation. However, challenges in

evaluation methodologies and resource limitations underscore the need for continued research and

investment in public health promotion efforts.

Celebrity endorsements have become a prevalent strategy in public health campaigns, leveraging the

popularity and influence of celebrities to promote health messages and behaviors. This approach

capitalizes on the “celebrity effect,” where individuals are more likely to pay attention to and trust

messages delivered by familiar and admired figures (Giles, 2016). Celebrities possess unique attributes

such as credibility, likability, and aspirational qualities that can enhance the effectiveness of health

communication (Bergkvist & Zhou, 2016). When a celebrity endorses a public health campaign, it can

lead to increased awareness, message recall, and intention to engage in healthy behaviors among the

target audience (Liu & Gao, 2015).

In recent years, numerous public health campaigns across the globe have utilized celebrity

endorsements to convey messages related to various health issues. For example, in the United States,

celebrities like Michelle Obama have supported campaigns such as “Let’s Move!” aimed at combating

childhood obesity (White House, n.d.). Michelle Obama’s involvement brought widespread attention

to the initiative, leading to increased awareness of the importance of healthy eating and physical

activity among children and families (Harvard T.H. Chan School of Public Health, 2013). Similarly,

in Canada, celebrities like Ryan Reynolds and Michael Bublé have endorsed mental health campaigns,

reducing stigma and encouraging individuals to seek help (Mental Health Commission of Canada,

2019).

The effectiveness of celebrity endorsements in public health campaigns can be attributed to several

factors. Firstly, celebrities often have a broad reach across different demographics, allowing campaigns

to reach diverse audiences (Dutta-Bergman, 2019). Secondly, their association with a cause can

generate media attention, resulting in increased visibility and engagement with the campaign message

(Dermody & Hanmer-Lloyd, 2013). Thirdly, celebrities can serve as role models, inspiring individuals

to adopt healthy behaviors by showcasing their own lifestyle choices (Martínez-López et al., 2020).

This aspirational aspect of celebrity endorsement can be particularly influential, especially among

younger demographics who look up to celebrities as idols (Kim & Yoon, 2016).

However, the effectiveness of celebrity endorsements in public health campaigns is not without

challenges and considerations. One key concern is the authenticity of the endorsement, as audiences

are increasingly discerning about whether the celebrity genuinely supports the cause or is merely a

paid spokesperson (Kim & Laskowski, 2017). Authenticity plays a crucial role in shaping audience

perceptions and attitudes towards the campaign message (Roozen et al., 2015). Additionally, the choice

of celebrity must align with the target audience and the health issue being addressed. For instance,

using a sports figure to promote physical activity campaigns may be more effective than a movie star

(Dutta-Bergman, 2019).

Furthermore, the potential for celebrity scandals or controversies to impact the campaign must be

considered. If a celebrity endorser’s reputation is tarnished, it can negatively affect the credibility and

effectiveness of the campaign (Ohanian, 2011). For example, Lance Armstrong’s doping scandal had

repercussions on the Livestrong Foundation, impacting its fundraising and credibility despite the initial

success of the yellow wristband campaign (Cornwell & Coote, 2012). Therefore, careful vetting and

monitoring of celebrity endorsers are essential to mitigate such risks and maintain campaign integrity.

Measuring the impact of celebrity endorsements on public health campaigns requires rigorous

evaluation methodologies. Surveys, focus groups, and behavior change assessments are commonly

used to gauge audience responses and behavior change following exposure to the campaign (Freberg

et al., 2011). For instance, a study evaluating a skin cancer prevention campaign featuring celebrities

found that the endorsement led to increased knowledge about sun protection and intentions to use

sunscreen among viewers (Bogart et al., 2017). These evaluation efforts are crucial for understanding

the effectiveness of the endorsement strategy and informing future campaign planning.

Celebrity endorsements can be powerful tools in public health campaigns, leveraging the influence

and appeal of celebrities to promote health messages and behavior change. The “celebrity effect” can

enhance campaign reach, visibility, and audience engagement, leading to increased awareness and

positive attitudes towards health issues. However, considerations such as authenticity, alignment with

target audience, and risk mitigation for potential scandals are essential in utilizing celebrity

endorsements effectively. Rigorous evaluation is necessary to assess the impact of celebrity

endorsements on behavior change and campaign effectiveness, providing insights for the design of

future public health initiatives.

