Healthy teeth and strong bones are two common reasons why moms and dads have for decades told their children, "Drink your milk." That advice can still be heard at dinner tables across the country, but now it's being echoed by the National Dairy Promotion Board (NDB) in its print advertisements to medical professionals encouraging them to spread the good news about dairy calcium.


Ads praising calcium's essential role in helping bodies grow, maintaining dental and cardiovascular health and in preventing osteoporosis (brittle bones) are part of the NDB's National Education Program for the Health Profession Community, a national advertising and educational program targeted to specific groups of health professionals. Since the program's inception in 1985, pre- and post-advertising tests have been conducted each year by the Datafax Co. Inc., an independent research firm in Maitland, Fla., to ascertain the degree to which awareness, attitudes and recommending behavior of the targeted health professionals have changed as a result of the advertising campaign.

Recommending calcium

"Our goal is to raise physicians' awareness of the role of dairy calcium in addressing health issues and problems, and to let them know it doesn't take a lot of it to get the necessary daily allotment," explains Bill Diggins, vice president of market and economic research at the NDB, Arlington, Va. "We also want them to change their attitudes and behaviors in recommending dairy calcium instead of calcium supplements, and to educate patients as to the usefulness of dairy products."

The NDB established three primary goals for the research that went behind the evaluation of the 1987 ad campaign: To measure advertising awareness, determine if there was a change in attitudes from the February/March pre-test to the August/September post-test, and determine if there were changes in overt behavior from the before and after study.

"The results from the pre-test to the post-test don't show massive shifts in attitude and behavior change because that's something which can't be changed overnight," continues Diggins. "We're looking at long-term change."

Nevertheless, the results from the 1986 pre-test compared to the 1987 post-test show a positive shift in results. For example, when asked if they recommend dairy food calcium, 32% of the surveyed health care professionals said they did in 1986 and 42% said they did so in 1987. When asked if they recommended a combination of dairy food calcium and dairy food supplements, in 1986 45% said that they did; in 1987, 47% reported that they did.

Evaluating the program

By evaluating the 1987 advertising program, the NDB learned if it was meeting its objectives.

"We wanted to find out how well the advertising program was doing, especially in terms of the particular time frame," explains Edie Hogan, vice president of nutrition programs at the NDB. "It helped us figure out if we should continue the program or how we could make it better."

Results from the 1987 pre- and post-advertising tests showed that "executionally, we needed to strengthen the advertising campaign," says Diggins. Those results dictated changes which were made for the 1988 campaign.

"The study pointed out to us areas we needed to look at because we didn't see the attitude and behavior shifts we were looking for, but it also showed us that the ad campaign had potential," Diggins says.

For those reasons, the ad concepts for the 1988 campaign were pretested. These ads began running in April, 1988, in medical journals nationwide. While still emphasizing calcium, the new 1988 ads also emphasize dietary fats and that a balanced diet which includes dairy foods doesn't mean it's high in fat.

Achieving better targeted advertising isn't the only benefit of evaluating an ad campaign. "It benefits the board, too, because we now have a more cost- effective program," says Hogan.

Target audience

The NDB's print-media campaign is targeted to specific groups of health professionals including physicians, dentists, dietitians, nutritionists, physician assistants, and nurses. These individuals were contacted by means of telephone-mail assisted survey, mail-telephone assisted survey, and mail survey with incentive for the pre-test on the 1987 advertising campaign. Dr. Gordon McAleer, president of the Datafax Co., along with Sheila Raw, vice president, and Felicia Lassk, associate project director, conducted the research.

Dr. McAleer says that when the company first did similar research for the NDB two years ago, the data collection method used was solely telephone. It learned, however, that it is almost impossible to reach medical professionals by telephone because of their unpredictable schedules and lack of time. If the interviewers managed to get respondents to come to the phone, there was often the impression that the physician just wanted to get the interview over with. Nevertheless, some telephone surveying was still conducted for the pre-test.

From that "experiment," it was decided for the post-test that a mail with incentive survey with only follow-ups tracked would be conducted. Only a few persons were contacted by telephone. Interestingly enough, no matter which method was used, the results and the response rates tracked perfectly, says Dr. McAleer.

Some findings

The following information describes the areas covered in the survey and some general findings from the study.

