Critical Reflections on COVID-19 Communication Efforts Targeting Adolescents and Young Adults.

The Centers for Disease Control and Prevention recommends social distancing (We use the term social distancing in concordance with the CDC, but note the call to shift to the use of physical distancing as a more appropriate term) as a prevention strategy for COVID-19; however, there is evidence this recommendation has not been taken seriously by adolescent and young adult (AYA) populations. One public example of this was the participation of many students in traditional Spring Break activities at a time when the World Health Organization had already declared COVID-19 a pandemic and the U.S. had 1,000 confirmed cases. Critical reflection on why AYAs have not taken the threat more seriously is necessary to more effectively engage them in future efforts to slow the spread of the virus. The public health messages aimed at AYAs need to be evaluated for the extent to which they follow best practices in message design such as being grounded in theory and developed in a participatory manner. To date, COVID-19 messaging for AYA populations has been deficient in both these areas.

Effective public health messaging is grounded in behavioral theory and knowledge of a population's messaging needs [1]. Many theories commonly used in public health highlight an individual's perceived susceptibility to and their perceived severity of a health concern as determinants of whether or not they will engage in protective actions [2,3]. Thus, for AYAs to participate in social distancing (a protective behavior), they need to believe that they are likely to contract COVID-19 and that the consequences of infection are severe. Most of the messaging has indicated that, although AYAs are susceptible, the majority are unlikely to experience severe effects [4,5]. However, highlighting the lack of severity of a health issue is a surefire way to ensure that any population will ignore protective recommendations. A better strategy might have been to focus messaging on severity from the perspective of individuals with meaningful connections to AYAs such as older family members and those with pre-existing health conditions who are likely to experience severe symptoms. There is evidence to suggest AYAs could be motivated by the need to protect others [6]. Unfortunately, current messaging has largely not utilized this strategy.

Much of the national messaging has ignored another important concept from many health behavior theories, efficacy. Theories such as the Extended Parallel Process Model [2] recognize two forms of efficacy, self-efficacy and response efficacy. To gain social distancing self-efficacy, young people need to understand the various forms of social distancing that may be required of them, but they also require “how-to” information and information on how to overcome barriers to successful social distancing. To gain response efficacy, they need to be persuaded social distancing will work to slow the spread. There has been consistent messaging highlighting the recommended six-foot distance, but very little information has been circulated on how to maintain this distance in different settings frequented by AYAs. Messaging strategies that could help build self-efficacy such as visuals of people engaging in the behavior (social modeling) and providing words of encouragement have been largely absent. Very little information has been provided on how AYAs can remain socially connected – a critical developmental need for this age group [7] – while implementing the recommendations about physical distance. While there has been messaging around social distancing slowing the spread of the virus, most individuals lack an advanced knowledge of transmission routes of respiratory illness or how contagious COVID-19 is. The messages have also not focused on the effectiveness of these measures to keep other at-risk individuals connected to the AYAs safe from infection. Thus, general information on slowing the spread may not be perceived as information about social distancing's response efficacy.

Finally, messaging efforts aimed at AYAs need to meet them where they are in terms of messaging needs (what information they need), preferences (e.g., visual style), and considerations such as communication channels. To achieve this, messaging efforts often rely on extensive formative data and participatory approaches. However, so far in this crisis, there is little evidence of meaningfully engaging AYAs [8]. When engaged meaningfully and effectively, young people are effective agents of change for themselves and their communities [9,10]. We need to do more to ensure they are actively engaged in decreasing the rates of COVID-19 transmission.

As we continue to grapple with the presence of COVID-19 in our communities, effective mitigation is dependent on messaging to AYAs that is developed by them, in partnership with them, is theory-based, tested, and rolled out through channels they define as meeting them where they are.