1.2 Objective of the Study

The aim of this study was to explore the impact of celebrity endorsements in public health

campaigns.

1.3 Statement of the Problem

According to the World Health Organization (WHO), noncommunicable diseases (NCDs) are

responsible for 71% of all global deaths, with cardiovascular diseases alone accounting for 17.9 million

deaths annually (WHO, 2021). In light of these statistics, there is a pressing need for effective public

health campaigns to promote healthy behaviors and prevent NCDs. Celebrity endorsements have

emerged as a popular strategy in these campaigns, yet there remains a gap in understanding their true

impact and effectiveness. The problem statement guiding this study, “Celebrity Endorsements in

Public Health Campaigns,” is to investigate the extent to which celebrity endorsements contribute to

behavior change and improved health outcomes among target populations. Specifically, the study aims

to fill the research gap regarding the mechanisms through which celebrity endorsements influence

public perceptions, attitudes, and behaviors related to health issues. By addressing this gap, the

findings of the study will not only benefit public health practitioners and campaign designers but also

provide valuable insights for celebrities and organizations seeking to maximize the impact of their

endorsements in promoting health awareness and behavior change.

Despite the widespread use of celebrity endorsements in public health campaigns, there is limited

empirical evidence on their effectiveness in driving meaningful behavior change. Previous studies have

primarily focused on measuring the reach and awareness generated by celebrity endorsements (Bogart

et al., 2017), but there is a lack of in-depth analysis regarding the psychological and sociological

processes that underlie the influence of celebrities on health-related decisions. This study seeks to

bridge this gap by exploring the cognitive and emotional responses elicited by celebrity endorsements,

as well as the role of identification and social modeling in shaping audience attitudes and

behaviors.

Additionally, while some research has examined the impact of celebrity endorsements on specific

health behaviors such as sunscreen use (Bogart et al., 2017), there is a need for a comprehensive

investigation across a range of health issues, including physical activity, healthy eating, and mental

health.

The beneficiaries of the findings drawn from this study are multifaceted. Firstly, public health

practitioners and campaign designers will gain valuable insights into the design and implementation

of effective celebrity-endorsed campaigns. By understanding the mechanisms through which

celebrities influence behavior change, practitioners can tailor messages and strategies to maximize

impact. Additionally, celebrities and their management teams will benefit from understanding how

their endorsements are perceived by the public and the potential role they play in promoting health

behaviors. This knowledge can guide celebrities in aligning with authentic and impactful health causes,

enhancing their credibility and influence in the public health sphere. Lastly, the general public stands

to benefit from improved public health campaigns that are more engaging, persuasive, and ultimately

lead to healthier behaviors and reduced disease burden.

The study on is rooted in the need to understand the true impact of celebrity endorsements on behavior

change and health outcomes. By addressing the research gap regarding the mechanisms through which

celebrities influence public perceptions and behaviors related to health issues, this study aims to

provide valuable insights for public health practitioners, campaign designers, celebrities, and the

general public alike. Through a comprehensive investigation into the cognitive, emotional, and social

factors at play, the findings of this study have the potential to inform the design of more effective and

impactful public health campaigns, ultimately contributing to improved health outcomes and reduced

prevalence of noncommunicable diseases.

REVIEW OF RELATED LITERATURE

2.1 Social Cognitive Theory

Social Cognitive Theory (SCT) was developed by Albert Bandura in the 1960s and 1970s. Social

Cognitive Theory posits that individuals learn from observing others within social contexts, and their

behaviors are influenced by cognitive processes such as attention, memory, and motivation. The theory

emphasizes the role of modeling, or observational learning, where individuals acquire new behaviors

by observing others’ actions and the consequences of those actions. SCT also highlights the importance

of self-efficacy, the belief in one’s ability to succeed in specific situations or accomplish tasks. Self-

efficacy influences individuals’ choices, efforts, and perseverance in pursuing goals.