Respondents were asked about the frequency of making certain recommendations with respect to calcium intake. Health care professionals made recommendations "often" or "regularly" over 77% of the time, it was found both in the before and after tests. The most popular recommendation was "a combination of dairy food calcium and calcium supplements" both before and after. Health care professionals are concerned about calcium intake and often recommend the use of dairy food calcium to a significant degree both before and after.

Respondents were asked, "How important is the regular consumption of dairy foods and products to your patients?" concerning certain situations. Regular consumption of dairy foods and products is regarded as being important in all categories except for "prevention, treatment-hypertension" and "prevention of alveolar bone loss" before and for "prevention, treatment-hypertension" after.

Respondents were asked "How often do you personally make recommendations concerning the regular consumption of dairy foods and products to your patients?" concerning certain situations. Regular consumption of dairy foods and products is being recommended in most situations. The exceptions being: 1. For adolescent male patients; 2. Patients subject to hypertension; 3. For enhancing dental health, and 4. For the purpose of preventing alveolar bone loss. The above results were true for both the before and after studies.

"206 Reasons"

Respondents were asked if they had seen specific NDB advertisements. Over 15% of all respondents before and 26% after reported seeing the "206 Reasons" advertisement. This increase in awareness is significant and could be attributed to either the attention attracting elements of the advertisement or to the increase in media exposure implemented in 1987. Of those respondents reporting that they had seen the advertisement, 32% reported that they had read most of the advertisement in the after study and nearly 72% regarded the advertisement as being appropriate. Approximately 60% of these respondents recalled reading the statement, "Dairy Calcium. Calcium The Way Nature Intended It."

Over 7% of all respondents before and 14% after reported seeing the "Inadequate Calcium" advertisement. This increase in awareness is significant and could be attributed to either the attention attracting elements of the advertisement or to the increase in media exposure implemented in 1987. Of those respondents reporting that they had seen the advertisement, 29% reported that they had read most of the advertisement in the after study and nearly 68 % regarded the advertisement as being appropriate. Approximately 50% of these respondents recalled reading the statement, "Dairy Calcium. Calcium The Way Nature Intended It."

The "Painless Approach" advertisement was reportedly seen by 21% of the dentists before and 36% after. Of those respondents reporting that they had seen the advertisement, 25 % reported that they had read most of the advertisement in the after study and nearly 69 % regarded the advertisement as being appropriate. Approximately 60% of these respondents recalled reading the statement, "Dairy Calcium. Calcium The Way Nature Intended It." Over 18% of all respondents before and 29% after reported that they saw at least one of the NDB advertisements.

Informing females

Respondents were asked to evaluate a series of statements in terms of the importance of informing female patients. There was little change across all respondents between the 1987 before study and the 1987 after study. The most important statements before and after were "The need for sufficient calcium during pregnancy," "The need for sufficient calcium during menopause," and "The effects of exercise as it relates to osteoporosis."

Respondents were asked to evaluate the degree of knowledge about selected subjects that were possessed by a typical female patient. Health care professionals feel that the typical female patient is more informed than in the past year. Female patients are perceived as being most informed in "The need for sufficient calcium during pregnancy," "The need for sufficient calcium after menopause," and "The use of calcium supplements as a means of enhancing calcium intake" both before and after.

Respondents were asked to react to a series of selected statements. There was little change across all respondents between the 1987 before and after studies. The most important statements were "Low?fat dairy products are the best source of dietary calcium," "In most cases, I would prefer to have my female patients receive their calcium through a balanced diet rather than through the use of calcium supplements," and "Patients have a tendency to use calcium supplements more than I would recommend." In general it can be concluded that the 1987 National Dairy Board Health Professionals Advertising campaign was successful.

Awareness up

Advertising awareness went up in several segments. This could be attributed to either the attention getting elements of the ads and/or the increased media exposure. Recall of the "Dairy Calcium. Calcium The Way Nature Intended It" statement was high among readers of the advertisements and most respondents felt that the advertisements were appropriate.

Dr. McAleer says the NDB was "enlightened" with the study findings because "the ads maintained a high level of awareness" and showed an overall improvement in the attitudes and behaviors of health care professionals in recommending dairy food calcium.

While major goals of the advertising campaign were to change attitudes and behaviors of health care professionals, very few changes in either of these areas were noted between the before study and after study in 1987. However, there was a noticeable shift in these areas from the 1986 pre-test to the 1987 post-test.

"The 1987 survey shows a lot of positive results," notes Dr. McAleer, "but we anticipate more specific achievements in the coming year."