![]() ![]() Over 11 million people received at least one ad before Thanksgiving (35% of users in the targeted regions), and over 23 million people received at least one video before Christmas (66% of users in targeted regions). Facebook subscribers in randomly selected zip codes in 820 counties in 13 states received these videos as sponsored content (ads Methods). and S.W.) recorded 20-s videos on their smartphones to encourage users to stay home for the holidays. ![]() Before Thanksgiving and Christmas, physicians and nurses (F.C.S., M.A., B.A., T.G., K.H., E.H., S.L., L.O-N., C.T., E.T.W. In this context, we ran a large clustered randomized controlled trial with users of Facebook, a platform that covers approximately 70% of American adults 7. Owing to concerns that holiday travel would lead to a surge in the epidemic, the Centers for Disease Control and Prevention recommended that people stay home for the holidays 6. In November 2020, the number of COVID-19 cases was rapidly increasing across the United States. In this study, we sought to estimate whether short video messages recorded by nurses and doctors and sent on a massive scale as part of a social media advertising campaign could affect human behavior and COVID-19 infections at the zip code (cluster) level. Furthermore, given the large sample required for such experiments, it has not been possible to test the effect of public health campaigns on COVID-19 infection thus, the clinical implications of our preliminary findings are unclear. However, there is no systematic evaluation of similar messages when distributed as part of large-scale public health campaigns. In previous work, we used online experiments to show that video messages, recorded by a diverse group of doctors, affect the knowledge and behaviors of individuals and that these effects seem to be strong regardless of race, education or political leanings 4, 5. Because individual adoption of preventative behavior, from mask wearing and staying at home to vaccination, is key to the control of the current and future pandemics, it is important to know whether this communication strategy is effective. For example, the Kaiser Family Foundation sponsored a large project where doctors recorded videos to provide explanations about COVID-19 vaccination and dispel doubts 1. During the COVID-19 crisis, many healthcare professionals in the United States used social media to spread public health messages 3. However, it is unknown if these healthcare professionals can influence behavior at scale by spreading public health messages using social media. Nurses and physicians are among the most trusted experts in the United States 1, 2, 3. Social media messages recorded by health professionals before the winter holidays in the United States led to a significant reduction in holiday travel and subsequent COVID-19 infections. Infections declined by 3.5% (adjusted 95% CI: −6.2%, −0.7% P = 0.013) in intervention compared to control zip codes. ![]() The third primary outcome was COVID-19 infections recorded at the zip code level in the 2-week period starting 5 days after the holiday. The fraction of people who left home on the holiday was not significantly affected (adjusted difference: 0.030 95% CI: −0.361, 0.420 P = 0.881). Average distance traveled in high-intensity counties decreased by −0.993 percentage points (95% confidence interval (CI): –1.616, −0.371 P = 0.002) for the 3 days before each holiday compared to low-intensity counties. The first two primary outcomes were holiday travel and fraction leaving home, both measured using mobile phone location data of Facebook users. The intervention was delivered to a large fraction of Facebook subscribers in 75% and 25% of randomly assigned zip codes in high- and low-intensity counties, respectively. We randomly assigned counties to high intensity ( n = 410 (386) at Thanksgiving (Christmas)) or low intensity ( n = 410 (381)). We conducted a randomized controlled trial of the effect of a Facebook advertising campaign consisting of short videos recorded by doctors and nurses to encourage users to stay at home for the Thanksgiving and Christmas holidays ( NCT04644328 and AEARCTR-0006821). During the Coronavirus Disease 2019 (COVID-19) epidemic, many health professionals used social media to promote preventative health behaviors. ![]()
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