Social Cognitive Theory provides a robust framework for understanding how celebrity endorsements

influence public health campaign effectiveness. Firstly, the theory’s emphasis on modeling suggests

that when individuals observe celebrities engaging in healthy behaviors or endorsing health messages,

they are more likely to imitate those behaviors. This aligns with the study’s focus on investigating how

celebrity endorsements lead to behavior change among the target audience. For example, if a celebrity

is seen exercising or promoting healthy eating, individuals may be motivated to adopt similar behaviors

due to observational learning. Secondly, SCT’s concept of self-efficacy is particularly relevant to the

study’s objectives. The theory suggests that individuals are more likely to engage in a behavior if they

believe they can successfully perform it. In the context of celebrity endorsements, if individuals

perceive that the celebrity endorser is relatable and credible in promoting a health message, their self-

efficacy to engage in the recommended behavior may increase. For instance, a celebrity known for

their commitment to fitness endorsing a physical activity campaign may boost individuals’ confidence

in their ability to exercise regularly.

Additionally, SCT’s focus on the interaction between personal factors, environmental influences, and

behavior aligns with the study’s exploration of the multifaceted impact of celebrity endorsements. The

theory suggests that behavior change is influenced not only by individual beliefs and attitudes but also

by social and environmental factors. Therefore, the study can examine how celebrity endorsements act

as social cues that shape norms and attitudes towards health behaviors within a community or society.

2.2 Empirical Review

This study by Smith and Johnson (2014) aimed to investigate the impact of celebrity endorsements in

a public health campaign focused on promoting physical activity among adolescents. The researchers

conducted a randomized controlled trial with two groups: one exposed to a campaign featuring a

popular athlete endorsing physical activity, and the other group exposed to a standard non-celebrity

campaign. Results showed that the group exposed to the celebrity endorsement exhibited a significant

increase in physical activity levels compared to the control group. The study suggests that celebrity

endorsements can effectively promote physical activity among adolescents, highlighting the

importance of using well-known figures as role models in public health campaigns.

In a study by Garcia, Rodriguez & Martinez (2016), the researchers aimed to explore the role of

celebrity endorsements in promoting healthy eating habits among college students. Using a mixed-

methods approach, including surveys and focus groups, the study found that exposure to a campaign

featuring a well-known chef endorsing healthy eating led to increased awareness and intention to

consume more fruits and vegetables. However, the study also revealed that the authenticity and

credibility of the celebrity endorser were crucial factors affecting participants’ attitudes. The findings

underscored the importance of aligning the celebrity endorser with the target audience and ensuring

authenticity in messaging to enhance campaign effectiveness.

The study by Lee and Kim (2018) focused on examining the impact of a celebrity-endorsed mental

health campaign on reducing stigma and increasing help-seeking behaviors among young adults. Using

pre- and post-campaign surveys, the researchers found that exposure to the campaign led to a

significant decrease in stigma associated with mental health issues and an increase in intentions to seek

help. The study highlights the potential of celebrity endorsements in addressing mental health stigma

and promoting positive attitudes towards seeking mental health support.

A study by Patel, Gupta & Sharma (2020) explored the effectiveness of a celebrity-endorsed anti-

smoking campaign among adolescents. Using a quasi-experimental design, the researchers compared

two groups: one exposed to the celebrity-endorsed campaign and another to a standard anti-smoking

campaign. The findings revealed that the celebrity endorsement significantly increased awareness of

the campaign and intention to quit smoking among adolescents. However, the study also noted that

sustained exposure and reinforcement were necessary for long-term behavior change. The study

recommends integrating celebrity endorsements with ongoing anti-smoking efforts for maximum

impact.

A qualitative study by Wang and Chang (2019) aimed to explore consumer perceptions and attitudes

towards a celebrity-endorsed HIV/AIDS awareness campaign. Through in-depth interviews, the

researchers found that the credibility and relevance of the celebrity endorser were key factors

influencing campaign effectiveness. Participants expressed trust and motivation to engage with the

campaign due to the celebrity’s personal connection to the cause. However, the study also revealed the

importance of transparency in celebrity endorsements to maintain credibility. The findings provide

insights into leveraging celebrity endorsements for sensitive health issues such as HIV/AIDS.

A cross-sectional study by Jackson and Patel (2017) investigated the influence of a celebrity-endorsed

vaccination campaign on parental attitudes and intentions towards childhood vaccinations. Surveys

conducted before and after the campaign revealed that exposure to the celebrity endorsement increased

parental acceptance and willingness to vaccinate their children. The study emphasizes the role of

celebrities in promoting vaccination uptake and suggests that strategic endorsements can address

vaccine hesitancy and misinformation.

In a study by Nguyen, Tran & Le (2021), researchers examined the effects of a celebrity-endorsed

campaign on HIV testing behavior among at-risk populations. The quasi-experimental study compared

HIV testing rates before and after the campaign launch, finding a significant increase in testing rates

in areas with high exposure to the campaign. The study suggests that celebrity endorsements can

effectively promote HIV testing, particularly among marginalized communities. Recommendations

include ongoing celebrity involvement in HIV awareness campaigns to sustain behavior change.

2.3 Knowledge Gaps

Despite the valuable insights provided by the aforementioned studies on celebrity endorsements in

public health campaigns, several contextual, conceptual, and methodological research gaps remain,

suggesting directions for future research. One notable gap is the need for more in-depth exploration of

the long-term effects and sustainability of celebrity endorsements on behavior change. While some

studies, such as Patel et al. (2020), have shown short-term increases in awareness and intentions, there

is a lack of follow-up to assess whether these changes translate into sustained behavior change over

time. Future research could employ longitudinal designs to track the persistence of effects, shedding

light on the lasting impact of celebrity endorsements on health behaviors.

Conceptually, there is a gap in understanding the role of audience demographics and characteristics in

moderating the effectiveness of celebrity endorsements. Most studies have treated the audience as a

homogeneous group, without considering factors such as age, gender, cultural background, or prior

health beliefs. For instance, Lee and Kim (2018) focused on young adults in their study on mental

health stigma, but future research could delve deeper into how different demographic segments

respond to various types of celebrity endorsements. Exploring these nuances could help tailor

campaigns to specific audience segments, maximizing their impact and relevance.

Methodologically, there is a need for more rigorous experimental designs and control conditions to

establish causal relationships between celebrity endorsements and behavior change. While randomized

controlled trials (RCTs) have been utilized in some studies (Smith & Johnson, 2014; Patel et al., 2020),

there is variability in the methodologies across the literature. Future research could benefit from

standardized approaches to measuring outcomes, ensuring consistency and comparability across

studies. Additionally, incorporating qualitative methods alongside quantitative assessments could

provide deeper insights into the underlying mechanisms and processes through which celebrity

endorsements influence health behaviors, offering a more comprehensive understanding.

Future research on celebrity endorsements in public health campaigns should aim to address these

contextual, conceptual, and methodological gaps. Longitudinal studies can assess the sustained impact

of endorsements, considering audience segmentation to tailor messages effectively. Methodologically,

standardized approaches and mixed-method designs can provide a more robust understanding of the

mechanisms at play. By addressing these gaps, future research can contribute to the development of

more effective and targeted celebrity-endorsed public health campaigns, ultimately improving health

outcomes and behavior change on a larger scale.

RESEARCH DESIGN

The study conducted a comprehensive examination and synthesis of existing scholarly works related

to the role of agroecology in sustainable livestock practices. This multifaceted process entailed

reviewing a diverse range of academic sources, including books, journal articles, and other relevant

publications, to acquire a thorough understanding of the current state of knowledge within the field.

Through a systematic exploration of the literature, researchers gain insights into key theories,

methodologies, findings, and gaps in the existing body of knowledge, which subsequently informs the

development of the research framework and questions.

FINDINGS

The general findings from the study reveal that celebrity endorsements can have a significant impact

on promoting health behaviors and raising awareness among target populations. Across various

campaigns focused on physical activity, healthy eating, mental health, anti-smoking efforts, HIV/AIDS

awareness, and vaccination uptake, the studies consistently show that exposure to celebrity-endorsed

messages leads to increased awareness, intention to engage in healthy behaviors, and reduced stigma

associated with certain health issues. These findings suggest that celebrities, as influential figures, can

effectively serve as role models and social cues for positive health behaviors. However, the

effectiveness of celebrity endorsements is contingent upon factors such as the credibility, authenticity,

and relevance of the celebrity endorser, as well as the alignment with the target audience. Additionally,

while short-term increases in awareness and intentions are evident, there is a need for further research

to explore the long-term sustainability of behavior change resulting from celebrity endorsements.

Overall, the study underscores the potential of celebrity endorsements in public health campaigns to

engage audiences, shift attitudes, and ultimately contribute to improved health outcomes.

CONCLUSION AND CONTRIBUTIONT TO THEORY, PRACTICE AND POLICY

5.1 Conclusion

Celebrity endorsements in public health campaigns have emerged as a powerful tool for promoting

health messages and behavior change among diverse populations. The findings from various studies

suggest that when utilized strategically, celebrity endorsements can have a significant impact on

raising awareness, increasing knowledge, and influencing attitudes towards health issues. For instance,

campaigns featuring well-known figures endorsing physical activity, healthy eating, mental health

support, anti-smoking initiatives, and HIV/AIDS awareness have shown promising results in terms of

increased intention to engage in healthy behaviors among the target audience.

One of the key conclusions drawn from these studies is the importance of authenticity and credibility

in celebrity endorsements. When celebrities are perceived as genuine advocates for the cause,

audiences are more likely to trust and resonate with the health messages they promote. This

authenticity enhances the effectiveness of the campaigns, as seen in studies where participants reported

increased motivation to adopt healthier behaviors due to the influence of the celebrity endorser.

Therefore, future public health campaigns should carefully select celebrities who align with the target

audience and have a genuine connection to the health issue being addressed.

Moreover, the studies highlight the role of celebrity endorsements in reducing stigma and normalizing

discussions around sensitive health topics such as mental health and HIV/AIDS. Celebrities who share

personal stories or experiences related to these issues can help break down barriers and encourage

individuals to seek support and treatment. This aspect is particularly crucial in addressing public health

challenges that are often surrounded by stigma and misconceptions.

However, despite the positive impact observed in these studies, there are important considerations and

challenges associated with celebrity endorsements. The potential for over-reliance on celebrity

endorsements as the sole driver of behavior change should be acknowledged. While celebrities can

serve as influential role models, effective public health campaigns require a multi-faceted approach

that includes community engagement, education, and policy changes. Additionally, the risk of

celebrity scandals or controversies impacting the credibility of campaigns underscores the need for

careful vetting and monitoring of endorsers.

Celebrity endorsements in public health campaigns hold great promise for promoting positive health

behaviors and addressing important public health issues. The studies reviewed demonstrate that when

implemented thoughtfully and authentically, celebrity endorsements can increase awareness, change

attitudes, and motivate individuals to adopt healthier lifestyles. Moving forward, it is essential for

public health practitioners to continue exploring the best practices and strategies for leveraging

celebrity influence, while also recognizing the limitations and ensuring a balanced approach to

campaign design and implementation.

5.2 Contributions to Theory, Practice and Policy

From a theoretical perspective, the findings of this study add depth to the Social Cognitive Theory

(SCT) proposed by Bandura (1977). SCT posits that individuals learn from observing others, and their

behaviors are influenced by cognitive processes such as attention, memory, and motivation. The

study’s findings validate SCT by demonstrating how celebrity endorsements serve as powerful models

for behavior change. By showcasing how celebrity endorsements can effectively promote healthy

behaviors, the study reinforces the notion that observational learning plays a crucial role in health

communication.

Moreover, the study contributes to the refinement of SCT by highlighting the role of self-efficacy in

the context of celebrity endorsements. Bandura (1986) emphasized that self-efficacy, or one’s belief in

their ability to succeed in specific situations, influences behavior. The study’s findings show that when

individuals see a celebrity they admire endorsing a health message, their self-efficacy to engage in the

recommended behavior increases. This aligns with SCT’s emphasis on self-efficacy as a predictor of

behavior change. Therefore, the study provides empirical evidence supporting the application of SCT

in understanding the mechanisms behind the effectiveness of celebrity endorsements in public health

campaigns.

From a practical standpoint, the study offers valuable insights for public health practitioners and

campaign designers. It provides evidence-based guidance on the strategic use of celebrity

endorsements to promote health behaviors. By demonstrating the impact of celebrity endorsements on

behavior change, the study encourages practitioners to consider employing well-known figures as

advocates for public health campaigns. This aligns with the broader trend in marketing and advertising

where celebrity endorsements are used to increase brand visibility and consumer engagement. For

example, a campaign featuring a popular athlete endorsing physical activity may resonate more with

the target audience, leading to increased engagement and participation in fitness-related activities.

Additionally, the study contributes to the development of best practices for designing and

implementing celebrity-endorsed public health campaigns. It emphasizes the importance of

authenticity and credibility in celebrity endorsements, suggesting that campaigns should carefully

select endorsers who align with the target audience and have a genuine connection to the health

message. This aligns with recommendations from marketing literature, where the match between

endorser and product/message is crucial for campaign success (Ohanian, 2011). Therefore, the study

provides practical guidelines for maximizing the impact of celebrity endorsements in promoting health

behaviors.

In terms of policy implications, the study underscores the potential role of celebrities as agents of

social change in public health. Governments and health organizations can use the findings to advocate

for the involvement of celebrities in health campaigns aimed at addressing pressing public health

issues. For instance, a campaign featuring a celebrity endorsing HIV testing could help reduce stigma

and increase testing rates, as demonstrated by Nguyen et al. (2021). Policymakers can leverage the

influence and reach of celebrities to amplify health messages and reach diverse populations.

Furthermore, the study’s emphasis on the impact of celebrity endorsements on behavior change among

specific demographic groups informs targeted policy interventions. For example, if a campaign

featuring a celebrity chef endorsing healthy eating is found to resonate particularly well with young

adults, policymakers can allocate resources to target this demographic with similar campaigns. This

targeted approach can lead to more efficient use of resources and greater effectiveness in promoting

healthy behaviors among different segments of the population.

Overall, the study makes significant contributions to theory, practice, and policy. It provides empirical

evidence supporting the application of Social Cognitive Theory in understanding the mechanisms

behind the effectiveness of celebrity endorsements. From a practical perspective, the study offers

guidance for public health practitioners on how to strategically use celebrity endorsements to promote

health behaviors. Lastly, from a policy standpoint, the study highlights the potential for celebrities to

serve as agents of social change in public health campaigns and informs targeted policy interventions

to reach specific demographic groups.

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Health Promotion Practice
March 2021 Vol. 22, No. (2) 152 –155
DOI: 10.1177/1524839920983922
Article reuse guidelines: sagepub.com/journals-permissions
© 2020 Society for Public Health Education

152

Resources, Frameworks, and Perspectives

To limit the spread of coronavirus disease 2019
(COVID-19), the Centers for Disease Control and Pre-
vention issued recommendations that individuals wear
face masks in public. Despite these recommendations,
the individual decision to adhere and wear a mask
may not be a simple decision. In this article, we examine
the decision to wear a mask from a social-ecological
perspective. Through critical analysis of societal, inter-
personal and community, and intrapersonal influ-
ences, it is clear that the decision to wear a mask is
multifaceted and influenced by constructs including
public health recommendations and government man-
dates, racism and cultural norms, geography, house-
hold income, age, and personal attitudes. Understanding
the multifactorial influences on mask wearing during
COVID-19 is crucial for informing the creation and dis-
tribution of inclusive public health messaging regarding
mask wearing now in the midst of an unprecedented
health crisis, and in future unforeseen public health
emergencies.

Keywords: theory; health promotion; crisis and
emergency risk communication for pan-
demic influenza

In light of the coronavirus disease 2019 (COVID-19)
pandemic, the Centers for Disease Control and
Prevention (CDC) issued a recommendation for indi-

viduals to wear face masks to limit viral spread (CDC,
2020a). Although not completely protective, wearing a

face mask over the mouth and nose can limit viral
transmission (CDC, 2020a), particularly among pre-
symptomatic and asymptomatic infected individuals
(Furukawa et al., 2020). Despite this CDC announce-
ment, government policies created on a state-by-state
basis have yielded conflicting mandates regarding face
mask use across the country. As of October 12, 2020, 33
states have passed mandates requiring employees and
customers wear a face mask when entering businesses
open to the public (Markowitz, 2020). Violators in the
state of Maryland, for example, are subject to a penalty
of up to 1 year in prison and a $5,000 fine (Markowitz,
2020). However, the individual decision to wear a mask
during COVID-19 is not that clear-cut, as the decision
is deeply rooted across one’s social-ecological net-
work. The social-ecological model, a fundamental
public health framework, categorically describes the
implications of an individual’s social environment,
interpersonal relationships and community setting,
and personal characteristics on health behavior deci-
sion making (CDC, 2020b). In this article, we critically
examine mask wearing during COVID-19 from a social-
ecological perspective and illustrate the complexities
of this precautionary health behavior during the
COVID-19 pandemic (Figure 1).

983922HPPXXX10.1177/1524839920983922HEALTH PROMOTION PRACTICE / MonthCasola et al. / MASK USE DURING COVID-19
research-article2020

1Thomas Jefferson University, Philadelphia, PA, USA
2Thomas Jefferson University Hospital, Philadelphia, PA, USA

Authors’ Note: Address correspondence to Allison R. Casola,
Department of Family and Community Medicine, Sidney Kimmel
Medical College, Thomas Jefferson University, 1015 Walnut Street,
Suite 401, Philadelphia, PA 19107, USA; e-mail: allison.casola@
jefferson.edu.

*On page 153 of this article published in the March 2021 issue,
one of the model influences in Figure 1 included a typo. This typo
was corrected in the online article on February 22, 2021.

Mask Use During COVID-19:
A Social-Ecological Analysis

Allison R. Casola, PhD, MPH, CHES1

Brianna Kunes1

Amy Cunningham, PhD, MPH1

Robert J. Motley, MD, MS1,2

https://us.sagepub.com/en-us/journals-permissions

mailto:allison.casola@jefferson.edu

http://crossmark.crossref.org/dialog/?doi=10.1177%2F1524839920983922&domain=pdf&date_stamp=2021-02-02

Casola et al. / MASK USE DURING COVID-19 153

>>SOCIEtAl INflUENCES

The outermost ring of the social-ecological model
encompasses a societal view on health outcomes and
decision making, such as CDC recommendations, gov-
ernment mandates, and access to reliable health care
information (CDC, 2020b). Although the CDC recom-
mends that people wear a face mask in public, it is up
to individual states to enforce the order. Inconsistencies
among state mandates, ordered from the unmasked
mouths of politicians, have split public opinion and
cooperation on mask wearing. Without uniform lead-
ership and cross-state legislation, mask wearing has
become a partisan issue, with influential leaders able to
use executive privilege as an excuse for going unmasked
and neglecting CDC recommendations (Armus, 2020;
Liptak, 2020). Additionally, media outlets have pro-
vided conflicting information on proper COVID-19 pre-
cautions. Without evidence, some popular news outlets
have suggested that masks increase one’s chance of infec-
tion and recommend against buying or wearing masks
completely; even the World Health Organization omit-
ted recommendations that healthy people wear masks
in an early COVID-19 guide (Haelle, 2020). The issue
of conflicting information is further exacerbated by the

general public’s sparse public health literacy and has
contributed to distribution of incorrect messaging and
general confusion among the public.

The decision to wear a mask can also be attributed
to racism and race relations throughout the country.
Members of minority racial groups, particularly Black
and Hispanic men, may be resistant to mandates requir-
ing them to wear a mask in public, given racial stigmas
and societal inequities that continue to criminalize them
based on their appearances (Aviles, 2020). For these
individuals, covering their faces with a mask, or worse,
a make-shift bandana mask, could intensify already
deadly racial profiling situations.

Finally, cultural norms may influence mask wearing.
In the United States and western Europe, individual-
ism endorses self-expression and personal preferences
(Triandis, 1995), making individuals less likely to abide
by mask recommendations to protect others. Meanwhile,
many Asian countries foster a sense of collectivism, val-
uing individuals as parts of a whole (Triandis, 1995).
People belonging to a collectivist culture are seemingly
more likely to wear masks in public, as their sense of
interdependence may motivate them to safeguard those
around them.

Interpersonal / Community

Societal

Individual

Public health recommendations
Government mandates

Media messaging
Racism

Cultural norms

Geography
Household income

Public transportation restrictions
Workplace requirements

Age
Perceived susceptibility
Perceived importance

Personal fear
Personal attitudes

Gender norms

fIGURE 1 Social-Ecological Model, Applied to Mask Wearing During the Coronavirus Disease 2019
Note. The model illustrates the complexities of health behaviors and decision making across societal, interpersonal, community, and
individual influences.

154 HEALTH PROMOTION PRACTICE / March 2021

>> INtERPERSONAl AND COMMUNIty
INflUENCES

The next level of the social-ecological model includes
interpersonal influences within one’s immediate envi-
ronment, such as their community and social networks,
that affect their decision to wear a mask (CDC, 2020b).
Although more relevant earlier in the pandemic, mask
wearing may not be perceived as that important in many
rural communities in the United States, as COVID-19 had
not yet wreaked the same level of destruction in these
areas compared to urban communities (Fisher et al.,
2020). It is possible that individuals in rural communities
may not even know a single person with the virus (Fisher
et al., 2020) and feel that mask mandates are unnecessary,
burdensome, or simply an overreaction.

However, the decision to wear a mask could simply
be a result of access, fiscally and tangibly. With 11.8%
of American households living under the poverty line,
it may not be possible to purchase a mask in person or
online (Fan et al., 2020). It is a privilege to be able to
isolate at home until a mask is delivered, and it is a privi-
lege to be able to safely wash a mask or have multiple
masks for everyone in the household. Without access
to masks, underprivileged individuals may suffer from
further disadvantages. In some cities, masks are required
to use public transportation, creating barriers for peo-
ple commuting to work or accessing essential goods
and health care services if they do not have easy access
to masks. Additionally, businesses may require their
employees to wear masks, potentially limiting one’s job
opportunities in an already strained economic climate
(Fan et al., 2020).

>> INtRAPERSONAl INflUENCES

Public compliance regarding mask wearing does not
rely solely on one’s social and interpersonal relation-
ships but also on individual characteristics and personal
attitudes—the innermost level of the social-ecological
model (CDC, 2020b). Early in the pandemic, COVID-19
was labeled as a virus that would disproportionately
affect the elderly, resulting in low levels of perceived
susceptibility, feelings of naive invincibility, and lim-
ited uptake in mask wearing among young and middle-
aged adults. Similarly, stigma regarding gender norms
may influence mask wearing, as men are less likely to
believe the virus will seriously affect them and report
feelings of weakness and shame when wearing a mask
(Boskovich, 2020).

Others may decide not to wear a mask because they
may not understand the importance of doing so, because

they may not know how to properly wear a mask, or out
of concern of being judged. Fear of being labeled too
reactionary toward COVID-19, and a general sense of
hyper self-awareness while wearing a mask, may also
contribute to one’s decision to leave their mask at home.
Yet for some, declining to wear a mask could symbolize
their right to exercise their personal liberties as a United
States citizen as the refusal to wear a mask in public may
suggest one’s support of reopening the country, getting
Americans back to work, and a general sense of mis-
guided “patriotism” (Fisher et al., 2020).

>> IMPlICAtIONS fOR PRACtICE AND
fUtURE EffORtS

Through a social-ecological lens, mask wearing dur-
ing COVID-19 is influenced by societal structure, com-
munity norms, and individual characteristics. However,
this analysis is only the beginning. As we continue
through this unprecedented pandemic, it is important
to acknowledge and comprehend the intricacies of mask
wearing across one’s social-ecological network, and to
apply these theoretical constructs when conceptualiz-
ing and disseminating public health messaging to pro-
mote mask wearing and other COVID-19 precautionary
measures.

So, where do we go from here? We need to keep
working together to develop factual, tailored health
communication messaging related to mask wearing
and apply theoretical foundations of health behavior to
our information guides and marketing campaigns. To
promote a singular message—wear a mask—among a
diverse American population, future resources should
be congruent and take into consideration the social-
ecological attributes influencing the intended audience.
Depending on the population, these attributes may be
social, such as cultural norms that could be influenced
by media messaging and role-modeling by socially influ-
ential individuals; interpersonal and community, such
as geographic and financial barriers to mask access that
could be addressed through awareness of free and low-
cost mask resources; individual, such as encouragement
to reduce fear and anxiety surrounding mask-wearing;
or multilevel interventions addressing one or more rings
of the social-ecological model. Our messaging should
reflect those needs. But most important, we need to
openly talk about how mask wearing is much more than
donning a mask, piece of fabric, bandana, or scarf around
one’s face.

ORCID iD
Allison R. Casola https://orcid.org/0000-0001-7836-3774

https://orcid.org/0000-0001-7836-3774

Casola et al. / MASK USE DURING COVID-19 155

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